PENGARUH PRETREATMENT FENTANIL 1 pg / KgBB INTRAVENA TERHADAP IRITASI JALAN NAFAS PADA INDUKSI INHALASI ISOFLURAN

Abstract

Backgrounds: Irritation of the airway is one of the most important features of inhalation anesthetic agents, especially when it is used for induction. Reflex of upper respiratory tract is very important to maintain airway and to prevent complication in the upper respiratory tract during anesthesia. Isoflurane may be used for inhalation induction despite the airway irritation it may cause. Pretreatment using fentanyl for isoflurane inhalation induction was expected to reduce the irritation of upper respiratory tract. Methods: This study was a phase III, stage 2 clinical trial in random double-blind manner. There were forty-two patients underwent elective surgery using isoflurane inhalation induction in Dr. Kariadi Hospital Semarang, age 15 - 40 years, physical status ASA I - II and fulfilling inclusion criteria. The patients were divided into two groups, group I (control group) received 10 ml of 0.9% NaCI in 10 ml syringe, group II (fentanyl group) received fentanyl pretreatment 1 pg /kilogram body weight diluted with 10 ml 0.9% NaCI in 10 ml syringe. Pretreatment was given slowly (more than 1 minute) and 2 minutes later the patients were given pre-oxygenation with oxygen 6 liters/minute for 3 minutes. Induction of anesthesia was started using 0.2 % MAC of isoflurane with 02: N20 = 50: 50. Isoflurane was increased 0,2 % MAC every two breaths until eyelash reflex became negative. The time when eyelash reflex was negative was recorded as the time of induction. Complications, breath holding, apnea, laryngeal spasm and spasm of bronchus that occurred were recorded. Systolic blood pressure, diastolic blood pressure, pulse and oxygen saturation were measured before and after the induction. Results: Baseline demographic data and clinical state of the two groups did not different significantly. The induction time of group II (fentanyl group) was faster than group I (control group) although the difference was not statistically significant. Incidence of breath holding in group I 2/21 (9.5 %) compared with group II 12/21. (4.8 %) was not differ significantly (p>0.05). Incidence of cough in group I 7/21 (33.3 %) compared with group if 2/21 (9.5 %) was statistically significant (p<0.05). There were no incidence of laryngeal spasm, bronchospasm and hipersecretion in the two groups. Conclusion: Pretreatment with 1 pg fentanyl/kilogram body weight can reduce irritation of the upper respiratory tract. Latar Belakang : Iritasi jalan nafas adalah salah satu sifat terpenting dari agen anestesi inhalasi, khususnya bila digunakan untuk induksi. Aktivitas reflek saluran nafas atas sangat penting untuk menjaga jalan nafas dan mencegah komplikasi jalan nafas atas selama anestesi. Isofluran dapat digunakan untuk induksi inhalasi meskipun dapat mengiritasi jalan nafas. Pemberian pretreatment fentanil pada induksi inhalasi isofluran diharapkan dapat mengurangi iritasi jalan nafas atas yang timbul. Metode : Merupakan uji klinis tahap 2 fase III yang dilakukan secara acak tersamar ganda. Empat pul uh dua pasien yang menjalani operasi elektif dengan anestesi isofl uran di RSUP Dr. Kariadi Semarang, usia 15 — 40 tahun, status fisik ASA I — II dan memenuhi kriteria inklusi. Penderita dibagi dalam 2 kelompok, yaitu kelompok I (kontrol) mendapat NaCl 0,9 % 10 cc dalam semprit 10 cc, kelompok 11 (fentanil) mendapat pretreatment fentanil 1 pg KgBB diencerkan sampai 10 cc dengan NaCI 0,9 % dalam semprit 10 cc. Pretreatment diberikan secara pelan — pelan ( > 1 menit ) , 2 menit kemudian pasien diberikan pre oksigenasi dengan 02 6 liter / menit selama 3 menit. Kemudian dimulai induksi anestesi dengan isofluran 0,2 % MAC dengan 02 : N20 = 50 : 50. Setiap 2 kali nafas, isofluran dinaikkan 0,2 % MAC sampai refleks bulu mata negatif Pada saat refleks bulu mata negatif dicatat sebagai waktu induksi anestesi.Dicatat komplikasi yang terjadi batuk, tahan nafas, apneu, spasme laring, spasme bronkus. Tekanan darah sistolik, tekanan darah diastolik, laju nadi , dan saturasi oksigen diukur sebelum dan sesudah induksi. Hasil : Data demografi dan keadaan klinis awal pada kedua kelompok berbeda tak bermakna. Waktu induksi kelompok II (fentanil) lebih cepat dibanding kelompok I (kontrol) meskipun secara statistik berbeda tak bennakna. Skor tahan nafas pada kelompok I : 2/21 (9,5 %) dibanding kelompok II : 1/21 (4,8 %) secara statistik berbeda tak bermakna (p>0,05). Skor batuk pada kelompok I : 7/21 (33,3 %) dibanding kelompok II : 2/21 (9,5) dengan menggunakan uji Chi-Square didapatkan Pc 0,05 (berbeda bermakna). Tidak didapatkan kejadian spasme laring, spasme_ bronkus dan sekresi yang berlebihan pada kedua kelompok. Kesimpulan : Pretreatment fentanil 1 pg / KgBB pada induksi inhalasi isofluran dapat mengurangi iritasi jalan nafas atas.