Çocuklarda trendelenburg pozisyonu ve valsalva manevrasının internal jugulre ven çapı ve yerleşimi üzerine etkisi
Date
2013
Authors
Dinçyürek, Gamze Naime
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada 2-12 yaş arası çocuklarda supin, supin+valsalva, trendelenburg, trendelenburg+valsalva, ters trendelenburg ve ters trendelenburg+valsalva manevralarının sağ internal juguler ven çapı (RIJV) üzerindeki etkilerinin ultrason (US) eşliğinde karşılaştırılmasını amaçladık. Etik kurul onayı ve hastaların ebeveynlerinden yazılı onam alındıktan sonra ASA I, 2-12 yaş arası 100 hasta çalışmaya dahil edildi. Operasyon odasına alınan hastaların yaş, boy, ağırlık, ASA grubu ve cerrahi tipi kaydedildi. Hastalara EKG, noninvaziv kan basıncı, periferik oksijen satürasyonu, soluk-sonu CO2 basınç monitorizasyonu uygulandı. %100 konsantrasyonda O2 ile 2-3 dakika preoksijenizasyonu takiben hastalara kirpik refleksi kayboluncaya kadar propofol ve 2 ?g/kg fentanil ile indüksiyon uygulandı. Larengeal maske yerleştirilerek hava yolu sağlanan hastaların anestezi idamesinde %50 hava-%50 O2 karışımı içinde %2 konsantrasyonda sevofluran kullanıldı. Genel anestezi altındaki olguların RIJV çapları supin, supin+valsalva, trendelenburg, trendelenburg+valsalva, ters trendelenburg ve ters trendelenburg+valsalva manevraları uygulanarak US eşliğinde ölçüldü. Trendelenburg ve ters trendelenburg pozisyonları için masaya 15 derece (º) açı verildi. Valsalva manevrası için hastaya 15 saniye süreyle 20 cm H20 hava yolu basıncı uygulandı. Ölçümler sırasında hasta başı 20º kontrlateral tarafa çevrildi. Supin (S) pozisyondaki RIJV çapları supin+valsalva (SV), trendelenburg (T), ters trendelenburg (TT), trendelenburg+valsalva (TV) ve ters trendelenburg+valsalva (TTV) ile karşılaştırıldı. Ters trendelenburg pozisyonunda anlamlı fark bulunmadı (p=0.111). Diğer pozisyonlarda anlamlı fark saptandı (p<0.01). RIJV çap ölçümlerinde en fazla çap artışı TV manevrasında saptandı (p<0.001). Sonuç olarak trendelenburg pozisyonu ve valsalva manevrası RIJV çapını anlamlı olarak arttırırken ters trendelenburg pozisyonunun RIJV çap değişimi üzerine etkisi yoktur. Ters trendelenburg pozisyonuna valsalva manevrası eklendiğinde RIJV çapı anlamlı olarak artmaktadır. Trendelenburg pozisyonu valsalva manevrası birlikte uygulandığında en anlamlı RIJV çap artışı bulunmuştur.
We aimed to compare the effects of supine, supine+valsalva, trendelenburg, trendelenburg +valsalva, the reverse trendelenburg and the reverse trendelenburg + valsalva maneuvers on the diameter of right internal jugular vein (RIJV) in ultrasound guidance in pediatric patients aged between 2 and 12 years old. After ethics committe approval obtained and written consent taken from patients’s parents, ASA I 100 patients aged between 2-12 were enrolled in the study. Age, heigth, weigth, ASA group and type of surgery of the patients who were taken in operation room were recorded. ECG, noninvasive blood pressure, peripheral oxygen saturation, end-of-breath CO2 pressure monitoring were applied to patients. Following pre- oxygenation with O2 in 100% concentration for 2-3 minutes, induction with propofol and 2 μg/ kg fentanyl was administered to patients until eyeflash reflex disappered. 2% concentration of sevoflurane in the mixture of 50% air -50% O2 was used in the anesthesia maintenance of patients who were provided with an air way by placing laryngeal mask. RIJV Diameters of the subjects under general anesthesia were measured with guidence of US by applying the maneuvers of supine, supine+valsalva, trendelenburg, trendelenburg+valsalva, the reverse trendelenburg and the reverse trendelenburg+valsalva. 15 degrees (°) angle was given to table for trendelenburg and the reverse trendelenburg positions. Air way pressure of 20 cm H20 was applied to the patient for valsalva maneuver. During the measurments,patient’s head was turned 20º to contralateral side. The RIJV diameters in supine (S) position were compared with the ones in supin+valsalva (SV), trendelenburg (T), ters trendelenburg (TT), trendelenburg+valsalva (TV) and the reverse trendelenburg+valsalva (TTV). v Significant difference could not be found in the reverse trendelenburg position (p=0.111). In other positions significant difference was determined (p<0.01). The most increase in measurements of the RIJV diameter was identified in the TV maneuver (p<0.001). As a result while the trendelenburg position and valsalva maneuver increase RIJV diameter significantly, the reverse trendelenburg position does not have significant effect on the change of RJIV diameter. When trendelenburg position was applied together with valsalva maneuver the most significant increase in the RIJV diameter was found.7
We aimed to compare the effects of supine, supine+valsalva, trendelenburg, trendelenburg +valsalva, the reverse trendelenburg and the reverse trendelenburg + valsalva maneuvers on the diameter of right internal jugular vein (RIJV) in ultrasound guidance in pediatric patients aged between 2 and 12 years old. After ethics committe approval obtained and written consent taken from patients’s parents, ASA I 100 patients aged between 2-12 were enrolled in the study. Age, heigth, weigth, ASA group and type of surgery of the patients who were taken in operation room were recorded. ECG, noninvasive blood pressure, peripheral oxygen saturation, end-of-breath CO2 pressure monitoring were applied to patients. Following pre- oxygenation with O2 in 100% concentration for 2-3 minutes, induction with propofol and 2 μg/ kg fentanyl was administered to patients until eyeflash reflex disappered. 2% concentration of sevoflurane in the mixture of 50% air -50% O2 was used in the anesthesia maintenance of patients who were provided with an air way by placing laryngeal mask. RIJV Diameters of the subjects under general anesthesia were measured with guidence of US by applying the maneuvers of supine, supine+valsalva, trendelenburg, trendelenburg+valsalva, the reverse trendelenburg and the reverse trendelenburg+valsalva. 15 degrees (°) angle was given to table for trendelenburg and the reverse trendelenburg positions. Air way pressure of 20 cm H20 was applied to the patient for valsalva maneuver. During the measurments,patient’s head was turned 20º to contralateral side. The RIJV diameters in supine (S) position were compared with the ones in supin+valsalva (SV), trendelenburg (T), ters trendelenburg (TT), trendelenburg+valsalva (TV) and the reverse trendelenburg+valsalva (TTV). v Significant difference could not be found in the reverse trendelenburg position (p=0.111). In other positions significant difference was determined (p<0.01). The most increase in measurements of the RIJV diameter was identified in the TV maneuver (p<0.001). As a result while the trendelenburg position and valsalva maneuver increase RIJV diameter significantly, the reverse trendelenburg position does not have significant effect on the change of RJIV diameter. When trendelenburg position was applied together with valsalva maneuver the most significant increase in the RIJV diameter was found.7
Description
Keywords
Ultrason, Trendelenburg, Ters trendelenburg, Valsalva, Kataterizasyon, Ultrasound, Trendelenburg, The reverse trendelenburg, Catheterisation
Citation
Dinçyürek, G. N. (2013). Çocuklarda trendelenburg pozisyonu ve valsalva manevrasının internal jugulre ven çapı ve yerleşimi üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.