Keefektifan Pencegahan Post Anesthesia Shivering (PAS) pada ras Melayu: Perbandingan Antara Pemberian Ondansetron 4 mg Intravena Dengan Meperidin 0.35 mg/kgBB Intravena - Nugroho, Alfan Mahdi; Harijanto, Eddy; Fahdika, Arnaz (Perdatin Pusat, 2016)
Post Aneshesia Shivering (PAS) adalah gerakan involunter satu otot rangka atau lebih yang biasanya terjadi padamasa awal pemulihan pascaanestesia. PAS dapat menyebabkan hipoksia arterial, meningkatnya curah jantung,risiko terjadinya infark miokard, dan mengganggu interpretasi alat-alat pemantauan tanda vital. Ondansetron danmeperidin adalah dua obat yang sering digunakan untuk mencegah PAS. Terdapat perbedaan ambang rangsangmenggigil antar ras. Penelitian ini bertujuan membandingkan keefektifan pencegahan PAS dengan pemberianondansetron 4 mg dengan meperidin 0,35 mg/kgBB intravena pada ras Melayu di Indonesia. Setelah mendapatkanizin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan ujiklinis, acak, tersamar ganda pada 92 pasien ras Melayu yang menjalani operasi elektif di RSCM Kirana. Pasien dibagidalam dua kelompok yaitu kelompok ondansetron dan kelompok meperidin. Pasien mendapatkan ondansetronatau meperidin sesaat sebelum anestesia. Semua pasien kemudian mendapatkan anestesia umum yang sama. Pascaanestesia, kekerapan dan derajat menggigil dicatat tiap lima menit selama tiga puluh menit pertama. Tidak terdapatperbedaan bermakna secara statistik (p>0,05) dalam kekerapan PAS pada kedua kelompok. Kekerapan kelompokondansetron sebesar 15,2%, sedangkan kekerapan kelompok meperidin sebesar 6,5%. Ondansetron 4 mg intravenasama efektifnya dengan meperidin 0,35 mg/kgBB dalam mencegah kejadian PAS pada ras Melayu di Indonesia. Kata kunci: Melayu, meperidin, ondansetron, post anesthesia shivering (PAS) Post Anesthesia Shivering (PAS) is the involuntary movements of one or more skeletal muscles that usually occurin the beginning of post-anesthesia recovery. PAS can cause arterial hypoxia, increased cardiac output, myocardialinfarction, and can interfere with vital sign monitoring tools interpretation. PAS is commonly prevented byondansetron and meperidine. Studies done showed that different races have different shivering thresholds. Thisstudy aims to compare the effectiveness of PAS prevention by administering ondansetron 4 mg with meperidine0,35 mg/kg, both intravenously in Malayan race patients in Indonesia. After approval from Ethics CommitteeFaculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients, this studyconducted a randomized, double-blind clinical trial on 92 Malayan race patients undergoing elective surgery in theRSCM-Kirana. Patients were divided into two groups: ondansetron and meperidine. Patients received ondansetronor meperidine shortly before anesthesia, then all patients received standardized anesthesia (premedication withmidazolam 0.05 mg/kgBW and fentanyl 2 mcg/kg, induced with propofol 1-2,5 mL/kg, intubation or LMAinsertion is facilitated with rocuronium or 0.6 mg/kg, maintenance with sevoflurane 2 vol% to compressed air: O2= 2: 1). The frequency and degree of shivering were recorded every five minutes for thirty minutes post-anesthesia.The side effects were also recorded. There was no statistically significant difference (p> 0.05) in the frequency ofPAS in both groups. Intravenous ondansetron 4 mg was as effective as meperidine 0.35 mg/kgBW in preventingthe incidence of PAS in Malayan race patients in Indonesia. Key words: Malayan, meperidin, ondansetron, post anesthesia shivering (PAS) Reference Tie Hong-Tao, Su Guang-Zhu, He Kun, Liang Shao-Rong, Yuan Hao-Wei, Mou Jun-Huan. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2014;14:12. Alfonsi P. Postanaesthetic shivering. epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol 2003;69:438–42. George YWH, Thaib MR, Harijanto E. Perbandingan keefektifan antara klonidin dan petidin untuk pencegahan menggigil pascaanestesia dengan N2O/O2/enfluran. Departemen Anestesiologi dan Terapi Intensif FKUI. 1999;2–42. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharmalogical treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 2002;94:453–60. Nurkacan A, Chandra S, Mahdi A. Keefektifan mengurangi insiden menggigil pascaanestesia: perbandingan antara ajuvan fentanyl 25 mcg intratekal dengan ajuvan sufentanyl 2,5 mcg intratekal pada pasien seksio sesarea dengan anestesia spinal.Departemen Anestesiologi dan Terapi Intensif FKUI. 2012;48:6–33. Kogsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al., Predictor of core hypothermia and the surgical intensive care unit Anesth Analg 2003; 96(4):826–33. Witte J D., Sessler D I. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002;96(2):467–84. de Brito Poveda V, Galvão CM, dos Santos CB. Factors associated to the development of hypothermia in the intraoperative period. Rev Latino-am Enfermagem. 2009;17(2): 228–33. Simatupang RDE, Dahlan R, Harijanto E Pencegahan menggigil pascaanestesia dengan N2O/O2/enfluran: perbandingan antara ondansetron 8 mg dan petidin 0.35 mg/kgBB intravena. Departemen Anestesiologi dan Terapi Intesif. FKUI 2003:5–23 Bakker LEH, Boon MR, van der Linden RAD, Arias-Bouda LP, van Klinken JB, Smit F, et al. Brown adipose tissue volume in healthy lean south asian adults compared with white caucasians: a prospective, case controlled observational study. The Lancet Diabetes & Endocrinology. 2014;2(3): 210–7.