Willianto, Andreas and dr. Isngadi, , M.Kes, Sp.An-TI, Subsp.An. O. (K) and dr. Ruddi Hartono, Sp.An-TI, Subsp. An.O.(K) (2023) Faktor risiko kejadian hipotensi paska anestesi spinal dan hasil luaran fetomaternal pada pasien yang menjalani operasi seksio sesarea elektif di Indonesia : bagian dari Studi Multisenter Anestesi Obstetri. Magister thesis, Universitas Brawijaya.
Abstract
Latar belakang: WHO (World Health Organization) melaporkan pada tahun 2011 rerata angka seksio sesarea berkisar antara 5 – 15% per 1000 kelahiran. Angka kelahiran dengan metode operasi seksio sesarea di Indonesia sebesar 9,8% dari total 49.603 kelahiran pada tahun 2010 hingga 2013.Teknik anestesi spinal menjadi pilihan utama untuk operasi seksio sesarea. Angka kejadian hipotensi setelah anestesi spinal berkisar 25-75% dan lebih tinggi pada wanita hamil terkait perubahan fisiologis saat kehamilan. Beberapa faktor risiko dikaitkan dengan kejadian hipotensi paska anestesi spinal tersebut dapat berupa faktor risiko maternal dan faktor risiko dari tindakan anestesi. Sampai saat ini belum ada penelitian yang membahas insiden hipotensi paska anestesi spinal dan faktor risiko yang berhubungan serta hasil luaran fetomaternanya dalam skala nasional, oleh karena itu dilakukan penelitian ini. Tujuan: Mengetahui insidensi dan faktor risiko kejadian hipotensi paska anestesi spinal pada ibu hamil yang menjalani operasi seksio sesarea secara elektif serta hasil luaran fetomaternal pada rumah sakit di Indonesia. Metode: Penelitian ini merupakan bagian dari penelitian multisenter anestesi obstetrik yang besifat studi prospektif observasional cross sectional. Subyek penelitian adalah wanita hamil yang menjalani seksio sesarea secara elektif. Variabel yang diteliti berupa faktor risiko maternal (usia ibu, BMI, jumlah kehamilan, dan penyakit komrobid ibu), faktor risiko tindakan anestesi (jenis jarum spinal, ukuran jarum spinal, teknik barbotage, obat adjuvan spinal, dan obat premedikasi), hasil luaran bayi (APGAR Score), dan hasil luaran ibu (morbiditas dan mortalitas). Pengumpulan data dilakukan pada periode Februari 2022 – April 2022 dan diinput menggunakan aplikasi REDCAP. Data dianalisa menggunakan aplikasi SPSS dan PLS. Hasil: Dari 475 pasien yang diteliti, sebanyak 30 pasien (6,3%) mengalami kejadian hipotensi paska anestesi spinal. Variabel yang meningkatkan risiko terjadinya hipotensi paska anestesi spinal berupa nilai BMI>30 (p value 0,017; OR 1,87). Pasien yang mengalami hipotensi paska anestesi spinal mempunyai angka morbiditas 6,7% (p value <0.05) dan mortalitas 0,4% (p value <0,05). Tidak didapatkan perubahan APGAR Score pada bayi baru lahir dari ibu yang mengalami hipotensi paska anestesi spinal. Kesimpulan: Angka kejadian hipotensi paska anestesi spinal pada penelitian ini sebesar 6,3%. Faktor risiko maternal berupa nilai BMI>30 meningkatkan risiko kejadian hipotensi paska anestesi spinal. Kejadian hipotensi paska anestesi spinal memperburuk hasil luaran ibu berupa meningkatnya morbiditas dan mortalitas. Kejadian hipotensi paska anestesi spinal tidak memiliki pengaruh terhadap hasil luaran bayi.
English Abstract
Background: WHO (World Health Organization) reported that in 2011 the average cesarean section rate ranged from 5-15% per 1000 births. The birth rate by cesarean section in Indonesia is 9.8% of a total of 49,603 births from 2010 to 2013. Spinal anesthesia is the main choice for cesarean section. The incidence of hypotension after spinal anesthesia ranges from 25-75% and is higher in pregnant women due to physiological changes during pregnancy. Some of the risk factors associated with the occurrence of hypotension after spinal anesthesia can be maternal risk factors and risk factors from anesthesia. Until now there has been no study that discusses the incidence of hypotension after spinal anesthesia and its associated risk factors and fetomatern outcomes on a national scale, therefore this study was conducted. Aim: To determine the incidence and risk factors for hypotension after spinal anesthesia in pregnant women undergoing elective cesarean section and fetomaternal outcomes in hospitals in Indonesia. Methods: This study is part of a multicenter obstetrical anesthesia study which is a prospective cross-sectional observational study. The research subjects were pregnant women who underwent elective cesarean section. The variables studied were maternal risk factors (maternal age, BMI, number of pregnancies, and maternal comorbidities), risk factors for anesthesia (type of spinal needle, size of spinal needle, barbotage technique, spinal adjuvant drugs, and premedication), infant outcomes (APGAR Score), and maternal outcomes (morbidity and mortality). Data collection was carried out in the period February 2022 – April 2022 and input using the REDCAP application. Data were analyzed using SPSS and PLS applications. Results: Of the 475 patients studied, 30 patients (6.3%) experienced hypotension after spinal anesthesia. The variable that increases the risk of developing hypotension after spinal anesthesia is a BMI > 30 (p value 0.017; OR 1.87). Patients who experienced hypotension after spinal anesthesia had a morbidity rate of 6.7% (p value <0.05) and a mortality rate of 0.4% (p value <0.05). There was no change in APGAR score in newborns of mothers who experienced hypotension after spinal anesthesia. Conclusion: The incidence of hypotension after spinal anesthesia in this study was 6.3%. Maternal risk factors in the form of BMI values> 30 increase the risk of developing hypotension after spinal anesthesia. The incidence of hypotension after spinal anesthesia exacerbates maternal outcomes in the form of increased morbidity and mortality. The occurrence of hypotension after spinal anesthesia has no effect on the outcome of the baby.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0423060019 |
| Uncontrolled Keywords: | Hipotensi, anestesi spinal, faktor risiko |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.9 Operative surgery and special fields of surgery > 617.96 Anesthesiology |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 03 Nov 2023 02:25 |
| Last Modified: | 03 Nov 2023 02:25 |
| URI: | http://repository.ub.ac.id/id/eprint/204283 |
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