Perbandingan Ketinggian Bantal 4,5 cm dan 9 cm terhadap Visualisasi Glotis Saat Laringoskopi di Rumah Sakit Dr. Hasan Sadikin Bandung

Mohamad Deny Saeful Alam, Suwarman Suwarman, Ike Sri Redjeki

Abstract


 

Intubasi ialah prosedur baku mempertahankan patensi jalan napas dengan melihat secara langsung glotis melalui alat laringoskop. Visualisasi glotis akan lebih jelas pada saat tindakan laringoskopi langsung pada sniffing position. Ketinggian bantal yang berbeda akan memberikan visualisasi glotis yang berbeda pula. Penelitian ini merupakan penelitian eksperimen kuasi. Jumlah sampel penelitian 30 orang dengan 2 perlakuan berbeda, yaitu bantal dengan ketinggian 4,5 cm dan 9 cm. Pemilihan subjek penelitian dilakukan secara consecutive sampling dengan mengambil setiap subjek penelitian yang memenuhi kriteria inklusi. Subjek penelitian semua pasien yang menjalani operasi elektif dengan anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli 2015 yang memenuhi kriteria inklusi. Tujuan penelitian ini adalah mengetahui pengaruh pemakaian bantal 4,5 cm dibanding dengan bantal 9 cm terhadap nilai visualisasi glotis.  Visualisasi glotis dengan ketinggian bantal yang berbeda pada saat tindakan laringoskopi langsung dinilai menggunakan skala kelas Cormarck–Lehane (CL) dan skor percentage of glotic opening (POGO). Distribusi data dengan uji Shapiro Wilks, nilai p ditentukan menggunakan uji Wilcoxon dan bermakna jika p<0,05. Hasil penelitian ini menunjukkan bahwa nilai skala CL modifikasi kedua bantal berada pada kisaran  skala 1 hingga 2c (p=0,007). Skor  POGO bantal ketinggian 4,5 cm berada pada kisaran  20–100% dengan rata-rata 69,33±21,48%. Bantal ketinggian 9 cm skor POGO berada pada kisaran 30,00–80,00% dengan nilai rata-rata 58,333±15,33% (p=0,001). Simpulan, penggunaan bantal ketinggian 4,5 cm memberikan visualisasi glotis yang lebih baik saat laringoskopi langsung dibanding dengan  bantal ketinggian 9 cm.

 

 

 

Comparison of 4.5 cm and 9 cm Pillow Height in Glottis Visualization on Laryngoscopy at Dr. Hasan Sadikin General Hospital

 

Intubation is a standard procedure to maintain patency of the airway by  directly visualizing glottis with a laryngoscope. Visualization of the glottis will be clearer when direct laryngoscopy is performed in sniffing position. Different pillows heights will provide different visualization of the glottis. This study was a quasi-experimental study on 30 subjects who were divided into 2 experimental groups of 4.5 cm and 9 cm pillow heights. Subjects were sampled consecutively according to the inclusion and exclusion criteria. The population was all patients underwent elective surgery with general anesthesia at Dr. Hasan Sadikin Hospital Bandung during the period of July 2015. The purpose of this study was to determine the effect of using a pillow height of 4.5 cm when compared to 9 cm pillow height on glottis visualization based on an assessment using Cormarck–Lehane (CL) scale and percentage of glotic opening (POGO) scores. Data distribution was tested by Shapiro Wilks while the p values were determined using Wilcoxon test and was considered meaningful if p<0.05. The results showed that the value of modified CL–class scale for both pillow heights were in the range scale of 1 to 2c (p=0.007). The POGO scores of the 4.5 cm pillow height was in the range of 20–100% with an average percentage of 69.33±21.48%, while the POGO scores of the 9 cm pillow height were in the range of 30.00–80.00% with an average score of 58.333±15.33% (p=0.001). Therefore, the use of 4.5 cm pillow height gives better glottis visualization in direct laryngoscopy compared to the 9 cm pillow height.

 

 

 


Keywords


Ketinggian bantal, laringoskopi langsung, sniffing position, visualisasi glotis

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References


Wargahadibrata AH. Teori anestesiologi. Anestesiologi untuk mahasiswa kedokteran. Edisi ke–3. Bandung: SAGA olahcitra; 2008.

Larson CP. Airway management. Dalam: Morgan GE, Mikhail MS, Murray MJ, penyunting. Clinical anesthesiology. Edisi ke-4. New York: McGraw–Hill; 2006. hlm. 91–4.

Hagberg CA, Artime CA. Airway management in the adult. Dalam: Miller RD, penyunting. Edisi ke-8. Philadelphia: Elsevier Saunders; 2015. hlm. 1647–83.

Kitamura Y, Isono S, Suzuki N, Sato Y, Nishino T. Dynamic interaction of craniofacial structures during head positioning and direct laryngoscopy in anesthetized patients with and without difficult laryngoscopy. Anesthesiology. 2007;107:875–83.

Sinha S, Layek A, Bhattacharjee S, Hazra A. The effect of different pillow heights on direct laryngoscopic views: a prospective randomised controlled study. Egyptian J Anaesth. 2013;29(4):279–83.

Park SH, Park HP, Jeon YT, Hwang JW, Kim JH, Bahk JH. A comparison of direct laryngoscopic views depending on pillow height. J Anesth. 2010;24:526–30.

Wanderley GHS, Lima LC, Couceiro TCM, Silva WV, Coelho RQGA. Clinical criteria for airway assessment: correlations with laryngoscopy and endotracheal intubation conditions. Open J Anesth. 2013;3:320–5.

Crosby ET. Airway management in adults after cervical spine trauma. Dalam: Warltier DC, penyunting. Anesthesiology. Edisi ke-2. Philadelpia: Lippincott Williams & Wilkins; 2006. hlm. 1293–318.

Dawson J, Malik A. Dynamic optimisation of the sniff position during laryngoscopy using a pressure infusion bag. Anaesthesia. 2012;67:669–83.

Greenland KB, Edwards MJ, Hutton NJ. External auditory meatus sternal notch relationship in adults in the sniffing position. Br J Anaesth. 2011:268–9.

Prakash S, Rapsang AG, Mahajan S, Bhattacharjee S, Singh R. Comparative evaluation of the sniffing position with simple head extension for laryngoscopic view and intubation difficulty in adults undergoing elective surgery. Hindawi Publishing Corporation. 2011;2011:1–6.

Bhattarai B, Shrestha SK, Kandel S. Comparison of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy. Kathmandu Univ Med. 2011;9(33):58–63.

Singhal SK, Malhotra N, Sharma S. Comparison of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy. Indian J Anaesth. 2008;52:546–50.

Hafiizhoh N, Choy CY. Comparison of the ‘sniffing the morning air’ position and simple head extension for glottic visualization during direct laryngoscopy. Middle East J Anaesthesiol. 2014;22(4):399–405.

Ambardekar M, Pandya S, Ahuja P. Comparison of the sniffing position with simple head extension for laryngoscopic view in elective surgical patients. Indian J Anaesth. 2007;17:1–19.

Takenaka I, Aoyama K, Iwagaki T, Ishimura H, Kadoya T. The sniff position provides greater occipitoatlanto–axial angulation than simple head extension: a radiological study. Can J Anesth. 2007;54:129–33.




DOI: http://dx.doi.org/10.15851/jap.v5n3.1170

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