Comparison Of Diaphragm Thickness Values In Cases of Adenotonsillectomy Before And After The Operation
Abstract
Aim: The ultrasonographic assessment in the operating room tends to increase daily, and ultrasonography is a method used to evaluate the thickness of the diaphragm. Measurement of the thickness of the diaphragm is a parameter that can be used to decide before separation from mechanical ventilation and extraction. In these cases where intubated and extubated at the end of the operation, it is planned to examine the ratio of the aperture muscle thickness to each other in the last inspirium and exprium before extubation. Determining the current ratio may be meaningful for determining the extubation time.
Material and Method: In the study, 60 patients, who were in the physical state of ASA I and II, 3-12 age range, and who were scheduled for elective adenotonsillectomy operation were included. Age, gender, body mass index (BMI), and operation time data of patients were recorded. Before and after the procedure, inspiratory and exprituar diaphragm thicknesses were measured by ultrasonography. In addition, the ratio of the last inspirium and the diaphragm muscle thicknesses in the last expiration were also calculated.
Results: There was no significant difference between the pre-operation values and the end of the operation in the diaphragm thickness measurements. The incidence of laryngospasm was 1.5 %.
Conclusion: Diaphragm thickness measurements with ultrasound have many benefits but further studies are needed.
Keywords
References
- 1. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69(5):423-7. doi: 10.1136/thoraxjnl-2013-204111.
- 2. Cappellini I, Ostento D, Loriga B, Tofani L, De Gaudio AR, Adembri C. Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial. Eur J Anaesthesiol. 2020;37(1):44-51. doi: 10.1097/EJA.0000000000001055.
- 3. El Naggar TAEH, Dwedar IA, Abd-Allah EFA. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Egypt J Bronchol. 2019;13:191-5. doi: 10.4103/ejb.ejb_59_18
- 4. Lang J, Liu Y, Zhang Y, Huang Y, Yi J. Peri-operative diaphragm ultrasound as a new method of recognizing post-operative residual curarization. BMC Anesthesiol. 2021;21(1):287. doi: 10.1186/s12871-021-01506-3.
- 5. Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J. 2014 Jun 7;6(1):8. doi: 10.1186/2036-7902-6-8.
- 6. Sferrazza Papa GF, Pellegrino GM, Di Marco F, Imeri G, Brochard L, Goligher E, et al. A Review of the Ultrasound Assessment of Diaphragmatic Function in Clinical Practice. Respiration. 2016;91(5):403-11. doi: 10.1159/000446518.
- 7. Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO. An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg. 2010;110(5):1349-54. doi: 10.1213/ANE.0b013e3181d5e4d8.
- 8. Mattila PS, Tahkokallio O, Tarkkanen J, Pitkäniemi J, Karvonen M, Tuomilehto J. Causes of tonsillar disease and frequency of tonsillectomy operations. Arch Otolaryngol Head Neck Surg. 2001;127(1):37-44. doi: 10.1001/archotol.127.1.37.
- 9. Bani-Ata M, Aleshawi A, Alali M, Kanaan Y, Al-Momani W, Kanaan N, et al. Familial and Environmental Risk Predisposition in Tonsillectomy: A Case-Control Study. Risk Manag Healthc Policy. 2020;13:847-853. doi: 10.2147/RMHP.S258748.
- 10. Altintas, M. Prevalence of atopy in children with hypertrophic tonsil and recurrent/chronic tonsillitis. Med Science. 2019.8(3):732-5. doi:10.5455/medscience.2019.08.9077
- 11. Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006;102(2):426-9. doi: 10.1213/01.ane.0000195543.61123.1f.
- 12. Wachtendorf LJ, Tartler TM, Ahrens E, Witt AS, Azimaraghi O, Fassbender P. et al. Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care. Br J Anaesth. 2023;130(2):133-141. doi: 10.1016/j.bja.2022.10.015.
- 13. Raval AD, Anupindi VR, Ferrufino CP, Arper DL, Bash LD, Brull SJ. Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies. J Clin Anesth. 2020;66:109962. doi: 10.1016/j.jclinane.2020.109962.
- 14. Ghaffar EA, Fattah SA, Atef HM, Omera MA, Abdel-Aziz MA. Kinemyography (KMG) Versus Electromyography (EMG) Neuromuscular Monitoring in Pediatric Patients Receiving Rocuronium during General Anesthesia. Egyptian Journal of Anaesthesia 2013:29:247-53. doi: 10.1016/j.egja.2013.02.006
- 15. Manouchehrian N, Jiryaee N, Moheb FA. Propofol versus lidocaine on prevention of laryngospasm in tonsillectomy: A randomized clinical trial. Eur J Transl Myol. 2022;32(3):10581. doi: 10.4081/ejtm.2022.10581.
Adenotonsillektomi Olgularında Ameliyat Öncesi ve Sonrası Diyafram Kalınlık Değerlerinin Karşılaştırılması
Abstract
Amaç: Ultrasonografinin ameliyathanede kullanımı gün geçtikçe artmakta ve ultrasonografi diyafram kalınlığını değerlendirmek için kullanılan bir yöntemdir. Diyaframın kalınlığının ölçülmesi, mekanik ventilasyon ve ekstraksiyondan ayrılmadan önce karar vermek için kullanılabilecek bir parametredir. Ameliyat sonunda entübe edilen ve ekstübe edilen bu olgularda ekstübasyon öncesi son inspirum ve son ekspiryumda diyafram kas kalınlığının birbirine oranının incelenmesi planlanmıştır. Bu oranın belirlenmesinin ekstübasyon süresinin belirlenmesinde anlamlı olabileceği düşünülmektedir.
Gereç ve Yöntem: Çalışmaya elektif adenotonsillektomi operasyonu planlanan 3-12 yaş aralığında fiziksel durumu ASA I ve II olan 60 hasta dahil edildi. Hastaların yaş, cinsiyet, vücut kitle indeksi (VKİ) ve operasyon süresi verileri kaydedildi. Ameliyat öncesi ve sonrası ultrasonografi ile inspiratuar ve ekspiratuar diyafram kalınlıkları ölçüldü. Son inspiryum ve son ekspirasyondaki diyafram kası kalınlıklarının oranı hesaplandı.
Bulgular: Diyafram kalınlık ölçümlerinde ameliyat öncesi değerler ile ameliyat sonu değerleri arasında anlamlı fark yoktu. Laringospazm insidansı %1.5 idi.
Sonuç: Ultrason ile diyafram kalınlığı ölçümlerinin birçok faydası vardır ancak daha ileri çalışmalara ihtiyaç vardır.
References
- 1. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69(5):423-7. doi: 10.1136/thoraxjnl-2013-204111.
- 2. Cappellini I, Ostento D, Loriga B, Tofani L, De Gaudio AR, Adembri C. Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial. Eur J Anaesthesiol. 2020;37(1):44-51. doi: 10.1097/EJA.0000000000001055.
- 3. El Naggar TAEH, Dwedar IA, Abd-Allah EFA. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Egypt J Bronchol. 2019;13:191-5. doi: 10.4103/ejb.ejb_59_18
- 4. Lang J, Liu Y, Zhang Y, Huang Y, Yi J. Peri-operative diaphragm ultrasound as a new method of recognizing post-operative residual curarization. BMC Anesthesiol. 2021;21(1):287. doi: 10.1186/s12871-021-01506-3.
- 5. Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J. 2014 Jun 7;6(1):8. doi: 10.1186/2036-7902-6-8.
- 6. Sferrazza Papa GF, Pellegrino GM, Di Marco F, Imeri G, Brochard L, Goligher E, et al. A Review of the Ultrasound Assessment of Diaphragmatic Function in Clinical Practice. Respiration. 2016;91(5):403-11. doi: 10.1159/000446518.
- 7. Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO. An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg. 2010;110(5):1349-54. doi: 10.1213/ANE.0b013e3181d5e4d8.
- 8. Mattila PS, Tahkokallio O, Tarkkanen J, Pitkäniemi J, Karvonen M, Tuomilehto J. Causes of tonsillar disease and frequency of tonsillectomy operations. Arch Otolaryngol Head Neck Surg. 2001;127(1):37-44. doi: 10.1001/archotol.127.1.37.
- 9. Bani-Ata M, Aleshawi A, Alali M, Kanaan Y, Al-Momani W, Kanaan N, et al. Familial and Environmental Risk Predisposition in Tonsillectomy: A Case-Control Study. Risk Manag Healthc Policy. 2020;13:847-853. doi: 10.2147/RMHP.S258748.
- 10. Altintas, M. Prevalence of atopy in children with hypertrophic tonsil and recurrent/chronic tonsillitis. Med Science. 2019.8(3):732-5. doi:10.5455/medscience.2019.08.9077
- 11. Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006;102(2):426-9. doi: 10.1213/01.ane.0000195543.61123.1f.
- 12. Wachtendorf LJ, Tartler TM, Ahrens E, Witt AS, Azimaraghi O, Fassbender P. et al. Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care. Br J Anaesth. 2023;130(2):133-141. doi: 10.1016/j.bja.2022.10.015.
- 13. Raval AD, Anupindi VR, Ferrufino CP, Arper DL, Bash LD, Brull SJ. Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies. J Clin Anesth. 2020;66:109962. doi: 10.1016/j.jclinane.2020.109962.
- 14. Ghaffar EA, Fattah SA, Atef HM, Omera MA, Abdel-Aziz MA. Kinemyography (KMG) Versus Electromyography (EMG) Neuromuscular Monitoring in Pediatric Patients Receiving Rocuronium during General Anesthesia. Egyptian Journal of Anaesthesia 2013:29:247-53. doi: 10.1016/j.egja.2013.02.006
- 15. Manouchehrian N, Jiryaee N, Moheb FA. Propofol versus lidocaine on prevention of laryngospasm in tonsillectomy: A randomized clinical trial. Eur J Transl Myol. 2022;32(3):10581. doi: 10.4081/ejtm.2022.10581.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | May 28, 2023 |
| Publication Date | June 21, 2023 |
| Submission Date | September 14, 2022 |
| Acceptance Date | March 31, 2023 |
| Published in Issue | Year 2023 Volume: 7 Issue: 1 |
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