Perbandingan Pemberian Dexmedetomidine dengan Fentanyl Intraoperatif terhadap Kedalaman Anestesia dan Kecepatan Pemulihan pada Operasi Bedah Saraf

Zafrullah Kany Jasa, Teuku Heriansyah, Muttaqin Muttaqin

Abstract


Latar Belakang dan Tujuan: Anestesi bebas opioid merupakan diskusi baru dalam dunia anestesi. Bukti menunjukkan bahwa opioid memiliki efek samping yang tidak diinginkan. Dexmedetomidine merupakan suatu reseptor agonis a2-adrenergik selektif yang memiliki efek sparing opioid serta kecepatan pulih sadar anestesi yang lebih baik. Penelitian ini bertujuan membandingkan efektifitas dexmedetomidine dan fentanyl terhadap kedalaman anestesi dan pemulihan pasca anestesi pada operasi bedah saraf supratentorial
Subjek dan Metode: Total 40 sampel penelitian dibagi menjadi 2 grup: A (Dexmedetomidine) dan B (Fentanyl) dengan total sampel 20 pada tiap grup. Kedua grup dilakukan pemasangan alat bispectral index (BIS) selama pembedahan. Kedua grup akan dinilai kecepatan pemulihan pasca anestesi sejak obat anestesi dihentikan.Hasil: Berdasarkan uji statistik didapatkan hasil bahwa penggunaan dexmedetomidine dan fentanyl memiliki efek anestesi optimal, dimana tidak terdapat perbedaan signifikan di antara keduanya dalam hal mencapai level anestesi optimal berdasar indeks BIS. Didapatkan pula hasil waktu pulih pasca anestesi dexmedetomidine lebih cepat dibandingkan pemberian fentanyl, dengan perbedaan waktu 5,10 menit (p<0,05), dengan terdapat perbedaan signifikan kecepatan pulih pasca anestesi antara penggunaan dexmedetomidine dan fentanyl.
Simpulan: Penggunaan dexmedetomidine pada operasi bedah saraf supratentorial memiliki kecepatan waktu pulih pasca anestesi yang lebih baik dibandingkan fentanyl

Comparison of Dexmedetomidine Administration with Intraoperative Fentanyl to The Depth of Anesthesia and Recovery Speed in Neurosurgery


Abstract

Background and Objective: Opioid free anesthesia is a new discussion in the world of anesthesia. The available evidence suggests that opioids also have unintended effects. Dexmedetomidine is a selective 2-adrenergic receptor (α2-AR) agonist drug, that this drug has an opioid-sparing effect, and a faster recovery rate after anesthesia. To compare the effectiveness of dexmedetomidine and fentanyl on the depth of anesthesia and post-anesthesia recovery in supratentorial neurosurgery operations.
Subject and Methods: A total of 40 research samples was divided into 2 groups, namely group A (Dexmedetomidine) and group B (Fentanyl). The number of research samples in each group was 20 people. Both groups of patients will be fitted with a bispectral index (BIS) during surgery. Both groups will measure the post-anesthesia recovery time since the anesthetic drug was discontinued
Results: Based on statistical tests, it was found that the use of dexmedetomidine and fentanyl had an optimal anesthetic effect, where there was no significant difference between these two anesthetic agents in achieving optimal anesthetic levels based on the BIS Index. From statistical analysis was found that post-anesthesia recovery time on dexmedetomidine was faster than the administration of fentanyl, with a difference of 5.10 minutes (p<0.05) with statistically significant difference in the speed of post-anesthesia recovery between the use of dexmedetomidine and fentanyl.
Conclusion: The use of dexmedetomidine in supratentorial neurosurgical surgery anesthesia has a faster post- anesthesia recovery time than the use of fentanyl.

 


Keywords


Bispectral index, bedah saraf, dexmedetomidine, fentanyl, masa pulih sadar

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References


Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg. 2009 Feb;108(2):527–35

Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR, Ramachandran SK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population. Anesthesiology. 2012 Oct 1;117(4):717–25.

Adapa R, Duane D, Gelb A, Gupta A, editors. Gupta and Gelb’s Essentials of Neuroanesthesia and Neurointensive Care. 2nd ed. Cambridge University Press; 2018.

Cottrell JE, Warner DS, Patel P. Cottrell and Patel’s Neuroanesthesia. Brooklyn, New York: Elsevier; 2016.

Butterwoth JF, Mackey DC, Wasnick JD. Analgesic agents. In: Morgan & Mikhail’s Clinical Anesthesiology. 6th ed. McGraw- Hill Education; 2018. 187–95.

Solihat Y. Penggunaan opioid sebagai balans anestesi pada craniotomi emergensi dengan meningioma. JAI b. 2013 Jul 1;5(2):124.

Ilhan O, Koruk S, Serin G, Erkutlu I, Oner U. Dexmedetomidine in the supratentorial craniotomy. EAJM. 2010 Aug 1;42(2):61–5.

Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Anaesthesia Group, editor. Cochrane Database of Systematic Reviews. 2019.

Solanki N, Solanki R, Patel R, Garg A. Effect of dexmedetomidine to attenuate the sympathetic response of laryngoscopy and intubation and perioperative hemodynamic stability in patients undergoing neurosurgery. Indian J Heal Sci. 2016;9(2):235.

Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al. The effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg. 2008;107(4):1340–47.

Su S, Ren C, Zhang H, Liu Z, Zhang Z. The opioid-sparing effect of perioperative dexmedetomidine plus sufentanil infusion during neurosurgery: A retrospective study. Front Pharmacol. 2016;7(OCT):1–9.

Herbert BAG, Ramaciotti PMG, Ferrari FTSA, Navarro LHC, Nakamura G, Rogrigues Jr GR, et al. The use of dexmedetomidine in neurosurgery. Rev Bras Anestesiol. 2007;57:223–31.

Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in enhanced recovery after surgery (ERAS) protocols for postoperative pain. Curr Pain Headache Rep. 2020;24(5).

Lavand’homme P. Opioid-free anaesthesia: Pro damned if you don’t use opioids during surgery. European Journal of Anaesthesiology. 2019 Apr;36 (4):247–9.

Ozair E, Ali QE, Siddiqi MMH, Amir SH, Naaz S. A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation. Asian J Med Sci. 2018;9(1):65–72.

Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in enhanced recovery after surgery (ERAS) protocols for postoperative pain. Curr Pain Headache Rep. 2020;24(5).

Afshani N. Clinical application of dexmedetomidine. South African J Anaesth Analg. 2014;16(3):50–6.

Mahajan C, Rath GP, Singh GP, Mishra N, Sokhal S, Bithal PK. Efficacy and safety of dexmedetomidine infusion for patients undergoing awake craniotomy: An observational study. Saudi J Anaesth. 2018;12(2):235–39.

Moss E, Powell D, Gibson RM, Mcdowall DG. Effects of fentanyl on intracranial pressure and cerebral perfusion pressure during hypocapnia. Br J Anaesth. 1978 ;50(8):779–84.

Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications Curr Opin Anaesthesiol. 2008;21(4):457–61.




DOI: https://doi.org/10.24244/jni.v11i2.463

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DOI:  https://doi.org/10.24244/jni 

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