lapsus sulit intubasi

8/18/2019 Lapsus Sulit Intubasi

1/59

Manajemen Perioperatif pada Pasien StrumaUninodosa Bilateral, Deviasi Trakea Ke Kanan,Sulit Intubasi

Oleh :

Karina Survival Rofiq (105070101111011)

Pembimbing :Dr. dr. A. Andyk Asmoro, Sp.An / dr. di

LABORATORIUM / SMF ANESTESIOLOGI DAN TERAPI INTENSIFFAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA

RUMAH SAKIT UMUM DR SAIFUL ANWARMALANG

!"#$

LAPSUS


2/59

Intubasi Sulit


3/59

De nisi

Intubasi Sulit%suatu keadaan intubasi yan

Dibutu!kannya " # kali usa!a intubasiatau usa!a

%intubasi yan terak!ir " $% menit&

'meri(an So(iety of 'nest!esiolo ist )Pra(ti(e *uidelines for Mana ement of T!eDi+(ult 'ir ay, 'n update report, -%%#


4/59

% Tra(!eal intubation is

best a(!ieved in t!e(lassi( "snifng themorning air" position in

!i(! t!e neck is exed

and there is extensionat the cranio-cervical(atlanto-occipital)

j nction

%t!e stru(tures of t!e upper air ay in t!e optimumposition for laryn os(opy and permits t!e best vieof t!e laryn.


5/59

%snifng position


6/59

/valuasi Kesulitan Intubasi

Kriteria )&01/M234

&1M M'P&5 D&6ilson 7isk S(ale

&Ma boul 5M


7/59

Skala 1/M23

Look e.ternally! valuate #8#8-8$ rule

allampati# bstru(tion$ e(k mobility


8/59

Tabel Skala 1/M23


9/59

#8#8- 7U1/


10/59


11/59

%Kelas $ ) Semua ba ian arkus palatum terli!at termasukarkus palato losus bilateral ju a terli!at !in a dasar&%Kelas - ) Ba ian atas arkus palato losus terli!at dan uvula ju a masi! terli!at&

%Kelas # ) 9anya palatum durum dan palatum molle yanterli!at&

%Kelas 5 ) 9anya palatum durum yan terli!at&

Skor Mallampati


12/59


13/59

:orma(k 1e!ane S(ore

%*rade I ) Seluru! apertura larin tervisualisasi

%*rade II ) 9anya komisura posterior dari aperturalarin yan tervisualisasi%*rade III ) 9anya epi lotis yan tervisualisasi%*rade I; ) 9anya palatum mole yan tervisualisasi


14/59

1M8M'P

Look for e.ternal fa(e deformitiesallampati

easure #8#8-8$ n ersAtlanto8o((ipital e.tensionP at!olo i(al obstru(tive (onditions


15/59

5 D

%entition


16/59

6ilson 7isk S(ore

6ei !t a movement


17/59

Ma boul 5 MS

allampatieasurement

ovementalformation of ST2P


18/59


19/59


20/59

Persiapan Dasar Intubasi

Sulit&'ssistant yan terlati! dokter anest!esi&1arin oskop berba ai ukuran&/TT berba ai ukuran&Introdu(er


21/59


22/59

&ailed int 'ation - #vervie o ailed int 'ation drill


23/59


24/59

1aporan Kasus


25/59

Identitas% N'm' : Tn T

% N( Regi)*e+ : ##!,-"$.

% U)i' : ., *' 0n

% Jeni) Ke1'min : L'2i&1'2i% A1'm'* : J1 B1imbing K'+'ng2'*e) M'1'ng

% Pe2e+3''n : B'ng0n'n

% S*'*0) : Meni2'

% TB : #," 4m% BB : 5$ 2g

% BMI : !67!


26/59


27/59


28/59

A : A1e+gi m'2'n'n 8&97 (b'* 8&9

! : &

" : DM 8&9 HT8&9

# : 5 3'm )ebe10m (

$ : Pasien men elu! benjolan di le!er kanandan kiri sejak 5 ta!un sebelum masuk ruma!

sakit& Benjolan ikut ber erak saat menelan&Sesak


29/59

%1 : Ai+;'< '*en7 ben=' ')ing 8&9 7 )0'+' *'mb' 'n neg'*i>7BM 6 J'+i 7M'11'm '*i II 7 3e3') 1e e+ 8&97 n


30/59

%' : G S .$57 0 i1 b01'* i)(2(+ 6mm/6mm7 R /% : BAK 8 9 ) (n*'n%5: F1'*7 S0 e17 BU 8 9 N7 Me*e(+i)m0) 8&9% : e=em' & / & 7 mem'+ 8&9 )i'n()i) 8&9 'nemi) 8&9 & &


31/59

%L'b(+'*(+i0m 8#" M'+e* !"#59%DL : #67@/## .@"/.!75 /!55 """%PPT/APTT : ='1'm b'*') n(+m'1%GDS : ##6%Hi*0ng 3eni) : " "/" !/@@ ./$ "/5 .%SE : #6./ .7.5/#"5%

T6/T./TSH : #7"5/#76!/"7@

Pemeriksaan Pen njang


32/59

Peme+i2)''n R'=i(1(gi



33/59

Peme+i2)''n R'=i(1(gi



34/59

& Kesimpulan )

& Tumor T!yroid


35/59

Assesment *'S' - Struma /ut!yroid, deviasi

trakea ke kanan, kemun kinan sulitintubasi

D. Beda! ) SM33T D S susp anas T#3%M%

7en(ana 2P ) Total T!yroide(tomy

7en(ana 'nestesi ) *' intubasi oral sleepnon apneu /TT diameter G


36/59

%/B; ? G% . G% k ? 5A%% ((%'B1 ? $#,H $% . 5A%% ? $#5A ((

% $#,H%M ?


37/59

Persiapan Pre 2p di7uan an%KI/


38/59

%Persiapan dasar Intubasi Sulit%S(ope L stetoskop, larin oskop% Tubes L /TT


39/59

Pemba!asan


40/59

Inde. 6ayneournal vol& -, 3o& CH%A=

$o +ejala $ilai

$ Sesak saat kerja E$

- Berdebar E-

# Kelela!an E-5 Suka udara panas 8C

C Suka udara din in EC

J Kerin at berlebi!an E#

G *u up E-

H 3afsu makan naik E#

A 3afsu makan turun 8#

$% Berat badan naik 8#

$$ Berat badan turun E#


41/59

T!e Britis! Medi(al >ournal vol& -, 3o& CH%A$o ,anda ( ) (-)

$ Tiroid teraba E# 8#

- Bisin tiroid E- 8-

# /.optalmus E- 8

5 Kelopak mata tertin al

erak bola mata

E$ 8

C 9iperkinetik E5 8-J Tremor jari E$ 8

G Tan an panas E- 8-

H Tan an basa! E$ 8$

A Fibrilasi atrial E5 8

$% 3adi teratur@ H%. menitH%8A%. menit"A%. menit

88E#

8#88


42/59

.asil skor

%@ $$ ) 9ipotiroid%$$8$A ) /utiroid%" $A ) 9ipertiroid

% T!e Britis! Medi(al >ournal vol& -, 3o& CH%A

Skor pada Pasien adala!$$

Skala 1/M23 pada


43/59

Skala 1/M23 padapasien


44/59


45/59


46/59

Grading the Airway(Cormack-Lehane)

Grade I - Full view of the glottic openingGrade II - Posterior portion of glottic opening visibleGrade III - Only tip of epiglottis is visible

Grade IV - Only soft palate is visible

Fi ure - :orma(k81e!ane


47/59


48/59

Special techni/ es or

int 'ation%A ake int 'ation nder localanaesthesia

T!e aim is to anaest!etise t!e upper air ay usin

lo(al anaest!eti( T!is avoids t!e need for general anaesthesiaand m scle relaxants to fa(ilitate intubation

T!is te(!niOue may be performed usin eit!er a0'reoptic exi'le 'ronchoscope or other0'rescope or sing direct lar1ngoscop1

'tropine C%% m( or ly(opyrrolate -%% m(s!ould be iven intramus(ularly !alf an !our beforeintubation to dry t!e mu(ous membranes


49/59


50/59

'lo aritma jalan nafas sulit

%Di(iptakan ole! 'meri(an So(iety of'nest!esiolo ists


51/59

Terimakasi!


52/59

2e'erapa hal 1ang har s diperhatikandalam menilai jalan na as 1ait antaralain (2 tter orth et al3 4567)*

%Pembukaan mulut dikatakan baik apabila lebi!dari # (m jarak antara i i insisi atas dan ba a!&

%Upper lip bite test &

%Klasi kasi Mallampati%Pasien den an obesitas atau BMI ≥ #% k m -

% T!yromental distan(e "# jari

%1in kar le!er ) apabila lin kar le!er " -G(mmaka didu a akan kesulitan untuk meli!atpembukaan lotis


53/59


54/59


55/59


56/59

D 2P


57/59

Durante 2P >enis anestesi ) *eneral 'nestesi Intubasi oral sleep non apneu /TTdiameter G

1ama anestesi ) $$% $G&%%


58/59

Post 2p

%Pasien masuk 77 jam $G&%%%Melakukan li(k test


59/59

lapsus sulit intubasi

Documents