PERBANDINGAN PEMBERIAN RINGERFUNDIN DENGAN RINGER LAKTAT COLOAD (SAAT) ANESTESI SPINAL DALAM MENCEGAH HIPOTENSI PADA PASIEN SEKSIO SESAREA ELEKTIF

Orizanov Mahisa, Dr. IG Ngurah Rai Artika, SpAn, KAKV.

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar Belakang : Hipotensi merupakan komplikasi yang paling sering ditemukan pada anstesi spinal. Salah satu usaha pencegahan yang dapat dilakukan adalah dengan cara pemberian cairan kristaloid saat anestesi spinal. Tujuan penelitian ini untuk membandingkan kejadian hipotensi antara pemberian Ringerfundin sebagai kristaloid isotonis dan Ringer Laktat sebagai kristaloid hipotonis. Metode : Rancangan penelitian ini adalah uji klinis acak terkontrol tersamar ganda. Subyek penelitian adalah 82 pasien yang menjalani operasi seksio sesarea elektif dengan anestesi spinal di RSUP Dr Sardjito Yogyakarta, RSUD Panembahan Senopati Bantul dan RSUD Sleman. Semua subyek/keluarga telah menandatangani surat persetujuan ikut serta penelitian. Kriteria inklusi : usia 20- 40 tahun, BMI 20-30 kg/m2, tinggi badan > 145 cm, kehamilan tunggal, aterm minimal 37 minggu, ASA 1 atau 2. Kriteria eksklusi : pasien dengan hipertensi kronis, penyakit paru, preeklampsia atau eklampsia. Kriteria drop out jika terjadi total spinal, gagal anestesi spinal. Pemilihan sampel dilakukan secara consecutive sampling dan randomisasi blok. Subyek penelitian dibagi menjadi dua kelompok, kelompok A pemberian coload Ringer Laktat 10 ml/kgbb dan kelompok B pemberian coload Ringerfundin 10 ml/kgbb. Cairan diberikan saat LCS telah terdeteksi di jarum spinal dengan cara membuka penuh tutup kontrol dari selang infus. Dilakukan monitoring hemodinamik pada menit ke-2, 4, 6, 8 dan 10 untuk melihat kejadian hipotensi setelah anestesi spinal.Disebut hipotensi jika terjadi penurunan tekanan darah sistolik ≥ 25% dari basal atau tekanan darah sistolik ≤ 90 mmHg. Terapi Efedrin dan bolus cairan diberikan untuk mengatasi hipotensi. Hasil : Tidak terdapat perbedaan bermakna (p=0.792) antara kejadian hipotensi pada pemberian coload Ringerfundin (51.2%) dan coload Ringer Laktat (60.9%). Simpulan : Pemberian cairan saat anestesi spinal (coloading) antara cairan isotonis (Ringerfundin) dan cairan hipotonis (Ringer Laktat) mempunyai efek yang sama dalam mencegah hipotensi selama anestesi spinal pada pasien seksio sesarea elektif.

Hypotension is the most common complication in spinal anesthesia. One of the prevention effort is made by an administration of coloading crystalloid. This study aims to compare hypotension incidence in the coloading administration of Ringerfundin as an isotonic crystalloid and Lactated Ringer as a hypotonic crystalloid. Methods : This study was a double blind randomized controlled trials. Subjects were 82 pregnant women, who undergoing caesarean section with spinal anesthesia at Dr Sardjito Hospital in Yogyakarta, Panembahan Senopati Hospital in Bantul and Sleman Hospital. This study was done following institutional ethical committee approval and obtaining patients written informed consent. Patients who were selected had normal singleton pregnancy, more than 37 weeks gestation, 20-40 years old, BMI 20-30 kg/m2, height more than 145 cm, ASA 1-2. The exclusion criteria included patients with decreased lung compliance, preeclampsia, eclampsia, hypertension. Drop out criteria were total spinal, failed spinal. Subject sampling was conducted in consecutive sampling and block randomly. The patients were divided into two groups, group A (coloading 10 ml/kgbw Lactated Ringer ) and group B (coloading 10 ml/kgbw Ringerfundin). Fluid administration immediately after CSF detection in spinal needle. Fluid boluses for both grups were given via a 18G iv catheter with a fully open control valve and gravity alone providing the driving pressure. Hypotension monitoring was recorded every 2 minutes for the first 10 minutes following spinal. In addition, hypotension (25% decrease in baseline BP or SBP < 90 mmHg) could be treated Ephedrin and additional iv fluid boluses of Lactated Ringer. Results : There were no statistical significant differences (p=0.792) in hypotension incidence between Lactated Ringer and Ringerfundin coload administration. Conclusion : The coloading isotonic solution (Ringerfundin) has the similar effect compared to hypotonic solution (Lactated Ringer) to prevent hypotension in spinal anesthesia during elective caesarean section.

Kata Kunci : Ringerfundin, Ringer Laktat, isotonis, coload, seksio sesarea