Perbandingan respon hemodinamik dan kondisi intubasi antara etomidate 0,3 mg/kgbb intravena dan thiopental 5 mg/kgbb intravena untuk Rapid-Sequence Induction

LISTUHAYU, Kararawi, Dr. Muhdar Abubakar, SpAn.,KIC

2006 | Tesis | PPDS I Anestesiologi dan Reanimasi

Telah dilakukan penelitian untuk mengetahui respon hemodinamik pasca induksi dan kondisi intubasi antara etomidate 0,3 mg/kgbb iv dan thiopental 5 mg/kgbb iv pada teknik rapid-sequence induction (RSI) dengan rocuronium. Desain penelitian adalah uji klinis acak tersamar ganda. Masing-masing kelompok terdiri dari 51 subyek, laki-laki atau perempuan (18-50 tahun), status fisik ASA I-II, yang akan menjalani operasi elektif di unit bedah sentral RSUP Dr. Sardjito. Seluruh subyek mendapat pretreatment fentanyl 1μg/kgbb iv 3 menit sebelum penelitian, kemudian dilakukan randomisasi untuk mendapat induksi anestesi etomidate 0,3 mg/kgbb iv atau thiopental 5 mg/kgbb iv. Pengukuran outcome berdasarkan pada nilai respon hemodinamik (tekanan darah sistolik, tekanan darah diastolik, mean arterial pressure dan heart rate) satu menit pasca induksi, pasca intubasi menit ke 1, 3, dan 5. Laringoskopi-intubasi dilakukan pada 60 detik pasca pemberian rocuronium, kondisi intubasi dinilai dengan skor dari Cooper oleh intubator yang tidak mengetahui jenis induksi yang diberikan. Satu menit pasca induksi, kelompok etomidate memberikan perubahan hemodinamik yang lebih kecil dibanding kelompok thiopental. Pada kelompok etomidate penurunan TDS adalah 4,7 ± 4,6 mmHg dibanding dengan kelompok thiopental 13,4 ± 5,7 mmHg (p<0.001). Penurunan TDD pada kelompok etomidate 3,4 ± 3,9 mmHg dibanding dengan kelompok thiopental 9,5 ± 6,2 mmHg (p=0.001). Penurunan MAP kelompok etomidate 4,0 ± 3,4 mmHg dibanding kelompok thiopental 10,8 ± 5,1 mmHg (p=0.001). Perubahan heart rate pada kelompok etomidate lebih stabil yaitu meningkat 2,2 ± 3,2 kali/menit sedangkan pada kelompok thiopental terjadi peningkatan heart rate 8,6 ± 5,2 kali/menit (p<0.001). Kondisi intubasi pada kelompok etomidate 90% sangat baik dan 10% baik sedangkan pada kelompok thiopental 82% sangat baik dan 18% baik, secara statistik tidak ada perbedaan bermakna (p=0.250). Dari tiga komponen yang dinilai, respon terhadap stimulus intubasi pada kelompok etomidate lebih baik secara bermakna dibanding dengan kelompok thiopental (p=0.024). Dari penelitian ini disimpulkan bahwa pada teknik RSI dengan rocuronium, induksi etomidate (0,3mg/kgbb) memberikan perubahan hemodinamik yang lebih kecil dan memberikan respon terhadap stimulus intubasi yang lebih baik dibandingkan dengan thiopental (5mg/kgbb).

The aim of this study were to know the haemodynamic responses post induction and intubating conditions following etomidate 0.3mg/kgbw i.v compared to thiopental 5 mg/kgbw iv in rapid sequence induction with rocuronium. The number of subjects of this study were 102 patients, men and women (18- 50 years old) with ASA I-II physical status, who were scheduled for elective surgery under general anesthesia in the central operating theatre Dr. Sardjito Hospital. The subjects were devided to group A (etomidate) and group B (thiopental). All subjects were administered fentanyl 1μg/kgbw three minutes before induction, then allocated randomly to received etomidate 0.3 mg/kgbw i.v or thiopental 5 mg/kgbw i.v for induction, and rocuronium 0.6 mg/kgbw. Laringoscopy was started 60 s later and intubation condition were evaluated according to Cooper’s score. Haemodynamic status (blood pressure, heart rate, and MAP) were recorded before induction, 1 minute after induction, as well as 1, 3, and 5 minutes after intubation. One minute post-induction mean of systolic blood pressure in the etomidate group decreased (4.7 ± 4.6 mmHg), which was significantly lower than in the thiopental group (13.4 ± 5.7 mmHg)(p<0.001). The mean value of diastolic blood pressure at the same time decreased (3.4 ± 3.9 mmHg) in the etomidate group and decreased (9.5 ± 6.2 mmHg) in the thiopental group (p=0.001), while MAP decreased (4.0 ± 3.4 mmHg) in the etomidate group and decreased (10.8 ± 5.1 mmHg) in the thiopental group (p=0.001). Average heart rate in etomidate group was(2.2 ±3.2min-1) significantly lower (p<0.001) than thiopental group (8.6 ± 5.2 min-1). In the etomidate group, 90% were scored excellent and 10% were good in overall intubating conditions. In the thiopental group, 92% were scored excellent and 18% were good. The difference between the two groups was not statistically significant (p=0.250). Of the three components of the intubation score assessed, responses to intubation stimulus was significantly less pronounced in group etomidate compared with group thiopental (p<0.05). The conclusions of this study showed that the haemodynamic responses post induction was less pronounced and better responses to intubation stimulus following etomidate 0.3 mg/kgbw than thiopental 5mg/kgbw in rapid sequence induction with rocuronium.

Kata Kunci : Respon Hemodinamik,Kondisi Intubasi,Teknik RSI, haemodynamic responses, intubating-conditions, etomidate, thiopental, rapid-sequence induction