PERBANDINGAN EFEKTIFITAS ANTARA TRAMADOL DAN MEPERIDIN UNTUK PENCEGAHAN MENGGIGIL PASCA ANESTESI UMUM COMPARISON OF EFFECTIVITY BETWEEN TRAMADOL AND MEPERIDINE FOR THE PREVENTION OF SHIVERING AFTER GENERAL ANESTHESIA

Abstract

Background : Post anesthesia shivering is common complication after anesthesia. It can causes uncomfortable situation and so many risk. Post anesthesia shivering must be prevented or treated. The most commonly drug that used is meperidine. Objective : The aim of this study is to proved that giving intra venous tramadol 2 mg kg as soon before the end of the surgery is more effective than intravenous meperidine 0.5 mg kg-I as soon before the end of the surgery to prevent shivering after general anesthesia Methods : This experimental study was designed as randomized post test only controlled group of 72 patients underwent elective surgery with general anesthesia. Vital sign (diastolic and systolic blood pressure, mean arterial pressure, heart rate and Sa02) were measured 5 minutes before induction. Induction procedure of standardized general anesthesia were done. Esophageal temperature was measured as soon as intubation done. Duration of operation was limited 2 — 3 hours. At the end of surgery, inhalation drugs were stopped. After adequate spontaneous breathing and laryngeal reflex shown, randomization was done. Patients divided into three groups, and received intravenously tramadol 2 mg kg' for T group, meperidine 0.5 mg kg-I for M group and NaCI 0,9 % for K group. Extubation was done 5 minutes after the drug was given. Vital sign were measured as soon as after extubation and every 5 minutes for 30 minutes long. Body temperature were measured as soon as and 15 minutes after extubation. After extubation patients were receiving oxygen 6L/minute face mask. Statistical analysis were performed by One-way Anova and chi-square, which were p-value < 0.05 was considered significant. Results : Basic data, clinical characteristic data before induction, were not significantly different (p>0.05), except heart rate 30 minutes after extubation between tramadol group and control group (p=0.029). Incidence of shivering on tramadol and meperidine group were developed on 4 subjects (16.6%) which all were at PI degree (p=0.650). Differences of body temperature between tramadol and meperidine group 15 minutes after extubation were significantly different (p=0.02). Side effects that developed on tramadol group were 2 subjects had nausea, which were meperidine group 6 subjects had nausea and 2 subjects had nausea and vomitus (p=0.036). Conclusions : Tramadol and meperidine have similar effectivity on the prevention of shivering after general anesthesia, but tramadol have lower side effect compare to meperidine. Latar belakang : Menggigil pasca anestesi merupakan komplikasi yang cukup sering terjadi. Menggigil menimbulkan keadaan yang tidak nyaman dan berbagai resiko. Karena itu menggigil harus segera dicegah atau diatasi. Sampai saat ini obat yang paling sering digunakan adalah meperidin. Tujuan : Membuktikan bahwa pemberian tramadol 2 mg/kgBB intra vena menjelang akhir operasi lebih efektif daripada meperidin 0,5 mg/kgBB intra vena menjelang akhir operasi untuk mencegah kejadian menggigil pasca anestesi umum. Metode : Merupakan penelitian eksperimental dengan desain "randomized post test only controlled group" pada 72 pasien usia yang menjalani operasi dengan anestesia umum. Tanda vital (tekanan darah diastolik dan sistolik, tekanan arteri rerata, laju jantung dan Sa02) diukur 5 menit sebelum induksi. Prosedur induksi anestesi umum dilakukan sesuai dengan standart. Temperatur esofagus diukur segera setelah induksi Lama operasi dibatasi antara 2 — 3 jam. Pada akhir operasi, obat inhalasi dihentikan. Setelah nafas spontan adekuat, reflek laringeal positip dilakukan randomisasi Pasien dibagi menjadi tiga kelompok, dan mendapatkan secara intravena tramadol 2 mg/kgBB untuk kelompok T, meperidin 0,5 mg/kgBB untuk kelompok M dan NaCI 0,9% untuk kelompok K. Ekstubasi dilakukan 5 menit setelah perlakuan. Tanda vital diukur dan dicatat segera setelah ekstubasi dan tiap lima menit selama 30 menit. Suhu tubuh diukur segera dan 15 menit setelah ekstubasi. Pasca ekstubasi pasien diberi oksigen 6L/menit. Uji statistik dilakukan dengan menggunakan One-way ANOVA dan Kai-kuadrat, dengan derajat kemaknaan yaitup < 0,05. Hasil : Data dasar dan data karakteristik klinis sebelum induksi, berbeda tidak bermakna (p>0,05), kecuali laju jantung 30 menit pasca ekstubasi antara kelompok tramadol dan kontrol berbeda bermakna (p=0,029). Kejadian menggigil pada kelompok tramadol dan meperidin terjadi pada 4 penderita (16,6%) yang semuanya pada derajat 1, dimana secara statistik berbeda tidak bennakna (p=0,650 ). Perbedaan suhu tubuh kelompok tramadol dan meperidin 15 menit pasca ekstubasi berbeda bermakna (p=0,02). Efek samping obat yang timbul pada kelompok tramadol 2 penderita mengalami mual, sedangkan kelompok meperidin 6 penderita mengalami mual dan 2 penderita mual muntah, dimana secara statistik berbeda bermakna (p=0,036). Kesimpulan : Tramadol dan meperidin mempunyai efektifitas yang sama dalam mencegah menggigil pasca anestesi umum, tetapi tramadol mempunyai efek samping obat yang lebih rendah dibandingkan meperidin.