COMPARISON OF THE EFFECTS OF ENDOTRACHEAL INTUBATION AND FLEXIBLE LARYNGEAL MASK ON POSTOPERATIVE COMPLICATIONS AND AGITATION IN PEDIATRIC STRABISMUS SURGERY

PEDİYATRİK ŞAŞILIK CERRAHİSİNDE ENDOTRAKEAL TÜP İLE FLEKSİBL LARİNGEAL MASKENİN POSTOPERATİF KOMPLİKASYONLAR VE AJİTASYON ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Abstract

Objective: During general anesthesia procedures, various devices are used for ensuring airway safety. Using flexible laryngeal mask airway (FLMA) in head and neck surgery provides advantages such as minimizing the risk of slipping from its location while keeping distance from the surgical field. In this study, our aim was to compare the effects of endotracheal tube and FLMA on postoperative complications and agitation in pediatric patients who were scheduled for strabismus surgery. Method: Following the approval obtained from Research Assessment Commission of Mersin University Medical Faculty, the study was conducted on a total of 84 patients, aged between 0-16 years and ASA I-II, scheduled for strabismus surgery under general anesthesia. In Group ETT (n=43), endotracheal tube (ETT) was placed and in Group FLMA (n=41), FLMA was placed. The demographic data of the patients, features of the operation, duration and number of attempts for insertion of the airway device and the hemodynamic and respiratory parameters measured preoperatively, before intubation, after intubation, perioperatively at 5 th , 10 th , 15 th , 30 th , 45 th , and 60 th minutes were recorded. Complications in the postoperative period (nausea, vomiting, laryngospasm, bronchospasm, dysphagia and hoarseness), pain (surgical field and throat) and agita- tion were assessed at 15 th minute, 1 st hour and 4 th hour. Results: The demographic data, features of the operations performed, hemodynamic and respiratory parameters were found similar in both groups (p>0.05). Duration for insertion of airway equipment was significantly less in Group FLMA when compared to Group ETT (p=0.02). Regarding postoperative complications; the incidence of post-extubation laryngospasm was statistically significantly higher in Group ETT, when compared to Group FLMA (p=0.019). Incidence of postoperative sore throat was found to be significantly higher in Group ETT than in Group FLMA (p=0.042, p=0.004) at 15 th minute and 4 th hour. There were no statistically significant differences between groups in terms of dysphagia and hoarseness at postoperative 15 th minute, 1 st hour and 4 th hour (p>0.05). Agitation score of Group ETT was statistically significantly higher than the score of Group FLMA (p=0.029). Conclusion: We suggest that FLMA causes fewer complications and less postoperative agitation when compared to endotracheal intubation and FLMA application can clinically be used effectively and safely.

Özet

Amaç: Genel anestezi uygulamalar› s›ras›nda havayolu güvenli¤inin sa¤lanmas› amac›yla çeflitli araçlar kullan›lmaktad›r. Fleksibl laringeal maske (FLMA) bafl ve boyun cerrahisinde kullan›labilmesi, cerrahi sahadan uzaklafl›rken yerinden kayma riskini minimalize edebilmesi gibi avantajlar sa¤lar. Bu çal›flmada flafl›l›k cerrahisi planlanan pediyatrik hastalarda endotrakeal entübasyon ile FLMA’n›n postoperatif dönemde görülebilen komplikasyonlar ve ajitasyon üzerine etkilerinin karfl›laflt›r›lmas› amaçland›. Yöntem: Çal›flma, Mersin Üniversitesi T›p Fakültesi Bilimsel Araflt›rmalar› De¤erlendirme Komisyonu’ndan onay al›nd›ktan sonra, genel anestezi alt›nda flafl›l›k cerrahisi planlanan, ASA I-II, 0–16 yafl aral›¤›nda, toplam 84 hasta üzerinde yap›ld›. Grup ETT ’de (n=43) hastalara ETT, grup FLMA’da (n=41) ise FLMA yerlefltirildi. Olgular›n demografik verileri, operasyon özellikleri, havayolu araçlar›n› yerlefltirme süreleri ve giriflim say›lar›, hemodinamik ve solunumsal parametreler preoperatif, entübasyon öncesi, entübasyon sonras›, peroperatif 5. 10. 15. 30. 45. 60. dk’larda kaydedildi. Postoperatif dönemdeki komplikasyonlar (bulant›-kusma, laringospazm, bronkospazm, yutma güçlü¤ü ve ses k›s›kl›¤›), a¤r› (cerrahi alan ve bo¤az) ve ajitasyon ise 15.dk, 1. ve 4. saatlerde de¤erlendirildi. Bulgular: Yap›lan ölçümlerde demografik veriler, operasyon özellikleri, hemodinamik ve solunumsal parametreler her iki gruptada benzer bulundu (p>0.05). Havayolu gereçlerinin yerlefltirme süreleri Grup FLMA da Grup ETT’ye göre anlaml› derecede düflük idi (p=0.02). Postoperatif komplikasyonlar›n de¤erlendirilmesinde; ekstübasyon sonras› laringospazm görülme s›kl›¤› Grup ETT’de Grup FLMA’ya göre istatistiksel olarak anlaml› derecede yüksek idi (p=0.019). Postoperatif bo¤az a¤r›s› 15.dk ve 4. saatte Grup ETT’de, Grup FLMA’ya göre anlaml› derecede yüksek saptand› (p=0.042, p=0.004). Hastalarda postoperatif 15.dk, 1. ve 4. saatteki yutma güçlü¤ü ve ses k›s›kl›¤› aç›s›ndan gruplar aras›nda istatistiksel olarak fark bulunmad› (p>0.05). Ajitasyon skoru Grup ETT’de Grup FLMA’ya göre istatistiksel olarak anlaml› derecede yüksek idi (p=0.029). Sonuç: FLMA’n›n endotrakeal entübasyona göre daha az komplikasyon ve postoperatif ajitasyona neden oldu¤u, klinik olarak FLMA uygulamas›n›n etkili güvenli bir flekilde kullan›labilece¤i kan›s›na var›ld›.