Yıl: 2002 Cilt: 24 Sayı: 1 Sayfa Aralığı: 7 - 13 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Zor entübasyon: Klinik ve radyolojik değerlendirme

Öz:
Amaç: Bu çalışmada, ameliyat öncesi yapılan klinik ve radyolojik incelemelerin entübasyon güçlüğünü tahmin etmedeki duyarlılığı incelendi. Hastalar ve Yöntemler: Çalışmaya genel anestezi altında ameliyat sırasında entübasyon güçlüğü beklenmeyen 165 hasta alındı ve 50 poliklinik hastasından kontrol grubu oluşturuldu. Ameliyat öncesinde hastalarda interinsizüral aralık, tiromental ve sternomental uzaklık, mastoid-sternoklavikuler eklem uzunluğu, krikoid seviyesinde boyun çevresi, ramus ve korpus mandibula uzunlukları ve mandibula açısı ölçüldü. Ağız içi yapılar Mallampati sınıflamasına göre değerlendirildi. Kafa nötral ve hiperekstansiyon pozisyonunda iken lateral servikal grafiler çekildi ve atlanto-oksipital aralık, mandibuler açı, mandibulo-hyoid uzaklık, serviko-hyoid ve mento-hyoid uzaklıklar ölçüldü. Larengoskopi sırasında larenksin görünümü Cormack ve Lehane (C-L) kriterlerine göre sınıflandırıldı. Yapılan ölçümler ile entübasyon güçlüğü arasındaki ilişki değerlendirildi. Bulgular: Larengoskopi sırasında üç hastada (%1.8) entübasyon güçlüğü belirlendi. Bu olgulardan biri C-L IV, ikisi C-L III olarak derecelendirildi. Wilson sınıflaması ile diğer klinik ölçümler arasında anlamlı bir korelasyon belirlenmedi. Mallampati sınıflaması ile yaş arasında pozitif (p=0.000), sternomental uzaklık arasında negatif korelasyon saptandı (p=0.023). Cormack ve Lehane sınıflaması ile vücut ağırlığı (p=0.048) ve boyun çevresi arasında (p=0.000) pozitif korelasyon bulundu. Radyolojik ölçümlerde serviko-hyoid uzaklık ile C-L sınıflaması arasında pozitif korelasyon belirlendi (p=0.039). Sonuç: Nötral ve hiperekstansiyon pozisyonunda alınacak lateral servikal grafilerin, entübasyon güçlüğü beklenen olgularda ek bilgi verebileceği sonucuna varıldı.
Anahtar Kelime: Radyoloji Risk değerlendirmesi Hava yolu tıkanıklığı Larinks hastalıkları Entübasyon, intratrakeal

Konular: Genel ve Dahili Tıp

Difficult intubation: Clinical and radiological evaluation

Öz:
Objectives: We investigated the sensitivity of preoperative clinic and radiologic evaluations in predicting difficulty dur-ing intubation. Patients and Methods: The study included 165 patients in whom difficult intubation was not estimated during general anesthesia. Preoperative measurements included the interincisural gap, thyromental and sternomental distances, mastoid-sternoclavicular joint distance, neck circumference at the cricoid level, the length of ramus and corpus mandible, and the mandibular angle. Intraoral structures were evaluated according to the Mallampati classification. On lateral cervical graphies of the neck, the atlanto-occipital distance, mandibular angle, mandibulo-hyoid distance, cervico-hyoid distance, and the mento-hyoid distance were measured. The appearance of the larynx was evaluated according to the Cormack and Lehane (C-L) classification. The relationship between measurements and difficulty of intubation was analyzed and the findings were compared with those of a control group of 50 outpatients. Results: Difficult intubation was determined in three patients (%1.8) during laryngoscopy. One of these patients was classified as C-L IV and the other two as C-L III. There was no cor-relation between the Wilson classification and other clinical measurements. The Mallampati classification showed a positive correlation with age (p=0.000), and a negative correlation with the sternomental distance (p=0.023). We found a positive correlation between the C-L classification and body weight (p=0.048), and neck circumference (p=0.000). The cervico-hyoid distance and the C-L classification were positively correlated according to radiological measurements (p=0.039). Conclusion: Lateral cervical graphies on neutral and hyperextension position may give additional information on possible difficult intubation preoperatively.
Anahtar Kelime: Radiology Risk Assessment Airway Obstruction Laryngeal Diseases Intubation, Intratracheal

Konular: Genel ve Dahili Tıp
Belge Türü: Makale Makale Türü: Diğer Erişim Türü: Erişime Açık
  • 1. Rocke DA, Murray WB, Rout CC, Gouws E. Relative risk analysis of factors associated with difficult intu¬ bation in obstetric anesthesia. Anesthesiology 1992; 77:67-73.
  • 2. Mallampati SR, Gatt SP, Gugino LD, Desai SP, WaraksaB, Freiberger D, et al. A clinical sign to pre dict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429-34.
  • 3. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988;61: 211-6.
  • 4. Benumof JL. Management of the difficult adult air¬ way. With special emphasis on awake tracheal intu¬ bation. Anesthesiology 1991;75:1087-110.
  • 5. Oates JD, Macleod AD, Oates PD, Pearsall FJ, Howie JC, Murray GD. Comparison of two methods for predicting difficult intubation. Br J Anaesth 1991; 66:305-9.
  • 6. Ovassapian A. The difficult airway. Fiberoptic endoscopy and difficult airway. 2nd ed. Philadelphia: Lippincot-Raven Press; 1996. p. 185-99.
  • 7. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105-11.
  • 8. Hirsch NP, Smith GB, Adnet F. Historical perspec¬ tive of the "sniffing position". Anesthesiology 2000;93:1366-7.
  • 9. Adnet F, Borron SW, Lapostolle F, Lapandry C. The three axis alignment theory and the "sniffing posi¬ tion": perpetuation of an anatomic myth? Anesthesiology 1999;91:1964-5.
  • 10. Charters P. What future is there for predicting diffi¬ cult intubation? Br J Anaesth 1996;77:309-ll.
  • 11. Cooper SD, Benumof JL, Ozaki GT. Evaluation of the Bullard laryngoscope using the new intubating stylet: comparison with conventional laryngoscopy. Anesth Analg 1994,79:965-70.
  • 12. Fridrich P, Frass M, Krenn CG, Weinstabl C, Benumof JL, Krafft P. The UpsherScope in routine and difficult airway management: a randomized, controlled clini¬ cal trial. Anesth Analg 1997;85:1377-81.
  • 13. Krafft P, Krenn CG, Fitzgerald RD, Pernerstorfer T, Fridrich P, Weinstabl C. Clinical trial of a new device for fiberoptic orotracheal intubation (Augustine Scope). Anesth Analg 1997;84:606-10.
  • 14. Hodgson RE, Gopalan PD, Burrows RC, Zuma K. Effect of cricoid pressure on the success of endotra- cheal intubation with a lightwand. Anesthesiology 2001;94:259-62.
  • 15. Tashayod ME. Two cases of difficult intubation managed by a handmade device. Br J Anaesth 2000; 85:626-8.
  • 16. Weiss M. Video-intuboscopy: a new aid to routine and difficult tracheal intubation. Br J Anaesth 1998; 80:525-7.
  • 17. Katz RL, Berci G. The optical stylet—a new intuba¬ tion technique for adults and children with specific reference to teaching. Anesthesiology 1979;51:251-4.
  • 18. Ovassapian A. Management of the difficult airway. Fiberoptic endoscopy and difficult airway. 2nd ed. Philadelphia: Lippincot-Raven Press; 1996. p. 210-30.
  • 19. Fell D. The conduct of anaesthesia and tracheal intu¬ bation. In: Nimmo WS, Smith G, editors. Anaesthesia. 1st ed. London: Blackwell Science Publications; 1989. p. 448-59.
  • 20. Fitzgerald RD, Krafft P, Skrbensky G, Pernerstorfer T, Steiner E, Kapral S, et al. Excursions of the cervi¬ cal spine during tracheal intubation: blind oral intu bation compared with direct laryngoscopy. Anaesthesia 1994;49:lll-5.
  • 21. Jones DH, Cohle SD. Unanticipated difficult airway secondary to lingual tonsillar hyperplasia. Anesth Analg 1993;77:1285-8.
  • 22. Gamlin F, Caldicott LD, Shah MV. Mediastinitis and sepsis syndrome following intubation. Anaesthesia 1994;49:883-5.
  • 23. Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993;78:597-602.
  • 24. Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41(5 Pt l):372-83.
  • 25. Al Ramadhani S, Mohamed LA, Rocke DA, Gouws E, Ramadhani SA. Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia. Br J Anaesth 1996;77:312-6.
  • 26. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth 1994;73:149-53.
  • 27. Williamson R. Endotracheal intubation in temporo- mandibular ankylosis. Anesth Analg 1988;67:602-3.
  • 28. Bilgin H, Ozyurt G. Screening tests for predicting difficult intubation. A clinical assessment in Turkish patients. Anaesth Intensive Care 1998;26:382-6.
  • 29. Tham EJ, Gildersleve CD, Sanders LD, Mapleson WW, Vaughan RS. Effects of posture, phonation and observer on Mallampati classification. Br J Anaesth 1992;68:32-8.
  • 30. Lewis M, Keramati S, Benumof JL, Berry CC. What is the best way to determine oropharyngeal classifi¬ cation and mandibular space length to predict diffi¬ cult laryngoscopy? Anesthesiology 1994;81:69-75.
  • 31.Samsoon GL, Young JR. Difficult tracheal intuba¬tion: a retrospective study. Anaesthesia 1987;42:487-90.
  • 32. Frerk CM. Predicting difficult intubation. Anaesthesia 1991;46:1005-8.
  • 33. Chou HC, Wu TL. Mandibulohyoid distance in dif¬ ficult laryngoscopy. Br J Anaesth 1993;71:335-9.
  • 34. Calder I, Calder J, Crockard HA. Difficult direct laryngoscopy in patients with cervical spine dis¬ ease. Anaesthesia 1995;50:756-63.
APA APAN A, KAZKAYASI M, yılmaz s, KOÇ M (2002). Zor entübasyon: Klinik ve radyolojik değerlendirme. , 7 - 13.
Chicago APAN Alpaslan,KAZKAYASI Mustafa,yılmaz sevda,KOÇ M. Can Zor entübasyon: Klinik ve radyolojik değerlendirme. (2002): 7 - 13.
MLA APAN Alpaslan,KAZKAYASI Mustafa,yılmaz sevda,KOÇ M. Can Zor entübasyon: Klinik ve radyolojik değerlendirme. , 2002, ss.7 - 13.
AMA APAN A,KAZKAYASI M,yılmaz s,KOÇ M Zor entübasyon: Klinik ve radyolojik değerlendirme. . 2002; 7 - 13.
Vancouver APAN A,KAZKAYASI M,yılmaz s,KOÇ M Zor entübasyon: Klinik ve radyolojik değerlendirme. . 2002; 7 - 13.
IEEE APAN A,KAZKAYASI M,yılmaz s,KOÇ M "Zor entübasyon: Klinik ve radyolojik değerlendirme." , ss.7 - 13, 2002.
ISNAD APAN, Alpaslan vd. "Zor entübasyon: Klinik ve radyolojik değerlendirme". (2002), 7-13.
APA APAN A, KAZKAYASI M, yılmaz s, KOÇ M (2002). Zor entübasyon: Klinik ve radyolojik değerlendirme. PTT Hastanesi Tıp Dergisi, 24(1), 7 - 13.
Chicago APAN Alpaslan,KAZKAYASI Mustafa,yılmaz sevda,KOÇ M. Can Zor entübasyon: Klinik ve radyolojik değerlendirme. PTT Hastanesi Tıp Dergisi 24, no.1 (2002): 7 - 13.
MLA APAN Alpaslan,KAZKAYASI Mustafa,yılmaz sevda,KOÇ M. Can Zor entübasyon: Klinik ve radyolojik değerlendirme. PTT Hastanesi Tıp Dergisi, vol.24, no.1, 2002, ss.7 - 13.
AMA APAN A,KAZKAYASI M,yılmaz s,KOÇ M Zor entübasyon: Klinik ve radyolojik değerlendirme. PTT Hastanesi Tıp Dergisi. 2002; 24(1): 7 - 13.
Vancouver APAN A,KAZKAYASI M,yılmaz s,KOÇ M Zor entübasyon: Klinik ve radyolojik değerlendirme. PTT Hastanesi Tıp Dergisi. 2002; 24(1): 7 - 13.
IEEE APAN A,KAZKAYASI M,yılmaz s,KOÇ M "Zor entübasyon: Klinik ve radyolojik değerlendirme." PTT Hastanesi Tıp Dergisi, 24, ss.7 - 13, 2002.
ISNAD APAN, Alpaslan vd. "Zor entübasyon: Klinik ve radyolojik değerlendirme". PTT Hastanesi Tıp Dergisi 24/1 (2002), 7-13.