PENGARUH PEMBERIAN NEOSTIGMIN TERHADAP MASA RETENSI URIN PASCA ANESTESI SPINAL

Abstract

The fieldwork has been done for 40 patients whom endured the elective surgery hernioraphy with their physical status are ASA I - II, their ages are 20 - 50 years old, their weights are 40 - 60 kg, their heights are 150 - 170 cm, there were not tale urethra and the others enclosed diseases. The fieldwork in Central Operating Theatre Rumah Sakit Dokter Kariadi Semarang, was for knowing the influences neostigmin to the duration of urine retention post spinal anesthesia. The patients were ascertained that there are not contra indication for spinal anaesthesia action and usage of neostigmin. All patients did not review premedication. Since they were observed the fasting period, the patients were given infusion 2 ml / kg / hour. Before spinal anaesthesia were done by the patients that had been given preload Ringer Lactate 15 ml /kg along 15 minute. Spinal anaesthesia had been done injection in the interspace lumbal 3 - 4 cephalad with 23 G spinal needle and injection of hyperbaric lidocaine 5 % 100 mg ( 2 ml ) with 5.10-6 adrenalin 0,2 ml, speed injection 1 ml / 5 second without barbotage. The patients were divided into 2 groups : Group A : Post surgery that the patients were given aqua pro injection intramuscular. Group B : Post surgery that the patients were given neostigmin 0,5 mg intramuscular. Post surgery urine retention was examined, are there urine retention or not, the datas were processed statistically and significantly if P < 0,05. The result that were got from variable, which was researched were ages, weights, heights ( BMI ), vital signs ( blood pressure, heart rates, MAP ) in pre anaesthesia periods, as long as surgery and post surgery statistically, was meant different not significant in both of the groups. While the urine retentions duration in group A were 8 patients ( 40 % ) and group B were 3 patients ( 15 %) statistically urine retention cases were not significant. But duration of urine retention in the in group B with giving neostigminpost surgery showed the shortness of urine retention in post spinal anaesthesia duration in proportion to group A that were wihtout giving neostigmin. The different durations of urine retention in to groups was caused by the neostigrnin influenced in area parasymphatic blockade, with inervated detrusor muscle of vesica urinary, that contracted to vesica urinary, that contracted to vesica urinary evacutionevacua ca shorten. By giving neostigmin in post spinal anaesthesia, the duration of urine retention shortened, because neostigmin spur for vesica urinary muscle contractions resulted parasymphatic spinal anaesthesia blockade Telah dilakukan penelitian terhadap 40 penderita yang menjalani operasi elektif herniorafi dengan status fisik ASA I - II, umur 20 - 50 tahun, berat badan 40 - 60 kg, tinggi badan 150 - 170 cm, tidak ada riwayat penyakit saluran kecing. Penelitian dilakukan di Ruang Bedah Sentral Rumah Sakit Dokter Kariadi Semarang, untuk mengetahui pengaruh pemberian neostigmin terhadap masa retensi urin pasca anestesi spinal. Penderita dipastikan tidak ada indikasi kontra terhadap tindakan anestesi spinal dan pemberian neostigmin. Sejak penderita dipuasakan diberi cairan infus 2 ml / kg BB / jam. Seluruh penderita tidak mendapat premedikasi dan sebelum dilakukan anestesi spinal diberi cairan preload Ringer Laktat 15 ml / kg BB dalam 15 menit. Anestesi spinal dilakukan dengan penyuntikan celah vertebra lumbal 3 - 4 ke arah kranial dengan jarum spinal 23 G, dengan lidokain 5 % hiperbarik 100 mg ( 2 ml ) ditambah adrenalin 1/200.000 sebanyak 0,2 ml dengan kecepatan penyuntikkan 1 ml / 5 detik tanpa barbotase. Penderita dibagi menjadi 2 kelompok : Kelompok A : Pasca operasi penderita diberi suntikkan aqua pro injeksi. Kelompok B : Pasca operasi penderita diberi injeksi neostigmin 0,5 mg. Pasca operasi dicatat kejadian retensi urin dan masa retensi urin. Data diolah secara statistik dan bermakna bila P < 0,05.Hasil yang diperoleh dari variabel yang diteliti yaitu umur, berat badan, tinggi badan, tanda-tanda vital ( tekanan darah, laju jantung, MAP ) pada periode pre anestesi, selarna operasi dan pasca operasi secara statistik menunjukkan perbedaan yang tidak bermakna pada kedua kelompok. Sedang kejadian retensi urin pada kelompok A sebanyak 8 penderita ( 40 % ) dan kelompok B 3 penderita ( 15 %) secara statistik berbeda tidak bermakna. Masa retensi urin pada kelompok B ( neostigmin ) menunjukkan pemendekan masa retensi urin dibanding kelompok A ( Kontrol ) secara statistik kedua kelompok menunjukkan hasil berbeda bermakna ( P = 0,031 atau P < 0,05 ). Perbedaan masa retensi urin pada kedua kelompok karena pengaruh pernberian neostigmin pada blokade saraf parasimpatis sakral 3 - 4 yang mensarafi otot detrusor kandung kemih. Dengan demikian pemberian neostigmin pasca anestesi spinal dapat memperpendek masa retensi urin karena pacuan neostigmin terhadap saraf parasimpatis.