Pengaruh Posisi Duduk Selama 3 Menit Setelah Induksi Spinal Anestesi terhadap Kejadian Hipotensi dan Bradikardi di RS PKU Muhammadiyah Gombong
DOI:
https://doi.org/10.55606/klinik.v5i1.5589Keywords:
Bradycardia, Hemodynamics, Hypotension, Sitting Position, Spinal AnesthesiaAbstract
Hypotension and bradycardia are common complications following spinal anesthesia due to extensive sympathetic blockade, which can lead to hemodynamic instability and decreased perfusion of vital organs. A simple non-pharmacological preventive measure is maintaining a sitting position immediately after induction to limit the upward spread of hyperbaric anesthetic agents toward the thoracic region. This study aimed to determine the effect of maintaining a sitting position for three minutes after spinal anesthesia induction on the incidence of hypotension and bradycardia at PKU Muhammadiyah Gombong Hospital. The research employed a quasi-experimental design with a pre–post test with control group approach involving 69 respondents selected through consecutive sampling. The intervention group (n = 34) maintained a sitting position for three minutes, while the control group (n = 35) was immediately placed in a supine position. Blood pressure and heart rate were observed at 5, 10, and 15 minutes after induction, and the data were analyzed using Chi-Square and binary logistic regression tests. The results showed that the incidence of hypotension and bradycardia was significantly lower in the intervention group (p < 0.05), indicating that the sitting position acted as a protective factor. In conclusion, maintaining a sitting position for three minutes after spinal anesthesia induction effectively reduces the incidence of hypotension and bradycardia and is recommended as a simple strategy to enhance patient hemodynamic stability.
References
Amin, N. F., Garancang, S., Abunawas, K., Makassar, M., Negeri, I., & Makassar, A. (2023). Konsep umum populasi dan sampel dalam penelitian. Jurnal Teknologi Pendidikan, 14(1), 15–31.
Befkadu, A., Timerga, S., Mihretu, F., Seyoum, F., & Alimawu, A. A. (2024). The sitting versus lateral position during induction of spinal anesthesia for elective cesarean delivery on block characteristics and severity of hypotension: A prospective randomized clinical trial. International Journal of Surgery Open, 62(4), 431–439. https://doi.org/10.1097/IO9.0000000000000091
Besha, A., Zemedkun, A., Tadesse, M., Hailu, S., Mossie, A., Shiferaw, A., Angasa, D., & Adamu, Y. (2023). Effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia: A randomized controlled trial. Journal of Pain Research, 16, 3545–3558. https://doi.org/10.2147/jpr.s428314
Bhattacharjee, A. (2020). Experimental designs: Two-group experimental designs.
Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2022). Morgan & Mikhail’s Clinical Anesthesiology (6th ed.). McGraw-Hill Education.
Djari, T. O. S., Artawan, I. M., Woda, R. R., Sihotang, J., & Riwu, M. (2021). Pencegahan kejadian hipotensi pasca anestesi spinal pada pembedahan seksio sesarea. Cendana Medical Journal (CMJ), 9(1), 72–76. https://doi.org/10.35508/cmj.v9i1.4938
Elagamy, A. E., Kamaly, A. M., Shahin, M. I., & Saleh, M. (2021). Norepinephrine versus ephedrine for hypotension prophylaxis during cesarean section under spinal anesthesia. Ain-Shams Journal of Anesthesiology, 13(1). https://doi.org/10.1186/s42077-020-00124-4
El-Hakeem, E. E. A., Kaki, A. M., Almazrooa, A. A., Al-Mansouri, N. M., & Alhashemi, J. A. (2019). Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for cesarean delivery: A randomized trial. Canadian Journal of Anesthesia, 58(12), 1083–1089. https://doi.org/10.1007/s12630-011-9593-4
Farooq, F., et al. (2020). Bezold–Jarisch reflex-mediated bradycardia during spinal anesthesia: A narrative review. PubMed Central.
Fasting, P., Agarkar, M., & Blanck, J. F. (2023). 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: Clear liquids with or without protein. Anesthesiology, 138(2), 132–151. https://doi.org/10.1097/aln.0000000000004381
Fauzan, R., Tavianto, D., & Sitanggang, R. H. (2016). Pengaruh duduk lima menit dibanding langsung dibaringkan pada pasien anestesi spinal dengan bupivakain hiperbarik terhadap tekanan arteri rata-rata. Jurnal Anestesi Perioperatif, 4(1), 50–55. https://doi.org/10.15851/jap.v4n1.746
Ghozali, I. (2016). Aplikasi analisis multivariate dengan program IBM SPSS 23. Semarang: Badan Penerbit Universitas Diponegoro.
Hendrik. (2022). Gambaran kejadian hipotensi pada pasien intra operasi dengan anestesi spinal di RSUD Undata Palu Sulawesi Tengah.
Kementerian Kesehatan RI. (2022). Pedoman nasional pelayanan kedokteran tata laksana anestesiologi dan terapi intensif. Jakarta: Kemenkes RI.
Kolarkar, P., Badwaik, G., Pahuja, H., Watve, A., Kalbande, J., Bhalerao, A., & Bhangale, N. (2019). Influence of prolonged sitting position on effects of spinal anaesthesia on caesarean delivery: A randomized controlled trial. Journal of Evolution of Medical and Dental Sciences, 3(33), 8860–8869. https://doi.org/10.14260/jemds/2014/3135
Kwofie, M. K., et al. (2018). The influence of patient positioning on the spread of spinal anesthesia: A clinical review. Anesthesia & Analgesia, 117(1), 125–129.
Li, X., et al. (2012). Incidence and risk factors of bradycardia following spinal anesthesia. Journal of Clinical Anesthesia, 24(4), 289–295.
Mayhew, D., Mendonca, V., & Murthy, B. V. S. (2019). A review of ASA physical status – historical perspectives and modern developments. Anaesthesia, 74(3), 373–379. https://doi.org/10.1111/anae.14569
Morgan, G. (2019). Anesthesia for patients with neuromuscular disease. USA: Churchill Livingstone.
Nika, F. S., Sukmaningtyas, W., Burhan, A., & Yantoro, A. T. (2023). Kejadian hipotensi pada pasien dengan anestesi spinal. Jurnal Keperawatan Anestesi Indonesia, 9(2), 102–108.
Ninda. (2019). Pengaruh posisi duduk selama tiga menit setelah induksi spinal anestesi terhadap kejadian hipotensi pada pasien di RSUD dr. Soedirman Kebumen.
Notoatmodjo, S. (2020). Metodologi penelitian kesehatan (5th ed.). Jakarta: Rineka Cipta.
Patel, R. K., & Singh, A. K. (2022). Gender-based differences in cardiovascular autonomic regulation and implications in anesthesia practice. International Journal of Cardiology, 343, 180–186.
Pranandaru, A., Sebayang, S. M., & Yudono, D. T. (2024). Pengaruh coloading terhadap perubahan tekanan darah pada pasien spinal anestesi. Madani: Jurnal Ilmiah Multidisipline, 2(9), 24–31.
Rehatta, E. H. A. R. T. I. S., Soenarto, D. Y. B., & Mayangsari, I. L. N. M. (2019). Anestesiologi dan terapi intensif.
Rizki, A. N. (2021). Anestesi low-dose spinal dan epidural pada pasien syok hemoragik dengan suspek COVID-19. Journal of Anaesthesia and Pain, 2(1), 48–55. https://doi.org/10.21776/ub.jap.2021.002.01.06
Salinas, F. (2019). Spinal anesthesia: A practical approach to regional anesthesia (4th ed.). New York: Lippincott Williams & Wilkins.
Shelina. (2021). Gambaran hipotensi, bradikardia, dan mual muntah pasca operasi dengan anestesi spinal pada seksio sesarea di RSU Kota Tangerang Selatan tahun 2020.
Simon, G., Veering, B. T., Stienstra, R., Van Kleef, J. W., & Burm, A. G. (2018). The effects of age on neural blockade and hemodynamic changes after epidural anesthesia with ropivacaine. Anesthesia & Analgesia, 94(5), 1325–1330. https://doi.org/10.1097/00000539-200205000-00052
Sugiyono. (2019). Metode penelitian kuantitatif, kualitatif, dan R&D (14th ed.). Bandung: Alfabeta.
Tanambel, P., Kumaat, L., & Lalenoh, D. (2021). Profil penurunan tekanan darah (hipotensi) pada pasien sectio caesarea yang diberikan anestesi spinal dengan bupivakain. E-Clinic, 5(1), 1–6. https://doi.org/10.35790/ecl.5.1.2017.15813
Tobiin, D., et al. (2024). Pengaruh duduk dua menit pasca induksi spinal terhadap kejadian hipotensi intra anestesi pada seksio sesarea. Jurnal Keperawatan Anestesi, 6(11), 2597–2606.
Umifa, K. N., & Samosir, T. A. (2024). Spinal anestesi pada pasien sectio caesarea di RSU Mitra. Jurnal Ilmiah Kesehatan, 5, 3034–3044. https://doi.org/10.31004/jkt.v5i2.27189
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