Perbandingan Efek Pemberian Deksmedetomidin 0,5 µg/kgBB Intravena dengan Fentanil 2 µg/kgBB Intravena terhadap Respons Perubahan Tekanan Darah dan Laju Nadi Selama Tindakan Laringoskopi dan Intubasi Endotrakeal

Tia Astriana; Budiana Rismawan; Ardi Zulfariansyah

doi:10.15851/jap.v11n3.3629

Perbandingan Efek Pemberian Deksmedetomidin 0,5 µg/kgBB Intravena dengan Fentanil 2 µg/kgBB Intravena terhadap Respons Perubahan Tekanan Darah dan Laju Nadi Selama Tindakan Laringoskopi dan Intubasi Endotrakeal

Tia Astriana, Budiana Rismawan, Ardi Zulfariansyah

Abstract

Tindakan laringoskopi dan intubasi endotrakeal dapat menyebabkan hipertensi dan takikardia yang berbahaya bagi penderita dengan faktor risiko kelainan serebrovaskular, kardiovaskular, dan tirotoksikosis. Tujuan penelitian ini membandingkan efektivitas dosis bolus deksmedetomidin dan fentanil dalam melemahkan hemodinamik respons stres setelah laringoskopi dan intubasi. Penelitian ini merupakan penelitian eksperimental dengan rancangan double blind randomized controlled trial yang dilakukan di RSUP Dr. Hasan Sadikin Bandung (RSHS) sejak tanggal 1 April 2023 hingga 31 Mei 2023. Penelitian ini melibatkan 42 pasien yang menjalani operasi elektif dengan anestesi umum yang dibagi menjadi dua kelompok, yaitu kelompok D menerima 0,5 µg/kgBB deksmedetomidin dan kelompok F menerima fentanil 2 µg/kgBB sebelum tindakan laringoskopi dan intubasi endotrakeal. Pengamatan dilakukan pada tekanan darah sistole, tekanan darah diastole, mean arterial pressure, dan laju nadi sesaat setelah tindakan intubasi dilanjutkan tiap menit hingga 5 menit setelah tindakan intubasi. Hasil menunjukkan bahwa perubahan tekanan darah sistole, diastole, MAP, dan laju nadi antara kelompol deksmedetomidin dan kelompok fentanil tidak terdapat perbedaan bermakna (p<0,05). Simpulan, pemberian deksmedetomidin menghasilkan respons perubahan tekanan darah dan laju nadi yang sebanding dengan pemberian fentanil.

Keywords

Deksmedetomidin; fentanil; intubasi; laringoskopi; respons hemodinamik

Full Text:

PDF

References

Hagberg C, Artime C, Aziz M. Physiologic and pathophysiologic responses to intubation. Dalam: Hagberg C penyunting, Airway Management. Edisi ke-4. Elsevier Inc; 2018. hlm. 163–75.
Mahiswar AP, Dubey PK, Ranjan A. Comparison between dexmedetomidine and fentanyl bolus in attenuating the stress response to laryngoscopy and tracheal intubation: a randomized double-blind trial. Braz J Anesthesiol. 2022;72(1):103–9.
Amri I, Arif SK. Anestesiologi B, Intensif dan Manajemen Nyeri P, Kedokteran F, Hasanuddin U. Perbandingan efek deksmedetomidin 0,75 µg/kgbb dengan fentanil 2 µg/kgbb intravena terhadap kebutuhan dosis induksi propofol dan respon hemodinamik selama tindakan laringoskopi dan intubasi trakhea. Healthy Tadulako Journal (Imtihanah Amri, Syafri K Arif. 2017;3(1):22–35.
Cummings K, Naguib M. Opioid Agonist and Antagonist. Dalam: Urman RD, penyunting, Stoelting’s Pharmacology and Physiology in Anesthetic Practice, Edisi ke-5. Philadelpia: Wolters Kluwer; 2015. hlm. 217–56.
De Cassai A, Geraldini F, Tulgar S, Ahiskalioglu A, Mariano ER, Dost B, dkk. Opioid-free anesthesia in oncologic surgery: the rules of the game. J Anesth Analg Crit Care 2022;2(1):8.
Beloeil H. Opioid-free anesthesia. Vol. 33, Best Practice and Research: Clinical Anaesthesiology. Bailliere Tindall Ltd; 2019. p. 353–60.
Kumari K, Gombar S, Kapoor D, Sandhu HS. Clinical study to evaluate the role of preoperative dexmedetomidine in attenuation of hemodynamic response to direct laryngoscopy and tracheal intubation. Acta Anaesthesiol Taiwan. 2015;253(4):123–30.
Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Ann Card Anaesth. 2012 Jan;15(1):39–43.
Chikkanargund GM, Dhummansure D. Lignocaine and fentanyl in laryngoscopy and intubation: comparison of changes in heart rate. Eur J Mol Clin Med. 2022;9(4):881–6.
Mohsin S, Ganaie AZ, Kundi H, Ahmed MB, Riaz B, Ahmed KN, dkk. Comparison of fentanyl and dexmedetomidine in preventing and increase in heart rate during intubation among patients undergoing general anesthesia: a meta-analysis. Cureus. 2022;14(6);e26194.
Gurulingappa, Aleem MA, Awati MN, Adarsh S. Attenuation of cardiovascular responses to direct laryngoscopy and intubation.-A comparative study between iv bolus fentanyl, lignocaine and placebo (NS). J Clin Diagn Res. 2012;6(10):1749–52.
Taqwin GM, Artika IGN, Rahardjo S. Hemodynamic response in endotracheal intubation. Journal of the Medical Sciences (Berkala Ilmu Kedokteran). 2014;1;46(02):78–87.
Sawano Y, Miyazaki M, Shimada H, Kadoi Y. Optimal fentanyl dosage for attenuating systemic hemodynamic changes, hormone release and cardiac output changes during the induction of anesthesia in patients with and without hypertension: a prospective, randomized, double-blinded study. J Anesth. 2013;27(4):505–11.
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.
Ping BF, Gang ZH, Mei ZS. Anesthetic considerations for patients with acute cervical spinal cord injury. Neural Regen Res. 2017;12(3):499.
Bhadiyadra R, Vaghela A, Patel S. Comparison of intravenous fentanyl vs dexmedetomidine in attenuation of pressure response during laryngoscopy and endotracheal intubation. Int J Sci Res. 2018;7(2):306–9.
Gunalan S, Venkatraman R, Sivarajan G, Sunder P. Comparative evaluation of bolus administration of dexmedetomidine and fentanyl for stress attenuation during laryngoscopy and endotracheal intubation. J Clin Diagn Res. 2015;9(9):UC06–9.
Sharma N, Mehta N. Therapeutic efficacy of two different doses of dexmedetomidine on the hemodynamic response to intubation, the intubating conditions, and the effect on the induction dose of propofol: a randomized, double-blind, placebo-controlled study. Anesth Essays Res. 2018;12(2):566.