Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Başın Hiperekstansiyonu Endotrakeal Kaf Basıncını Etkiler mi?
Does Hyperextension of Head Affect Endotracheal Cuff Pressure?
İlkay BARAN AKKUŞa, Ceyda ÖZHAN ÇAPARLARa
aSağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2020;18(1):1-7
doi: 10.5336/anesthe.2020-74178
Article Language: TR
Full Text
ÖZET
 Amaç: Havayolu güvenliği açısından pozisyonun değiştiği operasyonlarda, kaf basıncı ölçümünün önemini vurgulamaktır. Gereç ve Yöntemler: Hasta başının hiperekstansiyona getirildiği gruba, hiperekstansiyon (Grup H) ve nötral pozisyonda kalan grup supin (Grup S) olarak adlandırıldı. Hastaların kaf basıncı, hemodinamik parametreler entübasyondan sonra (t1), ilk ölçümden 10 dk sonra (t2), cerrahi sonrası 1. saat (t3) ve ekstübasyon öncesi (t4) ölçülmüştür. Grup H'de fiberoptik endoskop ile tüpün karinaya olan mesafesi ölçüldü. Bulgular: Kaf basıncı gruplar arası karşılaştırıldığında, t1 zamanı hariç Grup H'nin kaf basıncı, Grup S'den yüksek bulunmuştur. Grup içi karşılaştırıldığında, Grup H'de, t1'e göre t2, t3 ve t4'te kaf basıncı ortalaması anlamlı derecede yüksek bulunmuştur. Ortalama arter basıncı (OAB) gruplar arası karşılaştırıldığında; t1 hariç Grup H'nin OAB ortalaması Grup S'den yüksek bulunmuştur. Kalp atım hızı (KAH, nabız) gruplararası karşılaştırıldığında, Grup H ile Grup S arasında t1'de fark gözlenmemiştir. Diğer zamanlarda KAH ortalaması Grup H'de anlamlı derecede yüksek bulunmuştur. Grup içi karşılaştırıldığında, entübasyondan hemen sonra KAH Grup H'de ve Grup S'de yüksek bulunmuştur. Fiberoptik bronkoskopla, Grup H'deki hastaların, tüp ucunun karinaya mesafesinde 0,5±0,2 cm yer değişimi ölçülmüştür. Sonuç: Başın nötral pozisyondan hiperekstansiyona getirilmesinin, kaf basıncında ve hemodinamik ölçümlerde artmaya neden olduğu gösterilmiştir.

Anahtar Kelimeler: Entübasyon; basınç; supin pozisyon
ABSTRACT
 Objective: This study aims to emphasize the importance of cuff pressure measurement. Material and Methods: The group in which the patient's head was brought to hyperextension was called hyperextension (Group H), and the group that remained in the neutral position was supine (Group S). The cuff pressure of the patients, hemodynamic parameters were measured after intubation (t1), 10 minutes after the first measurement (t2), 1st hour after surgery (t3) and before extubation. In Group H, the distance of the tube to the carina was measured with a fiberoptic endoscope. Results: When cuff pressure was compared between groups, cuff pressure of Group H was found higher than Group S except for t1 time. When examined within the group, the average cuff pressure in t2, t3, and t4 were found to be significantly higher in Group H compared to t1. When the mean arterial pressure (MAP) was compared between groups, except for t1, the average MAP of Group H was higher than Groups S. When the heart rate (HR) was compared between the groups, no difference was observed in t1 between-Group H and Group S. At other times, the average HR was found significantly higher in Grup H. When compared within the group, HR was found high in Group H and Group S immediately after intubation. With a fiberoptic bronchoscope, 0.5±0.2 cm displacement was measured at the distance of the tube end of the patients in Grup H to the carina. Conclusion: Hyperextension of the head from the neutral position has been shown to cause an increase in cuff pressure and hemodynamic measurements.

Keywords: Entübation; pressure; supine position
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