Morbid obez hastalarda metalik çok kullanımlık laringoskop bleydleri ile plastik ve metalik tek kullanımlık laringoskop bleydlerinin entübasyon başarı oranlarının karşılaştırılması
Loading...
Date
2016
Authors
Kara, Ayşegül
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Havayolu yönetiminde kullanılan çok kullanımlık laringoskopların kontamine oldukları bildirilmiştir. Enfeksiyon riskini azaltmak için tek kullanımlık laringoskop bleydleri önerilmesine karşın bu bleydlerin başarısız entübasyon oranını arttırdığına ilişkin çalışmalar yayınlanmıştır (1,2). Anestezi ilişkili morbidite-mortalitenin en önemli nedeni havayolu yönetimindeki başarısızlıktır (3). Zor havayolu insidansı normal popülasyonda %1-4, obez olgularda ise %12-20 olarak bildirilmiştir (4). Tek kullanımlık bleydlerin kullanılmaya başlaması ve obez popülasyondaki artış nedeniyle biz, morbid obez olgularda plastik ve metalik tek kullanımlık bleydleri, metalik çok kullanımlık bleydler ile entübasyon başarısı açısından karşılaştırmayı amaçladık. Genel anestezi altında elektif cerrahi geçirecek, Amerikan Anesteziyologlar Derneği (ASA) sınıfı I-III, 18-60 yaş, VKİ>40 olan 150 hasta çalışmaya alınarak, kullanılan bleyde göre (Grup MÇK: Metalik çok kullanımlık, Grup MTK: Metalik tek kullanımlık ve Grup PTK: Plastik tek kullanımlık) 3 gruba ayrıldı. Entübasyon başarısı, entübasyon süresi, komplikasyonlar ve hemodinamik veriler kaydedildi. İstatistiksel analizde tek yönlü varyans analizi ve Kruskall Wallis.testleri kullanıldı. P<0.05 anlamlı kabul edildi. İlk girişimdeki entübasyon başarısı açısından farklılık bulunmadı (p>0,05). Larinksin görüntülenmesi ve toplam entübasyon süresi MTK bleyd grubunda daha kısa bulundu (sırasıyla 6,5±4,6 sn, 13,4±7,3 sn) (p˂0,05). PTK bleyd grubunda C-L sınıfı 1 hasta sayısının daha az olduğu (p˂0,05), entübasyon zorluk skalası skorunun daha yüksek ve artmış kaldırma gücü ihtiyacının daha fazla olduğu saptandı (p˂0,05). Sonuç olarak morbid obez hastalarda plastik tek kullanımlık bleydlerin metalik bleydler kadar başarılı olmadıklarını saptadık. Metalik tek ve metalik çok kullanımlık bleydlerin entübasyon başarıları arasında fark yokken, entübasyon süreleri metalik tek kullanımlık bleyd grubunda daha kısaydı. Morbid obez hastalarda metalik tek kullanımlık bleydlerin güvenle kullanılabileceğini düşünmekteyiz.
Reusable laryngoscope blades, which are preferred in airway management, have been reported to be frequently contaminated. Although disposable laryngoscope blades are recommended to reduce the risk of infection, there are studies revealing increased failed intubation rates (1, 2). The major cause of anesthesia-related mortality and morbidity is the failure of airway management (3). The incidence of difficult airway is reported to be between 1-4% in normal population while it ranges from 12-20% in obese patients (4). Following the introduction of disposable blades and considering the increased rate of failed intubation in obese patients, we aimed to make a comparison between the plastic and metallic disposable blades for intubation success in morbid obese patients. One hundred fifty patients, aged between 18-60 years; had a BMI >40 and ASA I-III classes enrolled in the study. They were divided into three groups considering the blade type used in laryngoscopy. Group MR: Metallic Reusable, Group MD: Metallic Disposable and Group PD: Plastic disposable. Data including intubation success, intubation duration, complications and hemodynamic data were recorded. The one-way ANOVA test and Kruskal Wallis test were used for statistical analyses. P<0.05 was considered statistically significant. No significant difference was detected between the groups for the first-attempt intubation success (p>0.05). The time to laryngeal visualization and the total intubation duration were found to be shorter in the MD blade group (respectively 6,5±4,6 sn, 13,4±7,3 sn) (p˂0.05). Although there were less C-L class 1 patients in the PD grup (p˂0.05), there were more patients with higher IDS score and patients with the need for lifting power (p˂0.05). In conclusion, we found that plastic disposable blades were not as successful as metallic blades in morbid obese patient. Even though there was no difference between the metallic reusable and metallic disposable blades in successful intubation, the time to intubation was shorter in the metallic disposable group. We, therefore, believe that metallic disposable blades can be safely used in the patients with morbid obesity.
Reusable laryngoscope blades, which are preferred in airway management, have been reported to be frequently contaminated. Although disposable laryngoscope blades are recommended to reduce the risk of infection, there are studies revealing increased failed intubation rates (1, 2). The major cause of anesthesia-related mortality and morbidity is the failure of airway management (3). The incidence of difficult airway is reported to be between 1-4% in normal population while it ranges from 12-20% in obese patients (4). Following the introduction of disposable blades and considering the increased rate of failed intubation in obese patients, we aimed to make a comparison between the plastic and metallic disposable blades for intubation success in morbid obese patients. One hundred fifty patients, aged between 18-60 years; had a BMI >40 and ASA I-III classes enrolled in the study. They were divided into three groups considering the blade type used in laryngoscopy. Group MR: Metallic Reusable, Group MD: Metallic Disposable and Group PD: Plastic disposable. Data including intubation success, intubation duration, complications and hemodynamic data were recorded. The one-way ANOVA test and Kruskal Wallis test were used for statistical analyses. P<0.05 was considered statistically significant. No significant difference was detected between the groups for the first-attempt intubation success (p>0.05). The time to laryngeal visualization and the total intubation duration were found to be shorter in the MD blade group (respectively 6,5±4,6 sn, 13,4±7,3 sn) (p˂0.05). Although there were less C-L class 1 patients in the PD grup (p˂0.05), there were more patients with higher IDS score and patients with the need for lifting power (p˂0.05). In conclusion, we found that plastic disposable blades were not as successful as metallic blades in morbid obese patient. Even though there was no difference between the metallic reusable and metallic disposable blades in successful intubation, the time to intubation was shorter in the metallic disposable group. We, therefore, believe that metallic disposable blades can be safely used in the patients with morbid obesity.
Description
Keywords
Entübasyon, Obezite, Tek kullanımlık bleyd, Metal, Plastik, Intubation, Obesity, Disposable blade, Metallic, Plastic
Citation
Kara, A. (2016). Morbid obez hastalarda metalik çok kullanımlık laringoskop bleydleri ile plastik ve metalik tek kullanımlık laringoskop bleydlerinin entübasyon başarı oranlarının karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.