Publication: Pozitif basınçlı mekanik ventilasyon uygulanan hastalarda "Laringeal maske" pozisyonunda oluşabilecek değişikliklerin fiberoptik laringoskopi ile değerlendirilmesi
Abstract
Pozitif basınçlı mekanik ventilasyon uygulanan hastalarda LM pozisyonunda oluşabilecek değişiklikleri fiberoptik laringoskopi yardımı ile belirlemeyi amaçladık. ASA I-III grubunda, 20-60 yaş arasında ve elektif periferik cerrahi geçirecek toplam 90 hasta çalışmaya dahil edildi. Anestezi indüksiyonu sonrası hastalarda havayolu devamlılığı uygun büyüklükte LM ile sağlandı. LM yerleştirildikten hemen sonra ve mekanik ventilasyonun 30. dk'sında fiberoptik bronkoskop LM içinden geçirildi ve glottis ile vokal kordların görünümü belirlenerek gruplandırıldı: Grade I; vokal kordların tamamının görüntülenebilmesi, Grade II; vokal kordların parsiyel görüntülenebilmesi, Grade III; vokal kordların görüntülenememesi. Hastalarda ventilasyon; 8 mL kg-1 tidal volüm ve ETCO2 değerleri 35±2 mmHg değerlerini sağlayacak solunum sayısında uygulandı. LM kaf basıncı çalışma süresince takip edilmiştir. Tüm veriler istatistiksel olarak değerlendirildi. LM yerleştirdikten hemen sonra vokal kordların görünümü; 65 hastada Grade I (% 75.58), 17 hastada Grade II (% 19.76), 4 hastada Grade III (% 4.65), 30 dk süre ile uygulanan pozitif basınçlı mekanik ventilasyon sonrası ise; 58 hastada Grade I (% 67.44), 23 hastada Grade II (% 26.74) ve 5 hastada Grade III (% 5.81) olarak bulundu. Dört hasta LM ile havayolu devamlılığı sağlanamadığı için çalışma dışı bırakıldılar. Klinik olarak LM ile yeterli havayolu devamlılığı sağlanan hastalarda, LM yerleşiminin ideal pozisyonda olmayabileceği ve mekanik ventilasyon ile LM pozisyonunda değişiklikler olabileceği akılda tutulmalıdır.
Our goal was to find out if there was any change in the position of LMA by fiberoptic laryngoscopy for patients receiving positive pressure mechanical ventilation. 90 patients aged 20-60 years old, ASA I-III were studied during elective peripheral surgery. LMA of the appropriate size was inserted to all patients after induction of general anesthesia. After LMA insertion and 30 min mechanical ventilation, fiberoptic laryngoscopy through LMA was performed in order to determine position of LMA according to appearance of vocal cord and glottis: Grade I; clear vision of the larynx, Grade II; partial vision of the larynx, Grade III; downfolding of the epiglottis obscured the laryngeal inlet. Mechanical ventilation was performed with 8 mL kg-1 tidal volume and a respiratory rate sufficient to maintain ETCO2 at 35±2 mm Hg. LMA cuff pressure was monitored during operation. All data were compared statistically. After insertion of LMA, 65 patients were in Grade I (75.58 %), 17 patients were in Grade II (19.76 %) and 4 patients were in Grade III (4.65 %). After 30 min mechanical ventilation; 58 patients in Grade I (67.44 %), 23 patients in Grade II (26.74 %) and 5 patients in Grade III (5.81 %). Four patients were discharged from the study because of insufficient ventilation with LMA. A clinically patient airway doesn't mean ideal LMA positioning and its position may change during positive pressure mechanical ventilation.
Our goal was to find out if there was any change in the position of LMA by fiberoptic laryngoscopy for patients receiving positive pressure mechanical ventilation. 90 patients aged 20-60 years old, ASA I-III were studied during elective peripheral surgery. LMA of the appropriate size was inserted to all patients after induction of general anesthesia. After LMA insertion and 30 min mechanical ventilation, fiberoptic laryngoscopy through LMA was performed in order to determine position of LMA according to appearance of vocal cord and glottis: Grade I; clear vision of the larynx, Grade II; partial vision of the larynx, Grade III; downfolding of the epiglottis obscured the laryngeal inlet. Mechanical ventilation was performed with 8 mL kg-1 tidal volume and a respiratory rate sufficient to maintain ETCO2 at 35±2 mm Hg. LMA cuff pressure was monitored during operation. All data were compared statistically. After insertion of LMA, 65 patients were in Grade I (75.58 %), 17 patients were in Grade II (19.76 %) and 4 patients were in Grade III (4.65 %). After 30 min mechanical ventilation; 58 patients in Grade I (67.44 %), 23 patients in Grade II (26.74 %) and 5 patients in Grade III (5.81 %). Four patients were discharged from the study because of insufficient ventilation with LMA. A clinically patient airway doesn't mean ideal LMA positioning and its position may change during positive pressure mechanical ventilation.