Tıkayıcı Uyku Apne Hastalarında Zor havayolu Antropometrik Ölçümlerinin Uyku Endoskopi Skorlarına Göre Değerlendirilmesi

Year 2022, , 306 - 316, 31.12.2022

Bora Bilal , Nagihan Bilal , Ömer Faruk Boran , Deniz Tuncel , Adem Doğaner , Feyza Çalışır

https://doi.org/10.36516/jocass.1130112

Abstract

Amaç: Çalışmamızın amacı Tıkayıcı uyku apnesi (TUA) cerrahisi yapılacak olanlarda preoperatif dönemde zor entübasyon ve entübasyon güçlüklerinin vurgulanmasına yönelik ölçümler belirlendi. Bu ölçümler ile hem Cormack Lehane skoru, hemde uyku endoskopisi sırasında olan obstrüksiyonlar değerlendirildi.
Gereç ve yöntemler: Ağustos 2018- Aralık 2019 tarihleri arasında horlama şikayeti ile polikliniğe başvuran polisomnografi yapılmış TUA tanısını yeni alan 40 hasta çalışmaya dahil edildi. Hastaların boyun çevreleri, boy ve kiloları ölçüldü, body mass index (BMI) hesaplandı. Tüm hastaların mallampati skalaları ölçüldü, ağız açıklığı, tiromental mesafe, sternomental mesafe not edildi. Hastalardan Epword slepiness scala, Berlin anketi, Stop bang anketi doldurması istendi. Hastalar operasyon öncesi DISE ile değerlendirildi. Anestezi indüksiyonu sonrası Cormack ve Lehane skorlaması yapıldı
Bulgular: Tiromental mesafe ile Cormack Lehane Skoru (CLS) arasındaki ilişkide istatistiksel olarak anlamlı farklılık izlendi (p=0,017). Stile ile entübe edilenler ile CLS arasındaki ilişkide istatistiksel olarak anlamlı farklılık izlendi (p=0,001). Entübasyon süresi ile CLS arasındaki ilişkide istatistiksel olarak anlamlı farklılık izlendi (p=0,012). CLS artıkça entübasyon süresinin ortalamasında artış izlendi. Eksternal bası ile CLS arasındaki ilişkide istatistiksel olarak anlamlı farklılık izlendi (p=0,001). CLS artıkça eksternal bası sayısında artış izlendi. Entübasyon deneme sayısı ile CLS arasındaki ilişkide istatistiksel olarak anlamlı farklılık izlendi (p=0,035). CLS artıkça deneme sayısında artış izlendi. Cormack-Lehane ile desatürasyon indeksi arasında pozitif korelasyon bulundu (p=0,035, r=0,334) (Figür 1). Cormack-Lehane skoru ile hipopne indeksi arasında pozitif korelasyon bulundu (p=0,031, r=0,342)
Sonuç: Tıkayıcı uyku apnesi olan hastalarda zor entübasyon BMI, mallampati, Stop Bang ve Cormack Lehane skorlama sistemi ile tekrar değerlendirildi. Hastaların hem uyku pozisyonuna göre hem de apne hipopne indeksi ve hipopne indeksine göre zor entübasyon ile ilgili ölçümleri ile birbirine bağımlı olarak bulunmuştur.

Keywords

Uyku apnesi, zor entübasyon, uyku endoskopisi, tiromental mesafe, Cormack Lehane skoru

Difficult Airway Anthropometric Measurements in Patients with Obstructive Sleep Apnea According to Sleep Endoscopy Scores

Abstract

Aim: The aim of the study was to determine the measures to evaluate difficult intubation and predictors of intubation difficulties in the preoperative period in patients undergoing obstructive sleep apnea syndrome (OSAS) surgery. With these measurements, both the modified Cormack Lehane score and obstructions during sleep endoscopy were evaluated.
Material Methods: The study included 40 patients who presented at the outpatient clinic with the complaint of snoring, underwent polysomnography, and were diagnosed with OSAS between August 2018 and December 2019. Measurements were taken of the modified Mallampati Index, mouth opening, thyromental distance, and sternomental distance. The modified Cormack Lehane scoring system was applied after anesthesia induction.

Results: A statistically significant correlation was observed between thyromental distance and the Modified Cormack Lehane Scoring-system (MCLS) (p = 0.017) and between intubation time and MCLS (p = 0.012). As MCLS increased, the average intubation time increased. A statistically significant correlation was observed between external compression and MCLS (p = 0.001) and between the number of intubation trials and MCLS (p = 0.035). A positive correlation was found between MCLS and the desaturation index (p = 0.035, r = 0.343) and between the MCLS and the hypopnea index (p = 0.031, r = 0.342)
Conclusion: There was found to be interdependence with the measurements related to difficult intubation according to both the sleep position and the apnea hypopnea index and hypopnea index

Keywords

Sleep apnea, difficult intubation, sleep endoscopy, thyromental distance, modified Cormack Lehane scoring system, airway management

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