Perbandingan Efektivitas antara Kombinasi 1,5 mg/kgBB Propofol 1% + 0,5 mg/kgBB Ketamin 1% dengan 1,5 mg/kgBB Propofol 1% + 2 mg/KgBB Fentanil terhadap Nilai Bis pada Tindakan Dilatasi dan Kuretase - Sinurat, Bonny Brian; Melati, Endang; Puspita, Yusni; , Theodorus (Majalah Anestesia dan Critical Care, 2014)
Nyeri akibat prosedur dilatasi dan kuretase memerlukan suatu manajemen anestesi. Kombinasi obat anestesi yang menghasilkan efek sedasi dan analgesi adekuat, hemodinamik stabil dan efek samping minimal dibutuhkan.Penelitian untuk mengetahui perbandingan efektivitas antara kombinasi 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamin 1% dengan 1,5 mg/kgBB propofol 1%+2 μg/kgBB fentanil terhadap nilai Bispectral Index Scale (BIS) pada tindakan dilatasi dan kuretase. Uji acak terkontrol, buta ganda, dilakukan di Central Operating Theatre RSUP Dr. Mohammad Hoesin Palembang, dari bulan Juni sampai Agustus 2013. Sebanyak 66 subjek penelitian diikutsertakan dan dibagi menjadi dua kelompok. Kelompok pertama diberikan kombinasi 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamin 1% dan kelompok kedua diberikan kombinasi 1,5 mg/kgBB propofol 1% + 2μg/kgBB fentanil. Selama prosedur, kedalaman BIS dicatat setiap 3 menit. Status hemodinamik dan lama bangun juga dicatat. Data dianalisis dengan statistical product and service solution (SPSS) versi 20. Lama bangun kedua kelompok secara statistik bermakna (p<0,05), sedangkan kedalaman sedasi, dan perubahan hemodinamik tidak (p>0,05). Kedalaman sedasi pada kedua kelompok dipertahankan antara BIS 40–60 dan secara klinis perubahan hemodinamik pada kombinasi propofol–ketamin lebih stabil. Kombinasi propofol-ketamin lebih efektif dibandingkan dengan propofol-fentanil karena menghasilkan kedalaman sedasi yang adekuat, lama bangun yang lebih singkat, status hemodinamik yang lebih stabil, serta tidak menimbulkan efek samping pada prosedur dilatasi dan kuretase. Kata kunci: BIS, dilatasi, fentanil, ketamin, kuretase, propofol Comparison of The Effectiveness of The Combination 1,5 mg/KgBW Propofol 1% + 0,5 mg/kgBB Ketamine 1% And 1,5 mg/kgbw Propofol 1% + 2 Μg/kgBW Fentanyl to The Bis Score in Dilatation and Curettage Pain in dilatation and currettage procedure requires anesthesia management. Combination of anesthetic drugs to achieve sedation and analgesia adequacy, hemodynamic stability and less adverse event are needed. to compare efficacy of combination 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamine 1% and 1,5 mg/kgBB propofol 1% + 2μg/kgBB fentanyl with Bispectral Index Score (BIS). A randomized controlled trials, double blind, has been conducted in Central Operating Theatre Dr. Mohammad Hoesin General Hospital Palembang from June to August 2013. A total of 66 subjects were included and divided into two groups. First group was anesthesized with propofol-ketamine and the second group with propofol-fentanyl. BIS score were noted every three minutes. Hemodynamic status and emergence time were also noted. The data were analyzed using statistical product and service solution (SPSS) version 20. Emergence time was statistically significant (p<0.05), while depth of sedation and hemodynamic status were not significantly different (p>0.05). Depth of sedation among two groups maintained between BIS 40–50 and clinically hemodynamic changes in the combination of propofol-ketamine were more stable than propofol-fentanyl. Combination of propofol-ketamine is more effective compared with propofol-fentanyl since it produces adequate depth of sedation, shorter emergence time, more stable hemodynamic status, and no side effect. Key words : BIS, currettage, dilatation, fentanyl, ketamine, propofol Reference Koulenti D, Christoforatos T. Ventilatorassociated pneumonia – epidemiology, pathogenesis, prevention and etiology. Eur Respir Dis. 2010;6:49–53. Safdar N, Crnich CJ, Maki DG. The Pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory care. 2005;50:725–39. Kollef MH. The prevention of ventilatorassociated pneumonia. N Engl J Med. 2005;340:627–4. DePew CL, McCarthy MS. Subglotticsecretion drainage. AACN Advanced Crit Care. 2007;18(4):366–79. Smulders K, Hoeven Hvd, Weers-PothoffI, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest. 2002;121:858–62. Koulenti D, Rello J. Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impacton patient care. Expert Opin Pharmacother. 2006;7:1555–69. Dezfulian C, Shojania K, Cllard H. Subglottic secretion drainage for preventing ventilatorassociate pneumonia: A meta-analysis. Am J Med. 2005;118:11–8. Bouza E, Perez MJ, Munoz P. Continuous aspiration of subglottic secretions in the prevention of ventilatorassociated pneumonia in the post-operative period of major heart surgery. Chest. 2008;134:938–45. Hunter JD. Ventilator associated pneumonia. Postgard Med J. 2006;82:172–8. Rachmayanti R, Turbawaty DK, Parwati I, Suraya N. Gambaran pola bakteri penyebab ventilator associated pneumonia (VAP) di intensive care unit Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. 2011.