Zor entübasyon düşünülen olgularda Storz DCI videolaringoskop ve Truview EVO2 videolaringoskopun entübasyon koşulları ve hemodinami yönünden karşılaştırılması
Comparison of Storz DCI video larynoscope and Truview EVO 2 video laryngoscope in terms of intubation conditions and hemodynamics on difficult intubation estimated patients
Yazar: ESRA SARIHASAN
Danışman: PROF. DR. H. AYLA TÜR
Ondokuz Mayıs Üniversitesi / Tıp Fakültesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2012
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation
Dizin: Entübasyon-intratrakeal = Intubation-intratracheal ; Hemodinamikler = Hemodynamics ; Laringoskopi = Laryngoscopy ; Video = Video

Özet:
Giri~ ve Ama~: Endotrakeal entlibasyon, hava yolunu gUvence altll1a almak veso]unumu kontrol etmek amacIyla trakea iyerisine bir tiip yerle~tirilmesidir. Bazen entlibasyoni~lemi esnasll1da zorlukla kar~Ila~Ilabilmekte ve hastalarda hemodinamik parametrelerbozulabilmektedir. Anesteziyolojide klinik pratiklere laringoskopun girmesinden beri biitiinyabalar laringoskop bladenin ~eklini mUkemmel yapmaya yoneliktir. Bunun amaCI laringealyapIlann, glottisin daha iyi goriilmesini saglayarak endotrakeal entiibasyonun ba~arI orammartnmaktIr. Video laringoskoplarda bu amayla geli~tirilmi~tir.Biz yaptIgImIz bu yah~mada, zor entlibasyon olabilecegi mallampati testi ile tahminedilen hastalarda Storz DCI video laringoskop ile Truview EV02 video laringoskopu glottikgoriintii kalitesi, entlibasyon siiresi, entiibasyona bagh ve postoperatif erken komplikasyonlarile entlibasyon somas I geli~en hemodinamik yamt yoniinden kar~lla~tIrmaYI amayladIk.Gere~ ve Yontem: c;ah~maya 18-65 ya~ arasll1da degi~en ASA I-II sImflamasll1agiren mallampatisi III-IV olan elektif cerrahi uygulanacak 60 hasta dahil edildi. Hastalarrastgele 30'arh iki gruba aynldl. Entiibasyonlar aym ki~i tarafll1dan uygulandl. Grup S; StorzDCI video laringoskop ile entiibasyon yapIlan grup, Grup T; Truview EV02 videolmingoskop ile entiibasyon yapIlan grup. Entiibasyon esnasmda tespit edilen C-L (CormackLehmme)skoru, entUbasyon siiresi, entlibasyona bagh ve postoperatif erken komplikasyonlarkaydedildi. Perioperatif kalp atIm hIZI (KAH), sistolik arter basmcI (SAB), diyastolik arterbasmcI (DAB), ortalama arter baSll1CI (OAB), periferik oksijen satfuasyonu (Sp02),indiiksiyondan once, indiiksiyondan soma, enilibasyondan hemen soma, entiibasyondansomaki 1., 2., 3., 4. ve 5. dakikalarda kaydedildi. End tidal karbondioksit (ETC02) iseentiibasyondan hemen soma, enilibasyondan somaki 1.,2., 3.,4. ve 5. dakikalarda kaydedildi.Bulgular: Her iki grupta glottik goriintii kalitesi kar~Ila~tlflldIgmda Grup S'de sadece1 hastada C-L skor III ile kar~Ila~IlIrken, Grup T'de ise 6 hastada kar~Ila~IldI (p<0.05).Enilibasyon siireleri ise Grup S' de 31 sn, Grup T'de ise 36 sn olarak bulundu (p<0.05) vebiitiin entlibasyonlar her iki grupta ba~arIyla geryekle~tiIildi. Komplikasyon olarak Grup T'de1 hastada laringoskpiye bagh dudakta laserasyon olurken Grup S' de hiybir komplikasyongoriilmedi (p>0.05). Entlibasyona bagh erken postoperatifkomplikasyon olarak oksiiriik GrupS'de 4 hastada Grup T'de 5 hastada geli~irken, bogaz agnsI Grup S' de 3 hastada Grup T'de 2hastada geli~ti (p>0.05). Hemodinamik parametreler ayIsll1dan iki grup arasll1da anlamh fark bulunmadl (p>O.05). Antihipertansif ihtiyacl avlsmdan da iki grup arasmda anlamh farkbulunmadl (p>O.05).Sonu~: Storz DCI video laringoskop Truview EV02 video laringoskopa gore,entiibasyon suresini losaltarak ve glottisi daha iyi ve net gostererek daha ba~anh birpeJfonnans sergilemi~tir. Bu nedenle entubasyon guvlUklerinde Storz DCI video laringoskopuTruview EV02 video laringoskopa tercih edebiliriz kanlsma varIldl.Anahtar Kelimeler: Endotrakeal entiibasyon, Storz DCI Video laringoskop, TruwievEV02 Video laringoskop.

Abstract:
Objective: Endotracheal is replacement a tube into the trachea for securing the airwayand control respiration. Sometimes, difficulties may occur during the intubation andhemodynamics of patients may go bad. Since the laryngoscope has been a routine practice inanesthesiology, all the efforts has been made for development ofthe laryngoscope. Because ofthe laryngeal structures can be seen well, success of intubation increased.Video laryngoscopeshas been developed for this aim.In this study, we tried to compare Storz video laryngoscope and Truview EV02 videolaryngoscope in terms of glottic image quality, intubation time, early and late complicationsrelated to intubation, and hemodynamic responses at difficult intubation expected patients viamallampaty score.Materials and Methods: 60 patients who were between 18-65 years old, ASA 1-2pyhsical status, Mallampathy 3-4 and will undergo elective surgery with general anesthesiahas included to the study.All the intubations has perfonned by the same operator. Patients inGroup S has intubated with Storz DCI video larynoscope and patiens in Group t has intubatedwith Truview EV02 video laryngoscope. Cormack-Lehane score, intubation time, early andlate complications related to intubation has recorded. Perioperative heart rate, systolic arterialpressure, diastolic alierial pressure, mean arterial pressure, peripheric oxygen saturation, hasrecorded before the intubation, just after the intubation and 1 st, 2nd, 3rd, 4th, 5th minutesafter the intubation has recorded. End tidal C02 has recorded just after the intubation and 1 st,2nd, 3th, 4th, 5th minutes after intubation has recorded.Results: In Group S only 1 patient was C-L grade 3 and in Group T 6 patient wasgrade 3 (p<0.05).Intubation time was 31 seconds in Group S and 36 seconds in GroupT(p<0.05). All the intubations has performed successfully in both groups. Lip laceration hasoccurred in one Group T patient and no complications occured in Group S (p>0.05). Aspostoperative early complications; cough has occured in 4 patients of group Sand 5 patientsof Group T. Sore throat has occured in 3 patients of group S and in 2 patients of group T(p<0.05). There was no significiant difference in terms ofhemodynemic parameters betweengroups(p>0.05). There was no significiant difference for antihipertansive requirementbetween groups. Conclusion: Storz video laryngoscope has a better perfonnance than Truview EV02because it has shortened the intubation time and provided a better laryngeal view. We suggestthat for difficult intubations, Storz video laryngoscope may be preferred rather than TruviewEV02 video laryngoscope.Keywords: Endotracheal intubation, Storz DCI Video laryngoscope, Truview EV02video laryngoscope.