Perbandingan Angka Keberhasilan dan Lama Intubasi antara Metode Laringoskopi Direk dan Videolaringoskopi pada Pasien Obesitas

Riri Lestari, Ezra Oktaliasah, Dhany Budipratama

Abstract


Obesitas merupakan salah satu prediktor independen jalan napas sulit. Laringoskopi direk menggunakan laringoskop Macintosh merupakan teknik standar yang paling sering digunakan untuk intubasi endotrakeal. Penggunaan videolaringoskop (VL) telah meningkatkan angka keberhasilan intubasi pada pasien dengan jalan napas sulit dan memberikan waktu intubasi yang lebih singkat dibanding dengan laringoskopi direk. Penelitian ini bertujuan mengetahui perbandingan angka keberhasilan dan lama intubasi antara metode laringoskopi direk dan videolaringoskopi pada pasien obesitas. Penelitian ini menggunakan metode prospektif analitik komparatif eksperimental, randomized single blind study dengan jumlah sampel sebanyak 22 pasien di Instalasi Bedah Sentral RSUP Dr. Hasan Sadikin Bandung pada periode November 2020–Januari 2021. Analisis statistik menggunakan Uji Eksak Fisher dan t dua kelompok independen. Dilakukan penilaian keberhasilan dan lama waktu intubasi endotrakeal setiap kelompok yang diuji. Pada kelompok VL, intubasi endotrakeal berhasil dilakukan pada 11 subjek dengan tidak ada subjek gagal, sementara pada kelompok direk didapatkan 6 subjek berhasil dan 5 subjek gagal. Lama intubasi pada kelompok VL rerata 27,69±7,73  detik dan kelompok direk 26,73±4,53 detik. Penelitian ini memberikan hasil angka keberhasilan intubasi endotrakeal dengan metode videolaringoskopi lebih tinggi secara signifikan (p<0,05) dengan waktu intubasi lebih lama yang tidak signifikan secara statistik (p>0,05). Simpulan, penggunaan metode videolaringoskopi pada saat intubasi pada pasien obesitas meningkatkan keberhasilan intubasi, namun tidak mempersingkat lama waktu intubasi.

 

Comparison of Success Rate and Intubation Time between Direct Laryngoscopy and Videolaryngoscopy Methods on Obese Patients

 

Obesity is one of independent predictors of difficult airway. Direct laryngoscopy with Macintosh blade is the frequent standard technique for endotracheal intubation. The use of videolaryngoscope has increased the success rate of intubation in patients with difficult airway and provided a shorter intubation time compared to direct laryngoscopy. The purpose of the study was to compare the result and time discrepancy when intubating obese patients with direct laryngoscopy and videolaryngoscopy methods. This study used prospective analytical comparative experimental, randomized single blind methods, on 22 patients at the central operating theatre Dr. Hasan Sadikin Hospital, Bandung during November 2020–January 2021. The study assessed the successful result and duration in doing endotracheal intubation from each study groups. In videolaryngoscopy group, 11 subjects were intubated successfully with no subject failed, while in group with direct laryngoscopy, 6 subjects were intubated successfully and 5 subjects failed. The mean time duration rate used to intubate in videolaryngoscopy group was 27.69±7.73 seconds, meanwhile in group with direct laryngoscopy was 26.73±4.53 seconds. The study shows higher successful rate of endotracheal intubation significantly (p<0.05) and longer time duration of intubation that is not significant statistically (p>0.05) in videolaryngoscopy group. In conclusion, intubation using videolaryngoscope increase the success of intubation but not  lessen the duration of  intubation time in  obese patients.


Keywords


keberhasilan intubasi; lama waktu intubasi; metode laringoskopi direk; metode videolaringoskopi; pasien obesitas

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References


Koh W, Kim H, Kim K, Ro Y-J, Yang H-S. Encountering unexpected difficult airway: relationship with the intubation difficulty scale. Korean J Anesthesiol. 2016;69(3):244.

Shiga T, Wajima Zi, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2015;103(2):429–37.

Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth. 2012;109(S1):i68–85.

Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscope in the setting of the predicted difficult airway. Anesthesiology. 2012;116(3):629–36.

Bhat R, Sanickop CS, Patil MC, Umrani VS, Dhorigol MG. Comparison of Macintosh laryngoscope and C-MAC video laryngoscope for intubation in lateral position. J Anaesthesiol Clin Pharmacol. 2015;31(2):226.

Shin M, Bai SJ, Lee KY, Kim HJ. Comparing McGRATH® MAC, C-MAC®, and Macintosh laryngoscopes operated by medical students: a randomized, crossover, manikin study. Biomed Res Int. 2016 Jan 1;2016.

Bradley P, Chapman G, Crooke B, Greenland K. Airway assessment. ANZCA. 2016;1(1):1–48.

Hagberg CA, Artime CA. Airway management in the adult. Dalam: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, penyunting. Miller’s anesthesia. Edisi ke-8. Philadelphia: Elsevier Saunders; 2015. hlm. 1647–83.

Butterworth J, Mackey DC, Wasnick J, penyunting. Airway management. Dalam: Morgan & Mikhails clinical anesthesiology. Edisi ke-6 McGraw Hill Companies; 2018. hlm 307–41.

Andersen J, Klock PA. Airway asessment and prediction of difficult airway. Dalam: Hagberg CA, penyunting. Benumof and Hagberg’s airway management. Edisi ke-4. Philadelphia: Elsevier Saunders; 2018. hlm. 185–96.

Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F, dkk. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy report from the multicenter perioperative outcomes group. Anesthesiology. 2013;119(6):1360–9.

Wang B, Zheng C, Yao W, Guo L, Peng H, Yang F, Wang M, Jin X. Predictors of difficult airway in a Chinese surgical population: the gender effect. Minerva Anestesiol. 2018;85(5):478–86.

Ogunnaike B, Joshi GP. Obesity, sleep apnea, the airway and anesthesia. Dalam: Hagberg CA, penyunting. Benumof and Hagberg’s airway management. Edisi ke-4. Elsevier; 2018. hlm. 732–40.

Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology. 2019;131(4):818–29.

Stojanovic M. The advantages of video laryngoscopy compared to standard laryngoscopy on intubation time and the quality of intubating conditions-a pilot study. EC Anaesthesia. 2019;5:59–64.

Goksu E, Kilic T, Yildiz G, Unal A, Kartal M. Comparison of the C-MAC video laryngoscope to the Macintosh laryngoscope for intubation of blunt trauma patients in the ED. Turk J Emerg Med. 2016;16(2):53–6.

Erdivanli B, Sen A, Batcik S, Koyuncu T, Kazdal H. Comparison of King vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial. Rev Bras Anestesiol. 2018;68(5):499–506.

Baek MS, Han M, Huh JW, Lim C-M, Koh Y, Hong S-B. Video laryngoscopy versus direct laryngoscopy for first-attempt tracheal intubation in the general ward. Ann Intensive Care. 2018;8(1):83.

Lascarrou JB, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T, Mercier E, dkk. Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients: a randomized clinical trial. JAMA. 2017;317(5):483–93.

Sakles JC, Mosier J, Chiu S, Cosentino M, Kalin L. A comparison of the C-MAC video laryngoscope to the macintosh direct laryngoscope for intubation in the emergency departement. Ann Emerg Med. 2012;60(6):739–48.

Ji SM, Lee JG, Kim S, Seo H, Lee BJ. The effect of low dose rocuronium on rapid tracheal intubation using a video laryngoscope. Medicine. 2018 Jun;97(22):e10921.

Zhou M, Xi X, Li M, Wang S, Liu Z, Liu JQ. Video laryngoscopy improves the success of neonatal tracheal intubation for novices but not for experienced medical staff. Front Pediatr. 2020;8:1–8.

Kim JW, Park SO, Lee KR, Hong DY, Baek KJ, Lee YH, Lee JH, Choi PC. Video laryngoscopy vs. direct laryngoscopy: which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? a prospective randomized controlled study of experienced intubators. Resuscitation. 2016;105:196–202.

Aziz MF, Brambrink AM. Video-assisted laryngoscopy. Dalam: Hagberg CA, penyunting. Benumof and Hagberg’s airway management. Edisi ke-4. Philadelphia: Elsevier; 2018. hlm. 417–27.

Hodgetts V, Danha RF, Mendonca C, Hillerman C. A randomised comparison of C-MAC videolaryngscope versus macintosh laryngoscope for tracheal intubation. J Anesthe Clinic Res. 2011;2:9.

Choi HY, Oh YM, Kang GH, Kang H, Jang YS, dkk. A randomized comparison simulating face to face endotracheal intubation of pentax airway scope, C-MAC video laryngoscope, glidescope video laryngoscope, and macintosh laryngoscope. Biomed Res Int. 2015; 2015: 961782.

Maarteens T, De Waal B. A comparison of direct laryngoscopy to video laryngoscopy by paramedic students in manikin-simulated airway management scenarios. Afr J Emerg Med. 2017;7(4):183–8.

Cavus E, Thee C, Moeller T, Kieckhaefer J, Doerges V, Wagner K. A randomised, controlled crossover comparison of the C-MAC videolaringoskop with direct laryngoscopy in 150 patients during routine induction of anaesthesia. BMC Anesthesiol. 2011;11(1):1–8.

Cattano D, Ferrario L, Patel CB, Maddukuri V, Melnikov V, dkk. Utilization of C-MAC videolaryngoscopy for direct and indirect assisted endotracheal intubation. J Anesthesiol Clin Sci. 2013;2:10.

Hall D, Steel A, Heij R, Eley A, Young P. Videolaryngoscopy increases ‘mouth-to-mouth’ distance compared with direct laryngoscopy. Anaesthesia. 2020;75(6):822–3.

Butterworth J, Mackey DC, Wasnick J, penyunting. Noncardiovascular monitoring. Morgan & Mikhails clinical anesthesiology. Edisi ke-6. United States: McGraw Hill Companies; 2018. hlm. 119–38.




DOI: https://doi.org/10.15851/jap.v9n2.2426



 

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