Efektivitas Midazolam Untuk Pencegahan Mual Muntah Pascabedah Pada Prosedur Laparaskopi

*Jamiludin Jamiludin  -  Bagian Ilmu Anestesi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Univeritas Hasanuddin, Indonesia
Husain AAA  -  Bagian Ilmu Anestesi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Univeritas Hasanuddin, Indonesia
Published: 1 Nov 2013.
Open Access
Citation Format:
Article Info
Section: Penelitian
Language: ID
In Vol 5, No 3 (2013): Jurnal Anestesiologi Indonesia
Statistics: 1189 772
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

Article Metrics:

  1. Islam S, Jain PN. Post operative nausea and vomiting (PONV): a review article. Indian J Anaesth. 2004; 48(4):253-58
  2. Cracken GM, Houston P, Lefebvre G. Guidline for the management of postoperative nausea and vomiting. SOGC Clinical Practice Guidline. 2008 July
  3. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting. American S of Anaesth. 1999; 91:693–700
  4. Licthor JL, Kalghatgi SV. Outpatient anesthesia. In: Longnecker DE, Brown DDL, Newman MF, Zapol WM, editors. Anesthesiology. New York: Mc Graw Hill; 2008. p.1608-19
  5. Gerges FJ, Kanazi GE, Jabbour-khoury SI. Anesthesia for laparoscopic. J Clin Anesth 2006; 18: 67-68
  6. Ali Z, Ahmad T, Ahmad I. Preoperative dexamethasone in laparoscopic cholecystectomy patients. J Professional Med. 2010; 3:394-99
  7. Habib SA, Gan TJ. Evidence based management of postoperative nausea and vomiting. Can J Anaesth. 2004; 51:326-41
  8. Stoelting Rk, Hillier SC. Benzodiazepin. In: Pharmacology & physiology in anesthetic practice. 4th Edition. Philadelphia: Lippincott Williams & Wilkins; 2006. p.104-8
  9. Rodola F. Midazolam as an antiemetic. Europ Rev for Medical and Pharmacological Sciences. 2006; 10:121-6
  10. Polati E, Verlato G, Finco G, Mosaner W, Grosso S, Gottin L, et al. Ondansetron versus metoclopramid in the treatment of postoperative nausea and vomiting. Anesth Analg. 1997; 85:395-9
  11. Riad W, Marouf H. Combination theraphy in the prevention of PONV after strabismus surgery in children: granisetron, ondansetron, midazolam and dexamethason. MEJ Anaesth. 2009; 20(3):431-36
  12. Sanjay OP, Tauro DI. Midazolam: an effective antiemetic after cardiac surgery-a clinical trial. Anesth Analg. 2004; 99:339-43
  13. Safavi MR, Honarmand A. Low dose intravenous midazolam for prevention of PONV in lower abdominal surgery. MEJ Anaesth. 2009; 20(1):75-82
  14. Jang JS, Lee JH, Lee JJ, Park WJ, Hwang SM, Lee SK, Lim SY. Postoperative nausea and vomiting after myringoplasty under continous sedation using midazolam with or without remifentanyl. Yonsei Med J. 2012; 53(5):1010-13
  15. Kim DS, Koo GH, Baek CW, Jung YH, Woo YC, Kim JY, Park SG. The antiemetic effect of midazolam or/and ondansetron added to intravenous patient controlled analgesia in patients of pelviscopic surgery. Korean J Anesthesiol. 2012; 62(4):343-49
  16. Becker DE. Nausea, vomiting, and hiccups: a review of mechanism and treatment. Anesth Prog. 2010; 57:150-57
  17. Chandrakantan W, Glass PS. Multimodal therapies for postoperative nausea and vomiting, and pain. Brt J Anaesth. 2010; 107:i27-i40
  18. Aitkenhead AR, Smith G, Rowbotham DJ, editors. Postoperative nausea and vomiting. In: Textbook of anaesthesia. 5th Edition. Edinburgh: 2007; p.526-32
  19. Apfel CC, Kranke P, Eberhart LH, Roos A, Roewer N. Comparison of predictive models for postoperative nausea and vomiting. Brt J Anaesth. 2002; 88: 234–40
  20. Gan TJ, Meyer T, Apfel CC. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007; 105:1615-27
  21. Riad W, Altaf R, Abdulla A, Oudan H. Effect of midazolam, dexamethasone and their combination on the prevention of nausea and vomiting following strabismus repair in children. Europ J of Anaesth. 2007; 24:697-701
  22. White PF, Sacan O, Nuangchamnong N, Sun T. The relationship between patient risk factors and early versus late postoperative emetic symptoms. Anesth Analg. 2008; 107: 459-63
  23. Scuderi P, Salem W. Postoperative nausea and vomiting: prevention and treatment. Can J Anaesth 2002; 49:241-46
  24. Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology. 2008; 58(4):203-5
  25. Crozier TA. Anaesthesia for laparoscopic surgery. In: Anaesthesia for minimally invasive surgery. Cambridge: Cambridge University Press; 2004. p.55-70
  26. Park EY, Lee SK, Kang MH, Lim KJ, Kim YS, Choi E, Park YH. Comparison of ramosetron with combined ramosetron and midazolam for preventing postoperative nausea and vomiting in patient at high risk following laparascopic gynaecological surgery. J of International Med Research. 2013; 0(0):1-10
  27. Wang S, Joseph G, Martin F. Evaluation of three 5-HT3 receptor antagonists in the prevention of postoperative nausea and vomiting in adults. P&T 2005; 30: 341-53
  28. Farid RM. Perbandingan efektifitas ondansetron dan metoclopramid dalam menekan mual muntah pasca operasi pada pembedahan perut bawah kasus ginekologi. Anesth and Crit Care. 2005; 23:127-32
  29. Habib AS, Reuveni J, Taguchi A, White WD, Gan TJ. A comparison of ondansetron with promethazine for treating postoperative nausea and vomiting in patients who received prophylaksis with ondansetron: a retrospective database analysis. Anesth Analg. 2007; 104:548-51
  30. Kasinath NS, Malak O, Tetzlaff J. A case report: Atrial fibrillation after ondansetron for the prevention and treatment of postoperative nausea and vomiting. Can J Anaesth. 2003; 50:228-31
  31. Shahriari A, Khooshideh M, Heidari MH. Prevention of nausea and vomiting in cesarean section under spinal anaesthesia with midazolam or metoclopramide?. J Pak Med Assoc. 2009; 59(11):756-59
  32. Alstrup AKO, Simonsen M, Landau AM. Type of anesthesia influences positron emission tomography measurements of dopamine D2/3 receptor binding in the rat brain. Scand J Lab Anim Sci. 2011; 38(3):195-201
  33. Tang J, Wang B, White PF, Gold M. Comparison of the sedation and recovery profiles of Ro 48-6791, a new benzodiazepine and midazolam in combination with meperidine for outpatient endoscopic procedures. Anesth Analg. 1999; 89:893-8

The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to JAI (Jurnal Anestesiologi Indonesia) and Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University as publisher of the journal. Copyright encompasses exclusive rights to reproduce and deliver the article in all form and media, including reprints, photographs, microfilms, and any other similar reproductions, as well as translations. 

JAI (Jurnal Anestesiologi Indonesia) and Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University and the Editors make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in JAI (Jurnal Anestesiologi Indonesia) are the sole and exclusive responsibility of their respective authors and advertisers.

The Copyright Transfer Form can be downloaded here:[Copyright Transfer Form JAI]. The copyright form should be signed originally and send to the Editorial Office in the form of original mail, scanned document:  

 

Uripno Budiono (Editor-in-Chief)

Editorial Office of JAI (Jurnal Anestesiologi Indonesia)

Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University/ Dr. Kariadi General Hospital Medical Center (RSUP Dr. Kariadi)

Jl. Dr. Soetomo No. 16 Semarang, Central Java, Indonesia, 50231

Telp. : (024) 8444346

Email : janestesiolgo@gmail.com