RELATIONHIPS BETWEEN PALM PRINT AND PRAYER SIGN TESTS WITH DIFFICULTCULT INTUBATION DIAGNOSIS TESTS

Öz

OBJECTIVE: We aimed to compare the prayer sign (PS) and palm print (PP) tests for difficult intubation diagnostic tests including open mouth distance, movement of neck and mandibula, thyromental distance, modified Mallampati scores (MMS), and Cormack-Lehane scores (CLS) in patients who required endotracheal intubation for general anesthesia.
MATERIAL AND METHODS: Three hundred and thirty patients as ASA I-III status who required endotracheal intubation for general anesthesia were included in this study. Patient’s demographic datas and chronic diseases were recorded. Diagnostic tests including open mouth distance, movement of neck and mandibula, thyromental distance, MMS, PS and PP tests were performed to all patients and recorded. All patients were intubated by an anesthesiologist who has at least two year experience. The kind of laryngoscope and blade, CLS, the necessity of guide, laryngeal mask airway, intubation laryngeal mask airway, fiber optic intubation, and cricoid pressure, the incidence of the difficult intubation were recorded. P <0.05 was considered statistically significant.
RESULTS: In our study; the incidence of difficult intubation was 5.2%. Difficult intubation was found higher in patients included in palm print test 2-3 and with positive PS test (p<0.05). A significant relationship was determined between PP test with CLS and MMS (p=0.013, p=0.044,respectively ). The frequency of MMS 3-4 and CLS III-IV was low in patients with positive praying sign (p> 0.05).Sensitivity to difficult intubation was found to be low in both tests (41% and 10%, respectively).
CONCLUSIONS: According to our results, PP test can be used as diagnosis of difficult intubation due to its significant relationship with MMS and CLS tests.

Anahtar Kelimeler

• Difficult intubation,Prayer Sign,Palm Print,diabetes mellitus,artritis

DUA EDEN İŞARETİ VE AVUÇ İÇİ BASKISI TESTLERİNİN ZOR ENTUBASYON TANI TESTLERİYLE İLİŞKİSİ

Öz

AMAÇ: Genel anestezi altında endotrakeal entübasyon gerektiren hastalarda dua eden işareti (DEİ) ve avuç içi baskısı (AİB) testlerinin görülme sıklığını belirleyip, zor entübasyon tanı yöntemleri olan ağız açıklığı, baş boyun ekstansiyonu, mandibulanın malpozisyonu, tiromental mesafe, modifiye Mallampati skoru (MMS), Cormack ve Lehane skoru (CLS) ile ilişkisini araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Çalışmamız; elektif şartlarda, genel anestezi altında ameliyat olan ASA I-III 330 hastayı kapsadı. Anestezi polikliniğine başvuran hastaların demografik özellikleri, zor entübasyon hikayesi ve kronik hastalıkları kayıt edildi. Ayrıca baş ekstansiyon, mandibulanın malpozisyonu, ağız açıklığı ve tiromental mesafe ölçümleri; MMS, DEİ ve AİB testleri uygulandı. Hastalara en az iki yıl deneyimli anestezi doktoru tarafından entübasyon gerçekleştirildi. Kullanılan laringoskop ve bleyd türü, endotrakeal tüp, rehber tel, CLS, larinks maske, entübasyon larinks maske, fiberoptik entübasyon kullanımına, dışarıdan bası uygulama gerekliliği, zor entübasyon varlığı ve olası komplikasyonlar belirlendi. P<0.05 istatistiksel anlamlı kabul edildi.
BULGULAR: Çalışmamızda; zor entübasyon insidansı % 5.2 idi. DEİ pozitif ve Grade 2-3 AİB olan hastalarda zor entübasyon görülme sıklığı daha yüksekti (p<0.05). Dua Eden işareti pozitif hastalarda; MMS 3-4 ve CLS III-IV sıklığı düşük bulundu (p>0.05). Avuç Baskısı testinin; CLS ve MMS arasında anlamlı ilişki saptandı. (sırasıyla p=0.013, p=0.044 ). Zor entübasyon görülme duyarlılığı, her iki test de düşük bulundu (sırasıyla, %41 ve %10).
SONUÇ: Avuç İçi Baskı testi, MMS ve CLS ile gösterdiği anlamlı ilişki nedeniyle zor entübasyon tanısında yer alabilir.

Anahtar Kelimeler

• Zor entübasyon, Prayer Sign,Palm Print,diyabet,artrit

Destekleyen Kurum

Uludağ Ünivesitesi Tıp Fakültesi

Kaynakça

1. 1.Esener Z: Endotrakeal entübasyon. Klinik Anestezi. 2. Baskı Logos yayıncılık İstanbul 1997;s: 218-2432. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for mana-gement of difficult airway: an updated report by the american society of anest-hesiologists task force on management of the difficult airway. Anesthesiology 2013;118:251-703.Nadal JL, Fernandez BG, Escobar IC, Black M, Rosenblatt WH.The palm print as a sensitive predictor of difficult laryngoscopy in diabetics. Acta Anaesthesiol Scand 1998 ; 42(2): 199-2034. Butter PJ, Dhara SS. Prediction of difficult larnygoscopy: an assessment of the thyromental distance and Mallampati predictive test. Anaesth Intensive Care 1992; 20: 139-1425. Oates DL, Macleod AD, Oater PD, Pearsall FJ, Howiec JC, Murray GD. Comparison of two methods for predicting difficult intubation. Br J Anaesth 1991; 66: 305-3096. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth 1994; 73: 149-1537. Reissell E, Orko R, Maunuksela EL, Lindgren L. Predictability of difficult laryngoscopy in patients with long-term diabetes mellitus Anaesthesia 1990; 45(12): 1024-10278. Erden V, Basaranoglu G, Delatioglu H, Hamzaoglu NS Relationship of difficult laryngoscopy to long-term non-İnsulin dependent diabetes and hand abnormality detected using the 'prayer sign'. Br J Anaesth 2003; 91(1): 159-1609. Rae R, Kinsella J, Daniel M, Booth M. The palm print as predict of difficult intubation.Acta Anaesthesiol Scand 2001; 45(8): 105310. Vani V, Kamath SK, Naik LD. The palm print as a sensitive redictor of difficult laryngoscopy in diabetics: a comparison with other airway evaluation indices. J Postgrad Med 2000; 46(2):75-9.11. Hogan K, Rusy D, Springman SR. Difficult laryngoscopy and diabetes mellitus. Anesth Analg 1988; 67: 1161-116512. Salzarulo HH, Taylor LA. Diabetic “stiff joint syndrome” a cause of difficult endotracheal intubation. Anesthesiology 1986; 64: 366-36813. Jonasson O. Surgical aspects of diabetes mellitus. In:Sabiston CD Jr Ed. Sabiston Textbook of Surgery. The biological basis of Modern Surgical Practice, 13th ed.Philadelphia: WB Saunders; 1997, pp 18314. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospectiv study. Anaesthesia 1987; 42: 487-49015. Chang K, Uitto J, Rowold EA, Grant GA, Kilo C, Williamson JR. Increased collagen cross linkages in experimental diabetes, reversal by B-amino proprionitrile and D-penicillamine. Diabetes 1980; 29: 778-78116. Schneller S: Medical considerations and perioperative care for rheumatoid surgery. Hand Clin 1989; 5: 11517. Nichol HC, Zuck D. Difficult laryngoscopy the “anterior” larynx and atlanto-occipital gap. Br J Anaesth 1983; 55: 41-14418. Fitzcharles MA, Duby S, Waddell OW, Banks E, Karsh J. Limitation of joint mobility in adult non- insulin dependent diabetic patients. Ann Rheum Dis 1984; 43: 251-25419. Hasim K, Thomas M. Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices Indian J Anaesth. 2014 May-Jun; 58(3): 298–30220. George SP, Jacob R. Predictability of airway evaluation indices in diabetic patients. Indian J Anaesth. 2003; 47:476-821. Mahmoodpoor A, Soleimanpour H. Sensitivity of Palm Print, Modified Mallampati Score and 3-3-2 Rule in Prediction of Difficult Intubation Int J Prev Med 2013 Sep; 4 (9): 1063-9