Perbandingan Efektifitas Antara Tramadol Dan Meperidin Untuk Pencegahan Menggigil Pasca Anestesi Umum
ABSTRACT

Background : Post anesthesia shivering is common complication after anesthesia. It can causes uncomfortable situation and so many risk especially to the patient with no optimal condition, patient with severe chronic obstructive pulmonary disease or patient with heart failure. Post anesthesia shivering must be prevented or treated. The most commonly drug that used is meperidine.

Objective : The aim of this study is to proved that giving intra venous tramadol 2 mg kg-1 as soon before the end of the surgery is more effective than intravenous meperidine 0.5 mg kg-1 as soon before the end of the surgery to  prevent shivering after general anesthesia

Methods : This experimental study was designed as randomized post test only controlled group. Seventy two  patients 16 – 60 year age, physical status ASA I – II, normal body weight underwent elective surgery with general anesthesia. Patient were fasted for 6 hours and receiving premedication midazolam 0.07 mg kg-1 and fentanyl 1.5 mg kg-1 intravenous 2 minutes before induction. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate and SaO2 were measured 5 minutes before induction. Anesthesia was induced with thiopentone 5 mg kg-1. After loss of eyelashes reflex, patients were receiving atracurium besylate 0.5 mg kg-1 and intubation was done. Maintenance of anesthesia were using isoflurane 0.8 – 1.7 vol%,N2O 70%,O2 30% and incremental dose 0.2 mg kg-1 of atracurium besylate. Esophageal temperature was measured as soon as intubation done. Duration of operation was limited 2 – 3 hours. At the end of surgery, inhalation drugs were stopped. After adequate spontaneous breathing and laryngeal reflex shown, randomization was done. Patients divided into three groups which were T group (receiving tramadol 2 mg kg-1), M group (receiving meperidine 0.5 mg kg-1) and K group (receiving NaCl 0,9%). Extubation was done 5 minutes after the drug was given. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate and SaO2 were measured as soon as after extubation and every 5 minutes for 30 minutes long. Body temperature were measured as soon as and 15 minutes after extubation. After extubation patients were receiving oxygen 6L/minute face mask. Statistical analysis were performed by One-way Anova and p-value < 0.05 was considered significant.    

Results : Basic data, clinical characteristic data before induction, comparison of measurement systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate and SaO2 were not significantly different (p>0,05) except heart rate 30 minutes after extubation between tramadol group and control group (p<0,05). Incidence and degree of shivering between tramadol group and meperidine group were not significantly different. Differences of body temperature 15 minutes after extubation and side effects of drug that showed between tramadol group and meperidine group were significantly different (p<0,05).

Conclusions : Tramadol and meperidine have similar effectivity on the prevention of shivering after general anesthesia, but tramadol have lower side effect compare to meperidine.

 

Keywords : post anesthesia shivering, tramadol, meperidine.
ABSTRAK

Latar belakang : Menggigil pasca anestesi merupakan komplikasi yang cukup sering terjadi. Menggigil menimbulkan keadaan yang tidak nyaman dan berbagai resiko terutama bagi pasien dengan kondisi fisik yang tidak optimal, pasien dengan penyakit paru obstruktif menahun yang berat, atau pasien dengan gangguan kerja pada jantung. Karena itu menggigil harus segera dicegah atau diatasi. Sampai saat ini obat yang paling sering digunakan adalah meperidin.

Tujuan : Membuktikan bahwa pemberian tramadol 2 mg/kgBB intra vena menjelang akhir operasi lebih efektif daripada meperidin 0,5 mg/kgBB intra vena menjelang akhir operasi untuk mencegah kejadian menggigil pasca anestesi umum.

Metode : Merupakan penelitian eksperimental dengan desain “randomized post test only controlled group” pada 72 pasien usia 16 – 60 tahun, status fisik ASA I – II, berat badan normal yang menjalani operasi dengan anestesia umum. Pasien dipuasakan 6 jam dan diberikan premedikasi midazolam 0,07 mg/kgBB dan fentanil 1,5 µg/kgBB intra vena 2 menit sebelum induksi. Tekanan darah diastolik, tekanan darah sistolik, tekanan arteri rerata, laju jantung dan SaO2 diukur 5 menit sebelum induksi. Induksi anestesi dilakukan dengan thiopental 5 mg/kgBB. Setelah reflek bulu mata hilang, diberikan atrakurium besilat 0,5 mg/kgBB dan dilakukan intubasi endotrakea. Rumatan anestesi menggunakan isofluran 0,8 – 1,7 vol%, N2O 70% dan O2 30%. Atrakurium intermiten diberikan dengan dosis 0,2 mg/kgBB. Temperatur esofagus diukur segera setelah induksi. Lama operasi dibatasi antara 2 – 3 jam. Pada akhir operasi, obat inhalasi dihentikan. Setelah nafas spontan adekuat, reflek laringeal positip dilakukan randomisasi. Pasien dibagi menjadi tiga kelompok yaitu kelompok T (mendapat tramadol 2 mg/kgBB), kelompok M (mendapat meperidin 0,5 mg/kgBB) dan kelompok K (mendapat NaCl 0,9%).  Ekstubasi dilakukan 5 menit setelah perlakuan. Tekanan darah diastolik, sistolik, tekanan arteri rerata, laju jantung dan SaO2 diukur dan dicatat segera setelah ekstubasi dan tiap lima menit selama 30 menit. Suhu tubuh diukur segera dan 15 menit setelah ekstubasi. Pasca ekstubasi pasien diberi oksigen 6L/menit. Uji statistik menggunakan One-way ANOVA, dengan derajat kemaknaan  p < 0,05. 

Hasil : Data dasar, data karakteristik klinis sebelum induksi, perbandingan pengukuran tekanan darah diastolik, tekanan darah sistolik, tekanan arteri rerata, laju jantung dan SaO2 berbeda tidak bermakna (p>0,05) kecuali laju jantung 30 menit pasca ekstubasi antara kelompok tramadol dan kontrol berbeda bermakna (p<0,05). Kejadian dan derajat menggigil kelompok tramadol dan meperidin berbeda tidak bermakna (p>0,05). Perbedaan suhu tubuh kelompok tramadol dan meperidin 15 menit pasca ekstubasi dan efek samping obat yang timbul berbeda bermakna (p<0,05).

Kesimpulan : Tramadol dan meperidin mempunyai efektifitas yang sama dalam mencegah menggigil pasca anestesi umum, tetapi tramadol mempunyai efek samping obat yang lebih rendah dibandingkan meperidin.

 

Kata kunci : menggigil pasca anestesi, tramadol, meperidin
Artikel Sekarang
Dipublikasi pada 01 November 2015
Penulis :
» Himawan Sasongko
Kategori : Penelitian
Berkas Artikel (PDF)
Dari Jurnal
Volume VII nomor 3, November 2015 Cover JAI
Daftar Isi | Berkas Full (PDF)

 

Beri komentar

A PHP Error was encountered

Severity: Warning

Message: Unknown: write failed: Disk quota exceeded (122)

Filename: Unknown

Line Number: 0

A PHP Error was encountered

Severity: Warning

Message: Unknown: Failed to write session data (files). Please verify that the current setting of session.save_path is correct (/var/cpanel/php/sessions/ea-php56)

Filename: Unknown

Line Number: 0