KESIMPULAN SARAN KESIMPULAN DAN SARAN

BAB 6 KESIMPULAN DAN SARAN

6.1 KESIMPULAN

1. Penggunaan lokal anestesi bupivakain 0.5 10 mg hiperbarik memiliki efek analgesia yang sama dengan bupivakain 0.5 15 mg. 2. Penggunaan lokal anestesi bupivakain 0.5 10 mg hiperbarik pada operasi bedah sesar resiko hipotensinya lebih rendah dari 15 mg. 3. Penggunaan dosis bupivakain 0.5 10 mg memiliki masa pemulihan motorik yang sama dengan 15 mg pada 2 jam post operasi.

6.2 SARAN

1. Penggunaan lokal anestesi bupivakain 0.5 10 mg sebagai alternatif untuk menurunkan resiko hipotensi yang terjadi pada pasien bedah sesar yang dilakukan spinal anestesi. 2. Perlu dilakukan penelitian lebih lanjut untuk meneliti apakah dosis kurang dari 10 mg dapat lebih mencegah terjadinya hipotensi. 3. Dengan melakukan preloading, koloding dan penggunaan vasopresor dapat lebih mengurangi terjadinya hipotensi. Universita Sumatera Utara DAFTAR PUSTAKA 1. Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology. 1982;56:68-70 2. Yu SC, Ngan Kee WD, Kwan ASK. Addition of meperidine to bupivacaine for spinal anaesthesia for caesarean section. Br J Anaesth. 2002;883:379-83 3. Mebazaa MS, Ouerghi S, Meftah RB, Cheikh MB, Mestiri T, Ammar MBS. Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve materna l sat isfaction by reducing incidence of low blood pressure episodes. M.E.J. Anesth. 2012;20 5:673-8 4. Morgan P. Spinal anaesthesia in obstetrics. Can J Anaesth. 1995;4212:1145-63 5. Magalhães E, Govêia CS, Ladeira LCA, Nascimento BG, Kluthcouski SMC. Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus. Rev Bras Anestesiol. 2009;591:11-20 6. Bintartho A, Pryambodho, Susilo. Keefektifan anestesia spinal menggunakan bupivakain 0.5 hiperbarik 7.5 mg ditambah fentanil 25 Universita Sumatera Utara mcg dibandingkan dengan bupivakain 0.5 hiperbarik 12.5 mg pada bedah sesar. Anestesia Critical Care. 2010;282:9 7. Langesæter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008; 1095: 856-63 8. Carvalho B, Collins J, Drover DR, Ralls LA, Riley ET. ED50 and ED95 of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology. 2011;1143:529–35 9. Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for caesarean delivery: systematic review and meta-analysis. Br J Anaesth. 2011;7:1-11 10. Al-Abdulhadi O, Biehl D, Ong B, Boker A. Hyperbaric spinal for elective cesarean section: Ropivacaine vs Bupivacaine. M.E.J. Anesth. 2007;192:385-97 11. Subedi A, Tripathi M, Bhattarai BK, Gupta PK, Pokharel K, Regmi MC. The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section. J Nepal Med Assoc. 2011;51181:1-6 12. Harsooor SS, Vikrant MS. Spinal anaesthesia with low dose bupivacaine with fentanyl for caesarean section. SAARC J Anesth. 2008;12:142-5 Universita Sumatera Utara 13. Gautier P, Kock MD, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003;915:684-9 14. Santos A, Pedersen H, Finster M, Edstrom H. Hyperbaric bupivacaine for spinal anesthesia in cesarean section. Anesth Analg. 1984;63:1009-13 15. Chung CJ, Bae SH, Chae KY, Chin YJ. Spinal anaestesia with 0,25 hyperbaric bupivacaine for caesarean : effects of volume. Br J Anaesth. 1996;77:145-9 16. Sarvela PJ, Halonen PM, Korttila KT. Comparison of 9 mg of intrathecal plain and hyperbaric bupivacaine both with fentanyl for cesarean delivery. Anest Analg. 1999;89:1257-62 17. Lamacraft G. Complications associated with regional anaesthesia for caesarean section. South Afr J of Anaesth Analg. 2004;2:15-20 18. Mazul-Sunko B. Low-dose spinal versus epidural anaesthesia for delivery and expected caesarean section. Period biol. 2011;1132:275-7 19. Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE, Baraka AS. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Anesth Analg. 2002;95:209–13 20. Liu SS. Current issues in spinal anesthesia. Can J Anesth. 2002;496:R1–R5 Universita Sumatera Utara 21. Cardiovascular effects of spinal anaesthesia. Covino BG, Scott DB, Lambert D H, penyunting. Dalam: Hand Book of Spinal Anaesthesia and Analgesia. Mediglobe;1994. h.59-94 22. Bernards CM. Epiduran and spinal anesthesia. Dalam : Barash PG, Cullen BF, Stoelting RK, penyunting. Clinical Anesthesia. Edisi 5. Lippincott Williams Wilkins;2006.h.692-718 23. McIntyre. Regional anesthesia safety. Finucane BT, penyunting. Dalam: Complications of Regional Anesthesia. Edisi 2. Canada: Springer;2007. h.1-262 24. Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. Edisi 4. LANGE. h.263-89 25. Update in Anaesthesia 1998 : Spinal Anaesthesia in Obstetrics : issue 12 2000 Article 8: Page 1- 7 26. Warren DT, Liu SS. Longnecker DE, Brown DL, Newman MF, Zapol WM, penyunting. Dalam : Anesthesiology. New York:Mc Graw Hill;2008. h.978-1008 27. Physiology of pregnancy. Yentis S, May A, Malhotra S, penyunting. Dalam : Analgesia, Anaesthesia and Pregnancy : A Practical Guide. Edisi 2. Cambridge: Cambridge University Press;2007. h.27-31 28. DAngelo R, Thomas JA. Regional analgesia in obstetrics. Palmer CM, DAngelo R, Paech MJ, penyunting. Dalam : Handbook Of Obstetric Anesthesia. British: BIOS Scientific Publishers Ltd;2002. h.41-68 Universita Sumatera Utara 29. Maternal physiological changes during pregnancy, labor, and the postpartum period. Datta S, penyunting. Dalam : Obstetric Anesthesia Handbook. Edisi 4. USA: Springer; 2006. h.1-210 30. Clift J. Maternal physiology and obstetrics. Clift J, Heazell A, penyunting. Dalam : Obstetrics for Anaesthetists. Cambridge: Cambridge University Press;2008. h.1-10 31. Lou L, Sabar R, Kaye AD. Local Anasthetics. Raj PR, penyunting. Dalam : Textbook of Regional Anesthesia. USA: Churchill Livingstone; 2001. h.200-43 32. Brown J. Recent developments in anaesthesia for caesarean section . McCormick, penyunting. Dalam : Update in anesthesia. UK: Torbay Hospital; 2007. h. 2-35 33. Complications, questions, and future trend. Malamed SF, penyunting. Dalam : Handbook of Local Anesthesia. Edisi 4. USA: Mosby; 1997. h.246-258 34. Hocking G, Wildsmith JAW. Intrathecal drug spread. Br J Anaesth. 2004;934:568–78 35. Yurtlu BS, Hanci V, Okyay RD, Bostankolu SE, Kayhan GE, Hakimoglu S, dkk. Effects on hypotension incidence: hyperbaric, isobaric, and combinations of bupivacaine for spinal anesthesia in cesarean section. Turk J Med Sci. 2012; 42 2: 307-13 36. Van De Velde M. Spinal anesthesia in the obstetric patient : prevention Universita Sumatera Utara and treatment of hypotension. Acta Anaesth Belg. 2006; 57:383-6 37. Mercier FJ. Fluid loading for cesarean delivery under spinal anesthesia: have we studied all the options?. Anesth Analg. 2011; 1134:677-80 38. Marciniak A, Wujtewicz M,Owczuk R.The impact of colloid infusion prior to spinal anaesthesia for caesarean section on the condition of a newborn — a comparison of balanced and unbalanced hydroxyethyl starch 1300.4. Anaesthesiol Intensive Ther. 2013;451:14–9 39. Riley ET, Cohen SE, Rubenstein AJ, Flanagan B Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated ringer’s solution. Anesth Analg. 1995; 81:838- 42 40. Jacob JJ, Williams A, Verghese M, Afzal L. Crystalloid preload versus crystalloid coload for parturients undergoing cesarean section under spinal anesthesia. Journal of Obstetric Anaesthesia and Critical Care. 2012; 2 1:10-5 41. Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol. 2010; 23:304–9 42. Lirk P, Haller I, Benzer A, Wong C A. Management of spinal anaesthesia- induced hypotension for cesarean delivery : a European survey. End report of survey to the European Society of Anaesthesiologists. Hal 1-21. 43. Iqbal MS, Ishaq M, Masood A, Khan MZ. Optimal dose of prophylactic Universita Sumatera Utara intravenous ephedrine for spinal-induced hypotension during cesarean section. Anaesth, Pain Intensive Care vol 14 2 p 1-5. Universita Sumatera Utara LAMPIRAN

1. Riwayat Hidup Peneliti

Nama : dr . Bastian Lubis Tempat Tgl Lahir : Lyon, 28 Desember 1984 Agama : Islam Alamat Rumah : Jl. Laksana no 15 Nama Ayah : dr. Asmin Lubis, Sp.An DAF, KAP, KMN Nama Ibu : Arneny Status : Menikah Nama Istri : dr. Putri Amelia, MKed Ped, Sp A Nama Anak : 1. Alisha Putri Lubis 2. M. Iqbal Ghazali Lubis Riwayat Pendidikan 1900 – 1996 : SD AL-ULUM 1996 – 1999 : SMP Bhayangkari 1 Medan 1999 – 2002 : SMU Negeri 1 Medan 2002 – 2008 : Fakultas Kedokteran USU Medan 2009 – Sekarang : PPDS-1 Anestesiologi dan Terapi Intensif FK – USU Medan Riwayat Pekerjaan 2010 – Sekarang : PNS KEMENDIKBUD Universita Sumatera Utara