.: ORİJİNAL ARAŞTIRMA
Zor Havayolu Öngörüsü Bulunan Obez Hastalarda C-MAC Video Laringoskop ile McCoy Laringoskopun Entübasyon Başarılarının Değerlendirilmesi
Evaluation of Intubation Success of McCoy Laryngoscope with C-MAC Video Laryngoscope in Obese Patients with Difficult Airway Prediction
Turkiye Klinikleri J Anest Reanim. 2019;17(3):89-95
doi: 10.5336/anesthe.2019-70633
Makale Dili: TR
Tam Metin
ÖZET
Amac: Fonksiyonel solunumu sağlamada en onemli unsur havayoludur. Obez hastaların zor havayolu nedeni ile entube edilememeleri, anestezi pratiğinde mortalite ve morbititenin en sık nedenidir. Son zamanlarda video laringoskoplar zor havayolunda daha onemli hale gelmektedir. Bu calışmada, zor entubasyon ongorusu olan obez hastalarda C-MAC video laringoskop ile McCoy laringoskopu; entubasyon başarısı, entubasyon kolaylığı ve hemodinamik yanıt uzerine etkileri acısından karşılaştırmayı amacladık. Gerec ve Yontemler: Yaş aralığı 18-65 yıl olan, Amerikan Anestezistler Derneği'nin II-III sınıflamasına giren, beden kitle indeksi (BKİ) ≥30 kg/m-2, Mallampati skorlaması 3 ve 4, elektif cerrahi uygulanacak 100 hasta bu prospektif randomize calışmaya kabul edildi. Hastaların yaş, BKİ, tiromental mesafe, sternomental mesafe, ağız acıklığı, Mallampati sınıfı ve modifiye Cormack-Lehane skorları kaydedildi. Hastalar rastgele 50'şer kişilik iki gruba ayrıldı. Grup VL: Entubasyonu C-MAC D blade video laringoskop ile gercekleştirilenler; Grup ML: Entubasyonu McCoy laringoskop ile gercekleştirilenler. Kalp atım hızı, ortalama arter basıncı ve SpO2 değerleri preoperatif, entubasyon sonrası 1 ve 5. dk'larda kaydedildi. Bulgular: Grup VL'de modifiye Cormack-Lehane skoru 3 olan hasta bulunmaz iken, Grup ML'de 15 hasta bu skordaydı. Calışmamızda VL grubunda 44 (%88) hastada Cormack-Lehane skorlaması 1 ve 2a skorunda iken, ML grubunda sadece 23 (%46) hasta bu skorda idi. Gruplar arası başarılı entubasyon suresi ve hemodinamik paremetreleri değerlendirildiğinde anlamlı farklılık yoktu. Ancak, entubasyon girişim sayıları Grup ML'de daha yuksek bulundu. Sonuc: Zor entubasyon duşunulen obez hastalarda C-MAC video laringoskopta McCoy laringoskopa gore daha az deneme sayısı elde edildi. Ayrıca, daha iyi glottik goruntu sağlayarak entubasyon kolaylığını ve başarısını artırmaktadır.
Anahtar Kelimeler: Obezite; zor entübasyon; C-MAC video laringoskop; McCoy laringoskop
Amac: Fonksiyonel solunumu sağlamada en onemli unsur havayoludur. Obez hastaların zor havayolu nedeni ile entube edilememeleri, anestezi pratiğinde mortalite ve morbititenin en sık nedenidir. Son zamanlarda video laringoskoplar zor havayolunda daha onemli hale gelmektedir. Bu calışmada, zor entubasyon ongorusu olan obez hastalarda C-MAC video laringoskop ile McCoy laringoskopu; entubasyon başarısı, entubasyon kolaylığı ve hemodinamik yanıt uzerine etkileri acısından karşılaştırmayı amacladık. Gerec ve Yontemler: Yaş aralığı 18-65 yıl olan, Amerikan Anestezistler Derneği'nin II-III sınıflamasına giren, beden kitle indeksi (BKİ) ≥30 kg/m-2, Mallampati skorlaması 3 ve 4, elektif cerrahi uygulanacak 100 hasta bu prospektif randomize calışmaya kabul edildi. Hastaların yaş, BKİ, tiromental mesafe, sternomental mesafe, ağız acıklığı, Mallampati sınıfı ve modifiye Cormack-Lehane skorları kaydedildi. Hastalar rastgele 50'şer kişilik iki gruba ayrıldı. Grup VL: Entubasyonu C-MAC D blade video laringoskop ile gercekleştirilenler; Grup ML: Entubasyonu McCoy laringoskop ile gercekleştirilenler. Kalp atım hızı, ortalama arter basıncı ve SpO2 değerleri preoperatif, entubasyon sonrası 1 ve 5. dk'larda kaydedildi. Bulgular: Grup VL'de modifiye Cormack-Lehane skoru 3 olan hasta bulunmaz iken, Grup ML'de 15 hasta bu skordaydı. Calışmamızda VL grubunda 44 (%88) hastada Cormack-Lehane skorlaması 1 ve 2a skorunda iken, ML grubunda sadece 23 (%46) hasta bu skorda idi. Gruplar arası başarılı entubasyon suresi ve hemodinamik paremetreleri değerlendirildiğinde anlamlı farklılık yoktu. Ancak, entubasyon girişim sayıları Grup ML'de daha yuksek bulundu. Sonuc: Zor entubasyon duşunulen obez hastalarda C-MAC video laringoskopta McCoy laringoskopa gore daha az deneme sayısı elde edildi. Ayrıca, daha iyi glottik goruntu sağlayarak entubasyon kolaylığını ve başarısını artırmaktadır.
Anahtar Kelimeler: Obezite; zor entübasyon; C-MAC video laringoskop; McCoy laringoskop
ABSTRACT
Objective: The airway is the most important factor in ensuring the functional respiratory. The failure of intubation and difficult airway in obese patients is the most common cause of mortality and morbidity in anesthesia practice. The importance of using video laryngoscope in patients with potential difficult airway is recently increasing. In this study, we aimed to compare C-MAC video laryngoscope and McCoy laryngoscope in terms of their effects on intubation success, ease of intubation and hemodynamic responses in obese patients at risk of difficult intubation. Material and Methods: A total of 100 obese patients aged between 18-65 years with American Society of Anesthesiologists physical status II-III and Mallampati grade of ≥3 scheduled for elective surgeries were included in this randomized prospective study. The age, body mass index (BMI), thyromental distance, sternomental distance, mouth opening, Mallampati scores and modified Cormack-Lehane grades of the patients were recorded. The patients were randomly divided into two groups consisting 50 patients each as: Group VL: Intubation with C-MAC D blade video laryngoscope. Group ML: Intubation with McCoy laryngoscope. Heart rate, the mean arterial pressure and SpO2 values were recorded preoperatively and also at 1st and 5th minutes after intubation. Results: In VL group there were no patients with modified Cormack-Lehane grade 3. In ML group, there were 15 patients with grade 3. In our study, 44 (88%) patients had Cormack-Lehane grade 1 and 2a in VL group while 23 (46%) patients had the same grade in ML group. There were no significant differences between the groups in terms of successful intubation times and hemodynamic parameters. However, the number of intubation attempts were higher in Group ML. Conclusion: In obese patients with difficult intubation, C-MAC video laryngoscope had fewer attempts than McCoy laryngoscope. It also increases the ease and success of intubation by providing a better glottic image.
Keywords: Obesity; difficult intubation; C-MAC video laryngoscope; McCoy laryngoscope
Objective: The airway is the most important factor in ensuring the functional respiratory. The failure of intubation and difficult airway in obese patients is the most common cause of mortality and morbidity in anesthesia practice. The importance of using video laryngoscope in patients with potential difficult airway is recently increasing. In this study, we aimed to compare C-MAC video laryngoscope and McCoy laryngoscope in terms of their effects on intubation success, ease of intubation and hemodynamic responses in obese patients at risk of difficult intubation. Material and Methods: A total of 100 obese patients aged between 18-65 years with American Society of Anesthesiologists physical status II-III and Mallampati grade of ≥3 scheduled for elective surgeries were included in this randomized prospective study. The age, body mass index (BMI), thyromental distance, sternomental distance, mouth opening, Mallampati scores and modified Cormack-Lehane grades of the patients were recorded. The patients were randomly divided into two groups consisting 50 patients each as: Group VL: Intubation with C-MAC D blade video laryngoscope. Group ML: Intubation with McCoy laryngoscope. Heart rate, the mean arterial pressure and SpO2 values were recorded preoperatively and also at 1st and 5th minutes after intubation. Results: In VL group there were no patients with modified Cormack-Lehane grade 3. In ML group, there were 15 patients with grade 3. In our study, 44 (88%) patients had Cormack-Lehane grade 1 and 2a in VL group while 23 (46%) patients had the same grade in ML group. There were no significant differences between the groups in terms of successful intubation times and hemodynamic parameters. However, the number of intubation attempts were higher in Group ML. Conclusion: In obese patients with difficult intubation, C-MAC video laryngoscope had fewer attempts than McCoy laryngoscope. It also increases the ease and success of intubation by providing a better glottic image.
Keywords: Obesity; difficult intubation; C-MAC video laryngoscope; McCoy laryngoscope
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