Gebelerde zor laringoskopinin belirlenmesinde ön boyun yumuşak doku kalınlığının ultrasonografi ile ölçümü

Year 2022, Volume: 47 Issue: 2, 800 - 810, 30.06.2022

Hilal Erdem Solak Canan Yılmaz , Derya Karasu , İsra Karaduman Sefika Gulsen Korfali , Ümran Karaca , Çağdaş Baytar , Ayşe Neslihan Balkaya

Abstract

Amaç: Bu çalışmanın birincil amacı, zor laringoskopi ile boyun ön yumuşak doku kalınlığı ölçümü arasındaki ilişkiyi genel anestezi altındaki sezaryenlerde incelemektir. İkincil amacımız, gebe kadınlarda zor laringoskopiyi saptamak için diğer prediktif testlerin ve indüksiyon sonrası göstergelerin etkinliğini belirlemektir.
Gereç ve Yöntem: Yüz elli iki gebe hasta (18-45 yaş, Amerikan Anesteziyologlar Derneği Fiziksel Durum Sınıf II) dahil edildi. Cormack ve Lehane skalası skoruna (I-II: kolay laringoskopi, III-IV: zor laringoskopi) göre hastalar iki gruba ayrıldı. Deriden trakeanın ön yüzüne kadar olan mesafe ultrasonografi ile 5 farklı seviyede (hyoid kemik, tirohyoid membran, vokal kord, tiroid istmus ve suprasternal çentik) ölçüldü. Zor laringoskopiyi önceden belirlemek için diğer öngörücü testler ve indüksiyon sonrası belirteçler kaydedildi.
Bulgular: Gruplar arasında boyun ön yumuşak dokusunun ultrasonografi ölçümlerinde anlamlı fark yoktu. Ağız açıklığının kısıtlı olması (4.80±0.51cm), sek dişleri (%20), Wilson Risk Skoru yüksek (0.73±0.82), boyun çevresi geniş (41.40±2.96cm), üst dudağı ısıramama (%43), ve yüksek Modifiye Mallampati Skoru (%33), zor laringoskopi grubunda istatistiksel olarak anlamlı derecede daha yaygın görüldü. Ayrıca “Geri, Yukarı, Sağa Basınç” manevrası, sakız elastik buji kullanımı, yüksek Entübasyon Zorluk Skoru ve >2 entübasyon girişimi zor laringoskopi grubunda daha sık bulundu.
Sonuç: Gebelerde boyun ön yumuşak dokusunun ultrasonografi ile ölçülmesi zor laringoskopiyi belirlemede etkili bir yöntem değildir. Ancak Mallampati Skoru, üst dudak ısırma testi, ağız açma, boyun çevresi, çıkık ön diş ve Wilson Risk Skoru gebelerde zor laringoskopinin belirlenmesinde faydalı olabilir.

Keywords

sezaryen, obstetrik anestezi, zor laringoskopi

Ultrasound measurements of anterior neck soft tissue thickness to predict difficult laryngoscopy in pregnant patients

Abstract

Purpose: The aim of this study is to examine the relationship between the measurement of anterior neck soft tissue thickness and the difficult laryngoscopy in which cesarean section under general anesthesia. Our secondary aim is to determine the efficacy of the other predictive tests and post-induction indicators to detect difficult laryngoscopy in pregnant women.
Materials and Methods: One hundred fiftytwo pregnant women (18-45 years old, American Society of Anesthesiologists Physical Status Class II) were included. According to Cormack and Lehane’s scale (Grade I-II: easy laryngoscopy, Grade III-IV: difficult laryngoscopy) patients were divided into two groups. The distance from the skin to the anterior aspect of the trachea was measured at five different levels (hyoid bone, thyrohyoid membrane, vocal cords, thyroid isthmus, and suprasternal notch) with ultrasound. In addition, the other predictive tests and post-induction indicators for predetermining difficult laryngoscopy were recorded.
Results: There was no significant difference in the anterior neck soft tissue ultrasound measurements between the groups. Having limited mouth opening (4.80±0.51cm), buck teeth (20%), high Wilson's Risk Score (0.73±0.82), large neck circumference (41.40±2.96cm), inability to bite the upper lip (43%), and high Modified Mallampati Score (33%) were seen statistically significantly more common in the difficult laryngoscopy group. In addition, ‘‘Backward, Upward, Rightward Pressure’’ maneuver, use of gum elastic bougie, high Intubation Difficulty Score, and >2 intubation attempts were more frequently found in the difficult laryngoscopy group.
Conclusion: Measuring the anterior neck soft tissue with ultrasound is ineffective for determining difficult laryngoscopy in pregnant women. On the other hand, Mallampati Score, upper lip bite test, mouth opening, neck circumference, buck teeth, and Wilson's Risk Score can be helpful in the determination of difficult laryngoscopy in pregnancies.

Keywords

cesarean section, obstetric anesthesia, difficult laryngoscopy

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