IDENTIFIKASI FAKTOR YANG BERHUBUNGAN DENGAN EMERGENCE DELIRIUM MENGGUNAKAN METODE CRAVERO PADA PASIEN PEDIATRIK YANG MENJALANI ANESTESI UMUM DI RSUP DR SARDJITO

HANIIFA HERLY HENDY, Dr. dr. Djayanti Sari, M.Kes., Sp.An., KAP, dr. Yunita Widyastuti, M.Kes., Sp.An., KAP, Ph.D, dr. Juni Kurniawaty, Sp.An., M.Sc., KAKV

2020 | Skripsi | S1 KEDOKTERAN

Latar Belakang: Emergence Delirium (ED) adalah gangguan selama masa pemulihan anestesi umum, terdiri dari halusinasi, delusi, dan aktivitas fisik involunter. Tingkat insidensi ED tertinggi ada pada pasien pediatrik dengan rentang usia 2-7 tahun. Penyebab yang mendasari belum ditentukan dikarenakan kurangnya studi klinis mengenai ED. Diperlukannya sebuah penelitian untuk mengidentifikasi faktor risiko serta keefektifan alat skoring Cravero dalam mendiagnosis ED. Tujuan: Tujuan penelitian ini adalah untuk mengidentifikasi faktor yang berhubungan dengan Emergence Delirium (ED) serta menghitung insidensi terjadinya ED menggunakan alat skoring diagnosis Cravero di RSUP Dr Sardjito. Metode: Subjek diberikan premedikasi 10 menit sebelum induksi. Parental separation dinilai sebagai kondisi mental pre-operasi. Pencatatan dilakukan pada tiga titik waktu per 10 menit. Hasil diolah dengan independent sample t-test dan uji Chi-square. Hasil signifikan dilanjutkan dengan uji regresi logistik univariat dan multivariat. Kemampuan diskriminasi diukur dengan kurva Receiver Operating Characteristic (ROC). Hasil: Hasil ED berdasarkan skor Cravero sebesar 40,5%. Uji independent sample t-test dan Chi square menghasilkan 5 variabel signifikan (p<0,25); umur, jenis kelamin, teknik anestesi, analgesik durante operasi, dan kondisi mental pre-operasi pasien. Umur dan jenis kelamin tetap dimasukkan karena memiliki interaksi dengan variabel lain. Uji regresi logistik univariat (p<0,05); umur, jenis kelamin, teknik anestesi, dan kondisi mental pre-operasi pasien. Uji regresi logistik multivariat (p<0,05); jenis kelamin. Luas area ROC=0,378 pada variabel jenis kelamin menunjukan jenis kelamin laki-laki menjadi faktor proteksi terhadap ED. Kesimpulan: Faktor yang berhubungan dengan terjadinya ED menggunakan metode skoring Cravero adalah jenis kelamin pasien.

Background: Emergence Delirium (ED) is a disorder during the recovery period after general anesthesia, consists of hallucinations, delusions, and involuntary physical activity. The highest incidence of ED is pediatric patients aged 2-7 years. The cause have not been determined due to lack of clinical studies on ED. This study is needed to identify risk factors and the effectiveness of the Cravero scoring tool in diagnosing ED. Aim: The purpose of this study was to identify factors associated with Emergence Delirium (ED) and calculate the incidence of ED using the Cravero diagnostic scoring tool at RSUP Dr Sardjito. Method: Subjects were given premedication 10 minutes before induction. Parental separation was assessed as a pre-operative mental condition. Records were taken three time every 10 minutes. The results were counted by independent sample t-test and Chi-square test. Significant results were followed by a univariate and multivariate logistic regression test. The discrimination ability was measured by the Receiver Operating Characteristic (ROC) curve and considered meaningful. Result: The result of ED based on Cravero Score was 40,5%. Independent sample t-test and Chi-square test showed 5 significant variables (p<0.25); age, gender, anesthetic technique, analgesic during surgery, and the patient's pre-operative mental condition. Age and gender are still significant because they have interactions with other variables. Univariate logistic regression test results (p<0.05); age, sex, analgesic during surgery, anesthesia techniques, and the patient's pre-operative mental condition. Multivariate logistic regression test results (p<0.05); sex. ROC area= 0.378 on the gender variable indicates that the male is a protective factor against ED. Conclusion: Factors that associated with ED using the Cravero scoring method are the sex of the patient.

Kata Kunci : emergensi delirium, faktor risiko, pediatrik, anestesi umum, skor cravero