EFEKTIFITAS PENAMBAHAN INFUS EFEDRIN 3MG/MENIT 2 MENIT SEBELUM BLOK SUBARAKHNOID DILANJUTKAN 1 MG/MENIT 18 MENIT BERIKUTNYA UNTUK MENGURANGI KEJADIAN HIPOTENSI KARENA BLOK SUBARAKHNOID PADA SEKSIO SESARIA

BAMBANG HANTORO SARTI AJI, Dr.Bambang Suryono Suwondo, Sp.An, KIC, KNA. M.Kes

2013 | Tesis | S2 Anestesiologi

Tujuan penelitian ini adalah untuk mengetahui efektifitas profilaksis prabeban ringer laktat 20 ml/kgbb, 30 menit sebelum blok subarakhnoid ditambah infus efedrin 3 mg/menit, 2 menit sebelum blok subarakhnoid dilanjutkan 1 mg/menit selama 18 menit berikutnya untuk mengurangi kejadian hipotensi pada pasien yang menjalani seksio sesaria. Desain penelitian Double Blind Randomized Controlled Clinical Trial. Subyek penelitian 92 pasien wanita, usia 20 – 45 tahun, BMI < 35 kg/m2, dan status fisik ASA I – II. Ruang lingkup penelitian adalah wanita hamil aterm yang menjalani seksio sesaria terencana dengan anestesi blok subarakhnoid, di kamar operasi RSUD Banyumas. Subyek dibagi 2 kelompok, masing-masing terdiri dari 46 pasien. Kelompok A adalah kelompok yang diberikan prabeban ringer laktat 20 ml/kgbb ditambah infus NaCl 0,9% 100 ml + efedrin 100 mg, sementara kelompok B adalah kelompok yang diberikan prabeban ringer laktat 20 ml/kgbb dan infus NaCl 0,9% 100 ml + NaCl 0,9% 2 ml. Pengukuran dilakukan pada semua subyek TDS, TDD, MAP dan SpO2 setelah prabeban ringer laktat, setelah pemberian infus efedrin sebelum blok subarakhnoid, selanjutnya setiap 2 menit sampai menit ke 20 setelah blok subarakhnoid. Komplikasi dan tindakan rescue dicatat dan dilaporkan. Analisis data kuantitatif menggunakan menggunakan uji independent samples ttest dan data kualitatif akan diuji dengan chi-square dengan tingkat kepercayaan 95%, dan dianggap bermakna bila p < 0,05 serta sangat bermakna bila p < 0,01. Kejadian hipotensi diukur dengan menghitung penurunan tekanan darah sistolik dari tekanan darah sistolik basal. Kelompok A (efedrin) terjadi hipotensi pada 7 pasien (15,2%) atau mengurangi hipotensi 84,8%, sedangkan pada kelompok B (kontrol) terjadi hipotensi pada 26 pasien (56,5%) atau mengurangi hipotensi 43,5%. Hal ini menunjukkan ada perbedaan bermakna diantara kedua kelompok p < 0,05 (p = 0,001) Kesimpulan : profilaksis prabeban ringer laktat 20 mg/kgbb, 30 menit sebelum anestesi blok subarakhnoid ditambah infus efedrin 3 mg/menit, 2 menit sebelum anestesi blok subarakhnoid dilanjutkan dengan 1 mg/menit selama 18 menit berikutnya efektif mengurangi kejadian hipotensi karena anestesi blok subarakhnoid pada pasien yang menjalani seksio sesaria.

The objective of the present research was to investigate the prophylactic effectiveness of preloading 20 ml/kg Ringer’s lactate given 30 minutes prior to subarachnoid block, with infusion of 3 mg/minutes ephedrine administered 2 minutes prior to subarachnoid block and 1 mg/minutes of which at 18 minutes afterwards, to reduce the incidence of hypotension among patients undergoing caesarean section. The research design was double blind randomized controlled clinical trial. Altogether 92 female patients (ranging age from, BMI< 35 kg/m2, and ASA I & II physical status) ranging age from 20 to 45 years were enrolled in the study. The scope of this research were full-term pregnant women who underwent elective caesarean section with subarachnoid block anesthesia in Banyumas District Hospital operating room. Subjects were divided into 2 groups, 46 patients of each group. Group A was preloaded by 20ml/kg Ringer’s lactate with infusion of 100 ml 0,9% NaCl+100 mg ephedrine, while group B was preloaded by 20ml/kg Ringer’s lactate and infusion of 100 ml 0,9 NaCl+2 ml 0,9% NaCl. Systolic and diastolic blood pressure, MAP, and SpO2 of all subjects were measured after preloaded by Ringer’s lactate, after ephedrine infusion prior to subarachnoid block, and every 2 minutes until the 20th minute after the subarachnoid block was performed subsequently. Both complication and action rescue were recorded and reported. Using independent samples t – test, we analyzed the quantitative data, while the qualitative data was analyzed by Chi – square at 95% significance level. P < 0,05 and p < 0,001 was considered to be significant and very significant, respectively. The incidence of hypotension was measured by calculating the decline in systolic blood pressure from the baseline. In group A (ephedrine), hypotension was occurred in 7 patients (15,2%), it means incidence of hypotension reduced by 84,8%, while in group B (control) hypotension was occurred in 26 patients (56,5%) or incidence of hypotension reduced by 43,5%. The results suggest that there was significant difference between two groups p < 0,05 (p = 0,001). In conclusion, prophylactic effectiveness of preloading 20 ml/kg Ringer’s lactate given within 30 minutes prior to subarachnoid block, with infusion of 3 mg/minutes ephedrine administered 2 minutes prior to subarachnoid block and 1 mg/minutes of which at 18 minutes afterwards; was effective to reduce incidence of hypotension due to subarachnoid block anesthesia in patients undergoing caesarean section. Finally, the overall performance was better in treatment group compared to control group.

Kata Kunci : ringer laktat, seksio sesaria, hipotensi, blok subarakhnoid, efedrin