efek pemberian magnesium sulfat intravena terhadap kebutuhan isofluran dan fentanil selama operasi...

EFEK PEMBERIAN MAGNESIUM SULFAT INTRAVENA TERHADAP KEBUTUHAN ISOFLURAN DAN FENTANIL

SELAMA OPERASI LAPAROSKOPI

Dr. FENDY DWIMARTYONO 

Dr. SYAFRUDDIN GAUS,PhD,SpAn-KMN 

James MFM. Magnesium : an emerging drug in anaesthesia. Br J Anaesth. 2009;103(4):465-7.Aronson JK. Meyler's side effect of drugs in anesthesia. New York: Elsevier; 2009. p. 1-10.

Latar Belakang

James MFM. Magnesium : an emerging drug in anaesthesia. Br J Anaesth. 2009;103(4):465-7.Aronson JK. Meyler's side effect of drugs in anesthesia. New York: Elsevier; 2009. p. 1-10.

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Herroeder S, Schonherr ME, Hert SGD, Hollmann MW. Magnesium essentials for anesthesiologist. Anesthesiology. 2011;114:971-93.Sirvinkas E, Laurinaitis R. Use of magnesium sulfate in anesthesiology. Medicina (Kaunas). 2002;38(7):695-8.Fawcett WJ, Haxby EJ, Male DA. Magnesium : physiology and pharmacology. Br J Anaesth. 1999;83(2):302-30.

Sirvinkas E, Laurinaitis R. Use of magnesium sulfate in anesthesiology. Medicina (Kaunas). 2002;38(7):695-8.Barbosa FT, Barbosa LT, Jucá MJ, Cunha RMd. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol. 2010;6(1):107-10.

Gupta K, Vohra V, Sood J. The role of magnesium as an adjuvant during general anaesthesia. Anaesthesia. 2006;61:1058-63.Telci L, Esen F, Akcora D, Erden T, Canbolat AT, Akpir K. Evaluation of effect of magnesium sulphate in reducing intraoperative anesthetic requirements. Br J Anaesth. 2002;89(4):594-8.

Lee DH, Kwon IC. Magnesium sulphate has beneficial effect as an adjuvant during general anesthesia for caesarean section. Br J Anaesth. 2009;103(6):861-6.

Rumusan Masalah

Tujuan Penelitian

Hipotesis Penelitian

Manfaat Penelitian

Herroeder S, Schonherr ME, Hert SGD, Hollmann MW. Magnesium essentials for anesthesiologist. Anesthesiology. 2011;114:971-93.Sirvinkas E, Laurinaitis R. Use of magnesium sulfate in anesthesiology. Medicina (Kaunas). 2002;38(7):695-8.Barbosa FT, Barbosa LT, Jucá MJ, Cunha RMd. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol. 2010;6(1):107-10.Fawcett WJ, Haxby EJ, Male DA. Magnesium : physiology and pharmacology. Br J Anaesth. 1999;83(2):302-30.

Reseptor NMDA

NMDA receptor. AnaesthesiaUK; 2005 [updated 12/1/2009; cited 2011 April 4th]; Available from: http://www.frca.co.uk/article.

Anestesi inhalasi dan MagnesiumAnestesi inhalasi dan Magnesium

Brosnan RJ, Thiesen R. Increased NMDA receptor inhibition at an increased Sevofluran MAC. BioMed Central; 2012 [cited 2012 14 May]; Available from: http://www.biomedcentral.com/1471-2253/12/9.Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium: Part I. Anesth Analg. 2001;92:1173-81.Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium. Part II: interactions with volatile anesthetics. Anesth Analg. 2001;92:1173-81.

Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium: Part I. Anesth Analg. 2001;92:1173-81.Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium. Part II: interactions with volatile anesthetics. Anesth Analg. 2001;92:1173-81.

Secara klinis konsentrasi anestesi inhalasi menghambat fungsi dari reseptor NMDA. Inhibisi ini bersifat reversible, concentration dependent dan voltage insensitive

Kogler J. The analgesic effect of magnesium sulfate in patients undergoing thoracotomy. Acta Clin Croat. 2009;48:19-26.Altan A, Turgut N, Yildiz F, Turkmen A, Ustun H. Effects of magnesium sulphate and clonidine on propofol consumption, haemodynamics and postoperative recovery. Br J Anaesth. 2005;94(4):438-41.Habib AS, Gan TJ. Role of analgesic in postoperative pain management. Anesthesiol Clin North America. 2005;23(85-107).

Opioid dan MagnesiumOpioid dan Magnesium

Herbert K, Thomas W, Peter M, Harald A, Klaus H, NIkolaus M. Magnesium sulfate reduces intra and postoperative analgesic requirement. Anesth Analg. 1998;87:206-10.

MgSO4 dapat dijadikan sebagai ajuvan dalam manajemen analgesia perioperatif.

Herbert K, Thomas W, Peter M, Harald A, Klaus H, NIkolaus M. Magnesium sulfate reduces intra and postoperative analgesic requirement. Anesth Analg. 1998;87:206-10.

Kerangka Teori

Kerangka Konsep

Kriteria inklusi

Kriteria eksklusi

Kriteria Drop Out

Pengolahan dan Analisa Data

Variabel N Rerata SD Min Maks kemaknaan (nilai p)

Umur (tahun) Kelompok MKelompok N

2020

38,636,5

9,8310,3

1920

5857

0,524*

IMTKelompok MKelompok N

2020

23,0322,55

2,622,26

18,7519,10

24,2923,70

0,522*

PS ASAKelompok MKelompok N

2020

11

22

0,06**

Jenis KelaminKelompok MKelompok N

2020

1,901,95

0,300,22

0,553**

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan *Independent-Samples T Test p<0,05, dan **Mann-Whitney U, p<0,05.

Tabel 1. Karakteristik Sampel

VariabelLama

Operasi

N Rerata SD Min Maks kemaknaan (nilai p)

Kelompok M

Kelompok N

20

20

88,00

79,75

23,3

51,2

55

40

120

115 0,524

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 2. Lama Operasi

VariabelJenis Operasi Laparoskopi

N Rerata SD kemaknaan (nilai p)

Kelompok M- Digestive- Ginekologi

Kelompok N- Digestive- Ginekologi

128

119

1,42 0,50 0,757

Data disajikan dalam bentuk nilai rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 3. Jenis Operasi

Jumlah PemakaianIsofluran

N Rerata SD kemaknaan (nilai p)

Kelompok MKelompok N

2020

21,4227,15

7,14,36

0,004

Data disajikan dalam bentuk nilai rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 4. Kebutuhan Isofluran

Data disajikan dalam bentuk nilai rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Diagram 1. Kebutuhan Isofluran

Dutton RC, Laster MJ, Xing Y, Sonner JM, Raines DE. Do N-Methyl-D-Aspartate mediate the capacity of inhaled anesthetics to suppress the temporal summation that contributes to minimum alveolar concentration? Anesth Analg. 2006;102:1412-8.

Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium. Part II: interactions with volatile anesthetics. Anesth Analg. 2001;92:1173-81.

Olgun B, Oguz G, Kaya M, Savli S, Eskicirak HE, Guney I, et al. The effects of magnesium sulphate on desflurane requirement, early recovery and postoperative analgesia in laparoscopic cholecystectomy. Magnes Res. 2012;25(2):72-8.

Oguzhan N, Guday I, Turan A. Effect of magnesium sulfate infusion on sevofluran consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag. 2008;4(2):105-10.

Jumlah Pemakaian

Fentanil

N Rerata SD kemaknaan (nilai p)

Kelompok MKelompok N

2020

86,25100,10

24,785,5

0,491

Data disajikan dalam bentuk nilai rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 5. Kebutuhan Fentanil

Data disajikan dalam bentuk nilai rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Diagram 2. Kebutuhan Fentanil

Nechifor M. Magnesium involvement in pain. Magnes Res. 2011;24(4):220-2.

Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: a comparative study. Indian J Anaesth. 2010;54(2):137-41.

Kogler J. The analgesic effect of magnesium sulfate in patients undergoing thoracotomy. Acta Clin Croat. 2009;48:19-26.

Ryu JH, Kang MH, Park KS, Do SH. Effect of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anaesthesia. Br J Anaesth. 2008;100(3):397-403.

Seyhan TO, Tugrul M, Sungur O, Kayacan S, Telci L, Pembeci K, et al. Effect of three different dose regimens of magnesium on propofol requirement, haemodynamic, variables and postoperative pain relief in gynaecological surgery. Br J Anaesth. 2005;96(2):247-52.

McCartney CJL, Sinha A, Katz J. A qualitative systematic review of the role N-Methyl-D-Aspartate antagonist in preventive analgesia. Anesth Analg. 2004;98:1385-400.

Lysakowski C, Dumont L, Czarnetzki C, Tramer MR. Magnesium as an adjuvant to postoperative analgesia : a systemic review of randomized trials. Anesth Analg. 2007;104(6):1532-8.

McCartney CJL, Sinha A, Katz J. A qualitative systematic review of the role N-Methyl-D-Aspartate antagonist in preventive analgesia. Anesth Analg. 2004;98:1385-400.Ko S-H, Lim H-R, Kim D-C, Han Y-J, Choe H, Song H-S. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology. 2001;95:640-6.

Respon HemodinamikTAR

Kelompok M N=20

Kelompok NN=20

(nilai p)

Rerata SD Rerata SD

TAR Basal 88,8 14,9 92,8 9,6 0,320TAR sebelum pemberian obat

87,3 15,1 89,5 11,4 0,597

TAR 10 menit setelah pemberian obat

80,8 11,5 86,8 11,6 0,107

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 6. TAR prainduksi

Respon HemodinamikLJ

Kelompok MN=20

Kelompok NN=20

(nilai p)Rerata SD Rerata SD

LJ Basal 77,4 15,7 77,3 11,2 0,991LJ sebelum pemberian obat

76,8 13,8 77,3 12,6 0,906

LJ 10 menit setelah pemberian obat

75,6 12,8 79,1 11,4 0,381

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 7. LJ prainduksi

Respon HemodinamikTAR

Kelompok M

N=20

Kelompok NN=20

(nilai p)

Rerata SD Rerata SD

TAR saat induksi 79,0 8,9 76,7 9,3 0,429TAR sesaat setelah intubasi

87,4 13,6 84,1 12,3 0,433Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 8. TAR induksi dan intubasi

Respon HemodinamikLJ

Kelompok MN=20

Kelompok NN=20

(nilai p)

Rerata SD Rerata SD

LJ saat induksi 74,3 8,9 73,9 13,9 0,925LJ sesaat setelah intubasi

76,2 12,5 74,7 10,6 0,685

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 9. LJ induksi dan intubasi

Respon HemodinamikTAR

Kelompok M

N=20

Kelompok NN=20

(nilai p)

Rerata SD Rerata SD

TAR 10 menit 80,1 10,2 87,2 13,9 0,074TAR 20 menit 90,8 14,7 89,9 13,4 0,832TAR 30 menit 97,0 12,5 93,2 11,7 0,328TAR 40 menit 96,5 14,9 92,1 12,8 0,324TAR 50 menit 93,1 16,0 92,2 12,3 0,852TAR 60 menit 89,7 13,4 91,9 11,0 0,574

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 10. TAR intraoperatif

Grafik 1. TAR intraoperatif

Respon HemodinamikLJ

Kelompok MN=20

Kelompok NN=20

(nilai p)Rerata SD Rerata SD

LJ 10 menit 73,0 9,4 72,1 10,8 0,781

LJ 20 menit 79,0 14,3 71,9 8,8 0,067

LJ 30 menit 80,9 16,3 72,8 7,4 0,051

LJ 40 menit 73,7 12,5 73,3 7,8 0,094LJ 50 menit 73,7 12,6 75,5 8,7 0,603LJ 60 menit 74,7 11,4 76,6 9,6 0,573

Data disajikan dalam bentuk nilai minimal, maksimal, rerata, standar deviasi kemudian probabilitas (nilai p) diuji dengan Independent-Samples T Test, p<0,05 dinyatakan signifikan.

Tabel 11. LJ intraoperatif

Grafik 2. LJ intraoperatif

Tramer MR, Schneider J, Marti R-A, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996;84:340-7.

Choi JC, Yoon KB, Um DJ, Kim C, Kim JS, Lee SG. Intravenous magnesium sulfate administration reduces propofol infusion requirements during maintenance of propofol-N2O anesthesia. Anesthesiology.

2002;97:1137-41.

Ryu JH, Kang MH, Park KS, Do SH. Effect of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anaesthesia. Br J Anaesth. 2008;100(3):397-403.

Lee DH, Kwon IC. Magnesium sulphate has beneficial effect as an adjuvant during general anesthesia for caesarean section. Br J Anaesth. 2009;103(6):861-6.

Kalra NK, Verma A, Agarwal A, Pandey H. Comparative study of intravenously administered clonidine and magnesium sulfate on hemodynamics response during laparoscopic cholecystectomy. J Anaesth Clin Pharm. 2011;27:344-8.

Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth. 2009;103(4):484-9.

Kalra NK, Verma A, Agarwal A, Pandey H. Comparative study of intravenously administered clonidine and magnesium sulfate on hemodynamics response during laparoscopic cholecystectomy. J Anaesth Clin Pharm. 2011;27:344-8.

Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth. 2009;103(4):484-9.

Herroeder S, Schonherr ME, Hert SGD, Hollmann MW. Magnesium essentials for anesthesiologist. Anesthesiology. 2011;114:971-93.

Telci L, Esen F, Akcora D, Erden T, Canbolat AT, Akpir K. Evaluation of effect of magnesium sulphate in reducing intraoperative anesthetic requirements. Br J Anaesth. 2002;89(4):594-8.

Ryu JH, Kang MH, Park KS, Do SH. Effect of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anaesthesia. Br J Anaesth. 2008;100(3):397-403.

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Rumus Isaac dan Michael

• S = jumlah sampel

• N = jumlah populasi

• d2 = presisi yang ditetapkan• λ2 dengan dk = 1, taraf kesalahan

1%,5%,10%• P = Q = 0,5• d = 0,05

s = λ2 . N. P. Q d2 (N-1) + λ2.P.Q