Perbandingan Osmolaritas Plasma Setelah Pemberian Manitol 20% 3 mL/kgBB dengan Natrium Laktat Hipertonik  3 mL/kgBB pada Pasien Cedera Otak Traumatik Ringan-Sedang

Budi Harto Batubara; Nazaruddin Umar; Chairul Mursin

Perbandingan Osmolaritas Plasma Setelah Pemberian Manitol 20% 3 mL/kgBB dengan Natrium Laktat Hipertonik 3 mL/kgBB pada Pasien Cedera Otak Traumatik Ringan-Sedang

Budi Harto Batubara, Nazaruddin Umar, Chairul Mursin

Abstract

Terapi osmotik adalah salah satu cara penanganan pada cedera kepala traumatik untuk menurunkan tekanan intrakranial (TIK) dengan cara mengatasi edema yang terjadi. Penelitian ini dilakukan pada 30 pasien cedera otak traumatik ringan-sedang yang masuk ke UGD Rumah Sakit H. Adam Malik Medan pada Oktober–Desember 2015 yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Subjek dibagi menjadi 2 kelompok secara acak, yaitu kelompok A diberikan manitol 20% 3 mL/kgBB dan kelompok B diberikan natrium laktat hipertonik 3 mL/kgBB. Dilakukan penilaian osmolaritas sebelum perlakuan dan 60 menit setelah perlakuan dengan cara pengambilan darah, kemudian dilakukan pemeriksaan laboratorium. Data hasil penelitian diuji dengan uji T-independent dan Uji Mann-Whitney. Dari hasil penelitian didapatkan efek perubahan osmolaritas plasma setelah perlakuan tidak bermakna secara statistik (p>0,05) walaupun osmolaritas plasma akhir setelah perlakuan pada kedua kelompok berbeda bermakna (p<0,05). Volume urin lebih banyak pada kelompok manitol dan bermakna secara statistik (p<0,05), akan tetapi tidak ada perubahan hemodinamik yang bermakna. Dari hasil penelitian disimpulkan bahwa manitol lebih baik dalam hal target osmolaritas plasma pada pasien cedera otak traumatik ringan sedang.

Kata kunci: Cedera otak traumatik, manitol 20%, natrium laktat hipertonik, osmolaritas

Plasma Osmolarity Changes After Mannitol 20% 3 mL/kgBW and Hypertonic Sodium Lactate Solution 3 mL/kgBW Administration in Patients with Mild-Moderate Traumatic Brain Injury

Abstract

Osmotic therapy is one of many modalities to manage traumatic brain injuries aimed to decrease intracranial pressure by alleviating the brain edema. A study was performed on 30 subjects with mild and moderate brain injuries admitted to the emergency department of Adam Malik General Hospital Medan during October–December 2015 who meet the inclusion and exclusion criteria. Subjects were divided randomly into 2 treatment groups, i.e. group A that received mannitol 20% 3 mL/kgBW and group B that received hypertonic natrium lactate 3 mL/kgBW. The measurement of osmolarity was performed before administration of either of mannitol and hypertonic natrium lactate and at 60 minutes after the administration by drawing the blood for blood check. . Data were statistically analyzed using T- independent test and Mann-Whitney test. Plasma osmolarity changes before and after the treatment were not statistically sifgnificant (p>0.05) for each group treatment even though post-treatment plasma osmolarity was statistically significant. Urin output in the mannitol group was higher than in the hypertonic sodium lactate group and was statistically significant (p>0.05); nevertheless, there was no significant difference in the hemodynamic change. Therefore, manitol is better than hypertonic natrium lactate for osmolarity target therapy in patients mild-moderate head injury.

Key words: Hypertonic natrium lactate, mannitol 20%, osmolarity, traumatic brain injury

DOI: 10.15851/jap.v4n3.677

Keywords

Cedera otak traumatik, manitol 20%, natrium laktat hipertonik, osmolaritas

Full Text:

PDF

References

Newfield P, Cottrell JE. Handbook of neuroanesthesia: anesthetic management of head trauma. Philadephia: Lippincott Williams & Wilkins; 2007.

Bisri T. Penanganan neuroanestesia dan critical care cedera otak traumatik. Bandung: Fakultas Kedokteran Universitas Padjajaran; 2012.

Saleh SC. Sinopsis neuroanestesia klinik: anstesi untuk trauma kepala. Surabaya: Fakultas Kedokteran Universitas Airlangga; 2013.

Butterworth JF, Mackey DC, Wasnick JD. Clinical anesthesiology: neurophysiology & anesthesia. Edisi ke-5. New York: McGraw-Hill Education; 2013.

White H, David C, Bala V. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesthesia Analgesia. 2006;102:1836–46.

Ichai C, Guy A, Orban JC, Berthier F, Rami L, Long CS, dkk. Sodium lactate vs. mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Crit Care. 2014;18;163–75.

Sharma RM, Setlur R, Swamy MN. Evaluation of mannitol as an osmotherapeutic agent in traumatic brain injuries by measuring serum osmolality. Med J Armed Force India. 2011:67:230–3.

Hanna, Ahmad MR. Effect of equiosmolar solutions of hypertonic sodium lactate versus mannitol in craniectomy patients with moderate traumatic brain injury. Fakultas Kedokteran Universitas Hasanuddin. Med J Indonesia. 2014;23;30–5.

Francony G, Fauvage B, Dominique F, Canet C, Dilou H, Lavagne P, dkk. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranical pressure. Crit Care Med. 2008;36:795–800.

Malik ZA, Mir SA, Nagas IA, Sofi KP, Wani AA. A prospective, randomized, double blind study to compare the effects of equiosmolar solutions of 3% hypertonic saline and 20% mannitol on reduction of brain-bulk during elective craniotomy for supratentorial brain tumor resection. Anesth Essays Researches. 2014;8(3);388–92.

Shawka H, Westwood M, Mortimer A. Mannitol: a review of its clinical uses. Contin Educ Anaesth Crit Care Pain. 2012;12:82–5.

Kyes J, Johnson JA. Hypertonic saline solutions in shock resuscitation. Conpendium: Continuing Education for Veterinarians. 2011. E1–7.

Wisniewsk P, Semon G, Liu Xi, Dhaliwal P. Severe traumatic brain injury management. webmaster@surgicalcriticalcare.net. 2014.1–14.

Olivecrona M. On severe traumatic brain injury, aspects of an intra cranial pressure-targeted therapy based on the lund concept (disertation). Swedia: University Medical Dissertations; 2008.

Sakellaridis N, Pavlou E, Karatzas S, Chroni D, Konstantinos V, Konstantinos C, dkk. Comparison of mannitol and hypertonic salie in the treatment of severe brain injuries. J Neurosurg. 2011;114:545–8.