PERUBAHAN SEGMEN ST, GELOMBANG T & INTERVAL (Th. AKIBAT INDUKSI ANESTESI & INTUBASI : STUD! PADA PENDERITA NORMAL DAN SUSPECT PENYAKIT JANTUNG ISKEMIK

Abstract

This study was performed to evaluated a change of ST segment, T wave and QTc interval do to induction and intubation in normally and suspected ischaemic heart diseases (IHDs) patients underwent elective surgery with general anesthesia in COT Dr. Kariadi general hospital Semarang during December 1998 — May 1999. This study was design in prospective cohort study, performed in 44 patients were devided into two groups. Each of two groups received premedication 0.05mg./Kg in 0,51 h preoperatively. induction of anesthesia•ith combined [Didn't:it= 0,2mg/Kg + thiopenton 3Ing/Kg plus vecuronium OS/Ring/Kg and ventilated with 7-81/min. The cardiovasculer responses and changes in ECG feature were recorded before and after the induction, and after intubation. After induction, in normal group STI was depressed insignificantly p=0.4267 and ST2 elevated insignificantly p=0,644, the amplitudo of T waves decreased significantly p=0,0088 and QTc intervals prolonged significant p=0.0002. In suspected IHDs group, STI and ST2 had insignificant of T waves increased insignificantly p=02581 and QTc intervals prolonged significantly p=0.0040. After intubation, in normal group STI depressed insignificantly p=0,3509, ST2 elevated significantly p=0,000, the amplitudo of T wave decreased insignificantly p=0,6413, and QTc interval shortened insignificantly p=0,6690 compared with that of postinduction. In suspected IUDs group, ST1 and ST2 were depressed insignificantly p=0,6180 and p=0,6435 respectively, the amplitudo of T waves increased insignificantly p=0,4417 and QTc intervals shortened insignificantly p=0,585 compared with that postinduction. We conclude, the changes in ST segment were still in normal range <1mm from J point or there were no ischaemic episodes found during the induction and intubation, but the RPP values after intubation in suspected IHDs group were >15.000. Along with the responses to induction and intubation, T waves were blunted but in the suspected IHDs group the T waves insignificantly increased. The QTc intervals in the two groups had prolonged >440msec from induction and intubation. dilakukan penclitian dengan tujuan mengetahui pertibaban segmen ST, gelombang I dan interval QTc akibat induksi anestesi dan intubasi pada penderita normal dan penderita suspect penyakit jantung iskemik (SPJI) yang akan menjalani operas' elektif dengan anestesi umum di IBS RSDK Semarang pada bulan Desember 1998 — Mei 1999. Penelitian dengan rancangan kohort prospektif ini dilakukan pada 44 penderita. Setiap penderita mendapat premedikasi midazolam 0,05 mg/KgBB im, induksi dengan midazolam 0,2mg/kgBB + tiopenton 3mg/KgBBiv ditambah vekuroneum 0,0mg/Kg13Biv dan diventilasi dengan oksigen 7-81/menit. Respon kardiovaskuler dan perubaban EKG dicatat sebelutn induksi, setJah induksi dan setelah intubasi. Pada kelompok normal, induksi anestesi menyebabkan penurunan STI yang tidak bermakna p=0,4267, ST2 meningkat tidak bermakna p=0,644, amplitude gelombang T turun bermakna p=0,0088, interval WIc memanjang bermakna p=0,0002. Pada kelompok SPA, induksi anestesi menyebabkan ST1 dan ST2 naik tidak bermakna masing — masing p=0,1146 dan p=0,2063, amplitudo gelombang T turun bermakna p=0,0088, interval QTc memanjang bermakna p=0,0002. Pada kelompok SPJI, induksi anestesi menyebabkan STI dan ST2 naik tidak bermakna masing-masing p=0,1146 dan p=0,2063, amplitudo gclornhang T naik tidak bermakna p=0,2581, interval QTc memanjang bermakna p=0,0040. Pada kelompok normal, intubasi menyebabkan STI turun tidak bermakna p=0,3509, ST2 turun bermakna p=0,000, amplitudo gelombang T turun tidak bermakna p=0,6413, QTc memendek tidak bermakna p=0,6690. Pada kelompok SPJI, STI dan ST2 turun tidak bermakna masing-masing p=0,6180 dan p=0,6435, amplitude gelombang T naik tidak bermakna p=0,44 I 7, interval QTc memendek tidak bermakna p=0,0585. Kesimpulan, pada kedua kelompok pentbahan segmen ST masih dalam batas normal atau tidak ditemukan episode iskemik selama induksi anestesi dan intubasi, walaupun nilai RPP pasca intubasi pada kelompok SPB>15.000. Kelompok normal, gelombang T menjadi tumpul bersamaan dengan respon akibat induksi/intubasi tetapi pada kelompok SPJI meningkat tidak bermakna. Interval QTc akibat induksi/intubasi menjadi memanjang >440mdetik pada kedua kelompok.