Ulus Travma Acil Cerrahi Derg. 2006; 12(4): 282-287

Perkütan trakeotomi sýrasýnda 'Laringeal Maske' ve 'Kaflý Orofaringeal Havayolu' kullanýmý

Fatma Nur Kaya, Nermin Kelebek Girgin, Belgin Yavaþcaoðlu, Ferda Kahveci, Gülsen Korfalý
Uludað Üniversitesi Týp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Bursa, Türkiye

AMAÇ: Bu çalýþmada, perkütan trakeostomi (PT) sýrasýnda havayolu idamesinde larengeal maske (LM) ve kaflý orofarengeal havayolu (KOFH) kullanýmý, havayolu güvenliði ve etkinliði açý- sýndan, endotrakeal tüp (ETT) ile karþýlaþtýrýldý. GEREÇ-YÖNTEM: Olgular PT iþlemi sýrasýnda havayolu saðlanmasýnda LM, KOFH ve ETT kullanýmýna göre rastgele LM grubu (n=35, E/K; 28/7, yaþ; 52 [18-79]), KOFH grubu (n=31, E/K; 23/8, yaþ; 57 [18-80]) ve ETT grubuna (n=30, E/K; 22/8, yaþ; 49 [18-80]) ayrýldý. Perkütan trakeostomi Griggs ve ark.nýn taný mladýðý gibi uygulandý ve PT sýrasýnda ve sonrasýnda geliþen komplikasyonlar ile havayolu açýklýðýný devam ettirebilmek için gereken havayolu manipülasyonlarý kaydedildi. BULGULAR: Perkütan trakeostomi süresi ETT grubunda diðer gruplardan daha uzundu (her 2 grup için; p<0.01); LM ile 35 olgunun 1'inde (%2.9), KOFH ile 31 olgunun 3'ünde (%9.7) yeterli havayolu açýklýðý saðlanamadý. Kaflý orofarengeal havayolu grubunda yeterli havayolu açýklýðý saðlamak için gereken havayolu manipülasyonu gereksinimi (%45.2) LM grubuna (%11.4) göre daha fazla bulundu (p<0.01). Komplikasyonlar açýsýndan gruplar arasýnda anlamlý farklýlýk bulunmadý. SONUÇ: Çalýþmamýzda, PT sýrasýnda LM ve KOFH yüksek baþarý oranlarýyla kolayca yerleþtirildi, ancak havayolu manipülasyonlarý KOFH grubunda daha fazlaydý. PT sýrasýnda havayolu açýklýðýnýn sürdürülmesinde supra/infraglottik hava yolu gereçlerinin, hastanýn durumu ve hekimin deneyimine göre seçilmesi gerektiði kanýsýndayýz.

Anahtar Kelimeler: Endotrakeal tüp, kaflý orofarengeal havayolu; larengeal maske; perkütan trakeostomi.

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The use of the 'Laringeal Mask Airway' and the 'Cuffed Oropharyngeal Airway' during percutaneous tracheotomy

Fatma Nur Kaya, Nermin Kelebek Girgin, Belgin Yavaþcaoðlu, Ferda Kahveci, Gülsen Korfalý
Uludag University Medical School, Department of Anesthesiology, Bursa, Turkey

BACKGROUND The aim of our study is to compare the safety and efficiency of the use of the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) with the use of endotracheal tube (ETT) for maintain patent airway during percutaneous tracheostomy (PCT). METHODS The patients were randomly assigned to LMA group (n=35, M/F; 28/7, age; 52 [18-79]), COPA group (n=31, M/F; 23/8, age; 57 [18-80]) and ETT group (n=30, M/F; 22/8, age; 49 [18-80]) with respect to use of LMA, COPA and ETT in order to maintain patent airway during PCT procedure. PT was performed as described by Griggs et al. Complications occurred during and after PCT procedure and airway manipulations required to maintain a patent airway were recorded. RESULTS Duration of PT was longer in the ETT group comparing with the other groups (for both groups; p<0.01). The LMA failed to maintain patent airway in 1 of 35 patients (2.9%) and the COPA failed to maintain patent airway in 3 of 31 patients (9.7%). The airway intervention required to maintain patent airway was found to be higher in the COPA group (45.2%) than in the LMA group (11.4%) (p<0.01). There was no significant difference with respect to the complications between the groups. CONCLUSION In our study, LMA and COPA were inserted easily during PCT with high success rates, but airway manipulations were higher in the COPA group. In our opinion, supra/infraglottic airway devices to maintain patent airway during PCT should be chosen according to patient's status and physician's experience.

Keywords: Endotracheal tube, cuffed oropharyngeal airway; laryngeal mask airway; percutaneous tracheostomy.

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