Perbandingan Pemakaian Lidocaine Spray 10% dan Penggunaan Teknik Blok Saraf Superior Laringeus dalam Mencegah Respon Hemodinamik dan Nyeri Pada Intubasi Endotrakeal di RS Haji Adam Malik Medan

Abstract

Background: Endotracheal intubation is act of inserting a tube into trachea with the aim of maintaining the airway, facilitating mechanical ventilation and administering anesthetic gases. However, intubation has many complications in the form of hemodynamic disturbances and airway trauma. Intubation stimulates cough reflex, laryngeal spasm, and stimulates the sympathetic nervous system resulting in an increase in blood pressure and pulse rate; This is dangerous for patients, especially patients who have a history of high blood pressure, cardiovascular disorders, and patients with head injuries. A number of topical and regional anesthetic techniques have been developed to facilitate intubation using local anesthetics to improve intubation quality and patient acceptance of intubation. The use of regional anesthesia with superior laryngeal nerve block is thought to have a better pain and hemodynamic response to endotracheal intubation than topical anesthetic lidocaine spray 10%. Objective: To compare the use of topical anesthetic lidocaine spray 10% with regional anesthesia superior laryngeal nerve block on pain and hemodynamic response in endotracheal intubation. The study was conducted by consecutive sampling method and single blind randomized controlled trial. Blood pressure, MAP, heart rate, RPP, and oxygen saturation were measured before and after intubation, sore throat response was measured by VAS. Results: BP, MAP, heart rata, and RPP had significant differences (p<0.05), where the lowest value was obtained in the superior laryngeal nerve block; except for oxygen saturation is not significantly different. The VAS of sore throat in the three groups was also not significantly different (p>0.05). Conclusion: The superior laryngeal nerve block has a better hemodynamic response than lidocaine spray 10%, but there is no difference in sore throat response between them.

Latar Belakang: Intubasi endotrakeal adalah tindakan memasukkan pipa ke dalam trakea bertujuan untuk menjaga jalan nafas, memfasilitasi ventilasi mekanik dan pemberian gas anestesi. Namun, tindakan intubasi memiliki banyak komplikasi berupa gangguan hemodinamik dan trauma jalan nafas. Intubasi menstimulasi refleks batuk, spasme laring, dan merangsang sistem saraf simpatis yang mengakibatkan peningkatan tekanan darah dan denyut nadi; Hal ini berbahaya bagi pasien khususnya pasien yang memiliki riwayat tekanan darah tinggi, gangguan kardiovaskular, serta pasien cedera kepala. Sejumlah teknik anestesi topikal dan regional telah dikembangkan untuk memfasilitasi intubasi menggunakan obat anestesi lokal demi meningkatkan kualitas intubasi dan penerimaan pasien terhadap intubasi. Penggunaan anestesi regional blok saraf superior laringeus diduga memiliki respon nyeri dan respon hemodinamik yang lebih baik pada intubasi endotrakeal dibanding anestesi topikal lidocaine spray 10%. Tujuan: membandingkan penggunaan anestesi topikal lidocaine spray 10% dengan anestesi regional blok saraf superior laringeus terhadap respon nyeri dan hemodinamik pada intubasi endotrakeal. Penelitian dilakukan dengan metode consecutive sampling dan single blind randomized controlled trial. Tekanan darah, MAP, denyut nadi, RPP, dan saturasi oksigen diukur sebelum dan sesudah intubasi, respon nyeri tenggorokan diukur dengan VAS. Hasil: TDS, MAP, denyut nadi, dan RPP memiliki perbedaan yang signifikan (p<0.05), dimana nilai terendah didapat pada perlakuan blok saraf superior laringeus; kecuali saturasi tidak berbeda signifikan. VAS nyeri tenggorokan pada ketiga grup juga tidak berbeda signifikan (p>0.05). Kesimpulan: Blok saraf superior laringeus memiliki respon hemodinamik yang lebih baik dibanding lidocaine spray 10%, namun tidak berbeda pada respon nyeri tenggorokan paska ekstubasi.