Efektifitas deksametason 4 MG IV dan ketorolak 30 MG IV dibandingkan dengan ketorolak 30 MG IV sebelum induksi anestesi dalam mengurangi derajat nyeri tenggorok pasca anestesi umum dengan pipa endotrakea

BRAHMANA, Musa, Dr. Yusmein Uyun, SpAn.KAO

2010 | Tesis |

Latar belakang: Teknik anestesi umum menggunakan pipa endotrakea memiliki efek samping nyeri tenggorok pascaoperasi, walaupaun keluhan nyeri tenggorok tersebut sudah dikontrol dengan baik. Penyebab utama nyeri tenggorok adalah trauma pada mukosa faringolaringeal karena tindakan laringoskopi. Efek samping ini dapat diturunkan dengan penggunaan ketorolak, namun derajat nyeri tenggorok pasca pemberian ketorolak masih tinggi, sehingga pemberian ketorolak setelah 1 menit pemberian deksametason diharapkan dapat mengurangi derajat nyeri tenggorok. Tujuan penelitian: Meneliti efektifitas deksametason 4 mg iv dan ketorolak 30 mg iv dibandingkan dengan ketorolak 30 mg iv sebelum induksi dalam mengurangi derajat nyeri tenggorok pasca anestesi umum dengan pipa endotrakea. Metode Penelitian: Desain penelitian menggunakan uji klinis secara acak buta ganda (double blind randomized controlled trial). Ruang lingkup penelitian adalah pasien yang menjalani operasi elektif dengan anestesi umum di GBST RSUP Dr. Sardjito Yogyakarta, RSUD Sleman, dan RSUD Banyumas, yang terdiri dari laki-laki dan perempuan, usia 18-50 tahun dan status fisik ASA I dan II. Subyek dibagi dalam 2 kelompok, masing-masing kelompok terdiri dari 61 pasien. Kelompok A (deksametason 4 mg iv dan ketorolak 30 mg iv) dan Kelompok B (ketorolak 30 mg iv). Nyeri tenggorok diukur setelah pasien sadar penuh, 2 jam dan 4 jam postoperasi dengan skor Conbay: tidak ada nyeri, nyeri ringan, sedang dan berat. Analisis data menggunakan uji independent-test dan uji chi-square dengan tingkat kepercayaan 95%, dan dianggap bermakna bila p<0,05 serta sangat bermakna bila p<0,01. Hasil penelitian: Menunjukkan derajat nyeri tenggorok pada kedua kelompok yaitu kelompok A dan kelompok B. Derajat nyeri saat sadar penuh, 2 jam dan 4 jam pasca ekstubasi secara statistik menunjukkan perbedaan sangat bermakna (p < 0,01). Derajat nyeri saat sadar penuh: tidak ada nyeri (76,3% vs 25,8%), nyeri ringan (23,7% vs 46,6%) dan nyeri sedang (0% vs 27,6%). Dua jam pasca ekstubasi tidak ada nyeri (91,5% vs 32,8%), nyeri ringan (8,5% vs 51,7%), dan nyeri sedang (0% vs 15,5%). Empat jam pasca ekstubasi tidak ada nyeri (93,2% vs 43,1%), nyeri ringan (6,8% vs 46,6%), dan nyeri sedang (0% vs 10,3%). Efektivitas penurunan nyeri tenggorok pada kelompok A terhadap kelompok B, saat sadar penuh (76,3% vs 25,9%), dua jam pasca ekstubasi (91,5% vs 32,8%), dan empat jam pasca ekstubasi (93,2% vs 43,1%). Kesimpulan: Pemberian deksametason 4 mg iv dan ketorolak 30 mg iv 10 menit sebelum induksi anestesi lebih efektif dalam mengurangi derajat nyeri tenggorok dibandingkan dengan ketorolak 30 mg iv pasca anestesi umum dengan pipa endotrakea (p < 0,01).

Background: The side effect of general anesthesia using endotracheal tube is post operative sore throat. The main cause is pharingolaringeal mucosa trauma resulted from laryngoscopy. This side effect could be controlled using ketorolac though the throat pain level was still high and hence dexamethasone was administered a minute after the ketorolac to lower the sore throat level. Objective: The objective of this study is to compare the effectiveness of dexamethasone 4 mg iv and ketorolac 30 mg iv with ketorolac 30 mg iv alone before induction to reduce the sore throat level of post operative for patients undergoing general and anesthesia using endotracheal tube. Material and Methode: The research design is double blind randomized controlled trial. The study was conducted in GBST RSUP Dr. Sardjito, Sleman District Hospital and Banyumas District Hospital. The research subjects were patients undergoing elective surgery under general anesthesia using endotracheal tube. Subjects were female and male patients aged 18-50 years old with physical status ASA I and II. The subjects were divided in two groups with 61 patients in each group. Group A (dexamethasone 4 mg iv and ketorolac 30 mg iv) and Group B (ketorolac 30 mg iv). Sore throat was measured after the patients were fully conscious, 2 hours and 4 hours postoperative using Conbay score which consisted of 4 categorization. The categorizations are none, mild, moderate and severe sore throat. The data was analyzed using independent t-test and chi-square at the confidence level 95% and p<0.05 was considered to be significant. Results: The results of the study showed that there was a significant difference (p < 0.01) between Group A and Group B. Results were measured in a fully conscious condition, 2 hours and 4 hours after extubation. The sore throat was measured at fully awake patients with the score of no sore throat was 76,3% vs 25,8%, mild was 23,7% vs 46,6% and moderate was 0% vs 27,6%. Two hours after intubation the score of no sore throat was 91,5% vs 32,8%, mild was 8,5% vs 51,7% and moderate was 0% vs 15,5%. Four hours after extubation the score of no sore throat was 93,2% vs 43,1%, mild was 6,8% vs 46,6% and moderate was 0% vs 10,3%. The effectiveness of the decreased level of sore throat in Group A and Group B were measured at fully conscious patients were 76,3% vs 25,9%, at two hours post extubation were 91,5% vs 32,8%, and at four hours post extubation were 93,2% vs 43,1%. Conclusions: The administration of dexamethasone 4 mg iv and ketorolac 30 mg iv 10 minutes before the anesthesia induction was more effective in alleviating sore throat than ketorolac 30 mg iv alone after general anesthesia using endotracheal tube (p < 0.01).

Kata Kunci : Pipa endotrakea,Nyeri tenggorok,Deksametason,Ketorolak, Background: The side effect of general anesthesia using endotracheal tube is post operative sore throat. The main cause is pharingolaringeal mucosa trauma resulted from laryngoscopy. This side eff