a prospective, randomized, controlled trial study
TRANSCRIPT
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A prospective, randomized, controlledtrial study of comparison of two
techniques for laryngeal mask airway
insertion
Jurnal..
Oleh :
Arisda HakimRosyid Ahmad
Pembimbing:
Dr. Kararawi Listuhayu Sp. An
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abstrack Introduction:In this study we compared the use of an intravenous propofol/propofol auto-
co-induction technique to propofol/midazolam for laryngeal mask insertion. We also studied
the incidence of undesirable effects in relation to LMA insertion.
Methodology: In this prospective, randomized, controlled trial study, 60 adults belonging to
ASA class 1 and 2 were randomly divided in three groups; Group1- Saline-propofol; Group 2-
Propofol-midazolam; Group 3- Propofol-propofol. The induction characteristics reviewing
various parameters like the induction dose required, hemodynamic changes and the cost of
induction were observed. Hemodynamic variables including heart rate (HR), systolic blood
pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) wererecorded at 2, 4 and 6 minutes post induction.
Results: We noticed a decrease in HR, SBP, and DBP & MAP in all 3 groups which was not
statistically significant. The total induction dose of propofol in Group 2 (106.3 21.26 mg)
and Group 3 (136.50 20.29 mg) was significantly lower than Group 1(159.75 31.39 mg) but
not statistically different between group 2 and 3. The total cost of induction was significantly
reduced in the midazolam co-induction group i.e. Group 2. The number of patients sufferingfrom apnea differed significantly between 3 groups i.e. 12 patients in Group 1, 6 patients in
Group 2 and 1 patient in Group 3. No significant difference was seen in 3 groups in incidence
of hiccups, excitatory phenomenon or laryngospasm.
Conclusion: Propofol co-induction (Group 2) and propofol auto co-induction is safe
alternative to propofol induction and is more cost effective as they decrease the cost of
induction. Midazolam co-induction is more economical than propofol auto co-induction.
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METODOLOGI
Insersi LMA
http://3.bp.blogspot.com/-lz-L5gbG-rY/T2u2kI7Z6ZI/AAAAAAAAAiA/c0MUVS-_b8c/s1600/Tehnik+insersi+LMA+dengan+staylet.jpghttp://4.bp.blogspot.com/-hymm3Bn2Gj8/T2u1feVfvQI/AAAAAAAAAhw/GoAOSOutPpY/s1600/Insersi+LMA.jpg -
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Penelitain acak pada 60 pasien dengan kondisi fisik ASA 1dan 2, yang masuk dalam kategori.
Grup 1 : saline-propofol
Grup 2 : midazolam-propofol
Grup 3 : propofol-propofol
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Dosis pemberian propofol
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Heart rate
Sistol, diastol dan MAP
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Respon pada pemasangan LMA
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Total biaya
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Kesimpulan
Penggunaan co-induksi midazolam-propofol
dan auto-induksi propofol terbukti aman, efek
samping lebih rendah, onset lebih cepat dan
biaya lebih murah dalam penggunaaannya
pada induksi propofol pada insersi LMA.
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Terima Kasih..
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Keuntungan Kerugian
Dibandingkan dengan
Face Mask
- Tangan operator bebas
- Fiksasi yang lebih baik pada penderita yang
berjenggot- Lebih leluasa pada operasi THT
- Lebih mudah untuk mempertahankan jalan
nafas
- Terlindung dari sekresi jalan nafas
- Trauma pada mata dan saraf wajah lebih
sedikit
- Polusi ruangan lebih sedikit
- Lebih invasif
- Resiko trauma pada jalan nafas lebih
besar- Membutuhkan keterampilan baru
- Membutuhkan tingkat anastesi lebih
dalam
- Lebih membutuhkan kelenturan
TMJ (temporo-mandibular joint)
- Difusi N2O pada balon
- Ada beberapa kontraindikasi
Dibandingkan dg ETT - Kurang invasif
- Kedalam anastesi yang dibutuhkan lebih
dangkal
- Berguna pada intubasi sulit
- Trauma pada gigi dan laryngx rendah
- Mengurangi kejadian bronkhospasme danlaryngospasme
- Tidak membutuhkan relaksasi otot
- Tidak membutuhkan mobilitas leher
- Mengurangi efek pada tekanan introkular
- Mengurangi resiko intubasi ke esofagus
atau endobronchial
- Meningkatkan resiko aspirasi
gastrointestinal
- Harus dalam posisi prone atau
jackknife
- Tidak aman pada pasien obisitas
berat- Maksimum PPV (positive pressure
ventilation) terbatas
- Keamanan jalan nafas kurang terjaga
- Resiko kebocoran gas dan polusi
ruangan lebih tinggi
- Dapat menyebabkan distensi
lambung
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Midazolam
Awitan aksi: IV 30 detik-1 menit; IM 15 menit;PO/rektal menit; intranasal < 10 menit;intranasal < 5 menit
Efek Puncak : IV 3-5 menit; IM 15-30 menit; PO30 menit; intranasal 10 menit; rektal 20-30 menit
Lama aksi: IV/IM 15-80 menit; PO/rectal 2-6 jam
Interaksi/toksisitas: Efek depresi SSP dansirkulasi dipotensiasi oleh alkohol, narkotik,sedatif,anestesik volatil, menurunkan MAC untukanestesik volatil; efeknya diantagonis olehflumazenil.
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Propofol