Penggunaan Fentanyl pada Pasien Sakit Kritis COVID-19

*Andi Muhammad Takdir Musba orcid scopus  -  Departemen Anestesiologi Terapi Intensif dan Manajemen Nyeri; Fakultas Kedokteran; Universitas Hasanuddin; Makassar, Indonesia
Haizah Nurdin  -  Departemen Anestesiologi Terapi Intensif dan Manajemen Nyeri; Fakultas Kedokteran; Universitas Hasanuddin; Makassar, Indonesia
Published: 1 Nov 2020.
DOI: https://doi.org/10.14710/jai.v12i3.32872 View
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Abstract

Latar Belakang: Nyeri merupakan salah satu masalah utama pada pasien yang dirawat di unit perawatan intensif (ICU). Kombinasi antara pressor response akibat nyeri dengan gangguan oksigenasi pada Corona Virus Disease 2019 (COVID-19) dapat berdampak negatif pada pasien, sehingga menghambat pemulihannya. Opioid sering digunakan untuk mengatasi nyeri di ICU. Namun, efek sampingnya, terutama efek imunosupresif pada pasien COVID-19 masih belum jelas. Opioid dianggap berpotensi memperburuk infeksi COVID-19 dan dapat menyebabkan efek depresi pernapasan pada pasien COVID-19 yang sakit kritis, namun masih kontroversial.

Kasus: Wanita, 53 tahun dirawat di unit perawatan intensif dengan pneumonia bilateral yang terkonfirmasi COVID-19. Pasien diberikan fentanyl intravena secara kontinyu sebagai analgesia selama perawatan bantuan pernapasan dengan intubasi endotrakeal dan ventilator mekanis. Pasien menerima opioid fentanyl selama lebih dari seminggu sampai lepas dari ventilasi mekanis dan kemudian diekstubasi. Setelah ekstubasi, pasien mendapat terapi oksigen dengan high flow nasal cannula (HFNC) hingga tidak membutuhkan suplemen oksigen. Pasien keluar dari unit perawatan intensif setelah 14 hari perawatan.

Pembahasan: Dengan menggunakan analgesia opioid fentanyl pada pasien ini, analgesia yang baik dapat tercapai. Penilaian analgesia selama ventilasi mekanis menggunakan behaviour pain scale dan terlihat respons yang baik pada pasien ini. Pasien tidak mengalami infeksi yang semakin parah seperti yang ditakutkan dengan penggunaan opioid pada pasien kritis, namun kemungkinan peran imunosupresif dari opioid masih perlu ditelusuri lebih lanjut.

Kesimpulan: Penggunaan opioid fentanyl dapat memberikan analgesia yang baik pada pasien COVID-19 yang sakit kritis dengan luaran pasien yang baik.

Note: This article has supplementary file(s).

Keywords: analgesia; COVID-19; opioid; pasien kritis; sistem imun

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