Prediktori zbrinjavanja otežanog dišnog puta u kirurgiji štitnjače: petogodišnja opservacijska prospektivna studija u jednom centru

Predictors of Difficult Airway Management in Thyroid Surgery: A Five-Year Observational Single-Center Prospective Study

Sestre Milosrdnice University hospital and Institute of Clinical Medical Research 2016

Otežana intubacija (OI) traheje je češća u kirurgiji štitnjače nego u drugim kirurškim granama zbog tireomegalije. Pravilna prijeoperacijska evaluacija dišnoga puta je neophodna za smanjenje brojnih potencijalnih komplikacija. Ispitivali smo učestalost OI u kirurgiji štitnjače, utjecaj dislokacije traheje i drugih čimbenika na OI. Provedena je prospektivna studija na 2379 bolesnika podvrgnutih operacijama štitne žlijezde u Centru za endokrinu kirurgiju Kliničkog centra Srbije u Beogradu u razdoblju od 2007. do 2012. godine. Bolesnici su bili podijeljeni u skupine s OI (n=162) i bez OI (n=2217). Uz dislokaciju i/ili stenozu traheje definirano je još 13 čimbenika rizika sadržanih u 13 probirnih testova i 3 dodatna čimbenika – spol, životna dob i dijagnoza. Učestalost OI u našoj studiji iznosila je 6,81%. Prisutnost dislokacije traheje bila je statistički značajan, ali ne i nezavisni prediktor OI. Kao najznačajniji i nezavisni prediktori OI izdvojili su se: dijagnoza, veliki obim i mala dužina vrata, prethodna OI, recesivna mandibula, karakteristike zuba i oralne anomalije. Najveću osjetljivost imali su obim i dužina vrata, a najveću specifičnost prethodna OI. Ako dovodi do dislokacije i/ili stenoze traheje, tireomegalija je značajan prediktor OI, ne samostalno, nego u kombinaciji s drugim čimbenicima.
Difficult tracheal intubation (DI) is more common in thyroid than in other surgical branches due to thyromegaly. Proper preoperative airway evaluation is necessary in order to reduce the potential numerous complications. The study examined the incidence of DI in thyroid surgery and the influence of tracheal dislocation and other risk factors on DI. A prospective study was conducted on 2379 patients who underwent thyroidectomy at the Center for Endocrine Surgery, Clinical Center of Serbia, from 2007 to 2012. Patients were divided into groups with (n=162) and without DI (n=2217). Besides tracheal dislocation, another 13 risk factors contained in 13 screening tests and three additional factors of gender, age and diagnosis were defined. The incidence of DI in our study was 6.81%. The presence of tracheal dislocation was statistically significant, but not an independent predictor of DI. The diagnosis, large circumference and small neck length, previous DI, recessive mandible, tooth characteristics and oral anomalies were the most significant and independent predictors of DI. Neck circumference and small neck length had highest sensitivity. Previous DI had highest specificity. Thyromegaly, if causing tracheal dislocation and/or stenosis, represents a significant DI predictor, not individually, but in combination with other factors.

Dišni put, zbrinjavanje; Intubacija, intratrahealna; Tireoidne bolesti – kirurgija; Dislokacija traheje; Airway Management; Intubation, Intratracheal – Methods; Thyroid Diseases - Surgery; Tracheal Dislocation; text; info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion

Open access content. Open access content
info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-nd/4.0

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