Tesis

Kombinasi anestesi umum dan spinal dibandingkan anestesi umum terhadap kebutuhan opioid dan kestabilan MAP pada bedah laparoskopi abdomen = Combined General and Spinal Anesthesia vs. General Anesthesia: Impact on Opioid Requirements and MAP Stability in Laparoscopic Abdominal Surgery.

Latar Belakang: Tindakan pembedahan dengan invasi minimal seperti laparoskopi abdomen seringkali menjadi modalitas terpilih dengan perkembangan teknologi. Selama pembedahan, digunakan teknik anestesi umum pada pasien. Teknik anestesi yang ideal adalah teknik yang dapat menjaga kestabilan kardiovaskular dan respirasi, mengurangi kejadial mual muntah pascabedah, serta dapat mengurangi derajat nyeri pascabedah. Namun, prosedur laparoskopi menyebabkan perubahan fisiologis akibat kondisi pneumoperitoneum yang disebabkan oleh insuflasi gas karbon dioksida selama pembedahan, yang merupakan sebuah tantangan tambahan dalam pemberian anestesi yang ideal. Maka, penelitian ini bertujuan untuk membandingkan efektivitas penggunaan kombinasi anestesi umum dan spinal dengan anestesi umum saja dalam pembedahan laparoskopi abdomen. Metode: Penelitian ini merupakan uji klinik acak terkendali tanpa penyamaran pada pasien laparoskopi abdomen di Rumah Sakit Cipto Mangunkusumo. Pemberian anestesi umum menggunakan lidokain, fentanyl, propofol, dan rocuronium. Pemberian anestesi spinal menggunakan bupivakain 10 mg. Luaran yang dinilai berupa kebutuhan opioid intraoperatif, kestabilan MAP, nyeri pascabedah, dan kejadian post-operative nausea and vomiting (PONV). Hasil: Kombinasi anestesi umum dan spinal menyebabkan penurunan kebutuhan opioid fentanyl intraoperatif (p < 0.001), kestabilan MAP yang lebih baik (p < 0.009), dan penurunan nyeri pascabedah secara signifikan dibandingkan kelompok anestesi umum. Tidak terdapat perbedaan signifikan dari tingkat kejadian PONV. Simpulan: Kelompok anestesi umum dan spinal menunjukan penurunan kebutuhan opioid intraoperatif dan MAP yang lebih stabil pada tindakan laparaskopi dibandingkan dengan kelompok anestesi umum.
Kata kunci: Anestesi umum, anestesi spinal, laparoskopi abdomen.


Background: Minimally invasive surgical procedures such as laparoscopic abdominal surgery have often become the preferred modality with technological advancements. During surgery, general anesthesia techniques are employed in patients. The ideal anesthesia technique is one that can maintain cardiovascular and respiratory stability, reduce postoperative nausea and vomiting, and alleviate postoperative pain. However, laparoscopic procedures induce physiological changes due to pneumoperitoneum conditions caused by the insufflation of carbon dioxide gas during surgery, posing an additional challenge in achieving ideal anesthesia. Therefore, this study aims to compare the effectiveness of using a combination of general and spinal anesthesia with general anesthesia alone in laparoscopic abdominal surgery. Methods: This research is a controlled randomized clinical trial without masking on patients undergoing laparoscopic abdominal surgery at Cipto Mangunkusumo Hospital. General anesthesia is administered using lidocaine, fentanyl, propofol, and rocuronium, while spinal anesthesia is administered using bupivacaine. The assessed outcomes include intraoperative opioid requirements, MAP stability, postoperative pain, and the incidence of postoperative nausea and vomiting (PONV). Results: The combination of general and spinal anesthesia resulted in a significant reduction in intraoperative fentanyl opioid requirements (p < 0.001), better MAP stability (p < 0.009), and a significant decrease in postoperative pain compared to the general anesthesia group. There was no significant difference in the incidence of PONV. Conclusion: The combination of general and spinal anesthesia group showed decreased intraoperative opioid requirements and more stable in mean arterial pressure (MAP) during laparoscopic procedures compared to general anesthesia group.
Keywords: General anesthesia, spinal anesthesia, laparoscopic abdominal surgery.