Efektivitas Dexmedetomidine terhadap Kadar Kortisol pada Pasien yang Menjalani Operasi Ginekologi dalam Anestesi Umum

Abstract

Respons stres adalah perubahan hormon dan metabolik yang terjadi setelah trauma seperti pembedahan, salah satunya terjadi peningkatan kadar kortisol. Dexmedetomidine dapat menurunkan respons stres dengan menghambat sintesis kortisol. Tujuan penelitian ini adalah mengetahui efek dexmedetomidine terhadap kadar kortisol pada pasien yang menjalani operasi ginekologi dalam anestesi umum yang dilakukan di RSUP dr. Mohammad Hoesin Palembang dari Januari–Maret 2018. Jumlah sampel 30 orang yang dibagi menjadi 2 kelompok, kelompok dexmedetomidine dan kelompok plasebo. Kelompok dexmedetomidine mendapatkan dosis dexmedetomidine awal 1 µg/kgBB selama 10 menit dilanjutkan 0,5 µg/kgBB/jam, 20 menit sebelum induksi. Pada kelompok plasebo menggunakan NaCl 0,9%. Induksi menggunakan propofol, fentanil 2 µg/kgBB, dan atrakurium 0,5 µg/kgBB serta pemeliharaan menggunakan sevofluran 3% dalam O2 dan N2O 50%:50%. Kemudian 1 jam pascaekstubasi diambil sampel darah kembali untuk pemeriksaan kadar kortisol. Hasil penelitian pada kedua kelompok terjadi peningkatan kadar kortisol saat 1 jam pascaekstubasi dibanding dengan awal (9,638±7,082 µg/dL menjadi 14,503±7,082 µg/dL pada kelompok dexmedetomidine dan 10,276±3,166 µg/dL menjadi 19,99±6,273 µg/dL pada kelompok placebo). Namun, kadar kortisol signifikan lebih tinggi pada kelompok plasebo. Simpulan, pada kedua kelompok terjadi peningkatan kadar kortisol dibanding dengan nilai awal, tetapi kadar lebih rendah pada kelompok dexmedetomidine.

Effectiveness of Dexmedetomidine on Cortisol Level in Patients Undergoing Gynecologic Surgery under General Anesthesia

Stress response is a term used to define the metabolic and hormonal changes following an injury or trauma, including as surgery. One of the responses is an increase in cortisol release. Dexmedetomidine may attenuate stress response by inhibiting cortisol synthesis. The aim of this study was to determine the effects of dexmedetomidine on cortisol level, compared to placebo, in patients undergoing major gynecological surgery under general anesthesia. A double-blind randomized clinical trial was performed at Mohammad Hoesin General Hospital from January to March 2018. There were thirty samples that were divided into two groups, dexmedetomidine group and placebo group. The dexmedetomidine group received an initial dexmedetomidine loading dose of 1 µg kg -1 over 10 min, followed by 0.5 µg kg-1h-1 20 minutes before induction. In the placebo group, 0.9% sodium chloride was administered. Anesthesia was induced with propofol, 2 µg/kgBW fentanyl, and 0.5 mg/kgBW atracurium and was maintained with 3% sevoflurane in O2 and N2O 50%:50%. After standard monitoring was established, blood samples were collected for cortisol plasma testing at baseline and 1 hour post-extubation. Hemodynamic data were recorded intraoperatively and postoperatively. Results in both groups presented a significant increase in cortisol level relative to the baseline at 1 hour post-extubation (9.638±7.082 µg/dL to 14.503±7.082 µg/dL in dexmedetomidine group and 10.276±3.166 µg/dL to 19.99±6.273 µg/dL in placebo group [P value<0.05]) with a significantly higher corticsol level in the placebo group when compared to the dexmedetomidine group (P value<0.05). In conclusion, the plasma cortisol level was found to increase significantly relative to baseline level in both groups. However, the increase was significantly lower in the dexmedetomidine group.