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Komplikasi dan Pemantauan Susunan Saraf Pusat pada Operasi Jantung Sudjud, Reza Widianto; Parmana, I Made Adi
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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TINJAUAN PUSTAKAPerkembangan tekhnologi dan jumlah operasi jantung di Indonesia semakin meningkat, perkembangan tersebut diikuti juga dengan semakin meningkatnya komplikasi pada susunan saraf pusat, seperti cedera otak. Banyak faktor dan kejadian selama pembedahan jantung yang dapat menyebabkan cedera otak. Kebanyakan cedera ini diakibatkan oleh hipoperfusi yang global atau fokal yang disebabkan oleh emboli Â mikro ataupun makro. Insidensi cedera otak tinggi dan pencegahan terjadinya insidensi tersebut harus dipertimbangkan pada setiap prosedur. Alat pemantauan untuk susunan saraf pusat semakin berkembang dan membutuhkan keahlian seorang dokter anestesi untuk menguasai alat pemantauan tersebut. Pemahaman yang lebih lanjut terhadap pembedahan dan perfusi, perbaikan teknologi perfusi dan juga anestesi yang lebih teliti, diharapkan dapat menurunkan tingkat kejadian cedera otak setelah operasi jantung terbuka.Kata Kunci: Komplikasi SSP, anestesi, operasi jantung terbukaÂ Complications and Monitoring of Central Nervous System on Cardiac SurgeryThe development of technology and numbers of heart operations in Indonesia has increased, but it is also followed with the ever increasing complications on the central nervous system, such as brain injury. Many factors and events during a heart surgery that cause brain injury. Most of these are due to a global or focal hypoperfusion caused by micro or macro emboli. The incidence rate of brain injury and prevention occurrence of the incident should be considered for each procedure. Tool monitoring for central nervous system has been growing and requires the expertise of an Anaesthesiologist for control these monitoring tools. Further understanding, improvement of the perfusion technology, and also a more meticulous anesthetic, surgical and perfusion is expected to reduce the incidence rate of brain injury after open heart surgery.Keywords : Complications CNS, anesthesia, openÂ heart surgeryÂ DOI: 10.15851/jap.v1n1.161

Angka Mortalitas dan Faktor Risiko pada Pasien Geriatri yang Menjalani Operasi Emergensi Akut Abdomen di RSUP Dr. Hasan Sadikin Bandung Tahun 2014â2015 Priyatmoko, Donny Prasetyo; Sudjud, Reza Widianto; Kadarsah, Rudi Kurniadi
Jurnal Anestesi Perioperatif Vol 5, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Geriatri memiliki kekhususan yang perlu diperhatikan dalam bidang anestesi dan tindakan operasi karena terdapat kemunduran sistem fisiologis dan farmakologis sejalan dengan penambahan usia. Penelitian di Yunani tahun 2007 menjelaskan bahwa angka mortalitas akibat tindakan operasi setelah usia 65 tahun menjadi 3 kali lipat dibanding dengan usia 18â40 tahun. Angka mortalitas geriatri tahun 2007 pada operasi elektif sebesar 5%, sedangkan operasi emergensi sebesar 10%. Tujuan penelitian ini adalah memperoleh angka mortalitas dan faktor risiko pada pasien geriatri yang menjalani operasi emergensi akut abdomen tahun 2014â2015. Tipe penelitian ini merupakan deskriptif dengan pendekatan retrospektif terhadap 180 subjek penelitian yang diambil di bagian rekam medis sejak JuliâOktober 2016 pada pasien geriatri yang menjalani operasi emergensi akut abdomen di RSUP Dr. Hasan Sadikin Bandung tahun 2014â2015. Hasil penelitian ini memperlihatkan angka mortalitas sebesar 9% dengan faktor penyebab mortalitas paling dominan adalah syok sepsis sebesar 50%. Faktor predisposisi disebabkan oleh indeks massa tubuh <18,5 kg/m2 sebesar 56,3%, diagnosis primer tumor intestinal sebesar 31,3%, penyakit penyerta diabetes melitus sebesar 31,3%, sepsis sebesar 93,8%, hipoalbumin sebesar 56,3% dan status fisik ASA 4E sebesar 62,5%. Simpulan, faktor presipitasi disebabkan oleh waktu respons penanganan >6 jam sebesar 93,8% dan komplikasi pascaoperasi severe sepsis disertai pneumonia sebesar 50%. Kata kunci: Akut abdomen, angka mortalitas, geriatri, operasi emergensiÂ Mortality Rate and Risk Factor in Geriatric Patients Undergo Emergency Surgery for Acute Abdoment in Dr. Hasan Sadikin Hospital Bandung in 2014â2015Geriatric has special anesthetic and surgical consideration because of reducing physiologic function and pharmacodynamic as the age increase. A study in Greece in 2007 shows that surgery in patient more than 65 year old has three times mortality rate than 18â40 years old patients. Geriatric mortality rate in 2007 undergo elective surgery is 5%, while the emergency surgery 10%. Purpose of this study was to obtain mortality rate and risk factor in geriatric patients underwent emergency surgery for acute abdomen in 2014â2015. This was a descriptive retrospective study of 180 subjects taken from the medical records in July to October, 2016 in geriatric patients underwent emergency surgery for acute abdomen at the Dr. Hasan Sadikin hospital in 2014â2015. Results of this study showed a mortality rate of 9%, with most dominant factors that cause mortality was septic shock (50%). Predisposing factors was the body mass index <18.5 kg/m2 (56.3%), the diagnosis of primary tumor intestinal amounted to 31.3%, comorbidities of diabetes mellitus at 31.3%, sepsis (93.8%), hipoalbumin (56.3%) and ASA physical status 4E (62.5%). In conclution, precipitation factors caused by response time >6 hours (93.8%) and postoperative complications of severe sepsis with pneumonia (50%).Key words: Acute abdomen, emergency surgery, geriatrics, mortality rate

Perbandingan Pemberian Cairan Liberal dan Restriktif terhadap Mean Arterial Pressure, Laju Nadi, dan Capaian Nilai Post Anesthetic Discharge Scoring System Usia 1â3 Tahun di Bedah Rawat Jalan Somalinggi, Melliana; Sudjud, Reza Widianto; Oktaliansah, Ezra
Jurnal Anestesi Perioperatif Vol 6, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Teknik pemberian cairan liberal yang masih banyak digunakan sering menjadi berlebihan termasuk pada bedah rawat jalan. Puasa yang tepat, operasi yang singkat, serta perdarahan yang minimal pada bedah rawat jalan hanya memerlukan pemberian cairan restriktif. Penelitian ini bertujuan mengetahui mean arterial pressure (MAP) dan laju nadi intraoperatif serta capaian postanesthetic dischange skoring system (PADSS) antara pemberian cairan liberal dan restriktif anak usia 1â3 tahun di bedah rawat jalan. Penelitian bersifat eksperimental acak terkontrol buta tunggal dengan randomisasi secara acak sederhana pada 42 anak usia 1â3 tahun, status fisik American Society of Anesthesiology (ASA) I-II di bedah rawat jalan RSUP Dr. Hasan Sadikin Bandung periode Desember 2016 sampai Mei 2017. Subjek penelitian dikelompokkan menjadi dua, yaitu kelompok liberal diberikan cairan rumatan intraoperatif formula Holiday-Segar, penggantian puasa serta penggantian cairan âruang ketigaâ; dan kelompok restriktif diberikan hanya cairan rumatan intraoperatif 2 mL/kgBB/jam. Data dianalisis dengan uji-t dan Uji Mann-Whitney. Dari hasil penelitian didapatkan gambaran MAP dan laju nadi intraoperatif, serta capaian PADSS pada kedua kelompok tidak berbeda bermakna (p>0,05). Simpulan, tidak terdapat perbedaan gambaran MAP dan laju nadi intraoperatif, serta capaian PADSS antara pemberian cairan liberal dan restriktif pada anak usia 1â3 tahun yang menjalani bedah rawat jalan.Kata kunci: Cairan intraoperatif, laju nadi, mean arterial pressure, pediatrik, postanesthetic discharge scoring system

Korelasi antara Lama Pintas Jantung Paru dan Lama Bantuan Ventilasi Mekanis pada Pasien Pascabedah Pintas Arteri Koroner di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung Redjeki, Ike Sri; Setiari, Tias Diah; Sudjud, Reza Widianto
Jurnal Anestesi Perioperatif Vol 5, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Pintas jantung paru (PJP) diperlukan untuk sebagian besar prosedur bedah pintas arteri koroner (BPAK). Fungsi paru dan oksigenasi menurun sekitar 2â90% pada pasien pascabedah jantung dengan PJP. Ketergantungan terhadap ventilator setelah BPAK secara signifikan berhubungan dengan morbiditas dan mortalitas. Tujuan penelitian ini adalah mengorelasikan waktu PJP dengan lama bantuan ventilasi mekanis pada pasien BPAK. Penelitian ini merupakan analisis kohort retorospektif pada 43 pasien yang menjalani BPAK dengan PJP yang dirawat di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Januari 2014 sampai Juni 2015. Lama PJP dibagi menjadi â¤90 menit dan >90. Lama bantuan ventilasi mekanis terbagi menjadi â¤12 jam dan >12 jam. Parameter yang dicatat pada penelitian ini adalah usia, berat badan, tinggi badan, indeks massa tubuh, lama PJP, waktu klem aorta, dan lama bantuan ventilasi mekanis. Analisis stastistik menggunakan uji korelasi Lambda, signifikan jika nilai p<0,05. Penelitian ini menunjukkan korelasi yang cukup kuat antara waktu PJP dan lama bantuan ventilasi mekanis setelah BPAK dengan korelasi positif (0,545) dan signifikan (p<0,05). Simpulan penelitian ini adalah semakin lama waktu PJP berkorelasi dengan memanjangnya lama bantuan ventilasi mekanis. Kata kunci: Bedah pintas arteri koroner, pintas jantung paru, ventilasi mekanis Correlation between Cardiopulmonary Bypass Time and Duration of Mechanical Ventilation after Coronary Artery Bypass Graft at Cardiac Intensive Care Unit of Dr. Hasan Sadikin General Hospital BandungCardiopulmonary bypass (CPB) is necessary for majority of procedures in coronary artery bypass grafting (CABG) surgery. Lung function and oxygenation are impaired in 20% to 90% of CPB cardiac surgery patients. Ventilator dependency following CABG is often associated with significant morbidity and mortality. This study aims to correlate the CPB time and duration of mechanical ventilation after coronary artery bypass graft. This was a retrospective analysis cohort study on 43 consecutive patients undergoing CABG on CPB who admitted to cardiac intensive care unit between January 2014 and June 2015 in Dr. Hasan Sadikin General Hospital Bandung. The CPB time divided into <90 minutes and â¥90 minutes. Duration of mechanical ventilation was defined as â¤12 hours and â¥12 hours ventilation. Parameters recorded in this study were age, weight, height, body mass index, CPB time, aortic cross-clamp time and duration of mechanical ventilation. Statistical analysis was performed using Lambda correlation, significanti if p value <0.05. This study showed moderate correlation between CPB time and duration of mechanical ventilation after CABG surgery with a positive (0.545) and significant correlation (p<0.05). Conclusion of this research is longer CPB timed correlated with prolonged mechanical ventilationKey words: Cardiopulmonary bypass time, coronary artery bypass grafting, mechanical ventilation

Angka Mortalitas pada Pasien yang Menjalani Bedah Pintas Koroner berdasar Usia, Jenis Kelamin, Left Ventricular Ejection Fraction, Cross Clamp Time, Cardio Pulmonary Bypass Time, dan Penyakit Penyerta Ariaty, Geeta Maharani; Sudjud, Reza Widianto; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 5, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Penyakit jantung koroner (PJK) adalah salah satu penyakit pada sistem kardiovaskularÂ yangÂ seringÂ terjadiÂ danÂ merupakanÂ problemaÂ kesehatanÂ utamaÂ diÂ negara maju. Bedah pintas koroner merupakan salah satu penanganan intervensi PJK. Beberapa faktor risiko berhubungan dengan peningkatan mortalitas pascabedah pintas koroner. Tujuan penelitian ini adalah mengetahui angka mortalitas pada pasien yang menjalani bedah pintas koroner berdasar atas usia, jenis kelamin, left ventricular ejection fraction, cross clamp time, cardio pulmonary bypass time, dan penyakit penyerta di RSUP Dr. Hasan Sadikin Bandung tahun 2014â2016. Metode yang digunakan pada penelitian ini adalah deskriptif observasional dengan pendekatan retrospektif berdasar atas data rekam medis yang dilakukan bulan April 2017. Dari penelitian diperoleh hasil angka mortalitas pascabedah pintas koroner sebesar 15,15%. Angka mortalitas pasien yang menjalani bedah pintas koroner dipengaruhi beberapa faktor diantaranya usia, jenis kelamin, left ventricular ejection fraction, cross clamp time, cardio pulmonary bypass time dan penyakit penyerta.Â Mortality Rate of Patients Underwent Coronary Artery Bypass Graft Surgery based on Age, Gender, Left Ventricular Ejection Fraction, Cross Clamp Time, Cardiopulmonary Bypass Time, and Coexisting DiseaseCoronary heart disease (CHD) is one of the most common cardiovascular diseases and is a major health problem in developed countries. Coronary artery bypass graft surgery (CABG) is one of the intervention treatments of CHD. Several risk factors are associated with increased postoperative CABG mortality. The purpose of this study was to determine the mortality rate of patients undergoing coronary bypass surgery based on age, gender, left ventricular ejection fraction, cross clamp time, cardio pulmonary bypass time, and coexisting disease at Dr. Hasan Sadikin Bandung General Hospital during 2014-2016. This study was an analytical descriptive study using retrospective approach based on medical record data during April 2017. It was shown that the mortality rate for post-coronary bypass was 30 patients (15.15%). Hence, themortality rate of patients undergoing coronary bypass surgery is affected by several factors including age, gender, left ventricular ejection fraction, cross clamp time, cardio pulmonary bypass time, and coexisting disease.Â

Anestesia dan Thalasemia Saeful Alam, M. Deny; Sudjud, Reza Widianto; , Indriasari
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Thalasemia merupakan penyakit keturunan atau herediter menurut hukum mandel yang melibatkan penurunan produksi salah satu atau lebih rantai globin (α,β,γ,δ) dari hemoglobin sehingga terjadi gangguan sintesis hemoglobin. Gejala sudah mulai terdeteksi sejak bulan pertama kehidupan ketika level Hb fetal menurun. Gejala klinis yang dijumpai biasanya berhubungan dengan anemia yang berat, erytropoisis yang inefektif, extramedular hematopoiesis, dan gejala yang muncul karena timbunnan tranfusion dan akibat peningkatan penyerapan besi. Kulit biasanya tampak pucat karena anemia dan kuning karena jaundice dari hiperbilirubinemia. Tulang kepala dan tulang-tulang yang lainnya biasanya mengalami deformitas karena erytroid hyperplasia dengan intramedullary expansion dan penipisan tulang kortek dikenal dengan facies colley. Pasien dengan thalasemia baik intermediate atau mayor pada suatu waktu mungkin memerlukan penanganan bedah seperti misalnya cholecystectomy ataupun spleenectomi sehingga memerlukan tindakan anestesi. Permasalahan yang perlu diperhatikan saat melakukan anestesi pasien thalasemia diantaranya komplikasi akibat anemia, komplikasi akibat timbunnan besi, dan komplikasi karena terapi chelation. Kata kunci: Anemia, anestesi, hemosiderosis, splenektomi, thalasemia Anaesthesia and Thalassaemia Thalassaemia is a hereditary disorder according to Mandel’s law, involving a reduction in one of the globin chains (α,β,γ,δ) from haemoglobin resulting in impaiment of haemoglobin synthesis. Sysmptoms may present as early as one month of life when there is reduction in fetal haemoglobin. Clinical symptoms usually relates to severe anemia, ineffective erythropoiesis and symptoms that occurs as a result of transfussion and iron loading. Skin usually appears pale due to anemia and yellow due to jaundice and hyperbilirubinemia. Deformity of skull and other bones usually occurs as a result of erythroid hyperplasia with intramedually expansion and thinning of cortex known as Facies Colley. Patients with thalassaemia, either intermediate or major, may require surgery some time in their life, such as cholecystectomy or splenectomy therefore requiring anaesthesia. Issues that need to be adressed during anaesthesia include complications due to anemia, iron loading and chelation therapy. Key words: Anemia, anaesthesia, haemosiderosis, splenectomy, thalassaemia Reference Lanzkowsky P. Manual of pediatric hematology and oncology. Edisi ke-4. Burlington: Elsevier Academic Press; 2005. Yaish HM. Thalasemia [diunduh 2 Januari 2011]. Tersedia dari: http//www.emedicine. com. DeBaun MR, Vichinsky E. Hemoglobinopathies. Dalam Kliegman RM, Behrman RE, Jenson HB, Stanton BF, penyunting. Nelson Textbook of Pediatrics. Edisi ke⎯18. Philadelphia: Elsevier Saunders; 2007. h. 2025⎯38. Permono B, Ugrasena IDG. Hemoglobin abnormal: talasemia. Dalam Permono B, Sutaryo, Ugrasena IDG, Windiastuti E, Abdulsalam M, penyunting. Buku ajar hematologi-onkologi anak. Cetakan ke-2. Jakarta: Badan Penerbit IDAI; 2006. hlm. 64-97. Lekawanvijt S, Chattipakorn N. Iron overload thalassemic cardiomyopathy: iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity. Can J Cardiol. 2009;25(4):213⎯8. Kushner JP, Porter JP, Olivieri NF. Secondary iron overload. Hematology. 2001:47⎯61. Rund D, Rachmilewitz E. β-Thalasemia. N Engl J Med. 2005;353:1135-46. Olivieri NF. The β-Thalasemia. N Engl J Med. 1999:341(2):99-109. Catlin AJ. Thalasemia: the facts and the controversies. Pediatr Nursing. 2003;29(6):447⎯51. Bahador A, Banani SA, Foroutan HR, Hosseini SM, Davani SZ. A comparative study of partial vs total splenectomy in thalasemia major patients. J Indian Assoc Pediatr Surg. 2007 vol 12, page 133⎯5 Grosfeld JL, dkk. The Spleen in Pediatric Surgery edisi ke 2 dan 6. Mosby Elsevier. 2006 hlm. 1691-1702. Wood JC. Cardiac complications in thalasemia major. PMC. 2010;33:81⎯6. Colan SD. Cardiomyopathies. Dalam: Keane JF, Lock JE, Fyler D. Nadas’ pediatric cardiology. Edisi ke⎯2. Philadelphia: Saunders Elsevier; 2006. hlm. 415⎯58. Cogliandro T, Derchi G, Mancuso L, Mayer MC, Pannone B, Pepe A. Guideline recommendations for heart complications in talasemia major. Cardiology Medi. 2008;9:515⎯25. Yao Fun Sun F, Anesthesiology Problem-Oriented Patient Management. Edisi ke 6. Lippincott Williams & Wilkins. 2008:986–987. Hines RL, Marschall KE. Stoelting’s Anesthesia and Co-Existing Disease. Edisi ke 5. Saunders Elsevier. 2008:412. Barash PG, Cullen BF, Stoelting RK, Calahan MK, Stock MC. Handbook of Clinical Anesthesia. Edisi ke 6. Lippincott Williams & Wilkins. 2009:240–241. 18. Morgan GE, Mikhail MS, Murray MJ.Clinical Anesthesiology. Edisi ke 4. Mc Graw Hill. 2005:471, 476–477.

Sedasi dan Analgesia di Ruang Rawat Intensif Sudjud, Reza Widianto; , Indriasari; Yulriyanita, Berlian
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Pasien sakit kritis, khususnya yang mendapatkan ventilasi mekanik, seringkali mengalami nyeri dan kecemasan. Prinsip utama dari perawatan di ruang rawat intensif (ICU) adalah memberikan rasa nyaman sehingga pasien dapat mentoleransi lingkungan ICU yang tidak bersahabat. Pengelolaan sedasi dan analgesia yang adekuat dapat mempersingkat penggunaan ventilasi mekanik dan lama perawatan di ICU. Hal ini dapat dilakukan dengan mengidentifikasi dan mengatasi penyakit dasar dan faktor pencetus, menggunakan metode nonfarmakologi untuk meningkatkan rasa nyaman, pemberian terapi sedasi dan analgesia dengan memilih obat yang tepat, serta pemantauan secara rutin untuk menghindari terapi yang berlebihan dan berkepanjangan. Kata kunci: Analgesia, cemas, nyeri, ruang rawat intensif, sedasi Critically ill patients, especially those who receive mechanical ventilation, oftenexperience pain and anxiety. The main principle of treatment in the intensive care unit (ICU) is to provide a sense of comfort so that the patient can tolerate the ICU environment.Management of adequate sedation and analgesia can shorten the use of mechanical ventilation and length of ICU care. This can be done by identifying and correcting the underlying disease and precipitating factors, use of non-pharmacological methods to improve comfort, sedation and analgesia therapy with choosing the right drug, as well as regular monitoring to avoid excessive and prolonged therapy. Key words: Analgesia, anxiety, intensive care unit, pain, sedation Reference Rathmell.P.James. Bonica’s Management of Pain. Pain management in the intensive care unit. Lippincott Williams 2012;112:1590–01. Sessler CN, Wilhem W. Analgesia and sedation in the intensive care unit: an overview of the issues Crit Care. 2008;12(Suppl 3): S1. Young J. Sedation. Dalam: Core topics in critical care medicine. New York: Cambridge university press; 2010:77–88. Singer M WAR. Oxford handbook of critical care. Pain and post operative intensive care. Oxford University Press Inc; 2005:530–35. Marino P L. The ICU book: Analgesia and Sedation. Lippincott williams & wilkins; 2007;49:938–66. McConachie I. Handbook of ICU therapy. Analgesia for the high risk patient. New York: Cambridge University Press; 2006;4:51–64. Sessler CN VK. Patient-Focused Sedation and Analgesia in The ICU. Chest 2008;133:552–65. Mitchell E. Pain control. Dalam : Core topics in critical care medicine. New York: Cambridge university press; 2010:72–6. Peitz J Gregory, Olsen M Keith. Top 10 Myths Regarding Sedation and Delirium in the ICU. J Critical Care Medicine 2013;41:S46–56. Reade C Michael, Finfer Simon. Sedation and Delirium in the Intensive Care Unit. J New England 2014:444–54. Riessen.R, Pech.R. Comparison of the ramsay score and the richmond agitation sedation score for the measurement of sedation depth. Crit Care 2012.16 (Suppl 1):326. Recommended standards for short latency auditory evoked potentials.American clinical neurophysiology society.2008:12-9. Stern. TA. Manual of intensive care medicine. Diagnosis and treatment of agitation and delirium in the intensive care unit patient. Lippincott williams.2000; 179:871–75.

Airway Management in Patient Trauma Maxillofacialwith Mild Head Injury, Open Fracture Depressed, and Skull Base Fracture Sudjud, Reza Widianto; , suwarman; Patrianingrum, Meilani
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Establishing a secure airway in a trauma patient is essentials. Any law in airway management may lead to gravemorbidity and mortality. Maxillofacial trauma presents a complex problem with regard to the patient’s airway.Moreover, this patient sometimes accompanied with head injury and fracture cervical.In this case report, wereported male, 41 years old, came to the hospital Hasan Sadikin General Hospital with complaints wounds in thehead and face as a result of trafic accidents. This patient suffered trauma maksilofasialis with addition of minorhead injuries, open fractures depressed more than one tabula, incomplete cervical injury and skull base fractures.Management airway in this patient is spontaneous breathing that is achieved by administering propofol and gasgradually Sevolurane inhalation. Meanwhile, to prevent hemodynamic disturbances during laryngoscopy Fentanylwas given. The manual in-line stabilization was performed to prevent neck lexion when laryngoscopy intubation.In cases where airway is dificult to manage, intubation technique chosen is the one that anesthesiologist most feltcomfortable. Both of these factors are more relevant than the choice of technology.

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