Geriatrik dişsiz hastalarda: (Sniffing) Koklama Pozisyonunda ve Laringoskop Klavuzlu Laringeal Maske Yerleştirme Yöntemlerinin Hava Yolu Yerleşim Koşullarının Ve Postoperatif Etkilerinin Karşılaştırılması

Öz

Giriş ve Amaç: Laringeal maske(LMA), hava yolunu başarılı bir şekilde güvence altına alabilen bir supraglottik hava yolu cihazıdır. Yaşlanan bir popülasyon da, yaşlı hastalarda karmaşık cerrahi müdahaleler gerçekleştirilir. Bu çalışmanın amacı, dişsiz geriatrik hastalarda kör teknikte veya laringoskop yardımıyla LMA ProsealTM yerleştirme başarısını fiberoptik bronkoskop ile; Brimacombe skorlaması ve Campbell kategorileri sonucunu karşılaştırmaktır. Gereç ve Yöntemler: Elektif ürolojik cerrahi geçirecek LMA ProsealTM yerleştirme endikasyonu olan, 60-85 yaş arasında 50 Amerikan Anestezistler Derneği (ASA) I-III dişsiz hasta yazılı bilgilendirilmiş onam alındıktan sonra çalımaya dahil edildi. Hastalar rastgele iki gruba ayrıldı. LMA ProsealTM, kör teknik kullanılarak veya laringoskop kullanılarak yerleştirildi. ProsealTM laringeal maske hava yolu yerleştirme değerlendirmesinde Brimacombe skorlaması ve Campbell kategorilerini kullandık. Fiberoptik değerlendirmeleri, yerleştirme sürelerini, yerleştirme kolaylığını, tiromental mesafeyi, boyun kalınlığını, kesici dişler arası mesafeyi ve eksik diş sayısını karşılaştırdık. Ayrıca Young kriterlerini, tidal hacimleri, tepe basıncını, postoperatif hava yolu morbiditesini, komplikasyonları ve hemodinamik değişkenleri karşılaştırdık. Sonuçlar: PLMA yerleştirme süresi kör teknik grubunda laringoskop kullanımına göre daha kısaydı (p<0,005). Gruplar arasında Brimacombe skorlaması ve Campbell kategorileri arasında fark yoktu. Ayrıca postoperatif hava yolu morbiditesi, komplikasyonlar ve hemodinamik değişkenlerde fark bulunamadı. Sonuç: Geriatrik dişsiz hastalar PLMA yerleştirme için daha hızlı, daha kolay ve daha basit bir seçeneğe ihtiyaç duymaktadır. PLMA yerleştirmenin en uygun seçeneği, Brimacombe skorlaması ve Campbell kategorileriyle doğrulanan kör teknik olarak düşünülebilir.

Anahtar Kelimeler

• Laringeal maske
• laringoskop
• geriatrik
• kör teknik
• fiberoptik değerlendirme

Brimacombe scoring and Campbell categories in assessment of ProsealTM laryngeal mask airway insertion in edentulous geriatric patients: blind technique vs use of laryngoscope

Öz

Abstract Background: A laryngeal mask airway is a supraglottic airway device that can successfully secure the airway. In an aging population, complicated interventions are performed in elderly patients. The aim of this study was to compare the success of inserting the ProSeal™ laryngeal mask airway (P-LMA) with the blind technique versus with the help of a laryngoscope. We used the fiber-optic assessments with edentulous geriatric patients. Material and Methods: We obtained written informed consent from participants. The study included 50 American Society of Anesthesiologists physical status I-III edentulous patients between 60 and 85 years of age who were undergoing elective urological surgery with an indication of P-LMA placement. Patients were randomly divided into two groups. The P-LMA was inserted with the blind technique or with the assistance of a laryngoscope. We used Brimacombe scoring and Campbell categories to assess the ProSeal™ laryngeal mask airway insertion. We compared the fiber-optic assessments, insertion times, ease of insertion, thyromental distance, neck thickness, interincisor distance, and number of missing teeth. We also compared Young’s criteria, tidal volumes, peak pressure, postoperative airway morbidity, complications, and hemodynamic variables. Results: The P-LMA insertion time was shorter in the blind technique group than in the laryngoscope-assisted group. Fiberoptic scoring’s did not differ between groups, and no difference was found in postoperative airway morbidity, complications, or hemodynamic variables. Conclusion: Geriatric edentulous patients require a faster, easier, and simpler option for P-LMA insertion. The blind technique is the most appropriate choice for P-LMA insertion, as verified by Brimacombe scoring and Campbell categories.

Anahtar Kelimeler

• laryngeal mask airway
• blind technique
• laryngoscope
• fiber-optic assessment
• geriatric

Kaynakça

1. 1. Nagalakshmi P, Leo S, Uthirapathi S. Use of Butorphanol, Fentanyl, and Ketamine as Co-Induction Agents with Propofol for Laryngeal Mask Airway Insertion: A Comparative Study. Anesth Essays Res. 2018;12(3):729-734. doi:10.4103/aer.AER_104_18
2. 2. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical Anaesthesia. 7th ed. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2013
3. 3. Tanaka A, Isono S, Ishikawa T, Sato J, Nishino T. Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway. Anesthesiology. 2003;99(2):252-258. doi:10.1097/00000542-200308000-00005
4. 4. Patil PC, Chikkapillappa MA, Pujara VS, Anandswamy TC, Parate LH, Bevinaguddaiah Y. ProSeal Laryngeal Mask Airway Placement: A Comparison of Blind versus Direct Laryngoscopic Insertion Techniques. Anesth Essays Res. 2017;11(2):380-384. doi:10.4103/0259-1162.206274
5. 5. Genez M, Küçükgüçlü S, Özbilgin Ş, Kuvaki B, Beydeş T, Aksoy Sari M. A comparison of usage of the laryngeal mask UniqueTM in denticulate and edentulate geriatric patients. Turk J Med Sci. 2017;47(3):854-860. doi:10.3906/sag-1603-206
6. 6. Beydeş T, Küçükgüçlü S, Özbilgin Ş, Kuvaki B, Ademoğlu M, Sarı M. Comparison of Laryngeal Mask Airway Supreme™ Versus Unique™ in Edentulous Geriatric Patients. Turk J Anaesthesiol Reanim. 2016;44(1):32-36. doi:10.5152/TJAR.2016.22129
7. 7. Butterworth JF, Mackey DC, Wasnick JD. Geriatric anesthesia. In: Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. New York, 11 NY, USA: McGraw-Hill; 2013. pp. 907-917.
8. 8 Racine SX, Solis A, Hamou NA, Letoumelin P, Hepner DL, Beloucif S, et al. Face mask ventilation in edentulous patients: a comparison of mandibular groove and lower lip placement. Anesthesiology. 2010;112(5):1190-1193. doi:10.1097/ALN. 0b013e3181d5dfea

9. 9. Brain AI. The laryngeal mask--a new concept in airway management. Br J Anaesth. 1983;55(8):801-805. doi:10.1093/ bja/55.8.801
10. 10. Young HS, Clarke RS, Dundee JW. Intubating conditions with AH 8165 and suxamethoniun. Anaesthesia. 1975;30(1):30-33. doi:10.1111/j.1365-2044.1975.tb00791.x
11. 11. Campbell RL, Biddle C, Assudmi N, Campbell JR, Hotchkiss M. Fiberoptic assessment of laryngeal mask airway placement: blind insertion versus direct visual epiglottoscopy. J Oral Maxillofac Surg. 2004;62(9):1108-1113. doi:10.1016/j.joms.2003.10.014
12. 12. Verghese C, Ramaswamy B. LMA-Supreme--a new single-use LMA with gastric access: a report on its clinical efficacy. Br J Anaesth. 2008;101(3):405-410. doi:10.1093/bja/aen174
13. 13. Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth. 1999;82(2):286- 287. doi:10.1093/bja/82.2.286
14. 14. Brimacombe J, Berry A. A proposed fiberoptic scoring system to standardize the assessment of laryngeal mask airway position. Anesth Analg. 1993;76(2):457.
15. 15. Ezri T, Ady N, Szmuk P, Glanz L, Shklar B, Katz J, et al. Use of cuffed oropharyngeal vs laryngeal mask airway in elderly patients. Can J Anaesth. 1999;46(4):363-367. doi:10.1007/BF03013229
16. 16. Eskidemir G, Küçükgüçlü S, Özbilgin Ş, Günenç F, Maltepe F. Investigating the frequency and causes of difficult mask ventilation in intraoperative in geriatric patients. Turk J Geriatr 2015;18: 238-245.
17. 17. Kubota Y, Toyoda Y, Kubota H. Face mask fitting for edentulous patients. Anesth Analg. 1993;76(2):450.
18. 18. Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Doré CJ. Effect of general anaesthesia on the pharynx. Br J Anaesth. 1991;66(2):157-162. doi:10.1093/bja/66.2.157.
19. 19. Khan ZH, Mofrad MK, Arbabi S, Javid MJ, Makarem J. Upper lip bite test as a predictor of difficult mask ventilation: a prospective study. Middle East J Anaesthesiol. 2009;20(3):377-382.
20. 20. Kim EM, Kim MS, Koo BN, Lee JR, Lee YS, Lee JH. Clinical efficacy of the classic laryngeal mask airway in elderly patients: a comparison with young adult patients. Korean J Anesthesiol. 2015;68(6):568-574. doi:10.4097/kjae.2015.68.6.568
21. 21. Brimacombe J, Keller C, Morris R, Mecklem D. A comparison of the disposable versus the reusable laryngeal mask airway in paralyzed adult patients. Anesth Analg. 1998;87(4):921-924. doi:10.1097/00000539-199810000-00033
22. 22. Chandan SN, Sharma SM, Raveendra US, Rajendra Prasad B. Fiberoptic assessment of laryngeal mask airway placement: a comparison of blind insertion and insertion with the use of a laryngoscope. J Maxillofac Oral Surg. 2009;8(2):95-98. doi:10.1007/ s12663-009-0025-8
23. 23. Campbell RL, Biddle C, Assudmi N, Campbell JR, Hotchkiss M. Fiberoptic assessment of laryngeal mask airway placement: blind insertion versus direct visual epiglottoscopy. J Oral Maxillofac Surg. 2004;62(9):1108-1113. doi:10.1016/j.joms.2003.10.014.
24. 24. Kim GW, Kim JY, Kim SJ, Moon YR, Park EJ, Park SY. Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion. BMC Anesthesiol. 2019;19(1):4. doi:10.1186/s12871-018-0674-6
25. 25. Choo CY, Koay CK, Yoong CS. A randomised controlled trial comparing two insertion techniques for the Laryngeal Mask Airway Flexible™ in patients undergoing dental surgery. Anaesthesia. 2012;67(9):986-990. doi:10.1111/j.1365-2044.2012.07167.x
26. 26. Ozgul U, Erdil FA, Erdogan MA, et al. Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal™ laryngeal mask airway: a prospective randomized study. BMC Anesthesiol. 2019;19(1):244. doi:10.1186/ s12871-019-0915-3
27. 27. Burgard G, Möllhoff T, Prien T. The effect of laryngeal mask cuff pressure on postoperative sore throat incidence. J Clin Anesth. 1996;8(3):198-201. doi:10.1016/0952- 8180(95)00229-4
28. 28. Patil PC, Chikkapillappa MA, Pujara VS, Anandswamy TC, Parate LH, Bevinaguddaiah Y. ProSeal Laryngeal Mask Airway Placement: A Comparison of Blind versus Direct Laryngoscopic Insertion Techniques. Anesth Essays Res. 2017;11(2):380-384. doi:10.4103/0259-1162.206274 29. Yurtlu BS, Hanci V, Köksal B, Okyay D, Ayoğlu H, Turan IÖ. Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate. Braz J Anesthesiol. 2015;65(6):