Perbandingan Capaian Kedalaman Anestesi dengan Konduksi Ketamin dan Fentanil pada Anestesi Umum di RSUD Dr. Zainoel Abidin Banda Aceh

Burhanuddin Burhanuddin, Zafrullah Khany Jasa, Zafrullah Khany Jasa, Rahmi Rahmi, Rahmi Rahmi

Abstract


Kedalaman anestesi yang memadai untuk mencegah komplikasi intraoperatif, termasuk intraoperative awareness. Ketamin dan merupakan obat koinduksi yang umum digunakan, namun keduanya memiliki profil hemodinamik dan efek terhadap kedalaman anestesi yang berbeda. Penelitian ini bertujuan membandingkan efek koinduksi ketamin dan fentanil terhadap kedalaman anestesi dan stabilitas hemodinamik menggunakan bispectral index score (BIS). Penelitian merupakan uji klinis acak tersamar tunggal terhadap 44 pasien yang menjalani anestesi umum di RSUD dr. Zainoel Abidin Banda Aceh periode April–Mei 2025. Subjek dibagi menjadi dua kelompok, yaitu ketamin 0,5kg/BB (n=22) dan fentanil 2 μg/kgBB (n=22). Parameter BIS, tekanan darah diastol, sistol laju jantung, laju napas dan SpO2 diukur pada menit ke-0, 5, 10, 15, dan 20 pascainduksi. Hasil menunjukkan bahwa ketamin menurunkan BIS lebih cepat dan lebih dalam, dengan perbedaan bermakna signifikan pada menit ke-5 (p=0,002), 15 dan 20 (p<0,001). Ketamin juga mempertahankan tekanan darah lebih stabil, sedangkan fentanil meningkatkan laju jantung lebih tinggi pada menit ke-10 (p=0,032). Tidak terdapat perbedaan bermakna pada laju napas dan SpO2.  Ketamin lebih unggul dalam mencapai kedalaman anestesi yang cepat dan stabil secara hemodinamik, dibanding dengan fentanil.

Keywords


Bispectral index score; fentanil; hemodinamik; kedalaman anestesi; ketamin

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References


  1. De Marco G, Simons J, Forsberg L, Douglas T. What makes a medical intervention invasive?. J Med Ethics. 2024;50(4):226−33.doi: 10.1136/jme-2023-109301
  2. Shaydakov ME, Tuma F. Operative risk. StatPearls. Treasure Island (FL): StatPearls Publishing. [Internet] 2023. [dikutip 2 Februari 2025]. Tersedia dari: https://www.ncbi.nlm.nih.gov/books/NBK532240/.
  3. Smith G, D'Cruz JR, Rondeau B, Goldman J. General Anesthesia for Surgeons. StatPearls. Treasure Island (FL): StatPearls Publishing. [Internet] 2023.[dikutip 2 Februari 2025]. Tersedia dari: https://www.ncbi.nlm.nih.gov/books/NBK493199/.
  4. Kane AD, Soar J, Armstrong R, Kursumovic E, Cook T, Davies M, dkk. Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the from the 7th national audit project (NAP 7) activity survey. Anaesthesia. 2023;78(1):11−22.
  5. Laferrière-Langlois P, Morisson L, Jeffries S, Duclos C, Espitalier F, Richebé P. Depth of anesthesia and nociception monitoring: current state and vision for 2050. Anesth Analg. 2024;138(2):295−307. doi: 10.1213/ANE.0000000000006860
  6. Bi Y, Huang J, Li M, Li S, Lei H. Monitoring and evaluation of anesthesia depth status data based on neuroscience. Open Life Sci. 2023; 18:(1):20220719. doi: 10.1515/biol-2022-0719
  7. Mathur S, Patel J, Goldstein S, Hendrix JM, Jain A. Bispectral index [Internet] 2023. Treasure Island (FL): StatPearls Publishing. [dikutip 3 Februari 2025]. Tersedia dari: https://www.ncbi.nlm.nih.gov/books/NBK539809/.
  8. Hirota K, Lambert DG. Ketamine; history and role in anesthetic pharmacology. Neuropharmacology. 2022;216:109171. doi: 10.1016/j.neuropharm.2022.109171
  9. Zhou J-s, Peng G-f, Liang W-d, Chen Z, Liu Y-y, Wang B-y, dkk. Recent advances in the study of anesthesia-and analgesia-related mechanisms of S-ketamine. Front Pharmacol. 2023;14:1228895. doi: 10.3389/fphar.2023.1228895
  10. Beaudrie-Nunn AN, Wieruszewski ED, Woods EJ, Bellolio F, Mara KC, Canterbury EA. Efficacy of analgesic and sub-dissociative dose ketamine for acute pain in the emergency department. Am J Emerg Med. 2023;70:133−9. doi: 10.1016/j.ajem.2023.05.026
  11. Karunarathna I. Fentanyl: clinical applications and pharmacological considerations [Internet]. Uva Clinical Lab; [dikutip 30 Januari 2025]. Tersedia dari: https://www.researchgate.net/publication/380270478_Fentanyl_Clinical_Applications_and_Pharmacological_Considerations.
  12. Delong C, Sharma S. Physiology, peripheral vascular resistance. StatPearls [Internet]: Treasure Island (FL): StatPearls Publishing; 2023. [dikutip 5 Januari 2025]. Tersedia dari:https://www.ncbi.nlm.nih.gov/books/NBK538289/.
  13. Brackley AD, Toney GM. Oxytocin receptor activation rescues opioid-induced respiratory depression by systemic fentanyl in the rat. J Pharmacol Exp Ther. 2021;378(2):96−107. doi: 10.1124/jpet.121.000535
  14. Mostafa M, Hasanin A, Reda B, Elsayad M, Zayed M, Abdelfatah ME. Comparing the hemodynamic effects of ketamine versus fentanyl bolus in patients with septic shock: a randomized controlled trial. J Anesth. 2024;38(6):756−64. doi: 10.1007/s00540-024-03383-9
  15. Linassi F, Troyas C, Kreuzer M, Spanò L, Burelli P, Schneider G, dkk. Effect of ketamine on the bispectral index, spectral edge frequency, and surgical pleth index during propofol-remifentanil anesthesia: an observational prospective trial. Anesth Analg. 2025;140(6):1276–85. doi: 10.1213/ANE.0000000000007255
  16. Schnetz MP, Reon BJ, Ibinson JW, Kaynar M, Mahajan A, Vogt KM. Bispectral index changes following boluses of commonly used intravenous medications during volatile anesthesia identified from retrospective data. Anesth Analg. 2024;138(3):635−44. doi: 10.1213/ANE.0000000000006633
  17. Huang Y-P, Lin S-P, Horng H-C, Chang W-K, Tsao C-M. The effect of low-dose ketamine on electroencephalographic spectrum during gynecology surgery under desflurane anesthesia. J Chin Med Assoc. 2024;87(10):933−9. doi: 10.1097/JCMA.0000000000001142
  18. McCulloch TJ, Sanders RD. Depth of anaesthesia monitoring: time to reject the index?. Br J Anaesth. 2023;131(2):196−9. doi: 10.1016/j.bja.2023.04.016
  19. Elder HJ, Varshneya NB, Walentiny DM, Beardsley PM. Amphetamines modulate fentanyl-depressed respiration in a bidirectional manner. Drug Alcohol Depend. 2023;243:109740. doi: 10.1016/j.drugalcdep.2022.109740




DOI: https://doi.org/10.15851/jap.v13n2.4457

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