HUBUNGAN ANTARA STATUS SIMPATIS SEBELUM ANESTESI SPINAL DENGAN KEJADIAN HIPOTENSI PADA ANESTESI SPINAL

Abstract

Incidence of hypotension due to spinal anesthesia in geriatric more frequently and in geriatric have occurred the dysfunction of the syrrpathetic nervous system. This study proposed to analyze the relationship between sympathetic status with the incidence and the degree of hypotensiai due to spinal anesthesia. We have performed a Cohort study to 33 geriatric patients with cluster sampling, age > 60 years old, ASA II, no contraindication to absolute of spinal anesthesia, who were planned to get elective lower abdorrinal, perineal and lower extrenity surgery using spinal anesthesia technique in central operating theatre of RSUP Cr. Kariadi Semarang, Pebruary 2000 — June 2000. Patients were dMded into three groups, each group consist of 11 patients, based on sympathetic function test represented by the change in systolic blood pressure (SBP) from the recumbent to the standing position. In group I (normally sympathetic status) the difference of SBP fran recumbent to 1 rrinute after standing position was s 10 rrmlig, in group II (borderline syn-pathetic status) the difference was 11 — 29 ti-lg, and in group III (abnormal sympathetic status) the cifference was 30 mmHg. Each patients received prehydration with Ringer Lactate solution 15 ni/kg bw for 15 — 20 minute before spinal anesthesia and then the patients were placed in the lateral position. Systolic and diastolic blocxl pressure, n-ean arterial pressure, heart rate dan respiratory rate before prehydration and during the first 31 minute after spinal anesthesia, the incidence of hypotension and others side effect, total dose or ephedrine used were recorded. aatistical analysis was performed using chi square test, Anova and paired t test with p < 0,05 was deemed statistically significant. The difference of the demographic data, ASA physical status before spinal anesthesia between the three groups are found to be insignificant (p>0,06). The difference of SBP decrease in group I is found to be statistically significant after 19 minutes post spinal anesthesia (pt0,020), in group II after the first minute post spinal anesthesia (p=0,001), and in group III after the third minute post spinal anesthesia (p=0,001). The decrease of SBP every 2 minute during the 3 rd — 31 st minute after spinal anesthesia in group III > group II > grotto I. hypotension is defined as a 30% or more decrease from baseline SBP. The overall incidence of spinal anesthesia — induced hypotension is 39,39%, ranging from 45,44% in group II to 74,72% in group III. The mean of the amount of ephedrine required in group III > in group II > in group I and is found to be significantly different (p=0,009). The incidence of bradycardia and shivering in group I, II and III is not significantly different (p>0,05). The relative risk of group III to group II and I = 3,2. Conclusion: The incidence and the degree of hypotension after spinal anesthesia in geriatric patients with abnormal syrnpathetic status is higher than in their counterparts with borderline sympathetic status and both groups are higher con-pared with group with normal sympathetic status. Insiden Npctensi yang diakibatkan deh anestesi spinal pada geriatrik lebih tinggi dan pada geriatrik telah terjadi gangguan sistem saraf sirrpatis. Penelitian ini bertujuan untuk rnenganalisa hubungan antara status sirrpatis dengan insiden dan derajat hipctensi yang diakibatkan deh anestesi spinal. Karr' telah melakukan stud' Cohort pada 33 pasien geriatrik secara klaster, urar > 60 tahun, AS/A 1t, tidak ada kcntraindikasi absclut anestesi spinal, menjalani cperasi elektif abdomen bagian bawah, perineum dan anggcta gerak bawah dengan teknik anestesi spinal ch Instalasi Bedah Sentral RSUP Dr. Kariadi Semarang dalam periode waktu Pebruari 2000 — Juni 2000. Pengelarpckan pasien berdasarkan status simpatis dad hasil uji tekanan darah tidur — berdiri. Kekrrpok I (status sirrpatis normal) bila perbedaan tekanan darah sistdik (TDS) berbaring dengan TDS 1 menit setelah berdiri 5 10 mmHg, kelompck II (status sirrpatis perbatasan) bila perbedaan tsb 11 — 29 nrrnlig, kelcrripck III (status sirrpatis abncrmal) bila perbedaan tsb z 30 mmHg. Setiap kelarpok terdiri dad 11 pasien, setiap pasien diberi geload larutan Ringer Lactate 15 rthkg bb selama 15 — 20 menit lalu dilakukan anestesi spinal 15 mg bupivakain 0,5% hiperbarik di L3- 4 dengan posisi berbaring di meja hcrizcntal miring ke arah lateral. TDS, tekanan darah diastdik (TDD), tekanan arteri rata-rata (TAR), laju jartung (LJ) dan laju nafas (LNI) sebelum preload dan selama 31 menit pertama setelah anestesi spinal, insiden hipctensi dan efek sarrping lain, junlah efedrin yang dibutuhkan dicatat. qi statistik menggankan chi square test, Anova dan paired t test dengan derajat kernaknaan p < 0,05. Data demografi dasar, status tisk ASA, pada ketiga kelorrpck berbeda tidak bermakna (p>0,05). Penurunan TDS secara statistik berbeda berrrekna pada kelorrpck I rrulal trent ke-19 (p=0,020), pada kelarpck II multii mart kesatu (p=0,001), pada kelarpok III rrulai menit ke-3 (p=0,001). Penurunan TDS setiap 2 menit mulai menit ke-3 — 31 pada kelorrpck III > kelorrpok II > kelarpck I. lipctensi bila penurunan TDS 30% dad TDS sebelum anestesi spinal. Insiden hipctensi pada kelarpck I 0%, pada kekrrpck II 45,44%, pada kelorrpck III 74,72%. Jurniah rata-rata pemakaian efedrin pada kelorrpck III > kelarpck II > kelorrpck I dan berbeda bermakna (p=0,009). Insiden bradikardia dan menggigil pada kelarpck I, II dan III berbeda tidak bermakna (p>0,05). Resiko relatif kelon-pck III terhadap kelarpok II dan I -= 3,2. Kesimpulan: Insiden dan derajat hipctensi pada anestesi spinal pada pasien geriatrik dengan status sinpatis abnamal !thin besar daripada pada status sirrpatis perbatasan dan keduanya lebih besar daripada pada status sirrpatls narrel.