Perbandingan premedikasi Dexmedetomidine 0,6ug/kgBB/i.v dan pemberian lidokain 1,5mg/kgBB/i.v praintubasi dalam mencegah kenaikan tekanan intraokuler pada laringoskopi-intubasi
SARWASTUTI, Iris, dr. Muhdar Abubakar, SpAN.KIC
2004 | Tesis | PPDS I Anestesiologi dan ReanimasiTujuan: Membandingkan efek premedikasi Dexmedetomidine 0,6ug/kgbb intravena dan pemberian Lidokain 1,5mg/kgbb/i.v praintubasi terhadap tekanan intraokuler sebelum dan sesudah intubasi Desain: Randomized Controlled Trial dengan pembutaan ganda Ruang Lingkup: Pasien operasi terencana dengan anestesi umum dan intubasi endotrakea yang bukan operasi mata di Instalasi Bedah Sentral Terpadu RSU Dr.Sardjito Yogyakarata Subjek: 70 orang pasien laki-laki dan wanita , usia 18-50 tahun, status fisik ASA I-II Intervensi: Subjek dibagi dalam dua kelompok , tiap kelompok sebanyak 35 orang. Kelompok A mendapat premedikasi Dexmedetomidine 0,6ug/kgbb/i.v dan kelompok B mendapat Lidokain 1,5 mg/kgbb/i.v 4 menit sebelum intubasi. Kedua kelompok mendapat premedikasi awal Diazepam 5mg p.o di bangsal 4-6 jam preoperative, Induksi Pentotal 5 mg/kgbb, fasilitas intubasi Rocuronium 0,6 mg/kgbb, dilanjutkan dengan pemeliharaan Oksigen – N2O - Enflurane 1-1,5%volume. Dilakukan pengukuran Tekanan Intraokuler, tekanan darah, laju nadi, sebelum intubasi dan menit ke 1, 3, 5 dan ke 10 sesudah intubasi. Saturasi oksigen, laju nafas dan skala sedasi diukur sebelum intubasi untuk mengukur efek lain Dexmedetomidine Pengukuran utama: Tekanan intraokuler, tekanan darah sebelum induksi dan sesudah intubasi pada menit ke 1, 3, 5, 10 setelah intubasi Hasil: Setelah premedikasi, saat pra-intubasi pada kelompok Dexmedetomidine TIO menurun sebesar 2,78mmHg (16,9%), sedangkan kelompok Lidokain TIO hampir tidak berubah setelah tercapai onsetnya (p<0,05) Menit pertama intubasi, peningkatan TIO kelompok Dex 7,26% dari nilai TIO awal dan kelompok Lidokain meningkat 26,7% dari nilai TIO awal. (p<0,05) Pada Menit ke 3, 5 dan 10 post intubasi TIO kelompok Dex menurun 16,75 -7,84 -7,97(%) dan kelompok Lidokain menurun 21- 8,28 -8,21(%),TIO Kelompok Dex tetap lebih rendah dibandingkan kelompok Lidokain (p<0,05) Kesimpulan: Premedikasi Dexmedetomidine 0,6ug/kgbb/i.v dapat mencegah peningkatan tekanan intraokuler lebih besar daripada pemberian Lidokain 1,5 mg/kgbb 4 menit praintubasi pada saat laringoskopiintubasi (p<0,05)
Objective: To compare the effect between premedication Dexmedetomidine 0,6ug /kg body weight intravenously and Lidocaine 1,5 mg/kg body weight intravenously preintubation on intraocular pressure Design: Double blind randomized clinical trial study Setting: Non eye surgery patients underwent elective operation, performed under general anaesthesia and tracheal intubation at Central Operating Theatre of Sardjito General Hospital Yogyakarta Subject: 70 patients male and female, ages between 18-50 years old, the physical status ASA I-II Intervention: Subject were divided into two groups, each group consist of 35 patients. The group A were premedicated by Dexmedetomidine 0,6 ug/kg body weight intravenously and the group B were administered Lidocaine 1,5 mg/kg body weight intravenously 4 minutes before intubation. Both of groups were administered Diazepam 5 mg orally at the ward 4-6 hours preoperatively, Pentothal 5 mg/kg body weight for induction and Rocuronium 0,6 mg/kg body weight. Maintenance by O2-N2O- Enflurane 1-1,5 %volume. The intraocular pressure, blood pressure and heart rate were observed before induction and 1,3,5,10 minutes after intubation. The oxygen saturation, respiratory rate and sedation state were observed before induction to monitor the side effect of Dexmedetomidine Main Measurement: The intraocular pressure, blood pressure before induction, before intubation and 1, 3, 5, 10 minutes after intubation. Result: After premedication, before intubation the intraocular pressure of the Dexmedetomidine group getting decrease 2,78mmHg (16,9%), and the Lidocaine group were reflects still remain pressure after its onset. One minute intubation, the Dex groups getting increase 7,26% from baseline value, however the Lidocaine group getting increase 26,7% from baseline (p<0,05) The 3rd, 5th and 10th minutes after intubation the both of groups getting decrease with almost the same value, the Dex group 16,75 -7,84 -7,97(%) and the Lidocaine group 21- 8,28 - 8,21(%) but the Dex group still reflects lower pressure than Lidocaine.(p<0,05) Conclusion: The Dexmedetomidine 0,6 ug/kg body weight/ i.v as premedication leads to prevent the increase intraocular pressure better than administration of Lidocain 1,5 mg/kg body weight/i.v 4 minutes before intubation. at laryngoscopy-intubation (p<0,05)
Kata Kunci : Premedikasi Dexmedetomidine,Lidokain,TIO Normal, Dexmedetomidine, Intraocular pressure ,Tracheal Intubation
