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Uji Kesahihan dan Keandalan QoR-40 versi Indonesia sebagai Instrumen untuk Menilai Kualitas Pemulihan Pasca-anestesia Umum Harijanto, Eddy; Wijaya, Andi Ade; Handayani, Dini
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Quality of Recovery-40 (QoR-40) adalah salah satu instrumen yang telah digunakan luas di dunia untuk menilai kualitas pemulihan pasca-anestesia umum. Saat ini belum ada instrumen spesifik yang menilai kualitas pemulihan pasca-anestesia di Indonesia. Hasil terjemahan akan diujikan pada 115 subjek yang menjalani anestesia umum satu hari praoperasi dan satu hari pascaoperasi. Uji kesahihan isi menggunakan koefisien Aiken v, uji kesahihan konstruksi (analisis faktor dan uji korelasi pearson), konsitensi internal (Chronbach α), ketanggapan (responsiveness) dengan standard respons mean (SRM). Uji kesahihan isi formula Aiken V didapatkan bahwa QoR-40 versi Indonesia sahih dengan nilai ≥0,5. Uji kesahihan konstruksi dengan analisis faktor menunjukan semua faktor memiliki korelasi yang tinggi (korelasi≥0,5). Uji korelasi Pearson didapatkan 3 item pertanyaan dari dimensi dukungan tehadap pasien yang tidak sahih (mendapat dukungan dari dokter Rumah Sakit, ρ=0,252), (mampu memahami arahan dan nasehat ρ=1,98), (merasa bingung ρ=0,202). Standart respons mean (SRM) pada uji ketanggapan adalah 1,06. Terdapat hubungan negatif antara skor QoR-40 versi Indonesia dengan lama masa rawatan. QoR -40 versi Indonesia menunjukkan kesahihan dan keandalan yang memuaskan. Dimensi dukungan terhadap pasien dengan koefisien kesahihan terendah dan tiga pertanyaan yang tidak memiliki kesahihan konstruksi. Instrumen Qor-40 versi Indonesia sensitif untuk menilai perubahan klinis pascanestesia umum. Kata Kunci: Indonesia, kesahihan dan keandalan, kualitas pemulihan, QoR-40 Validity and reliability test Qor -40 version of Indonesia to assess the quality of recovery after general anesthesiaQuality of Recovery-40 (Qor-40) is one of the instruments that have been used widely in the world to assess quality of recovery after general anesthesia. There is no specific instrument tot assesses the quality of recovery after general anesthesia in Indonesia up to now. The translation was tested on 115 subjects undergoing general anesthesia on one day preoperative and one day postoperative. Validity test of the content was done by coefficient Aiken V, Construction validity (factor analysis and Pearson correlation), Internal consistency (Chronbach α), and responsiveness test with Standard response mean (SRM).The content validity of Aiken V formula showed that Qor-40 Indonesian version was valid with ≥0.5 value. Construction validit ytest by factor analysis showed high correlations for all factors (correlation ≥0.5). Pearson correlation test item found 3 questions that were not valid ( Getting support from Hospital doctors, ρ=0.252), (Able to understand the direction and advice of ρ=1.98), (Feeling confused ρ=0.202). SRM on the responsiveness test was 1,06. There was a negative correlation between the scores Qor-40 version Indonesia with long term care. QoR-40 Indonesian version showed a satisfactory validity and reliability. Patients support dimension had the lowest validity coefficient with three questions that did not have valid construction. Indonesian version of Qor-40 wa ssensitive to assess clinical changes after general anesthesia. Key words: Indonesia, Qor-40, quality of recovery, validity and reliability

Keefektifan Pencegahan Post Anesthesia Shivering (PAS) pada ras Melayu: Perbandingan Antara Pemberian Ondansetron 4 mg Intravena Dengan Meperidin 0.35 mg/kgBB Intravena Nugroho, Alfan Mahdi; Harijanto, Eddy; Fahdika, Arnaz
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Post Aneshesia Shivering (PAS) adalah gerakan involunter satu otot rangka atau lebih yang biasanya terjadi padamasa awal pemulihan pascaanestesia. PAS dapat menyebabkan hipoksia arterial, meningkatnya curah jantung,risiko terjadinya infark miokard, dan mengganggu interpretasi alat-alat pemantauan tanda vital. Ondansetron danmeperidin adalah dua obat yang sering digunakan untuk mencegah PAS. Terdapat perbedaan ambang rangsangmenggigil antar ras. Penelitian ini bertujuan membandingkan keefektifan pencegahan PAS dengan pemberianondansetron 4 mg dengan meperidin 0,35 mg/kgBB intravena pada ras Melayu di Indonesia. Setelah mendapatkanizin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan ujiklinis, acak, tersamar ganda pada 92 pasien ras Melayu yang menjalani operasi elektif di RSCM Kirana. Pasien dibagidalam dua kelompok yaitu kelompok ondansetron dan kelompok meperidin. Pasien mendapatkan ondansetronatau meperidin sesaat sebelum anestesia. Semua pasien kemudian mendapatkan anestesia umum yang sama. Pascaanestesia, kekerapan dan derajat menggigil dicatat tiap lima menit selama tiga puluh menit pertama. Tidak terdapatperbedaan bermakna secara statistik (p>0,05) dalam kekerapan PAS pada kedua kelompok. Kekerapan kelompokondansetron sebesar 15,2%, sedangkan kekerapan kelompok meperidin sebesar 6,5%. Ondansetron 4 mg intravenasama efektifnya dengan meperidin 0,35 mg/kgBB dalam mencegah kejadian PAS pada ras Melayu di Indonesia. Kata kunci: Melayu, meperidin, ondansetron, post anesthesia shivering (PAS) Post Anesthesia Shivering (PAS) is the involuntary movements of one or more skeletal muscles that usually occurin the beginning of post-anesthesia recovery. PAS can cause arterial hypoxia, increased cardiac output, myocardialinfarction, and can interfere with vital sign monitoring tools interpretation. PAS is commonly prevented byondansetron and meperidine. Studies done showed that different races have different shivering thresholds. Thisstudy aims to compare the effectiveness of PAS prevention by administering ondansetron 4 mg with meperidine0,35 mg/kg, both intravenously in Malayan race patients in Indonesia. After approval from Ethics CommitteeFaculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients, this studyconducted a randomized, double-blind clinical trial on 92 Malayan race patients undergoing elective surgery in theRSCM-Kirana. Patients were divided into two groups: ondansetron and meperidine. Patients received ondansetronor meperidine shortly before anesthesia, then all patients received standardized anesthesia (premedication withmidazolam 0.05 mg/kgBW and fentanyl 2 mcg/kg, induced with propofol 1-2,5 mL/kg, intubation or LMAinsertion is facilitated with rocuronium or 0.6 mg/kg, maintenance with sevoflurane 2 vol% to compressed air: O2= 2: 1). The frequency and degree of shivering were recorded every five minutes for thirty minutes post-anesthesia.The side effects were also recorded. There was no statistically significant difference (p> 0.05) in the frequency ofPAS in both groups. Intravenous ondansetron 4 mg was as effective as meperidine 0.35 mg/kgBW in preventingthe incidence of PAS in Malayan race patients in Indonesia. Key words: Malayan, meperidin, ondansetron, post anesthesia shivering (PAS) Reference Tie Hong-Tao, Su Guang-Zhu, He Kun, Liang Shao-Rong, Yuan Hao-Wei, Mou Jun-Huan. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2014;14:12. Alfonsi P. Postanaesthetic shivering. epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol 2003;69:438–42. George YWH, Thaib MR, Harijanto E. Perbandingan keefektifan antara klonidin dan petidin untuk pencegahan menggigil pascaanestesia dengan N2O/O2/enfluran. Departemen Anestesiologi dan Terapi Intensif FKUI. 1999;2–42. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharmalogical treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 2002;94:453–60. Nurkacan A, Chandra S, Mahdi A. Keefektifan mengurangi insiden menggigil pascaanestesia: perbandingan antara ajuvan fentanyl 25 mcg intratekal dengan ajuvan sufentanyl 2,5 mcg intratekal pada pasien seksio sesarea dengan anestesia spinal.Departemen Anestesiologi dan Terapi Intensif FKUI. 2012;48:6–33. Kogsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al., Predictor of core hypothermia and the surgical intensive care unit Anesth Analg 2003; 96(4):826–33. Witte J D., Sessler D I. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002;96(2):467–84. de Brito Poveda V, Galvão CM, dos Santos CB. Factors associated to the development of hypothermia in the intraoperative period. Rev Latino-am Enfermagem. 2009;17(2): 228–33. Simatupang RDE, Dahlan R, Harijanto E Pencegahan menggigil pascaanestesia dengan N2O/O2/enfluran: perbandingan antara ondansetron 8 mg dan petidin 0.35 mg/kgBB intravena. Departemen Anestesiologi dan Terapi Intesif. FKUI 2003:5–23 Bakker LEH, Boon MR, van der Linden RAD, Arias-Bouda LP, van Klinken JB, Smit F, et al. Brown adipose tissue volume in healthy lean south asian adults compared with white caucasians: a prospective, case controlled observational study. The Lancet Diabetes & Endocrinology. 2014;2(3): 210–7.

Perbandingan Efektivitas Tablet Hisap Amylmetacresol-dibenal dengan Profilaksis Deksametason Intravena Sebelum Pemasangan Pipa Endotrakeal untuk Mengurangi Kekerapan Nyeri Tenggorok Pascaoperasi Harijanto, Eddy; Firdaus, Riyadh; Kurnia, Dedy
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Nyeri tenggorok pascaoperasi post-operative sore throat (POST) merupakan salah satu komplikasi yang sering muncul pada anestesia umum dengan teknik intubasi. Tujuan penelitian ini ialah untuk membandingkan antara efektivitas tablet hisap amylmetacresol-dibenal dengan profilaksis deksametason intravena sebelum pemasangan pipa endotrakeal untuk mengurangi kekerapan POST. Setelah mendapatkan izin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan uji klinis prospektif yang diacak dan tersamar ganda pada 121 pasien yang menjalani operasi dalam anestesia umum menggunakan pipa endotrakeal. Pasien dibagi menjadi dua kelompok, yaitu Grup A 61 orang dan grup B 60 orang. Sebelum induksi, pasien dalam grup A diberikan tablet hisap amylmetacresol-dibenal dan suntikan NaCl 0,9% 2 mL dan grup B diberikan Deksametason 10 mg intravena dan tablet hisap plasebo. Nyeri tenggorok pascaoperasi dievaluasi dengan numerical rating scale (NRS) sebanyak 3 kali, yaitu setelah operasi saat Alderette skor 10, 2 jam pascaoperasi dan 24 jam pascaoperasi.  Kekerapan dan derajat nyeri tenggorok pascaoperasi dicatat dan dianalisis dengan uji chi-kuadrat. Tidak didapatkan perbedaan kekerapan nyeri tenggorok pascaoperasi bermakna pada kedua kelompok sesaat setelah operasi berakhir, jam ke-2 dan jam ke-24 pascaoperasi. Derajat nyeri tenggorok pascaoperasi tidak berbeda bermakna di antara kedua kelompok. Tablet hisap amylmetacresol-dibenal sebelum pemasangan pipa endotrakeal memiliki efektivitas yang sama dengan profilaksis deksametason intravena dalam mengurangi kekerapan nyeri tenggorok pascaoperasi. Kata kunci: Amylmetacresol-dibenal, deksametason, intubasi endotrakeal, nyeri tenggorok pascaoperasi, Strepsils® Comparison between Amylmetacresol-dibenal Lozenges and Prophylactic Intravenous Dexamethasone Before Intubation to Reduce the Incidence of Postoperative Sore Throat (POST) Post-operative sore throat (POST) is one of the complications that often arise in the general anesthesia with intubation techniques. The purpose of this study was to compare the effectiveness of amylmetacresol-dibenal lozenges with prophylactic intravenous dexamethasone before intubation to reduce the incidence of POST. After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients,a prospective randomized clinical,double-blind trial was done in 121 patients that would undergo surgery under general anesthesia using endotracheal tube. Patients were divided into two groups randomly; Group A 61 people and group B 60 people. Before induction, patients in group A was given amylmetacresol - dibenal lozenges and injection of 2 mL of 0.9% NaCl, while group B was given intravenous dexamethasone 10 mg and placebo lozenges. POST was evaluated by the numerical rating scale (NRS) 3 times, after surgery when Alderette score of 10, 2 hours postoperatively and 24 hours postoperatively. The frequency and degree of POST were recorded and analyzed with Chi-Square test. There were no significant difference in the incidence of POST in both groups after surgery when Alderette score of 10  , h 2, and the 24th hour postoperatively. The degree of POST was not significantly different between the two groups. Amylmetacresol - dibenal lozenges before intubation tube has the same effectiveness of prophylactic intravenous dexamethasone in reducing the incidence of POST. Key words: Amylmetacresol-dibenal lozenges, dexamethasone, endotracheal intubation, postoperative sore throat (POST), Strepsils®

Gangguan Tidur pada Peserta Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Harijanto, Eddy; Hidayat, Jefferson; Pratiwi, Astrid
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
Publisher : Perdatin Pusat

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Dokter anestesiologi adalah profesi kedokteran yang rentan mengalami kelelahan akibat jam kerja yang panjang, beban kerja dengan tingkat stress pekerjaan yang tinggi. Sebanyak 80% kesalahan medis berhubungan dengan sindrom burnout dengan gangguan tidur sebagai keluhan yang sering dialami dokter anestesiologi. Penelitian ini menggunakan 2 kuesioner yang telah divalidasi di Indonesia; Kuesioner pittsburgh sleep quality index (PSQI) untuk menilai kualitas tidur dan kuesioner epworth sleepiness scale (ESS) untuk menilai skala kantuk berlebih. Setelah mendapatkan izin komite etik dan informed consent, penelitian observasional potong lintang dengan subjek 98 orang peserta PPDS Anestesiologi dan Terapi Intensif FKUI dilakukan di RSCM selama April–Mei 2016. Sampel mengisi kedua kuesioner. Analisis deskriptif dilakukan terhadap gangguan kualitas tidur dan skala kantuk, distribusi karakteristik dan data jam kerja. Analisis bivariat dan multivariat dilakukan terhadap hasil kuesioner PSQI dan ESS. Faktor durasi tidur, keluhan tidur dan skala kantuk berlebih adalah faktor signifikan penyebab kualitas tidur kurang. Skala kantuk memiliki kecenderungan sebesar 132,8 kali sebagai faktor gangguan kualitas tidur. Faktor jumlah hari bebas tugas per bulan, tahap jaga, dan kualitas tidur subjek menjadi faktor signifikan penyebab skala kantuk berlebih. Gangguan kualitas tidur memiliki kecenderungan sebesar 38,73 kali sebagai faktor skala kantuk berlebih.70% subjek memiliki kualitas tidur kurang dan 65% subjek memiliki skala kantuk berlebih. Terdapat hubungan signifikan antara kualitas tidur dengan skala kantuk berlebih. Kata Kunci: dokter anestesiologi, gangguan kualitas tidur, skala kantuk Factors Affecting Sleep Disorder in Trainees of Anesthesiology and Intensive Care Anesthesiologists are very susceptible to fatigue due to long working hours and work load with high levels of job stress. 80% of medical errors are associated with burnout syndrome; with sleep disorders as the most common complaint from anesthesiologists. This study investigated sleep quality and sleepiness scale using 2 validated questionnaires in Indonesia; Pittsburgh Sleep Quality Indexto (PSQI) assess sleep quality and Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness. This was an observational cross sectional study of Anesthesiology and Intensive Therapy residents in Faculty of Medicine Universitas Indonesia. After obtaining permission from ethics committee and informed consent, this study was done in Cipto Mangunkusumo Hospital during April–May 2016 on 98 residents as the sample. Subjects filled PSQI and ESS questionnaires. Descriptive analysis included sleep quality and sleepiness scale, distribution characteristics and working hour. The bivariate and multivariate analysis assessed the questionnaires score results. Results, sleep duration, sleep complaints of participants and excessive daytime sleepiness caused sleep quality disorder significantly. Excessive daytime sleepiness hds 132.8 times tendency to impair the quality of sleep. Offduty days number per month, the academic level, and sleep quality caused excessive daytime sleepiness significantly. Impaired quality of sleep had 38.73 times tendency as a factor of excessive daytime sleepiness. 70% subjects had sleep quality disorder and 65% subjects had excessive daytime sleepiness. There was a significant relationship between sleep quality disorder and excessive daytime sleepiness. Key words: Anesthesiologist, excessive daytime, impaired quality of sleep, sleepiness scale

Luas Kolaps Paru pada Anestesia Umum dengan Penilaian Electrical Impedance Tomography Durasi Kurang dari 2 Jam dan Lebih dari 2 Jam chandra, Susilo; Nashella, Nazalia; Harijanto, Eddy; , Rahendra
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Anestesia dan pembedahan dapat menyebabkan atelektasis intraoperasi, penurunan volume paru dan atelektasis akan menyebabkan komplikasi paru pascaoperasi. Electrical impedance tomography (EIT) merupakan alat pencitraan noninvasif untuk menilai distribusi ventilasi paru. Tujuan penelitian ini adalah untuk membandingkan luas kolaps paru yang terjadi pada anestesia umum dengan durasi kurang dari 2 jam dan lebih dari 2 jam dengan menggunakan EIT dan algoritma Costa dkk, dengan sebelumnya menghilangkan faktor komorbid dan faktor prediktor yang lain. Penelitian ini merupakan uji klinis prospektif yang dilakukan di RSCM Kirana selama bulan Maret sampai Mei 2013 pada 42 pasien dewasa usia 18–59 tahun, ASA 1–2 dan IMT <30 kg/m2 yang menjalani operasi mata elektif dengan anestesia umum. Pengamatan dilakukan selama operasi dengan menggunakan EIT. Pasien dibagi ke dalam dua kelompok berdasarkan durasi anestesia lebih dari 2 jam dan kurang dari 2 jam. Dilakukan pengukuran variasi tidal regional, volume tidal, peak inspiratori presure ,dan positive end-expiratory pressure. Hasil pengukuran dihitung sesuai algoritme Costa dkk untuk mencari luas kolaps yang terjadi. Pada kelompok anestesia umum dengan durasi lebih dari 2 jam didapatkan luas kolaps 16,83±8,47 % dan pada durasi kurang dari 2 jam didapatkan luas kolaps 16,16±11,93 % (p>0,05). Tidak terdapat perbedaan bermakna antara luas kolaps yang terjadi pada anestesia umum dengan durasi lebih dari 2 jam dan kurang dari 2 jam. Kata kunci: Electrical impedance tomography, kolaps paru, komplikasi paru pascaoperasi Anesthesia and surgery can cause intraoperative atelectasis, whereas decreased lung volume, and atelectasis can lead to postoperative pulmonary complications. Electrical impedance tomography (EIT) is a noninvasive imaging to assess lung distribution of ventilation. The aim of this study was to compare lung collapse in patients without co morbid and other predictor of PPCs that undergone general anesthesia with duration more than 2 hours and less than 2 hours using EIT and Costa algorithm. This study was a prospective clinical trial conducted in RSCM Kirana during March to May 2013 on 42 patients aged 18–59 years, physical status ASA 1–2, and BMI < 30 kg/m2 underwent elective eye surgery under general anesthesia. The EIT was used intraoperatively. At the end of anesthesia, the patients were divided into two groups based on the duration of anesthesia more than 2 hours and less than 2 hours. The regional tidal variation, tidal volume, peak inspiratory pressure, and positive end-expiratory pressure were observed then. Costa algorithm was used to calculate the lung collapse. In duration of anesthesia more than 2 hours group the lung collapse was 16,83 ± 8,47 %. In duration of anesthesia less than 2 hours group the lung collapse was 16,16±11,93 % (p>0,05). There was no significant difference between lung collapse in anesthesia duration more than 2 hours and less than 2 hours group. Key words: Electrical impedance tomography, lung collapse, postoperative pulmonary complications Reference Degani-Costa LH, Faresin SM, Falcao LF. Preoperative evaluation of the patient with pulmonary disease. Brazilian J Anesthesiol. 2014;64:22–34. Hedenstierna G. Respiratory physiology. Dalam:Miller’s Anesthesia, edisi ke-7. Philadelphia: Churchill Livingstone Elsevier: 2010, hlm. 361-89. Tusmana G, Bohm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anesthesiol. 2012; 25: 1–10 Pelosi P, Gregoretti C. Perioperative respiratory Complications and the Postoperative qonsequences-atelectasis and risk factors. Euro Crit Care and Emerg Med 2009. Maceiras PR. Peri-Operative Atelectasis andAlveolar Recruitment Manoeuvres. ArchBronconeumol. 2010;46(6):317–324 Scholes RL, Browning L, Sztendur EM, Denehy L. Duration of anesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Austral J f Physiotherapy. 2009;55: 191–8. Sogame LCM, Vidotto MC, Jardim JR, Faresin SM. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008 Aug;109(2):222–7. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, dkk. Prediction of Postoperative Pulmonary Complications in a Populationbased Surgical Cohort. Anesthesiology 2010; 113(6):338–50. Talab HF, Zabani IA, Abdelrahman HS, Bukhari WL, Mamoun I, Ashour MA, Sadeq B, Sayed SIE. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoinglaparoscopic bariatric surgery. Anesth Analg. 2009; 109 (5): 1511–16. Reinius H, Jonnson L, Gustaffson S, Sundborn M, Duvernoy O, Pelosi P, dkk. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis–a computarized tomography study. Anesthesiology. 2009;111:979–87. Costa ELV, Borges JB, Melo A, Sipman FS, Junior CT, Bohm SH dkk. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedancetomography. Intens Care Med. 2009;35:1132–7. Moerer O, Hahn G, Quintel M. Lung impedance measurements to monitor alveolar ventilation. Curr Opin Crit Care. 2011;17:260–7. Blankman P, Gommers D. Lung monitoring at the bedside in mechanically ventilated patients. Curr Opin Crit Care 2012;18: 261–6. Muders T, Luepschen H, Putensen C. Impedance tomography as a new monitoring technique. Curr Opin Crit Care 2010; 16: 269–75. Stoelting RK, Hiller SC. The lungs. Dalam: Penyunting. Brown B, Murphy F. Pharmacology and physiology in anesthetic practice,edisi ke- 4. Philadelphia: Lippincott Williams and Wilkins; 2006, hlm. 771–82. Davison R, Cottle D. The effect of anesthesia on respiratory function. ATOTW. 2010

Perbandingan Kecepatan Penyuntikan Fentanil 5 Detik dan 20 Detik Terhadap Angka Kejadian Fentanyl-Induced Cough (FIC) Sedono, Rudyanto; Harijanto, Eddy; ., Safroni
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Fentanil merupakan analgetik opioid yang hampir selalu digunakan sebagai ko-induksi di ruang operasi. Namunpenggunaan fentanil intravena bisa menimbulkan batuk yang dikenal juga sebagai fentanyl-induced cough (FIC).Batuk merupakan hal yang tidak diinginkan saat induksi karena bisa menyebabkan peningkatan tekanan intrakranial,tekanan intraokular dan tekanan intra-abdominal. Kejadian FIC salah satunya dihubungkan dengan kecepatanpenyuntikan fentanil. Penelitian ini bertujuan untuk membandingkan antara kecepatan penyuntikan fentanil 5 detikdan 20 detik terhadap angka kejadian dan derajat FIC pada pasien ras Melayu yang menjalani anestesia umum diRumah Sakit Cipto Mangunkusumo. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap 124 pasienras Melayu yang menjalani operasi dengan anestesia umum di Rumah Sakit Cipto Mangunkusumo. Subjek dibagimenjadi 2 kelompok (kelompok kecepatan 5 detik dan kecepatan 20 detik). Pasien secara acak diberikan fentanil 2mcg/kgBB sebagai co-induksi dengan kecepatan penyuntikan 5 detik atau 20 detik. Insiden dan derajat FIC dicatatpada masing-masing kelompok. Derajat FIC dibagi berdasarkan jumlah batuk yang terjadi, yaitu ringan (1–2 kali),sedang (3–5 kali) dan berat ( >5 kali). Analisis data dilakukan dengan uji Chi-square dan uji Kolmogorov-Smirnovsebagai uji alternatif. Insiden FIC pada kelompok 20 detik lebih rendah secara bermakna dibandingkan kelompok5 detik, 8,07% vs 29,03% (p<0,05). Derajat FIC antara kedua kelompok secara statistik tidak berbeda bermakna(p>0,05). Insiden dan derajat FIC lebih rendah pada kelompok 20 detik dibanding dengan kelompok 5 detik padapenggunaan fentanil 2 mcg/kgBB sebagai co-induksi. Kata kunci: Fentanil, fentanyl-induced cough (FIC), kecepatan penyuntikan Fentanyl, an analgesic opioid, is commonly used by anaesthesiologists in the operating room as co-induction.However, co-induction of intravenous fentanyl bolus is associated with coughing, known as fentanyl-inducedcough (FIC). Coughing during anesthesia induction is undesirable as it is associated with increased intracranial,intraocular, and intraabdominal pressures. Incidence of FIC is associated with injection rate of fentanyl. Thisstudy compared the incidence and severity of FIC between 5 seconds and 20 seconds fentanyl injection rate inMelayan race patients in Cipto Mangunkusumo hospital. This was a double blind randomized study in Melayanrace patients that underwent operations with general anesthesia at Cipto Mangunkusumo hospital. 124 subjectswere included in the study and divided into 2 groups (5 seconds and 20 seconds group). Subjects were randomizedto receive co-induction fentanyl 2 mcg/kgBW with either 5 second or 20 seconds injection rate. The incidenceand severity of FIC were recorded in each group. Based on the number of coughs observed, cough severity wasgraded as mild (1–2), moderate (3–5), or severe (>5). Data was analyzed by Chi-square and Kolmogorov-Smirnovtest. The incidence of FIC was significantly lower in the 20 seconds group than in the 5 seconds group, 8,07%vs 29,03% (p<0,05). The severity of FIC wast statistically not significant in both groups (p>0,05). Incidence andseverity of FIC was lower in the 20 seconds group compared with the 5 seconds group in co-induction usingfentanyl injection 2 mcg/kgBW. Key words: Fentanyl, fentanyl-induced cough (FIC), rate of injection Reference Lin CS, Sun WZ, Chan WH, Lin CJ, Yeh HM, Mok MS. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl induced cough. Can J Anesth 2004; 5: 654–9. Horng HC, Wong CS, Hsiao KN, Huh BK, Kuo CP, Cherng CH, et al . Pre-medication with intravenous clonidine suppresses fentanyl induced cough.Acta Anaesthesiol Scand 2007; 51: 862–5. Yu J, Lu Y, Dong C, Zhu H, Xu R : Premedication with intravenous dexmedetomidine–midazolam suppresses fentanyl-induced cough. Ir J Med Sci. 2012; 181:517–20. Fauzi R. Keefektifan Dilusi Fentanil 10 mcg/ml Terhadap Efek Batuk yang Ditimbulkannya. Tesis Fakultas Kedokteran Universitas Indonesia Program Studi Anestesiologi dan Terapi Intensif, Jakarta Juni 2008. Hlm. 18–23. Lin JA, Yeh CC, Lee MS, Wu CT, Lin SL, Wong CS. Prolonged injection time and light smoking decreases the incidence of fentanylinduced cough. Anesth Analg. 2005;101: 670–4. Stellato C, Cirillo R, Paulis A, Casolaro V, Patella V, Mastronardi P, et al. Human basophil/ mast cell releasability. IX. Heterogeneity of the effect of opioids on mediator release. Anesthesiology 1992;77:932–40. Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D. Salbutamol, beclomethasone, or Sodium  \ chromoglycate suppress coughing induced by i.v. fentanyl. Can J Anaesth. 2003;50:297–300. Phua WT, Teh BT, Jong W: Tussive effect of a fentanyl bolus. Can J Anaesth. 1991;38: 330–4. Bailey P: Possible Mechanism (s) of Opioid-induced Coughing. Anesthesiology. 1999;90:335. Ai Q, Hu Y, Wang YJ, Wu S, Qin Z, Wang J, et al . Pentazocine pretreatment suppreses fentanyl-induced cough. Pharmacol Rep 2010; 62: 747–50. Yu H, Yang XY, Zhang X, Li Q, Zhu T, Wang Y, et al . The effect of dilution and prolonged injection time on fentanyl-induced coughing. Anesthesia. 2007;62:919–22. Hung KC, Chen CW, Lin CH, Weng HC, Hsieh: The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing. Anaesthesia 2010; 65: 4–7. Kim JE, Min SK, Chae YJ, Lee YJ, Moon BK, Kim JY. Pharmacological and nonpharmacological prevention of fentanylinduced cough: a meta-analysis. J Anesth. 2014;28:257–66. Schaperrneier D, Hopf HB. Fentanyl-induced

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