Tatalaksana Jalan Napas pada Pasien dengan Fraktur Listesis Servikal Tidak Stabil

Abstract

Cedera tulang belakang leher/cervical spine injury (CSI) tetap menjadi penyebab utama morbiditas dan mortalitas di negara maju. Sekitar 12.000 kasus baru cedera tulang belakang terjadi di Amerika Serikat setiap tahunnya. Kebanyakan dari cedera tersebut (55%) merupakan cedera servikal, sedangkan 15% merupakan cedera yang berhubungan dengan torakolumbal. Studi epidemiologis baru, menunjukkan bahwa cedera tulang belakang leher terjadi sekitar 1,8% hingga 4% pada kasus cedera trauma tumpul dan menyebabkan sekitar 6.000 kematian dan 5.000 kasus baru quadriplegia per tahun. Kasus laki-laki usia 55 tahun dengan riwayat trauma leher 5 bulan sebelum masuk rumah sakit. Pemeriksaan fisik didapatkan adanya tetraparese dan nyeri hebat pada daerah leher, terutama saat ekstensi kepala. Dari pemeriksaan laboratorium tidak didapatkan kelainan, dari pemeriksaan magnetic resonance imaging (MRI) leher didapatkan spondilolisthesis C6-7 berat sehingga korpus C6 di anterior C7. Dilakukan anestesia umum, dengan manajemen jalan napas intubasi manual in-line, serta menggunakan video laringoskop. Intubasi dilakukan 2 kali percobaan karena kesulitan visualisasi pita suara. Operasi berlangsung 10 jam, pasien kemudian dirawat di ICU selama 1 hari sebelum pindah ruang rawat biasa. Airway Management in Patient with Unstable Listhesis Cervical Fracture Cervical spine injury (CSI) remains a major cause of morbidity and mortality in developed countries. About 12,000 new cases of spinal cord injury occur in the United States each year. Most of these injuries (55%) are cervical injuries, while 15% are torakoumbal-related injuries. New epidemiological studies show that cervical spine injuries occur in about 1.8% to 4% in blunt trauma cases and cause around 6,000 deaths and 5,000 new cases of quadriplegia per year. The case of a 55-year-old male with a history of neck trauma 5 months before being hospitalized. Physical examination is found for tetraparese and severe pain in the neck area, especially during head extension. From the laboratory examination no abnormalities were found, from the magnetic resonance imaging (MRI) examination of the neck obtained severe C6-7 spondylolisthesis so that corpus C6 was anterior to C7. General anesthesia, with manual in-line intubation airway management with using a video laryngoscope. Intubation was carried out 2 times because of difficulty in visualizing the vocal cords. The operation lasted 10 hours, the patient was then admitted to the ICU for one day, then moved to ward.

Keywords

• fraktur
• jalan napas
• manajemen anestesia
• servikal
• airway management
• anesthesia management
• cervical spine
• fracture