Person: ESEN, ASIM
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Publication Metadata only A new maneuver for classical laryngeal mask airway insertion: Prospective randomized study(2022-08-01) Esen A.; Bakan M.; Topuz U.; Ertaş Dursun Z.; Karaaslan K.; ESEN, ASIM; KARAASLAN, KAZıMBackground/Aim: Laryngeal mask airway (LMA) has been frequently used for airway management. But the satisfaction of the insertion and trauma at insertion remain problems. We present a new insertion maneuver for classical LMA (cLMA) with a partially inflated cuff and examine its success and complication rate.Methods: In 4 months, 158 patients who were classified as ASA I–III and older than 18 years old and were planned for LMA were included in this study consecutively (according to the study design, one patient was excluded during the study). Emergency cases, patients with any contraindications with LMA, patients who were expected to undergo surgery for more than 2 h, patients with preoperative respiratory tract infection or sore throat, patients undergoing oral or nasal surgery, and patients with aspirated oropharyngeal secretions after removal of LMA was excluded from the study. Age, gender, height, weight, ASA scores, comorbidities, and the duration of anesthesia and surgery of the patients were recorded. One-hundred-fifty-seven consecutive patients were randomized into two groups by a coin toss [control group (group C) and study group (group S)]. The groups were compared in terms of LMA insertion success, the number of insertion attempts, the presence of blood on the LMA or in secretions, and postoperative sore throat. Classical Laryngeal Mask Airway was inserted with Brain’s standard technique in group C and with the new technique in group S. In the new technique, the head and neck of the patient were supported in a straight position, the mouth was opened, cLMA was held with a dominant hand from the tube part and inserted until the tip touches to the oropharynx. The index finger of the non-dominant hand was inserted into the mouth to pass by the cLMA and reach the tip of the cLMA. The tip of cLMA was directed to the caudal by the index finger. Then, cLMA was inserted by the guidance of the index finger until it reached the triangular base of the oropharynx.Results: There was no statistically significant difference in terms of demographic data and placement success; placement success was better in the study group (100% versus 98.6% and P = 0.45). Similarly, the count of attempts was better in the study group. The mean attempt number was 1.11 in group S and 1.28 in group C (P = 0.02). Also, blood on LMA was seen to be more common in group C (P = 0.04). There were no statistical differences in sore throat, but it was less seen in group S.Conclusion: The new maneuver was better than the standard technique and easy to use in daily practice.Keywords: Airway management, Laryngeal mask airway, ComplicationsPublication Metadata only Genel anestezi altında diş tedavisi planlanan akçaağaç şurubu idrar hastalığı olan hastada anestezik yaklaşım(2022-02-13) Esen A.; Uysal H.; Sümer İ.; ESEN, ASIM; UYSAL, HARUN; SÜMER, İSMAİLGenel anestezi altında diş tedavisi planlanan akçaağaç şurubu idrar hastalığı olan hastada anestezik yaklaşımDr. Öğr. Üyesi Asım ESENBezmialem Vakıf Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, esen1122@hotmail.com, ORCİD No: 0000-0001-7222-7499, GSM: +90 533 521 94 55Dr. Öğr. Üyesi Harun UYSALBezmialem Vakıf Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, drharunuysal@hotmail.com, ORCİD No: 0000-0003-0426-8525, GSM: +90 506 343 34 94Dr. Öğr. Üyesi İsmail SümerBezmialem Vakıf Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, isosumer@gmail.com, ORCİD No: 0000-0002-0133-0218 GSM: +90 533 220 15 76GirişAkçaağaç şurubu idrar hastalığı (MSUD) otozomal resesif, doğumsal ve sıklığı yaklaşık 1/185000 olan bir metabolik hastalıktır. Hastalığın sebebi dokularda yaygın olarak bulunan ve dallı zincirli aminoasitlerin oksidatif dekarboksilasyonundan sorumlu bir enzimin eksikliğidir. Bu eksiklik, dallı zincirli aminoasitler olan valin, lösin ve izolösinin kanda ve idrarda birikmesine neden olur. Hastalığın beş ayrı klinik fenotipi vardır. Klinik gidiş, fenotipe ve tedaviye başlanma zamanına bağlı olarak değişir.OlguHastamız 5 yaşında, 22 kg, 96 cm ve anne-babası akraba olan erkek çocuktu. Genel anestezi altında diş tedavisi planlanan hastamızda hafif bir motor-mental ve büyüme-gelişme geriliği mevcuttu. Tedavisine erken dönemde (postpartum onbeşinci gün) başlanan hasta valin-lösin replasman tedavisi, profilaktik antiepileptik ve multivitamin ilaçları almaktaydı. Preoperatif testlerinde önemli bir anormallik yoktu. Çocuk metabolizması ünitesine danışılan hastanın preoperatif açlık döneminde alması için total parenteral nutrisyon (TPN) hazırlandı. 0,5 mg/kg midazolam ile premedike edilen hasta ameliyathaneye alındı ve intravenöz anestezi indüksiyonu sonrası nazotrakeal entübasyon uygulandı. İnhalasyon anestezisi ile idame sağlandı. Ameliyat ve anestezi süreci olaysızdı. Ameliyat esnasında ve derlenme ünitesi sürecinde aralıklı kan şekeri takibi yapıldı. Derlenme ünitesinde yaklaşık yarım saat takip edildi ve her hangi bir problem yaşanmadı. Postoperatif dönemde oral beslenme başlanana kadar TPN nin devam edilmesi önerisiyle hasta servise verildi.Tartışma ve SonuçMSUD hastalarının preoperatif dönemde detaylı olarak değerlendirilmesi gerekir. İyi kontrol edilmiş bir süreçle ameliyata hazırlanan hastaların peroperatif dönemi genellikle sıkıntısız seyretme eğilimindedir. Ancak kontrol altında bir hasta değilse, nörokognitif gelişme geriliği, kasılma epizodları, epileptik nöbetler, hipoglisemi atakları, asidoz, dehidratasyon, beyin ödemi ve kafa içi basınç artışı gibi morbidite ve mortalite ihtimali yüksek problemler görülebilir. Bu nedenle peroperatif dönem için özellikle ilaçların düzenli alınıyor olması, sıvı replasmanı, beslenmeye dikkat ve yakın kan şekeri takibi önemlidir.Anahtar kelimelerAkçaağaç şurubu idrar hastalığı, genel anestezi, havayolu yönetimiAnesthetic approach to the patient with maple syrup urine disease which is planned for dental treatment under general anesthesiaBackroundMaple syrup urine disease (MSUD) is an autosomal recessive congenital metabolic disease. The frequency of disease is approximately 1/185000. The cause of the disease is the deficiency of an enzyme located in the inner membrane of the mitochondria, which is responsible for the oxidative decarboxylation of branched-chain amino acids. This enzyme is found in many tissues such as skeletal muscles, liver, brain and kidney. Deficiency of this enzyme causes the branched-chain amino acids valine, leucine and isoleucine to accumulate in the blood and urine. The disease has five different clinical phenotypes. The clinical course varies depending on the phenotype and the time of initiation of treatment.CaseOur patient is a 5-year-old boy, 22 kg, 96 cm, and whose parents are related. Our patient, who was scheduled for dental treatment under general anesthesia, had mild motor-mental and growth retardation. The patient, whose treatment was started in the early period (postpartum fifteenth day), was taking valine-leucine replacement therapy, some prophylactic antiepileptic drugs and multivitamin drugs. There was no significant abnormality in the preoperative laboratory tests. Total parenteral nutrition (TPN) solution was prepared for the patient to take during the preoperative fasting period, who was consulted with the pediatric metabolism unit. The patient, who was premedicated with 0.5 mg/kg midazolam, was taken into the operating room. After induction of intravenous anesthesia, nasotracheal intubation was performed. Maintenance of anesthesia was provided with inhalation anesthesia. Surgery and anesthesia were uneventful. Intermittent blood glucose monitoring was performed during the surgery and during the recovery unit. He was followed in the recovery unit for about half an hour and no problems were encountered. In the postoperative period, the patient was transferred to the ward with the recommendation to continue TPN until oral feeding was started.Discussion and ConclusionMSUD patients should be evaluated in detail in the preoperative period. The perioperative period of patients who are prepared for surgery with a well-controlled process generally tends to be uneventful. However, if the patient is not under control, problems such as neurocognitive disorders, convulsive episodes, epileptic seizures, hypoglycemia attacks, acidosis, dehydration, brain edema and increased intracranial pressure may be seen with a high probability of morbidity and mortality. For this reason, it is important to take medications regularly, fluid replacement, attention to nutrition and close blood sugar monitoring for the peroperative period.Keywords Maple syrup urine disease, general anesthesia, airway management