Oleh Admin Kalbe Medical pada April 10, 2017 07:30

Dosis HES untuk Caesarean Section

Anestesi spinal merupakan metode anestesi yang paling sering digunakan pada caesarean section karena onset kerja yang cepat dan risiko yang sangat minimal pada janin. Kerugian dari metode anestesi ini adalah durasi kerja yang terbatas dan insidens hipotensi yang tinggi. Hipotensi merupakan hal yang merugikan pada keadaan hamil karena dapat menyebabkan fetal distress dan turunnya APGAR score. Kejadian hipotensi pada caesarean section dengan anestesi spinal dapat diatasi dengan penambahan cairan intravena atau dengan obat-obatan seperti phenylephrine. Meskipun demikian, tentunya kejadian hipotensi tersebut lebih baik dicegah daripada diatasi. Salah satu metode yang sering dilakukan ialah dengan melakukan preloading cairan sebelum anestesi spinal dilakukan pada caesarean section.

Hydroxyethyl Starch (HES) sebagai cairan preloading sebelum anestesi spinal pada caesarean section telah terbukti lebih unggul dibandingkan ringer’s lactate dan NaCl 0,9% dalam mencegah terjadinya hipotensi setelah pemberian anestesi spinal. Namun, HES juga memiliki kerugian berupa efek negatif terhadap fungsi ginjal. Pada studi yang membandingkan HES dengan Gelatin, efek negatif ini dikaitkan dengan dosis koloid yang digunakan. Efek negatif terhadap ginjal dapat dikurangi dengan meminimalisir dosis HES yang digunakan.


Suatu studi dilakukan untuk menentukan minimum effective fluid volume (MEFV) HES 130/0,4 yang diberikan dengan cara preload sebelum anestesi spinal untuk mencegah hipotensi pada 50% pasien yang menjalani caesarean section dengan anestesi spinal. Studi ini merupakan studi prospektif, tersamar ganda, dan studi pencarian dosis menggunakan up-down sequential allocation design. Dosis HES awal yang digunakan adalah 500 mL yang diberikan 10 menit sebelum anestesi spinal. Dosis tersebut disesuaikan lagi untuk pasien selanjutnya dengan tujuan mendapatkan dosis optimum yang dapat mencegah hipotensi sistolik (<80%) pada 50% subjek. Pada hasil studi ini dicantumkan bahwa MEFV HES untuk mencegah hipotensi pada 50% subjek adalah sekitar 700 mL (733 mL). Dosis tersebut diberikan sebelum anestesi spinal yang akan menghasilkan peningkatan stroke volume dan cardiac output


Simpulan:

Penggunaan HES sebagai cairan pre-loading pada caesarean section telah terbukti efektif untuk mencegah terjadinya hipotensi pasca anestesi spinal. Efek samping HES terhadap ginjal dikaitkan dengan dosis yang digunakan. MEFV HES untuk mencegah hipotensi pada 50% subjek adalah sekitar 700 mL (733 mL). (AHA)

Image : Ilustrasi
Referensi:
1.Alimian M, Mohseni M, Sefaeian R, Faiz SHR, Majedi MA. Comparison of Hydroxyethyl starch 6% and crystalloids for proloading in elective caesarean section under spinal anathesia. doi: 10.5455/medarh.2014.68.279-281.
2.Albrecht FW, Glas M, REnsing H, Milles DK, Volk T, Mathes AM. A change of colloid from hydroxyethyl stach to gelatin does not reduce rate of renal failure or mortality in surgical critical care patients: results of a retrospective study. Doi: 10.1016/j/jcrc.2016.07.005.
3.Lubert C, Gagnon PO, Fernando R. Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using a prophylactic phenylephrine infusion: An up-down sequential allocation study.

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