Langgeng Raharjo
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Efektivitas Ketamin Sebagai Analgesia Preemptif Terhadap Nyeri Pasca Bedah Onkologi

Jurnal Anestesiologi Indonesia Vol 1, No 3 (2009): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Background : Excitatory amino acids participate in the activation of nociceptive dorsal horn neurons as agonists of the N-methyl-D-aspartate (NMDA) receptor. A. series of experimental data provides evidence that NMDA receptors play a significant role in neuronal plasticity and processes leading to central sensitization to pain. The concept of preemptive analgesia on the assumption that the administration of an analgesic dr µg before the occurrence of nociceptive input can prevent sensitization and thus improve postoperative analgesia.Objectives : The aim of our study was to test the hypothesis that preemtive ketamine administration would further reduce postoperative pain in oncology surgery.Method : Our institutional review board approved the study protocol, and all patients gave informed,written consent Patients were randomized to apreemptive or control group. Preoperatively visual analog scale (VAS) for pain assessment Patient received premedication with midazolam 0,07 mg/kg iv, sulfas atropin 0,0 2 mg/kg, metoclopramide 10 mg/kg at the operating room . Anesthesia was induced with thiopental 5 mg/kg iv,. Fentanyl 2 mg/kg was administered to facilitate tracheal intubation. Main tenance with atracurium 0,02 mg/kg IV if needed maintenance of anesthesia consisted of O :N O = 2 2 30%:70% and isoflurane 1%. In the preemtive group, ketamine bolus of 0,5 mg/kg IV was administered after induction of general anesthesia before incision. Postoperatively analgesia was achieved with meperidine 0,5 mg/kg iv as needed during the post anesthesia care unit (PACU) stay. The time that the patient first requested analgesic medication (TFA) was recorded if VAS pain scores > 3 cm (0= no pain, 10 = worst pain imaginable), vital sign pre and post operative. Meperidine consumption totals were recorded for the ward stay .Result : There were no statistically significant differences between the two groups in meperidine consumption total at 24 hours and VAS pain score, and there were statistically significant diferences between the two grups in the firs opioid required timeKeywords : ketamine, preemptive , analgesia ,oncology, surgery pain.ABSTRAKLatar belakang : Asam amino eksitatori berperan dalam aktivasi saraf nosisepsi kornu medula spinalis pada reseptor N-methyl-D-aspartate (NMDA). Data penelitian melaporkan reseptor NMDA berperan dalarn proses sensitisasi sentral terhadap nyeri. Analgesia preemptif berdasar bahwa pemberian obat analgesia sebelum input nosisepsi dapat mencegah sensitisasi dan memperbaiki nyeri pasca bedah.Tujuan : Mengetahui efetktifitas ketamin sebagai analgesia pre emptif, terhadap derajat nyeri pasca bedah onkologi.Metode : Merupakan penelitian eksperimental randomized past test only controlled group design. Empat puluh dua pasien yang menjalani operasi elektif onkologi dengan anestesi umum inhalasi di RS Dr. Kariadi Semarang; memenuhi kriteria inklusi dan eksklusi dibagi dalam dua kelompok dicatat tanda vital pra bedah. Premedikasi dengan midazolam 0,07 mg/kgBB iv, metoclopramid l0 mg iv, aulfas atropin 0,01 mg/kgBB. Induksi dengan tiopental 5 mg/kgBB, atrakurium 0,5 m/kgBB, fentanyl 2 µ/kgBB dilakukan intubasi. Rumatan anestesi dengan N2O:O2=70%: 30%, isofluran 1% atrakurium intermiten kelompok kontrol (II) diberi NaCl 0,9%- Selesai operasi pasien diekstubasi, dilakukan observasi di ruang pemulihan. Bila skor nyeri atau nilai visualAnalog Scale (VAS) >3 cm diberi meperidin 0,5mg/kgBB iv. Dicatat tanda vital pasca bedah, waktu pertama kali diberikananalgetik di bangsal, diberi analgetik meperidin 0,5 mg/kgBB bila Vas > 3 cm. Dicatat jumlah total kebutuhan meperidin. Efek samping yang terjadi dicatat.Hasil : Jumlah meperidin yang diberikan dan nilai VAS dalam 24 jam tidak Berbeda bermakna pada dua kelompok (p=0,692 dan (p>0,05), dan berbeda bermakna pada waktu pertama kali diperlukan analgetik (F0,000).Simpulan : Ketamin dosis 0,5 mg/kgBB iv tidak memberikan efek analgesia preemptif pada operasi bedah onkologi.Kata kunci : ketamin, analgesia preemptif, nyeri pasca bedah onkologi.

Perioperatif Early Goal Directed Theraphy Pada Bedah Jantung

JAI (Jurnal Anestesiologi Indonesia) Vol 8, No 3 (2016): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

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Abstract

Perawatan paska bedah jantung dapat meningkatkan morbiditas dan mortalitas apabila terjadi ketidakstabilan hemodinamik. Pasien yang berhasil baik, didapatkan nilai cardiac output dan delivery oxygen yang lebih tinggi. Dengan mengenali dan mengelola lebih awal terjadinya cardiac output yang rendah, dapat menghindari kejadian hipoksia jaringan. Dengan metode Early Goal Directed Therapy, mengatur jumlah cairan dan inotropik, pengelolaan preload, afterload, dan kontraktilitas jantung dapat mempertahankan kecukupan hemodinamik.