Beruflich Dokumente
Kultur Dokumente
PENELITIAN
Perbandingan Efek Pemberian Ondansetron dan Petidin Intravena untuk
Mencegah Menggigil Pasca Anestesi Umum
Comparison of The Effect of Intravenous Pethidine and Ondansetron for
Prevention of Shivering After General Anesthesia
Arie Z ain ul Fa ton i *, I sngad i*, W iwi J aya*
*Bagian/SMF Anestesi dan Terapi Intensif Fakultas Kedokteran Universitas Brawijaya / RSU dr Saiful Anwar Malang
Korespondensi / correspondence: ariezainulfatoni@gmail.com
ABSTRACT
Background : Shivering is a common complication after general anesthesia that can
cause uncomfortable condition and several risks. Because of that, post anesthesia
shivering must be prevented or treated immediately. The most commonly drug that
used in dr.Saifu Anwar Hospitasl is pethidine but it has adverse reaction such as
nausea, vomiting and respiratory depression. Ondansetron is a specific 5-HT3
antagonist that can reduce nausea-vomiting and postanesthesia shivering.
Objective : To compare the effect of intravenous pethidine 0.4 mg/kgbw and
ondansetron 0.1 mg/kgbw for prevention of shivering after general anesthesia
Methods : This experimental study was designed as single blind true experimental
design of 32 patients 18-40 years od who underwent 1-3 hours surgery in general
anesthesia. At the end of surgery, we made patient breathed spontaneously. Twenty
minutes before extubation, patients were divided into two groups : Group I received
pethidine 0.4 mg/kgbw and group II received ondansetron 0.1 mg/kgbw. After
adequate spontaneous breathing and laryngeal reflex recovery, extubation was done.
After extubation patients were receiving oxygen 8L/minute. Vital signs, side effects and
shivering were measured every 5 minutes for 30 minutes long. Statistical analysis were
performed by Mann whitney, with p-value < 0.05 was considered significant.
Results : Patient characteristics of the two groups were not significantly different
(p>0.05). Incidence of shivering in group I were developed in 4 patients (25%) which
3 patients were 1st degree and 1 patient was 2nd degree. In group II, 3 patients
(18.75%) had incidence of shivering, which 2 patients were 1st degree and 1 patient
was 2nd degree. The incidence and grades of shivering between two groups were not
significantly different (p>0.05). Tympanic membrane temperature of group I and
group II were not significanlty different s (p>0.05). Nausea occured in group I
(12.5%) on the other side group II had no side effects but the results were not
significantly different (p>0.05).
Conclusion : Pethidine 0.4 mg/kgbw and ondansetron 0.1 mg/kgbw have similar effect
in preventing post anesthesia shivering
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89
METODE
Penelitian
ini
merupakan
penelitian
eksperimental
dengan
rancangan penelitian single blind true
experimental design.
Kelompok
penelitian
dibagi
menjadi
dua
kelompok, yaitu : kelompok I
mendapatkan petidin 0.4 mg/kgBB
menjelang akhir anestesi dan kelompok
II mendapatkan ondansetron 0.1 mg/
kgBB menjelang akhir anestesi.
Tempat
penelitian
adalah
Rumah Sakit Umum dr. Saiful Anwar
(RSSA) Malang. Kriterian inklusi
adalah pasien berusia 18 40 tahun,
status fisik berdasarkan American
Society of Anesthesiologist (ASA) I-II,
lama anestesi 1-3 jam,
tidak
mempunyai
kelainan
psikiatris,
kelainan neuromuskular dan kelainan
jantung. Sedangkan kriteria eksklusi
adalah pasien yang memerlukan obat
vasokonstriktor
selama
tindakan
anestesi, pasien yang mengalami
komplikasi selama tindakan anestesi
seperti infark miokard akut, syok, henti
jantung dan pasien yang memerlukan
perawatan di ruang intensif pasca
pembedahan.
Pemilihan sampel dilakukan
dengan purposive sampling dengan
jumlah sampel yang diperlukan adalah
32 sampel, yang dibagi menjadi dua
kelompok, dimana masing masing
kelompok berjumlah 16 sampel.
Setelah mendapat persetujuan
komisi etik RSSA Malang, pasien yang
93
94
Karakteristik
Sampel
Usia (tahun) (2)
Jenis kelamin(2)
Laki-laki
7
Perempuan 9
Berat Badan/BB (kg) (1)
53.6
Tinggi Badan/TB (cm) (1)
157.2
2 (2)
BMI (kg/m )
21.5
Durasi Anestesi
(menit) (2)
125
Suhu membran timpani
sebelum induksi (Celcius)(2)
36.7
Suhu Kamar
Operasi (Celcius) (1)
21.0
Jenis Operasi(2)
Ortopedi
3
Onkologi
3
Plastik
2
Digestif
1
Neurosurgeri 2
Mata
3
THT
2
Jumlah Perdarahan (ml) (2)
129.3
Jumlah Cairan (ml) (2)
850.0
Std.
dev.
8.30
Ondansentron
Mean/
Std.
Total
dev.
30.0
6.91
43%
57%
7.76
5.84
1.99
9
7
51.8
156.5
20.9
57%
43%
9.45
11.14
1.91
0.486
47.69
109
44.35
0.322
0.25
36.6
0.19
0.382
0.88
21.0
0.48
0.934
0.924
18.8%
18.8%
12.5%
6.20%
12.5%
18.8%
12.5%
94.9
380.78
3
4
1
1
2
1
4
88.1
734.3
18.8%
25%
6.20%
6.20%
12.5%
6.20%
25%
99.4
368.20
Uji Statistik
(p)
0.137
0.558
0.828
0.363
0.069
0.301
Keterangan:
(1)
Uji t independen
(2)
Uji Mann whitney
Tabel 2. Perbandingan Kejadian dan Derajat Menggigil antara kedua kelompok
Derajat menggigil pasca
anestesi umum (1)
Petidin
Jumlah
Prosentase
Ondansetron
Jumlah
Prosentase
Menggigil derajat 0 /
tidak menggigil
12
Menggigil derajat 1
18.75%
12.5%
Menggigil derajat 2
6.25%
6.25%
Menggigil derajat 3
0%
0%
Menggigil derajat 4
0%
0%
Kejadian menggigil(2)
25%
18.75%
0.674
12.5%
0.151
96
75%
13
81.25%
0.695
97
DAFTAR PUSTAKA
1. Ayatollahi, V., Hajiesmaeili, M.R.,
Behdad, S., Gholipur, M., Abbasi, H.R.
Comparison Of Prophylactic Use Of
Meperidine And Two Low Doses Of
Ketamine For Prevention Of PostAnesthetic Shivering: A Randomized
Double-Blind Placebo Controlled Trial. J
Res Med Sci 2011; 16(10): 1340-1346
2. Butterworth, J.F., Mackey, J.D., Wasnick,
D.C. Morgan & Mikhails Clinical
Anesthesiology Fifth Edition. Chapter 52
Thermoregulation,
Hypothermia,
&
Malignant Hyperthermia. USA; 2013. p.
1184 1191
3. Sidiq, S., Qazi, S.M., Dar, A.M. A Placebo-
100