Efektivitas Midazolam Untuk Pencegahan Mual Muntah Pascabedah Pada Prosedur Laparaskopi

*Jamiludin Jamiludin -  Bagian Ilmu Anestesi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Univeritas Hasanuddin Makassar, Indonesia
Husain AAA -  Bagian Ilmu Anestesi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Univeritas Hasanuddin Makassar, Indonesia
Published: 1 Nov 2013.
Open Access
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Article Info
Section: Penelitian
Language: ID
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Abstract
Latar belakang : Seluruh pasien yang menjalani pembedahan beresiko untuk mengalami mual dan muntah pasca bedah (PONV). Kejadian PONV menjadi gejala yang sangat merugikan terutama setelah prosedur pembedahan ambulatori serta mengganggu proses pemulihan pasca anestesi dan pembedahan sehingga memperpanjang waktu perawatan. Laparoskopi adalah suatu prosedur pembedahan minimal invasif yang disertai insidens PONV cukup tinggi. Penyebab tingginya angka kejadian PONV pada pembedahan laparaskopi disebabkan oleh gas yang digunakan untuk insuflasi dan menyebabkan penekanan pada nervus vagus yang memiliki hubungan dengan pusat muntah di medulla oblongata. Selain itu, penyebab lain seperti teknik anestesi, jenis kelamin, nyeri, perawatan pasca operatif dan data demografik pasien yang berhubungan dengan pengaruh terjadinya emesis. Midazolam sebagai agen anti emetik dan  anxiolitik yang  menurunkan sintesis, pelepasan dan efek pasca sinaptik dopamin serta menhambat reuptake adenosin, sehingga menurunkan input dopamin dan 5-HT3 terhadap CRTZ dan mengurangi input dari thalamus yang mempengaruhi langsung pusat muntah.

Tujuan: mengevaluasi pemberian midazolam sebagai agen anti emetik dan  anxiolitik

Metode: Empat puluh delapan pasien yang akan menjalani prosedur pembedahan laparaskopi elektif secara acak dibagi menjadi dua kelompok. Setelah diberikan obat premedikasi, kelompok M (n=24) diberikan midazolam 35 μg/kgBB intravena kelompok O (n=24) diberikan ondansetron 4 mg intravena. Selama prosedur anestesi, pemakaian opioid dan lama operasi dicatat. Kemudian kejadian mual muntah pasca bedah diamati dan dicatat selama periode 8 jam pascabedah.

Hasil: Kejadian mual muntah setelah prosedur pembedahan laparaskopi pada penelitian ini diukur menggunakan skor PONV dengan interval 30 menit selama di ruang pemulihan dan setiap 1 jam di ruang perawatan selama 8 jam pasca bedah. Pada penilitian ini, terdapat perbedaan yang bermakna diantara kedua kelompok dengan hasil p=0,022 (p<0,05) pada waktu pengamatan P2 (60 menit pasca bedah)    .

Kesimpulan: Midazolam 35 μg/kgBB setelah premedikasi pada anestesi umum pada prosedur pembedahan laparaskopi elektif menurunkan kejadian mual muntah pascabedah terutama pada 1 jam pasca bedah.

Keywords
midazolam; ondansetron; pusat muntah; mual muntah pasca bedah; laparaskopi

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