Standart Pediatrik Endotrakeal Entübasyon Maketinde; Laringoskopi Esnasında Farklı Bleydler ile Orofaringeal Dokulara Uygulanan Kuvvetlerin Karşılaştırılması

Abstract

Background: Videolaryngoscopy is frequently used in the management of patients who are predicted to have a difficult airway. Compared to direct laryngoscopy, it offers a better laryngeal view and increases the likelihood of successful intubation. It is among the most preferred difficult airway instruments, especially due to its ease of use, portability and similarity to direct laryngoscopy. Laryngoscopy and intubation normally require the application of a force to the base of the tongue. Although short-term in most cases, this pressure can cause an increase in heart rate, blood pressure, and catecholamine levels. In this study, we aimed to objectively measure the force applied to the base of the tongue in a standard pediatric intubation model and to examine possible related factors. Materials and Methods: After obtaining the approval of the Local Ethics Committee numbered 21/348; The study was carried out with the participation of research assistants in Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation. Each research assistant who agreed to participate in the study performed endotracheal intubation with a standard pediatric intubation model with GlideScope LoPro T2, Storz C-MAC pediatric D-blade and direct laryngoscope Macintosh 2 blade. The pressure applied to the base of the tongue and the vallecula was recorded with FSR 402 pressure/force sensors attached to the blades. Results: A total of 52 participants (34.6% male and 65.4% female) who participated in the study performed a total of 156 intubation procedures, once with each laryngoscopy method (direct laryngoscope Mac 2, GlideScope LoPro T2 and C-MAC pediatric D-bleyd). It was observed that the intubation time of female participants was statistically longer than males (p=0.033). Mean intubation times were similar in all three laryngoscopy methods (p=0.27). While Cormack-Lehane class 2 images were obtained less frequently with videolaryngoscopic methods compared to direct laryngoscopy, class 3 images were not observed (p<0.001). When intubation methods were compared according to forces apllied obtaining the glottic view (Cormack-Lehane) (p=0.001) and passage of endotracheal tube (p<0.001), similar force values were obtained in direct laryngoscopy and GlideScope videoingoscopy, but significantly lower force was shown in C-MAC videoryngoscopy compared to the other two methods. Similar results were obtained when the average of these two applied forces were taken as the measuring paramater. Conclusion: It is known that videolaryngoscopy increases the success of intubation as a result of obtaining a better and wider laryngeal view and provides significant advantages especially in difficult airway patients. In this study, it was shown that the glottic image improved independently of the experience of the practitioners in standard pediatric model. It is generally accepted that less force is exerted on the oropharyngeal tissues due to the good visualization of videolaryngoscopy. Reducing the force applied to the oropharyngeal tissues as much as possible is important in terms of complications such as hypertension, dysrhythmias, increased intracranial pressure and local tissue traumas due to compression that may occur during laryngoscopy. Although studies in adults support this opinion, the literature data on the pediatric patient group is very limited. In our study, the forces measured at the time of acquisition of the target CL image and at the time of ETT insertion were significantly lower with the C-MAC pediatric D-bleyd compared to the other two laryngoscopes. As a result, in our study, we believe that videolaryngoscopy should be considered as the first choice in the pediatric patient group as it provides better glottic view, and that practitioners should act as little traumatically as possible with the awareness of the force exerted on the oropharyngeal tissues and the possible complications that this may cause during all intubations.