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Öğe A comparison of angled (D-Blade) and Macintosh (C-MAC) videolaryngoscopes for simulated pediatric difficult airway: a randomized single-blind study(Turkiye Klinikleri, 2022) Kuş, Alparslan; Aksu, Can; Yörükoğlu, Hadi Ufuk; Alparslan, Volkan; Toker, KamilBackground/aim: Being prepared for difficult airway (DA) is nevertheless of great importance. Failed or delayed tracheal intubation (TI) can increase morbidity and mortality, and the pediatric population is more prone to hypoxia. With the development of different types of videolaryngoscope (VL), these have become the device of choice in patients with DA. Our primary aim was to compare intubation times with D-blade and Macintosh blade of Storz C-MAC® in a simulated pediatric DA scenario with this randomized controlled trial. Materials and methods: Children aged 1-5 years scheduled for elective surgery were included in the study. Patients were randomized into two groups: the D-Blade (n = 20) and MAC (n = 21) groups. All children underwent inhalational induction, and a neuromuscular relaxant was routinely administered (rocuronium 0.6 mg.kg-1). After the appropriate size of semirigid foam neck collar had been positioned around the patient’s neck, the D-Blade group patients were intubated using a size 2 D-Blade, and the MAC group patients used a size 2 VL Macintosh blade. Intubation, time was measured. Patients’ modified Cormack-Lehane system scores (MCLS), pre and postintubation blood pressure values and heart rates, and complications during intubation were recorded. Results: Demographic data were similar between the groups. There were also no significant differences in pre and postintubation heart rates, blood pressure, or SpO2 values (p > 0.05 for all). Mean intubation times for the MAC and D-Blade groups were 12.14 ± 2.79 s and 18.31 ± 10.86 s, respectively (p = 0.022). MCLS scores were lower in the D-Blade group (p = 0.030). Intubation success rates were 100% in the MAC group and 90% in the D-Blade group, although the difference was statistically insignificant (p = 0.165). Conclusion: A better laryngoscopic view was obtained with D-Blade. However, the Storz® C-Mac videolaryngoscope Macintosh blade was superior to the D-Blade in achieving a shorter time for TI. © 2022, Turkiye Klinikleri. All rights reserved.Öğe Does lumbar ultrasonography improve epidural catheterization for labor analgesia? A randomized controlled study(American University of Beirut, 2017) Balaban O.; Şahin T.; Şahin L.; Solak M.; Toker, KamilBackground: Palpation of anatomic landmarks is difficult in pregnant patients due to physiological changes. This can complicate epidural catheterization and determination of needle insertion site to place an epidural catheter. The purpose of our study was to compare prepuncture lumbar ultrasonography and palpation method for epidural needle insertion among pregnant. Methods: Forty parturients scheduled for labor analgesia were randomized into two groups: Ultrasound group (n=20) and control group (n=20). Needle insertion point was identified by lumbar ultrasonography in ultrasound group and by palpation in control group. We recorded number of puncture attempts, number of necessary puncture levels, epidural catheterization time and complications during epidural catheterization. Results: Number of puncture attempts was 1.35±0.58 in ultrasound group and 1.2±0.4 in control group. Number of puncture levels was 1.05±0.22 in ultrasound group and 1.10 ±0.3 in control group. Duration of epidural procedure was 93 seconds in ultrasound group and 88 seconds in control group. No statistically significant differences were found between the two groups. Sudden low back pain during needle insertion was significantly lower in ultrasound group (p=0.03). Conclusions: Pre-puncture lumbar ultrasonography lowered sudden back pain during needle insertion. Ultrasound guidance did not reduce number of puncture attempts, necessary puncture levels and time of epidural catheterization among normal weight pregnant. © 2017, American University of Beirut. All rights reserved.Öğe Fluoroscopic comparison of cervical spine motion using LMA CTrach, C-MAC videolaryngoscope and macintosh laryngoscope(Aves, 2018) Şahin, Tulay; Arslan, Zehra İpek; Akansel, Gür; Balaban, Onur; Berk, Derya; Solak, Mine; Toker, KamilObjective: Endotracheal intubation should be performed with care when cervical spine (C-spine) injury is suspected. The aim of this study was to evaluate the movement of the C-spine using fluoroscopy during intubation with Laryngeal Mask Airway (LMA) CTrach, C-MAC videolaryngoscope and Macintosh laryngoscope. Methods: This was a single-centre, prospective, observational, controlled trial. In total, 22 surgical patients aged 18-65 years planned to undergo operation under general anaesthesia, were enrolled. X-ray images of the C-spine were obtained using fluoroscopy with the patients' head in a neutral position. All patients underwent laryngoscopy using a Macintosh blade, LMA CTrach and C-MAC videolaryngoscope, and fluoroscopic images of the C-spine were obtained. All the patients were intubated at the last laryngoscopy simulation (using the C-MAC). The atlanto-occipital distance (AOD) and angles between C0C1, C0C2, C0C3, C0C4, C1C2 and C2C3 lines were measured and compared between each device. Results: The mean AOD was measured as 20.4 mm in a neutral position, which decreased to 13.1, 17.2 and 12.3 mm after the insertion of the Macintosh laryngoscope, LMA CTrach and C-MAC videolaryngoscope, respectively. The differences were significant (p < 0.001). Moreover, significant difference was noted in C0C2, C0C3 and C1C2 angles with the insertion of the three devices (p < 0.001). The LMA CTrach resulted in significantly lesser C-spine movements in C0C2, C0C3 and C0C4 angles compared to the Macintosh laryngoscope and C-MAC videolaryngoscope (p < 0.001). Conclusion: The LMA CTrach resulted in lesser C-spine movements compared to Macintosh laryngoscope and C-MAC videolaryngoscope. In case of the C-spine injury, LMA CTrach may be preferred and may cause fewer traumas during endotracheal intubation.Öğe General anesthesia practices during the COVID-19 pandemic in Turkey: a cohort study with a national survey(CUREUS INC, 2020) Aksu, Can; Cesur, Sevim; Kuş, Alparslan; Toker, KamilIntroduction This study aimed to examine the anesthesia practices applied to the cases during the pandemic, to analyze the rate of the precautions taken in emergency/elective operations in non-COVID patients, what precautions were taken, what resources the clinics had, and the patient management in the perioperative period by organizing a survey among anesthesiologist in Turkey. Methods After obtaining approval from the Turkish Ministry of Health (2020-05-04T09_30_03) and the local ethics committee (GOKAEK-2020/10.09), a survey consisting of 21 questions was formed over the online survey inquiry (surveymonkey.com). The survey was conducted in Turkish. Results The survey aimed at reaching the anesthesiologists, who were Turkish Anesthesiology and Reanimation Society (TARD) members, by e-mail, and it was seen that 120 people out of approximately 2700 members who had received our e-mail participated in the survey. After the first case was reported in our country, it was understood that 62.1% of the participants stopped accepting elective cases in their institutions. The anesthesia method preferred in this period was general anesthesia by 47.6%, regional anesthesia by 52.1%, and sedation by 0.3%. The arrival time of coronavirus disease COVID-19 tests (PCR and/or rapid diagnostic kits showing antibodies) to the hospital was questioned; seven people (5.83%) stated that tests were not performed at their hospitals. It was observed that tests arrived and were applied at the hospitals of the remaining participants in an average of 2.7 +/- 1.6 weeks. It was determined that 59.32% of the participants avoided positive pressure ventilation after induction, 5.98% of the intubation on the patients were performed by anesthesia technicians, 66.67% by anesthesiologists, 25.64% by senior resident doctors with at least two years of experience, and 1.71% by junior anesthesia assistants with less than two years of experience. The use of personal protective equipment (PPE) is applied by 95% of the participants. 22.69% of the participants stated that they preferred to use supraglottic airway (SGA) devices during this period. While 45.06% of the participants stated that they provided oxygen support to the patient with the mask belonging to the circuit after extubation, 14.8% preferred the nasal cannula, and 33.1% used an oxygen mask. Our results showed that 90% of additional precautions were taken in our country's clinics, and 95% of PPE was used. Also, the use of video laryngoscope (VL) was 75% in this period. Finally, it was found that 50.85% of the patients were taken to the recovery unit after being extubated, and 49.15% were sent directly to the service. Conclusion We can reveal that each clinic made arrangements according to its own conditions. We think that plans should be made to standardize clinical facilities and algorithms throughout the country. Apart from technological and financial facilities, we believe that the continuity of the training organized by national and international associations should be ensured so that anesthesiologists' knowledge, skills, and experience who manage this process can remain at the highest level.Öğe Measurement of the endotracheal tube diameter using computed tomography ımages for pediatric patients: comparison with classic formulas(2021) Özcanoğlu, Hatice Dilek; Türkay, Berna; Kutlutürk Şahin, Neşe; Ulubay, Zeliha Özlem; Revanlı, Ayşe Sevinç; Toker, KamilObjective: In this retrospective study, we aimed to evaluate the compatibility of endotracheal tube (ETT) size used during surgery with tracheal diameter measured by computed tomography(CT) and classic formulas in children who underwent CT imaging preoperatively due to surgical indications. Methods: The study included preoperatively CT scanned, 0-3 year-old patients who were operated due to congenital heart diseases between June 1-October 1, 2018.Using the CT scans, transverse and anteroposterior tracheal diameters were measured from the subglottic level. As these diameters reflect the external diameter of the ETT, the inner diameter-which corresponds the ETT size-was calculated using a correction formula. Besides, Cole’s formula was used to calculate the ETT size for each child, and the tube sizes used during surgeries were obtained from anesthesia charts.ETT sizes were compared. Results: 43 patients (22 girls [51.2%],21 boys [48.8%]) were included.The mean age was 10.5±9.6 months. 18 patients (41.9%) had cyanotic, 25 patients (58.1%) had acyanotic heart disease.Mean corrected transverse and anteroposterior tracheal diameters at CT images were 4.35±0.69mm and 4.30±0.71 mm, respectively. The mean diameter calculated by Cole’s formula was 4.22±0.20 mm. The mean tube size used during surgeries was 4.37±0.60 mm. There was no statistically significant difference between the tube sizes used during the surgeries and the corrected transverse tracheal diameters from CT measurements (p>0.05). But the tube sizes used during the surgeries found significantly larger than the diameters obtained by Cole’s formula (p<0.05). Conclusion: In 0-3 years of age pediatric patients who undergo a congenital heart surgery,corrected tracheal transverse diameter measured by CT is more effective,reliable and less invasive than classic formulas for determining appropriate ETT size.Öğe Videolaryngoscopic evaluation of hypopharyngeal lesions caused by PLMA and I-gel: a randomised controlled clinical trial(Churchill Livingstone, 2021) Gümüş, Nevin Esra; Tekin, Murat; Arslan, Zehra İpek; Öztürk, Murat; Toker, KamilObjective: The ProSeal laryngeal mask airway (PLMA) and I-gel, both second-generation supraglottic airway devices have been compared in previous studies but with inconsistent results regarding their safety and efficacy. Their influence on the hypopharyngeal mucosa have not been evaluated before under videolaryngoscopy. Methods: One hundred ASA I-II patients, aged 18–70 years who underwent elective surgery were randomly allocated for airway management with the I-gel or ProSeal laryngeal mask airway. Mucosal oedema, mucosal colour change and nodularity were evaluated with videolaryngoscopy. Insertion times, oropharyngeal leak pressure and complications were assessed. Results: For the ProSeal laryngeal mask airway, the mean insertion time (28 ± 15 vs. 18 ± 9.91, P < 0.001) and oropharyngeal leak pressure at the time of insertion (27 ± 7 vs. 23 ± 5, P = 0.01) were significantly higher than the I-gel. With the ProSeal laryngeal mask airway, the incidences of dysphagia were higher at 1 and 12 hours postoperatively (30% vs.12%, P = 0.024) and (16% vs. 4%, %, P = 0.046). A significant relationship was found between hypopharyngeal hyperemia and dysphagia (P = 0.001). Conclusion: The use of the I-gel resulted in fewer complications than the ProSeal laryngeal mask airway and seems to be advantageous over the ProSeal laryngeal mask airway in adults under general anaesthesia.
