Pengaruh anestesi spinal dan anestesi umum terhadap kejadian asfiksia bayi yang dilahirkan secara seksio sesarea di RS Sardjito Jogjakarta

DEWI, Eliza Eka Puspita, Dr.dr. H. Ibnu Pranoto, SpAnd.,SpOG,(K)

2003 | Tesis | PPDSI Obstetri dan Ginekologi

Latar belakang. Anestesi pada seksio sesarea dapat mempengaruhi aliran darah dengan mengubah tekanan perfusi atau resistensi vaskuler baik secara langsung maupun tidak langsung. Anestesi spinal dan anestesi umum mempunyai pengaruh yang berbeda pada ibu maupun janinnya. Salah satu pengaruh anestesi terhadap janin adalah asfiksia neonatal. Tujuan. Penelitian ini bertujuan untuk mengetahui pengaruh jenis anestesi spinal dibandingkan anestesi umum pada tindakan seksio sesarea terhadap kejadian asfiksia neonatal. Rancangan. Kohor prospektif. Tempat. RS Sardjito, Jogyakarta. Bahan dan cara.Semua pasien yang melahirkan secara seksio sesarea di RS Sardjito Jogyakarta mulai Juli 2002 sampaai Juli 2003 yang memenuhi kriteria inklusi dan eksklusi penelitian. Tindakan anestesi dilakukan oleh residen anestesi dalam pengawasan dokter spesialis anestesi, tindakan seksio sesarea dilakukan oleh residen obsgin, dan bayi baru lahir ditangani oleh residen anak yang bertugas di bagian perinatologi. Data dianalisis dengan chi square, t-test dan logistics regression dengan menggunakan komputer. Hasil. Didapatkan 140 kasus yang memenuhi kriteria subyek penelitian, masing masing kelompok terdiri atas 70 kasus. Dari kedua kelompok dibandingkan umur, lama ketuban pecah, lama persalinan, selisih tekanan darah, umur kehamilan, kadar hemoglobin, dan lama anestesi. Angka kejadian asfiksia menit pertama pada anestesi spinal lebih rendah dibanding anestesi umum (15,7% vs 52,9%; RR: 0,30; 95% CI 0,17-0,53; p 0,00). Angka kejadian asfiksia pada menit kelima pada anestesi spinal lebih rendah dibanding anestesi umum (2,9% vs 8,6%; RR 0,33; 95% CI 0,07-1,60; p 0,28). Kesimpulan. Asfiksia neonatal pada ibu yang menjalani seksio sesarea dengan menggunakan anestesi spinal lebih rendah dibanding ibu yang menjalani seksio sesarea dengan anestesi umum. Hasil analisis multivariat menunjukkan, selain jenis anestesi, asfiksia neonatal juga dipengaruhi oleh berat badan lahir.

Background. Anesthesia in cesarean section can effect circulation by changing the direct and indirect perfusion pressure or the vascular resistance. Spinal and general anesthesia have some different effect in the mother and fetal condition. One adverse effect of anesthesia to the neonates is asphyxia. Objectives. To find out the effect of spinal anesthesia vs. general anesthesia on the neonatal asphyxia in cesarean cases. Design. Prospective cohort. Study site. Sardjito Hospital, Jogyakarta. Material and methods. Eligible cases of cesarean delivery at Sardjito Hospital from July 2002 to July 2003 were recruited. Anesthesia was conducted by the resident of Anesthesiology Department supervised by the specialist. Cesarean delivery was conducted by the resident of Obstetrics and Gynecology Department, while neonatal asphyxia was assessed by the resident of the Pediatrics Department. Data were processed with the computer. Chi square, t-test and logistics regression were statistical analysis used in this study. Results. 140 uncomplicated pregnant women who were to be delivered by cesarean section were recruited, 70 cases were received spinal anesthesia, and 70 cases were received general anesthesia. Both group were comparable in terms of the age, rupture of amniotic membrane, duration of labor, blood pressure changes, fetal heart rate, gestational age, hemoglobin level, and duration of anesthesia. The rate of first minute asphyxia in the spinal anesthesia group was lower compared to the general anesthesia (15,7% vs. 52,9%; RR 0,30; 95% CI 0,17-0,53; p 0,00). The rate of fifth minute asphyxia in the spinal anesthesia group was lower compare to the general anesthesia group (2,9% vs. 8,6%; RR 0,33; 95% CI 0,07- 1,60; p 0,28). Conclusions . Spinal anesthesia during cesarian section gives rise to a lower incidence of neonatal asphyxia compared to the general anesthesia. Multivariate analysis showed that in addition to the type of anesthesia, neonatal asphyxia was also influent by the infant birth weight.

Kata Kunci : Persalinan Seksio Sesaria,Asfiksia Bayi,Anestesi Spinal, Spinal anesthesia, general anesthesia, asphyxia