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Perbandingan Efektivitas Pemberian Tropisetron 5 mg dan Ondansetron 8 mg untuk Mengurangi Efek Mual dan Muntah Pascaoperasi Ginekologis per Laparatomi Sepriwan, Tori; , Zulkifli; Harimin, Kusuma
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Salah satu efek samping pascaoperasi dengan anestesi umum adalah mual muntah. Obat 5-HT3 reseptor antagonis telah terbukti efektif mencegah terjadinya mual dan muntah pascaoperasi. Ondansetron merupakan 5-HT3 reseptor antagonis yang sering dipakai, namun memiliki efek samping nyeri kepala. Tropisetron merupakani obat alternatif untuk mencegah mual muntah pascaoperasi. Tujuan penelitian adalah membandingkan efektifitas pemberian tropisetron 5 mg dengan ondansetron 8 mg untuk mengurangi efek mual dan muntah pascaoperasi ginekologis per laparatomi. Uji klinik acak tersamar ganda dilakukan pada 66 pasien di bagi menjadi dua kelompok perlakuan, kelompok tropisetron dan kelompok ondansetron. Data hasil penelitian diuji secara statistik dengan uji t dan uji chi-kuadrat. dari data penelitian diperoleh hasil bahwa skor mual pada kelompok tropisetron berbeda bermakna dibanding kelompok ondansetron sebesar dengan p<0,05. Keluhan mual pada kelompok ondansetron yaitu sebanyak 21 subjek (63,6%) sedangkan pada kelompok tropisentron sebanyak 10 subjek (30,3%) berbeda bermakna dengan p<0,05. Tidak ada perbedaan bermakna pada kedua kelompok pada keluhan muntah dengan 2 subjek (6,1%) yang mengalami muntah. Simpulan penelitian ini adalah pemberian tropisetron 5 mg lebih efektif dibandingkan dengan ondansetron 8 mg untuk mengurangi efek mual dan muntah pascaoperasi ginekologis perlaparatomi.Kata kunci: Mual muntah, ondansetron, skor mual, tropisetron. Post operative nausea and vomitus (PONV) is one of side effect caused by general anesthesia. 5- HT3 antagonist receptor is effectively proven in preventing PONV. Ondansetron is a common antagonist 5- HT3 receptor widely used with side effect especially complaints of headache. Tropistron can be used as an alternative to prevent PONV. The aim of this study is to compare the effectiveness of 5 mg tropisetron to 8 mg ondansetron in reducing PONV. Double blind randomized control trial was delivered to 66 patients divided into 2 treatment groups, tropisetron and ondansetron. The result of the study was statistically tested with t test and chi square test. The study shows the score of nausea in tropisetron group was less than ondansetron group with p<0,05. Nausea was complained in 21 subject of ondansetron group (63,6%), while in tropisetron group was complained in 10 subject (30,3%) with p<0,05. No significance difference was found in both group with 2 subject ( 6,1%) complaining vomiting. The conclusion of this study is tropisetron 5 mg is more effective than ondansetron 8 mg in reducing PONV Key words: nausea score, nausea and vomiting, ondansetron, tropisetron Reference Tsui SL, Ng KFJ, Wong LC, Tang GW, Pun TC, Yang JC. Prevention of postoperative nausea and vomiting in gynaecological laparotomies: a comparison of tropisetron and ondansetron. Anaesthesia and Intensive Care. 1999;27:471–6. Watcha MF, White PR. Postoperative nausea and vomiting, its etiology, treatment and prevention Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth. 1992;69:24S–32S. Junger A, Klasen J, Benson M, et al. Factors determining length of stay of surgical daycase patients. Eur J Anaesthesiol. 2001;18: 14–21. Wu CL, Berenholtz SM, Pronovost PJ, et al. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology. 2002;96:994–1003. Gan T, Sloan F, Dear Gde L, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg. 2001;92:393–400. Bosek V, Hu P and Robinson LA. Acute myocardial ischemia after administration of ondansetron hydrochloride. Anesthesiology. 2000;92: 885–7. Gan TJ, Meyer TC, Christian C, Cheng F, Davis PJ, Eubank S, dkk. Consenseus guideline for managing postoperative nausea and vomiting. Anest Analg. 2003;97:62–71. Morgan GE, Mikhail MS, Murria MJ, Larson CP. Clinical Anethesiology. Edisi ke-3. California: McGraw-Hill Medical Publishing Division;2002.Hlm. 242–50. Jokela R. Prevention of postoperative nausea and vomiting-studies on different antimetic, their combination and doping regiments. Academic dissertation: Dep ofAnaesthesiology University of Oulu, Findaln; 2003. Raman Sikka, Kaul TK, Anju G, Aprajita S. Postoperative nausea and vomiting. Anesth Clin Pharmacol. 2007;23(4):341–356. Scuderi PE, James RL, Harris L, et al. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg. 2000;91:1408-14. Gautam PL. Kaul TK. PONV-an unsolved problem. J Anaesth Clin Pharmacol. 2002; 18(1):3–6. White H, Black RJ, Jones M, Mar Fan GC. Randomized comparison of two antiemetic strategies in high risk patients undergoing day cas gynecological surgery. Br J Anaesth. 2007;98:470–6. Sebastian P, Gaelle C, Christian C. A risk store Dependent antiemetic approach effectively reduce postoperative nausea and vomiting a continous quality improvement initiative Can J Anaesth. 2004;51:320–5. Rama MP, Ferreira TA, Molin N, Sanduence Y, Bautista AP. Less postoperative nausea and vomitting after propofol remifentanil versus propofol fentanyl anaesthesia during plastic surgery. Acta Anaesthesiologica Scandinavia. 2005;49:305–11. Hill RP, Lubarsky DA, Phillips-Bute B, Fortney JT, Creed MR, Glass PS, dkk. Costeffectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology. 2000;92: 958–67. Figueredo ED and Canosa LG. Ondansetron in the prophylaxis of postoperative vomiting:a metaanalysis. J Clin Anesth. 1998; 10: 211–21. Arcioni R, della Rocca M, Romano S, et al. Ondansetron inhibits the analgesic effects of tramadol: a possible 5-HT(3) spinal receptor involvement in acute pain in humans. Anesth Analg. 2002; 94: 1553–7 Deane Y, Valentine RGN. An audit of nausea and vomiting in a post anaesthetic care unit. British Journal of Anaesthetic & Recovery Nursing. 2005;6:4–6.

Sensitivity and Specificity of Neutrophil Gelatinase Associated Lipocalin as an Early Biomarker or Acute Kidney Injury Andriani, Meili; , Zulkifli; Puspita, Yusni; , Theodorus
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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in hospital. Incidence of AKI is about 60%–70% and mortality rate from those patients is 60%. AKI is diagnosed by measuring serum creatinine concentration, which is an unreliable and delayed marker of deterioration of kidney function. It’s rising occurs when a significant amount of renal function has lost. Neutrophil gelatinase associated lipocalin (NGAL) level in AKI patients can increase quickly and earlier compared to serum creatinine and could be as a marker for AKI. The purpose of this study was to assess the sensitivity and specificity plasma NGAL. A diagnostic test was conducted in ICU and high care unit (HCU) of RS Dr. Moh. Hoesin Palembang since December 2014 to February 2015. There were 53 subjects included. All samples were examined with Alere Triage® kit and serum creatinin. Data analysis were performed by receiver operating characteristic (ROC) using SPSS® version 22.0.and MedCalc version 12.7. This study shows that a cut-off point 150 ng/mL for plasma NGAL has sensitivity of 88%, specificity of 81%, positive predictive value of 88%, negative predictive value of 81% and accuracy of 85%. Examination of plasma NGAL is more sensitive and specific in determining the start time of the occurrence of AKI compared with serum creatinine examination.

Efektivitas Pemberian Kombinasi Parasetamol 2 mg/kgBB dan Propofol Mct/Lct terhadap Pengurangan Nyeri Penyuntikan Fuyanto, Indra; , Zulkifli; Haloho, Agustina Br.
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Propofol adalah obat anestesi yang paling banyak digunakan dan sering menimbulkan nyeri saat penyuntikan. Nyeri ini menempati posisi ketiga kondisi yang tidak diinginkan. Ada 2 macam propofol yaitu propofol LCT dan propofol MCT/LCT. Parasetamol adalah obat analgetik yang aman untuk semua usia dan dapat mengurangi nyeri penyuntikan propofol. Penelitian ini bertujuan untuk mengetahui efektivitas penambahan parasetamol 2 mg/kgBB terhadap pengurangan nyeri penyuntikan propofol. Uji klinik acak berbanding buta ganda dilakukan di RSUP Dr. Mohammad Hoesin Palembang pada bulan Februari–April 2014. Sampel 99 orang dan dibagi dalam tiga kelompok. Penelitian pada skor nyeri, rasa nyeri, dan kualitas nyeri menggunakan skor VAS. Analisis menggunakan uji-t, One Way Anova dan post hoc dengan program SPSS versi 20. Uji-t menunjukkan sampel penelitian bersifat homogen. Uji One Way Anova menunjukkan perbedaan skor nyeri, rasa nyeri dan kualitas nyeri antar ketiga kelompok perlakuan. Uji post hoc didapatkan kelompok P memiliki skor nyeri yang lebih rendah dibandingkan dengan kelompok L dan M secara bermakna. Kelompok P tidak memiliki perbedaan rasa nyeri dan kualitas nyeri yang bermakna dibandingkan dengan kelompok M. Penambahan parasetamol 2 mg/kgBB terbukti efektif mengurangi nyeri penyuntikan propofol. Kata kunci: Nyeri, parasetamol, propofol, uji klinik acak berbanding Propofol is the most widely used as anesthetic drug in general anesthesia. Pain while propofol was given, has already ranked in third place as many patients complain of pain during the injection. There are two types of propofol which is available: propofol LCT and propofol MCT/LCT. Paracetamol is known as analgesics drug which is safe for all ages and can be used to reduce the pain of propofol injection. The aim of this study was to determine the efficacy of reducing the pain of propofol injection by the addition of paracetamol 2 mg/kgBW. Randomized controlled trial, double blind has been conducted at Dr. Mohammad Hoesin Palembang hospital from February to April 2014. There were 99 samples that divided into three groups. The groups were L group, M group and P group. The research is about pain scores, pain, and quality of pain. Measurement of pain using the VAS score. Data is analyzed with t-test, One Way Anova, and Post Hoc test using SPSS program 20.00 version. T-Test showed that the respondents were homogeneous in all groups. One Way Anova test showed the differences in pain scores, pain and quality of pain among all groups. Post Hoc test showed that P group has lower pain scores differences than L group and M group significantly. It can be concluded that the addition of paracetamol 2 mg/kgBW before propofol injection can reduce the pain caused by the injection. Reference Key words: Pain, paracetamol, propofol, randomized controlled trial Reves JG, Glass PSA, Lubarsky DA, McEvoy MD, Ruiz RM. Intravenous Anesthetics. Dalam: Miller RD, penyunting. Miller’s Anesthesia. Edisi ke-7. California: Elsevier; 2009. hlm.719–68. Evers AS, Crowder M, Balser JR. General Anesthetics. Dalam: Brunton LL, penyunting. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. Edisi ke-12. New York: McGraw-Hill; 2011. hlm. 501–36. Kumar P. Propofol. 2013 (diunduh 2 Oktober 2013). Tersedia dari: http://www.anaesthesia.co.in. Wijeysundera DN, Kavanagh BP. Prevention of pain from propofol injection: adequately studied, but inadequately managed. Br Med J. 2011.hlm. 667–8. Sethi N, Jayaraman L, Sethi M, Sharma S, Sood J. Prevention of propofol pain: a comparative study. Middle East J Anaesthesiol. 2009. hlm. 71–4. Zahedi H, Maleki A, Rustami G. Ondansentron pretreatment reduces pain on injection of propofol. Acta Med Iran. 2012. hlm. 239–43. Zhao GY, Guo Y, Bao SM, Meng LX, Zhang LH. Prevention of propofol induced pain in children: pretreatment with small doses of ketamine. J Clin Anaesth. 2012.hlm.284–8. Yadav M, Durga P, Gopinath R. Role of steroids in prevention of pain on propofol injection. J Anaesth Clinic Res. 2011. hlm.132–5. Kwak HJ, Min SK, Kim JS, Kim JY. Prevention of propofol induced pain in children: combination of alfentanil and lidocaine vs alfentanil or lidocaine alone. Br J Anaesth. 2009. hlm. 410–2. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. Euro Soc Anaesthesiol. 2010. hlm. 253–7. Ozkan S, Sen H, Sizlan A, Yanarates O, Mutlu M, Dagli G. Comparison of acetaminophen (with or without tourniquet) and lidocaine in propofol injection pain. Bullet Clin Psychopharmacol. 2011. hlm.100–4. Demir A, Aydinli B, Tezcan B, Ucar P, Ince D, Oztuna D, dkk. Influence of temperature and pH changes on propofol injection pain. Turk J Anaesth Reanim. 2013;p34–7. Beyaz S, Tufek A, Tokgor O. The effect of propofol lipuro with and without lidocaine on injection pain in children. Niger J Clin Practice. 2011. hlm. 60–4. Zahoor A, Ahmed N. The effects of duration of propofol injection on hemodynamics. M E J Anesth. 2010. hlm. 845–50. Dewhirst E, Lancaster C, Tobias JD. Hemodynamic changes following the administration of propofol to facilitate endotracheal entubation during sevoflurane anesthesia. Int J Clin Exp Med. 2013.hlm. 26–9. Nyman Y, Hofsten KV, Georgiadi A, Eksborg S, Lunnqvist PA. Propofol injection pain in children: a prospective randomized double blind trial of a new propofol formulation versus propofol with added lidocaine. Br J Anaesth. 2009. hlm. 222–5. Nyman Y, Hofsten KV, Eksborg PS, Lonnqvist PA. Etomidate-lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. Br J Anaesth. 2009. hlm. 536–9. Schaub E, Kern C, Landau R. Pain on injection: a double blind comparizon of propofol with lidocaine pretreatment versus propofol formulated with long and medium chain triglyserides. Anaesth Analg. 2009. hlm. 699–702. Canbay O, Celebi N, Arun N, Karagoz AH, Saricaoglu F, Ozgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth. 2009. hlm. 95–8. Ohmizo H, Obara S, Iwama H. Mechanism of injection pain with long and long medium chain triglyceride emulsive propofol. Canad J Anesth. 2009. hlm. 595–9.

Efektivitas Penambahan Sufentanil 10 mg pada Anestesi Epidural 15 mL Levobupivakain 0,5% untuk Tindakan Operasi Ekstremitas Bawah Werda Laksana, Ngurah Putu; , Zulkifli; Harimin, Kusuma; , Theodorus
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Walaupun memiliki profil keamanan yang lebih baik daripada racemic, levobupivakain tetap memiliki mula kerja lambat dan lama kerja terbatas. Kombinasi opioid lipofilik sufentanil-levobupivakain akan memberikan efek sinergistik sehingga memperbaiki kekurangan tersebut, tetapi masih sedikit penelitian yang menilai kombinasi ini. Tujuan penelitian ini adalah untuk menilai efektivitas penambahan sufentanil 10 μg pada anestesi epidural levobupivakain 0,5% 15 mL dalam hal mula dan lama kerja blokade sensorik-motorik. Uji klinik randomized control trial (RCT) telah dilakukan terhadap 44 pasien (dibagi 2 kelompok; kelompok I (sufentanil 10 μg), kelompok II (2 mL NaCl 0,9%)) yang menjalani operasi ekstremitas bawah dengan anestesi epidural levobupivakain 0,5% di RSUP Dr. Mohammad Hoesin Palembang dari bulan Mei–Agustus 2013 yang memenuhi kriteria inklusi. Dilakukan penelitian terhadap mula, lama kerja blokade sensorik-motorik. Analisis data menggunakan SPSS® versi 20.0. Mula dan lama kerja blokade sensorik kelompok sufentanil secara statistik lebih bermakna daripada kelompok NaCl (p<0,001), sedangkan mula dan lama kerja blokade motorik tidak memiliki perbedaan bermakna secara statistik. Penambahan sufentanil 10 μg pada anestesi epidural levobupivakain 0,5% 15 mL mempercepat mula dan memperpanjang durasi kerja blokade sensorik. Kata kunci: Anestesi epidural, levobupivakain, sufentanil Although levobupivacaine has better safety profile than racemic bupivacaine, it has a slow onset of action and limited blockade duration. Combination of lipophilic opioid sufentanil-levobupivakain will provide synergetic effects that improve the shortcomings, but lack of research to support this. The aim of this study is to evaluate the efficacy of additional 10 μg sufentanyl to 15 mL 0.5% levobupivacaine epidural anesthesia toward sensory-motoric blockade onset and duration. Randomized controlled trials double blind study (RCT) has been conducted to 44 patients (divided into 2 groups : group I (sufentanil 10 μg), group II (2 mL NaCl0.9%)) underwent lower extremity surgery with epidural anesthesia 15 mL 0,5% levobupivakain in Dr. Mohammad Hoesin central hospital from May–August 2013 that met inclussion criteria. Onset and duration of action sensory-motoric blockade were studied. Data analysis using SPSS® version 2.0. The onset and the duration of sensory blockade in sufentanil group is statistically significant than NaCl group (p<0.001). However the onset and duration of motoric blockade are not statistically significant. The addition of 10 μg sufentanil to 15 mL of 0.5% levobupivacaine epidural anesthesia hasten the onset and prolong the duration of sensory blockade. Key words: Epidural anesthesia, levobupivacaine, sufentanyl Reference Bajwa SJS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: a systematic review. J Anaesth Clin Pharmaco. 2013;29:530–9. Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Therapeutics and Clinical Risk Management. 2008;4(2):381–92. Casimiro C, Rodrigo J, Mendiola MA, Rey F, Barrios A, Gilsanz F. dkk. Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgery. Minerva Anestesiol. 2008;74:381–91. Liu SS, Lin Y. Local Anesthetics. Dalam: Barash PG, Cullen, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, penyunting. Clinical anesthesia. Edisi ke-6. Philadelphia: Lippincott Williams & Wilkins; 2009. hlm. 531–48. Leone S, Cianni SD, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92–105. Khangure N. Adjuvant agents in neuroaxial blockade [document on the internet]. Western Australia: World Federation of Societies of Anaesthesiologist; 2011 [diperbarui tanggal 2011 July 4; diunduh 1 Februari 2013]. Tersedia dari: http://www.totw. anaesthesiologists.org. Kaur M. Adjuvants to local anesthetics: a combination wisdom. Anesth Essays Res. 2010:4;122–3. Christiansson L. Update on adjuvants in regional anaesthesia. Periodicum Biologorum. 2009;111:161–70. Yeerdaoolaiti Y, Long W, Jian-Hua DU. Clinical effect of sufentanil combined with ropivacaine used in epidural anesthesia for abdominal hysterectomy. Modern Preventive Medicine. 2011;19:4096–103. Bachman-Mennenga B, Veit G, Stenicke B, Biscoping J, Heesen M. Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for caesarean section. Acta Anaesthesiol Scand. 2005;49:532–7. Bachman-Mennenga B, Veit G, Biscoping J, Stenicke B, Heesen M. Epidural ropivacaine 1% with and without sufentanil addition for caesarean section. Acta Anaesthesiol Scand. 2005;49:525–31. Prabowo RSE. Pengaruh penambahan fentanil 1,5 μg.kg1 pada ropivakain 0,75% terhadap mula dan lama kerja blokade anestesi epidural untuk operasi ekstermitas bawah. Dokter Spesialis Anestesi [Tesis]. Bandung: Universitas Padjajaran; 2004. Macres SM, Moore PG, Fishman SM. Acute pain management. Dalam: Barash PG, Cullen, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, penyunting. Clinical anesthesia Edisi ke-6. Philadelphia: Lippincott Williams & Wilkins; 2009. hlm. 1473–1504. NYSORA. Epidural Blockade [document on the internet]. New York: New York School of Regional Anesthesia; 2009 [diperbarui tanggal 2009 January 3; diunduh 1 Februari 2013]. Tersedia dari http://www.nysora.com. Pain Community Centre. Epidural: the mode of action of local anaesthetics and opioids in the epidural. Wales: Cardiff University; 2012[diunduh 1 Februari 2013]. Tersedia dari: http://www.paincommunitycentre.org. Vora KS, Shah VR, Patel B, Parikh GP, Butala BP. Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination. J Anaesth Clin Pharmaco. 2012;28:491–5. Visser WA, Lee RA, Gielen MJM. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Intern Anesth Research Soc. 2008;107(2):708–21. Staahl C, Olesen AE, Andreses T, Arendt- Nielsen L, Drewes AM. Assesing analgesic actions of opioids by experimental pain models in healthy volunteers-an updated review. Bri J Clin Pharmaco.2009;68(2):49–68. George MJ. The site of action of epidurally administered opioids and its relevance to postoperative paint management. Anaesthesia. 2006;61:659–64. Veering BT, Cousins MJ. Epidural neural blockade. Dalam: Cousins MJ, Bridenbaugh PO, penyunting. Neural blockade in clinical anesthesia and management of pain Edisi ke-4. Philadelphia: Lippincott–Raven Publishers; 2008. hlm. 241–95.

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