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INDONESIA
Majalah Anestesia dan Critical Care
Published by Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif Indonesia
ISSN : -     EISSN : 25027999     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Majalah ANESTESIA & CRITICAL CARE (The Indonesian Journal of Anesthesiology and Critical Care) is to publish peer-reviewed original articles in clinical research relevant to anesthesia, critical care, and case report . This journal is published every 4 months (February, June, and October) by Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif Indonesia (PERDATIN).
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Search results for , issue " Vol 32 No 2 (2014): Juni" : 10 Documents clear
Penyebaran Zat Pewarna Metilen Biru di Ruang Paravertebral: Penelitian Blok Paravertebral Lumbal 4 Teknik Injeksi Satu Titik pada Kadaver , Pryambodho; Prawiro, Eric; Tantri, Aida Rosita; Sukmono, R. Besthadi
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Blok paravertebral lumbal secara teori dapat dijadikan alternatif dari blok psoas dan dapat dilakukan secara blind/landmark-based. Penelitian ini bertujuan untuk mengetahui penyebaran zat pewarna pasca injeksi 1 titik di ruang paravertebral L4 terkait area pleksus lumbalis. Penelitian menggunakan kadaver segar yang tidak dikenal. Pada semua kadaver dilakukan penyuntikan 30 mL zat pewarna metilen biru 1% pada injeksi 1 titik di ruang paravertebral L4 menggunakan jarum blok standar, kemudian dilakukan diseksi untuk mengetahui penyebaran zat pewarna tersebut. Penelitian ini mengikutsertakan 16 kadaver yang memenuhi syarat. Didapatkan penyebaran terjauh ke arah sefalad mencapai level L1 (6,25%) dengan rata-rata mencapai level L3 (50%). Penyebaran terjauh ke arah kaudad mencapai level S2 (12,5%) dengan rata-rata mencapai level L5 (56,25%). Penyebaran kontralateral sebanyak 18,75%. Penyebaran segmental paling sedikit sebanyak 2 segmen (6,25%), paling banyak sebanyak 5 segmen (12,5%), dan sebaran segmental terbanyak (43,75%) ialah sebanyak 4 segmen. Injeksi 1 titik 30 mL metilen biru 1% pada blok paravertebral L4 dapat mencapai area pleksus lumbalis. Penelitian lebih lanjut diperlukan untuk mengetahui volume optimal serta lokasi injeksi teraman dan efektif untuk menghasilkan penyebaran yang lebih baik pada pleksus lumbalis maupun pleksus lumbosakral. Kata kunci: Blok paravertebral, blok psoas, kadaver, metilen biru, pleksus lumbalis Lumbar paravertebral block theoretically can be used as an alternative for psoas block, furthermore it can be done with a landmark-based technique. The object of this study was to determine the spreading of 30 ml 1% methylene blue dye after single point injection in the L4 lumbar paravertebral space, regarding the area of lumbar plexus. The study used fresh unclaimed cadavers. On all cadavers, a single dose of 30 mL 1% methylene blue injected in the L4 lumbar paravertebral space, using a standard b-bevel needle. Then the cadavers dissected on lumbar area to determine the spreading of the methylene blue. Sixteen cadavers which met the criteria were included. The most cephalad spread was at L1 level (6.25%) with average at the L3 level (50%). The most caudad spread was at the S2 level (12.5%) with average at the L5 level (56.25%). The contralateral spread was found in 18.75% of cadavers. The minimal segmental spread were 2 segments (6.25%) and the maximum segmental spread were 5 segments (12.5%), and the average segmental spread were 4 segments (43.75%). Single point injection of 30 mL 1% methylene blue in the L4 lumbar paravertebral space can cover the lumbar plexus area. Further studies are needed to determine the optimal volume, the effective and safer site for injection technique to produce better spread in the lumbar plexus and lumbosacral plexus innervation as well. Keywords: Cadaver, methylene blue, lumbar plexus, paravertebral block,psoas block Reference Hala. EA Paravertebral block : an overview. Curr Anaesth & Crit Care. 2009;20:65–70. Dodd M, Hunsley J. Thoracic paravertebral block: landmark techniques. Anaesthesia tutorial of the week 224. May 2011 [diunduh 28 Januari 2013]. Tersedia dari: http://www.frca.co.uk/Documents/224%20Paravertebral%20block,%20Landmark%20techniques.pdf Naja ZM, El Rajab M, Al Tannir MA, Zaide FM, Tayara K, Youne F, dkk. Thoracic paravertebral block: influence on the number of injections. Reg anesthesia Pain Med. 2006;31:196–201. Batra RK, Krishnan K, Agarwal A. Paravertebral block. J Anaesthesiol Clin Pharmacol. 2011 Jan–Mar;27(1):5–11. Lee EM, Murphy KP, Ben-David B. Postoperative analgesia for hip arthroscopy: Combined L1 and L2 paravertebral blocks. J Clin Anesth. 2008;20:462–5. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: a randomized doubleblind study. Anesth Analg. 2007;105:1848–51.[diunduh 11 Januari 2013] Tersedia dari: http://www.northeasternanesthesia.com/youranasthesia/peripheral.php. Hocking G, McIntyre O. Achieving change in practice by using embalmed cadavers to teach ultrasound-guided regional anaesthesia. Ultrasound. 2011;19:31–5. Azharflz. Standard IMT (indeks massa tubuh) untuk orang Indonesia. 2011.[diunduh 27 Mei 2013]. Tersedia dari: http://www.medicalera.com/3/9599/standard-imt-indeks-massatubuh-untuk-orang-indonesia. Thoraco lumbar paravertebral block. The New York School of Regional Anesthesia. 2009 [diunduh 3 Oktober 2011]. Tersedia dari: http://www.nysora.com/peripheral_nerve_blocks/classic_block_tecniques/3068-thoraco_lumbar_paravertebral_block.html. Karmakar MK, Kwok WH, Kew J. Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral body. Br J Anesth. 2000;84(2):263–5. Cheema SP, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia. 1995;50:118–21. Saito T, Den S,Tanuma K, Tanuma Y, Carney E, Carlsson C. Anatomical bases for paravertebral anesthesia block: fluid communication between thoracic and lumbar paravertebral regions. Surg Radiol Anat. 1999;21:359–63.
Anestesi Epidural Thorakal pada Operasi Shapp Plate pada Pasien dengan Fraktur Kosta Tertutup Multipel Fardian, Dedy; Laksono, Ristiawan Muji
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Teknik anestesi epidural thorakal banyak digunakan dengan atau tanpa anestesi umum pada operasi daerahthoraks, abdomen dan retroperitoneal. Penggunaan kombinasi dengan anestesi umum akan mengurangi kedalamananestesi dan hemodinamik lebih stabil, serta pulih lebih cepat. Laporan kasus ini, wanita usia 65 tahun, dengandiagnosis fraktur tertutup costae 3–7 sebelah kanan yang menjalani operasi SHAPP klipping kosta dengan anestesiumum dikombinasi epidural thorakal. Status isik pasien ASA 3 dengan geriatri, hipertensi terkontrol, iskemiaanteroekstensif. Anestesi epidural dengan pendekatan median setinggi vertebra T7-8, teknik loss of resistance padakedalaman 3,5 cm dan kateter sedalam 5 cm. Setelah test dose negatif, dilakukan intubasi endotrakeal. Bupivakain0,25% 8 mL+fentanil 50 μg didiberikan ke dalam kateter epidural. Operasi berlangsung stabil dengan tingkatsedasi ringan anestesi inhalasi. Penatalaksanaan nyeri pascaoperasi dengan bupivakain 0,125%+morin 1 mg totalvolume 8 mL, VAS score 0–1. Pada hari ke-4, kateter epidural dicabut diganti obat NSAID oral. Pasien dipulangkanpada hari ke-5. Anestesi epidural thorakal merupakan teknik anestesi yang mempunyai beberapa kelebihan efekanalgesianya, efek perubahan hemodinamik minimal serta menurunkan risiko komplikasi pascaoperasi sehingga berperan utama dalam anestesi bedah thoraks pada geriatri termasuk penatalaksanaan nyeri pascaoperasinya. Kata kunci: Anestesi epidural thorakal, geriatri, hemodinamik stabil, komplikasi pascaoperasi, penatalaksanaan nyeri pascaoperasi Thoracic epidural anesthesia has become widely used with or without general anesthesia for thoracic, abdominal,and retroperitoneal procedures. Combined with general anesthesia, it decreases the need for deep level of anesthesiaand provides more hemodynamically stable operative course and faster emergence of general anesthesia. In thiscase report, an elderly woman, 64 years old, suffered from right 3rd–7th closed rib fracture undergo SHAPP clippingrib surgery under general anesthesia combined with thoracic epidural anesthesia. The physical status was ASA 3with geriatric, controlled hypertension, anteroextensive ischemia. Epidural anesthesia was performed with medianapproach in level T7-8, loss of resistance technique had been used to ind epidural space at 3.5 cm depth, and 5cm catheter was inserted. After the test dose showed negative result, the endotracheal intubation was performed.Bupivacaine 0.25% 8 mL+fentanyl 50 μg was injected intra epidural catheter. The operation went stable with lowlevel sedation of inhalation anesthetics agent. For post operative pain management we used regimen bupivacaine0.125%+morphine 1 mg total volume 8 mL, VAS score 0–1. On the day 4 after surgery, the epidural catheter wasremoved and switched to oral NSAID and the patient discharged on day 5. Thoracic epidural anesthesia is oneof regional anesthesia technique with many advantages such as superiority of pain relief, minimally changes inhemodynamic also lowering risk of postoperative complication, so it plays a major role providing anesthesia inthoracic surgery especially in geriatric, including post operative pain management.Key words: Geriatric, hemodynamically stable, post operative complication, post operative pain management, thoracic epidural anesthesia Reference Yilmaz M, Wong CA. Technique of neuraxial anesthesia. Dalam: Wong CA, penyunting. Spinal and Epidural Anesthesia. New York: McGraw-Hill, Inc; 2007. hlm. 56–9. Hadzic A. Epidural blockade. Dalam: Hadzic A, penyunting. Textbook of regional anesthesia and acute pain management. New York: McGraw-Hill; 2007. hlm. 253–56, 267–70. Brown, DL. Spinal, epidural and caudal anesthesia. Dalam: Miller RD, penyunting. Miller’s Anesthesia. Edisi ke-7. Philadelphia: Churcill Livingstone; 2009. hlm.1611–38, 2261–76. Xie Z, Lanahan J. Anesthesia for geriatric patients. Dalam: Dunn, PF, penyunting. Clinical anesthesia procedures of the massachusetts general hospital. Edisi ke-7. Philadelphia: Lippincott Williams and wilkins; 2007.hlm. 487–91. Akhtar S. Ischemic heart disease. Dalam: Stoelting’s Anesthesia and co-existing disease. Edisi ke-5. Philadelphia: Churcill livingstone; 2009. hlm.11–20. Wu CL, Hurley RW. Post operative pain management and patient outcome. Dalam: Post operative pain management: an evidencebased guide to practice. Philadelphia: Saunders; 2006. hlm. 50, 75–9. Strebel BM, Ross S. Chronic postthoracotomy pain syndrome. CMAJ 2007177: 1029. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101:77–86. Gerner P. Post-thoracotomy pain management problems. Anesthesiol Clin. 2008;26(2):355. Sokouti M, Aghdam BA, Golzari SEJ, Moghadaszadeh M. A comparative study of post operative pulmonary complications using fast track regimen and conservative analgesic treatment: a randomized clinicaltrial. Tanaffos 2011;10(3):12–9 Kettner SC , Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? Br J of Anaesth. 2011;107(S1):i90–5.
Perbandingan Kejadian Post Dural Puncture Headache pada Pasien Seksio Sesarea dengan Anestesi Spinal Menggunakan Teknik Median dan Paramedian , Rizki; , Suwarman; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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spinal (LCS) berpengaruh terhadap timbulnya PDPH. Berbagai faktor yang memengaruhi insidensi kejadian PDPH, meliputi jenis kelamin, usia, kehamilan, riwayat PDPH sebelumnya, ukuran dan bentuk jarum, arah jarum, jumlah percobaan tusukan, teknik penusukan median atau paramedian, dan keahlian ahli anestesi. Tujuan penelitian adalah membandingkan kejadian PDPH wanita hamil yang dilakukan seksio sesarea dengan anestesi spinal menggunakan teknik median dan paramedian di RS Dr. Hasan Sadikin Bandung, periode Maret–April 2014. Penelitian ini dilakukan secara uji klinis acak terkontrol tersamar tunggal terhadap 44 pasien wanita hamil aterm dengan status fisik American Society of Anesthesiologists (ASA) I dan II yang menjalani seksio sesarea dengan anestesi spinal. Subjek dibagi menjadi dua, kelompok paramedian (P) dan kelompok median (M). Kelompok P dilakukan penusukan menggunakan teknik paramedian dan kelompok M menggunakan teknik median dengan m jarum spinal ukuran 25-gauge tipe Quincke. Data hasil penelitian dianalisis menggunakan metode chi-kuadrat Hasil penelitian menunjukkan tidak ada perbedaan yang bermakna pada kedua kelompok (p=0,351), terdapat 2 kejadian (9%) PDPH pada kelompok median (n=22) dan tidak ditemukan kejadian pada kelompok paramedian (n=22). Simpulan penelitian ini adalah tidak ada pengaruh teknik penusukan menggunakan teknik paramedian atau median terhadap kejadian PDPH pada wanita hamil yang dilakukan seksio sesarea Kata kunci: Anestesi spinal, teknik paramedian, post dural puncture headache, teknik median Post dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Cerebro spinal fluid (LCS) leak have effect on the incidence of PDPH. Various factors affect the incidence of PDPH include gender, age, pregnancy, history of previous PDPH, the size and shape of the needle, the needle direction, the number of attempted punctures, median or paramedian puncture technique, and skill of the operator. The purpose of this study was to compare the incidence of PDPH in pregnant women who performed caesarean section under spinal anesthesia using median and paramedian techniques in Dr. Hasan Sadikin Hospital Bandung at April-May 2014. This research was conducted in single-blind randomized controlled clinical trial on 44 at term pregnant women with American Society of Anesthesiologists (ASA) physical status I and II undergoing cesarean section with spinal anesthesia. Subjects were divided into two groups paramedian (P) and the median (M). Group P performed using paramedian puncture technique and M groups using the median technique. Both of technique using a 25- gauge Quincke needle. The data were analyzed using chi-square method The results of this study showed no significant difference in both groups (p=0.351) , with 2 incidences of PDPH (9 % ) in the group median (n=22) and not found in the paramedian group (n=22). Conclusions there is no difference between median and paramedian techniques on the incidence of PDPH in pregnant women who performed caesarean section. Key words: Median, paramedian, post dural puncture headache, spinal anesthesia Reference Paech MJ, Whybrow T. The prevention of anaesthesiology. Asean J Anaesth.2007;8:86–95. Amorim JA, Gomes de Barros MV, Valenca MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012 Sep;32(12):916−23. Singh J, Ranjit S, Shrestha S, Limbu T, Marahatta SB. Post dural puncture headache. J Inst Med. 2010;32(2):30−2. Mosaffa FK, Madadi F, Khoshnevis SH, Besheli LD, Eajazi A. Post-dural puncture headache: a comparison between median and paramedian approaches in orthopedic patients. Anesth Pain. 2011;1(2):66–9. Wu CL, Christo P, Richman JM, Hsu W. Postdural puncture headache: an overview. Int J Pain Med Pall Care. 2004;3(2):53–9. Turnbull DK, Shepherd DB. Postdural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003 Nov;91(5):718−29. Ghaleb A, Khorasani A, Mangar D. Postdural puncture headache. Intern J General Med. 2012;5:45–51 Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needle in obstetric patients. Anesth Analg. 2000;91:916−20. Lybecker H, Moller JT, May O, Nielsen HK. Incidence and prediction of post dural puncture headache: a prospective study of 1021 anesthesia. Anesth Analg. 1990;70:389–94. Haider SZ, Aziz MA., Qasim M. Post dural puncture headache - a comparison of midlineand paramedian approaches. Biomedica. 2005;21:90−2. Valenca MM, Amorim JA, Moura TP. Why don't all individuals who undergo dura mater/arachnoid puncture develop postdural puncture headache? Anesth Pain. 2012;1(3):207–9. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Canadian J Anesth. 2003;50(5):460–9. Jabbari A, Alijampour E, Mir M, Hashem NB, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013;4(1):595–602. Kempen P, Mocek C. Bevel direction, dura geometry, and hole size in membrane puncture: laboratory report. Reg Anesth. 1997;22(3):267–72. Fink BR, Walker S. Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. Anesth Analg. 1989 Dec;69(6):768–72. Hatfalvi B. Postulated mechanisms for postdural puncture headache and review of laboratory models. Clinical experience. Reg Anesth. 1995;20(4):329−36.
Manajemen Emboli Paru di Intensive Care Unit (ICU) Redjeki, Ike Sri; Satrio, Wijanarko
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Emboli paru merupakan komplikasi utama tromboemboli vena (VTE). Emboli paru termasuk dalam kegawatan kardiovaskular. Tersumbatnya pembuluh darah arterial paru dapat mengancam kehidupan disertai kegagalan ventrikel kanan yang dapat reversibel. Diagnosis (PE) yaitu adanya gejala umum dan tanda-tanda klinis seperti hipoksia, takipnea, dan takikardia. Di ICU, sebagian besar pasien memerlukan sedasi dan ventilasi mekanis sehingga manifestasi klinis tidak khas dan biasanya atipikal. Baku emas diagnosis PE adalah ditemukannya sumbatan pada angiografi paru. Diagnosis dan tatalaksana suportif menjadi sangat penting mengingat mortalitasnya yang tinggi. Oksigenasi, intubasi, dan ventilasi mekanik diperlukan untuk kegagalan pernafasan. Terapi vasopressor harus dipertimbangkan jika tekanan darah masih rendah. Terapi antikoagulan memainkan peran penting dalam pengelolaan pasien PE. Heparin dan low molecular weight heparin dapat diberi di awal. Pada kasus yang berat mungkin memerlukan trombolisis dengan obat-obatan seperti tissue plasminogen activator (tPA) atau mungkin memerlukan intervensi bedah melalui thrombectomy paru. Kata kunci: Antikoagulan, emboli paru, tromboemboli vena Pulmonary embolism is the major complication of venous thromboembolism (VTE). Pulmonary embolism is a cardiovascular emergency. By occluding the pulmonary arterial bed it may lead to acute life threatening but potentially reversible right ventricular failure. The diagnosis of (PE) is usually suspected by the presence of common symptoms and clinical signs include hypoxia, tachypnea, and tachycardia. However in ICU, the most of patients required sedation and mechanical ventilation. The clinical manifestations is usually atypical. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, once it is suspected, a diagnostic plan and supportive measures are essential. Oxygen supplementation, intubation, and mechanical ventilation are instituted as necessary for respiratory failure. Vasopressor therapy should be considered if the blood pressure is not rapidly restored. Anticoagulant treatment plays a pivotal role in the management of patients with PE. Heparin, low molecular weight heparins is administered initially. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy. Key words: Anticoagulant, pulmonary embolism, venous thrombus Reference Zochios V, Keeshan A. Pulmonary embolismin the mechanically-ventilated critically ill patient: is it different? The intensive care societty 2013. 2013;14:36–44. Marino P, penyunting. Venous thromboembolism. Philadelphia: Lipincott Williams Wilkins; 2007. Williams M, Aravindan N, Wallace M. Venous thromboembolism in the intensive care unit. Crit Care Clin 2003;19:185–207. Adam T, Arnaud P, Konstantinides S, Agnelli G, Galle N, Pruszczyk P. Guidelines on the diagnosis and management of acute pulmonary embolism. European Heart Journal. 2008;29:2276–315. Forgione A. Managing patients with suspected pulmonary embolism. JAAPA. 2006;19:22–8. Stoelting K, Dierdorf S, Penyunting. Deep vein thrombosis and pulmonary embolism. Philadelphia; 2002. Bahloul M, Chaari A, Kallel H, Abid L, Hamida C, Dammak dkk. Pulmonary embolism in intensive care unit: predictive factors, clinical manifestations and outcome. Ann Thorac Med 2010;5:97–103. Waldmann c, Vincent JL. Pulmonary Embolism the future, Optimising the prevention of PE in the critically ill patient. Journal of the intensive care society. 2014;15:2–16.
Manajemen Anestesia pada Operasi Reseksi Malformasi Arteri Vena Otak Januarrifianto, Desy; Auerkari, Aino Nindya; Firdaus, Riyadh
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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AbstrakMalformasi arteri-vena otak, atau cerebral arteriovenous malformation (AVM) merupakan kondisi yang jarang, namun morbiditas neurologis dan mortalitasnya bermakna. Salah satu pilihan terapi untuk AVM adalah operasi reseksi dengan bedah mikro. Perhatian khusus untuk ahli anestesia pada operasi ini adalah upaya mencegah iskemia sekunder jaringan otak dengan mempertahankan hemodinamik stabil agar tekanan perfusi otak sedekat mungkin dengan nilai normal, mengupayakan agar tidak terjadi pembengkakan otak dan mengantisipasi perdarahan. Di laporan ini, kami menjabarkan manajemen anestesia pada laki-laki 22 tahun dengan AVM simtomatik yang menjalani operasi reseksi AVM pada tanggal 10 April 2012 di Instalasi Bedah Pusat RS dr. Cipto Mangunkusumo, dan mengalami perdarahan akibat ruptur arteri intraoperasi. Kata kunci: Anestesia, AVM, malformasi arteri-vena, operasi reseksi Cerebral arteriovenous malformation (AVM) is a rare vascular condition carrying significant neurologic morbidity and mortality. Among the treatment options are surgical resection using microsurgery technique. Special anesthetic consideration in this type of surgery is on preventing secondary ischemia of brain tissue by maintaining stable haemodynamics to achieve as normal cerebral perfusion pressure as possible, preventing cerebral edema and anticipating hemorrhage. In this report, we describe the anaesthetic management of a 22 year-old male presenting with symptomatic AVM, who underwent surgical resection on April 10th 2012 in Central Operating Theater of RS dr. Cipto Mangunkusumo, and experienced intraoperative bleeding from an arterial rupture. Key words: Anesthesia, arteriovenous malformation, AVM, surgical resection
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
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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.
Sakit Kepala yang dihubungkan dengan Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Sakit kepala adalah salah satu keluhan yang sering setelah cedera otak traumatik (COT) dan disebut sebagai “post-traumatic headache” sakit kepala pascatrauma. Berkisar 30–90% pasien mengalami sakit kepala setelah cedera. Sakit kepala setelah COT dapat berlangsung lama, datang dan hilang dalam waktu satu tahun, menyulitkan melakukan aktivitas sehari-hari, sulit berfikir dan mengingat sesuatu. Setelah cedera kepala berat, pasien mungkin mengalami sakit kepala akibat dari operasi pada tulang kepalanya atau masih adanya kumpulan kecil darah atau cairan di ruang intrakranial. Sakit kepala bisa setelah cedera kepala ringan, sedang dan berat. Sakit kepala ini dapat disebabkan berbagai kondisi antara lain perubahan dalam otak akibat cedera, cedera leher dan tulang kepala yang belum pulih seluruhnya, tegangan dan stres, atau efek samping pengobatan. Ada beberapa tipe sakit kepala antara lain sakit kepala tipe migraine, tension, cervicogenic, dan rebound. Terapi dapat dilakukan dengan merubah pola hidup misalnya harus cukup tidur, olah raga, hindari kopi, hindari makanan tertentu yang memicu sakit kepala seperti anggur (red wine), monosodium glutamat, keju dan terapi obat-obatan misalnya asetaminophen, gabapentin, antidepresant. Akan tetapi, lebih utama adalah pencegahan dengan cara menghindari cedera otak primer, dan apabila terjadi cedera otak primer sebaiknya menghindari dan mengobati cedera otak sekunder dengan pengelolaan perioperatif yang tepat. Kata kunci: Bedah saraf, cedera otak traumatik, neuroanestesi, sakit kepala Headache is one of the most common symptoms after traumatic brain injury (TBI) and called “post-traumatic headache”. Approximately 30–90% of people having headaches. Headaches after TBI can be long-lasting, coming and going even past one year. Headaches can make it hard for you to carry out daily activities or can cause you to have more difficulty thinking and remembering things. Right after a severe TBI, people may have headaches because of the surgery on their skulls or because they have small collections of blood or fluid inside the skull. Headaches can also occur after mild, moderate and severe TBI. These headaches can be caused by a variety of conditions, including a change in the brain caused by the injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication.There are many kinds of headaches,migraine headaches, tension-type headaches, cervicogenic headaches, and rebound headaches. Treatment a headache after TBI will depend on each individual case. They are lifestyle changes like get enough sleep, get daily exercise, avoid caffeine, avoid certain foods that may trigger a headache, like red wine, monosodium glutamate or certain cheeses, and medicine therapy as acetaminophen, gabapentin, antidepresant. But, more important is prevention with avoid primary brain injury and avoid and treatment secondary brain injury with adequate periopeative management. Key words: headache, neuroanesthesia, neurosurgery, traumatic brain injury Reference Levin M, Ward TN. Headache. Dalam: Silver JM, McAllister TW, Yudofsky SC, penyunting. Textbook of traumatic brain injury. Edisi ke-2. Washington: American Psychiatric Pub Inc;2011,343–50. Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC. Characteristics and treatment of headache after traumatic brain injury: A focused review. Am J Phys Med Rehabil 2006;85(7):619–27. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro C A. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med 2008;358(5):453–63. Mihalik JP, Stump JE. Collins MW, Lovell MR, Field M, Maroon JC. Posttraumatic migraine characteristics in athletes following sports-related cocussion. J Neurosurg 2005;102(5):850–55. Hofman JM, Lucas S, Dikmen S, Braden CA, Brown AW, Brunner R, dkk. Natural history of headache after traumatic brain injury. Journal of Neurotrauma 2011;28:1719–25. Walker WC, Seel RT, Curtiss G, Warde DL. Headache after moderate and severe traumatic brain injury: a longitudinal analysis. Arch Phys Med Rehabil 2005;86:1793–800. Sherman KB, Goldberg M, Bell KR. Traumatic brain injury and pain. Phys Med Rehabil Clin N Am. 2006;17:473–90. De Lima Martin HA, Ribas VR, Martins BBM, Ribas RMG, Valenca MM. Posttraumatic headache. Arq Neuropsiquiatr 2009;67(1):43–45. McAllister TW. Mild brain injury. Dalam: Silver JM, McAllister TW, Yudofsky SC, Penyunting. Textbook of traumatic brain injury. Edisi ke-2. Washington: American Psychiatric Pub Inc;2011. hlm. 239–57. Lew Hl, Lin Pri, Fuh JL, Wong SJ, Clark DJ, Walker WC. Characteristic and treatment of headache after traumatic Broun Injury: a focused review. Am J Phys Med Rehabil. 2006;85(7):619–27
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
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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.
Perbandingan Kadar Kortisol dan Efek Analgesia Pascabedah Anestesi Spinal Kombinasi Bupivakain Hiperbarik 0,5% 8 mg dan Klonidin 30 μg dengan Bupivakain Hiperbarik 0,5% 8 mg dan Morfin 0,1 mg pada Pasien yang Menjalani Prosedur Seksio Sesaria Irawan, Hery; , Wahyudi; , Hisbullah
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Penurunan hormon kortisol pada masa intraoperatif dapat terjadi dengan menggunakan mekanisme penghambatan pada sistem saraf pusat. Anestesi spinal merupakan pilihan dalam mekanisme tersebut. Penelitian bertujuan untuk membandingkan kadar kortisol dan efek analgesia pascabedah pada anestesi spinal kombinasi Bupivakain hiperbarik 0,5% 8 mg+Klonidin 30 μg dan Bupivakain hiperbarik 0,5% 8 mg + morfin 0,1 mg pada seksio sesarea. Penelitian menggunakan uji klinis acak tersamar tunggal pada 50 pasien dengan kriteria inklusi, dibagi menjadi kelompok anestesi spinal kombinasi Bupivakain hiperbarik 0,5% 8 mg + Klonidin 30 μg (BK) n=25 dan kelompok kombinasi Bupivakain hiperbarik 0,5% 8 mg + morfin 0,1 mg (BM) n=25. Analisis statistik dengan Uji Mann-whitney dan uji-tes, dengan p<0,05 bermakna secara signifikan. Hasil penelitian menunjukkan pada kelompok BM sama efektif dengan kelompok BK dalam mencegah peningkatan kadar kortisol intraoperatif. Efek analgesia pascabedah anestesi spinal kombinasi kelompok BM lebih baik dibandingkan dengan kombinasi BK. Efek samping diantara kedua kelompok dinyatakan tidak bermakna. Kesimpulan penelitian adalah kelompok BM sama efektif dengan kelompok BK dalam mencegah peningkatan kadar kortisol saat pembedahann namun e fek analgesia pascabedah anestesi spinal kombinasi kelompok BM lebih baik dibandingkan dengan kombinasi BK. Kata kunci: Anestesi spinal, kortisol, klonidin, morfin, seksio sesarea The decrease of cortisol hormone level during intraoperative period may occur due to inhibitory mechanism on central nervous system. Spinal anesthesia is an option to prevent the proccess. This study aimed to compare cortisol hormone level and postoperative analgesia between spinal anesthesia combination of 0.5% hyperbaric Bupivacaine 8 mg and Clonidine 30 μg + hyperbaric 0.5 % Bupivacaine 8 mg + 0.1 mg morphine in cesarean section. The study was a single-blind randomized clinical trial in 50 patients with inclusion criteria, divided into BK group (a combination of 0.5 % Hyperbaric Bupivacaine 8 mg + 30 mg Clonidine; n=25) and BM group (a combination of 0.5 % hyperbaric Bupivacaine 8 mg + morphine 0.1 mg; n=25). Statistically analyzed using Mann-Whitney Test and t-test, with p<0.05 statistically significance. Research shows that BM group as effective as BK group in preventing the increase of cortisol level. Effect of postoperative analgesia in group BM was better than group BK. Side effects between the two groups revealed no significant difference. The conclusion of this study group BM as effective as group BK in preventing the increase of cortisol level during surgery. However, effect of postoperative analgesia in group BM was better than group BK.Key words: Cortisol, caesarean section, clonidin, morphin, spinal anesthesia. Reference Hurley RW, Wu CL. Acute post operative pain. dalam: Miller RD, Eriksson LI, Fleisher LA, Wiener JP, Young WL, penyunting. Miller’s anesthesia. Edisi ke-7. Philadelphia: Elsevier Churchill Livingstone; 2008. hlm. 321–33. Paech MJ. Anesthesia for cesarean delivery. Dalam: Palmer CM, D’Angelo R, Paech MJ, penyunting. Obstetric anesthesia. New York: Oxford University Press; 2011. hlm.79–155. Ahmad MR, Marwoto. Pengelolaan nyeri pasca seksio sesaria. Dalam: Bisri T, Wahjoeningsih S, Suryono B, penyunting. Anestesi Obstetri. Bandung: Saga Olahcitra; 2013. hlm. 301–12. Persec J, Persec Z, Zinovic H. Post operative pain and systemic inflammatory stress response after preoperative analgesia with clonidine or levobupivacaine: a randomized controlled trial. Br J Anesth. 2009;121(17–18):558–3. Bhure A, Kalita N, Ingley D, Gadkari CP. Comparative study of intrathecal hyperbaric Bupivakaine with clonidine, fentanyl and midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section. People J of Sci Research. 2012; 5(1):19–23. Bhushan SB, Suresh JS, Vinayak SR, Lakhe JN. Comparison of different doses of clonidine as an adjuvant to intrathecal Bupivakaine for spinal anesthesia and postoperative analgesia in patients undergoing caesarian section. Anaesth, Pain Intens Care. 2012;16(3):266– 72. Pongpit P. Comparison postoperative analgesic efficacy of intrathecal morphine and without intrathecal morphine in patients who underwent cesarean section with spinal anesthesia in Nakhonphanom hospital: a rectrospective observational analitycal study. Yasothon Med Jr. 2014;14(2):1–3. Rochette A, Raux O, Troncin R, Dadure C, Verdier R, Capdevila X. Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging study. Anesth Analg. 2004;98: 56–9. Kwan JW. Use of infusion devices for epidural or intrathecal administration of spinal opioids. Am J Hosp Pharm 2008;47:18–23. Tanra, AH. Nyeri pascabedah implikasi sensitisasi perifer dan sentral. Dalam: makalah simposium pengelolaan nyeri. Jakarta. 2004. Prasetyo AH. Efek klonidin sebagai ajuvan anestesi spinal terhadap hormon stress [Tesis]. Surakarta; 2011. Cianni S, Rossi M, Casta A. Spinal anesthesia: an evergreen technique. Acta Biomed. 2008; 79:9–17. Vercauteren M. Analgesia after Caesarean section: are neuraxial techniques outdated?. Jr Român de Anestezie Terapie Intensivã 2009;16(2):129–133. Kirsten M, Laura M. Bohn. Mu opiod receptor regulation and opiate responsiveness. The AAPS Journal. 2005;7(3):572–83. Tonner PH. Alpha2- adrenoceptor agonis in anaesthesia. Europ Anesth society. 2004; 35–40. Vercauteren M. Analgesia after Caesarean delivery in the 21st century. ESA Jr.2009 ;(13):1–2 Zhou H, Chen SR, Chen H, Pan HL. Opioidinduced long-term potentiation in the spinal cord is a pre synaptic event. J Neuro Sci. 2010; 30(12):4460–6. Miller RD, penyunting.Bupivakaine. Edisi ke-6. New York: Elsevier, Churchill Livingstone; 2006. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005; 101:62–9. Christiansson L. Update on adjuvant in regional anesthesia. Period boil. 2009; 111(2): 161–70.
Perbandingan Kadar Prostaglandin-E2 (PGE2) Setelah Pemberian Metamizol Intravena dengan Parasetamol Intravena pada Pasien Cedera Otak Sedang sampai Berat dengan Demam Tandiarrang, Ajutor Donny; Arif, Syafri K.
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Metamizol intravena dan parasetamol intravena dapat menurunkan suhu tubuh pasien cedera otak sedang sampai berat dengan menghambat produksi PGE2 sebagai mediator demam. Penelitian ini bertujuan untuk membandingkan pemberian metamizol intravena dengan parasetamol intravena terhadap kadar PGE2 plasma dalam menurunkan suhu tubuh pasien cedera otak sedang sampai berat dengan demam. Sampel penelitian adalah 44 pasien cedera otak sedang sampai berat dengan demam, dibagi dalam 2 kelompok. Kelompok M (n=22) diberikan metamizol IV 15 mg/kgBB, sedangkan kelompok P (n=22) diberikan parasetamol 15 mg/kgBB. Analisis statistik dilakukan dengan Uji Mann U-Whitney dan Uji Pearson, dengan p<0,05 bermakna secara signifikan. Hasil penelitian menunjukkan bahwa terdapat penurunan suhu dan kadar PGE2 plasma yang bermakna pada kedua kelompok (p<0,05). Hasil Uji korelasi Person memperlihatkan bahwa semakin tinggi suhu semakin tinggi pula kadar PGE2 plasma. Metamizol intravena sama efektifnya dengan parasetamol dalam menurunkan suhu tubuh dan kadar PGE2 plasma pada pasien cedera otak sedang sampai berat dengan demam. Kata kunci: Cedera otak, kadar PGE2, metamizol, parasetamol, suhu Intravenous metamizol and paracetamol can lower body temperature on moderate to severe traumatic brain injury patients with fever by inhibiting the production of PGE2 as a mediator of fever. This study aims to compare the effect between intravenous metamizol and paracetamol on the PGE2 plasma level in lowering body temperature on moderate to severe traumatic brain injury patients with fever. The study samples consist of 44 severe to moderate traumatic brain injury patients with fever divided in 2 groups: M group (n=22) was given metamizol IV of 15 mg/BW body weight and P group (n=22) was given paracetamol of 15 mg/BW body weight. Statistically analyzed was using Mann U-Whitney Test and Pearson chi-square test with p<0,05 of statistical significance. Temperature and PGE2 plasma levels significantly decrease in both groups (p<0,05). The result of the Pearson correlation test shows that the higher the temperature the higher the PGE2 plasma level. Intravenous metamizol and paracetamol have proven effective to lower body temperature and PGE2 plasma levels of moderate to severe traumatic brain injury patients with fever. Key words: Metamizol, paracetamol, PGE2 level, temperature, traumatic brain injury Reference Ryan M, Levy MM. Clinical review: fever in intensive care unit patients. Crit Care. 2007: 221–5. Dimopoulos G, Falagas ME. Approach to the febrile patient in the ICU. Infect Dis Clin N Am 23. 2009:471–84. Kothari VM. New onset fever in the intensive care unit. JAPI. 2005;33:949–53. Thompson HJ, Kirknes CJ, Mitchell PH. Intensive care unit management of fever following traumatic brain injury. Intensive Crit Care Nurs. 2007;23(2):91–6. Fischer M, Lackner P, Beer R, Helbok R, Klien S,Ulmer H, dkk. Keep the brain coolendovascular cooling in patients with severe traumatic brain injury: A case series study. Neurosurgery. 2011;68(4): 867–73. Badjatia N. Fever management. Continuum. 2009:83–99. Mrozek S, Vardon F, Geeraerts T. Brain temperature: physiology ang pathophysiology after brain injury. Anesthesiology Research and Practice. 2012. Bisri T. Penanganan neuroanestesia dan critical care cedera otak traumatik. Edisi ke-3 Bandung: Saga Olahcitra; 2012. Marion DW. Controlled normothermia in neurologic intensive care. Crit Care Med. 2004; 32 Suppl2:43–5. Torbey MT, penyunting. Neurocritical Care. Cambridge: cambridge University Press; 2010. Protheroe RT, Gwinnutt CL. Early hospital care of severe traumatic brain injury. Anaesthesia. 2011;66 :1035–47. Davies AR. Hypothermia improves outcome from traumatic brain injury. Crit Care Resus. 2005;7:238–43. Masaoka H. Cerebral flow and metabolism during mild hypothermia in patients with severe traumatic brain injury. J Med Dent Sci. 2010;57:133–38. Żukowski M, Kotfis K. Safety of metamizol and paracetamol for acute pain treatment. Anaesthesiology Intensive Therapy 2009;(3):141–145. Porat R, Dinarello CA. Pathohysiology and treatment of fever in adults. UpToDate. 2004. Dalal S, Zhukowsky DS. Pathophysiology and management of fever. J Supp Onco. 2006;4(1):9–16. Blatteis CM. The onset of fever: new insights into its mechanism. Progress in Brain Research. 2007;2007;162: 3–14 Cruz P, Garutti I, Díaz S, Fernández-Quero L. Metamizol versus pracetamol: comparative study of the hemodynamic and antipyretic effects in critically ill patients. Rev Esp Anestesiol Reanim 2002;49(8):391–6. Gozzoli V, Treggiari MM, Kleger GR, Roux-Lombard P, Fathi M, Pichard C,dkk. Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynamics and inflammatory response. Intensive Care Med .2004;30(3):401–7. Honarmand H, Abdollahi M, Ahmadi A, Javadi MR, Khoshayand MR, Tabeefar H, et all. Randomized trial of the effect of intravenous paracetamol on inflammatory biomarkers and outcome in febrile critically ill adults. Daru. 2012;20(1):1–9. Vera P, Zapata L, Gich I, Mancebo J, Betbese AJ. Hemodynamic and antipyretic effects of paracetamol, metamizol and dexketoprofen in critical patients. Med Intensiva. 2013. Aranoff DM, Neilson EG. Antipyreticcs: mechanisms of action and clinical use in fever suppression. Am J Med. 2001;111: 304–15. Ivandri, Arif SK, Ahmad MR, Patellongi I. Perbandingan efek kombinasi metamizolcooling blanket dengan parasetamol-cooling blanket dalam menurunkan demam pasien cedera kepala. Bagian Anestesiologi, Perawatan Intensif, dan Manajemen Nyeri

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