UJI BANDING TEKANAN KEBOCORAN JALAN NAFAS ANTARA SUNGKUP LARING I-GEL DAN PIPA ENDOTRAKHEAL

Diah Annisa Oktaviningsih, Dr. Calcarina FRW, Sp.An., KIC.

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar belakang. Selama ini intubasi dengan pipa endotrakeal dinilai paling efektif dalam penatalaksanan jalan nafas karena cuff pada pipa endotrackeal dapat mengamankan jalan nafas dengan mencegah terjadinya aspirasi oleh karena regurgitasi cairan lambung. Sekarang beberapa alat jalan nafas supraglotik dinilai lebih sedikit menimbulkan gejolak hemodinamik karena kurang infansif. Sungkup laring I-Gel adalah jenis alat jalan nafas yang baru dan inovatif dengan cuff tanpa udara yang bersifat elastis yang dinilai cukup efektif digunakan selama anestesi dengan ventilasi spontan ataupun dengan ventilasi tekanan positif. Salah satu keterbatasan dari sungkup laring I-Gel dibandingkan dengan pipa endotrakheal adalah gangguan ventilasi bila terjadi kebocoran dan risiko terjadinya regurgitasi akibat terjadinya insuflasi gastrik. Dengan mengetahui tekanan kebocoran dari sungkup laring I-Gel ventilasi yang kita berikan lebih efisien apabila ventilasi positif yang kita berikan tidak melebihi dari tekanan kebocoran jalan nafas. Tujuan.Uji banding tekanan kebocoran jalan nafas antara sungkup laring I gel dengan pipa endotrakeal. Metode. Uji klinis acak terkontrol . Subyek penelitian adalah pasien-pasien yang menjalani pembedahan dengan anestesi umum menggunakan alat jalan nafas supraglotis di GBST RS Dr. Sardjito. Penelitian ini telah mendapatkan persetujuan komite etik dan pasien-pasien telah menyetujui informed consent, sebanyak 106 pasien dan memenuhi kriteria inklusi dan eksklusi dibagi menjadi 2 kelompok kelompok A (anestesi umum dengansungkup laring I-Gel) dan kelompok B (anestesi umum dengan sungkup laring pipa endotracheal). Tekanan kebocoran jalan nafas diukur dengan cara menutup katup ekspirasi, menutup below, APL pada mesin anestesi dengan FGF O2 sebesar 3 L/mnt, dan dicatat tekanan jalan nafas ketika dial manometer aneroid dengan satuan cmH2O terkalibrasi yang terdapat pada mesin anestesi ketika jarum pada manometer arenoid sudah tidak naik lagi Hasil Tekanan kebocoran jalan nafas menggunakan I-Gel sebesar 25,81 cmH2O ± 8,093, sementara itu jalan nafas menggunakan pipa endotrakeal tidak ada kebocoran sampai dengan tekanan 40 cmH2O. Kesimpulan Tekanan kebocoran jalan nafas antara sungkup laring I gel dibandingkan dengan pipa endotrakeal berbeda bermakna.

Background.The endotracheal tube has been the best methods in airway management, since it’s very effective in protecting the airway by preventing aspiration caused by the regurgitation of gastric acid. Today, there are many supraglottic airway tools that were used because of having little effect on the disturbance cardiovascular system since they were less invasive than the endotracheal tube. I-Gel was a new and inovative airway management’s tool with elastic non air cuff that considered to be effective during spontaneus ventilation anaesthesi, or with positive pressure ventilation. One of the disadvantage of I-Gel compared to the ordinary endotracheal tube is ventilation disturbance if there were any leak, and the risk of regurgitation caused by gastric insufflation. By knowing the leak pressure from the I-Gel, the anaesthetist could give a much more effective ventilation when the given positive ventilation was not exceeding the airway pressure leak. Objective. Clinical trial of the airway leak pressure between the I-Gel and endotracheal tube. Methods. Randomized controlled trial. The subjects were patients the were underwent surgical procedure with a general anaesthesia using supraglottic airway management tools in the Central Operating Room Sardjito General Hospital. This they has been approved by the ethic committee and the patient had signed the informed consent. There were 106 patients entered by the inclusion and exclusion criteria, divided in to two groups, the A group received general anaesthesia using I-Gel laryngeal mask, and B received general anaesthesia using endotracheal tube. Airway leaks pressure was measured by closing the expiration valve, closing the ventilation bag, APL in the anaesthetic machine with 3l/mnt FGF of O2, the airway leakage pressure were reached at the pressure the manometer aneroid when no more increase. Result The airway leakage pressure using I gel were 25,81 ± 8,093 where are no leakage using endotrakeal tube until airway pressure to 40 cmH2O. Conclusion There was a significant difference between leakage pressure in the IGel compared to the endotracheal tube.

Kata Kunci : Tekanan kebocoran jalan napas, sungkup laring I-Gel, Pipa Endotrakeal