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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 34 No 1 (2016): Februari" : 8 Documents clear
Kefektifan Sedasi antara Campuran Ketamin Propofol (Ketofol), dan Propofol Fentanil pada Prosedur Endoscopic Retrograde Cholangiopancreatography (ERCP) Sugiarto, Adhrie; Perdana, Aries; Jefrey Tuhulele, Norman Rabker
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Sedasi adekuat diperlukan untuk menjaga kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasienselama prosedur ERCP. Propofol merupakan sedasi yang tanpa efek analgesia namun memiliki efek depresikardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan menurunkankebutuhan dosis propofol dalam mempertahankan kedalaman sedasi, analgesia, kestabilan hemodinamik danrespirasi. Penelitian ini membandingkan keefektifan sedasi antara campuran ketamin-propofol (ketofol) danpropofol-fentanil pada prosedur ERCP. Penelitian ini adalah uji klinis acak tersamar ganda, 36 pasien dewasayang menjalani prosedur ERCP, dibagi menjadi dua kelompok yaitu kelompok KF (n=18) yang mendapatkanketofol 1:4 dalam semprit 50 mL, serta kelompok PF (n=18) yang mendapatkan fentanil 1 mcg/kgBB dan propofoldalam semprit 50 mL. Kedalaman sedasi diukur dengan Ramsay Sedation Scale. Hasil penelitian didapatkan reratakonsumsi propofol permenit, kelompok ketofol lebih rendah bermakna dibanding dengan kelompok propofolfentanil (p<0.05). Jumlah kebutuhan fentanil pada kelompok ketofol lebih rendah dibanding dengan kelompokpropofol-fentanil (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol-fentanil lebih cepat dibandingdengan kelompok ketofol (p<0.05). Kejadian hipotensi pada kedua kelompok tidak berbeda bermakna (p>0.05).Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Simpulan adalah ketofol lebihefektif daripada propofol-fentanil untuk kedalaman sedasi dan analgesia serta memiliki efek samping yangminimal. Kata kunci: ERCP, Propofol, ketamin, fentanil, sedasi, analgesia The effectiveness of sedation is the ability of the drugs to maintain sedation depth and analgesia, and to controlpatients movements during ERCP procedure. Propofol is a sedative agent that has no analgesia effect and hasa dose-dependent cardiovascular and respiratory depressant effects. The addition of small dose of ketamin isexpected to reduce the required dose to maintain hemodinamic and respiratory stability. This study comparedthe effectiveness of sedation between 1:4 ketamin propofol mixtures (ketofol) and propofol-fentanyl in ERCPprocedure. This research a double blind randomised clinical trial was done in 36 adult patients who underwentERCP procedure, which were divided into two groups: KF group (n = 18), which were treated with ketofol 1:4in a 50 mL syringe, and PF group (n = 18) which were treated with fentanil 1 mcg/kgBW and propofol in a 50mL syringe. The depth of sedation was measured by Ramsay Sedation Scale (RSS). The average consumption ofpropofol per minute of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The medianfentanyl consumption of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The onsetand the recovery time in fentanyl propofol group were faster than ketofol group (p<0.05). There was no significantdifferent in the incidence of hypotension in both groups (p>0.05). There were no desaturation events or nausea/vomiting in both groups. Conclution ketofol was more effective than fentanyl-propofol mixture in maintaining thedepth of sedation and analgesia and has minimal side effects. Key words: Analgesia,ERCP, fentanyl, ketamine, propofol, sedation Reference Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62(1):1–8. Glomsaker TB. Endoscopic Retrograde Cholangiopancreatography (ERCP) in Norway, University of Bergen, 2013. Available at http://www.ivs.no/downloads/ thesis_Glomsaker.pdf, accessed on October 24, 2014 Chainaki IG, Manolarki MM, Paspatis GA. Deep sedation in gastrointestinal endoscopy, World J Gastroentero, 2011, 3 (2): 34–9. Sumaratih L. Perbandingan keluaran antara teknik pemberian propofol bolus berkala dengan Target Controlled Infusion pada pasien endoskopi saluran cerna di RSUPN Cipto Mangunkusumo, Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Indonesia, Jakarta, 2013. Wang Y, Jiang X, Pan L, Dong S, Feng Y, Prajapati SS, et al. Randomized double-blind controlled study of the efficacy of ketofol with propofolfentanyl and propofol alone in ttermination of pregnancy. Afr. J.Pharm. pharmacol.2012;6(34):2510–14. Coulter FLS, Hannam JA, Anderson BJ. Ketofol dosing simulations for procedural sedation, Pediatr Emerg Care, 2014;30(9): 621–30. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamin propofol (ketofol), Acad Emerg Med, 2010;17:194–201. Hassenein R, El-Sayed W. Ketamin/propofol versus fentanyl/propofol for sedating obese patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP), Egypt J Anesth, 2013;29:207–11. Thom G. The evolving role of ketofol and its use as sedation agent in PSA in children: systemic review, 2013. Available at http://sedationspecialists.co.za/wpcontent/uploads/2013/07/Ketofol-in-sedationnew-developments_Dr-George-Thom.pdf, accessed on October 11, 2014.
Perbandingan Pemberian Kombinasi Haloperidol 0,5 mg dan Deksametason 5 mg dengan Ondansetron 4 mg terhadap Kejadian Mual Muntah Pascaoperasi Modified Radical Mastectomy dengan Anestesi Umum Rahmadsyah, Teuku; Fuadi, Iwan; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Mual muntah pascaoperasi dapat meningkatkan morbiditas dan memperpanjang masa rawat pascaoperasi.Haloperidol adalah obat tranquilizer major golongan dari butirofenon yang mempunyai efek reseptor D2 antagonis.Penggunaan kombinasi haloperidol dan deksametason sebagai antiemetik profilaksis dapat menguntungkan.Penelitian ini bertujuan untuk membandingkan kombinasi haloperidol 0,5 mg dan deksametason 5 mg denganondansetron 4 mg terhadap kejadian mual muntah pascaoperasi pada operasi modified radical mastectomy.Penelitian dilakukan terhadap 42 wanita (kurang dari 50 tahun) status fisik ASA I-II yang menjalani operasimodifikasi mastektomi radikal secara uji acak terkontrol buta ganda dalam anestesi umum. Pasien dibagi menjadidua kelompok yaitu 21 orang menerima haloperidol 0,5 mg ditambah deksametason 5 mg dan 21 orang menerimaondansetron 4 mg yang diberikan setelah intubasi dilakukan. Pasien diberikan analgetik ketorolak dan petidinintravena secara kontinu pascaoperatif. Evaluasi yang dinilai adalah tekanan darah, laju nadi, dan saturasioksigen. Hasil dari penelitian menunjukan terdapat kecenderungan keluhan mual muntah pascaoperasi lebihbanyak terjadi pada kelompok ondansetron 4 mg (38,1%) dibanding dengan kelompok kombinasi haloperidol0,5 mg dan deksametason 5 mg (4,8%). Pada analisis statistik yang dilakukan dengan uji Chi-Square didapatkanhasil perbedaan yang bermakna (p kurang dari 0,05). Simpulan dari penelitian ini adalah pemberian kombinasihaloperidol 0,5 mg dan deksametason 5 mg intravena lebih baik dibandingkan dengan ondansetron 4 mg intravenadalam menurunkan kejadian mual muntah pascaoperasi modified radical mastectomy. Kata kunci: deksametason, haloperidol, modified radical mastectomy, mual muntah, ondansetron Postoperative nausea and vomiting can lead to increase morbidity and lengthened postoperative hospital stay.Haloperidol is a major tranquilizer with a D2 receptor antagonist effect. A combination of haloperidol anddexamethasone is also effective to prevent postoperative nausea and vomiting, which offers beneficial effectssuch as lower cost, longer duration and are easy to find. The aim of this study is to compare a combination ofhaloperidol 0,5 mg and dexamethasone 5 mg with ondansetron 4 mg in managing postoperative nausea andvomiting following modified radical mastectomy. The study was done by conducting a double blind randomizedcontrolled trial of 42 subjects, women aged under 50 years old, who underwent modified radical mastectomy undergeneral anesthesia, with physical status ASA I-II. Patients were divided into two groups: 21 patients receivedcombination of haloperidol 0,5 mg and dexamethasone 5 mg, and 21 patients received ondansetron 4 mg, afterintubation. Intravenous ketorolac and pethidine were given as postoperative analgesia. Blood pressure, heartrate, oxygen saturation and length of surgery was recorded.The result of this study was postoperative nausea andvomiting occurs more frequent in the ondansetron 4 mg group (38,1%) compared to combination of haloperidol0,5 mg and dexamethasone 5 mg group (4,8%). In statistical analysis performed with Chi-Square test showedthere was significant difference between the two groups (p<0,05). As a conclusion of this study is intravenouscombination of haloperidol 0,5 mg and dexamethasone 5 mg better than ondansetron 4 mg in lowering theincidence of postoperative nausea and vomiting after modified radical mastectomy. Key words: Dexamethasone, haloperidol, modified radical mastectomy, nausea and vomiting, ondansetron Reference Daabiss MA. Ephedrine-dexamethasone combination reduces postoperative nauseaand vomiting in patients undergoing laparoscopic cholecystectomy. Internet Anesthesiol. 2008;18(1):1092 ̶ 100. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting. Can J Anesth. 2004;51:326 ̶ 41. Watcha MF, White PF. Postoperative Nausea and Vomiting, lts Etiology, Treatment, and Prevention. Anesthesiology. 1992;77:162–84. Gan TJ. Risk factors of postoperative nausea and vomiting. Anaesth Analg. 2006;102:1884 ̶ 98. Islam S, Jain PN. Postoperative nausea and vomiting (PONV): a review article. Indian J Anesth. 2004;48:253 ̶ 8. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999;91:109 ̶ 18. Ho KY, Chiu JW. Multimodal antiemetic therapy and emetic risk profiling. Ann Acad Med Singapore. 2005;34:196 ̶ 205. Matthew TV, Chan, Chui PT, Ho WS, King WK. Single dose tropisetron for preventing post operative nausea and vomiying after breast surgery. Anesth Analg. 1998;87:931 ̶ 5. McQuaid KR. Drugs used in the treatment of gastrointestinal diseases. Dalam: Basic & clinical pharmacology. Edisi ke-9. Boston: The McGraw-Hill Companies. 2004. hlm. 1045 ̶ 60. Raman S, Kaul TK, Anju G, Aprajita S. Postoperative nausea and vomiting. Anesth Clin Pharmacology. 2007;23:341 ̶ 56. Ku CM, Ong BC. Postoperative nausea and vomiting: a review of current literature. Singapore Med J. 2003;44(7):366 ̶ 74. Splinter WM, Roberts DJ. Dexamethasone decreases vomiting by children after tonsillectomy. Anesth Analg. 1996;83:913 ̶ 6. O’Brien C. Nausea and vomiting. J Can Family Physician. 2008;54:861 ̶ 3. Zarate E, et.al. A Comparison of The Cost and Efficacy of Ondansetron versus Dolasetron for Antiemetic Prophylaxis. Anaesth Analg. 2000;90:1352 ̶ 8. Rosow CE, et.al. Haloperidol versus Ondansetron for Prophylaxis of Post operative Nausea and Vomiting. Anesth Analg. 2008; 106:1407 ̶ 9. Azwar. Pencegahan mual dan muntah pascaoperasi pada anestesi umum: Perbandingan haloperidol 1mg iv dengan ondansetron 4 mg iv [Jakarta: Universitas Indonesia. 2009. Adipraja K, Himendra A, Bisri T. Pengaruh premedikasi haloperidol (serenace®) terhadap efek samping ketamine pada penderita rawat Intensif Fakultas Kedokteran UNPAD/RSHS Bandung. 1992; hlm. 1 ̶ 9. Smith JC, Wright EL. Haloperidol: An Alternative Butyrophenon for Nausea and’ Vomiting Prophylaxis in Anesthesia. AANA journal. 2005;75:273 ̶ 5. Digregio GJ. Anti Psichotic Drugs and Lithium. Dalam: Basic Pharmacology in Medicine. Edisi ke-3. New York: Mc Graw-Hill. 1990. hlm. 261 ̶ 2. Moorselli PL. Haloperidol: Clinical Pharmacokinetics and Significance of Theurapeutic Drug Monitoring. Dalam: Theurapeutic Drug Monitoring. Churchill Livingstone. 1981. hlm. 296 ̶ 301. Khan MP, Singh V, Kumar M, Singh B, Kapoor R, Bhatia VK. Prophylactic antiemetic therapy using combinations of granisetron, dexamethasone and droperidol in patients undergoing laparoscopic cholecystectomy. The Internet Journal of Anesthesiology. 2009;21(1):1092 ̶ 102.
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
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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.
Pola Kuman Terbanyak Sebagai Agen Penyebab Infeksi di Intensive Care Unit pada Beberapa Rumah Sakit di Indonesia Taslim, Emilzon; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Tingkat penggunaan antibiotik yang tinggi di ruang perawatan intensif atau intensive care unit (ICU) telahmenyebabkan peningkatan kejadian resistensi antibiotik terhadap kuman. Penulisan tinjauan pustaka iniberdasarkan studi kepustakaan yang dikumpulkan dari berbagai sumber. Hasil penulisan ini menunjukkan bahwakuman yang paling banyak terdapat di ICU adalah Pseudomonas aeruginosa dan Klebsiella pneumonia. Selain itu,didapatkan pula peningkatan kejadian Methycillin Resistant Staphylococcus Aureus (MRSA) . Beberapa antibiotiktidak sensitif lagi terhadap kuman-kuman yang terdapat di ICU, antara lain ampicillin, cefotaxime, tetracycline,ceftazidime, chloramphenicol, dan ciprofloxacin. Disarankan agar dilakukan perputaran penggunaan antibiotik(antibiotic cycling) berdasarkan pola kepekaan bakteri dan pola sensitivitas antibiotik untuk mengurangi kejadianresistensi antibiotik. Kata kunci: Intensive Care Unit , pola kuman, resistensi antibiotik High usage of antibiotics in the Intensive Care Unit (ICU) have led to increased incidence of antibiotic resistanceto microbial agents. This paper based on the study of literature gathered from various sources. The results of thispaper show that most numerous microbial agents found in the ICU was Pseudomonas aeruginosa and Klebsielapneumonia. Besides that, there is also an increase of the incidence of MRSA (Methycilin Resistant StaphylococcusAureus). Some antibiotics that are no longer sensitive to microbial agents in the ICU are ampicilin, cefotaxime,tetracycline, ceftazidime, chloramphenicol, and ciprofloxacin. Recommended to do an antibiotic cycling basedon the antibiotics usage pattern and bacterial sensitivity patterns to reduce the incidence of antibiotic resistance. Key words: Antibiotic resistance, bacterial patterns, Intensive Care Unit Reference Undang-Undang Republik Indonesia No. 44 Tahun 2009. Widyaningsih R, Buntaran L. Pola Kuman Penyebab Ventilator Associated Pneumonia (VAP) dan Sensitivitas Terhadap Antibiotik di RSAB Harapan Kita. Sari Pediatri. 2012;13(6):384–90. Noer SF. Pola Bakteri dan Resistensinya Terhadap Antibiotik yang Ditemukan pada Air dan Udara Ruang Instalasi Rawat Khusus RSUP dr.Wahidin Sudirohusodo Makassar. Majalah Farmasi dan Farmakologi. 2012;16(2):73–8. Adisasmito AW, Hadinegoro SR. Infeksi Bakteri Gram Negatif di ICU Anak: epidemiologi Manajemen Antibiotik dan Pencegahan. Sari Pediatri. 2004;6(1):32–9. Dwiprahasto I. Kebijakan untuk Meminimalkan Risiko Terjadinya Resistensi Bakteri di Unit Perawatan Intensif Rumah Sakit. JMPK. 2005;8(4):177–81. Fauziyah S, Radji M, Nurgani A. Hubungan Penggunaan Antibiotika pada Terapi Empiris dengan Kepekaan Bakteri di RSUP Fatmawati Jakarta. Jurnal Farmasi Indonesia. 2011;5(3):150–58. Setiawan MW. Pola Kuman Pasien yang Dirawat di Ruang Rawat Intensif RSUP Dr. Kariadi Semarang. Artikel Penelitian. Semarang: Fakultas Kedokteran Universitas Diponegoro; 2010. 2–16. Saharman YR, Lestari DC. Phenotype Characterization of Beta-Lactamase Producing Enterobacteriaceae in the Intensive Care Unit (ICU) of Cipto Mangunkusumo Hospital in 2011. Acta Med Indones.2013;45(1):11–6. Peta Bakteri Terbanyak yang dapat Diisolasi dari Berbagai Spesimen di Ruang ICU di Rumah Sakit Hasan Sadikin Bandung 2012. Tyas WM, Suprapti B, Hardiono, Widodo ADW. Analysis of Antibiotic Use in VAP (Ventilator-Association Pneumonia) Patients. Folia Medica Indonesiana. 2013;49(3):168–72. Mahmudah R, Soleha TU, Ekowati CN. Identifikasi Methicillin-Resistant Staphylococcus Aureus (MRSA) pada Tenaga Medis dan Paramedis Di Ruang Intensive Care Unit (ICU) dan Ruang Perawatan Bedah Rumah Sakit Umum Daerah Abdul Moeloek. Med J Lampung Univercity. 2013;2(4):70–8.
Antibiotik Empirik di Intensive Care Unit (ICU) Aditya, Ricky; Kestriani, Nurita Dian; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Penemuan jenis antibiotik baru diimbangi dengan penemuan resistensi dari bakteri tersebut terhadap beberapa obat.Secara garis besar, antibiotik dibagi menjadi tiga golongan berdasarkan cara kerja, spektrum, dan efek bakterisidal.Terapi antibiotik terhadap pasien kritis merupakan hal yang menjadi perhatian di dunia akibat tingginya mortalitasdan morbiditas. Aspek efektifitas terapi terus menjadi perhatian akibat peningkatan kebutuhan ruang Intensive CareUnit. Kontrol infeksi dan pemilihan antibiotik yang sesuai merupakan intervensi utama dan harus menjadi prioritasdalam manajemen pasien kritis. Pengetahuan mengenai farmakokinetik dan farmakodinamik antibiotik merupakanfaktor yang esensial karena penentuan dosis antibiotik berkaitan dengan keluaran pasien kritis. Perubahan padavolume of distribution dan clearance antibiotik pada pasien kritis mungkin berefek pada target konsentrasi obatdalam serum. Hal ini menjadi bukti bahwa parameter pharmacokinetics (PK)/pharmacodynamics (PD) berperanterhadap efek obat yang terkait dengan keluaran pasien dan resistensi. Kata kunci: Antibiotik, farmako dinamik, farmako kinetik, ICU, pasien kritis The discovery of new types of antibiotic resistance offset by the discovery of bacteria to multiple drugs. In general,antibiotics are divided into three groups based on the spectrum shape, and the bactericidal effect. Antibiotictherapy for critically ill patients is a concern in the world due to the high mortality and morbidity. Aspects of theeffectiveness of therapy remains a concern due to the increasing needs of the ICU. Pemilihian infection controland appropriate antibiotic is a major intervention and should be a priority in the management of patients in criticalcondition. Knowledge of the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics is essential todetermine the doses of antibiotics related to production factor of critically ill patients. Changes in the volumeof distribution and clearance of antibiotics in critically ill patients may have an effect on a target serum drugconcentrations. This is proof that the PK/PD parameter contribute to the effects associated with the drug and theoutput resistance of the patient. Key words: Antibiotic, Critical patients, ICU, pharmacodynamis, pharmacokinetis Reference Davies, JD. Origins and Evolution of Antibiotic Resistance. Microbiology and Molecular Biology Reviews, 2010;74(3): 417–33. Waksman, SA. What is an Antibiotic or an Antibiotic Substance?. Mycoglia. 1947; 39(5):565–9. Bruton, LL., Chabner AB., & Knollmann CB. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 12th ed. California: McGraw-Hill Education, 2010. Aminov, RI. A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future. Frontier in Microbiology. 2010;1(134). Davies, J. & Davies D. Origins and Evolution of Antibiotic Resistance. Microbiology and Molecular Biology Review.2010;74(3). Saga, T. & Yamaguchi, K. History of Antimicrobial Agents and Resistant. Research and Reviews.2009;52(2). Kohanski MA, Dwyer DJ, Collins JJ. How Antibiotics Kill Bacteria: from Target to Network. Microbiology.2010;8(1). Mitchigan State University. Antimicrobial Resistence Learnig Site Pharmacology. 2011, Diakses pada 28 Oktober 2015 dari: http://amrls.cvm.msu.edu . Roberts, JA. & Jeffrey L. Pharmacokinetic Issues for Antibiotics in the Critically Ill Patient. Continuing Medical Education Article: Concise Definite Review. 2009;37(3):540–51. McKellar, QA., SF. Sanchez Bruni, & DG. Jones. Pharmacokinetic/Pharmacodynamic Relationship of Antimicrobial Drugs Used in Veterinary Medicine. Journal of Veterinary Pharmacology and Therapeutics. 2004;27:503–14. Finberg, RW. & Guharoy R. Clinical Use of Anti-infective Agents: A Guide on How to Prescribe Drugs Used to Treat Infections. Springer Science & Business Media, LLC. 2012. p. 5–13 Maramba-Lazarte, CC. Determining Correct Dosing Regimens of Antibiotics Based on the Their Bacterial Activity. Pediatric Infectious Disease Society of the Philippines Journal, 2010;11(2):44–9. Levison, ME. & Levison JH. Pharmacokinetics and Pharmacodynamics of Antibacterial Agent. Infectious Desease Clinical North America, 2009;24(3):791–830. Bennet, PN. Brown, MJ. Clinical Phamacology, 9th ed. Spain: Elvisier, 2003.
Perbandingan Pengaruh Pemberian Bupivakain 0,25% Intraperitoneum dan Infiltrasi Kulit dengan Plasebo terhadap Nilai Skala Analog Visual Pascaoperasi Laparatomi Ginekologi dengan Anestesi Umum Ridwan, Romi; Herman, Ruli; ., Suwarman
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Nyeri pascaoperasi adalah masalah penting dalam pembedahan. Studi terbaru menyatakan bahwa pemberiananalgesik perioperatif dapat mencegah serta mengurangi nyeri pascaoperasi. Studi ini bertujuan untuk menjelaskanefek analgesik preemtif dalam penanganan nyeri pascaoperasi laparatomi ginekologi. Jenis penelitian ini adalahprospektif, uji acak terkontrol buta ganda dan uji plasebo-kontrol, dimana 46 pasien dengan American SocietyAssociation (ASA) I dan II yang menjalani operasi laparatomi ginekologi secara acak di central operating theatre(COT), RS. Dr. Hasan Sadikin pada September sampai Desember 2012 diberikan 50 mL bupivakain 0,25% denganepinefrin 5μ per mL atau 50 mL normal salin; setiap 25 mL nya dimasukkan ke dalam rongga peritoneum daninfiltrasi kulit. Skor nyeri pasien dievaluasi dengan sistem Visual Analog Scale (VAS) saat diam dan mobilisasi,dinilai 6 jam pertama, lalu dilanjutkan jam ke- 8,12 dan 24 pascaoperasi. Dihitung jumlah pemakaian analgesikpertolongan selama 24 jam pertama. Hasil penelitian menunjukkan bahwa nyeri saat mobilisasi grup plasebo (P)lebih tinggi dibandingkan dengan grup bupivakain (B). Skor nyeri grup P secara signifikan lebih tinggi daripadagrup B saat mobilisasi (p<0,05). Kombinasi bupivakain secara intraperitoneum dan infiltrasi kulit akhir operasilaparatomi ginekologi dapat mengurangi nyeri pascaoperasi saat mobilisasi. Kata kunci: Bupivakain, intraperitoneum, nilai skala analog visual, nyeri pascaoperasi. Postoperative pain is an important surgical problem. Recent studies shows that perioperative administration ofanalgesics may be possible to prevent or reduce postoperative pain. This study was planned to investigate theefficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. In thisprospective, double-blinded, randomized, and placebo-controlled trial, 46 ASA physical status I and II patientsundergoing major abdominal gynecologic surgeries were randomized to receive 50 mL of bupivacaine 0.25% withepinephrine 5μ per mL or 50mL of normal saline; each 25 mL of the treatment solution was administered into theperitoneal cavity and incision. The pain score of the patients was evaluated by the visual analogue scale (VAS) atrest and movement, and every hours untill 6h, 8, 12, and 24h after surgery. Pain on movement was significantlymore intense in the Placebo group than in the Bupivacaine group. Measurement of the quality of pain by using theVAS values during mobilization is better than at rest. Pain scores were significantly higher in the placebo groupthan in the bupivacaine group on movement (p<0.05). A combination of intraperitoneal and incisional bupivacaineinfiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on movement. Keywords: Bupivacaine, intraperitoneal, postoperative pain, visual analog scale. Reference Macres SM, Moore PG, Fishman SM. Acute Pain Management. Dalam: Barash PG, Cullen BF, Soelting RK, editor. Clinical Anesthesia. Edisi ke-6. Philadelphia: Lippincot William & Wilkins 2009. hlm.1405–40. Tsui BC, Rosenquist RW. Peripheral Nerve Blockade. Dalam: Barash PG, Cullen BF, Soelting RK, editor. Clinical Anesthesia. Edisi ke-6. Philadelphia: Lippincot William & Wilkins 2009. hlm. 718–45. Rukewe A, Fatiregun A. The use of regional anesthesia by anesthesiologists in Nigeria. Anesth Analg 2010;110:234–4. Atashkhoii S, Shobeiri MJ, Azarfarin R. Intraperitoneal and incisional bupivacaine analgesia for major abdominal/gynecologic surgery: a placebo-controlled trial. Iran: Medical Journal of The Islamic Republic of Iran 2006;20(1):19–22. Visalyaputra S, Lertakyamanee J, Pethpaisit N, Somprakit P, Parakkamodom S, Suwanapeum P. Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation. Anesth Analg. 1999;88:1077–88. Ng A, Smith G. Intraperitoneal administration of analgesia: is this practice of any utility? Br J Anaesth 2002;4:535–7. Simpson RB, Russell D. Anesthesia for daycase gynaecological laparoscopy: a survey of clinical practice in the United Kingdom. Anesthesia 1999;54:72–80. Groudine SB, Fisher HAG, Kaufman RP, Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocain speeds the return of bowel function, decrease postoperative pain and shorters hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 1998;86:235–9. Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90:899–912. Williamson KM, Cotton BR, Smith G. Intraperitoneal lignocaine for pain relief after total abdominal hysterectomy. Br J Anaesth 1997;78:675–7. Ali PB, Cotton BR, Williamson KM, Smith G. Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy. Br J Anaesth 1998;80:245–7. Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebocontrolled comparison of bupivacaine and ropivacaine. Anesth Analg 2000;91:403–7. Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine following total abdominal hysterectomy. Anesth Analg 2002;95:158–62. Morgan GE, Mikhail MS, Murray MJ. Pain Management. Dalam: Morgan GE, Mikhail MS, Murray MJ, editor. Clinical anesthesiology. Edisi ke-4. New York: McGraw-Hill;2006. hlm. 360–72. Lou L, Sabar R, Kaye AD. Local Anesthetics. Dalam : Raj PP. Textbook of Regional Anesthesia. Edisi ke-3. Philadelphia. Churchill Livingstone. 2002. hlm. 214–53 Hannibal K, Galatius H, Hansen A, Obel E, et al. Preoperative wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy. Anesth Analg. 1996;83:376–81
Perbandingan Trapezius Squeezing Test dan Jaw Thrust Sebagai Indikator Kedalaman Anestesia pada Pemasangan Sungkup Laring Hidayat, Jefferson; Sugiarto, Adhrie; Alatas, Anas
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Abstract

Manajemen jalan napas merupakan salah satu aspek penting dalam anestesiologi. Salah satu jenis alat bantu jalannafas yang sering digunakan adalah Laringeal Mask Airway (LMA/sungkup laring). Pemasangan sungkup laringtanpa pelumpuh otot membutuhkan kedalaman anestesi yang cukup. Trapezius squeezing test dan jaw thrustadalah dua uji klinis sederhana yang digunakan untuk menguji kedalaman anestesia. Penelitian ini bertujuan untukmembandingkan trapezius squeezing test dan jaw thrust sebagai indikator klinis menilai kedalaman anestesi padapemasangan sungkup laring dengan induksi anestesia menggunakan propofol. Sebanyak 128 pasien dirandomisasimenjadi dua kelompok yaitu kelompok 1 (kelompok jaw thrust) dan kelompok 2 (kelompok trapezius squeezingtest). Setelah premedikasi dengan midazolam 0,05 mg/kgBB dan fentanil 1 μg/kgBB, untuk induksi anestesiadiberikan propofol dosis titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saatrespon motorik dari manuver hilang dilakukan pemasangan sungkup laring. Keberhasilan pemasangan padakelompok 1 dan 2 adalah 93,8% vs. 90,6% (p >0,05). Rata-rata penggunaan propofol pada kelompok 1 sebesar120,34 mg dan kelompok 2 sebesar 111,86 mg (p > 0.05). Pada kelompok 1 apnea dijumpai pada 10 pasien(15.6%) sedangkan pada kelompok 2 sebanyak 11 pasien (17.2%). Trapezius squeezing test sama baiknya denganjaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring. Kata Kunci: Jaw thrust, kedalaman anestesia, propofol, sungkup laring, trapezius squeezing test Airway management remains as one of the most important aspect in anesthesiology. Laryngeal Mask Airway(LMA) has been widely used as an airway device. Laryngeal mask insertion without muscle relaxant facilitationrequires an adequate anesthesia level. The purpose of this study was to compare trapezius squeezing test andjaw thrust maneuver as an indicator of anesthesia depth for laryngeal mask insertion, with propofol as inductionagent. There were 128 subjects who had been randomized into two groups: Group 1 (jaw thrust group) andGroup 2 (trapezius squeezing test group). All subjects received midazolam 0.05 mg/kg and fentanyl 1 μg/kg aspremedication. Propofol with titrated dose were used for anesthesia induction. Jaw thrust or trapezius squeezingtest maneuver were performed every 15 seconds in each group. When motoric responses were lost after maneuver,LMA was inserted. Succesfull LMA insertion were found in 93,8% patients (Group1) and 90,6% (Group 2) withp >0,05. Mean propofol consumptions were 120.34 mg in Group 1 and 111,86 mg in Group 2. Apnea was found in10 patients (15,6%) in Group 1 and 11 patients (17.2%) in Group 2. Trapezius squeezing test was as good as jawthrust maneuver as an adequate depth of anesthesia indicator for laryngeal mask insertion. Keywords: Departement of anesthesia, jaw thrust, laryngeal mask, propofol, trapezius squeezing test Reference Sood J. Laryngeal mask airway and its variants. Indian J Anaesth 2005;49(4):275–0. Verghese C, Berlet J, Kapila A, Pollard R. Clinical assessment of single use laryngeal mask airway the LMA Unique. Br J Anaesth 2006:80;677–9. Easley EH. The laryngeal mask airway: a review and update. J Clin Anaesth. 2005:16; 114–23. Cook TM. The classic laryngeal mask airway: a tried and tested airway. Br J Anaesth 2006; 96(2):149–52. Cressey DM, Claydon P, Bhaskaran NC, Reilly CS. Effect of midazolam pretreatment on induction dose requirement of propofol in combination with fentanyl in younger and older adult. Anaesth 2011;56:108–13. Towsend R. Jaw thrust as a predictor of insertion conditions for the proseal laryngeal mask airway. Anaesth 2009;20(1):59–62. Krishnappa S. Optimal anaesthetic depth for LMA insertion. Indian J Anaesth 2011;55(5): 504–7. Chang C. Comparison of the trapezius squeezing test and jaw thrust as indicators for laryngeal mask airway insertion in adults. Korean J Anesth 2011;61(3):201–4. Peacock JE, Lewis RP, Reilly CS, Nimmo WS. Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients. Br J Anaesth 1990;65:346–52. Peacock JE, Spiers SP, Mclauchlan GA, Edmondson WC, Berthoud BM, Reilly CS. Infusion of propofol to identify smallest effective doses for induction of anaesthesia in Yong and elderly patients. Br J Anaesth 1992; Stokes DN, Hutton P. Rate dependent induction phenomena with propofol: Implications for the relative potency of intravenous anesthetics. Anesth Analg 1991; 72:578–83. Scanlon P, Carey M, Power M. Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone. Can J Anaesth 1993;40:816–8. Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivate as a tool for predicting the depth of sedation and anesthesia induced by sevoflurance. Anesthesiology 1998;88:642–50. Rudy N. Keefektifan trapezius squeezing test sebagai indicator kedalaman anesthesia saat pemasangan sungkup laring dihubungkan dengan bispectral index. Universitas Indonesia, 2012. Drage MP, Nunez J, Vaughn RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anesth 1996; 51: 11667–70. Chang C. Optimal condition for laringeal mask airway insertion in children can be determinate by the trapezius squeezing test. J Clin Anaesth 2008;20:99–102. Reves GJ, Peter S.A, David AL, et al. Intravenous nonopiod anesthetics. In Miller’s Anesthesia. 7th ed. Philadelpia: Churchill Livingstone, 2010. p. 318–25. Morgan GA, Mikhail MS. Nonvolatile anesthetic agents: Clinical Anesthesiology. 4th ed. New York : McGraw-Hill, 2006. p.179–203 Hillier SC. monitored anesthesia Care. In: Barash’s. Clincal anesthesia. 5th ed. Philadelphia: Lippincott William & Wilkins, 2006. p . 2576–607.
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
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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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