PERBANDINGAN EFEK TIOPENTAL - ROKURONIUM DAN TIOPENTAL - SUKSINILKOLIN TERHADAP KARDIOVASKULER PADA TERAPI KEJANG LISTRIK

Abstract

Background : Succinylcholine was a muscle relaxing agent, which was often used to paralyze the patients during Electro Convulsive Therapy (ECT). It had some advantage effects, but it aslo had some diadvantage effects; for instance muscle pain effect to cardiovascular effecL Rocuronium was a new muscle relaxant which was used to subtitute succinylcholine, because of its rapid onset and fulfil the criterion of ideal muscle relaxant It had been studied the combination of thiopental - succinylcholine and thiopental - rocuronium on cardiovascular system during ECT in Phsychiatric Central Hospital in Semarang and in Surakarta on January to April 2001. Objective : The aim of this study was proving that patients' cardiovascular system who underwent ECT by combination of thiopental - rocuronium anesthesia was different from that of combination thiopental - succinylcholine. Methods and subjects : The study has been carried out in 54 male and female patients aged 20 — 40 years old, body weight 40 — 60 lcgs, physical status ASA I, electro cardiography and blood pressure measurement were within normal limit. The method used was Randomized Control Trial design. The patients devided into two groups, the first group was administered with 1 mg kg 1 succinylcholine as nniscle relaxant and the second group was administered with 0,4 mg kg -I rocuronium, after they were induced by 4 mg kg-I of thiopental. After the muscles were paralyzed totally, then ECT was done. The blood pressure and heart rate measurement were recorded before the induction anasthesia, after the induction, after administration of muscle relaxant on 1, 3, 5, 10 and 15 minutes after ECT. Time for returning conscious and spontaneous breathing were also recorded. The data processing was done by SASS program using the t test and paired t test (p < 0,05) was significant. Result : The result of the study showed that there was significantly different on sistolic and diastolic blood pressure (p < 0,05) between two groups, whereas on the heart rate was no difference. Time for returning to conscious was no difference, but time for returning to spontaneous breathing was significantly different (p < 0,05). Conclusion : The cardiovascular system effected by combination of thiopental-rocuronium was less then that of thiopental — succinylcholine. Latar belakang masalah : suksinilkolin adalah pelumpuh otot yang banyak digunakan. Disamping berbagai kelebihan, suksinilkolin mempunyai banyak efek yang tidak menguntungkan mulai dari nyeri otot hingga efek kardiovaskuler Rokuronium merupakan pelumpuh otot pilihan pengganti suksinilkolin karena mula kerjanya cepat dan memenuhi kriteria pelumpuh otot ideal. Telah dilakukan penelitian untuk membandingkan efek tiopental - suksinilkolin dan tiopental - rokuronium terhadap kardiovaskuler pada terapi kejang listrik di Rumah Sakit Jiwa Semarang dan Surakarta pada bulan Januari sampai April 2001. Tujuan penelitian : untuk membuktikan bahwa sistem kardiovaskuler pasien yang mendapat terapi kejang listrik dengan anestesi tiopental - rokuronium berbeda dibandingkan dengan tiopental - suksinilkolin. Subyek dan metode : penelitian dilakukan terhadap 54 penderita pria / wanita usia 20 — 40 dengan berat badan 40 — 60 kg, ASA I, EKG dan tekanan darah dalam batas normal dengan rancangan Randomized Control Trial. Penderita dibagi menjadi 2 kelompok. Kelompok I mendapat suksinilkolin 1 mg / kg BB sebagai pelumpuh otot dan kelompok II mendapat rokuronium 0,4 mg / kg BB. Setelah terjadi kelumpuhan otot total dilakukan terapi kejang listrik. Pengukuran tekanan darah dan laju jantung dilakukan pada saat pra induksi, induksi, paska ECT 1 menit, 3 menit, 5 menit, 10 menit dan 15 menit. Dicatat pula pulih sadar dan napas spontan. Pengolahan data dilakukan dengan metode SPSS dengan uji statistik t test dengan p < 0,05 dianggap bermakna. Hasil penelitian : menunjukkan bahwa ada perbedaan yang bermakna pada tekanan darah sistolik dan diastolik pada kelompok Suksinilkolin dan Rokuronium ( p < 0,50), sedangkan laju jantung ada perbedaan yang tak bermakna. Waktu pulih sadar berbeda tak bermakna (p > 0,05), tetapi waktu pulih napas spontan terdapat perbedaan yang bermakna