ASTUTI, YULIA WAHVU VILLY (2002) PEMBERIAN KETAMIN 0,1 mg/kg BB INTRAVENA UNTUK MENCEGAH HIPOTENSI PADA ANESTESI SPINAL DENGAN LIDOKAIN 5% HIPERBARIK. Masters thesis, Program Pascasarjana Universitas Diponegoro.
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Abstract
Background: The most common complication in spinal anesthesia is hypotension. This complication should be prevented by using intrvenous fluid and or vasopressor drug . As a sympatomimetic drug, ketamine is an alternative in preventing hypotension during spinal anesthesia. Method: This study was designed as second stage of double blind clinical randomized controlled trial on forty eight patients electively programmed for lower abdominal and perineum surgery. Patients were divided into two groups of 24 patients each. Patients • in different groups either received 5 ml ofNaCl 0,9% and 0,05 nig midazolam before spinal anesthe•ia and after spinal anesthesia had done wa• continued with 5 ml NaCl 0,9% on control group ( group I ) , 0,1 mg kg t.ketamine and 0,05 mg kg midazolam tv before spinal anesthesia and after spinal anesthesia had done was continued with 0,1 ing kg-' h-' ketamine drip on ketamine group ( group II ) . Blood pressure ( systolic, diastolic, and mean arterial pressure/MAP ), heart rate, and respiratory rate were measured immediately after injection of ketamine or 5 ml NaCI and after spinal anesthesia then serially repeated every 2 minutes for the first fifteen minutes and every 5 minutes for the second fifteen minutes. Data was analyzed using student t-test and chi- square with level of significancy p <0,05. Results: There is no significant difference on demographic and pre clinical data. Mean systolic pre•sure on ketdmine group ( 115,58 L.15,72 minHg) is different from those on control group ( 109,42 i 12,79 .mmflg ) but not significant. Mean MAP on ketamine group ( 82,29 + 9,16 mmHg ) is different from those on control group (76,41 + 18,51 mmHg) but not significant . Hypotension develops on 11 subjects of control group and 0 subject of ketamine group, this difference is signifkant Mean heart rate on ketamine group ( 85,54 + 13,08 ) i• not significantly different •om those on control group ( 84,54 + 15,99) , but there are 3 subject on control group and 1 subject on ketamine group develops bradycadia. No significant difference in respiratory rate between two groups. Conclusion: 0,1 mg kg-' ketamine before spinal anesthesia continued with 0,1 mg kg-' h ketamine drip is an effective in preventing hypotension during spinal anesthesia without side effect on cardiorespiratory system. Latar belakang : Komplikasi anestesi spinal yang paling sering terjadi adalah hipotensi yang hams dicegah dan diatasi dengan infus cairan dan atau obat-obat vasopreSoi. Ketamin yang bersifat simpatornimetik diharapkan dapat merupakan alternatif untuk mencegah terjadinya hipotensi pada anestesi spinal. Metode: Uji klinis tahap 2 yang dilakukan secara acak tersamar ganda. Empat puluh delapan pasien dengan program operasi elektif perut bagian bawah, perineum dibagi dalam 2 kelompok, kelompok kontrol ( kel. I ) 24 orang dan kelompok ketamin ( kel. II ) 24 orang Kelompok kontrol diberikan 5 ml NaC1 0.9% bolus dan mida7olani 0,05 mg/kgBB intravena dilanjutkan drip NaC1 0,9% 5m1/jam, kelompok ketamin diberikan ketamin 0,1 mg/kgBB bolus dan midazolam 0,05 mg/kgBB intravena dilanjutkan drip ketamin 0,1 mg/kgBB/jam. Tekanan darah ( sistolik, diastolik, tekanan arteri rerata ), laju jantung, laju napas diukur setelah pemberian ketamin dan setelah anestesi spinal diulang serial tiap 2 menit pada 15 menit pertama, tiap 5 menit pada 15 menit sampai menit ke 30. Data diuji dengan student-t-test dan chi-square dengan derajat kemaknaanp < 0,05. Hasil: Data demografi, data keadaan Minis awal, dan tinggi blok anestesi pada kedua kelompok berbeda tak bermakna.Tekanan darah sistolik rerata dan rerata tekanan darah rerata kelompok ketamin (115,58+15,72) mmHg dan ( 82,29+9,16) mmHg, kelompok kontrol (109,42+12,79) mmHg dan (76,46+18,51) mmHg , perbedaan ini secara statistik berbeda tak bermakna. Kejadian hipotensi didapatkan pada kelompok kontrol 11 subyek sedang kelompok ketamin tidak didapatkan, secara statistik bermakna. Laju jantung pada kelompok ketamin (85,29+13,08) dan kelompok kontrol (84,54+15,99), perbedaan ini secara statistik berbeda tak bermakna, pada kelompok kontrol clidapatkan 3 subyek mengalami bradikardi, sedangkan 1 subyek pada kelompok ketamin. Tidak ada perbedaan bermakna dalam perubahan laju napas pada kedua kelompok uji. Kesimpulan : Ketamin 0,1 mg/kg BB bolus sebelum anestesi spinal dilanjutkan drip 0,1 mg/kg BB/jam efektif untuk mencegah hipotensi pada anestesi spinal. Efek samping tidak didapatkan.
Item Type: | Thesis (Masters) |
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Subjects: | R Medicine > R Medicine (General) |
ID Code: | 14732 |
Deposited By: | Mr UPT Perpus 2 |
Deposited On: | 17 Jun 2010 08:01 |
Last Modified: | 17 Jun 2010 08:01 |
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