Perbedaan Respon Hemodinamik terhadap Penambahan Clonidin 1 dan 2 mcg/kgbb pada Scalp Block untuk Operasi Kraniotomi

Abstract

Latar Belakang dan Tujuan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik seperti tekanan darah, tekanan arteri rata-rata (mean arterial pressure/MAP) dan laju nadi terutama pada waktu pemasangan pin, insisi kulit, dan insisi durameter pasien kraniotomi. Adjuvan sering ditambahkan pada anestesi lokal untuk memperkuat dan memperpanjang efek analgesia pada blok saraf tepi. Klonidin memiliki aksi yang sinergis dengan agen lokal anestesi. Dosis yang umum adalah 2 mcg/kgbb. Tujuan penelitian ini untuk mengetahui efektifitas penambahan klonidin 1 mcg/kg dan 2 mcg/kg pada blok scalp sebagai analgetik kraniotomi. Subjek dan Metode: Penelitian pada 30 pasien memenuhi kriteria inklusi. Subyek dibagi tiga kelompok, kelompok I: blok scalp dengan levobupivacain 0,25%, kelompok II: blok scalp ditambah klonidin 1 mcg/kg, dan kelompok III: blok scalp ditambah klonidin 2 mcg/kg. Semua pasien mendapatkan perlakuan anestesi umum sesuai standar kemudian dilakukan penilaian tekanan darah, MAP, laju nadi pada sebelum intubasi, pemasangan pin, insisi kulit dan insisi duramater. Hasil: Ada perbedaan signifikan penambahan klonidin dibandingkan dengan kelompok kontrol terutama pada laju nadi dan diastolik kraniotomi. Klonidin 2 mcg/kgbb pada beberapa waktu menunjukkan perbedaan signifikan dibandingkan dosis klonidin 1 mcg/kgbb. Simpulan: Penambahan klonidin pada blok scalp levobupivakain efektif dalam menjaga respon hemodinamik terutama laju nadi dan tekanan darah diastolik. Differences in Hemodynamic Response to 1 and 2 mcg/kgbw Clonidine Addition to Scalp Block Abstract Bacground and Objective: The addition of a levobupivacaine scalp block is effective in reducing hemodynamic responses such as blood pressure, mean arterial pressure (MAP) and pulse rate, especially when pinning, skin incisions, and durameter incisions in craniotomy. Adjuvants are often added to local anesthetics to enhance and prolong the analgesic effect of peripheral nerve blocks. Clonidine has a synergistic action with local anesthetic agents. Clonidine increases sensory and motor blocks in both peripheral and neuraxial blocks. The common dose is 2 mcg/kgbw. The aim of this study was to determine the effectiveness of adding clonidine 2 mcg/kg and 1 mcg/kg on scalp block as craniotomy analgesic. Subjects and Methods: Study on 30 patients met the inclusion criteria. Subjects were divided into three groups, group I: scalp block with levobupivacain 0.25%, group II: scalp block plus clonidine 1 mcg/kg, group III: scalp block plus clonidine 2mcg/kg. All patients were treated with general anesthesia according to the standard then assessed their blood pressure, MAP, pulse rate before intubation, pinning, skin incision and duramater incision. Results: There was a significant difference in the addition of clonidine with the control group, especially in the pulse and diastolic rates. Clonidine 2 mcg/kg at several times showed a significant difference compared to 1 mcg/kgbb dose. Conclusion: The clonidine addition to scalp block of levobupivacaine was effective in maintening hemodynamic responses, especially pulse rate and diastolic blood pressure.

Keywords

• blok scalp, klonidin, levobupivakain, kraniotomi