Rapid squences intubation pada kasus status epileptikus
https://doi.org/10.22146/bns.v18i1.55064 Desin Pambudi Sejahtera(1), Imam Rusdi(2*), Damodoro Nuradyo(3)
(1) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author
Abstract
Status epileptikus merupakan kegawatdaruratan medik yang memerlukan terapi cepat dan agresif untuk mencegah kerusakan neuronal dan komplikasi sistemik. Masalah utama dan pertama yang harus dipikirkan adalah terjaganya patensi jalan nafas. Pengetahuan dan ketrampilan mengenai tatalaksana jalan nafas merupakan keahlian yang paling dibutuhkan dalam penanganan kegawatan SE di instalasi gawat darurat. Gangguan yang terjadi pada jalan nafas akan sangat cepat berpotensi mengakibatkan kematian. Target tatalaksana jalan nafas adalah menjamin patensi jalan nafas yang ditandai tercukupinya oksigenasi dan ventilasi. Tahapan penting dalam menjaga patensi jalan nafas, melakukan manuver sederhana untuk membebaskan jalan nafas, dan memberikan ventilasi secepatnya.
Tatalaksana jalan nafas berawal dari menilai patensi jalan nafas, menilai kesadaran, dan usaha nafas yang adekuat, dengan melihat peningkatan dada, dan dengan mendengar serta merasakan hembusan udara dari mulut dan hidung pasien. Pasien dengan obstruksi jalan nafas tidak dapat mencukupi pertukaran gas yang efektif. Obstruksi jalan nafas bisa sebagian atau total. Pasien dengan obstruksi jalan nafas total, tidak akan bisa bicara, dan mengalami hipoksia, dan akan sangat cepat mengalami penurunan kesadaran. Obstruksi nafas sebagian, lebih karena fungsional, karena palatum mole, lidah, dan jatuhnya epiglotis ke belakang dan bertemu dengan pharing bagian posterior. Manuver pembebasan jalan nafas meliputi head tilt, chin lift, dan manuver jaw thrust. Terkadang manuver-manuver tersebut tidak berhasil sehingga diperlukan alat bantu seperti Oropharingeal Airway ataupun Nasopharingeal Airway. Apabila dengan alat bantu tidak tercapai target oksigenasinya, maka perlu dipasang alat bantu nafas definitif berupa pemasangan Intubasi Endotrakea metode Rapid Squences Intubation (RSI). Pemasangan Intubasi Endotrakea RSI harus memperhatikan indikasi, tahap, komplikasi, dan mempertimbangkan risiko kegagalan.
Kegagalan intubasi dapat dikenali dengan berbagai pemeriksaan sederhana. Toleransi maksimal kegagalan tiap pasien berbeda, dengan estimasi tiga kali percobaan, atau sekitar sepuluh menit.
Keywords
Full Text:
PDFReferences
1.Chapman MG, Smith M, Hirsch NP. Review article: Status Epilepticus. Anaesthesia. 2001;56:648-659.
2.Marik PE & Varon J. Critical Review: The Management of Status Epilepticus. Chest. 2004;126:582-592
3.Osborne A, Taylor L, Reuber M, Gru RA, Parkinson M, Dickson JM. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines. 2015. Available from: http://doi.org/10.1016/j. seizure.2014.09.002
4.Mundlamuri RC, Sinha S, Subbakrishna DK, Prathyusha PV, & Nagappa M. Management of generalised convulsive status epilepticus (SE): A prospective randomised controlled study of combined treatment with intravenous lorazepam with either phenytoin, sodium valproate or levetiracetam Pilot study. Epilepsy Research. 2015. Available from: http://doi.org/10.1016/j.eplepsyres.2015.04.013
5.Perdossi. Pedoman Tatalaksana Epilepsi. Surabaya: Airlangga University Press; 2014.
6.Holt P. Status Epilepticus, Evaluation and Management. Emory Pediatric Acute Care Symposium. Atlanta: Departement of Pediatrics Emory University; 2000
7.George Kovacs, J. Adam Law, Ross J, Tallon J, MacQuarrie K, Petrie D, et al. Acute airway management in the emergency department by non-anesthesiologist. Canadian Journal Anesthesiology. 2008;174-180.
8.Browne TR & Holmes GL. Epilepsy: Definitions and Background, In: Handbook of Epilepsy. 2nd edition. Philadelphia: Lippincott Williams & Wilkins; 2000: 1-17.
9.Pagani J, Villa MP. Role of Continuous Positive Airway Pressure Therapy on the Pathogenesis of Sleep-Related Frontal Lobe Epilepsy in a Child With Obstructive Sleep Apnea Syndrome. NCBI; PMID: 18079319. 2008;124–128.
10.Chen JWY, Naylor DE, Wasterlain CG. Advances in the Pathophysiology of status epilepticus. Acta Neurol Scand. 2007;7-15
11.Shorvon S. The Management of Status Epileticus. J Neurol Neurosurg Psychiatry. 2001;70(2):1122-1127.
12.Huff JS. Status Epilepticus. E medicine Journal: Gilroy J. Basic Neurology. New York: McGraw-Hill; 2000:553-555.
13.Pornsriniyom D, Bena J, Andrews ND, Moul D, Foldvary-schaefer N. Epilepsy & behavior effect of positive airway pressure therapy on seizure control in patients with epilepsy and obstructive sleep apnea. Epilepsy&Behavior. 2014;13:270–275. Available from: http://doi.org/10.1016/j.yebeh.2014.07.005
14.Klemen P, Gremec S. Effect of pre-hospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury. Journal compilation Acta Anaesthesiol Scand. 2006;50:1250–1254.
15.Ohchi F, Komasawa N, Imagawa K, Minami T. Combination of videolaryngoscope and tracheal tube introducer for difficult infant airway management. Journal of Clinical Anesthesia. 2015. Available from: http://doi.org/10.1016/j. Jclinane. 2015.09.006
16.Graham CA, Gordon MWG. Status epilepticus in accident and emergency. Y cult case. 2001:492–493.
17.Stuart F, Reynolds, Jhon Heffner. Airway Management of the Critically Ill Patient: Rapid Sequence Induction. Chest. 2005;127:1397-1412.
18.Sluga M, Umenhofer, Wolfgang, Studer, Siegemund, Martin, et al. Rocuronium versus Succynylcholine for Rapid Sqquence Induktion of Aesthesia and Endotrakea Intubation: A Prospective, Randomized Trial in Emergent Cases. Anesthesia & Analgesia. 2005;1356-1361.
19.Longnecker DE, Brown DL, Newman MF, Zapol WM. Pharmacology of Intravenous Anesthetics. Anesthesiology. 2008:234-267.
20.Arya R, Carpenter JL, Chapman KE, Gaillard WD, Glauser TA, Goldstein DB, Status P. Gaps and opportunities in refractory status epilepticus research in children: A multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. 2014;23;87–97. Available from: http://doi.org/10.1016/j.seizure.2013.10.004
21.Von Elm EP, Schoettker I, Henzi J, Osterwalder, Walder. Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence. British Journal of Anaesthesia. 2009;103(3):371–386.
22.Rao BK, Vinod K Singh, Sumit Ray, Manju Mehra. Airway Management in Trauma. Indian J Crit Care Med April-June. 2004;8(2):98-105.
23.Walls RM, Murphy MF. Rapid Sequence Intubation, Manual of Emergency Airway Management, Third Ed. Lippincott: Wolters Kluwer; 2008:24-34.
24.Adrian AM. The Critical Airway. Canadian Journal of Anesthesia 2005;30(19):993-994.
25.Rick Kulkarini, MD. Tracheal Intubation, Rapid Sequence Intubation, Article Last Updated: 2006;Mar13.
26.Collin Dibble. Rapid sequence induction in the emergency department by emergency medicine personal. BestBETs. 2005:1-4. 2
7.Davis DP, Samir MF, Henry EW, Eileen MB. The Relationship Between Out-Of-Hospital Airway Management And Outcome Among Trauma Patients With Glasgow Coma Scale Scores Of 8 Or Less. Prehospital Emergency care. 2011:15(2).
28.Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology Internasional, 4th Edition. New York: Lange; 2006.
29.Morris J, Cook TM. Rapid sequence induction: a national survey of practice. Anaesthesia. 2001;56:1090-1095.
30.Freid EB. The Rapid Sequence Induction Revisited: Obesity and Sleep Apnea Syndrome. Anesthesiologi Clinics. 2005;8:551-554.
31.Pousman RM. Rapid Sequence Induction for Prehospital Provider. The Internet Journal of Emergency and Intensive Care Medicine. 2000;4(1):1-7.
32.Neligan P. How to Intubate Intensive Care Patient. Pulmonary Critical Care Medicine Tutorial. Michigan: University of Michigan; 2003:235-276.
33.Papadakos PJ. Approach to Sedation and Airway Management in the ICU. The Intensive Care Manual. 2001;14:350-359.
34.Simpson GD, Ross MJ, Mckeown DW, Ray DC. Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. 2012. Available from: http://doi.org/10.1093/bja/aer504 3
5.Franschman GSM, Peerdeman S, Greuters J, Vieveen ACM, Brinkman HMT, Christiaans EJ, et al. Prehospital endotrakea intubation in patients with severe traumatic brain injury: Guidelines versus reality. Journal Resuscitation. 2009;80:1147–1151.
36.Sørensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium–sugammadex compared with succinylcholine : a-randomized-trial. 2012:682–689. Available from: http://doi.org/10.1093/bja/aer503
DOI: https://doi.org/10.22146/bns.v18i1.55064
Article Metrics
Abstract views : 2371
| 
views : 6111
Refbacks
- There are currently no refbacks.
Copyright (c) 2020 Berkala NeuroSains
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.