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"Pendahuluan. Angka kejadian POST dilaporkan dapat mencapai 60%. LMA masih memiliki kejadian POST hingga 26.3%. Berkumur dengan benzydamine hydrochloride terbukti efektif mengurangi POST, namun distribusinya di Indonesia belum merata. Kumur magnesium sulfat dapat dijadikan alternatif untuk mengurangi POST, harga dan distribusinya lebih merata. Penelitian ini bertujuan untuk membandingkan efektifitas kumur magnesium sulfat dengan benzydamine hydrochloride dalam mengurangi POST pascapemasangan LMA. Metode. Penelitian ini merupakan uji klinis acak tersamar tunggal. Sebanyak 164 subjek penelitian diambil secara consecutive sampling. Subjek penelitian mendapatkan botol penelitian yang berisikan obat kumur yang sudah dirandomisasi, dilanjutkan dengan prosedur anestesi. Setelah selesai operasi, pasien akan dinilai : kejadian nyeri tenggorok, derajat nyeri tenggorok, efek samping, odinofagia dan disfagia pada jam ke 2, 6, 24 dan 48 pascaoperasi. Hasil. Berdasarkan hasil penelitian, tidak didapatkan perbedaan bermakna antara kedua kelompok; pada kejadian nyeri tenggorok pasca-LMA di jam ke 2, 6 dan 24 dengan nilai P > 0.05 dan perbandingan derajat nyeri pasca-LMA kedua kelompok dengan nilai P > 0.05. Kejadian odinofagia kedua kelompok rendah dan hampir serupa. Tidak didapatkan efek samping dan kejadian disfagia pada penelitian ini. Simpulan. Kumur magnesium sulfat memiliki efektifitas yang tidak lebih buruk dibandingkan dengan kumur benzydamine hydrochloride dalam mengurangi kejadian nyeri tenggorok pascapemasangan LMA

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Introduction. The reported incidence of POST can reach 60%. LMA still has a POST incidence of up to 26.3%. Gargling with benzydamine hydrochloride has been proven to be effective in reducing POST, but its distribution in Indonesia is not evenly distributed. Magnesium sulfate gargle can be used as an alternative to reduce POST; its price and distribution are more even. This study aims to compare the effectiveness of magnesium sulfate gargle with benzydamine hydrochloride in reducing POST after LMA insertion. Method. This study was a single-blind, randomized clinical trial. A total of 164 research subjects were selected by consecutive sampling. Research subjects received research bottles containing randomized mouthwash, followed by an anesthesia procedure. After completion of the operation, the patient will be assessed for the incidence of throat pain, the degree of throat pain, side effects, odynophagia, and dysphagia at 2, 6, 24, and 48 hours after surgery. Results. Based on the research results, there were no significant differences between the two groups on the incidence of post-LMA throat pain at 2, 6, and 24 hours with a P value > 0.05 and a comparison of the degree of post-LMA pain between the two groups with a P value > 0.05. The incidence of odynophagia in both groups was low and almost similar. There were no side effects or incidences of dysphagia in this study. Conclusion. Magnesium sulfate gargle has no worse effectiveness than benzydamine hydrochloride gargle in reducing POST after LMA insertion."

"Latar belakang: Nyeri tenggorok pascaoperasi merupakan salah satu komplikasi yang terjadi setelah intubasi endotrakeal. Pencegahannya dapat menggunakan magnesium sulfat. Magnesium sulfat dapat menghambat pelepasan tromboksan A2, substansi P, dan glutamat, serta antagonis reseptor NMDA. Penelitian ini untuk membandingkan teknik pemberian magnesium sulfat melalui inhalasi dan kumur untuk mencegah kejadian nyeri tenggorok pascaoperasi.Metode: Penelitian ini merupakan uji klinik acak tersamar ganda terhadap pasien dewasa yang menjalani pembiusan umum dengan intubasi endotrakeal di RSCM pada bulan Oktober sampai November 2018. Sebanyak 108 pasien dialokasikan menjadi kelompok inhalasi (inhalasi magnesium sulfat 225 mg) dan kelompok kumur (kumur magnesium sulfat 20 mg/kg). Kejadian nyeri tenggorok dinilai hingga 6 jam pascaoperasi. Analisis data menggunakan uji bivariat dengan Chi-Square.Hasil: Kejadian nyeri tenggorok pascaoperasi pada kelompok inhalasi magnesium sulfat sebesar 14 (25,9%) dan kelompok kumur magnesium sulfat sebesar 5 (9,3%) dengan perbedaan bermakna (p 0,023). Tidak ada efek samping berupa iritasi, mual, hipotensi, depresi nafas, dan desaturasi. Hipermagnesium terjadi pada 1 (1,8%) pada kelompok kumur magnesium sulfat, namun secara klinis tidak terjadi intoksikasi magnesium.Simpulan: Inhalasi dan kumur magnesium sulfat dapat mencegah kejadian nyeri tenggorok pascaoperasi. Inhalasi magnesium sulfat tidak lebih baik dari kumur magnesium sulfat dalam mencegah kejadian nyeri tenggorok pascaoperasi.

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Background: Postoperative sore throat (POST) is one of the most common complications after endotracheal intubation. Magnesium sulphate can be used to prevent POST. Magnesium sulphate inhibits release of thromboxan A2, substance P, and glutamate, and also as NMDA receptor antagonist. This study is to compare between nebulized and gargle magnesium sulphate to prevent POST.

Method: A randomized double-blinded clinical trial study involving adult patients who underwent general anesthesia with endotracheal intubation at RSCM during October to November 2018. A total of 108 patients allocated to nebulized group (nebulized magnesium sulphate 225 mg) and gargle group (gargle magnesium sulphate 20 mg/kg). POST measured until 6 hours postoperative. Data were analyzed using bivariate analysis test with Chi-Square.

Results: Incidence of POST in nebulized group was 14 (25,9%) and gargle group was 5 (9,3%) with significant difference (p 0,023). No adverse events such as irritation, nausea, hypotension, respiratory depression, and desaturation. Hypermagnesium at 1 (1,8%) at gargle group, but clinically there was no magnesium intoxication.

Conclusion: Nebulized and gargle magnesium sulphate prevent POST. Nebulized magnesium sulphate was not better than gargle magnesium sulphate to prevent POST.

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"Latar Belakang: Manajemen jalan nafas alternatif dengan menggunakan Laryngeal Mask (LM) yang dilakukan perawat sebagai penolong pertama yang melakukan resusitasi jantung paru (RJP) pada situasi henti jantung didalam rumah sakit sebelum tim resusitasi datang. Penelitian ini meneliti perawat dengan pengalaman minimal melakukan manajemen jalan nafas akan lebih mudah melakukan pemasangan Laryngeal Mask Supreme pada manekin dibandingkan dengan pemasangan Laryngeal Mask Unique. Metode: Sebanyak 86 perawat dengan pengalaman manajemen jalan nafas minimal ikutserta sebagai subyek penelitian. Materi tentang anatomi jalan nafas, teknik, demonstrasi dan latihan pemasangan LM Supreme dan LM Unique pada manekin diberikan sampai subyek penelitian mampu memasang alat tersebut. Data penelitian diambil setelah pemberian materi selesai. Kemudahan pemasangan ditentukan jika memenuhi semua kriteria dari variabel keberhasilan pemasangan, jumlah upaya pemasangan < 2 kali dan lama waktu pemasangan < 30 detik. Hasil: Pemasangan LM Supreme yang mudah didapatkan sebesar 82 (52,6%) dan LM Unique 74 (47,4%). Pemasangan LM Supreme yang tidak mudah didapatkan sebesar 4 (25,0%) dan LM Unique 12 (75,0%). Uji statistik dengan uji Chi Square didapatkan perbedaan bermakna dalam hal kemudahan pemasangan (p<0,05). Kesimpulan: Pemasangan LM Supreme yang dilakukan oleh perawat pada manekin lebih mudah dibandingkan dengan pemasangan LM Unique.

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Background: Alternative airway management using the Laryngeal Mask by nurses who performed the first cardiac pulmonary resuscitation (CPR) on the situation in hospital cardiac arrest before resuscitation teams arrived. This study examined nurses with minimal experience doing airway management will be easier to perform the insertion of the Laryngeal Mask Supreme on manikins compared with Laryngeal Mask Unique insertion.

Methods: Eighty six nurses with minimum experience of airway management were participate in the study. The material on airway anatomy, technique of insertion, demonstration and practice insertion of Supreme Laryngeal Mask and Unique Laryngeal Mask on the manikins is given until subjects were able to insert the tool. The data were taken after the administration of the material is complete. Ease of installation is determined if it meets all the criteria of the variable success of the insertion, the number of attempts <2 times and installation time <30 sec.

Results: Insertion of the Supreme Laryngeal Mask easily obtained for 82 (52.6%) and Unique Laryngeal Mask 74 (47.4%). Insertion Supreme Laryngeal Mask that is not easy to come by 4 (25.0%) and LM Unique 12 (75.0%). Statistical test Chi Square test found a significant difference in terms of ease of insertion (p <0.05).

Conclusion: Insertion of the Laryngeal Mask Supreme performed by nurses on a manikins easier than the insertion of the Laryngeal Mask Unique."

"Pendahuluan : Percobaan insersi LMA yang berulang atau memanjang berkaitan dengan berbagai komplikasi. Masalah utama yang menjadi penyebab kegagalan insersi ialah ujung LMA yang dapat tertekuk ke arah kranial selama insersi. Diperlukan metode insersi LMA lainnya untuk meningkatkan angka keberhasilan insersi LMA.Metode: Penelitian ini adalah uji klinis acak yang melibatkan 92 pasien berusia 18- 60 tahun yang dilakukan anestesia umum dengan LMA UniqueÒ. Pada metode manipulasi digiti intraoral, jari telunjuk tangan non dominan dimasukkan ke dalam mulut, melewati sisi ipsilateral dan berada di belakang cuff. Pada saat ujung cuff mendekati palatum, dilakukan fleksi jari telunjuk, kemudian tangan dominan mendorong LMA. Kelompok kontrol dilakukan insersi LMA dengan metode standar (tanpa manipulasi digiti intraoral).Hasil: Insersi LMA dengan metode manipulasi digiti intraoral memiliki keberhasilan pada percobaan pertama yang lebih tinggi (100% dibandingkan 84,6%, p=0,012), waktu insersi yang lebih singkat (21,38 detik dibandingkan 32,42 detik, p<0,001), dan jumlah percobaan yang lebih sedikit (p=0,012). Pada kelompok perlakuan, didapatkan 10,9% nyeri tenggorokan dan 13,0% bercak darah setelah eksersi LMA. Terlipatnya ujung LMA dapat dicegah dengan menggunakan bantuan jari yang menahan mask tip agar tidak terlipat.Simpulan: Metode manipulasi digiti intraoral untuk insersi LMA UniqueÒ memiliki keberhasilan yang lebih tinggi dibandingkan dengan metode standar.

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Introduction: Prolonged and multiple attempts at LMA insertion are associated with various complications. Primary issue leading to insertion failure is potential folding of the LMA tip towards the cranial direction. Another LMA insertion method is needed to improve the success rate of LMA insertion.

Methods: This research is a randomized clinical trial involving 92 patients aged 18-60 undergoing general anesthesia with the LMA UniqueÒ. In intraoral digit manipulation method, non-dominant index finger is inserted into the mouth, passing by the ipsilateral side and slightly behind the cuff. When the cuff tip approaches the palate, the index finger is flexed, and then the dominant hand pushes the LMA. The control group undergoes LMA insertion using standard method.

Results: LMA insertion with intraoral digit manipulation method has a higher success rate in first attempt (100% compared to 84.6%, p=0.012), shorter insertion time (21.38 seconds compared to 32.42 seconds, p<0.001), and fewer insertion attempts compared to the standard method (p=0.012). In treatment group, the incidence of sore throat and blood stain were 10.9% and 13.0%. The incidence of blood stain after LMA removal was 13.0%. The folding of the LMA tip can be prevented by using finger support to hold mask tip in place and prevent it from folding.

Conclusion: The intraoral digit manipulation method for LMA UniqueÒ insertion has a higher success rate compared to the standard method."

"Tujuan. Tujuan pertama yaitu mengetahui kemudahan pemasangan Laryngeal Mask Airway(LMA) dengan teknik baku disertai penekanan lidah. Tujuan kedua yaitu mengetahui perbandingan kemudahan pemasangan LMA antara teknik baku disertai penekanan lidah dan teknik baku. Latar Belakang. Laryngeal Mask Airway merupakan alat bantu jalan nafas untuk mengatasi kesulitan jalan nafas. Teknik terbaru pemasangan Laryngeal Mask Airway berdasarkan penelitian Roodneshin dkk yang dipublikasikan pada Tanaffos 2011 yaitu teknik baku disertai penekanan lidah memberikan angka keberhasilan pemasangan 100%(tingkat keberhasilan paling tinggi pada penelitian LMA). Pemasangan LMA diharapkan mulus dan berhasil dalam pemasangan pertama tanpa menimbulkan trauma tetapi dalam prakteknya, pemasangan LMA bisa lebih dari satu kali. Penelitian ini dilakukan di RSUPN-Cipto Mangunkusumo sebagai penelitian perbandingan pertama dari penelitian Roodneshin dkk dengan beberapa penyesuaian. Metode. Penelitian ini dilakukan pada 80 pasien dewasa yang menjalani operasi elektif dengan anestesia umum menggunakan Laryngeal Mask Airway. Secara random, 40 pasien mengalami pemasangan LMA dengan teknik baku disertai penekanan lidah dan 40 pasien mengalami pemasangan LMA dengan teknik baku. Upaya pemasangan dan kemudahan pemasangan LMA dicatat dan dinilai. Pemasangan mudah bila kurang atau sama dengan 2 kali pemasangan LMA. Komplikasi pemasangan LMA berupa noda darah, nyeri menelan dan nyeri tenggorokan dicatat dan dinilai. Analisa statistik dilakukan dengan uji Chi-square dan Fisher Exact. Batas kemaknaan yang digunakan untuk semua uji adalah p<0,05. Hasil. Perbandingan proporsi keberhasilan upaya pemasangan pertama kali antara kelompok teknik baku disertai penekanan lidah dan teknik baku adalah 87,5% dibandingkan 65%. Perbandingan proporsi keberhasilan upaya pemasangan maksimal dua kali antara kelompok teknik baku disertai penekanan lidah dan teknik baku adalah 100% dibandingkan 97,5%. Secara statistik, perbandingan upaya pemasangan, kemudahan, komplikasi nyeri menelan, komplikasi nyeri tenggorokan antara teknik baku disertai penekanan lidah dan teknik baku, tidak berbeda bermakna. Kesimpulan. Pemasangan Laryngeal Mask Airway dengan teknik baku disertai penekanan lidah tidak lebih mudah dibandingkan teknik baku(100% dibandingkan 97,5%). Kekerapan komplikasi yang berbeda bermakna berupa noda darah (0% pada teknik baku disertai penekanan lidah dibandingkan 6,2% pada teknik baku).

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Purpose, The objective of this study is to know easiness of inserting Laryngeal Mask Airway(LMA) with the classic approached combined with tongue supression technique. Secondly, the study is to compare the success rate between classic approached combined with tongue supression technique and classic approached technique.

Background. Laryngeal Mask Airway is a device to overcome the difficulty of the airway management. Novel technique of Laryngeal Mask Airway insertion based on Roodneshin et aI research, publicised in Tanaffos 2011 was the classic approached combined with tongue supression technique resulted in 100% succes rate of insertion(highest success rate based on LMA research or study). LMA insertion is expected to be smooth and successful in the first attempt without inflicting trauma but in daily practice, insertion LMA can be more than once. This research is done at Cipto Mangunkusumo Hosptal, as the first comparison of research Roodneshin et al with some adjustments.

Methods. The study was done at 80 adult patients who underwent elective surgery with general anesthesia. A total of 80 adult patients was scheduled for elective operation with general anesthesia using Laryngeal Mask Airway. In random, 40 patients undergoing LMA insertion with classic approached combined with tongue supression technique and 40 patients undergoing LMA insertion with classic approached technique. The effort and success rate of LMA insertion was noted and evaluated. The easiness is if the insertion is attempted maximally twice. Complications of LMA insertion such as blood stains, sore throat, dysphagia was noted and evaluated. Statistical analysis conducted by test Chi-square and Fischer Exact. P<0,05 was considered significant.

Result. Comparison proportion first attempt of Laryngeal Mask Airway insertion between classic approached combined with tongue supression technique and classic approached technique was 87,5% compared with 65%. The proportion maximally twice attempt of Laryngeal Mask Airway insertion between classic approached combined with tongue supression technique and classic approached technique was 100% compared with 97,5%. Statistically, comparison attempt, success rate, dysphagia, sore throat between classic approached combined with tongue supression technique and classic approached technique, not significantly different.

Conclusion, Laryngeal Mask Airway insertion with classic approached combined with tongue supression technique no more easy compared with classic approached technique(100% compared with 97,5%). Complication which statistically significant different was blood stains(0% with classic approached combined with tongue supression technique compared with 6,2% classic approached technique)."

"Latar BeJakang: Laryngeal Mask Airway (LMA) telah diterima secara umum sebagai alat jalan napas. Pada praktik klinis, insersi LMA pada percobaan pertama dengan waktu sesingkat mungkin merupakan kondisi yang diharapkan sehingga efek samping agen anestesi minimal tanpa menimbulkan komplikasi demi keselamatan pasien. Dosis kecil atrakurium sebelum induksi dipilih untuk operasi dengan durasi singkat, agar tidak menunda pemulihan akibat pelumpuh otot namun perlu diperhatikan efek samping gejala kelemahan. Penelitian ini bertujuan mengetahui pengaruh pemberian atrakurium sebelum induksi dosis 75 dan 150 rncglkgBB terhadap keberhasilan percobaan pertama dan waktu insersi sehingga dapat menjadi standar dosis atrakurium untuk insersi LMA. Metode: Penelitian uji klinis acak tersamar ganda ini mengelompokkan 150 pasien dewasa yang mendapat layanan anestesia di ruang operasi RSCM rnenjadi 2 kelompok. Setelah koinduksi midazolam dan fentanyl, pasien kelompok eksperimen diberikan atrakurium dosis 75 mcglkgBB, sedangkan kontrol 150 mcglkgBB. Setelah 1 menit, diamati gejala keJernahan, yaitu ptosis, diplopia, dan sesak napas sebelurn induksi propofol. Insersi LMA dilakukan setelah pasien tidak respon terhadap jaw thrust setelah 90 detik pemberian propofol. Diambil data keberhasilan percobaan pertama dan waktu insersi, selain itu dicatat nilai rasio TOF sebelurn insersi, respon hernodinamik, dan komplikasi pascainsersi. Hasil: Keberhasilan insersi pertama kedua kelornpok tidak berbeda signifikan, yaitu 90,7% pada kelompok eksperimen dibandingkan 93,3% kontrol (p=0,547). Begitu pula waktu insersi 36,05±16,98 detik dan 33,75±13,55 detik untuk dosis 75 dan 150 mcglkgBB berurutan (p=0,359). Kornplikasi insersi pada kelompok ekspersimen 90,7% dan 93,3% kelompok kontrol. Gejala kelemahan ditemukan harnpir 2 kali lipat di kelompok kontrol dengan nilai rasio TOF yang juga lebih rendah. Respon hemodinamik setelah insersi LMA mirip di kedua kelompok. Simpulan: Penggunaan atrakurium dosis 75 mcglkgBB sama baiknya dibandingkan 150 mcglkgBB dalam memudahkan insersi LMA.

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Background: In clinical practice, success on first attempt of LMA insertion with the shortest times is aimed to achieve minimal adverse eventfrom. Small dose of atracurium given beJore induction is chosen Jor brieJ duration procedure therefore has minimal or no effect to recovery from neuromuscular blocking agent, but the consequences of partial paralysis before induction should be a concern. This study aims to compare the success onfirst attempt and insertion time oJLMA between 75 and 150 mcglkgBWatracurium, given beJore propofol induction in search for standard dose of atracurium to ease LMA insertion. Methotl: This double-blind randomized clinical trial divided 150 adult patients who received anesthesia procedllre in Cipto Mangunkusumo General Hospital operating theatres into two groups. After coinduction with midazolam and Jentanyl, patients in the study group received 75 mcglkgBWalracurium, meanwhilefor the control group was 150 mcglkgB W After 1 minute all the samples were evaluated for paralysis symptoms of ptosis, diplopia and shortness oj breath before propofol induction. LMA insertion then attempted after no response to jaw thrust manuever evaluated after 90 seconds from propoJol injection. Success on first attempt and time of insertion were the main outcomes evaluated, beside TOF ratio, hemodynamic responses and complications. Result: Success on first attempt rate was not significally worse, which was 90.7% for experiment group compare to 93.3% in .control (p=0,547). Insertion time was 36.05±I6,98 and 33,75±i3,55 second Jor respective group (p=0.359). Postinsertion complication in experiment group were higher but the paralysis symptoms were lower. Conclusion: Low dose oJ 75 mcglkgBW atracurium is equal compared to 150 mcglkgBW 10 ease LMA insertion."

"Latar belakang: Nyeri tenggorok pascaoperasi (POST) merupakan salah satu komplikasi yang sering muncul pada anestesia umum dengan teknik intubasi. Tujuan penelitian ini untuk membandingkan efektivitas tablet hisap amylmetacresol-dibenal dengan profilaksis deksametason intravena sebelum pemasangan pipa endotrakeal untuk mengurangi kekerapan POST.Metode: Penelitian ini adalah uji klinis prospektif yang diacak dan tersamar ganda pada 121 pasien yang menjalani operasi dalam anestesia umum menggunakan pipa endotrakeal.Pasien dibagi menjadi dua kelompok secara acak; Grup A 61 orang dan grup B 60 orang. Sebelum induksi, pasien dalam grup A diberikan tablet hisap amylmetacresol-dibenal dan suntikan NaCl 0,9% 2 ml dan grup B diberikan Deksametason 10 mg intravena dan tablet hisap plasebo. Nyeri tenggorok pascaoperasi dievaluasi dengan Numerical Rating Scale (NRS) 3 kali; setelah operasi saat Alderette skor 10, 2 jam pascaoperasi dan 24 jam pascaoperasi. Kekerapan dan derajat nyeri tenggorok pascaoperasi dicatat dan dianalisis dengan uji chi-kuadrat.Hasil. Tidak didapatkan perbedaan kekerapan nyeri tenggorok pascaoperasi bermakna pada kedua kelompok sesaat setelah operasi berakhir (18% pada kelompok A dan 16,7% pada kelompok B, p = 0,843), jam ke-2 (16,4% pada kelompok A dan 25% pada kelompok B, p = 0,242),dan jam ke-24 pascaoperasi. Derajat nyeri tenggorok pascaoperasi tidak berbeda bermakna di antara kedua kelompok.Simpulan. Tablet hisap amylmetacresol-dibenal sebelum pemasangan pipa endotrakeal memiliki efektivitas yang sama dengan profilaksis deksametason intravena dalam mengurangi kekerapan nyeri tenggorok pascaoperasi.

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Background. POST is one of the complications that often arise in the general anesthesia with intubation techniques. The purpose of this study was to compare the effectiveness of amylmetacresol - dibenal lozenges with prophylactic intravenous dexamethasone before intubation to reduce the incidence of POST.Methods. This study is a prospective randomized clinical trials and double-blind trial in 121 patients undergo surgery under general anesthesia using endotracheal tube. Patient divided into two groups at random ; Group A 61 and group B of 60 people. Before induction, patients in group A was given amylmetacresol - dibenal lozenges and injection of 2 ml of 0.9% NaCl and group B was given intravenous dexamethasone 10 mg and placebo lozenges . POST was evaluated by the Numerical Rating Scale ( NRS ) 3 times ; after surgery when Alderette score of 10 , 2 hours postoperatively and 24 hours postoperatively . The frequency and degree of POST were recorded and analyzed with Chi-Square test.Results. There were no differences in the incidence of POST significant in both groups after surgery when Alderette score of 10 ( 18 % in group A and 16.7 % in group B , p = 0.843 ) , h 2 ( 16.4 % in group A and 25 % in group B , p = 0.242 ), and the 24th hour postoperatively . The degree of POST was not significantly different between the two groups.Conclusion. Amylmetacresol - dibenal lozenges before intubation tube has the same effectiveness of prophylactic intravenous dexamethasone in reducing the incidence of POST."

"Anestesia umum dengan intubasi endotrakeal menggunakan pipa endotrakeal sering digunakan untuk memberikan ventilasi tekanan positif dan mencegah aspirasi. Namun, penggunaan alat ini dapat menimbulkan komplikasi atau keluhan pasca bedah seperti nyeri tenggorok. Penelitian ini dilakukan untuk membandingkan keefektifan profilaksis deksametason intravena dengan triamsinolon asetonid topikal dalam mengurangi nyeri tenggorok pasca bedah.Metode: Penelitian ini adalah uji klinis prospektif yang diacak dan tersamar ganda. Sebanyak 121 pasien yang dijadwalkan menjalani pembedahan dalam anestesia umum menggunakan pipa endotrakeal dimasukkan ke dalam dua kelompok secara acak; Grup A 61 orang dan grup B 60 orang. Sebelum induksi, pasien dalam grup A diberikan 10 mg deksametason intravena dan pasta plasebo dioleskan pada kaf pipa endotrakeal. Pasien dalam grup B diberikan 2 mL NaCl 0,9% dan pasta triamsinolon asetonid dioleskan pada kaf pipa endotrakeal. Skor nyeri tenggorok pasca bedah dievaluasi 3 kali; sesaat setelah pembedahan berakhir, 2 jam pasca bedah dan 24 jam pasca bedah. Insidens dan derajat nyeri tenggorok pasca bedah dicatat.Hasil: Tidak didapatkan perbedaan bermakna di kedua kelompok pada insidens nyeri tenggorok pasca bedah sesaat setelah pembedahan berakhir (27,9% pada kelompok A dan 18,3% pada kelompok B, p = 0,214). Derajat nyeri tenggorok pasca bedah tidak berbeda bermakna di antara kedua kelompok.Simpulan: Triamsinolon asetonid topikal memiliki keefektifan yang sama dengan profilaksis deksametason intravena dalam mengurangi insidens nyeri tenggorok pasca bedah.

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Tracheal intubation for general anesthesia is often used to give positive-pressure ventilation and prevent aspiration during anesthesia. However, the use of this airway device can cause complications and complains about postoperative sore throat (POST). This study was undertaken to compare the effectiveness of prophylactic intravenous dexamethasone to triamcinolone acetonide paste in reducing POST. Methods : This was a prospective, randomized, double-blind clinical trial. A total of 121 patients scheduled for surgery under general anesthesia using endotracheal tube were randomly allocated into two groups; 61 (group A) and 60 (group B). Before induction, group A receives 10 mg of intravenous dexamethasone and placebo paste applied over the endotracheal tube cuff. Group B receives 2mL of intravenous normal saline and triamcinolone acetonide paste applied over the endotracheal tube cuff. POST scores were evaluated 3 times; immediately after the operation, 2-hours, and 24-hours after the operation. The incidence and severity of POST were recorded.Results: There were no significant differences in the incidence of POST immediately after the operation between the two groups (27,9 % in group A vs 18,3% in group B, p = 0,214).The severity scores of POST were not significantly different between the two groups.Conclusion: Topical triamcinolone acetonide was equally effective compared to prophylactic intravenous dexamethasone in reducing the incidence of POST."

"Latar Belakang: Seorang dokter umum diharapkan mampu melakukan tindakan medis pada kedaruratan. Pada kondisi seperti resusitasi jantung paru, manajemen jalan nafas merupakan salah satu prioritas. Intubasi memiliki angka kegagalan tinggi bila dilakukan oleh bukan dokter anestesiologi. Sungkup laring (SL) sebagai alternatif manajemen jalan nafas memiliki tingkat keberhasilan yang tinggi. Di Fakultas Kedokteran Universitas Indonesia (FKUI), mahasiswa diharapkan mampu melakukan pemasangan SL pada pasien. Untuk mencapainya, Departemen Anestesiologi dan Intensive Care FKUI melakukan pengajaran rutin. Metode pengajaran yang direkomendasikan untuk pengajaran prosedur medis seperti pemasangan SL adalah metode empat langkah pengajaran. Penelitian ini bertujuan mengetahui perbandingan hasil pengajaran pemasangan SL oleh mahasiswa kedokteran yang mendapat metode empat langkah pengajaran dengan pengajaran rutin pada pasien dewasa yang menjalani anestesia umum di RSCM. Metode: Penelitian ini adalah uji klinik Randomized Controlled Trial (RCT), dilakukan secara terbuka (tidak tersamar). Subyek dilakukan randomisasi untuk menentukan metode pengajaran pemasangan SL pada manikin yang akan diterima. Setelah menerima pengajaran, subyek melakukan pemasangan SL pada pasien dewasa yang menjalani anestesia umum. Keberhasilan pengajaran dinilai dari pengembangan dada pasien ketika dilakukan ventilasi, jumlah upaya pemasangan, serta nilai seal pressure. Hasil: Sebanyak 46 subyek di awal penelitian, 3 orang masuk kepada kriteria pengeluaran. 43 subyek penelitian yang melakukan pemasangan SL pada pasien kemudian dianalisis. Pengembangan dada pasien ketika diventilasi didapatkan pada semua pasien di kedua kelompok. Kelompok metode empat langkah pengajaran membutuhkan jumlah upaya yang lebih sedikit, dan menghasilkan seal pressure yang lebih tinggi dibanding kelompok yang mendapatkan pengajaran rutin. Kesimpulan: Hasil pengajaran pemasangan SL oleh mahasiswa kedokteran yang mendapat metode empat langkah pengajaran lebih baik dibandingkan dengan pengajaran rutin.

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Background: A general physician is expected to perform medical procedures in emergency situations. in cardiopulmonary resuscitation, airway management is one of the priorities. Intubation has high failure rate when performed by non-anesthesiologist. Laryngeal mask (LM) as an alternative airway management has high success rate. In Faculty of Medicine University of Indonesia (FMUI), students are expected to perform the insertion of LM to patients. To achieve it, Department of Anesthesiology and Intensive Care FMUI perform regular teaching method. Teaching method that is recommended for teaching medical procedures such as the insertion of LM is a four stage teaching method. This study aims to compare the results of teaching LM insertion by medical students who get a four stage teaching method with regular teaching in adult patients undergoing general anesthesia in RSCM.

Study design: 46 subjects were included in the inclusion criteria for randomization to determine the insertion of LM teaching methods that will be accepted on a mannequin. After this course, every subject inserts LM in adult patients undergoing general anesthesia. The success of the teaching is assessed by the rising of patient's chest when ventilated, a number of attempts, and seal pressure.

Results: By 46 subjects in the initial study, 3 subjects have to exclude from this study. Then, the rest subjects inserting LM on patients are analyzed. The results of the study in both groups obtain 100% the rising of patient's chest when ventilated. Four stage teaching method's group requires less number of attempts than another and the shows higher in seal pressure than receiving regular teaching's group.

Conclusion: The result of the teaching LM insertion by medical students who get the four stage teaching method is better than the regular teaching method."

"[ABSTRAKLatar Belakang. Manajemen jalan nafas merupakan salah satu tahap yang paling penting dalam bidang anestesiologi. Salah satu jenis Alat bantu jalan nafas yang telah dipergunakan secara luas adalah Laringeal Mask Airway (LMA/Sungkup Laring). Pada pemasangan sungkup laring tanpa menggunakan pelumpuh otot membutuhkan kedalaman anestesi yang cukup, Tes klinis yang mudah, akurat dan aplikatif diperlukan untuk menghindari terjadinya komplikasi. Penelitian ini bertujuan untuk membandingkan trapezius squeezing test dan jaw thrust sebagai indikator kedalaman anestesi pada pemasangan sungkup laring dengan propofol sebagai agen induksiMetode. Sebanyak 128 pasien di randomisasi ke dalam 2 kelompok yaitu jaw thrust dan trapezius squeezing test. Seluruh pasien mendapatkan premedikasi dengan midazolam 0.05 mg/kgBB dan Fentanyl 1 mcg/kgBB. Induksi menggunakan propofol titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saat respon motorik hilang dilakukan pemasangan sungkup laring. Dicatat keberhasilan pemasangan, dosis propofol, tekanan darah, laju jantung, dan insiden apneu.Hasil. Keberhasilan pada kelompok jaw thrust 93.8%, sedangkan trapezius squeezing test yang 90.6%. Penggunaan rerata propofol pada kelompok jaw thrust yaitu sebesar 120.34 mg, sedangkan pada kelompok trapezius squeezing test yaitu sebesar 111,86 mg. Insiden apneu yang pada kelompok jaw thrust terjadi pada 10 (15.6%) pasien, sedangkan pada kelompok trapezius squeezing test sebesar 11 (17.2%) pasien. Tidak terdapat perubahan hemodinamik yang berarti pada kelompok jaw thrust sedangkan sedangkan pada kelompok trapezius squeezing test terdapat perubahan hemodinamik yang berarti di menit ke 3 dan ke 4Kesimpulan. Trapezius squeezing test tidak lebih baik daripada jaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring.

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ABSTRACTBackground. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.;Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion., Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.]"