Kardiomiopati peripartum adalah salah satu penyebab dari kardiomiopati dilatasi yang timbul pada waktu akhir trimester tiga kehamilan sampai 5 bulan kelahiran. Tanda karakteristik kardiomiopati peripatum adalah berkurangnya fraksi ejeksi ventrikel kiri dan berhubungan dengan gagal jantung kongesti, yang dapat meningkatkan resiko aritmia, tromboemboli dan henti jantung mendadak. Pengertian mendalam tentang fisiologi selama kehamilan dan patofisiologi penyakit jantung pada ibu sangat penting untuk dokter anestesi, dokter kandungan dan dokter jantung yang terlibat pada penanganan pasien PPCM selama periode kehamilan dan persalinan (perawatan peripartum). Penatalaksanaan kardiomiopati peripartum sebagian besar bersifat suportif. Tujuan terapi pada pasien dengan kardiomiopati peripartum adalah optimalisasi hemodinamik, mengoptimalkan preload, menurunkan afterload dan meningkatkan kontraktilitas. Keputusan jenis persalinan pasien dengan kardiomiopati peripartum harus dibuat berdasarkan indikasi obstetri. Pilihan tehnik anestesi yang akan digunakan disesuaikan dengan kondisi klinis ibu pada saat itu dengan memperhatikan efek obat terhadap ibu maupun janin. Baik tehnik anestesi umum maupun tehnik anestesi regional dapat digunakan untuk parturien dengan kardiomiopati peripartum. Pathophysiology and Management of Peripartum Cardiomyopathy Abstract Peripartum cardiomyopathy (PPCM) is a number of cause of dilated cardiomyopathy which occured during the end third trimester of pregnancy until the fifth months of birth. The characteristic sign of peripartum cardiomyopathy is reduced the ejection fraction of left ventricle and associated to congestive heart failure, increased risk of arrhythmia, thromboemboli and sudden cardiac arrest. A comprehensive understanding of the physiology of pregnancy and pathophysiology of maternal cardiac disease is importance for anesthesiologist, gynecologists and cardiologists involved in peripartum care in patients with peripartum cardiomyopathy during the pregnancy and childbirth periods. Management of peripartum cardiomyopathy is mostly supportive therapy. The goal of therapy in patients with peripartum cardiomyopathy is hemodynamic optimization, such as maintaining preload, reducing afterload and improving contractility. Decision of the mode of delivery of patient with peripartum cardiomyopathy hould be based on obstetric indication. The choice of anesthesia technique should consider the current clinical condition of parturient and the effect of the drug for the mother and fetus. Both general anesthesia and regional anesthesia techniques can be an option for parturients with peripartum cardiomyopathy.
Propofol has been frequently used as an induction and maintenance of general anesthesia. However, it often causes pain at the site of injection. Various premedications have been used to alleviate the propofol-induced pain, but the results does not satisfy. This study was conducted to compare the efficacy of ephedrine and lidocaine for reducing pain on injection of propofol in Indonesian adult surgical patients. This was a double-blind randomized controlled trial study conducted in Dr. Sardjito General Hospital, Yogyakarta and its affiliation hospitals. One hundred and twenty eight patients who underwent elective surgery with general anesthesia and met inclusion and exclusion criteria involved in this study. Patients were allocated into two groups with 64 patients of each group. The first group was patients who given lidocaine 2% 40 mg IV (lidocaine group) and the second group was patients who given ephedrine 30 ìg/kg BW IV (ephedrine group). Sixty seconds after lidocaine or ephedrine infusion, patients were then intravenously induced with propofol 2 mg/kg BW. Clinical pain intensity of patients in both groups was then scored and compared statistically using Chi-Square test. The results showed that no significantly different in pain intensity in group receiving lidocaine infusion in comparison with ephedrine infusion was observed (p=0.201). Moreover, no significantly different in the incidence of pain in both groups was observed (p=0.068). However, clinically ephedrine has the ability to eliminate the pain on propofol injection more better than lidocaine as indicated by lower pain incidence in group receiving ephedrine (7.8%) than in group receiving lidocaine (18.7%). Patients who have no pain were also higher in group receiving ephedrine (92,2%) than in group receiving lidocaine (81.3%). In conclusion, the efficacy of ephedrine 30 µg/kg BW IV and lidocaine 2% 40 mg IV was comparable for reducing pain on injection of propofol in Indonesian adult surgical patients. ABSTRAKPropofol sering digunakan untuk menginduksi dan mempertahankan anestesi umum. Namun demikian propofol sering menyebabkan nyeri pada tempat penyuntikan. Berbagai obat premedikasi telah digunakan untuk meredakan nyeri akibat induksi propofol, namum hasilnya masih belum memuaskan. Penelitian ini dilakukan untuk membandingkan efektivitas efedrin dengan lidokain untuk menurunkan nyeri pada penyuntikan propofol pada pasien bedah dewasa Indonesia. Penelitian ini merupakan penelitian klinik menggunakan rancangan uji terkontrol plasebo secara acak tersamar ganda yang dilakukan di RSUP Dr. Sardjito, Yogyakarta dan rumah sakit afiliasi. Seratus dua puluh delapan pasien yang menjalani bedah elektif dengan anestesi umum dan memenuhi kriteria inklusi dan eksklusi terlibat dalam penelitian ini. Pasien dibagi dalam dua kelompok masing-masing kelompok 64 pasien. Kelompok pertama (kelompok lidokain) adalah 21 Mujahidin et al., Comparison of the efficacy of ephedrine and lidocaine for reducing pain on propofol injection in Indonesian adult surgical patients...
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