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Beckwith-Wiedemann sendromu; eksofalos, makroglossi, hipoglisemi, organomegali, omfalosel ve gigantizim gibi çeşitli anomalileri içerir. Beckwith-Wiedemann sendromlu olgular sıklıkla infant dönemde cerrahiye gereksinim duyarlar. Anestezi yönetimindeki temel problemler sıklıkla; zor hava yolu ve hipoglisemidir. Makroglossinin maske ventilasyonu ve entübasyonu zorlaştırabileceği akılda tutularak indüksiyondan önce zor hava yolu hazırlığı yapılmalıdır. Dikkatli intraoperatif glukoz takibi hipogliseminin neden olacağı nörolojik sekelleri önlemede oldukça önemlidir. Bu sunuda laringeal maskenin potansiyel zor hava yolu anatomisine sahip Beckwith-Wiedemann sendromlu olguda endotrakael tüpe alternatif olarak kullanılabileceğine değindik. Anahtar kelimeler: Beckwith-Wiedemann Sendromu; Anestezi; Zor Hava Yolu; Laringeal Maske., Beckwith-Wiedemann syndrome consists of various abnormalities, such as exomphalos, macroglossia, hypoglcemia, visceromegaly, omphalocele, gigantism. Patients with Beckwith-Wiedemann syndrome frequently require surgical intervention during infant period. Common problems associated with anesthetic management of Beckwith-Wiedemann syndrome are difficult airway and hypoglycemia. Macroglossia might cause difficult ventilation and intubation for that reason preparation for airway difficulty should be made before induction. Intraoperative plasma glucose monitoring is particularly important to prevent the neurologic sequelae. In this presentation, we addressed the use of laryngeal mask may be an alternation to the endotracheal tube patients with Beckwith-Wiedemann which consist potentially difficult airway anatomy. Key words: Beckwith-Wiedemann Syndrome; Anesthesia, Difficult Airway; Laryngeal Mask.

Objective: Endotracheal intubation (ETI) and laryngeal mask airways (LMA) can cause various laryngeal symptoms and changes in the acoustical characteristics of the voice in the postoperative period. In this study, we aimed to compare the effects of ETI, classical LMA, proseal LMA and I gel LMA on laryngeal symptoms and acoustic analysis parameters of the voice. Material and Methods: Eighty patients who underwent lower abdomen and extremity surgery, which do not effect the formation of the voice, were included in the study. A clinical survey sheet that included questions about hoarseness, globus pharyngeus, need for clearing throat, sore throat, loss of voice, unpleasant voice and cracking voice, was filled by the patients preoperatively, and on postoperative 2nd and 24th hours. All patients had acoustic analyses in an isolated room in the Otorhinolaryngology polyclinic. Acoustic analysis included parameters of basic frequency, jitter (measures of the cycle-to-cycle variations of fundamental frequency), shimmer (measures of the cycle-to-cycle variations of fundamental amplitude), harmonic/noise ratio and normalized noise energy. Results: The increase was statistically significant in group ETI preoperatively and on postoperative 2nd hour when compared to the other groups (p=0.005). In ETI group, hoarseness and need to clearing throat were significantly higher. In classical LMA group, need to clearing throat was significantly higher. No differences were found between T2 and T24 time periods for loss of voice parameters (p=0.179, p=1.000). These clinical evaluations were present in the early postoperative period, and they decreased to normal values on the postoperative 24th hour. In acoustic analysis, only the jitter parameter in the proseal LMA group changed significantly on the 2nd postoperative hour. Other acoustic parameters did not change significantly. Conclusion: We suppose that ETI and classical LMA may have effects on voice functions in the early postoperative period, and newly developed LMAs, especially gel structured laryngeal mask airways, which are not dilated with air, have minimal effects on voice functions and laryngeal complaints. © 2014 by Türkiye Klinikleri.

Amaç: Bu çalışmada kısa süreli operasyon olan küretajlarda kullandığımız LMA'nın kafının 40 cmH2O ve 60 cmH2O basınçlarında şişirilmesinin intraoperatif hemodinami ve postoperatif boğaz ağrısı, kulak ağrısı, ses kısıklığı, yutma güçlüğü, kanama, bulantı, kusma açısından farklarının karşılaştırılması amaçlanmıştır.Yöntem ve Gereç: Çalışma prospektif randomize olarak düzenlendi. Genel anestezi altında elektif küretaj operasyon geçirecek ASA I-II olan 14-70 yaş arası 60 kadın olgu 2 gruba ayrıldı. Grup I (n=30) LMA kafı 60 cmH2O, Grup II (n=30) LMA kafı 40 cmH2O basıncına kadar şişirildi.Preoperatif kalp hızı, sistolik, diyastolik ve ortalama kan basıncı, SpO2, bazal değerleri intraoperatif kalp hızı, sistolik, diyastolik ve ortalama kan basıncı, SpO2 ve End-tidal CO2, Larengeal Maske kaf basıncı değerleri (LMA uygulama sonrası 1, 5, 10, 15 ve 20. dakikalarda) kaydedildi. Postoperatif 20. dakikada kalp hızı, sistolik, diyastolik ve ortalama kan basıncı, SpO2 değerleri kaydedildi. Preoperatif ve postoperatif 20'inci dakikada boğaz ağrısı, kulak ağrısı, ses kısıklığı, yutma güçlüğü, kanama, bulantı ve kusma kaydedildi.Bulgular:Hastaların demografik özelliklerine göre dağılımları, operasyon süreleri ve LMA deneme süresi açısından gruplar arasında fark saptanmamıştır. İntraoperatif hemodinami ve postoperatif boğaz ağrısı, kulak ağrısı, ses kısıklığı, yutma güçlüğü, kanama, bulantı, kusma açısından gruplar arasında fark görülmemiştir.Sonuç: Kısa süreli operasyon olan küretajlarda kullandığımız LMA'nın kafının 40 cmH2O ve 60 cmH2O basınçlarında şişirilerek kullanılmasında intraoperatif hemodinami ve postoperatif boğaz ağrısı, kulak ağrısı, ses kısıklığı, yutma güçlüğü, kanama, bulantı, kusma açısından fark görülmemiştir kaf basınçları devamlı olarak ölçülmüştür, kullandığımız kaf basınçları güvenle kullanılabilir.Anahtar Kelimeler: Larengeal Maske, kaf basıncı, postoperatif morbidite, intraoperatif hemodinami.İletişim adresi: drsahinali@ yahoo.com Objective: This study was aimed to investigate and compare the effect of the inflation of LMA cuff to pressures of 40 cmH2O and 60 cmH2O on intraoperative hemodynamy and postoperative sore throat, earache, dysphonia, dysphagia, bleeding, nausea, vomitting during curettages that are short-duration operations.Methods: This is a prospective, randomized study. Sixty ASA I-II female patients who would undergo elective curettage under general anesthesia were randomized to two groups. The LMA cuff was inflated to 60 cmH2O in Group I (n=30) patients and 40 cmH2O in Group II (n= 30) patients.Preoperative basal heart rate; systolic, diastolic and mean blood pressures, SpO2 values, intraoperative heart rate, systolic, diastolic and mean blood pressure, SpO2 and end-tidal CO2 values, laryngeal mask cuff pressure (following the LMA application at 1st, 5th, 10th, 15th and 20th minutes) values were all recorded. Also, heart rate, systolic, diastolic and mean blood pressure, SpO2 values at the 20th minute of postoperative period were recorded. Sore throat, earache, dysphonia, dysphagia, bleeding, nausea, vomitting at the 20th minute of preoperative and postoperative periods were recorded.Results: There were no differences between the two groups with respect to demographic characteristics of the patients, duration of operations and LMA trying periods. Also there were no differences between the two groups concerning the intraoperative hemodynamy and postoperative sore throat, earache, dysphonia, dysphagia, bleeding, nausea, vomitting.Conclusion: Inflation of LMA cuff to 40 cmH2O and 60 cmH2O during curettages which are short-duration operations, did not make any differences concerning the intraoperative hemodynamy and postoperative sore throat, earache, dysphonia, dysphagia, bleeding, nausea, vomitting. Cuff pressures were measured continuously. Cuff pressures that we used can be used safely.Key Words: Laryngeal Mask, cuff pressure, postoperative morbidity, intaoperative hemodynamyContact Adress: drsahinali@yahoo.com 48