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Krikoide Basınç Nasıl Öğretilmeli?

How to Train for Cricoid Pressure?

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2009

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Cricoid pressure (CP) to occlude the upper ocsophegcal sphincter, also called the Sellick manoeuvre, may be used to decrease the risk of pulmonary aspiration of gastric contents during intubation for rapid induction of anesthesia. We designed a device that can be used for CP training and also used for testing for competency. We enrolled first year (n=21) and second year (n=21) anesthesia technican students. Theoretical knowledge of participants was initially assessed by a pretraining questionnaire and then feedback was provided. Each participant was instructed to apply blinded CP within the target range of 20 N (49 mmHg±%30) to awake patients and 40 N (91 mmHg±%20) for anesthesized patients. After reaching these pressures in unblinded practice rounds on the same model, a repeated blinded application of force was recorded. The pre-and post-intervention results were compared. Practical and theoretical ability was assessed again one year later with 15 participants and results were compared with those obtained one year ago.The data were subjected to statistical analysis using Mc Nemar and t- test. At the pre-intervention stage, for awake patients 28.6% participiants applied pressure within the target range, increasing to 83.3% at the post-intervention stage (p<0.001) and for anesthesized patients pre-intervention stage, 26.2% participiants applied target pressure, increasing to 78.6% at the post-intervention stage (p<0.001). There was no difference between the current results and those obtained one year ago (p>0.05). In conclusion, theoretical and practice traning appeared to improve performance regarding cricoid pressure training. The effects of training diminished rapidly with time. Training periods of less than one year may therefor be useful.
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Abstract (Original Language): 
Sellick Manevrası olarak da adlandırılan krikoide basınç; özefagusun kapanmasını sağlayan ve entübasyon sırasında doğru uygulandığı zaman pulmoner aspirasyon riskini azaltan bir işlemdir. Biz anestezi teknikerliği öğrencilerinin krikoid basınç hakkındaki bilgi düzeylerini ölçmek ve bir model üzerinde eğitim vererek eğitim öncesi ve sonrası başarı sonuçlarını karşılaştırmayı amaçladık. Sağlık Meslek Yüksek Okulu (SMYO) anestezi teknikerliği 1. (n=21) ve 2. (n=21) sınıf öğrencilerinin teorik bilgileri anket ile sınandı ve doğru yanıtlar anlatıldı. Tasarladığımız model üzerinde pratik eğitim verildi ve eğitim öncesi ve sonrası başarıları karşılaştırıldı. Katılımcıların 15‘ine 1 yıl sonra çalışma tekrarlanarak, bir yıl önceki değerleri ile karşılaştırıldı. Uyanık hastada önerilen 20 N=49 mmHg±%30’una (34.3-63.7) ve anestezi altındaki hastada 40 N=91 mmHg±%20’sine (63.7-118.3) ulaşanlar başarılı olarak kabul edildi. İstatistiksel analizlerde Mc Nemar ve t-testi kullanıldı. Eğitim öncesinde uyanık hastada hedef basınca öğrencilerin %28.6’sı ulaşırken, eğitim sonrası bu oran %83.3’e çıktı (p<0.001). Eğitim öncesi öğrencilerin %26.2’si; anestezi altındaki hastada hedef basınca ulaşırken eğitim sonrası bu oran %78.6 oldu (p<0.001). Bir yıl sonraki 15 katılımcının pratik uygulamasında, anlamlı fark bulunmadı (p>0.05). Sonuçlarımıza göre; krikoide uygulanması gereken basınç miktarı teorik ve pratik eğitimler sonucunda öğretilebilir. Fakat bir yıldan kısa sürelerde tekrarlanması yararlıdır.
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REFERENCES

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