Prima, dr. Dian and dr. Ruddi Hartono, Sp.An-TI, FCTA, Subsp.An.O.(K) and dr. Taufiq Agus Siswagama, Sp.An-TI.,Subsp..M.N. (K) (2024) Hubungan Antara Faktor Risiko dan Kejadian Mual Muntah Paska Anestesi Spinal Serta Outcome Fetomaternal Pada Operasi Seksio Sesarea Elektif di Indonesia : Bagian dari Studi Multisenter Anestesi Obstetri. Magister thesis, Universitas Brawijaya.
Abstract
Dalam tiga dekade terakhir, angka Seksio Cesarea meningkat signifikan dari 7% pada tahun 1990 menjadi 21%, melewati angka ideal Seksio cesarea yaitu 10-15% menurut World Health Organization (WHO). Di Indonesia menurut data dari Riset Dasar Kesehatan (RISKESDAS) tahun 2018 melaporkan bahwa 17,6% persalinan dilakukan dengan metode Seksio cesarea, dengan proporsi tertinggi pada DKI Jakarta sebanyak 31,1%, diikuti oleh Bali sebanyak 30,2%, dan Sumatera Utara sebanyak 23,9%. Anestesi neuraksial spinal merupakan metode anestesi yang diterima luas untuk memberikan blokade sensorik dan motorik yang cepat, simetris, dan dalam. Akan tetapi anestesi spinal berhubungan dengan beberapa efek samping, salah satunya yaitu mual dan muntah. Secara keseluruhan, pasien obstetri lebih rentan mengalami kejadian mual dan muntah dibandingkan operasi lainnya. Akan tetapi, penelitian yang menganalisis mengenai kejadian mual dan muntah paska anestesi spinal pada pasien SC di Indonesia masih terbatas. Penelitian ini bertujuan untuk menggambarkan kejadian mual muntah paska anestesi spinal pada operasi Seksio sesarea Elektif di Indonesia serta luaran pada ibu dan bayi akibat insiden tersebut. Penelitian dilakukan untuk mengetahui hubungan antara faktor risiko terhadap kejadian mual dan muntah paska anestesi spinal pada ibu hamil yang menjalani operasi seksio sesarea dan hasil luaran fetomaternal pada rumah sakit di Indonesia. Penelitian ini merupakan bagian dari penelitian multisenter anestesi obstetrik yang besifat studi retrospektif observasional cross sectional. Pengumpulan data dilakukan pada periode Februari 2022 – April 2022 dan diinput menggunakan aplikasi REDCAP. Data dianalisa menggunakan aplikasi SPSS dan PLS. Subyek penelitian ini berjumlah 1138 pasien dari 64 Rumah sakit di Indonesia. Insiden kejadian mual durante operasi didapatkan sebesar 3,7%, muntah durante operasi 0,6%, dan PONV post operasi sebesar 0,3%. Faktor risiko maternal yang diteliti berupa usia ibu, BMI ibu, dan jumlah kehamilan dan tidak ditemukan hubungan bermakna antara faktor risiko tersebut dengan kejadian mual muntah paska anestesi spinal. Faktor risiko tindakan anestesi yang diteliti berupa jenis jarum spinal, ukuran jarum spinal, teknik barbotage, dan obat adjuvan. Didapatkan hubungan bermakna antara kejadian mual muntah paska anestesi spinal dengan ukuran jarum spinal (p value <0,05) serta didapatkan hubungan bermakna kejadian muntah dan hasil luaran ibu berupax Hipotensi 18 pasien (mual) 15,4% (p value <0,05) 10 pasien (muntah) 8,5% (p value <0,05), morbiditas ibu 4 pasienn 4,9% (p value <0.05) dan mortalitas ibu 1 pasien (33,3%) (p value <0,05). Tidak didapatkan hubungan bermakna antara kejadian mual munntah paska anestesi spinal dengan hasil luaran bayi. Faktor risiko tindakan berupa jenis jarum spinal memiliki hubungan yang bermakna terhadap kejadian mual dan muntah paska anestesi spinal. Kejadian mual muntah paska anestesi spinal memiliki hubungan bermakna terhadap kejadian hipotensi, morbiditas dan mortalitas ibu.
English Abstract
In the last three decades, the cesarean section rate has significantly increased from 7% in 1990 to 21%, surpassing the ideal cesarean section rate of 10-15% as recommended by the World Health Organization (WHO). In Indonesia, according to data from the Basic Health Research (RISKESDAS) in 2018, it was reported that 17.6% of deliveries were conducted via cesarean section, with the highest proportion in DKI Jakarta at 31.1%, followed by Bali at 30.2%, and North Sumatra at 23.9%. Spinal neuraxial anesthesia is a widely accepted method for providing rapid, symmetrical, and deep sensory and motor blockade. However, spinal anesthesia is associated with several side effects, one of which is nausea and vomiting. Overall, obstetric patients are more susceptible to experiencing nausea and vomiting compared to other surgical procedures. However, research analyzing the incidence of nausea and vomiting following spinal anesthesia in cesarean section patients in Indonesia is still limited. This study aims to describe the occurrence of post-spinal anesthesia nausea and vomiting in elective cesarean section operations in Indonesia, as well as the outcomes for mothers and infants resulting from these incidents. The aim of this study is to determine the relationship between risk factors and the incidence of nausea and vomiting after spinal anesthesia in pregnant women undergoing cesarean section surgery and fetomaternal outcomes in hospitals in Indonesia. This study is part of a multicenter obstetric anesthesia research project that is a retrospective observational cross-sectional study. Data collection was conducted from February 2022 to April 2022 and inputted using the REDCAP application. The data were analyzed using SPSS and PLS applications. The study subjects consisted of 1138 patients from 64 hospitals in Indonesia. The incidence of nausea during surgery was 3.7%, vomiting during surgery was 0.6%, and postoperative nausea and vomiting (PONV) was 0.3%. Maternal risk factors studied included maternal age, maternal BMI, and number of pregnancies, and no significant relationship was found between these risk factors and the occurrence of post-spinal anesthesia nausea and vomiting. Anesthesia procedural risk factors studied included type of spinal needle, size of spinal needle, barbotage technique, and adjuvant drugs. A significant relationship was found between the occurrence of post-spinal anesthesia nausea and vomiting and the size of the spinal needle (p value <0.05), and a significant relationship was found between vomiting and maternal outcomes such as hypotension in 18 patients (nausea) 15.4% (p value <0.05), 10 patients (vomiting)xii 8.5% (p value <0.05), maternal morbidity in 4 patients 4.9% (p value <0.05), and maternal mortality in 1 patient (33.3%) (p value <0.05). No significant relationship was found between the occurrence of post-spinal anesthesia nausea and vomiting and infant outcomes. Procedural risk factors such as the type of spinal needle have a significant relationship with the occurrence of nausea and vomiting after spinal anesthesia. The occurrence of nausea and vomiting after spinal anesthesia has a significant relationship with the occurrence of hypotension, maternal morbidity, and mortality.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0424060056 |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | Unnamed user with username nova |
| Date Deposited: | 06 Sep 2024 07:38 |
| Last Modified: | 06 Sep 2024 07:38 |
| URI: | http://repository.ub.ac.id/id/eprint/225424 |
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