PERBANDINGAN LUARAN SEKSIO SESAREA DENGAN ANESTESI UMUM DAN SPINAL: PERUBAHAN KADAR HEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYI - Ifrinda Giantari; Ibnu Pranoto; Risanto Siswosudarmo (JURNAL KESEHATAN REPRODUKSI, 2014)
PERBANDINGAN LUARAN SEKSIO SESAREA DENGANANESTESI UMUM DAN SPINAL: PERUBAHAN KADARHEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYIIfrinda Giantari, Ibnu Pranoto, Risanto SiswosudarmoABSTRACTBackground: Cesarean section is the most common surgical procedure in obstetrics. In 2008, nearly a third ofdeliveries was done by cesarean section. Two types of anestesi are used in cesarean section i.e., general andregional anestesi with their advantages and disadvantages. General anestesi is often used in emergency casesbut is often associated with greater risk of blood loss during surgery and depression of central nervous system ofthe newborn. Based on these facts, the decision of the type of anesthesia for cesarean section is still debated.Objective: To compare the effects between general and spinal anestesi in the alteration of maternal hemoglobinand hematocrit levels and the neonatal Apgar score.Method: This study was conducted at Setjonegoro Hospital Wonosobo, Banjarnegara, and Sardjito HospitalYogyakarta between September to December 2010. Patients undergoing cesarean section, who met inclusionand exclusion criteria were included in this study. Hemoglobin and hematocrit levels before and 6-12 hours aftersurgery were recorded, as well as the first minute Apgar score. Chi-square and t-test were used for statisticalanalysis.Results and Discussion: A total of 114 patients consisting of 59 cases for general anestesi and 55 for spinalgroups were recruited. They were comparable in terms ofmaternal age, age of gestation, parity, BMI and indicationof operation. Hemoglobin and hematocrit levels before surgery were also comparable.The decrease of hemoglobin level after operation in the group of general anesthesia was greater than in thespinal group (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d; p=0,00). The same was seen in the decrease of hematocritlevel (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). There were 28 cases of asphyxia in the group of general comparedto 22 cases in the group of spinal anestesi, but it was not statistically different (RR 1,16; 95% CI 0,81-1,65).Conclusion: The decreased level of hemoglobin and hematocrit after cesarean section in general anesthesia werehigher than spinal anesthesia group, although the difference was not clinically significant. There was no significantdifference in the incidence of asphyxia at first minute in both groups.Keywords: general anestesi, spinal anesthesia, cesarean section, hemoglobin, hematocrit, Apgar score   ABSTRAKLatar belakang: Seksio sesarea merupakan prosedur operatif obstetri yang paling sering dilakukan. Pada tahun2008, hampir sepertiga dari persalinan dilakukan dengan cara seksio sesarea. Dua jenis anestesi sering digunakanyakni anestesi umum dan spinal yang masing-masing mempunyai kelebihan dan kekurangannya. Anestesi umumsering digunakan pada kasus kedaruratan meskipun sering dikaitkan dengan risiko kehilangan darah yang lebihbesar dan penekanan pada susunan syaraf pusat bayi. Anestesi spinal sering dikaitkan dengan keadaan hipotensimaternal.Tujuan: Membandingkan penurunan kadar hemoglobin dan hematokrit ibu dan skor Apgar bayi pada seksiosesarea dengan anestesi umum dan spinal.Metode: Kohort prospektif.Penelitian dilakukan di RS Setjonegoro Wonosobo, RS Banjarnegara, dan RS Sardjitopada bulan September sampai Desember 2010. Pasien yang menjalani seksio sesarea dan memenuhi kriteriainklusi dan eksklusi dimasukkan dalam penelitian ini. Sampel penelitian diikuti sesuai dengan kelompok jenisanestesi. Kadar hemoglobin dan hematokrit sebelum operasi dan 6-12 jam sesudah operasi serta skor Apgar 1menit dicatat. X-square dan t-test dipakai untuk analisis data.Hasil dan Pembahasan: Sebanyak 114 kasus seksio sesarea memenuhi kriteria kelayakan, yang terdiri dari 59kasus kelompok anestesi umum dan 55 kasus anestesi spinal. Kedua kelompok komparabel dalam hal umur,umur kehamilan, paritas BMI dan indikasi operasi. Demikian juga kadar hemoglobin dan hematokrit sebelumoperasi, tidak menunjukkan perbedaan yang bermakna. Penurunan kadar hemoglobin setelah operasi padakelompok anestesi umum lebih besar dibanding kelompok spinal (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d;p=0,00), demikian juga penurunan kadar hematocrit (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). Pada penilaianmenit pertama terdapat 28 kasus asfiksia (skor Apgar < 6) pada kelompok anestesi umum dan 22 kasus padakelompok anestesi spinal (RR 1,16, 95%CI 0,81-1,65), tetapi tidak bermakna secara statistik (p=0,42).Kesimpulan: Terdapat penurunan kadar hemoglobin dan hematokrit ibu yang bermakna pada kelompok yangmenjalani seksio sesarea dengan anestesi umummeskipun secara klinis tidak bermakna. Tidak terdapat perbedaanbermakna secara statistik pada kejadian asfiksia pada menit pertama.Kata kunci: anestesi umum, anestesi spinal, seksio sesarea, hemoglobin, hematokrit, skor Apgar