PENGARUH TEKNIK EKSTUBASI TERHADAP KEJADIAN SPASME LARING PADA OPERASI TONSILEKTOMI

Abstract

Background: Laryngeal spasm is the most common cause of airway obstruction after extubation in general anesthesia, particularly on airway surgery such as tonsillectomy and adenoidectomy, the incidence rates 21-28%. Many studies have been performed to prevent the occurrence of laryngeal spasm, especially by using medications. Nevertheless, very few studies have been focused on extubation techniques to prevent laryngeal spasm besides deep extubation technique, but this technique carries the risk of aspiration because airway incompetence and ventilation inadequacy. Objective: To assess the effect of “ no-touch “awake extubation technique (treatment group) on the incidence of laryngeal spasm in tonsillectomy with or without adenoidectomy compared to deep extubation technique (control group). Method: Double-blind, randomized clinical study on 60 children with physical states of ASA I-II, meeting the inclusion criteria, who underwent tonsillectomy elective with or without adenoidectomy in Dr. Kariadi Hospital. The parent of each children was given information about the procedure and gave written informed consent on their children’s participation in the study. 30 children underwent “ no-touch “ awake extubation technique, and the remaining 30 underwent deep extubation technique. The degree of laryngeal spasm was assessed using 4 point scale. Statistical analysis was performed using SPSS (Statistical Package for Social Sciences) with Chi square test (level of significance, p < 0.05). Result: There was no significant difference in demographic characteristics between groups (treatment and control). No children (0%) of the “ no-touch “ awake extubation group and 4 children (13,33%) of the deep extubation group (control) had laryngeal spasm, respectively. Conclusion: “ no-touch “ awake extubation technique has lower incidence of laryngeal spasm compared with deep extubation technique in tonsillectomy with or without adenoidectomy. Keywords: “no touch” awake extubation, deep extubation, laryngeal spasm, tonsillectomy, adenoidectomy