Tıkayıcı Uyku Apne Hastalarında Zor havayolu Antropometrik Ölçümlerinin Uyku Endoskopi Skorlarına Göre Değerlendirilmesi
Öz
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.
Anahtar Kelimeler
Uyku apnesi zor entübasyon uyku endoskopisi tiromental mesafe Cormack Lehane skoru
Kaynakça
- Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107:1543–63.
- Kurtipek O, Isık B, Arslan M, et al. A study toinvestigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome. J res Med Sci 2012;17(7):615-20.
- Meoli AL, Rosen CL, Kristo D, et al. Clinical Practice Review Committee; American Academy of Sleep Medicine. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications. Sleep. 2003;26:1060–5.
- Dette FG, Graf J, Cassel W, et al. Combination of STOP-BANG Score with Modified mallampati Score fails to improve specificity in the prediction of sleep-disordered breathing. Minerva Anes¬tesiol 2016;82:625-34.
- Hiremath AS, Hillman DR, James AL, et al. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998;80:606-11.
- Yentis SM, Lee DJ. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia, 1998. 53(11): pp. 1041-4.
- Bradley P, Chapman G, Crooke B, Greenland K. Airway Assesment. Aust New Zelland College of Anaesthetists. 2016;1-63.
- Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429–434
- Agrawal J, Shenai PK, Chatra L, Kumar PY. Evaluation of normal range of mouth opening using three finger index: South India perspective study. Indian J Dent Res 2015;26(4):361-5
- Ramadhani SAL, Mohamed LA, Rocke A, Gouws E. Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia Br J Anaesth 1996;77(3):312-6
- Panjiar P, Kochhar A, Bhat KM, Bhat MA. Comparison of thyromental height test with ratio of height to thyromental distance, thyromental distance, and modified Mallampati test in predicting difficult laryngoscopy: A prospective study. J Anaesthesiol Clin Pharmacol 2019;35(3):390-395.
- Khan ZH, Kashfi A, EbrahimKhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg 2003; 96: 595-9.
- Stanski DR. Monitoring depth anesthesia. In : Miller RD (eds). Anesthesia: 3rd edition. New York Churchill LivingstoneInc:2000,1087-116.
- Maddison KJ, Shepherd KL, Baker VA, et al. Effect on upper airway collapsibility of presence of a pharyngeal catheter. J Sleep Res. 2015;24(1): 92-99.
- Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV for the American Academy of Sleep Medicine. The AASM Manual fort he Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.0 www.aasmnet.org, Darien, Illınois: American Academy of SleepMedicine, 2012.
- Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595–600.
- Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg. 2002;95:1098–102.
- Burgess LP, Derderian SS, Morin GV, et al. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg, 1992; 106: 81–86.
- Fidan H, Fidan F, Ünlü M. Obstructive sleep apnea and anasthesia. The medical Journal of Kocatepe. 2005;6:1-5.
- Kravath RE, Pollak CP, Borowiecki B, Weitzman ED. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence. J Pediatr, 1980; 96: 645–648.
- Bilal B, Bilal N, Boran ÖF, Doganer A. Obstrüktif uyku apnesi hastalarında uyku endoskopisinde pozisyon ve uyku derinliğine göre obstrüksiyon derecesinin değerlendirilmesi. Medical journal of Süleyman Demirel University. 2019;26(3):240-246.
- Selcuk A, Ozer T, Esen E, et al. Evaluation of effect of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with püre snoring and obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2017;274(5): 2183-2188.
- Eggerstedt M, Urban MJ, Chi E, et al. The anesthesia airway evaluation: Correlation with sleep endoscopy findings. Am J Otolaryngol. Epub ahead. Doi: 10.1016/j.amjoto.2019.102362
Difficult Airway Anthropometric Measurements in Patients with Obstructive Sleep Apnea According to Sleep Endoscopy Scores
Öz
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
Anahtar Kelimeler
Sleep apnea difficult intubation sleep endoscopy thyromental distance modified Cormack Lehane scoring system airway management
Kaynakça
- Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107:1543–63.
- Kurtipek O, Isık B, Arslan M, et al. A study toinvestigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome. J res Med Sci 2012;17(7):615-20.
- Meoli AL, Rosen CL, Kristo D, et al. Clinical Practice Review Committee; American Academy of Sleep Medicine. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications. Sleep. 2003;26:1060–5.
- Dette FG, Graf J, Cassel W, et al. Combination of STOP-BANG Score with Modified mallampati Score fails to improve specificity in the prediction of sleep-disordered breathing. Minerva Anes¬tesiol 2016;82:625-34.
- Hiremath AS, Hillman DR, James AL, et al. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998;80:606-11.
- Yentis SM, Lee DJ. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia, 1998. 53(11): pp. 1041-4.
- Bradley P, Chapman G, Crooke B, Greenland K. Airway Assesment. Aust New Zelland College of Anaesthetists. 2016;1-63.
- Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429–434
- Agrawal J, Shenai PK, Chatra L, Kumar PY. Evaluation of normal range of mouth opening using three finger index: South India perspective study. Indian J Dent Res 2015;26(4):361-5
- Ramadhani SAL, Mohamed LA, Rocke A, Gouws E. Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia Br J Anaesth 1996;77(3):312-6
- Panjiar P, Kochhar A, Bhat KM, Bhat MA. Comparison of thyromental height test with ratio of height to thyromental distance, thyromental distance, and modified Mallampati test in predicting difficult laryngoscopy: A prospective study. J Anaesthesiol Clin Pharmacol 2019;35(3):390-395.
- Khan ZH, Kashfi A, EbrahimKhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg 2003; 96: 595-9.
- Stanski DR. Monitoring depth anesthesia. In : Miller RD (eds). Anesthesia: 3rd edition. New York Churchill LivingstoneInc:2000,1087-116.
- Maddison KJ, Shepherd KL, Baker VA, et al. Effect on upper airway collapsibility of presence of a pharyngeal catheter. J Sleep Res. 2015;24(1): 92-99.
- Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV for the American Academy of Sleep Medicine. The AASM Manual fort he Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.0 www.aasmnet.org, Darien, Illınois: American Academy of SleepMedicine, 2012.
- Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595–600.
- Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg. 2002;95:1098–102.
- Burgess LP, Derderian SS, Morin GV, et al. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg, 1992; 106: 81–86.
- Fidan H, Fidan F, Ünlü M. Obstructive sleep apnea and anasthesia. The medical Journal of Kocatepe. 2005;6:1-5.
- Kravath RE, Pollak CP, Borowiecki B, Weitzman ED. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence. J Pediatr, 1980; 96: 645–648.
- Bilal B, Bilal N, Boran ÖF, Doganer A. Obstrüktif uyku apnesi hastalarında uyku endoskopisinde pozisyon ve uyku derinliğine göre obstrüksiyon derecesinin değerlendirilmesi. Medical journal of Süleyman Demirel University. 2019;26(3):240-246.
- Selcuk A, Ozer T, Esen E, et al. Evaluation of effect of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with püre snoring and obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2017;274(5): 2183-2188.
- Eggerstedt M, Urban MJ, Chi E, et al. The anesthesia airway evaluation: Correlation with sleep endoscopy findings. Am J Otolaryngol. Epub ahead. Doi: 10.1016/j.amjoto.2019.102362
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji, Kulak Burun Boğaz |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2022 |
| Kabul Tarihi | 31 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 5 Sayı: 3 |
