Verification of the displacement of the mask during operation in pediatric cases with laryngeal mask by ultrasonography and fiberoptic bronchoscopy

Verification of the displacement of the mask during operation in pediatric cases with laryngeal mask by ultrasonography and fiberoptic bronchoscopy, Ahmet KAHRAMAN, Speciality in Medicine Thesis, Manisa 2020 In our study, it was aimed to compare the air leak test, FOB and USG results in the change of LMA position in operations performed with LMA in pediatric patients; and to reveal the risk factors causing LMA position change. 79 ASA1-2 patient groups (35 girls and 44 boys) were included in our study. The demographic data, physical examination results and resumes of the patients were recorded on the case follow-up form. Routine anesthesia monitoring (blood pressure, peripheral O2 saturation, ECG, end-tidal CO2, patient status index) was performed to the patients participating in the study, and general anesthesia was maintained with intravenous anesthesia induction following general anesthesia induction. During the operation, the findings of the case were recorded at regular intervals, as in every case. Tidal volume, airway pressure values, pulse, end tidal carbon dioxide value, peripheral oxygen saturation and anesthesia agents were recorded in the follow-up of the patient, the size of the LMA used during the operation, at which entry it was placed, and if necessary, what size it was replaced with LMA. To confirm LMA placement, the air leak test was evaluated every 30 minutes after the LMA was inserted and thereafter, and at the end of the procedure, by ultrasonography and fiberoptic bronchoscopy. Tidal volume, airway pressure values, pulse, end tidal carbon dioxide value, peripheral oxygen saturation, anesthesia agents, the size of the LMA used during the operation, at which entry it was placed, and if necessary, what size it was replaced with LMAwere recorded in the follow-up of the patient. In order to verify the LMA placement, evaluations were made with the air leak test, USG and FOB every 30 minutes of operation and at the end of the operation. SPSS 23.00 was used to analyze the data. Descriptive statistics were shown as mean ± standard deviation or median (minimum-maximum) for continuous variables. Categorical variables were expressed as number of patients and percent. Kappa statistics were used to determine the level of compliance of air leak test and FOB results with USG results. The t-test was used to compare the measurement results between independent binary groups, ANOVA and Bonferroni was used to compare between three and more groups. Pearson's Chi-Square or Fisher's Precise Chi-Square analyzes were also performed for the discontinuous variables to evaluate the relationship between the displacement condition and other discontinuous parameters in the air leak test, FOB and USG results. All results were evaluated at 95% confidence interval and 5% significance level. According to the findings of our study, displacement in the LMA position in the range of 0-30 minutes which are identified by USG were 37% compatible with the air leak test, 40% with FOB and 70% with FOB rotation. In the 0-60 min range, USG results were 32% compatible with air leak test, 47% with FOB and 74% with FOB rotation. According to the results of FOB between 0-60 minutes, the BMI averages of patients with LMA shift were significantly higher than non-shift. FOB and FOB rotation results between 0-30 minutes; In the 0-60 minute interval, the results of air leak test, USG, FOB and FOB rotation were differentiated according to mallampati score. On the other hand, according to the results of USG in the range of 0-60 minutes, the tidal volume changes of the patients with a shift in the LMA position were low and the ETCO2 changes were high. Within the framework of these findings, it is thought that USG can be used to evaluate the placement of LMA in the operations with the thought that USG is a less invasive method and will cause less harm to the patient.