PERBANDINGAN EFEKTIFITAS KLONIDIN 3 AG KG-1 IV DAN MEPERIDIN 0,5 MG KG-1 IV UNTUK PENCEGAHAN MENGGIGIL PASCA ANESTESI

Abstract

Background: Post anesthetic shivering is a conunon phenomenon with a reported incidence varying from 5 to 65 %. It is important to prevent or treat post anesthetic shivering because shivering increases 02 demand and metabolic rate up to 400 %. Patients with ischemic heart disease and cardiac failure are endangered by an increase of oxygen consumption because of post anesthetic shivering. Objective: The purpose of this study is to compare the efficacy between clonidine and meperidine to prevent post anesthetic shivering. Methods: This study was conducted in Central Operation Theatre of Karyadi Central General Hospital Semarang Indonesia from September to November 2000. Seventy-two patients ASA I — aged between 15 — 60 years old scheduled for elective surgery with general anesthesia. This study used post test done by control group design and randomized double-blinded triul. After the induction of anesthesia with 5 mg / kg thiopental and 0,5 mg / kg atracurium , the lungs were ventilated with halothane 0,5 — 1,5 vol. % vaporized in 70 %1\1.20 and 30 % 02. Five minutes before tracheal extubation, each group (n = 24) randomly received clonidine 3 pg / kg, meperidin 0,5 mg / kg, or saline (placebo) intravenously. Arterial blood pressure, heart rates, axilla and esophageal temperature, sedations score, postoperative pain were measured and the incidence, grade and duration of post anesthetic shivering were evaluated. Data were expressed as mean ± standard deviation and range. Statistical analysis used Chi — square and analysis of variance (ANOVA). A p value less.than 0,05 were considered statistically significant. Results: Demographic data, duration of anesthesia and clinical data were similar among groups. There was a statistically significant difference (p c 0,05) between clonidine group and placebo group and between meperidine group and placebo group for the incidence, grade and duration of post anesthetic shivering. There were no difference between clonidine group and meperidine group (p > 0,05) for the incidence, grade and duration of post anesthetic shivering. The. incidence of post anesthetic shivering were zero for clonidine group, 8,3 % for meperidine group and 37,5 % for placebo group. Duration of post anesthetic shivering for meperidine group were 35,85 ± 48,50 seconds. Clonidine administration significantly reduced postoperative pain and increased sedations score. Heart rates and arterial blood pressure were lower after administration of clonidine than after administration of meperidine or placebo. Conclusion: Post anesthetic administration of clonidine (3 pg / kg) or meperidine (0,05 mg / kg) are both suitable for prevention of post anesthetic shivering. Latar Belakang : Menggigil pasca anestesi dilaporkan insidennya antara 5 — 65 %. Pencegahan dan terapi menggigil sangat penting karena menggigil dapat meningkatkan kebutuhan 02 , dan meningkatkan metabolisme sampai 400 % , sehingga dapat membahayakan terutama pada penderita dengan penyakit jantung iskernik atau gagal jantung. Tujuan : Penelitian Mi bertujuan membandingkan efektifitas klonidin 3 pg / kg iv dibanding meperidin 0,5 mg / kg iv untuk pencegahan menggigil pasca anestesi. Metode : Penelitian dilakukan di Instalasi Bedah Sentral RSUP dr. Kariadi Semarang dari September sampai Nopember 2000. Tujuh puluh dua penderita ASA I — II , usia 15 — 60 tahun yang direncanakan menjalani operasi elektif dengan anestesi umum disertakan dal= penelitian Penel Man menggunakan rancangan eksperimental sederhana dilakukan secara acak tersamar ganda Incluksi dengan tiopental 5 mg / kg dan atrakurium 0,5 mg / kg , rumatan anes:esi dengan halotan 0,5 — 1,5 vol % dalam N20 70 % , dan 02 30 %. Lima menit sebelum ekstubasi endotrakea , penderita dikelompokkan secara random menjadi 3 kelompok ( n = 24 ). Kelompok I mendapat klonidin 3 gg / kg , kelompok II mendapat meperidin 0,5 mg / kg , dan kelompok III mendapat NaCI 0,9 % ( plasebo ) intra vent Tekanan darah , frekwensi denyut jantung , temperatur aksila dan oesofagus , skor sedasi , nyeri pasca operasi diukur , setta insiden , durasi , dan deraj at menggigil dinilai. Data disajikan dal am rerata ± simpang baku dan kisaran. Uji siatistik menggunakan chi square dan ANOVA , p < 0,05 menunjukkan uji statistik berbeda bennalcna Flasil : Data demografi durasi operasi dan data klinis berbeda tidak bermakna pada masing — masing kelompok. Insiden , derajat , dan durasi menggigil pasca anestesi secara statistik berbeda bennakna ( p < 0,05 ) antara kelornpok klonidin dan plasebo , juga antara kelompok meperidin dan plasebo. Insiden , derajat , dan durasi menggigil pasi.a anestesi kelompok . klonidin dan meperidin secara statistik berbeda tidak bermakna ( p > 0,05 ). Insiden menggigil pasca anestesi kelompok klonidin 0 % , kelompok meperidin 8,3 % , clan kelompok plasebo 37,5 %.Durasi menggigil kelompok meperidin 4,08 ± 17,59 detik , dan plasebo 35,85 ± 48,50 detik. Klonidin signifikan menurunkan nveri pasca operasi. Skor sedasi secara statistik berbeda bermakna dibanding keloinpok tneperidin atau plasebo. Frekwensi denyut jantung dan tekanan darah setelah pemberian klonidin lebih rendah dibanding sete.lah pemberian meperidin atau plasebo. Keshnpulan : Klonidin 3 pg / kg infra vena Mau meperidin 0,5 mg / kg intra vena pada akhir op erasi keduanya efbktif untuk mencegah menggigil pasca anestesi.