UAO Prabedah 2013

8/13/2019 UAO Prabedah 2013

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Pra Bedah 2013


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1.Thyroid Cartilage2. Cricothryoid Space

3. Cricoid Cartilage4. Trachea

A. Cricothyroid MembraneB. Tracheal Ring


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Obstruction of the portion of the airways located above the thinletNoseNasopharynxOropharynxLarynx (supraglottis, subglottis)Trachea (extrathoracic)


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Mc Pherson K et al. Managing Airway Obstruction. British Journal of HospitalMedicine, October 2012, Vol 73, No 10


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Stridor (Inspiratoar)

Hoarseness (involvement of vocal cords)Respiratory distress (suprasternal retraction)CoughSigns of hypoxemiaAnxietyRestlessnessTachycardiaPallorCyanosis: late sign


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Recession (sternal, lower costal margin) Tachypnoea Tachycardia Expiratory difficulty (abdominal muscles contract) Depressed consciousness Cyanosis Noise soft/absent


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SnoringRetraction of the sternumRocking motion of the chest not insync with respiratory effortHarsh, high-pitched sound uponinspiration (stridor)

HypoxemiaHypercarbia

Lack of any air movemenLack of breath soundsRetraction of the sternumRocking motion of the chsync with respiratory effoHypoxemia

Hypercarbia

Lower Airway Obstruction: Air trapping (percussion), Upper border of liver displaced downwards, Cardiac dullness detected


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Anamnesis: usia, riwayat penyakit sebelumnya

Pemeriksaan fisikPemeriksaan penunjang: simultan


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Tracheal deviation

Extrinsic compressionRadiopaque foreign bodiesLateral insensitive & delay in securing the airway

Hammer J. Aqcuired Upper Airway Obstruction.PAEDIATRIC RESPIRATORY REVIEWS (2004) 5, 25 33


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Hammer J. Aqcuired Upper AirwayPAEDIATRIC RESPIRATORY REVIE


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Stable patient or in the unstable patient with an already

secured airway.High-resolution CT: intrinsic and extrinsic tumors, vascularstructures, and foreign bodies.Degree and extension of airway compromise


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Gradual and mild symptoms of UAO.

Relatively insensitive & has no role in acute respiratorydistressAnalysis of the flow-volume loops may be helpful suggestingthe location and functional severity of the obstruction


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Most effective tool (diagnosis & tx).

Rigid bronchoscope (emergency setting)Flexible bronchoscopy (establish the diagnosis, delivertreatment: laser therapy, photoresection, electrocautery,electrosurgery, balloon bronchoplasty, and tracheal stenting)


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Traumatic causes : Laryngeal stenosis, Airway burn, Acute

laryngeal injury, Facial trauma (mandibular or maxillaryfractures), HemorrhageInfections Suppurative parotitis, Retropharyngeal abscess,Tonsillar hypertrophy, Ludwigs angina, Epiglottitis, LaLaryngotracheobronchitis (croup), Diphtheria

Iatrogenic causes Tracheal stenosis post-tracheostomy,Tracheal stenosis post-intubation, Mucous ball fromtranstracheal catheter


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Foreign bodies

Vocal cord paralysisTumors Laryngeal tumors (benign or malignant), Laryngealpapillomatosis, Tracheal stenosis (caused by intrinsic orextrinsic tumors)Angioedema Anaphylactic reactions, C1 inhibitor deficiency

Angiotensin-converting enzyme inhibitors


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Establishing a secure and patent airway

Medical Interventions Heimlich maneuver, Oropharyngeal airwaysEndotracheal intubation (transnasally or orally), Racemic epinephrine,Corticosteroids, Helium oxygen mixtureSurgical or Bronchoscopic InterventionsFiberoptic intubationCricothyroidotomyTracheostomyLaser/electrocautery/balloon dilationAirway stenting


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Using a 12 or 14-gauge cannula: extreme emergency, unable todo an open cricothyroidotomy, and in children.Effective ventilation: cannula attached to high pressure jet ventilation.


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Indikasi:

Airway obstruction proximal to the subglottisRespiratory failurePulmonary toiletteBronchosopy

Mc Pherson K et al. Managing Airway Obstruof Hospital Medicine, October 2012, Vol 73, N


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Tindakan operatif membuka trakea, yang bisa merupakan tindakan

sementara atau terkadang merupakan tindakan permanen membuatpada trachea.INDIKASI : Obstruksi mekanik saluran nafas atas (kongenital, infeksi, keganasan, tparalisis pita suara, dan benda asing)Melindungi saluran nafas bawah dari resiko aspirasi (GBS, MS, MiasteGravis, Tetanus, koma, Trauma yang menyebabkan banyak perdarahansaluran nafas atas).

Update of Surgical Airway Management. Simposium, workshop, and hands onexperiences XX. Surabaya, 9-10 September 2012.Hai AA and Ahmed SW. Islamic Legacy of Modern Surgery. IOS Minaret2010;Vol. 5 Issue 8 01 - 15 September


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Kondisi Gagal Nafas (PenyakitParu: Bronkitis kronis, emfise

paru, asma berat, pneumonia; Penyakit saraf: MS, motor neudisease; Trauma berat pada dada: flail chest, multiple Frakturkostae)Retensi SputumTrakeostomi Elektif, mengiringi tindakan operatif daerah kepleher


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Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of SurgicalOperations. 9 th edition. New York. McGraw Hill.


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Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of SurgicalOperations. 9 th edition. New York. McGraw Hill.


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Zollinger RM, Ellison EC. 2011. ZollinOperations. 9 th edition. New York. Mc


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Early complications

Pneumothorax, bleeding, decannulation, obstruction,infectionsLate complications

Granuloma, decannulation, tracheocutaneous fistula


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1. Mc Pherson K et al. Managing Airway Obstruction. British Journal oMedicine, October 2012, Vol 73, No 10

2. Hammer J. Aqcuired Upper Airway Obstruction. PAEDIATRIC RESPREVIEWS (2004) 5, 25 33

3. Update of Surgical Airway Management. Simposium, workshop, and experiences XX. Surabaya, 9-10 September 2012.

4. Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of Surgical Operatedition. New York. McGraw Hill.

UAO Prabedah 2013

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