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Abstrak :
ABSTRAK
Latar belakang : Pemasangan sungkup laring tanpa menggunakan obat pelumpuh otot membutuhkan tingkat kedalaman anestesia yang cukup untuk mendepresi refleks jalan napas sehingga menghindari tersedak, batuk dan laryngospasm. Tes klinis yang mudah, akurat dan aplikatif diperlukan untuk menghindari terjadinya komplikasi seperti di atas. Tujuan penelitian ini adalah mengetahui keefektivan trapezius squeezing test sebagai indikator kedalaman anestesia saat pemasangan sungkup laring dihubungkan dengan Bispectral Index. Metode : Setelah lolos kaji etik dan mendapatkan persetujuan klinik, 105 pasien ASA 1-2 dilakukan pemasangan sungkup laring dengan trapezius squeezing test sebagai prediktor kedalaman anestesia. Semua pasien mendapatkan premedikasi midazolam 0,05mg/kgBB dan fentanyl 1 mcg/kgBB. Induksi dilakukan dengan propofol titrasi, dengan kedalaman anestesia diukur dengan trapezius squeezing test. Pemasangan sungkup laring dilakukan bila trapezius squeezing test negatif. Dicatat keberhasilan pemasangan sungkup laring. Tekanan darah, laju nadi dan nilai Bispectral Index juga didokumentasikan. Hasil : Sungkup laring berhasil dipasang pada 88 pasien sedangkan 14 pasien gagal dilakukan pemasangan sungkup laring walaupun trapezius squeezing test negatif. Nilai median Bispectral Index saat trapezius squeezing test negatif adalah 35. Kesimpulan : Trapezius squeezing test merupakan indikator klinis yang dapat diandalkan untuk menilai kedalaman anestesia saat pemasangan sungkup laring.

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ABSTRACT
Background : Laryngeal mask insertion without using muscle relaxant requires a level of depth of anesthesia sufficient to depress airway reflexes to avoid choking, coughing and laryngospasm. Easy, accurate and applicable clinical tests are required to avoid complications as above. The purpose of this study was to determine the effectiveness of the trapezius squeezing test as an indicator of the depth of anesthesia when inserting laryngeal mask airway associated with Bispectral Index. Methods : After ethical clearance and receive informed consent, 105 ASA 1-2 patients were done laryngeal mask insertion with trapezius squeezing test as a predictor of anesthesia depth. All the patient were receive premedication midazolam 0,05 mg/kg and fentanyl 1 mcg/kg. Induction were done by propofol titration with anesthesia depth is measured by trapezius squeezing test. Laryngeal mask were inserted when trapezius squeezing test negative. The successful of laryngeal mask insertion was recorded. Blood pressure, pulse rate and Bispectral Index score were also documented. Result :Larygeal mask successfully inserted in 88 patients while 14 patients failed despite the negative results of trapezius squeezing test. The median score of Bispectral Index when trapezius squeezing test negatif was 35. Conclusion : Trapezius squeezing test is a reliable clinical indicator to assess the depth of anesthesia during laryngeal mask insertion.

Abstrak :
Latar Belakang : Penyapihan dari ventilasi mekanik adalah hal yang penting dalam merawat pasien kritis dan mendapatkan ventilasi mekanik. Tujuan dari penelitian ini adalah ingin mengetahui ketepatan parameter fraksi penebalan diafragma, nilai CRP, jumlah balans kumulatif dan nilai Rapid Shallow Breathing Index dalam memprediksi kemudahan penyapihan ventilasi mekanik pada pasien kritis di ICU. Metode: Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian adalah pasien dewasa yang dirawat menggunakan ventilasi mekanik. Dilakukan pemeriksaan fraksi penebalan diafragma, nilai CRP, jumlah balans kumulatif dan nilai Rapid Shallow Breathing Index pada saat 24 jam pertama di ICU dan pada saat ventilasi mekanik mode PS<8 atau T-Piece sampai maksimal hari ketujuh perawatan di ICU atau pada hari ketujuh bila belum berhasil disapih. Hasil: Pada penelitian ini didapatkan ketidakbermaknaan secara statistik antara fraksi penebalan diafragma terhadap kemudahan penyapihan ventilasi mekanik (p=0,071) pada uji bivariat. Pada analisis bivariat, pengaruh CRP terhadap kemudahan penyapihan ventilasi mekanik didapatkan hasil yang tidak bermakna secara statistik (p=0,724). Balans kumulatif dan nilai RSBI juga didapatkan hasil yang tidak bermakna secara statistik untuk memprediksi kemudahan penyapihan ventilasi mekanik (p=0,510 dan p=0,116). Kesimpulan: Fraksi Penebalan Diafragma, Nilai CRP, Jumlah Balans Kumulatif dan Nilai Rapid Shallow Breathing Index secara statistik tidak tepat untuk memprediksi kemudahan penyapihan ventilasi mekanik pada pasien kritis di ICU. ......Background: Weaning from mechanical ventilation is essential in caring for critically ill patients and obtaining mechanical ventilation. The purpose of this study was to determine the accuracy of diaphragm thickening fraction, CRP, cumulative fluid balance and Rapid Shallow Breathing Index in predicting the ease of weaning mechanical ventilation in critical patients in the ICU. Method: This study is a prospective cohort study in which the subjects were adult patients wo were treated using mechanical ventilation. The diaphragm thickening fraction, CRP value, cumulative fluid balance and Rapid Shallow Breathing Index value were examined during the first 24 hours in the ICU and during mechanical ventilation in PS <8 or T-Piece mode until a maximum of the seventh day of the treatment in the ICU or on the seventh day if have not been successfully weaned. Result: in this study, it was found that there was no statistical significance between the diaphragm thickening fraction and the ease of weaning from mechanical ventilation (p=0.071) in both bivariate. In bivariate analysis, the effect of CRP on the ease of weaning on mechanical ventilation was not statistically significant (p=0.724). The cumulative balance and RSBI values were also not statistically significant to predict the ease of mechanical ventilation weaning (p=0.510 and p=0.116) Conclusion: the diaphragm thickening fraction, CRP value, cumulative fluid balance and Rapid Shallow Breathing Index statistically not accurate to predict the ease of weaning mechanical ventilation in critical patients in the ICU.