Uripno Budiono
Bagian Anestesi dan Terapi Intensif Fakultas Kedokteran Universitas Diponegoro/ RSUP Dr. Kariadi Semarang.

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PENGARUH PENGGUNAAN KETAMIN TERHADAP KEJADIAN MENGIGIL PASCA ANESTESI UMUM

MEDIA MEDIKA MUDA 2012:MMM VOLUME 1 NUMBER 1 YEAR 2012
Publisher : MEDIA MEDIKA MUDA

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ABSTRACTBackground: Post anesthesia shivering is common complication after get anesthesia.It can causes discomfort situation and so many risk.Post shivering anesthesia must be prevented.Ketamin is derivate of phencyclidine which is has analgesic effect as same as meperidine as commonly drug to prevent shivering post anesthesia.Objective: the aim of this study is to prove that giving intra venous ketamine 0,25 mg kg-1 as soon before the end of surgery is effective to prevent shivering after general anesthesia.Methods: this is an observational study with cross sectional design.Using second data which consists of 48 patient with range of age is 16-60 years old underwent elective surgery with general anesthesia.At the end of surgery,they divided into two groups which one receive intravenous ketamine 0,25 mg kg-1 and the other receive NaCl 0,9%.After that the data were processed using computer program.Data analyses were done by using Chi square,Mann whitney test,and independent sample T-test.Results: Characteristic data show there were not significantly different(p>0,05).There are 4(16.6%) people shivering after receive ketamine which 3 people are suffer 1st degree and 1 person suffer 2nd degree.In Salin group there are 13(54.16%) people shivering,3 people are suffer 1st degree,6 people suffer 2nd degree,2 people are suffer 3rd and also 2 people suffer 4th degree which both oh ketamine and salin groups were not significantly different (p>0,05).Conclusions: Ketamine 0,25 mg kg-1 is effective for prevention of shivering after general anesthesia.Keywords: post anesthesia shivering,ketamin

EFEKTIVITAS TRAMADOL SEBAGAI PENCEGAH MENGGIGIL PASCA ANESTESI UMUM

MEDIA MEDIKA MUDA 2012:MMM VOLUME 1 NUMBER 1 YEAR 2012
Publisher : MEDIA MEDIKA MUDA

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ABSTRACTBackground: One of the most frequently happened complications in a post-anesthesia patient is shivering. Shivering caused an inconvenient feeling and created a variety of risks especially in a patient who had unwell physical condition such as severe chronic obstructive pulmonary disease patient, or patient with heart disorder. Tramadol is a medicine that works by affecting temperature control mechanism e2specially through the μ-opioid agonist reseptor. Therefore, tramadol can be used as shivering prevention medicine.Objective : The aim of this study was to prove that giving intra venous tramadol 2 mg/kg as soon before the end of the surgery is effective to prevent shivering after general anesthesia.Methods: This study used cross sectional analytic design. Using medical record which consists of 48 patients with range of age is 16 – 60 years old underwent elective surgery with general anesthesia. Data divided into 2 groups, control group and tramadol group. Each subject in its group was being observed to know the shivering incidence, degree, and duration. After that the data were processed using computer program. Data analyses were done by using Chi Square test, Mann Whitney test, and independent sample T- test.Results: Characteristic data show there were not significantly different (p>0,05). There were 4 people (16,6%) shivering which all of them suffered 1st degree in tramadol group and there were 13 people (54,2%) shivering which 7 people (29,2%) suffered 1st degree, 3 people (12,5%) suffered 2nd degree, 2 people (8,3%) suffered 3rd degree and 1 people suffered 4thdegree in control group. The incidence and degree of shivering in tramadol group were significantly different ( p<0,05) compared to control group.Conclusion: Tramadol 2 mg/kg body weight usage is effective for shivering prevention in post general anesthesia patients.Keywords: Shivering, Tramadol

Pengaruh Premedikasi Klonidin terhadap Interval Q-Tc dan Skor Rate Pressure Product pada Laringoskopi Intubasi

JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 2 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background : Endotracheal intubation laryngoscopy is an act done in generalanesthesia. Laryngoscopy and intubation actions than can cause trauma, can alsocause cardiovascular changes in the form of increased blood pressure, increased heartrate, increased scores rate pressure product (RPP) which increased cardiac oxygendemand and Q-Tc interval prolongation by sympathetic stimulation caused bylaryngoscopy intubation. Role of clonidine premedication administration aims toreduce cardiovascular changes of decreased blood pressure and decreased heart rate. Objective : This study aimed to study the effect of oral clonidine tablets for bloodpressure, heart rate, Q-Tc interval and score rate pressure product (RPP) duringlaryngoscopy intubation Methods : Forty-eight subjects aged 14-40 years with ASA physical status I and II, withno sign of trouble intubation were randomly divided into groups of clonidine (KI) andthe control group (K II). KI group get oral clonidine premedication 0.15 mg 2 hoursbefore surgery, while K2 placebo. Both groups received the same treatment aslaryngoscopy intubation. Blood pressure, heart rate, Q-Tc interval and RPP score iscalculated at 2 minutes post-induction, 2 min and 5 min after intubation laryngoscopy. Results : heart rate, RPP Score and QTc intervals did not differ significantly betweenthe two groups. However blood pressure in the clonidine group was significantly lowerin the clonidine group. Conclusions : Premedication with oral clonidine 0.15 mg dose did not affect the Q-Tcinterval, RPP scores, and heart rate were significantly laryngoscopy intubation inadult patients. Latar belakang : Laringoskopi intubasi endotrakea merupakan tindakan yang banyakdilakukan pada anestesi umum tindakan laringoskopi dan intubasi selain dapatmenimbulkan trauma, juga dapat menimbulkan gejolak kardiovaskuler berupapeningkatan tekanan darah, peningkatan laju jantung, peningkatan score ratepressure product (RPP) yaitu peningkatan kebutuhan oksigen jantung danpemanjangan interval Q-Tc oleh stimulasi simpatik akibat laringoskopi intubasiPeran pemberian premedikasi klonidin bertujuan untuk mengurangi gejolakkardiovaskuler berupa penurunan tekanan darah dan penurunan laju jantung. Tujuan : Penelitian ini bertujuan untuk mempelajari pengaruh pemberian klonidintablet oral terhadap tekanan darah, laju jantung, interval Q-Tc dan skor rate pressureproduct (RPP) saat laringoskopi intubasi. Metode : Empat puluh delapan subjek berusia 14-40 tahun dengan status fisik ASA Idan II, tanpa tanda kesulitan intubasi dibagi secara acak menjadi kelompok klonidin(K I) dan kelompok kontrol (K II). Kelompok KI mendapatkan premedikasi klonidinoral 0,15 mg 2 jam sebelum operasi sedangkan K2 mendapatkan plasebo. Keduakelompok mendapatkan perlakuan yang sama saat laringoskopi intubasi. Tekanandarah, laju jantung, interval Q-Tc dan skor RPP dihitung pada 2 menit pasca induksi,2 menit dan 5 menit pasca laringoskopi intubasi. Hasil : Laju jantung, Skor RPP dan interval QTc tidak berbeda bermakna antarakedua kelompok . Akan tetapi tekanan darah pada kelompok klonidin secara bermaknalebih rendah pada kelompok klonidin Simpulan : Premedikasi klonidin oral pada dosis 0,15 mg tidak mempengaruhiinterval Q-Tc, skor RPP, dan laju jantung secara bermakna pada laringoskopiintubasi pasien dewasa.

Perbandingan Penggunaan Triamcinolone Acetonide dan Lidocaine Pada Pipa Endotrakea Terhadap Angka Kejadian Nyeri Tenggorok Pasca Intubasi Pada Anestesi Umum

JAI (Jurnal Anestesiologi Indonesia) Vol 6, No 3 (2014): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Latar Belakang : Salah satu komplikasi pemasangan pipa endotrakea adalah nyeri tenggorok paska operasi akibat kerusakan mukosa trakhea. Triamcinolone acetonide gel mengandung kortikosteroid disamping dapat sebagai agen lubrikasi juga mempunyai efek anti inflamasi. Tujuan : Membandingkan efek lubrikasi pipa endotrakea dengan triamcinolone acetonide gel dan lidocaine jelly terhadap angka kejadian nyeri tenggorok paska intubasi. Metode : 58 pasien yang menjalani operasi elektif dengan anestesi umum di RSUP Dr.Kariadi Semarang dan memenuhi kriteria inklusi dibagi secara acak menjadi 2 kelompok. Induksi menggunakan propofol 2 mg/kgBB iv, rokuronium 0,6 mg/kgBB iv dan fentanyl 1 mcg/kgBB iv kemudian dilakukan intubasi dilakukan intubasi dengan pipa endotrakea high volume low pressure non kinking dengan ukuran 7.0 untuk perempuan dan 7,5 untuk laki-laki. Kelompok 1 (K1) diberikan triamcinolone acetonide in orabase 0,1 % pada pipa endotrakea, kelompok 2 (K2) diberikan Lidocaine Jelly masing-masing diberikan 0,5 cc dilubrikasikan pada pipa endotrakea sepanjang 15 cm dari ujung distal. Selanjutnya cuff dikembangkan dengan udara dalam spuit 20 cc sampai tidak terdengar kebocoran udara napas. Rumatan anestesi dengan isofluran 1-1,5 % dalam O2 dan N2O 50% dan pelumpuh otot rokuronium intermiten. Analgetik diberikan ketorolak 30 mg dan tramadol 2 mg/kgBB iv. Selesai operasi, ekstubasi pipa endotrakea dilakukan saat pasien sudah sadar. Dilakukan observasi nyeri tenggorokan 1 jam, 6 jam dan 24 jam setelah ekstubasi. Hasil : Angka kejadian nyeri tenggorok paska intubasi endotrakea pada kelompok 1 lebih rendah dibandingkan pada kelompok 2. Kesimpulan : Triamcinolon acetonide jelly lebih baik dibanding lidocaine jelly dalam mengurangi nyeri tenggorok paska anestesi umum dengan intubasi.

Perbandingan Sekresi IL-10 di Jaringan Sekitar Luka Insisi Dengan dan Tanpa Infiltrasi Levobupivakain : Studi Imunohistokimia pada Tikus Wistar

Jurnal Anestesiologi Indonesia Vol 1, No 1 (2009): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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ABSTRACTBackground : The acute pain occurs after wound could depress the immune function that leads to the inhibition of the wound healing processes. Local anesthetic which has a long duration effect such as levobupivacain could be used to relief the pain so that protect the depression of immune function. Activation of macrophage can promote the T cell to produce IL -10.Objective: To compare the IL-10 secretion between levobupivacain tread and non levobupivacain on the tissue surround the wound.Methods: A laboratoric experimental study designed wi th randomized post test only control group method. Thirty five female rats were randomly devided into three groups. Control group (K), Non-Levobupivacain infiltration group (P1) and Levobupivacain infiltration group (P2). No incision and no infiltration in K group. Two cm of skin incision was performed to P1 and P2. After the incision, levobupivacain infiltration were given every 8 hours for 24 hours to the P2 group. No levobupivacain was given to the first st nd th group. On day 1 , 2 , 3 the rats were sacrified and the tissue surround the wound were taken for immunohistochemistry staining. The IL-10 secretion were analyzed for histologic scoring. Kruskal Wallis Test, Mann- Whitney Test were used for statistic analysis.Result : It was demonstrated in this study that the histologic score of IL-10 of the levobupivacain treated group was significanly higher than non levobupivacain group in nd 2 day (mean 5.36 ± 1.25 vs 3.00 ± 2.11 respectively, p=0,023 ; p<0,05).Conclusion : The IL-10 secretion was significantly higher in levobupivacain treated group than non levobupivacain group on the tissue surround the woundKeywords : IL-10 secretion, levobupivacain infiltration, after incision painABSTRAKLatar belakang : Nyeri menyebabkan peningkatan hormon glukokortikoid yang memperlama penyembuhan luka. Transmisi nyeri dapat dihambat dengan obat anestesi lokal levobupivakain. Terapi ini akan mengurangi supresi imunitas seluler sehingga fungsi makrofag dalam membantu aktifasi sel T tidak terhambat. Aktifasi sel T ini diduga akan meningkatkan sekresi IL-10.Tujuan : Membandingkan sekresi IL-10 di jaringan sekitar luka dengan dan tanpa infiltrasi levobupivakain.Metode: Eksperimental laboratorik dengan desain Randomized Post test only control group design, pada tiga puluh lima ekor tikus Wistar. Kelompok penelitian dibagi menjadi tiga kelompok secara acak, Kelompok Kontrol (K) 5 ekor, Perlakuan 1 (P1) dan Perlakuan 2 (P2) masing -masing lima belas ekor. Kelompok Kontrol, tikus tanpa insisi dan tanpa infiltrasi. Kelompok P1, tikus yang dilakukan insisi 2 cm, tanpa diberikan infiltrasi levobupivakain. Kelompok P2, tikus yang dilakukan insisi 2 cm, diberikan infiltrasi levobupivakain tiap 8 jam selama 24 jam. Ekspresi IL -10 di sekitar luka insisi dinilai dengan skor histologi dari preparat dengan menggunakan pengecatan imunohistokimia, yang diambil dari biopsi jaringan pada hari ke 1, 2, dan 3. Metode perhitungan statistik menggunakan Kruskal Wallis Test dilanjutkan Mann Whitney Test.Hasil: Hasil penelitian menunjukkan pada jaringan insisi rerata skor histologi IL -10 pada kelompok levobupivakain lebih tinggi (5.36 ± 1.25) dibanding kelompok tanpa levobupivakain (3.00 ± 2.11) pada hari ke dua. Perhitungan statistik antara kedua kelompok tanpa levobupivakain dan dengan kelompok levobupivakain berbeda bermakna (p=0,023 ; p<0,05).Kesimpulan: Sekresi IL-10 di jaringan sekitar luka dengan infiltrasi levobupivakain lebih tinggi dibanding tanpa levobupivakainKata kunci : Sekresi IL-10, infiltrasi levobupivakain, nyeri pasca insisi.

Heparin Intravena Terhadap Rasio PF pada Pasien Acute Lung Injury (ALI) dan Acute Respiratory Distress Syndrome (ARDS)

JAI (Jurnal Anestesiologi Indonesia) Vol 4, No 3 (2012): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background: Acute respiratory distress syndrome (ARDS) gained major medical attention with the availability of mechanical ventilation and establishment of intensive care units. ALI/ ARDS patient are associated with aggravate or initiate pulmonary inflammation and lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether low dose intravenous heparin improved arterial PO2/FiO2 (PF ratio)Objectives: To analize effect of low dose intravenous heparin on PF Ratio in ALI/ARDS patients with Mechanical Ventilation Methods: Thirty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a randomized trial divided into two groups (n=15). Group 1 were gived heparin 10 iu/kgbw/hr and group 2 as control. Mann-Whitney U test and post hoc test with LSD was performed to compare these groups.Results: Intravenous heparin was not associated with a significant improvement PF ratio in day 0 (p=0,152), day 1 ( p=0,287) and day 2 (p=0,879). The average daily of thrombocytes were not significant at both heparin group and control grup ( p=0,216 in day 0, p=0,911 in day 1 and p=0,941 in day 2) .Conclusions: Intravenous heparin with dose 10 unit/kgbw/hr in ALI/ARDS patients with mechanical ventilator was not associated with improvement of PF ratio. Further trials are required to confirm these findings.Keywords : ALI/ARDS, mechanical ventilator, intravenous heparin  Latar Belakang: Dengan adanya ICU dan penggunaan ventilator mekanik, ARDS menjadi salah satu perhatian di bidang medis. Pasien ALI/ ARDS berhubungan dengan reaksi inflamasi dalam paru-paru dan terjadinya deposit fibrin yang mengakibatkan kerusakan paru, salah satu tandanya adalah terjadi penurunan PF Ratio. Heparin mungkin dapat mengurangi proses inflamasi dan deposit fibrin dalam paru. Pada penelitian ini dilakukan penilaian apakah pemberian heparin intravena dosis rendah dapat meningkatkan nilai perbandingan PO2/FiO2 (PF ratio).Tujuan: Untuk menilai pengaruh pemberian heparin intravena pada pasien ALI/ARDS dengan ventilator mekanik.Metode: Tiga puluh pasien yang diperkirakan membutuhkan ventilator minimal dua hari dipilih secara acak dan di ikutkan dalam penelitian. Group pertama ( 15 pasien) diberi heparin 10 unit/kgbb/ jam dan group kedua sebagai kontrol. Untuk membandingkan rerata kedua group digunakan tes Mann-Whitney U dan dilakukan uji post hoc dengan LSD.Hasil: Pemberian heparin intravena tidak menunjukkan peningkatan rasio PF secara bermakna baik pada hari 0 (p=0,152) , hari 1 (p=0,287) atau hari 2 (p=0,287). Jumlah rata-rata trombosit juga menunjukkan perbedaan yang tidak bermakna baik pada hari 0 (p=0,216), hari 1 (p=0,911) atau hari 2 (p=0,941).Simpulan: Pemberian heparin intavena dengan dosis 10 unit/kgbb/ jam pada pasien ALI/ARDS dengan ventilator mekanik menghasilkan rasio PF yang berbeda tidak bermakna dengan kelompok kontrol. Penelitian lebih lanjut diperlukan untuk mengkonfirmasi hasil penelitian ini

Pengaruh Anestesi Regional dan General pada Sectio Cesaria pada Ibu dengan Pre Eklampsia Berat terhadap Apgar Score

JAI (Jurnal Anestesiologi Indonesia) Vol 4, No 2 (2012): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background : in patients with severe preeclampsia intubation is dangerous because of the actions associated with airway management and hemodynamic fluctuations that may occur. Spinal anesthesia avoided many risks associated with hypotensive but some studies have shown that spinal anesthesia is safe for both mother and fetus. debate about the influence of general anesthesia and spinal anesthesia on Apgar score is something interesting. Some research suggests that there was no difference in anesthesia on both of them but other studies say that the appreciation of the general anesthesia will result in a lower than spinal anesthesia.Objective: to compare the influence of general anesthesia and spinal anesthesia on children born to mothers with a sectio caesaria because of severe preeclampsia.Methods: an experimental study design with prospective randomized control trial study, the research group is divided into two (n: 8), Group I is the group that received general anesthesia with pentothal 5mg/bb dose and dose muscle paralytic suksinilkholis 1.5mg/bbConclusion: Apgar score in the group of spinal anesthetics are higher than general anesthesia in patients with sectio caesaria because of severe preeclampsia, but clinically by Apgar score categories of the two groups togetherKeywords : pre-eclampsia, Apgar score, spinal anesthesia, sectio Cesaria, hemodynamic ABSTRAKLatar belakang : pada pasien preeklampsia berat intubasi merupakan tindakan yang berbahaya karena berkaitan dengan menejeman jalan napas dan gejolak hemodinamik yang mungkin terjadi. Anestesi spinal banyak dihindari berkaitan dengan resiko hipotensinya namun beberapa penelitian telah menunjukkan bahwa anestesi spinal adalah aman bagi ibu maupun janin . perdebatan tentang pengaruh anestesi umum dan anestesi spinal terhadap Apgar score adalah sesuatu yang menarik. Beberapa penelitian menunjukkan bahwa tidak ada perbedaan anestesi pada keduanya namun pada penelitian lainnya dikatakan bahwa dengan apresiasi umum akan menghasilkan anestesi yang lebih rendah daripada anestesi spinal.Tujuan : untuk membandingkan pengaruh anestesi umum dan anestesi spinal terhadap anak yang dilahirkan oleh ibu dengan sectio caesaria karena preeklampsia berat.Metode : merupakan penelitian eksperimental dengan desain penelitian prospective randomized control trial, kelompok penelitian dibagi menjadi dua (n:8), kelompok I merupakan kelompok yang mendapat anestesi umum dengan pentothal dosis 5mg/bb dan pelumpuh otot suksinilkholis dosis 1.5mg/bbKesimpulan : Apgar score pada kelompok anesthesi spinal lebih tinggi daripada anestesi umum pada pasien sectio caesaria karena preeklampsia berat, tetapi secara klinis berdasarkan kategori Apgar score kedua kelompok sama

Pengaruh Pemberian Cairan Ringer Laktat Dibandingkan Nacl 0,9% Terhadap Keseimbangan Asam-Basa Pada Pasien Sectio Caesaria Dengan Anestesi Regional

Jurnal Anestesiologi Indonesia Vol 4, No 1 (2012): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background : Administration of crystalloid solution in patients prone for surgery, especially sectio caesarian rarely completed with blood electrolyte examination previously so could cause electrolyte imbalance and worse metabolic and healing process. Because of fluid intervention during surgery, post operative electrolyte examination are important to control electrolyte level and acid base balance.Method : An experimental study with double blind randomize control trial method which purposed to find the better solution, RL or NaCl 0,9% for SID acid base balance on Stewart method. Patients prepared for sectio caesarian as require for regional anesthesia and prevent nausea and vomit. At the operation theatre an intravenous line inserted while at the same time blood venous sample was taken. Before inducing anesthesia patient received pre medication and fluid “loading” to prevent regional anesthesia induce hypotension. During surgery patient received crystalloid solution. At the end of surgery venous blood are examined. The noted data for statistic count in this study is electrolyte level. Statistical t -test are used in this study.Result : Pre operative SID of RL (38,58 ± 2,28) show alkalosis state, while SID of NaCl (37,42 ± 1,18) show acidosis. Post operative mean of RL SID (37,79 ± 1,18) more stable than alkalosis NaCl SID (39,67 ± 3,10).Conclusion : Administration of RL solution in caesarean section patients is more benefit than sodium chloride (NaCl) 0,9% because of it lack effect on SID acid -base balance shifting.Keywords : Crystalloid solution, Stewart Acid base balance, caesarian section, regional anesthesia.ABSTRAKLatar belakang: Pemberian cairan pada pasien yang akan operasi, khususnya sectio caesaria (SC), sebelumnya jarang dilakukan pemeriksaan elektrolit, sehingga dapat menimbulkan gangguan keseimbangan elektrolit yang akan memperberat proses metabolik dan penyembuhannya. Pemeriksaan elektrolit setelah operasi sangat penting, karena intervensi cairan selama operasi, dengan alasan untuk mengontrol elektrolit dan keseimbangan asam-basa.Metode: Penelitian ini termasuk eksperimental berupa uji klinik tahap 2 yang dilakukan secara acak tersamar ganda dengan tujuan untuk mengetahui cairan mana yang lebih baik, RL ataupun NaCl 0,9% terhadap strong ion difference (SID) keseimbangan asam-basa yang didasarkan pada metode Stewart. Pasien yang dipersiapkan untuk menjalani operasi SC, sebagai salah satu persyaratan untuk menjalani tindakan pembiusan dan mencegah mual muntah. Kemudian dilakukan pemasangan jalur intravena serta pengambilan darah vena di ruang bedah sentral dan diberikan premedikasi serta “loading” cairan sebelum dibius dengan tujuan untuk mencegah terjadinya hipotensi akibat obat regional anestesinya. Setelah itu, selama operasi pasien diberikan cairan kristaloid. Setelah operasi selesai, dilakukan pemeriksaan darah vena. Data-data yang dicatat untuk perhitungan statistik yang termasuk dalam tujuan penelitian ini adalah kadar elektrolit. Uji statistik dengan menggunakan t-test.Hasil: Rerata sebelum operasi SID RL (38,58±2,28) menunjukkan alkalosis, sedangkan SID NaCl (37,42±4,35) menunjukkan asidosis. Rerata setelah operasi SID RL (37,79±1,18) menunjukkan kestabilan dibandingkan rerata SID NaCl (39,67±3,10) yang alkalosis.Kesimpulan: Pemberian RL pada pasien sectio caesaria lebih menguntungkan dibandingkan NaCl, karena NaCl sangat mempengaruhi pergeseran SID keseimbangan asam-basa Stewart.

Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida

Jurnal Anestesiologi Indonesia Vol 3, No 2 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Background: Apoptosis as a pathologic mechanism of multiple organs dysfunction syndrome in sepsis can be induced by lipoplysaccharide via the transcriptional factor NF-kB activation. Nitric oxide (NO), a proinflammatory factor cytokine, has a potential rule in pathogenesis of systemic hypotension in sepsis which is caused by the activation of NF-kB. Antioxidant can reduce the effect of lipopolysacharide and inhibit NF-kB production. Midazolam, as an sedative anesthetic agent, is commonly used in intensive care unit for septic patients. This agent is recognized has antioxidant and anti-inflammatory effects via blockade of ubiquitin system of NF-kB, so the NO production can be inhibited. Objectives: to study the effect of midazolam 0,07-0,2 mg/kg on intraperitoneal NO level on Balb/c mice with injection of lipopolysaccharide intraperitoneally. Methods: a randomized post test only controlled group laboratoric experimental study on animal, used 20 male Balb/c mice divided into 4 groups, P1 as the control group. All mice were injected by lipopolysaccharide 20mg/kg intraperitoneally and 6 hours later were injected by midazolam 0,07;0,1; and 0,2mg/kg intravenously in group P2, P3, and P4 respectively. NO was taken from peritoneal macrophage culture and observed by Grease method. The results will be analyzed by Kruskal-Walis and Mann-Whitney statistical assay, with reliability p < 0,05. Results: Mann-Whitney nonparametric assay for intraperitoneal macrophage NO level showed no significant differences between group P2 and P1 (1,77 ± 0,23 vs. 1,76 ± 0,26, p=0,841) and between group P3 and P1 (1,50 ±0,22 vs. 1,76 ± 0,26, p=0,310). NO level of group P4(3,11 ± 0,44) was higher than control groupsignificantly (p=0,032). Conclusion: Midazolam is not effective for decreasing nitric oxide level in sepssi mechanisms. Midazolam 0,1 mg/kg can not decrease intraperitoneal nitric oxide level significantly. Midazolam 0,2 mg/kg will increase intraperitoneal nitric oxide level significantly.Keywords : midazolam, lipopolysaccharide, nitric oxide.ABSTRAKLatar belakang: Lipopolisakarida dapat mengaktivasi NF-kB (Nuclear Factor kappa B) untuk terjadinya apoptosis dan kegagalan organ. NO (nitric oxide), suatu sitokin pro inflamasi, memiliki peranan penting dalam patogenesis terjadinya hipoten si sistemik pada syok septik akibat aktivasi faktor transkripsional NF-kB. Antioksidan dapat melemahkan efek paparan dari lipopolisakarida dan memblok produksi NF-kB. Midazolam, obat sedasi yang seringkali digunakan di ruang rawat intensif (ICU) untuk penderita sepsis, diduga memiliki efek antioksidan dan anti inflamasi melalui penghambatan sistem ubiquitin NF-kB, sehingga pembentukan NO dapat dihambat. Tujuan: mengetahui pengaruh pemberian Midazolam dalam dosis 0,07-0,2 mg/kg terhadap kadar NO mencit yang diberi endotoksin lipopolisakarida intraperitoneal. Metode: merupakan penelitian eksperimental laboratorik dengan desain randomized post test only controlled group pada 20 ekor mencit Balb/c yang disuntik lipoplisakarida intraperitoneal dan midazolam dosis 0,07 ; 0,1 ; dan 0;2 mg/kg intravena. Mencit dibagi menjadi 4 kelompok secara random, yaitu kelompok P1 sebagai kontrol, kelompok P2 yang mendapat midazolam 0,07 mg/kg, kelompok P3 yang mendapat midazolam 0,1 mg/kg, dan kelompok P4 yang mendapat midazolam dosis 0,2 mg/kg. Pemeriksaan NO diambil dari kultur makrofag intraperitoneal setelah 6 jam pemberian midazolam. Hasil dinilai dengan uji statistik nonparametrik Kruskal Walis dan Mann-Whitney dengan derajat kemaknaan p<0,05. Hasil: Tidak terdapat perbedaan kadar NO yang signifikan pada kelompok P2 dibanding P1 (1,77 ± 0,23 vs. 1,76 ± 0,26, p=0,841) dan P3 dibanding P1 (1,50 ±0,22 vs. 1,76 ± 0,26, p=0,310). Kadar NO pada kelompok P4 (3,11 ± 0,44) lebih tinggi dibanding P1 Secara signifikan (p=0,032). Simpulan: Pada mencit Balb/c sepsis, pemberian midazolam 0,1 mg/kg tidak dapat menurunkan kadar NO intraperitoneal secara signifikan. Pemberian midazolam 0,2 mg/kg meningkatkan kadar NO intraperitoenal mencit endotoksemia secara signifikan.

Ketamin dan Meperidin Untuk Pencegahan Menggigil Pasca Anestesi Umum

Jurnal Anestesiologi Indonesia Vol 3, No 2 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Background: Post anesthesia shivering is common complication after anesthesia. It can causes uncomfortable situation and so many risk. Post anesthesia shivering must be prevented or treated. Most commonly drug that used is meperidine. Objective: The aim of this study is to proved that giving intra venous ketamine 0,25mg/kgBW as soon before the end of the surgery is more effective than intravenous meperidine 0.5mg /kgBW as soon before the end of the surgery to prevent shivering after general anesthesia. Methods: This experimental study was designed as randomized post test only controlled group of 72 patients underwent elective surgery with general anesthesia. Vital sign (diastolic and systolic blood pressure, mean arterial pressure, heart rate and SaO 2) were measured five minutes before induction. Induction procedure of standardized general anesthesia were done. Esophageal temperature was measured as soon as intubation done. Duration of operation was limited 2 - 3 hours. At the end of surgery, inhalation drugs were stopped. After adequate spontaneous breathing and laryngeal reflex shown, randomization was done. Patients divided into three groups, and received intravenously ketamine 0,25 mg/kgBW for group 1, meperidine 0.5 mg/kgBW for group 2 and NaCl 0,9 % for group 3. E xtubation was done 5 minutes after the drug was given. Vital sign were measured as soon as after extubation and every 5 minutes for 30 minutes long. Body temperature were measured as soon as and 15 minutes after extubation. After extubation patients were receiving oxygen 6L/minute face mask. Statistical analysis were performed by One-way Anova and chi-square, which were p-value < 0,05 was considered significant. Results : Basic data, clinical characteristic data before induction, were not significantly different (p>0.05). Vital sign after extubation between group 1 and group 3 were significantly different (p<0.05). Incidence of shivering on group 1 is 4 people (16.6%) consisted of 3 people suffer 1 st degree and 1 people suffer 2 nd degree, while at group 2 is 5 people (20.8%) consisted of 4 people suffer 1 st degree and 1 people suffer 2 nd degree, this matter statistically were not significantly different (p=0.500). Differences of body temperature between group 1 and group 2 were not significantly different (p>0.05). Side effects that developed on group 1 were 2 subjects had nausea, which group 2 were 7 subjects had nausea and 2 subjects had difficulty for breathing, this matter statistically were significantly different (p=0.012). Conclusions : Ketamine 0,25 mg/kgBW and meperidine 0.5 mg/kgBW have similar effectivity on the prevention of shivering after general anesthesia, but ketamine have lower side effect nausea than meperidine.Keywords : post anesthesia shivering, ketamine, meperidine.ABSTRAKLatar Belakang: Menggigil pasca anestesi merupakan komplikasi yang cukup sering terjadi. Menggigil menimbulkan keadaan yang tidak nyaman dan berbagai resiko. Karena itu menggigil harus segera dicegah atau diatasi. Sampai saat ini obat paling sering digunakan adalah meperidin. Tujuan: Membuktikan bahwa pemberian ketamin 0,25 mg/kgBB intra vena menjelang akhir operasi lebih efektif dari pada meperidin 0,5mg/kgBB intra vena menjelang akhir operasi untuk mencegah kejadian menggigil pasca anestesi umum. Metode: Merupakan penelitian eksperimental dengan desain “randomized post test only controlled group” pada 72 pasien dengan usia 16 – 60 tahun yang menjalani operasi dengan anestesia umum. Tanda vital ( Tekanan darah diastolik dan sistolik, tekanan arteri rerata, laju jantung dan SaO2 ) diukur 5 menit sebelum induksi. Prosedur induksi anestesi umum dilakukan sesuai standar. Temperatur esofagus diukur segera setelah induksi. Lama operasi dibatasi antara 2 -3 jam. Pada akhir operasi, obat inhalasi dihentikan. Setelah nafas spontan adekuat, reflek laringeal positif dilakukan randomisasi. Pasien dibagi menjadi tiga kelompok, dan mendapatkan secara intravena ketamin 0,25 mg/kgBB untuk kelompok 1, meperidin 0,5 mg/kgBB untuk kelompok 2 dan NaCI 0,9% untuk kelompok 3. Ekstubasi dilakukan 5 menit setelah perlakuan. Tanda vital di ukur dicatat segera setelah ekstubasi dan tiap lima menit selama 30 menit. Suhu tubuh diukur segera dan 15 menit setelah ekstubasi. Pasca ekstubasi pasien diberi oksigen 6L/menit. Uji statistik dilakukan dengan menggunakan One-way ANOVA dan Chi- kuadrat, dengan derajat kemaknaan yaitu p<0,005 Hasil : Data dasar dan data karakteristik klinis sebelum induksi, berbeda tidak bermakna (p>0,05). Terdapat perbedaan bermakna tanda vital antara kelompok 1 dengan kelompok 3 saat setelah ekstubasi. Kejadian menggigil pada grup 1 yaitu 4 orang (16,6%) terdiri dari 3 orang menderita derajat 1 dan 1 orang menderita derajat 2, sedangkan pada kelompok 2 terjadi pada 5 orang (20,8%) terdiri dari 4 orang derajat 1 dan 1 orang derajat 2, hal ini secara statistik berbeda tidak bermakna (p=0,500). Perbedaan suhu tubuh grup 1 dan grup 2 berbeda tidak bermakna (p>0,05). Efek samping obat yang timbul pada kelompok 1 sebanyak 1 penderita mengalami mual, sedangkan kelompok 2 sebanyak 7 penderita mengalami mual dan 2 penderita depresi nafas, berbeda bermakna (p=0,012). Kesimpulan: Ketamin 0,25 mg/kgBB dan meperidin 0,5 mg/kgBB mempunyai efektifitas yang sama dalam mencegah menggigil pasca anestesi umum, tetapi ketamin mempunyai efek samping mual yang lebih rendah dibandingkan meperidin.