Dilek YAZICIOĞLU, Ömer BAYIR, Cem ÇATAROĞLU, Aysel GÜZEL, Aslı DÖNMEZ

TİROİDEKTOMİ SONRASI VOKAL KORD HAREKETİNİN DEĞERLENDİRİLMESİNDE DİREKT LARİNGOSKOPİ FİBEROPTİK LARİNGOSKOPİ VE ULTRASONOGRAFİ YÖNTEMLERİNİN KARŞILAŞTIRILMASI

Amaç: Tiroidektomi ameliyatından hemen sonra vokal kord hareketlerinin değerlendirilmesinde ultrasonografi (USG), direkt laringoskopi (DL) ve fiberoptik laringoskopi (FL) yöntemlerinin etkinliğinin ve değerlendirme sırasındaki dolaflım ve solunum ile ilgili istenmeyen olayların görülme sıklığının karflılafltırılmasıdır. Yöntem: Bu prospekti f randomize arafltırma, etik kurul izni ile aydınlatılmıfl hasta onamı alınmıfl tiroidektomi yapılan ve Amerikan Anestezistler Derneği fiziksel durumu I-II olan 75 eriflkin hastayı kapsamaktadır. Hastalar 3 gruba ayrıldı, ekstübasyondan sonra, Grup DL: eğri-bleydli laringoskop ile direkt laringoskopi; Grup FL: nazal fiberoptik endoskop ile laringoskopi ve Grup USG: 5-12 MHz lineer transduser, boyunda orta hatta tiroid kıkırdağın üzerine horizontal yerlefltirilerek ultrasonografi ile vokal kord hareketleri değerlendirildi. Gruplar arasında vokal kord görüntülenme skoru (0: görüntülenemiyor; 1: görüntüleniyor); görüntüleme ifllemi sırasında hasta yanıtı skoru (HYS: 1: yanıt yok; 2: yüzde ağrılı rahatsız i fade; 3: rahatsız kafa hareketleri; 4: koruyucu kafa ve kol hareketleri; 5: öksürme, öğürme); görüntüleme süresi; hemodinamik değifliklikler; dolaflım ve solunum ile ilgili istenmeyen olayların görülme sıklığı karflılafltırıldı. Bulgular: Kord vokal görüntüleme etkinliği bakımından yöntemler arasında fark bulundu. Vokal kordlar Grup USGde n: 25 (%100); Grup DLde n: 16 (%64); Grup FLde n: 22 (%76) hastada görüntülendi (p=0.005). HYS, Grup DLde en yüksek bulundu, 5 hastada skor ≥4 olduğu için ifllem sonlandırıldı. DL ve FL ile görüntüleme esnasında dolaflım ve solunumla ilgili istenmeyen olayların görülme sıklığı USGden yüksek bulundu (p

COMPARISON OF THE EFFECTIVENESS OF DIRECT LARYNGOSCOPY FIBEROPTIC LARYNGOSCOPY AND ULTRASONOGRAPHY IN THE ASSESSMENT OF VOCAL CORD MOBILITY AFTER THYROID SURGERY

Objective: Direct laringoscopy (DL), fiberoptic laryngoscopy (FL) and ultrasonography (US) techniques were compared in terms of effectiveness and incidence of adverse events during the assessment of vocal cord (VC) mobility after thyroid surgery. Method: After obtaining ethical approval and informed consent, 75 adult patients were randomized into 3 groups and the mobility of the vocal cords were assessed after extubation according to group allocation. Group USG: ultrasonography by placing a 5-12 MHz lineer transducer horizontally-midline on the thyroid cartilage; Group DL: laringoscopy with a curved laryngoscope; Group FL: laringoscopy with a fiberoptic laryngoscope, meanwhile a remi fentanil infusion was maintained. The vocal cord visualization score (1: visible; 0: not visible), the patient reactivity score (PRS: 1: no grimace, 2: grimacing facial expression, 3: head movements, 4: protective head and limb movements, 5: coughing and gagging), hemodynamic parameters, adverse events and the duration of the assessment were compared bet- ween groups. Results: Groups were di fferent with regard to the ability of the techniques to visualize the vocal cords. Symmetrical abductive and adductive vocal cord motion could be visualized in n: 25 (100%); n: 16 (64%); n: 22 (76%) patients in Group USG, Group DL and in Group FL respectively (p= 0.005). The PRS was the highest in Group DL and the incidence of adverse events concerning both the respiratory and circulatory system (hypertension, tachycardia desaturation, coughing breath-holding) were higher in the groups DL and FL (p<0.001). Conclusion: Ultrasonography is an effective method for the assessment of vocal cord mobility after thyroid surgery whereas assessment with DL and FL is associated with a high incidence of adverse events

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