Perbandingan Kedalaman Sedasi antara Deksmedetomidin dan Kombinasi Fentanil-Propofol Menggunakan Bispectral Index Score pada Pasien yang Dilakukan Kuretase
Abstract
Kuretase tergolong bedah minor yang menyebabkan nyeri dan ketidaknyamanan pasien sehingga memerlukan tindakan sedasi-analgesi. Tujuan penelitian adalah membandingkan kedalaman sedasi antara deksmedetomidin dan kombinasi fentanil-propofol menggunakan bispectral index score (BIS) pada pasien yang dilakukan kuretase. Penelitian ini merupakan penelitian randomized controlled trial dengan teknik double blind pada 36 pasien dengan status fisik American Society of Anesthesiologists (ASA) I−II yang menjalani kuretase di ruangan Obstetri dan Ginekologi RSUP Dr. Hasan Sadikin Bandung periode Juli sampai Oktober 2017. Kelompok deksmedetomidin mendapatkan loading dose deksmedetomidin 1 mcg/kgBB dalam waktu 10 menit dilanjutkan dosis pemeliharaan 0,5 mcg/kgBB/jam. Kelompol fentanil-propofol mendapatkan loading dose propofol 1 mg/kgBB dalam 10 menit diikuti dosis pemeliharaan 50 mcg/kgBB/jam ditambah fentanil 1 mcg/kgBB dalam 5 menit, lalu dicatat nilai BIS. Data dianalisis dengan uji-t dan Uji Mann-Whitney dengan p<0,05 dianggap bermakna. Analisis data statistik nilai BIS kelompok deksmedetomidin 79,50±2,121 dan fentanil-propofol 85,22±0,732 dengan perbedaan bermakna (p<0,05). Simpulan, penelitian ini menunjukkan kedalaman sedasi pada kelompok deksmedetomidin menghasilkan nilai BIS lebih rendah dibanding dengan fentanil-propofol pada pasien yang dilakukan kuretase.
Kata kunci: Bispectral index score(BIS), dexmedetomidine, fentanil, kuretase, propofol
Comparison of Sedation Depth between Dexmedetomidine and Fentanyl-Propofol using Bispectal Index Score in Patients Undergoing Curettage
Curettage is a minor surgical procedure that can cause pain and anxiety. Therefore, analgesia and sedation are needed. The purpose of this research was to compare the depth of sedation using bispectral index score (BIS) scale between dexmedetomidine and fentanyl-propofol combination in patients undergoing curettage. This was a double blind randomized controlled trial on 36 patients with American Society of Anesthesiologists (ASA) physical status I−II at the delivery room of Dr. Hasan Sadikin General Hospital from July to October 2017. Subjects were randomized into two groups: dexmedetomidine group receiving a loading dose of 1 mcg/kgBW dexmedetomidine in 10 minutes followed by 50 mcg/kgBW/hour for maintenance and fentanyl-propofol group receiving a loading dose of 1 mg/kgBW propofol in 10 minutes and fentanyl 1 mcg/kg within 5 minutes followed by a maintenance dose of propofol 50 mcg/kgBW/hour. The BIS score in dexmedetomidine group (79.0±2.121) was significantly lower than in fentanyl-propofol group (85.22±0.732) with p<0.05. Hence, the sedation depth observed through BIS score evaluation shows that the score in dexmedetomidine group is lower than in fentanyl-propofol group in patients undergoing curettage.
Key words: Bispectral index score (BIS), curettage, dexmedetomidine, fentanyl, propofol
Keywords
Full Text:
PDFReferences
Chen B, Littman E, Schmiesing C, Milki A, Westpal L. Gynecology/infertility surgery. Dalam: Jaffe R, Samuels S, penyunting. Dilatation and curettage: anesthesiologists manual of surgical procedures. Edisi ke-5. Philadephia: Lippincott Williams & Wilkins; 2014. hlm. 1254–8.
Calvache JA, Delgado-Noguera M, Lesaasffe E, Stolker RJ. Anestesia for evacuation of incomplete miscarriage (review). Cochrane Database Systematic Rev. 2012;4(2):1–45.
Yuce H, Kucuk A, Altay N, Bilgic T, Karahan M. Propofol-ketamine combination has favorable impact on orientation times and pain scores compare to propofol in dilatation and curettage. A randomized trial. Acta Medica Med. 2013;29(1):539–44.
Whitaker E, Mukherjee, Liu T. Introduction to moderate and deep sedation. Dalam: Urnam E, Kaye A, penyunting. Moderate and deep sedation in clinical practice. New York: Cambridge University Press; 2012. hlm. 1–7.
Kelley SD. Monitoring consciousness using bispectral index™ (BIS™) during anesthesia: a pocket guide for clinicians. Edisi ke-2. Colorado: Covidien; 2010.
Chattopadhyay U, Mallik S, Ghosh S, Bhattacharya S, Bisai S, Biswas H. Comparison between propofol and dexmedetomidine on depth of anesthesia: a prospective randomized trial. J Anaesthesiol Clin Pharmacol. 2014;30(4):550–4.
Kaye A, Gayle J, Kaye A. Pharmacology principles. Dalam: Urnam E, Kaye A, penyunting. Moderate and deep sedation in clinical practice. New York: Cambridge University Press; 2012. hlm. 8–32.
Sethi P, Sindhi S, Verma A, Tulsiani K. Dexmedetomidine versus propofol in dilatation and curettage: an open-label pilot randomized controlled trial. Saudi J Anesth. 2016;9(3):258–62.
Alfonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012;62(1):118–33.
Kasuya Y, Govinda R, Rauch S, Mascha E, Sessler D, Turan A. The correlation between bispectral index and observasional sedation scale in volunteers sedated with dexmedetomidine and propofol. Anesth Analg. 2009;109(6):1811–5.
Wang W, Feng L, Bai F, Zhang Z, Zhao Y, Ren C. The safety and efficacy of dexmedetomidine vs sulfentanil in monitored anesthesia care during burr-hole surgery for chronic subdural hematom: a retrospective clinical trial. Front Pharmacol. 2016;410(7):1–9.
Bishnoi V, Kumar B, Bhagat H, Saluke P, Bisnoi S. Comparison of dexmedetomidine versus midazolam-fentanyl combination for monitored anesthesia care during burr-hole surgery for chronic subdural hematom. J Neurosurg Anesthesiol. 2015;1(1):1–6.
Donaldson M, Goodchild J. Use of bispectral index system (BIS) to monitor enteral conscious (moderate) sedation during general dental procedures. J Canadian Dental Assoc. 2009;75(10):709a–h.
Tomar GS, Singh F, Ganguly S, Gaur N. Is dexmedetomidine better than propofol and fentanyl combination in minor day care procedures? a prospective randomized double-blind study. Indian J Anaesth. 2015;59(6):359–64.
Okeke F, Shaw S, Hunt K, Korsten M, Rosman A. Safety of propofol used as a rescue agent during colonoscopy. J Clin Gastroenterol. 2015;1(1):1–4.
DOI: https://doi.org/10.15851/jap.v6n2.1424
Article Metrics
Abstract view : 1678 timesPDF - 5708 times
This Journal indexed by
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Stats