GEJOLAK KARDIOVASKULER AKIBAT LARINGOSKOPI INTUBASI: PERBANDINGAN ANTARA PEMBERIAN DEKSMEDETOMIDIN DENGAN LIDOKAIN

Abstract

Background : Laryngoscopy and intubation often provoke a reflex with increase in both symphatic and symphatoadrenal activity, which may result hypertension, tachycardia and dystrimia. In susceptible individuals, especially those with hypertension, intracranial aneurysm, coronary and cerebrovascular disease. Many pharmacological techniques have been devised to reduce this responses, including the use of pioids, local anaesthetics, beta blocker, alfa 2 adrenergic agonist and vasodilatating agents. Dexmedetomidine is an alternative agent to reduce cardiovascular responses with minimal side effect. The objective study is to show whatever dexmedetomidine is effective to reduce cardiovascular response to laryngoscopy intubation. Objective : The objective of this study was to show if dexmedetomidine is effective to reduce cardiovascular response after laryngoscopy intubation. Methods : In this randomized, double-blind controlled study, 48 physical status ASA I or II patients undergoing elective surgery with general anaesthesia in Dr. Kariadi Hospital Semarang, were divided into two groups of 24 patients each. Patients in different groups either received 0,6 ug kg' dexmedetomidine (group I) or 1,0 mg kg-1 lidocain group (group II) intravenously before laryngoscopy and intubation. No premedication was given. Induction of anaesthesia using propofol 2,0 mg kg' and vecuronium 0,08 mg kg', then maintened with 50 % N20 in oxygen 1,0 vol. % isofluran. Systolic, diastolic, mean arterial pressure and heart rate were monitored at 1 st,3rd, 5th- minute after tracheal intubation, and also side effect. Data was analyzed using student t-test and chi-square test. P < 0,05 is considered as significant. Result : Demographic and preclinical data were not significantly different. Cardiovascular responses were significantly different between groups (p<0,05) in which that they were reduced after dexmedetomidine except for diastolic pressure in the first minute. Side effects were not significantly different, except for hypertensive event which was significantly higher after lidocaine. Conclusion : Dexmedetomidine 0,6 ug kg-1 intravenous reduces caidit-vascular response to laryngoscopy intubation better than lidocain 1,0 mg kg-1 intravenous with minimal side effect. Latar belakang : Laringoskopi intubasi endotrakhea menimbulkan reflek peningkatan aktifitas simpatis maupun simpatoadrenal yang menimbulkan hipertensi, takikardi dan disritmia. Beberapa obat telah dicoba digunakan untuk mengurangi respon ini. Deksmedetomodin merupakan obat altenatif untuk mengurangi gejolak kardiovaskuler. Tujuan Penelitian ini bertujuan untuk membuktikan apakah deksmedetomodin efektif untuk mengurangi gejolak kardiovaskuler akibat tindakan laringoskopi intubasi. Metode : Dengan cara random dan teknik double—blind controlled study, 48 pasien status fisik ASA I dan II yang direncanakan operasi elektif dengan anestesi umum di Rumah Sakit Dr. Kariadi Semarang, dibagi menjadi dua kelompok masing—masing 24 pasien. Setiap pasien pada masing-masing kelompok menerima 0,6 lig / kgBB deksmedetomidin (kelompok I) dan 1,0 mg / kgBB lidokain (kelompok II) bolus intravena sebelum laringoskopi intubasi. Semua pasien tidak diberikan premedikasi. Induksi dengan propofol 2,0 mg / kgBB dan vecuronium 0.08 mg / kgBB, maintenance dengan 1420 50 % dalam oksigen dan isoflurane 1,0 vol %. Tekanan darah sistolik, tekanan darah diastolik, tekanan arteri rerata dan laju jantung dicatat pada 1,3 dan 5 menit setelah intubasi, dan juga efek samping. Data analisa dengan student t-test dan chi—square dengan derajat kernaknaan p<0,05. Hasil : Data demografi dan keadaan klinis awal pada kedua kelompok berbeda tidak bermakna (p>0,05). Pada kelompok lidokain menunjukkan peningkatan gejolak kardiovaskuler kecuali LJ menit 3 dan 5, TDS menit 5, TAR menit 5, sedangkan kelompok deksmedetomidin terjadi penurunan gejolak kardiovaskuler kecuali TDD menit 1. Gejolak kardiovaskuler pada kedua kelompok berbeda bermakna (p<0,05) pada semua veriabel kecuali LJ dan TDS menit 5. Kejadian takikardi dan bradikardi berbeda tidak bermakna (p>0,05), kejadian hipertensi berbeda bermakna (p<0,05) antara kedua kelompok. Kesimpulan : Deksmedetomidin 0,6 jig / kgBB intravena lebih efektif dibandingkan lidokain 1,0 mg / kgBB intravena untuk mengurangi dan mencegah peningkatan gejolak kardiovaskuler pada tindakan laringoskopi intubasi endotrakhea, dengan efek samping