- Kesalahan teknik pemasangan face mask dapat menyebabkan kempisnya reservoir bag mesin anestesi walaupun klep tertutup, keadaan tersebut biasanya disebabkan adanya kebocoran didaerah sekitar sungkup. Tekanan sirkuit breathing yang tinggi dengan pergerakan dada yang minimal dan suara pernafasan yang redup menunjukkan adanya suatu obstruksi jalan nafas.
- Laryngeal Mask Airway (LMA) melindungi laring secara partial dari sekresi faringeal (bukan dari regurgitasi cairan lambung), dan LMA jangan dicabut sampai reflek jalan nafas pasien pulih kembali.
- Setelah pipa endotrakheal (TT) diinsersikan, balon TT dikembangkan dengan udara yang diperlukan selama ventilasi tekanan positif untuk meminimalkan tekanan yang ditransmisikan pada mukosa trakhea.
- Meskipun deteksi CO2 dengan capnograph merupakan konfirmasi terbaik dari adanya TT dalam trakhea, tapi tidak menghilangkan kemungkinan adanya intubasi bronkhial. Manifestasi dini dari bronkhial intubasi adalah peningkatan dari puncak tekanan inspirasi.
- Setelah intubasi balon TT tidak boleh berada diatas level kartilago krikoid, karena lokasi di intralaringeal yang lama dapat menyebabkan suara serak pada post operasi dan meningkatnya resiko dari kejadian terekstubasi.
- Pencegahan intubasi esofagus yang tidak disengaja adalah dengan terlihatnya ujung TT melewati pita suara, auskultasi dengan terdengarnya suara nafas di kedua dada, dan tidak ada suara gargling di gaster, atau dengan capnograf.
- Diagnosa intubasi endobronchial adalah suara nafas unilateral, desaturasi, tidak dapat dipalpasi balon TT di sternal notch.
- Tekanan negatif intratorak yang besar dapat menyebabkan edema paru tekanan negatif.
Keahlian penanganan jalan nafas merupakan keahlian utama untuk seorang dokter anestesi. Bab ini menerangkan anatomi dari saluran nafas atas, menguraikan alat-alat yang diperlukan, teknik, dan mendiskusikan komplikasi dari laringoskopi, intubasi, dan ekstubasi. Keamanan pasien tergantung dari pemahaman menyeluruh dari setiap topik-topik ini.
Referensi:
- Morgan, G. Edward. 2005. Clinical Anesthesiology, 4th Edition. Mc Graw-Hill Companies, Inc. United State.
- http://www.truphatek.com/
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