73
BAB VI
KESIMPULAN DAN SARAN
6.1. Kesimpulan
1. Tidak
ada perbedaan efektifitas antara Dexamethason 0,2 mgkgBB IV dengan
Lidokain 1,5 mgkgBB IV dalam hal mencegah nyeri tenggorokan setelah
operasi dengan intubasi endotrakeal pada anestesi umum. 2.
Angka kejadian nyeri tenggorokan dengan menggunakan Dexamethason 0,2
mgkgBB IV sebanyak 31.4
3. Angka
kejadian nyeri tenggorokan dengan menggunakan Lidokain 1,5 mgkgBB
IV sebanyak 35.1 4.
Pada jam ke‐1 tidak ada hubungan antara lama pembedahan dengan angka
kejadian nyeri tenggorokan. Pada jam ke‐6 ada hubungan antara lama
pembedahan dengan angka kejadian nyeri tenggorokan, semakin lama
pembedahan angka kejadian nyeri tenggorokan semakin meningkat. Pada
jam ke‐12 tidak ada hubungan antara lama pembedahan dengan angka
kejadian nyeri tenggorokan.
6.2. Saran
1. Pada
tindakan anestesi dengan intubasi endotrakeal disarankan penggunaan dexamethason
0,2 mgkgBB IV atau Lidokain 1,5 mgkgBB IV untuk mencegah
nyeri tenggorokan setelah operasi.
Universitas Sumatera Utara
74
2. Kepada
praktisi anestesiologis sebaiknya selalu melakukan pengukuran tekanan
cuff ETT agar tidak berlebihan dari yang dianjurkan. 3.
Perlu dilakukan penelitian selanjutnya untuk mencari obat yang lebih efektif
untuk mencegah nyeri tenggorokan setelah operasi.
Universitas Sumatera Utara
75
BAB VII
DAFTAR PUSTAKA
1. Thomas S, Beevi S, Dexamethason reduces the severity of postoperative sore
throat, CAN J ANESTH, 2007, 54:11: 897‐ 901.
2. Ayoup CM
, Ghobashi A, Koch ME, McGrimley L, Pascale V, Qadir S et al,
Widespread application of Topical Steroids to decrease sorethroat,
hoarseness, and cough after tracheal intubation, Anesthesia and analgesia,
1998;87;714 ‐6.
3. Soltani
HA, Omid A, The effect of different Lidocaine application methods on postoperative
cough and sorethroat, Journal of Clinical Anesthesia, 2002; 14:15
‐18. 4.
Sue RD, Irawan S, Long‐term complications of artificial airways, Clinics in
Chest Medicine 24 2003 p. 460.
5. Hara
K, Maruyama K, Effect of additives in Lidocaine spray on postoperative sorethroat,
hoarseness and dysphagiabafter total intravenous anesthesia, Acta
Anaesthesiologica Scandinavia 49 2005 p. 466. 6.
Sumathi P.A, Shenoy T, Ambareesha M, Krisna H.M, Controlled comparison
between Betamethason gel and Lidocaine jelly applied over trachea tube to
reduce postoperative sorethroat, cough, and hoarseness of voice, British
Journal of Anesthesia 2008;100 2: 215‐8.
7. Zahran IA, AL‐Sukkar M, Endotracheal tube cuff using air or saline to prevent
postoperative hoarseness and sorethroat, JRMS Dec 2003; 102: 38‐40.
Universitas Sumatera Utara
76
8. Maruyama
K, Sakai H, Miyazawa H, Toda N, Linuma Y, Mochizuki N et al , Sorethroat
and hoarseness after total intravenous anesthesia, British Journal of
Anesthesia 2004;924: 541‐3. 9.
Park SH, Hee Han S, Hwan Do S, Won Kim J, Young Rhee K, Hee Kim J ,
Prophylactic Dexamethason decrease the incidence of sorethroat and
hoarseness after tracheal extubation with a double‐lumen endobronchial
tube, Anesthesia and Analgesia vol 107 issue 6 2008, p.1814‐8.
10. Azim H, Safavi M, Beclomethason inhaler versus intravenous Lidocaine in the
prevention of postoperative airway and throat complaints, Ann Saudi Med
2008;281: 11‐16.
11. Ali
NP, Mulck T, Noor M, Mollick MT, Ahmed M, Chowdhury M, Lidocaine as endotracheal
tube cuff inflating agent, JAFMC Bangladesh. Vol 5, No I June 2009.
12. Higgins
P.P, Chung F, Mezei G, Postoperative sorethroat after ambulatory surgery,
British Journal of Anesthesiology 2002;88 4: 582‐3. 13.
Chandler M, Tracheal intubation and sorethroat: a mechanical explanation,
Anesthesia 57,2002, p.155.
14. Herlevsen
P, Bredahl C, Hindshlom K, Kruhoffer P.K, Prophylactic laringo‐ tracheal
aerosolized Lidocaine against postoperative sorethroat, Acta Anaesthesiologica
Scandinavia 1992: 36: 505‐6. 15.
Miller RD. Preoperative preparation and intraoperative management. In
Stoelting RK, Miller RD, editors. Basics of Anesthesia 5
th
ed. Philadelpia , Churcill
Livingstone Elseiver, 2007, p. 218.
Universitas Sumatera Utara
77
16. Anonim.
Endotracheal Intubation. http:www.medicined.comskiptmain; [diunduh
2 juli 2010]. 2002. 17.
Gisele AD. orotracheal Intubation. http:www.medstudent.com ; [diunduh 2
juli 2010]. 2002.
18. Morgan
GE, Mikhail MS, Murray MJ, Airway Management. In : Morgan GE, Mikhail
MS, Murray MJ, editors. Clinical Anesthesiology 4
th
ed. USA, McGraw‐ Hill
Companies, Inc.2006, p. 98‐06. 19.
Steven L, Ore B, Atlas of Airway Management, Chapter 3, 1
st
Edition, 2007. 20.
Martins GHR, Braz CRJ, Dias HN, Castilho CE, Braz GL, Navarro CHL,
Hoarseness after tracheal intubation, Revista Brasileria de Anestesilogia, Vol
56 No 2, Marco‐April, 2006.
21. James
RH, Steven HR, Bradly JN, Duane KR ,
Postoperative left vocal cord
disfunction caused by Ortner’s Cardiovocal Syndrome, Anesthesia analgesia
2001;92 : 1071‐2.
22. Thomas
M, Knoll H, Schreiber J, Echternach M, Klein S, Schomburg G et al, Rocuronium
is not associated with more vocal cord injures than Succinylcholin after
Rapid‐Squence Induction, Anesthesia Analgesia 2006;102 : 943‐9. 23.
Seegobin RD, Hasselt van GL, Endotracheal cuff pressure and tracheal mucosal
blood flow : endoscopy study of effects of four large volume cuffs, British
Medical Journal vol. 288,1984, p. 965‐68.
24. Castilho
EC, Braz JR, Cataneo AJ, Martins RH, Gregorio EA, Monteiro ER, Effects
of tracheal tube cuff limit pressure 25 cmH2O and seal pressure on
Universitas Sumatera Utara
78
tracheal mucosa of Dogs, Revista Brasileira de Anestesiologia vol. 53, N
o
6, Novembro
– Dezembro, 2003, p. 749‐54. 25.
Sengupta P, Sessler ID, Maglinger P, Wells S, Vogt A, Durrani J et al,
Endotracheal tube cuff pressure in three hospitals, and the volume required
to produce an appropriate cuff pressure, BMC Anesthesiology 2004; 4:8, p. 1‐
6. 26.
Braz JRC, Navarro LHC, Takata IH, Paulo NJ, Endotracheal cuff pressure : need
for precise measurement, Sao Paulo Med J Rev Paul Med 1999; 117 6 :243‐
7. 27.
Hakim El. M, Beclomethason prevents postoperative sore throat, Acta
Anaesthesiol Scand 1993; 37 : 250‐2.
28. McHardy
FE, Chung F, Postoperative sore throat : cause, prevention and treatment,
Anaesthesia, 1999; 54; p. 444‐53. 29.
Casino P, Hoarseness, American Academy of Oto laringology‐Head and Neck
Surgery one prince St. Alexandria, VA 22314‐3357,1‐703‐836‐4444, 2006.
30. Calvey
N, Williams N, Corticosteroids and Hipoglicaemic Agents ; Local Anaestetics.
In : Calvey N, Williams N, editors. Principles and Practice of Pharmacology
for Anaesthetists: Fiffth Edition, 2008, p. 329‐31; 160. 31.
Katzung, Adrenocorticosteroid and Adrenocortical Antagonist. In : Katzung,
editors. Basic and Clinical Pharmacology, 9
th
Edition, Section VII, Chapter 39, p.
907‐11.
Universitas Sumatera Utara
79
32. Neal
JM, Glucocorticoid ; Local Anaesthetics. In : Neal JM, editors. Medical Pharmacology
at a Glance Division of Pharmacology and Therapeutic Kings College
London, Fourth Edition, 2002, p. 17;73. 33.
Beggs S, Cosgarea M, Hatfield TN, Menshouse D, Salinas E, Slack AJ et al, Adrenocortical
Hormones. In : Beggs S, Cosgarea M, Hatfield TN, Menshouse D,
Salinas E, Slack AJ et al, editors. Introductory Clinical Pharmacology , 2008;Seventh
Edition, Unit IX, Chapter 50, p. 522‐4. 34.
Brunton L, Blumenthal D, Buxton L, Parker K, Gilman’s and Goodman
, Adrenocortical
Steroids ; Local Anesthetics. In : Brunton L, Blumenthal D, Buxton
L, Parker K, Gilman’s and Goodman, editors. Manual of Pharmacology and
Therapeutics , 2008; p. 1026‐31 ; 242‐6. 35.
Stoelting RK, Hillier SC, Local Anesthetics. In : Stoelting RK, Hillier SC, editors.
Pharmacology and Physiology In Anesthetic Practice 4
th
ed. Philadelphia, Churchill
Livingstone, 2000, p. 179‐80. 36.
Lauretti GR, Mechanisms of Analgesia of Intravenous Lidocaine, Revista
Brasileria de Anestesiologia, Vol 58, N
o
3, Maio‐Junho, 2008; p. 283‐5. 37.
Jackson T, Hamish H, Pharmacology of Local Anesthetics, Opthalmol Clin N Am
19, 2006, p. 155‐61.
38. Miller
RD. Local Anesthetics. In : Miller RD, editors. Anesthesia, 1998; 5
th
ed. Vol
2, Chapter 13, p. 491‐522. 39.
Tsai PS, Buerkle H, Huang LT, Lee TC, Yang LC, Lee JH, Lidocaine concentration
in plasma and cerebrospinal fluid after systemic bolus administration in
humans, Anesthesia Analgesia, 1998;87: p.601‐4.
Universitas Sumatera Utara
80
40. Peralta
R, toxicity;Lidocaine, Anesthesia and Emergency Medicine, May 30, 2008.
41. Charapov
L, Reid D, Bryson G, Krolczyk G, Caveno J, Intraoperative Lidocaine infusion
Analgesia trial, Intravenous Lidocaine Infusion Analgesia, December 18,
2007; p. 1‐19. 42.
Arlina RM, Amir S, Farida R, Perbandingan keefektifan penggunaan obat
kumur Listerin
®
dan Benzydamine Hydrochloride 0,075 sebelum intubasi untuk
mengurangi insiden nyeri tenggorok pasca intubasi, Anesthesia dan Critical
Care, 2008; Vol 26, No. 2,,125. Sun
‐young Park, Sang Hyun Kim, Ae‐ri Lee, Sung‐Hwan Cho, Won Seok Chae, Hee
Cheol Jin, Jeong Seok Lee, and Yong Ik Kim 43.
Park S, Hyun Kim S, Lee A, Hwan Cho S, Seok Chae W, Cheol Jin H et al,
Prophylactic effect of Dexamethason in reducing postoperative sore throat,
Korean J Anesthesiol, 2010;58:15‐9.
44. Kai
Hung N, Tang Wu C, Ming Chan S, He Lu C, Shiou Huang Y, Chang yeh C et al,
Effect on postoperative sore throat of spraying the endotracheal tube cuff with
Benzydamine Hydrochloride, 10 Lidocaine, and 2 Lidocaine, Anesthesia
Analgesia, 2010;X:X. 45.
Biro P, Seifert B, Pasch T, Complaints of sore throat after tracheal intubation :
a prospective evaluation, European Journal of Anesthesiology, 2005;22:307‐
11 46.
Canbay O et al, Ketamin gargle for attenuating postoperative sore throat,
British Journal of Anesthesia, 2008;100;4:490‐3
Universitas Sumatera Utara
81
47. Ebneshahidi
A, Mohseni M, Strepsils® tablets reduce sore throat and hoarseness
after tracheal intubation, Anesthesia‐Analgesia, 2010;X:1‐3 48.
Rahimi M, Makarem J, Effects of Diclofenac Epolamine Patch on postoperative
sore throat in parturients after Cesarean Delivery under endotracheal general
anesthesia, Acta Anesthesiol Taiwan, 2009;471:17‐21
49. Ahmed
A, Abbasi S, Ghafoor H, Ishaq M, Postoperative sore throat after elective
surgical procedures, J Ayup Med Coll Abbottabad, 2007;192:12‐14 50.
Gallinski M et al, Intracuff pressures of Endotracheal tube in the management
of airway emergencies: The need for pressure monitoring, Annals of
Emergency Medicine, 2006;47:545‐547
Universitas Sumatera Utara
82
BAB VIII
LAMPIRAN 8.1
Lampiran 1
RIWAYAT HIDUP PENELITI
Nama : dr . John Frans Sitepu
Tempat Tgl Lahir
: Laubuluh, 22 Februari 1980 Agama
: Islam Alamat
Rumah :
Jl. Kol. Yos Sudarso No. 8 Simp. Martubung, Medan
Nama Ayah
: Lesna Sitepu Nama
Ibu : Nurliana Perangin‐angin
Status : Menikah
Nama Istri
: Deasy Linda Samosir Nama
Anak : Thalita Saqhy Sitepu
Riwayat Pendidikan
Universitas Sumatera Utara
83
1986 – 1992
: SD Negeri 040500 Jinabun
1992 – 1995
: SMP Deli Murni Bandar Baru
1995 – 1998
: SMA Negeri 1 Pancur Batu
1998 – 2004
: Fakultas Kedokteran UISU Medan
2008 – Sekarang
: PPDS Anestesiologi dan Reanimasi FK – USU
Medan
Universitas Sumatera Utara
84
8.2 Lampiran 2
