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Abstrak :
Latar Belakang. Propofol merupakan obat anestesi intravena yang paling sering digunakan dalam pembiusan umum tetapi propofol dapat menimbulkan rasa nyeri pada lokasi injeksi dengan angka kejadian 28-90%. Pemberian lidokain sebelumnya paling sering digunakan untuk mengurangi nyeri yang ditimbulkan propofol, akan tetapi tingkat kegagalannya 13-32. Tujuan penelitian ini adalah untuk mengetahui perbandingan pemberian pre-emptive ketamin 0,1 mg/kg dan lidokain 1 mg/kg untuk mengurangi derajat nyeri pada saat induksi anestesi menggunakan propofol. Metode. Penelitian ini merupakan uji klinis tersamar ganda, bersifat eksperimental. Pasien dengan kriteria klinis ASA I-II sejumlah 50 orang yang akan menjalani operasi elektif dengan pembiusan umum, dilakukan randomisasi sederhana menjadi 2 kelompok yaitu kelompok I (lidokain 1 mg/kg) dan kelompok II (ketamin 0,1 mg/kg) yang diberikan 1 menit sebelum induksi propofol. Derajat nyeri dinilai berdasarkan Verbal Rating Scale (VRS). Hasil. Penelitian menunjukkan pemberian pre-emptive ketamin dapat menurunkan derajat nyeri yang lebih baik (84% tidak nyeri, 16% nyeri ringan) dibandingkan kelompok pre-emptive lidokain (56% tidak nyeri, 28% nyeri ringan, 12% nyeri sedang dan 4% nyeri berat) dengan nilai p = 0.021 (p bermakna < 0.05) pada uji statistik menggunakan Mann Whitney. Kesimpulan. Pemberian pre-emptive ketamin 0.1 mg/kg BB intravena lebih baik dibandingkan dengan pemberian pre-emptive lidokain 1 mg/kg BB untuk mengurangi derajat nyeri akibat penyuntikan propofol intravena. ...... Background. Propofol is a popular IV anesthetic induction drug that causes pain when given IV. The incidence of which is between 28-90%. Lidocaine pre-treatment has been commonly proposed to decrease propofol induced pain, but its failure rate is between 13-32%. The purpose of this study was to compare a pre-emptive ketamine 0,1 mg/kg and pre-emptive lidocaine 1 mg/kg to minimize the injection pain of propofol during anesthesia induction. Methods. A comparative, randomized, double blind study of 50 patients (ASA I-II) scheduled surgery under general anesthesia were randomly allocated into two groups. Group I received lidocaine 1 mg/kg and group II received ketamine 0,1 mg/kg one minute before the anesthesia induction with propofol IV. Each patient’s pain score were evaluated by using Verbal Rating Scale (VRS) Result. The result of this study described that pre-emptive ketamine had significantly lower incidence of pain and lower pain score (84% no pain, 16% mild pain) compared with pre-emptive lidocaine (56% no pain, 28% mild pain, 12% moderate pain and 4% severe pain) with p value = 0.021 (significant p < 0.05) using Mann Whitney statistic test. Conclusion. Pre-emptive ketamine 0,1 mg/kg significantly in reducing degree of propofol pain injection compare with pre-emptive lidocaine 1 mg/kg IV.

Abstrak :
Latar belakang. Endoscopic retrograde cholangio pancreatography ERCP merupakan tindakan yang dapat menimbulkan rasa tidak nyaman dan nyeri pada pasien, sehingga diperlukan obat sedasi yang adekuat. Propofol dan ketamin adalah dua obat sedasi yang sering digunakan. Penambahan ketamin pada propofol dapat melawan efek depresi pernapasan dan kardiovaskular dari propofol. Kombinasi propofol dan ketamin ketofol telah digunakan sebagai obat sedasi pada berbagai prosedur medis. Namun, evaluasi efektivitas berbagai konsentrasi ketofol terkait perubahan hemodinamik, waktu pulih, dosis, dan efek samping belum banyak diteliti. Penelitian ini bertujuan untuk membandingkan efektivitas sedasi ketofol rasio 6:1 dengan rasio 4:1 pada ERCP. Metode. Penelitian ini merupakan uji klinis acak tersamar tunggal terhadap pasien yang menjalani ERCP di PESC RSCM pada bulan Maret-Mei 2017. Sebanyak 58 pasien diambil dan dirandomisasi menjadi dua kelompok. Kelompok K61 n=29 mendapat infus kombinasi propofol:ketamin 6:1, sedangkan kelompok K41 n=29 mendapat infus kombinasi propofol:ketamin 4:1. Kedalaman sedasi diukur menggunakan skor sedasi Ramsay. Analisis data menggunakan uji-t tidak berpasangan atau Mann-Whitney. Hasil. Rerata kebutuhan propofol antara ketofol 6:1 125,49 30,49 mcg/kg/mnt dan ketofol 4:1 121,28 28,94 mcg/kg/mnt tidak berbeda bermakna. Waktu pulih ketofol 6:1 6,55 0,5-19 mnt lebih cepat dibandingkan ketofol 4:1 11,37 4,9-20,53 mnt ......Background. Endoscopic retrograde cholangiopancreatography ERCP is a painful procedure that requires analgesic and sedative. Propofol and ketamine are common drugs that are used as sedative in ERCP. The addition of ketamine to propofol may counteract the cardiorespiratory depression caused by propofol. Ketofol, a combination of propofol and ketamine has been used as sedative in various medical procedures. However, evaluation of the effectiveness of different concentration of ketofol in procedural operation regarding changes in hemodynamic, recovery time, doses, and adverse effects was not yet studied. This study was conducted to compare the effectiveness of ketofol ratio of 6 1 with ratio of 4 1 in ERCP. Methods. This was a randomized, single blinded study in patients underwent ERCP in PESC RSCM during March May 2017. There were 58 subjects who were randomized into two groups. K61 group n 29 received an infusion of ketofol ratio of 6 1, whereas K41 group n 29 received an infusion of ketofol ratio of 4 1. Sedation level was measured with Ramsay sedation score. Data were analyzed by t test or Mann Whitney test.Results. The average requirement of propofol between K61 125,49 30,49 mcg kg min and K41 121,28 28,94 mcg kg min was not significantly different. Recovery time of K61 6,55 0,5 19 min was faster compare to K41 11,37 4,9 20,53 min . There were no desaturation and emergence delirium recorded in both groups. Hypotension was recorded in one patient in each group. Hypersalivation only reported in one patient 3.4 in K61 group, whereas in K41 group there were five patients who were reported have hypersalivation. The incidence of nausea vomiting in K61 group was 6 20.7 and in K41 group was 11 37.9 . The level of postoperative pain in both groups was not significantly different. Conclusion. Ketofol 6 1 was not more effective than ketofol 4 1 because the requirement of the drugs between both groups was not different, however ketofol 6 1 has faster recovery time and fewer adverse effects.