Baş boyun cerrahisi uygulanan hastalarda zor havayolu tanısında antropometrik ölçümlerin ve klinik testlerin değerlendirilmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Anesteziyle ilişkili komplikasyonların en sık nedeni hava yolu yönetiminde yaşanan sorunlardır ve ölümlerin %30-40'ını oluşturur. Anestezi uygulamaları sırasında karşılaşılan zor hava yolu insidansı, hastaların klinik ve fiziki özelliklerine göre farklılık göstermekle birlikte genel popülasyon için %1,5-13,5 arasında bildirilmektedir. Ancak baş-boyun bölgesi ile ilgili operasyonlar sırasında zor hava yolu çok daha büyük bir sorundur. Operasyon öncesi dönemde zor hava yolunun tahmininde kullanılan çeşitli testler ve ölçümler mevcuttur. Ancak baş-boyun cerrahisi uygulanan hastalarla ilgili literatürde sınırlı sayıda bilgi bulunmaktadır. Bu çalışmanın amacı, baş boyun cerrahisi için operasyona alınan hastalardaki zor hava yolu insidansı ile bu hastalarda zor hava yolu tahmininde kullanılacak antropometrik ölçümler ve klinik testleri araştırmaktır.
Gereç ve Yöntem; Kulak burun boğaz ameliyathanesinde ASA I-III sınıfı, 18 yaş üzeri, baş-boyun cerrahisi uygulanan toplam 200 hastada gerçekleştirilen bu çalışmada, hastaların operasyon öncesi dönemde demografik verileri (yaş, cinsiyet, kilo, boy, VKİ), baş boyun bölgesine uygulanan önceki operasyonları/radyoterapi öyküsü ve OSA semptomları kaydedildi. Fizik muayenede, hastaların çene yapısı, ağız açıklığı, çene hareketi, diş yapısı, Modifiye Mallampati sınıfı, Wilson risk skorlaması, baş-boyun hareketleri, boyun çevresi, tiromental mesafe, sternomental mesafe, atlantooksipital eklem hareketliliği, üst dudak ısırma testi, laringoskopi sırasında ise Cormack-Lehane sınıflaması kaydedildi. Bulgular; Çalışma sonucunda zor maske ventilasyonu hiçbir hastada görülmezken, zor laringoskopi oranı %19, zor entübasyon oranı ise %8 olarak belirlendi. Baş-boyun ile ilgili operasyon öyküsü (p=0,002) olma ve tanı konulmamış ancak OSAS semptomlarından en az ikisinin bulunması (p=0,008), Modifiye Mallampati skoru (p=0,009), Wilson risk skorlaması (p=0,004), üst dudak ısırma testi (p<0,0001) ve ağız açıklığı (p=0,001) zor laringoskopi ile ilişkili olarak bulunmuştur. Zor entübasyonla ilişkili faktörler arasında ise yine Modifiye Mallampati skoru (p=0,002), Wilson risk skorlaması (p<0,0001), üst dudak ısırma testi (p<0,0001) ve ağız açıklığının (p<0,0001) yanı sıra sternomental mesafe (p=0,003), Atlantooksipital eklem hareketliliği (p=0,001) ve Cormack-Lehane sınıflaması (p<0,0001) saptanmıştır. Tartışma ve sonuç; Baş-boyun cerrahisi uygulanan hastalarda, zor hava yolu insidansının daha yüksek olduğu görüldü. Özellikle Modifiye Mallampati skoru, Wilson risk skorlaması, üst dudak ısırma testi ve ağız açıklığı hem zor laringoskopi hem de zor entübasyonla ilişkili bulunurken sternomental mesafe, atlantooksipital eklem hareketliliği ve Cormack-Lehane sınıflamasının sadece zor entübasyonla ilişkili olduğu görüldü.
The most common cause of anesthesia-related complications is airway management problems and accounts for 30-40% of deaths. Although the incidence of difficult airway encountered during anesthesia practices varies according to the clinical and physical characteristics of the patients, it is reported between 1.5% and 13.5% for the general population. There are various tests and measurements can be used to predict difficult airway in the pre-operative period. However, there is limited data in the literature about patients who underwent head and neck surgery. The aim of this study is to investigate the difficult airway incidence in patients undergoing surgery for head and neck surgery, and anthropometric measurements and clinical tests to be used in predicting difficult airway in these patients. Materials and Methods; In this study, which was conducted in a total of 200 patients in the ASA I-III class, older than 18 years of age and who underwent head and neck surgery in the ear-nose-throat operating room, the demographic data of the patients in the preoperative period (age, gender, weight, height, BMI), the previous operations performed on the head and neck, history of radiotherapy and OSA symptoms were recorded. In the physical examination, patients' jaw structure, mouth opening, jaw movement, tooth structure, Modified Mallampati class, Wilson risk scoring, head-neck movements, neck circumference, thyromental distance, sternomental distance, atlantooccipital joint mobility, upper lip bite test, and during laryngoscopy Cormack-Lehane classification were recorded. Results: At the end of the study, difficult mask ventilation was not observed in any patient, while the difficult laryngoscopy rate was 19% and the difficult intubation rate was 8%. Operation history related to head and neck (p = 0.002) and undiagnosed, but at least two OSAS symptoms (p = 0.008), Modified Mallampati score (p = 0.009), Wilson risk score (p = 0.004), upper lip bite test (p<0.0001) and mouth opening (p = 0.001) were found to be associated with difficult laryngoscopy. Modified Mallampati score (p = 0.002), Wilson risk score (p <0.0001) and mouth opening (p <0.0001) as well as sternomental distance (p = 0.003), atlantooccipital joint mobility (p=0.001) and Cormack-Lehane classification (p <0.0001) which are among the factors associated with difficult intubation were all determined. Discussion and conclusion: It was observed that the incidence of difficult airway was higher than expected in patients who underwent head and neck surgery. In particular, Modified Mallampati score, Wilson risk scoring, upper lip bite test and mouth opening were found to be associated with both difficult laryngoscopy and difficult intubation, while sternomental distance, atlantooccipital joint mobility and Cormack-Lehane classification were found to be associated only with difficult intubation.
The most common cause of anesthesia-related complications is airway management problems and accounts for 30-40% of deaths. Although the incidence of difficult airway encountered during anesthesia practices varies according to the clinical and physical characteristics of the patients, it is reported between 1.5% and 13.5% for the general population. There are various tests and measurements can be used to predict difficult airway in the pre-operative period. However, there is limited data in the literature about patients who underwent head and neck surgery. The aim of this study is to investigate the difficult airway incidence in patients undergoing surgery for head and neck surgery, and anthropometric measurements and clinical tests to be used in predicting difficult airway in these patients. Materials and Methods; In this study, which was conducted in a total of 200 patients in the ASA I-III class, older than 18 years of age and who underwent head and neck surgery in the ear-nose-throat operating room, the demographic data of the patients in the preoperative period (age, gender, weight, height, BMI), the previous operations performed on the head and neck, history of radiotherapy and OSA symptoms were recorded. In the physical examination, patients' jaw structure, mouth opening, jaw movement, tooth structure, Modified Mallampati class, Wilson risk scoring, head-neck movements, neck circumference, thyromental distance, sternomental distance, atlantooccipital joint mobility, upper lip bite test, and during laryngoscopy Cormack-Lehane classification were recorded. Results: At the end of the study, difficult mask ventilation was not observed in any patient, while the difficult laryngoscopy rate was 19% and the difficult intubation rate was 8%. Operation history related to head and neck (p = 0.002) and undiagnosed, but at least two OSAS symptoms (p = 0.008), Modified Mallampati score (p = 0.009), Wilson risk score (p = 0.004), upper lip bite test (p<0.0001) and mouth opening (p = 0.001) were found to be associated with difficult laryngoscopy. Modified Mallampati score (p = 0.002), Wilson risk score (p <0.0001) and mouth opening (p <0.0001) as well as sternomental distance (p = 0.003), atlantooccipital joint mobility (p=0.001) and Cormack-Lehane classification (p <0.0001) which are among the factors associated with difficult intubation were all determined. Discussion and conclusion: It was observed that the incidence of difficult airway was higher than expected in patients who underwent head and neck surgery. In particular, Modified Mallampati score, Wilson risk scoring, upper lip bite test and mouth opening were found to be associated with both difficult laryngoscopy and difficult intubation, while sternomental distance, atlantooccipital joint mobility and Cormack-Lehane classification were found to be associated only with difficult intubation.
Açıklama
Anahtar Kelimeler
Genel Anestezi, Baş-Boyun Cerrahisi, Zor Hava Yolu, Zor Entübasyon, Zor Laringoskopi, General Anesthesia, Head and Neck Surgery, Difficult Airway, Difficult Intubation, Difficult Laryngoscopy
