Serviko-oksipital fiksatörlü ön kol yaralanması olan hastada uyanık fiberoptik entübasyon
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Dosyalar
Tarih
2013
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Cilt Başlığı
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yirmi üç yaşında serviko-oksipital fiksatörü olan hastada, sağ ön kol yaralanması nedeniyle ameliyat planlandı. Hastanın Mallampati skoru grade 4, tiromental mesafesi 5 cm, ağız açıklığı grade II, sternomental mesafesi 10 cm idi. Başta rotasyon ve ekstansiyon kaybının olması zor entübasyon kriteri olarak değerlendirildi. Serviko-oksipital fiksatörlü hast- alarda kısıtlı servikal ekstansiyon hem entübasyonu hem de ventilasyonu komplike hale getirir. Bu olguda uyanık fiberoptik bronkoskopi (FOB) ile gerçekleştirilen endotrakeal entübasyon ve genel anestezi deneyimi sunulmuştur. Yaşamsal bulguların monitörizasyonundan ve premedikasy- ondan sonra, hastanın her iki burun deliğinden %10 lidokain, iki kez sıkılarak hipofaringeal bölge anestezisi gerçekleştirildi. Hiyoid kemik boynuzunun 1 cm altına lokal anestetik infiltrasyonu uygulanarak süperior laringeal sinir blokajı yapıldı. Glossofarengeal sinirin lingual ve faringeal dalları bloke edildi. Transtrakeal blok yapıldı. Lokal anestezisi tamam- lanan, 5 L dk-1 hızında oksijen uygulanan olgu, uyanık olarak FOB ile entübe edildi. Gerekli kas gevşemesi sağlanan olguya mikrocerrahi ile, 5 saatte, ön kolda 8 tendon, 1 arter ve 1 sinir onarımı yapıldı. Ekstübasyon kriterleri sağlanınca olgu ekstübe edildi. Serviko-oksipital fiksatörü olan ve dolayısı ile boyun hareketleri ileri derecede kısıtlı olan hastalarda uyanık fiberoptik entübasyonun akılda tutulmasının uygun olacağı kanısındayız.
A 23-year-old male patient with cervico-occipital fixator was scheduled for surgery due to injuries to the right forearm. The patient’s thyromental dis- tance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. The loss of extension of the neck in particular indica- ted difficult intubation. Anaesthetic procedures are almost always difficult in patients with cervico-occipital fixators; the limited cervical extension complicates both intubation and ventilation. In this report, application of general anaesthesia using awake fibre-optic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedica- tion, hypopharyngeal topical anaesthesia was applied with 10% lidocaine sprayed twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following comp- letion of local anaesthesia, the patient, who was oxygenated with 5 L min-1 of 100% O2, was intubated using the awake FOB technique. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of cervi- co-occipital fixation, which causes severe limitation of neck movements, the use of awake fibre-optic intubation should be considered.
A 23-year-old male patient with cervico-occipital fixator was scheduled for surgery due to injuries to the right forearm. The patient’s thyromental dis- tance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. The loss of extension of the neck in particular indica- ted difficult intubation. Anaesthetic procedures are almost always difficult in patients with cervico-occipital fixators; the limited cervical extension complicates both intubation and ventilation. In this report, application of general anaesthesia using awake fibre-optic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedica- tion, hypopharyngeal topical anaesthesia was applied with 10% lidocaine sprayed twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following comp- letion of local anaesthesia, the patient, who was oxygenated with 5 L min-1 of 100% O2, was intubated using the awake FOB technique. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of cervi- co-occipital fixation, which causes severe limitation of neck movements, the use of awake fibre-optic intubation should be considered.
Açıklama
Anahtar Kelimeler
Serviko-Oksipital Fiksasyon, Fiberoptik Bronkoskop, Uyanık Entübasyon, Zor Entübasyon, Başta Rotasyon Kaybı, Cervico-Occipital Fixation, Fibre-Optic Bronchoscope, Awake İntubation, Difficult İntubation, Loss Of Extension Of Neck
Kaynak
Türk Anestezi ve Reanimasyon Dergisi
WoS Q Değeri
Scopus Q Değeri
N/A
Cilt
41
Sayı
5
