Oleh Admin Kalbe Medical pada October 23, 2012 06:15

Dexmedetomidine sebagai Alternatif Premedikasi Anestesi pada Anak

Menghilangkan kecemasan pra- dan pascaoperasi merupakan perhatian utama khususnya untuk spesialis anastesis anak. Kecemasan dapat menghasilkan reaksi agresif, meningkatkan stres, dan kesulitan dalam tatalaksana nyeri pascaoperasi. Golongan benzodiazepine, seperti midazolam, seringkali digunakan sebagai terapi pra-anestesi pada anak sebelum operasi. Midazolam memiliki beberapa keuntungan, seperti efek sedasi, onset cepat, dan durasi kerja yang terbatas. Akan tetapi, penggunaan midazolam belum merupakan terapi yang ideal oleh karena efek samping yang ditimbulkan, seperti restlessness, gangguan kognitif, amnesia, dan depresi napas.

Terdapat golongan α2-agonist baru yang dapat digunakan sebagai alternatif dari midazolam, yaitu dexmedetomidine. Dexmedetomidine memiliki efek sedasi dan analgesik, serta menghindari terjadinya efek depresi napas. Karakteristik ini dapat memiliki potensi untuk digunakan sebagai premedikasi anestesi yang baik.

Sebuah studi dilakukan secara acak dan tersamar ganda untuk membandingkan efek dari premedikasi anestesi dexmedetomidine intranasal dan midazolam oral. 120 pasien anak yang akan menjalankan pembedahan elektif adenotonsilektomi secara acak diberikan dexmedetomidine intranasal 1 μg/kg (kelompok D) atau midazolam oral 0,5 mg/kg (kelompok M) sebelum operasi. Beberapa parameter yang dinilai pada studi ini adalah efek sedasi praoperasi, perubahan tingkat kecemasan, dan kemudahan pelepasan antara anak dan orang tua sebelum operasi.

Berikut adalah hasil dari studi tersebut: Kelompok D memiliki tingkat efek sedasi yang lebih rendah secara bermakna jika dibandingkan dengan kelompok M (p=0,042). Tingkat kecemasan lebih rendah pada kelompok D secara bermakna jika dibandingkan dengan kelompok M (p=0,036). Kemudahan pelepasan anak dan orang tua lebih mudah secara bermakna pada kelompok D jika dibandingkan dengan kelompok M (p=0,029). Waktu yang diperlukan untuk mencapai skor Aldrete 10 sebanding antara kedua kelompok (p=0,067). Jumlah anak yang memerlukan rescue analgesik fentanyl lebih rendah secara bermakna pada kelompok D jika dibandingkan dengan kelompok M (p=0,027).

Kesimpulan: Dexmedetomidine memiliki efektivitas yang sebanding dalam hal menurunkan kecemasan praoperasi dan efek sedasi yang bekerja secara sinergis dengan agen anestesi jika dibandingkan dengan terapi standar midazolam. Parameter perbedaan efek samping tidak disebutkan pada kedua studi tersebut. Dexmedetomidine dapat dijadikan alternatif premedikasi anestesi pada anak.(MAR)



Image: Ilustrasi
Referensi :
1. Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: A comparison of intranasal dexmedetomidine versus oral midazolam. Saudi J Anaesth. 2011;5(4):387-91.
2. Akin A, Bayram A, Esmaoglu A, Tosun Z, Aksu R, Altuntas R, et al. Dexmedetomidine vs midazolam for premedication of pediatric patients undergoing anesthesia. Paediatr Anaesth. 2012;22(9):871-6.

 

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Read What is Browsing hijacking And RemovaL tips for Gstatic Virus
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## Max Taranov
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## Max Taranov
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