PICO DAN CRITICAL APRAISSAL JURNAL COMPARISON OF

PROSEALTM LARYNGEAL MASK AIRWAY (PLMA) WITH CUFFED

AND UNCUFFED ENDOTRACHEAL TUBES IN INFANTS IN
OPERATION CENTRAL ROOM GENERAL HOSPITAL ULIN
BANJARMASIN

ERWIN IRWANDI 113063J116060

MARIA WILHELMINA EKA 113063J116062
RIANI MARSELINA113063J116067
RYAN KRISTANTO 113063J116069

NURSING SCIENCE STUDY PROGRAM AND PROFESSION OF

HIGHSCHOOL SCIENCE HEALTH SUAKA INSAN
BANJARMASIN
2017
 Background
Endotracheal intubation is a "gold standard"
for airway management. This procedure can
be performed in a number of cases of patients
with airway obstruction, loss of reflex
protection, keeping the lungs from secretions
in order to avoid aspiration and for any type of
respiratory failure. Endotracheal intubation
can be done through the nose or mouth.
The use of intubation in patients undergoing surgery may
prevent airway obstruction and serve as a means of
providing oxygen (O2) to the lungs and as a channel for
volatile anesthetic agents. So also in patients who will
undergo surgery in the operation room Ulin hospital
Banjarmasin especially patients who will require General
Anesthesia, for example on brain tumor surgery,
Laparastomy and others. According to the group
observation during practice in the ± four-day operation
room, the group found that of 44 patients in operation
there were about 35 patients (79.5%) using General
Anesthesia and ETT was performed, about 9 patients
(20.5%) using Spinal anesthesia. Based on these data the
group wanted to discuss more deeply about the
comparison of ETT use in surgical patients with patients
who did not use ETT at the time of surgery.
 PICO
P (Population)
Pediatric patients requiring general anesthesia
for elective lower abdominal surgery.
 Intervensi
 Group P
Inadvertent use of mask ventilation was avoided during the
induction of anesthesia before the insertion of the airway device.
After inserting the PLMA in the Group P, the correct position was
confirmed by the absence of audible sound escaping from the
mouth and by adequate chest expansion during ventilation. A
manometer (Portex Cufflator Endotracheal Tube Inflator and
Manometer, Portex Limited, Hythe, Kent, UK) was used to adjust
the intracuff pressure to 40 cm H2O. Then, gastric insufflation was
assessed by auscultating the epigastrium, which was performed by
a blinded observer. Then, a nasogastric tube was inserted into the
PLMA drainage tube. Air leakage to the stomach was controlled by
checking for bubbles (foam) at the proximal end of the nasogastric
tube. Patients for whom the PLMA could not be placed correctly
after the third trial were excluded from the study.
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• Group C
The Truview infant EVO-2 laryngoscope (Truphatek) was used for the
endotracheal intubation groups. If resistance to the tube was
encountered at the larynx, then the size of the tube was decreased
by 0.5 mm. According to the recommendations of Motoyama et al.
and Lee et al., the tube sizes were checked after intubation by
testing air leak pressure. A positive airway pressure of 20 cm H2O
with the ventilator pressure release valve closed was applied with
the patient’s head in the neutral position and without inflating the
fully deflated cuff. If air leakage was not observed, the tube number
was decreased by 0.5 mm. The appropriateness of tube location
was confirmed by capnography and auscultation. After these
procedures, the cuff was inflated and the cuff pressure was
adjusted to 20 cm H2O. The number of tubes changed to
determine the appropriate size was recorded.
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• Group C and UC
Gastric insufflation in the groups C and UC was
assessed by auscultation of the epigastrium.
Then, a nasogastric tube was inserted through
the nose of the patient. Furthermore, air leakage
to the stomach was controlled by the use of
bubbles (foam) at the proximal end of the
nasogastric tube. The number of airway device
insertion attempts was recorded in all groups.
 Comparison
Comparison the volume and liquid fraction
between ProSeal laryngeal mask airway
(PLMA) and endotracheal intubation groups:
Cuffed ETT uncuffed ETT in patients aged 1-24
months who underwent surgery under the
elective abdomen.
 Outcome
• A significantly fewer number of attempts were
made to insert the airway device in the Group_P
than in the groups_C and UC (p < 0.01 and p < 0.01,
respectively). No significant difference was
recorded between the groups_C and UC
(p_=_1.00).
• No significant difference in gastric insufflation was
observed between the groups (p = 0.24).
• A significant difference in leak volumes and leak
fractions was observed between the Group_UC and
the other groups (p_< 0.01)
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• The incidence of laryngospasm at extubation was
significantly lower in the Group P than in the
other groups, but no difference was observed
between the groups C and UC (p < 0.01). The
incidence of coughing was lower in the Group P
than in the other groups (p = 0.03). No
differences were observed among the groups
related to stridor, croupretching, vomiting, blood
on the PLMA/ETT, blood at aspiration, treatment
of stridor, or desaturation incidence.
Thank you