Efek Granisetron Intravena terhadap Perubahan Tekanan Darah pada Seksio Sesarea dengan Anestesi Spinal

Jaya Supriyanto, Suwarman Suwarman, Iwan Abdul Rachman

Abstract


Hipotensi merupakan komplikasi paling sering pada seksio sesarea dengan anestesi spinal. Pencegahan hipotensi dapat dilakukan dengan pemberian cairan, obat-obatan, pengurangan dosis obat anestesi lokal, dan intervensi mekanik. Granisetron sebagai antagonis reseptor 5hydroxytryptamine3 (5HT3) dapat digunakan untuk mencegah hipotensi pada seksio sesarea dengan anestesi spinal. Penelitian ini bertujuan mengetahui pengaruh pemberian granisetron 1 mg intravena terhadap perubahan tekanan darah pada seksio sesarea dengan anestesi spinal. Penelitian ini dilakukan periode Desember 2019–Februari 2020 di RSUP Dr. Hasan Sadikin Bandung. Metode penelitian ini adalah uji klinis tersamar ganda pada 34 pasien ASA II yang menjalani seksio sesarea dengan anestesi spinal. Subjek penelitian dibagi secara acak menjadi 2 kelompok, yaitu kelompok kontrol diberikan NaCl 0,9% dan kelompok granisetron diberikan granisetron 1 mg intravena pada 5 menit sebelum anestesi spinal. Tekanan darah diperiksa setiap 1 menit selama 20 menit setelah anestesi spinal, kemudian setiap 2,5 menit sampai operasi selesai. Data dianalisis dengan uji t, Uji Mann Whitney, dan Uji kolmogorov-smirnov, nilai p<0,05 dianggap bermakna. Kejadian hipotensi pada kelompok kontrol (79%) lebih tinggi dari kelompok granisetron (29%). Penurunan tekanan darah pada kelompok kontrol lebih besar dibanding dengan kelompok granisetron dengan perbedaan signifikan (p<0,05). Simpulan, pemberian granisetron 1 mg intravena dapat mengurangi kejadian hipotensi pada seksio sesarea dengan anestesi spinal.


Effect of Intravenous Granisetron on Blood Pressure in Cesarean Section under Spinal Anesthesia

Hypotension is the most frequent complication in cesarean section with spinal anesthesia. The prevention of hypotension includes fluid and drugs administration, lower local anesthetic doses, and mechanic interventions. Granisetron is a 5HT3 receptor antagonist that can be used to prevent hypotension in cesarean section with  spinal anesthesia. This study aimed to determine the effects of intravenous administration of 1 mg granisetron on blood pressure in patients undergoing cesarean section with spinal anesthesia. This study was a double blinded clinical study on 34 patients ASA II undergoing cesarean sections with spinal anesthesia in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of December 2019 to February 2020. Subjects were  divided randomly into 2 groups; a control group that received 0.9% NaCl  and a granisetron group that received 1 mg intravenous granisetron 5 minutes before spinal anesthesia.  Blood pressure was evaluated every minute for 20 minutes after the spinal anesthesia, and then every 2.5 minutes until the surgery was  completed.  Data were analyzed using t-test, Mann Whitney test, and Kolmogorov-Smirnov test with p value<0.05 considered significant. Incidence of hypotension in the control group was higher than the granisetron group (79%vs29%) with blood pressure decrease significantly higher in the control group (p<0.05). Thus, administration of intravenous 1 mg granisetron may reduce the incidence of hypotension in cesarean sections with spinal anesthesia.

Keywords


Anestesi spinal, hipotensi, granisetron, seksio sesarea

Full Text:

PDF

References


Lawrence C, Tsen M. Anesthesia for cesarean delivery. Dalam: David H, Chestnut M, Cynthia A, Wong M, Lawrence C, Tsen M, dkk., penyunting. Chestnut’s obstetric anesthesia: principles and practice. Edisi ke-5. Philadelphia: Elsevier Inc.; 2014. hlm. 545–603.

Armstrong S. Spinal anesthesia for cesarean section. Dalam: Capogna G, penyunting. Anesthesia for cesarean section. Edisi ke-1. Switzerland: Springer International Publishing; 2017. hlm. 47–66.

Eldaba AA, Amr YM. Intravenous granisetron attenuates hypotension during spinal anesthesia in cesarean delivery: a double-blind, prospective randomized controlled study. J Anaesthesiol Clin Pharmacol. 2015;31(3):329–32.

Abdalla W, Ammar M. Systemic granisetron can minimize hypotension and bradycardia during spinal anesthesia in patients undergoing elective lower-abdominal surgeries: a prospective, double-blind randomized controlled study. Ain-Shams J Anaesthesiol. 2017;10(1):247–52.

Hasanin A, Mokhtar AM, Badawy AA, Fouad R. Post-spinal anesthesia hypotension during cesarean delivery, a review article. Egypt J Anaesth. 2017;33(2):189–93.

Rustini R, Fuadi I, Surahman E. Insidensi dan faktor risiko hipotensi pada pasien yang menjalani seksio sesarea dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung. JAP. 2016;4(1):42–9.

Lee JE, George RB, Habib AS. Spinal-induced hypotension: incidence, mechanisms, prophylaxis, and management: summarizing 20 years of research. Best Pract Res Clin Anaesthesiol. 2017;31(1):57–68.

Warren DT, Nelson KE, Neal JM. Neuraxial anesthesia. Dalam: Longnecker DE, Sandberg WS, Mackey SC, Zapol WM, Newman MF, penyunting. Anesthesiology. Edisi ke-3. New York: McGraw-Hill Education; 2018. hlm. 727–48.

Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of spinal anesthesia-induced hypotension during cesarean delivery by 5-hydroxytryptamine-3 receptor antagonists: a systematic review and meta-analysis and meta-regression. Anesth Analg. 2016;123(4):977–88.

Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, dkk. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2017;8(8):CD002251.

Jain P, Valecha D. Comparative evaluation of preloading and coloading of crystalloids to prevent spinal induced hypotension in caesarean section. Int J Contemp Med Res. 2017;4(2):411–4.

Abe H, Sumitani M, Uchida K, Ikeda T, Matsui H, Fushimi K, dkk. Association between mode of anaesthesia and severe maternal morbidity during admission for scheduled caesarean delivery: a nationwide population-based study in Japan, 2010–2013. Br J Anaesth. 2018;120(4):779–89.

Sinisa Š, Kresmir O. Sudden cardiorespiratory arrest following spinal anesthesia. Periodic Biologorum. 2013; 115(2):283–8.

Ismandiya AI, Maskoen TT, Sitanggang RH. Efek ondansetron intravena terhadap tekanan darah dan laju nadi pada anestesi spinal untuk seksio sesarea. JAP. 2015;3(2):73–80.

Braveman FR, Scavone BM, Blessing ME, Wong CA. Obstetric anesthesia. Dalam: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, dkk., penyunting. Clinical anesthesia. Edisi ke-8. Philadelphia: Wolters Kluwer; 2017. hlm. 2841–926.

Paulraj S, Sundararajan L, Ali AA. Intravenous granisetron attenuates hypotension during spinal anaesthesia in cesarean delivery: a double-blind, prospective randomized controlled study. Indian J Appl Res. 2018;8(3):13–5.

Kinsella SM, Carvalho B, Dyer RA, Fernando R, Mcdonnell N, Mercier FJ, dkk. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71–92.

Spartinou A, Nyktari V, Papaioannou A. Granisetron: a review of pharmacokinetics and clinical experience in chemotherapy induced-nausea and vomiting. Expert Opin Drug Metab Toxicol. 2017;13(12):1289–97.

Julius JM, Tindall A, Moise KJ, Refuerzo JS, Berens PD, Smith JA. Evaluation of the maternal-fetal transfer of granisetron in an ex vivo placenta perfusion model. Reprod Toxicol. 2014;49:43–7.

Sharma S, Singh M. Efficacy of granisetron for prevention of nausea and vomiting in patients undergoing cesarean section under spinal anesthesia: a randomized double blind placebo-controlled study. J Advan Med Dental Sci Res. 2019;7(1):152– 5.




DOI: https://doi.org/10.15851/jap.v8n2.2041

Article Metrics

Abstract view : 879 times
PDF - 566 times



 

This Journal indexed by

                   

           


 
Creative Commons License
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 



View My Stats