Tatalaksana Bronkospasme selama Anestesi Umum

Bronkospasme selama prosedur anestesi umum merupakan salah satu kejadian yang tidak diharapkan. Menurut beberapa literatur, etiologinya dapat disebabkan oleh proses anafilaksis, faktor mekanis, maupun farmakologis. Karakteristik utama dari bronkospasme adalah pemanjangan waktu ekspirasi, mengi, dan peningkatan peak airway pressure. Identifikasi dan penatalaksanaan segera dari bronkospasme selama anestesi umum harus dapat segera diketahui agar tidak menyebabkan hipoksia berkepanjangan, hipotensi, dan peningkatan angka morbiditas dan mortalitas. Penyebab utama dari bronkospasme harus diketahui segera selama penatalaksanaan yang dilakukan

A Randomized Crossover Comparison of Airway Sealing with the Laryngeal Mask Airway Ambu AuraFlex at Three Intracuff Pressures in Pediatric Laparoscopic Surgery

Objective An adequate intracuff pressure is important to ensure sufficient sealing function when using supraglottic airway devices to protect the airway from secretions and achieve adequate positive pressure ventilation. The aim of this study is to analyze a feasible and effective alternative Ambu AuraFlex intracuff pressure in child's laparoscopic surgery. Study Design Seventy-two children were included in this study. After insertion of the laryngeal mask airway AuraFlex, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 10, 30, and 60-cmH2O according to one of six sequences produced on the basis of 3 × 6 Williams crossover design. During the intraoperative period, AuraFlex was maintained using the last intracuff pressure of the allocated sequence. Oropharyngeal leak pressure, peak airway pressure, the fiberoptic view, mucosal change, and complications were assessed at three intracuff pressures. Results The OLP at the intracuff pressure of 10 cmH2O was significantly lower than that of 30 cmH2O (2# 18.1 ± 1.5 vs. 19.5 ± 1.4 cmH2O, p = 0.001; 2.5# 17.7 ± 1.2 vs. 20.2 ± 1.4, p = 0.001) and 60 cmH2O (2# 18.1 ± 1.5 vs. 20.0 ± 1.3 cmH2O, p = 0.002; 2.5# 17.7 ± 1.2 vs. 20.8 ± 1.1, p = 0.003). Compared with the peak airway pressure in pre-and postpneumoperitoneum, the OLP was significantly higher. Subgroup analysis showed no differences in mucosal change and complications. Conclusion Intracuff pressures of 30 may be sufficient for the Ambu AuraFlex in child's laparoscopic surgery, and there may be no added benefit of an intracuff pressure of 60 cmH2O, as oropharyngeal leak pressures were similar.

Comparison of ProSeal laryngeal mask airway, classical laryngeal mask airway with endotracheal tube in gynecological laparoscopy under controlled ventilation

Background: PLMA is a recent, complex, and ingenious development with some added feature of classic LMA like modified dual cuff, drain tube, positive pressure ventilation at higher peak inspiratory pressure. Study was to evaluate and compare the use of classical laryngeal mask airway, ProSeal laryngeal mask airway, and endotracheal tube with controlled ventilation in patients undergoing gynecological laparoscopic procedure.Methods: About 150 patients, ASA risk I and II, posted for elective gynecological laparoscopy were recruited in the study. All the patients between 18 to 45years of age were randomly divided in three groups, group PLMA, group CLMA, group ETT (50 patients each). Attempt of insertion of airway device, leaks pressure, pulmonary ventilation, hemodynamic; heart and MAP, gastric distention was recorded. All patients were of middle age group, comparable in weight. Mean duration of laparoscopy was comparable in all the groups.Results: Significant rise in heart rate and mean arterial pressure seen in group ETT after induction of anesthesia. Changes in the end tidal CO2 and peak airway pressure after induction of anesthesia, before and after pneumoperitonium were comparable in all three groups. After head low position peak airway pressure is slightly raised in group PLMA, group CLMA. Gastric distension was noted higher in group 10 % as compare to group PLMA (8%) and group (2%). Incidence of sore throat (22%), nausea vomiting (14%) and airway trauma (14%) was higher in group ETT.Conclusions: Hemodynamic stability was better in and CLMA group at time of induction and comparable in all three groups at time of pneumoperitoneum and trendelenburg position along with pulmonary ventilation. Post-operative sore throat, nausea vomiting was higher with endotracheal tube.

Manual hyperinflation and the role of physical therapy in intensive care and emergency units

Introduction: Although manual hyperinflation (MHI) is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8%) in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.