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Majalah Anestesia dan Critical Care
Published by Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif Indonesia
ISSN : -     EISSN : 25027999     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Majalah ANESTESIA & CRITICAL CARE (The Indonesian Journal of Anesthesiology and Critical Care) is to publish peer-reviewed original articles in clinical research relevant to anesthesia, critical care, and case report . This journal is published every 4 months (February, June, and October) by Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif Indonesia (PERDATIN).
Arjuna Subject : -
Articles 91 Documents
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Perioperative Management Transposition of The Great Arteries for Arterial Switch Procedure Wahjudi, Andrianto; Cintyandy, R.; Dwijatmiko, Heru
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Abstract

Transposition of the great arteries (TGA) merupakan kelainan kongenital kardiovaskular berat di mana penegakan diagnosi dilakukan segera setelah bayi lahir. Aliran pembuluh darah balik sistemik akan menuju jantung kanan dan dipompakan ke seluruh tubuh oleh aorta, sedangkan darah yang berasal dari jantung kiri akan dipompakan ke paru-paru. Kelangsungan hidup setelah bayi lahir terjadi apabila terdapat percampuran darah yang adekuat di antara kedua sirkulasi. Percampuran darah dapat terjadi di tingkat atrial melalui atrial septal defect (ASD) atau patent foramen ovale (PFO), melalui defek di ventrikel/ ventricular septal defect (VSD) dan/atau melalui patent ductus arteriosus (PDA). Premedikasi anestesi tidak diperlukan dan induksi anestesi umumnya menggunakan teknik anestesi berbasis narkotik. Pemberian beban volume cairan kadang-kadang dapat memperbaiki keadaan. Kedalaman anestesi yang adekuat berguna menurunkan kebutuhan oksigen. Kata kunci: Anestesia perioperatif, Transposition of the great arteries (TGA) Perioperative Management Transposition of The Great Arteries for Arterial Switch Procedure Transposition of the great arteries (TGA), is the most common severe congenital cardiac abnormality, the diagnosis made shortly after birth. Systemic venous blood return to the right heart and is pumped to body through the transposed aorta, and left heart blood is pumped to the lungs. Survival after birth is possible only if mixing occurs between the two circulations (e.g,ASD,PFO, VSD, PDA). Premedication anesthesia is not necessary, an intravenous induction usually is used with predominant narcotic technique. Volume loading occasionally will improve the situation. Adequacy depth of anesthesia may be helpful to decrease oxygen consumption. Key words: Perioperative anesthesia, transposition of the great arteries (TGA)
Duration of Analgesia and Blood Pressure by Giving Midazolam 2 mg Compared to Fentanyl 25 mcg in Hyperbaric Bupivacaine 10 mg During Cesarean Delivery Sitanggang, Ruli Herman; Harniati, Siti; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Abstract

Pain free episode after Cesarean deliveryis needed by the mother to take care the baby. Opioid is the most common adjuvant used in spinal anesthesia, but still has unpleasant side effects, while Midazolam 2 mg is known to prolong analgesia. This study was using randomized double-blind experimental design. The subject of this study is 40 pregnant women with ASA II who underwent Cesarean delivery with spinal anesthesia. Research subjects are divided into 2 groups of study. The first group was given a combination of Fentanyl 25 mcg + 0.5% Bupivacaine 10 mg (BF) while the second group was given Midazolam 2mg+0,5% Bupivacaine 10 mg (BM). The duration of analgesia in 2 groups was assessed using a numeric rating scale (NRS). Then the data were analyzed using T-test, Mann Whitney test and Chi square test. The results showed no significant difference in both groups in a decrease of systolic blood pressure (p>0.05). Duration of analgesia in Midazolam group is 217.5 (39.32) minutes longer than Fentanyl group 124.0 (10.83) minutes. The conclusion is additional Midazolam 2 mg may prolong analgesia compared with Fentanyl 25 mcg without a decrease in blood pressure in Caserean delivery.
Pengaruh Magnesium Sulfat Intravena terhadap Kebutuhan Fentanil dan Propofol Intraoperatif pada Pasien yang Dilakukan Histerektomi dengan Anestesi Umum Thayeb, Srilina; Bisri, Tatang; Oktaliansah, Ezra
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Abstract

Pemberian adjuvan analgetik dan sedatif intraoperatif bisa mengurangi pemakaian fentanil dan propofol sehingga akan mengurangi efek samping. Magnesium sulfat (MgSO4) mempunyai efek analgetik dan sedatif dengan bekerja sebagai antagonis reseptor N-Methyl D-Aspartat (NMDA) dan menghambat saluran kalsium (Ca-channel blocker). Penelitian ini bertujuan untuk mengetahui efektivitas pemberian MgSO4 untuk mengurangi penggunaan fentanil dan propofol intraoperatif. Penelitian dilakukan di Central Operating Theatre (COT) Rumah Sakit Dr. Hasan Sadikin Bandung sejak bulan Agustus−Oktober 2013 dengan uji klinis acak tersamar ganda pada 58 pasien yang menjalani histerektomi dengan anestesi umum. Pasien dibagi dalam 2 kelompok, masing-masing 29 orang. Kelompok MgSO4 mendapatkan MgSO4 30 mg/kgBB sebelum induksi anestesi dilanjutkan 10 mg/kgBB/jam sampai akhir operasi. Kelompok kontrol mendapatkan NaCl 0,9% dengan jumlah yang sama. Anestesi yang adekuat dinilai dengan patient response to surgical stimulus (PRST) dan bispectral index (BIS). Data hasil penelitian diuji dengan uji-t dan Uji Mann-Whitney. Hasil penelitian didapatkan bahwa dengan pemberian MgSO4 untuk mempertahankan nilai BIS 40−60 dan PRST 2−4 menggunakan fentanil dan propofol yang lebih sedikit dibanding dengan kelompok kontrol, dengan pebedaan sangat bermakna (p<0,01). Simpulan penelitian ini adalah pemakaian MgSO4 bisa mengurangi kebutuhan fentanil dan propofol intraoperatif. Kata kunci: Bispectral index, fentanil, propofol, patient response to surgical stimulus Administration of intraoperative analgetic adjuvant will reduce major fentanyl requirement dose, in consideration of increasing fentanyl dose denotes more side effects. Magnesium sulphate (MgSO4 )acts as NMDA receptor – antagonist and blocks calcium channel (Ca channel blocker) and give effect analgesia and anesthesia. The aim of this study is to understand effectiveness of magnesium sulphate administration to reduce fentanyl and propofol requirement intraoperative.This study was conducted with double blind randomized controlled trial method to 58 patients who underwent hysterectomy in general anesthesia and divided into two groups of 29 persons .The MgSO4 group was administered 30mg/kgBW MgSO4 intravenously before induction and 10 mg/kgBW during surgery. The NaCl group was administered NaCl 0,9% intravenous. In both groups, PRST and BIS was assessed. This test results in administration of magnesium sulphate to maintain BIS score 40−60 and PRST 2–4 could reduce dose fentanyl and propofol requirement dose the lower in magnesium group (p<0,01). The Conclusion of this study is there is MgSO4 can reduce fentanyl and propofol intraoperatif. Key words: Bispectral index, fentanyl, propofol, patient response to surgical stimulus Reference Chin KJ, Yeo SW. Bispectral index values at sevoflurane concentrations of 1% and 1.5% in lower segment cesarean delivery. Anesth Analg. 2004;98:1140–4. Barbosa FT, Barbosa LT, Jucá MJ, Cunha RMd. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol. 2010;60:481–97. Nurrochmad A, Masahiko O, Narita M, Suzuki T. The advantages of fentanyl for the treatment of pain: studies of pharmacological profiles and fentanyl related side effects. Majalah Farmasi Indonesia. 2004;15:185. Ray M, Bhattacharjee DH, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoprative recovery: a comparative study. Indian J Anaesth.2010;54:137–41. Kothari D, Mehrotra A, Choudhary B, Mehra A. Effect of intravenous magnesium sulfate and fentanyl citrate on circulatory changes during anaesthesia and surgery: a clinical study. Br J Anesth.2008;52:800–4. Na HS, Lee JH, Hwang JY, Ryu JH, Han SH, Jeon YT, dkk. Effect of magnesium sulphate on intraoperative neuromuscular blocking agent requrements and postoperative analgesia in children with cerebral palsy. Br J Anesth. 2010;104:344–50. Jee H, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anesth. 2009;103:484–9. Lee DH, Kwon IC. Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for caesarean section. Br J Anesth.2009;103:861–6. Choi JC, Yoon KB, Um DJ, Kim C, Kim JS, Lee SG. Intravenous magnesium sulfate administration reduces propofol infusion requirements during maintenance of propofol–N2O anesthesia. Anesthesiology 2002;97:1137–41. Levaux CB, Dewandre PY. Effect of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopedic surgery. Anaesthesia 2003;58:131–5. Širvinskas E, Laurinaitis R. Use of magnesium sulfate in anesthesiology. Medicina.2002;38:695. Dube LG, JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anesth. 2003;50:732–46. Rao M. Acute postoperative pain. Indian JAnaesth 2006;50:340–4. Koinig H, Wallner T, Marhofer P, Andel H, Rauf KH, Mayer N. Magnesium sulfate reduces intra and postoperative analgesic requirements. Anesth Analg. 1998;87:206–10. Morgan JM, Murray MJ. Pain management. Dalam: Morgan JM, Murray MJ, penyunting. Clinical Anesthesiology. Edisi ke-4. New York: McGraw Hill Companies; 2006. Hlm.359–411. Seyhan TO, Tugrul M, Sungur MO, Kayachan S, Telci L, Pembeci K, dkk. Effect of three diffrent dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. Br J Anaesth. 2006;96:247–52.
NutritionTherapy in ICU Patiens Kestriani, Nurita Dian; Budipratama, Dhany; Pradian, Erwin
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Under ordinary circumstances, feeding is not considered as medical therapy. When normal diet fail to meet daily requirements or when assessment documents deficiencies, then nutritional planning becomes a part of medical therapeutics. The goals of nutritional support for critically ill patients include preserving tissue mass, decreasing usage of endogenous nutrient stores and catabolism, and maintaining or improving organ function (i.e., immune, renal, and hepatic systems; muscle). Specific goals include improving wound healing, decreasing infection, maintaining the gut barrier (decreasing translocation), and decreasing morbidity and mortality all of which may contribute to decreasing the ICU or hospital stay and hospitalization costs.
Perbandingan Efektivitas Tablet Hisap Amylmetacresol-dibenal dengan Profilaksis Deksametason Intravena Sebelum Pemasangan Pipa Endotrakeal untuk Mengurangi Kekerapan Nyeri Tenggorok Pascaoperasi Harijanto, Eddy; Firdaus, Riyadh; Kurnia, Dedy
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
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Nyeri tenggorok pascaoperasi post-operative sore throat (POST) merupakan salah satu komplikasi yang sering muncul pada anestesia umum dengan teknik intubasi. Tujuan penelitian ini ialah untuk membandingkan antara efektivitas tablet hisap amylmetacresol-dibenal dengan profilaksis deksametason intravena sebelum pemasangan pipa endotrakeal untuk mengurangi kekerapan POST. Setelah mendapatkan izin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan uji klinis prospektif yang diacak dan tersamar ganda pada 121 pasien yang menjalani operasi dalam anestesia umum menggunakan pipa endotrakeal. Pasien dibagi menjadi dua kelompok, yaitu Grup A 61 orang dan grup B 60 orang. Sebelum induksi, pasien dalam grup A diberikan tablet hisap amylmetacresol-dibenal dan suntikan NaCl 0,9% 2 mL dan grup B diberikan Deksametason 10 mg intravena dan tablet hisap plasebo. Nyeri tenggorok pascaoperasi dievaluasi dengan numerical rating scale (NRS) sebanyak 3 kali, yaitu setelah operasi saat Alderette skor 10, 2 jam pascaoperasi dan 24 jam pascaoperasi.  Kekerapan dan derajat nyeri tenggorok pascaoperasi dicatat dan dianalisis dengan uji chi-kuadrat. Tidak didapatkan perbedaan kekerapan nyeri tenggorok pascaoperasi bermakna pada kedua kelompok sesaat setelah operasi berakhir, jam ke-2 dan jam ke-24 pascaoperasi. Derajat nyeri tenggorok pascaoperasi tidak berbeda bermakna di antara kedua kelompok. Tablet hisap amylmetacresol-dibenal sebelum pemasangan pipa endotrakeal memiliki efektivitas yang sama dengan profilaksis deksametason intravena dalam mengurangi kekerapan nyeri tenggorok pascaoperasi. Kata kunci: Amylmetacresol-dibenal, deksametason, intubasi endotrakeal, nyeri tenggorok pascaoperasi, Strepsils® Comparison between Amylmetacresol-dibenal Lozenges and Prophylactic Intravenous Dexamethasone Before Intubation to Reduce the Incidence of Postoperative Sore Throat (POST) Post-operative sore throat (POST) is one of the complications that often arise in the general anesthesia with intubation techniques. The purpose of this study was to compare the effectiveness of amylmetacresol-dibenal lozenges with prophylactic intravenous dexamethasone before intubation to reduce the incidence of POST. After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients,a prospective randomized clinical,double-blind trial was done in 121 patients that would undergo surgery under general anesthesia using endotracheal tube. Patients were divided into two groups randomly; Group A 61 people and group B 60 people. Before induction, patients in group A was given amylmetacresol - dibenal lozenges and injection of 2 mL of 0.9% NaCl, while group B was given intravenous dexamethasone 10 mg and placebo lozenges. POST was evaluated by the numerical rating scale (NRS) 3 times, after surgery when Alderette score of 10, 2 hours postoperatively and 24 hours postoperatively. The frequency and degree of POST were recorded and analyzed with Chi-Square test. There were no significant difference in the incidence of POST in both groups after surgery when Alderette score of 10  , h 2, and the 24th hour postoperatively. The degree of POST was not significantly different between the two groups. Amylmetacresol - dibenal lozenges before intubation tube has the same effectiveness of prophylactic intravenous dexamethasone in reducing the incidence of POST. Key words: Amylmetacresol-dibenal lozenges, dexamethasone, endotracheal intubation, postoperative sore throat (POST), Strepsils®
Gangguan Tidur pada Peserta Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Harijanto, Eddy; Hidayat, Jefferson; Pratiwi, Astrid
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Dokter anestesiologi adalah profesi kedokteran yang rentan mengalami kelelahan akibat jam kerja yang panjang, beban kerja dengan tingkat stress pekerjaan yang tinggi. Sebanyak 80% kesalahan medis berhubungan dengan sindrom burnout dengan gangguan tidur sebagai keluhan yang sering dialami dokter anestesiologi. Penelitian ini menggunakan 2 kuesioner yang telah divalidasi di Indonesia; Kuesioner pittsburgh sleep quality index (PSQI) untuk menilai kualitas tidur dan kuesioner epworth sleepiness scale (ESS) untuk menilai skala kantuk berlebih. Setelah mendapatkan izin komite etik dan informed consent, penelitian observasional potong lintang dengan subjek 98 orang peserta PPDS Anestesiologi dan Terapi Intensif FKUI dilakukan di RSCM selama April–Mei 2016. Sampel mengisi kedua kuesioner. Analisis deskriptif dilakukan terhadap gangguan kualitas tidur dan skala kantuk, distribusi karakteristik dan data jam kerja. Analisis bivariat dan multivariat dilakukan terhadap hasil kuesioner PSQI dan ESS. Faktor durasi tidur, keluhan tidur dan skala kantuk berlebih adalah faktor signifikan penyebab kualitas tidur kurang. Skala kantuk memiliki kecenderungan sebesar 132,8 kali sebagai faktor gangguan kualitas tidur. Faktor jumlah hari bebas tugas per bulan, tahap jaga, dan kualitas tidur subjek menjadi faktor signifikan penyebab skala kantuk berlebih. Gangguan kualitas tidur memiliki kecenderungan sebesar 38,73 kali sebagai faktor skala kantuk berlebih.70% subjek memiliki kualitas tidur kurang dan 65% subjek memiliki skala kantuk berlebih. Terdapat hubungan signifikan antara kualitas tidur dengan skala kantuk berlebih. Kata Kunci: dokter anestesiologi, gangguan kualitas tidur, skala kantuk Factors Affecting Sleep Disorder in Trainees of Anesthesiology and Intensive Care Anesthesiologists are very susceptible to fatigue due to long working hours and work load with high levels of job stress. 80% of medical errors are associated with burnout syndrome; with sleep disorders as the most common complaint from anesthesiologists. This study investigated sleep quality and sleepiness scale using 2 validated questionnaires in Indonesia; Pittsburgh Sleep Quality Indexto (PSQI) assess sleep quality and Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness. This was an observational cross sectional study of Anesthesiology and Intensive Therapy residents in Faculty of Medicine Universitas Indonesia. After obtaining permission from ethics committee and informed consent, this study was done in Cipto Mangunkusumo Hospital during April–May 2016 on 98 residents as the sample. Subjects filled PSQI and ESS questionnaires. Descriptive analysis included sleep quality and sleepiness scale, distribution characteristics and working hour. The bivariate and multivariate analysis assessed the questionnaires score results. Results, sleep duration, sleep complaints of participants and excessive daytime sleepiness caused sleep quality disorder significantly. Excessive daytime sleepiness hds 132.8 times tendency to impair the quality of sleep. Offduty days number per month, the academic level, and sleep quality caused excessive daytime sleepiness significantly. Impaired quality of sleep had 38.73 times tendency as a factor of excessive daytime sleepiness. 70% subjects had sleep quality disorder and 65% subjects had excessive daytime sleepiness. There was a significant relationship between sleep quality disorder and excessive daytime sleepiness. Key words: Anesthesiologist, excessive daytime, impaired quality of sleep, sleepiness scale
Respiratory Failure due to Transfusion Related Acute Lung Injury (TRALI) and Atelectasis and Acute Kidney Injury Post Cardiac Surgery: A Case Report wullur, caroline; Sitanggang, Ruli Herman
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Postoperative pulmonary complications and acute kidney injuries are the most frequent and significant contributor to morbidity, mortality and costs associated with hospitalization. Despite the prevalance of these complications in cardiac surgery patients, recognition, diagnosis and management of this problem vary widely. Many factors may contribute to the pathogenesis of lung complications include atelectasis, Transfusion Related Acute Lung Injury (TRALI) and Acute Respiratory Distress Syndrome (ARDS). While haemodynamic, inflammatory and nephrotic factors are involved and overlap each other in leading to kidney injury. A 54-year-old patient with history of hypertension and diabetes melitus underwent coronary artery bypass graft. On postoperative day 1, he had worsening respiratory and renal function with suspected atelectasis and TRALI. Alveolar lung recruitment maneuvers as well as Sustained Low-Efficiency Dialysis (SLED) were conducted. He was transferred to regular ward on postoperative day seven and discharged uneventfully two days later. Early recognition and management including alveolar recruitment maneuvers and dialysis have an important role in the prevention and treatment of these complications.
Pengaruh Perioperative Albumin Infusion dan Diet Normal Protein terhadap Perubahan Sitokin Proinflamsi (TNFα, IL1 and IL6) dan CRP , Utariani; Raharjo, E.; Perdanakusuma, D.S
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Malnutrisi dapat mempengaruhi sitokin proinflamasi TNF, IL1, IL6 dan CRP perioperatif, sehingga dapat meningkatkan morbiditas dan mortalitas. Sedangkan patofisiologi interaksi ini masih belum jelas. Penelitian ini dirancang untuk menganalisis peran perioperatif albumin infus dan protein diet pada perubahan sitokine proinflamasi TNFa, IL1, IL6 dan CRP. Penelitian eksperimental murni dilakukan dengan menggunakan dua puluh lima tikus Sprague Dawley diacak dan dibagi menjadi 5 kelompok; kelompok kontrol (A) yang diberi diet protein normal, kelompok hipoalbuminemia diberikan infus albumin praoperasi (B), kelompok hipoalbuminemia dengan perioperatif diet protein normal (C), kelompok hipoalbuminemia diberiinfus albumin pasca operasi (D) dan hypoabuminemia dengan diet rendah protein (E). Metode pemeriksaan Elisa digunakan untuk mengukur plasma TNF, IL1, IL6, dan CRP. Penelitian ini menunjukkan hasil diet protein rendah praoperasimeningkatkan TNF, IL1, IL6 dan CRP secara signifikan. Sedangkan pemberian infus albumin dan diet protein normal praoperasi menurunkan TNF, IL1, IL6 dan CRP secara signifikan, pemberian infus albumin praoperasi dan pasca operasi terjadi perubahan penurunan TNF, IL1, IL6, dan CRP namun tidak signifikan. Simpulan penelitian ini adalah pemberian infus Albumin dan diet protein normal menurunkan sitokin proinflamasi (TNF , IL1 , IL6), dan CRP secara signifikan. Hal ini juga berarti dapat menurunkan morbiditas dan mortalitas . Kata kunci: Diet protein, perioperatif albumin, sitokin proinflamasi Protein malnutrition may affect perioperative TNFα, IL1 ,IL6 and CRP,that increases morbidity and mortality. The pathophysiology of this interaction is still unclear. This study was designed to analyze the role of perioperative albumin infusion and protein diet on the changes of TNFα, IL1, IL6 and CRP. The laboratory experimental research with post test only-control group design was conducted. Twenty five Sprague Dawley Rats were randomized and divided into 5 groups; control group which was given normal protein diet, hypoalbuminemia group given preoperative albumin infusion, hypoalbuminemia with perioperative normal protein diet, hypoalbuminemia group given postoperative albumin infusion and hypoabuminemia with low protein diet. Four incisions were made on the rats for operation model. Elisa method was used to measure plasma TNFα, IL1, IL6 and CRP. This study showed that as the result of preoperative low protein diet, TNFα, IL1, IL6 and CRP increased significantly. The albumin infusion and normal protein diet then decreased the TNFα, IL1 and CRP significantly, whereas the changes were not significant in preoperative and postoperative albumin infusion. conclution from this research is Albumin infusion and normal protein diet significantly decrease proinflammatory cytokines (TNFα, IL1, IL6) and CRP on hypoalbuminemia state. 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Penatalaksanaan Aspirasi Benda Asing pada Pasien Pediatrik wullur, caroline; Rasman, Marsudi
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Abstract

Aspirasi benda asing adalah kejadian yang sering terjadi terutama pada populasi anak-anak. Kejadian ini dapat membahayakan nyawa sehingga diperlukan tindakan ekstraksi benda asing tersebut dengan segera. Diagnosis pasti dapat terhambat terutama bila dari anamnesa tidak spesifik, ketika orang tua tidak mampu menyadari pentingnya gejala, atau bahkan ketika temuan klinis dan radiologis tidak spesifik atau terlewatkan oleh dokter. Aspirasi bahan organik dapat menyebabkan peradangan mukosa saluran napas berat. Jika bahan organik tidak segera diekstraksi, peradangan kronis akan menyebabkan terbentuknya jaringan granulasi di sekitar benda asing, yang pada akhirnya dapat menyebabkan infeksi paru-paru, baik pneumonia maupun abses. Pada kejadian aspirasi benda asing, tidak jarang pasien datang dengan komplikasi sekunder, seperti demam terus-menerus, “asma”, atau pneumonia berulang untuk waktu yang lama. Pada tulisan ini akan diulas mengenai kejadian aspirasi-benda asing, berbagai samaran klinisnya, tata laksana ekstraksi dan anestesi yang tersedia, serta langkah-langkah yang dapat dilakukan untuk mencegah aspirasi. Kata kunci: Aspirasi, benda asing, bronkoskopi Foreign-body aspiration is a relatively common occurrence in children. It may present as a life-threatening event that necessitates prompt removal of the aspirated material. However, the diagnosis may be delayed when the history is atypical, when parents fail to appreciate the significance of symptoms, or when clinical and radiologic findings are misleading or overlooked by the physician. Aspiration of organic matter causes severe airway mucosal inflammation. If the organic matter is not promptly removed, chronic inflammation leads to the development of granulation tissue around the foreign body, which may ultimately present as a lung infection. In this setting, it is not uncommon to treat patients for secondary complications, such as persistent fever, “asthma,” or recurrent pneumonia for long periods. Here we review the incidence of foreign-body aspiration, its various clinical presentations, its management including anesthesia techniques, and measures we can do to prevent future aspirations. Key words: Aspiration, foreign body, bronchoscopy Reference Kalyanappago VT, Kulkarni NH, Bidri LH. Management of tracheobronchial foreign body aspirations in paediatric age group – A 10 year retrospective analysis. Indian J. Anaest 2007; 51(1): 20–23 Fidkowski C.W, Zheng H, Firth PG, The anaesthetic considerations of tracheobronchial foreign body in children: a literature review of 12.979 cases. Anaest Analg. 2010; 111(4): 1016–25 Roberts S and Thomington RE, Pediatric bronchoscopy. Contin educ anaesth crit care pain. 2005; 5 (2): 41 ̶ 44 Cote C, Lerman J, Anderson B. Otolaryngiologic procedure. Chapter 31 Page 657 ̶ 681. In: A practice of anesthesia for infants and children. 5th edition. Philadephia: Saunders Elsevier Publishing; 2013. Weir PM. Foreign Body Aspiration. Chapter 27, Pages 163–166. In: Problems in Anaesthesia: Paediatric Anaesthesia. Stoddart PA, Lauder GR (editors). London: Taylor and Francis Books Ltd; 2004 Naragund AI, Mudhol RS, Harugop AS, Patil PH, Hajare PS, Metgudmath VV. Indian J Otolaryngol Head Neck Surg. 2014; 66(S1): 180–5 A-Kader HH. Foreign body ingestion: children like to put objects in their mouth. World J Pediatr. 2010, 6(4): 301 ̶ 310 Seth D, Kamat D, Pansare M. Foreign body aspiration, a guide to early detection, optimal therapy. Consultant 360 for Pediatricians. 2007; 6(1) Farrell PT. Rigid Bronchoscopy for foreign body removal: anaesthesia and ventilation. Paediatric Anaesthesia 2005; 14: 84–89. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Pediatric Basic Life Support. Circulation. 2005;112:156–166
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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Abstract

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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