Perbandingan Kadar Sevoflurane dan Nitrous Oxide (N2O) selama Anestesi di Ruang-ruang Operasi dengan Filter HEPA (High Efficiency Particulate Arrestance) dan Tanpa Filter HEPA

AKHMAD SYAIFUL FATAH HUSEIN, Bambang Suryono, Bhirowo Yudo Pratomo

2016 | Tesis-Spesialis | SP ILMU ANESTESIOLOGI DAN REANIMASI

Latar belakang. Semakin luasnya penggunaan sevoflurane sebagai zat anestesi inhalasi dan nitrous oksida (N2O) masih menjadi zat inhalasi umum karena memiliki efek anxiolitik, analgesi dan euforia. Sevoflurane dalam jangka panjang dapat menyebabkan gangguan ginjal akibat akumulasi metabolit dalam urin, sementara N2O berpotensi menyebabkan pemanasan global, tetapi keduanya tidak diukur secara rutin. Kadar keduanya sangat dipengaruhi oleh adanya instalasi HEPA, sistem penghisapan (exhausted) di ruang operasi dan sirkuit napas mesin anestesi. Tujuan. Penelitian ini bertujuan untuk mengetahui kadar Sevoflurane dan N2O di ruang-ruang operasi yang memiliki filter HEPA dibandingkan dengan ruang-ruang operasi tanpa filter HEPA yang berada di RSUP Dr. Sardjito Yogyakarta. Kadarnya dinilai keseuaiannya dengan standard National Institute of Occupational Safety and Health 1977 (NIOSH 1977). Metode. Dengan metode potong lintang, hasil penelitian diambil dari populasi seluruh ruang operasi yang digunakan operasi dengan anestesi umum lebih dari 2 jam dan menggunakan anestesi sevoflurane dan N2O selama operasi. Dari 18 ruang operasi didapatkan sampel sebanyak 7 ruang operasi dan diukur pada zona 4 dan zona 5 pada 30 menit sebelum anestesi dimulai, jam ke-2 anestesi, jam ke-4 anestesi dan 30 menit setelah anestesi. Hasil. Hasilnya didapatkan rata-rata kenaikan kadar sevoflurane dan N2O di ruang-ruang operasi dengan sistem HEPA adalah 12,69 ppm (2,27 %) dan 17,53 ppm (2,70%). Kenaikan kadar sevoflurane dan N2O di ruang-ruang operasi tanpa filter HEPA adalah 168,46 ppm (3,45 %) dan 8,61 ppm (1,86 %). Kesimpulan. Ruang operasi yang menggunakan sistem filter HEPA kadarnya lebih rendah 65,5 % dibanding ruang operasi tanpa filter HEPA dan masih memenuhi standard NIOSH 1977.

Background. The more the extent of the use of sevoflurane as an inhalation anesthetic and nitrous oxide (N2O) is still a common inhaled substances because it has anxiolytic effect, analgesia and euphoria. Sevoflurane in the long term can lead to kidney disorders due to the accumulation of metabolites in the urine, while N2O has the potential to cause global warming, but they are not routinely measured. Levels of both are affected by the installation of HEPA, suction system (exhausted) in the operating room and anesthesia machine breathing circuit. Aim. This study aims to determine the extent of Sevoflurane and N2O in operating rooms that has a HEPA filter compared to operating rooms without a HEPA filter that is located in the department of Dr. Sardjito. Levels rated keseuaiannya with standard National Institute of Occupational Safety and Health 1977 (NIOSH 1977). Method. With cross sectional method, the results drawn from the entire population that used the operating room under general anesthesia operations of more than 2 hours and using sevoflurane and N2O anesthesia during surgery. Of the 18 samples obtained operating room seven operating rooms and is measured in zone 4 and zone 5 at 30 minutes before anesthesia is started, 2 hours in anesthesia, anesthesia 4th hour and 30 minutes after anesthesia. Results. The result shows the average increase in the levels of sevoflurane and N2O in operating rooms with HEPA system is 12.69 ppm (2.27%) and 17.53 ppm (2.70%). Increased levels of sevoflurane and N2O in operating rooms without a HEPA filter was 168.46 ppm (3.45%) and 8.61 ppm (1.86%). Conclusion. The operating room system using HEPA filter lower levels of 65.5% compared to the operating room without a HEPA filter and still meets the NIOSH standard in 1977.

Kata Kunci : Sevoflurane, nitrous oxide, HEPA filter, NIOSH 1977, operating room, inhaled anesthesia level