Zor havayolunu belirlemede anamnez, El Ganzourı Risk İndeksi (EGRI), Entübasyon Zorluk Skalası (EZS) ile ultrasonografik havayolu parametrelerinin karşılaştırılması
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Dosyalar
Tarih
2023
Kurum Yazarları
Önal, Harun
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
Bursa Uludağ Üniversitesi
Özet
Zor havayolu, klasik eğitim almış bir anestezistin yüz maskesi ile ventilasyonda, trakeal entübasyonda ya da her ikisinde de güçlükle karşılaşmasıdır. Havayolu erişiminin sağlanamaması yaşamı tehdit eden komplikasyonlara yol açabilir. Günümüzde zor havayolunun öngörülememesinden kaynaklı havayolu ile ilişkili morbidite, anestezi uzmanı için birincil endişe olmayı sürdürmektedir. Çalışmamızda ultrasonografik görüntülemeyle ölçtüğümüz cilt-trakea mesafeleri aracılığıyla zor havayolunu öngörebilmeyi amaçladık. Preoperatif bekleme odasında hastaların ASA skoru, vücut ağırlığı, boyu, vücut kitle indeksi (VKİ), boyun çevresi kalınlığı (BÇK), gece horlaması öyküsü, Obstrüktif Uyku Apnesi Sendromu (OSAS) tanısı, OSAS tanısı mevcut sapozitif havayolu basıncı tedavisi (PHBT) öyküsü kaydedildi. Ayrıca hastaların ağız açıklığı, tiromental mesafesi (TMM), modifiye Mallampati skoru (MMP), boyun hareketliliği, prognat (alt çeneyi ilerletebilme) yeteneği ve zorentübasyon öyküsü değerlendirilerek El Ganzouri Risk İndeksi (EGRI) skoru hesaplandı. Operasyon odasında direkt laringoskopi ve endotrakeal entübasyon uygulaması sırasında hastaların Entübasyon Zorluk Skalası (EZS) skoru hesaplandı. Çalışmamıza katılan hastalar preoperatif bekleme odasında, standart hasta transport sedyesi üzerinde, supin pozisyonda uzandıktan sonra GEL ogiq e BT09 ultrason cihazı lineer probu ile boyun taranarak; tüm hastaların cilt-hyoid kemik arası mesafesi (CHM), cilt-epiglottis orta noktası arası mesafesi (CEM), cilt-vokal kordların anterior komis sürü arası mesafesi (CVKM), cilt-tiroid isthmus arası mesafesi (CTİM), cilt-suprasternal çentik seviyesindeki trakea arası mesafesi (CSSM) ultrasonografik olarak ölçüldü. Çalışmamızda ultrasonografik görüntüleme ile ölçülen CHM, CEM, CVKM, CTİM, CSSM mesafeleri ile hastaların havayolu anamnez bulguları, EGRI ve EZS skorları karşılaştırılarak zor havayolunun öngörülebilirliği araştırıldı. Ölçülen ultrasonografik havayolu mesafelerinden; CHM, CEM, CVKM ölçümlerindeki mesafe artışının zor havayolu ile anlamlı ilişki gösterdiği; CTİM, CSSM ölçümleri ile zor havayolu arasında anlamlı ilişki göstermediği saptandı.
Difficult airway is when a classically trained anesthetist encounters difficulties with face mask ventilation, tracheal intubation, or both. Failure to provide airway access can lead to life-threatening complications. Today, airway-related morbidity due to the unpredictability of the difficult airway remains a primary concern for the anesthesiologist. In our study, we aimed to predict difficult airway through skin-trachea distances measured by ultrasonographic imaging. In the preoperative waiting room, patients have ASA score, body weight, height, body mass index (BMI), neck circumference thickness (CCT), history of night snoring, diagnosis of Obstructive Sleep Apnea Syndrome (OSAS), positive airway pressure therapy (PAPT) if there is a diagnosis of OSAS was recorded. In addition, El Ganzouri Risk Index (EGRI) score was calculated by evaluating patients' mouth opening, thyromental distance (TMD), modified Mallampati score (MMP), neck mobility, prognath (advancing the lower jaw) ability and history of difficult intubation. Intubation Difficulty Scale (IDS) scores of the patients were calculated during direct laryngoscopy and endotracheal intubation in the operating room. the position of the vocal cords during intubation'. Difficulty Scale (IDS) score was calculated. After the patients who participated in our study were lying in the supine position in the preoperative waiting room, on the standard patient transport stretcher, the neck was scanned with the linear probe of the GE Logiq e BT09 ultrasound device; skin-hyoid bone distance (DSHB), skin-epiglottis mid-point distance (DSEM), skin-to-vocal cord anterior commissure distance (DSVC), skin-thyroid isthmus distance (DSTI), skin-suprasternal notch level skin-tracheal distance (DSSN) was measured ultrasonographically.In our study, DSHB, DSEM, DSVC, DSTI, DSSN distances measured by ultrasonographic imaging; Airway anamnesis findings of the patients were compared with EGRI and IDS scores, and predictability of difficult airway was investigated. From the measured ultrasonographic airway distances; It was determined that the increase in distance in DSHB, DSEM, DSVC measurements showed a significant relationship with the difficul tairway; It was determined that there was no significant correlation between DSTI, DSSN measurements and difficult airway.
Difficult airway is when a classically trained anesthetist encounters difficulties with face mask ventilation, tracheal intubation, or both. Failure to provide airway access can lead to life-threatening complications. Today, airway-related morbidity due to the unpredictability of the difficult airway remains a primary concern for the anesthesiologist. In our study, we aimed to predict difficult airway through skin-trachea distances measured by ultrasonographic imaging. In the preoperative waiting room, patients have ASA score, body weight, height, body mass index (BMI), neck circumference thickness (CCT), history of night snoring, diagnosis of Obstructive Sleep Apnea Syndrome (OSAS), positive airway pressure therapy (PAPT) if there is a diagnosis of OSAS was recorded. In addition, El Ganzouri Risk Index (EGRI) score was calculated by evaluating patients' mouth opening, thyromental distance (TMD), modified Mallampati score (MMP), neck mobility, prognath (advancing the lower jaw) ability and history of difficult intubation. Intubation Difficulty Scale (IDS) scores of the patients were calculated during direct laryngoscopy and endotracheal intubation in the operating room. the position of the vocal cords during intubation'. Difficulty Scale (IDS) score was calculated. After the patients who participated in our study were lying in the supine position in the preoperative waiting room, on the standard patient transport stretcher, the neck was scanned with the linear probe of the GE Logiq e BT09 ultrasound device; skin-hyoid bone distance (DSHB), skin-epiglottis mid-point distance (DSEM), skin-to-vocal cord anterior commissure distance (DSVC), skin-thyroid isthmus distance (DSTI), skin-suprasternal notch level skin-tracheal distance (DSSN) was measured ultrasonographically.In our study, DSHB, DSEM, DSVC, DSTI, DSSN distances measured by ultrasonographic imaging; Airway anamnesis findings of the patients were compared with EGRI and IDS scores, and predictability of difficult airway was investigated. From the measured ultrasonographic airway distances; It was determined that the increase in distance in DSHB, DSEM, DSVC measurements showed a significant relationship with the difficul tairway; It was determined that there was no significant correlation between DSTI, DSSN measurements and difficult airway.
Açıklama
Anahtar kelimeler
Havayolu ultrasonu, El Ganzouri Risk İndeksi (EGRI), Entübasyon Zorluk Skalası (EZS), Zor havayolu, Airway ultrasound, El Ganzouri Risk Index (EGRI), Intubation Difficulty Scale (IDS), Difficult airway
Alıntı
Önal, H. (2023). Zor havayolunu belirlemede anamnez, El Ganzourı Risk İndeksi (EGRI), Entübasyon Zorluk Skalası (EZS) ile ultrasonografik havayolu parametrelerinin karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.