PENGARUH MAGNESIUM SULFAT SEBELUM PEMBERIAN SUKSINILKOLIN PADA KADAR KALIUM DARAH DAN FASIKULASI OTOT (Effect of magnesium sulphate on potassium and fasciculation before succinylcholine administration)

Abstract

Latar belakang penelitian : Suksinilkolin merupakan obat pelumpuh otot golongan depolarisasi yang sering digunakan dan merupakan pilihan untuk tindakan yang singkat maupun tindakan dimana jalan nafas belum tentu dapat dikuasai. Efek samping yang sering timbul dan tidak diinginkan adalah kenaikan kadar kalium darah dan fasikulasi otot. Tujuan : Membuktikan bahwa pemberian Magnesium Sulfat 40% 40mg/kgBB dapat mengurangi kenaikan kadar kalium darah dan dapat mengurangi kejadian fasikulasi otot akibat suksinilkolin. Metode : Merupakan penelitian eksperimental dengan desain quota sampling pada 52 pasien yang menjalani operasi dengan anestesi umum. Semua penderita dipuasakan 6 jam tanpa premedikasi. Sampel darah vena diambil di daerah antebrakhii kontralateral infus untuk kadar kalium pra perlakuan. Penderita dikelompokkan secara random dengan menggunakan tabel random menjadi 2 kelompok. Kelompok I diberi pretreatment NaCl 0,9% dan kelompok II diberi pretreatment MgSO4 40% 40mg/kgBB, 15 menit kemudian dilakukan induksi dengan suksinilkolin 1,5 mg/kgBB pada masing-masing kelompok. Skor fasikulasi dicatat dengan menggunakan skor Mingus, 7 menit setelah intubasi dilakukan pengambilan sampel darah vena kontralateral infus untuk pemeriksaan kadar kalium post perlakuan. Uji statistik menggunakan paired t-test dan chi-square, dengan derajat kemaknaan α = 0,05. Hasil : Tidak ada perbedaan yang bermakna pada distribusi karateristik penderita serta jenis operasi dan kadar kalium sebelum perlakuan. Kadar kalium pada kelompok I sebelum dan sesudah intubasi berbeda bermakna (p<0,0001) demikian juga pada kelompok II, kadar kalium sebelum dan sesudah intubasi juga berbeda bermakna (p<0,0001). Kadar kalium setelah intubasi antara kelompok I dan kelompok II berbeda bermakna (p<0,0001). Untuk kejadian fasikulasi pada kelompok I : fasikulasi ringan 12 (46,2%), fasikulasi sedang 9 (34,6%), fasikulasi berat 4 (15,4%), tidak fasikulasi 1 (3,8%). Kelompok II : fasikulasi ringan 5 (19,2%), fasikulasi sedang 2 (7,7%), fasikulasi berat 0 dan tidak mengalami fasikulasi 19 (73,1%). Terdapat perbedaan yang bermakna antara kelompok I dan kelompok II untuk derajat fasikulasi (p<0,0001). Kesimpulan : Pemberian MgSO4 40% /kgBB dapat mengurangi kenaikan kadar kalium darah dan mengurangi kejadian fasikulasi otot akibat pemberian suksinilkolin. Background : succhinylcholine administration is often use and gold standard for rapid intubation, short operation or difficult airway controlled. Unexpected complication after succinylcholine administration is fasciculation and increase of potassium blood level. Purpose : aim of this study to prove that magnesium sulphate 40% 40mg/kgBB can alter the increase of potassium blood level and fasciculation after succinylcholine administration. Methods : It is experimental study with quota samplingdesign on 52 patients which are undergoing surgery with general anesthesia. All of the patients were fasting 6 hours and give no premedication. Blood vein were taken to measure the potassium level before premedication given. Patients devided into two group, group I premedicated with NaCl 0,9% and group II premedicated with MgSO4 40mg/kgBW. Induction with succinylcholine 1,5 mg/kgBB fifteen minute after premedication. Fasciculation were recorded with Mingus score. Seven minute after induction, blood vein were taken on contralateral inffusion to measure potassium blood level after induction. Statistical analysis were performed by paired t-test and chi square which were α=0,05 was considered significant. Result : There was no difference for patients characteristics data, surgery distribution and blood potassium level before induction between two groups. On group I and group II potassium blood level was significantly difference before and after induction (p<0,0001).. Between group I and group II, the blood potassium level after induction was significantly difference too (p<0,0001). Incidence of fasciculation on group I : 12 patient were mild (46,2%), 9 patients were moderate (34,6%), 4 patients were severe (15,4%) and no fasciculation were 1 (3,8%). On group II : 5 patients were mild (19,2%), 2 patients were moderate (7,7%), no patient for severe (0%) and no fasciculation were 19 (73,1%). For fasciculation between two group were significantly difference (p<0,0001) Conclusions : the administration of magnesium sulphate 40% 40 mg/kgBW can alter the increase of potassium blood level and fasciculation after succinylcholine administration.