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Perbandingan Granisetron denganondansetron untuk pencegahanmual muntah pasca operasi pada

craniotomy: Sebuah studirandomized controlled tersamar

gandaAulia Risma Lestari

01211!!"

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#asalah

• $irstly% the incidence o& post craniotomy nausea and 'omiting isrelati'ely high ())*+0,-.

• Secondly% in addition to causing /uid and electrolyte imbalances%emesis may precipitate an increase in intracranial and cerebralintra'ascular pressures% eopardizing hemostasis and cerebral

per&usion.•  hirdly% depressed air3ay re/e4es in the immediate post*operati'e

period due to residual e5ect o& anesthetic drugs and in'ol'ement o&lo3er cranial ner'es augment the chances o& pulmonary aspiration.

• $ourthly% the need &or neurocogniti'e monitoring post*operati'elymakes use o& sedating antiemetic undesirable in these patients.

• 6o3e'er% the relati'e e7cacy o& granisetron compared 3ith theprototypical ondansetron has yet not been &ully elucidated inpatients undergoing electi'e craniotomy &or supratentorial andin&ratentorial brain tumors.

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 uuan

•  hus% a prospecti'e% randomized and double*blind clinical study 3as conducted to comparethe e7cacy and sa&ety o& combination o&

de4amethasone 3ith granisetron% ondansetronor normal saline (8S- &or P98 prophyla4isuntil ); h post craniotomy.

• <ntuk membandingkan e&ekti'itas dan

keamanan kombinasi de4amethason dengangranisetron ondansetron atau normal salineuntuk pencegahan mual muntah pasca operasisampai ); am pasca craniotomy.

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#etode Penelitian

=riteria eksklusi

• Patients 3ith Glasgo3 coma scale >1)%

• not e4tubated at the end o& surgery%

• on pre*operati'e antiemetic therapy%

• pre'ious history o& P98?motionsickness?Gastro esophageal re/u4disease

• history o& allergy to @6! antagonists

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=riteria inklusi:

• A&ter institutional thical Bommitteeappro'al and 3ritten in&ormed consent%

• +@ American Society o& Anesthesiologist(ASA- C D?DD?DDD adult patients o& either se4

• scheduled &or electi'e craniotomy &or

brain tumors 3ere enrolled in thepresent study.

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• A routine pre*anesthetic check*up 3as done &or all patients 3ith special re&erenceto history o& P98% smoking and opioid use.

• pre*medicated 3ith tablet (tab- ranitidine 1@0 mg and tab alprazolam 0.2@ mg 2 hbe&ore surgery.

• (BG- lead DD% (EP-% (Sp92- and capnography 3ere established and baseline (pre*

induction- measurements 3ere recorded.

• Fe4amethasone ; mg 3as gi'en to administered to all the patients at induction.• induced 3ith propo&ol 2*2.@ mg?kg and tracheal intubation &acilitated 3ith

'ecuronium bromide 0.1 mg?kg.

• Lignocaine 1.@ mg?kg 3as gi'en "0 s be&ore intubation in order to obtund thehypertensi'e response to laryngosopy and intubation and subseuent rise inintracranial tension.

• Anesthesia 3as maintained 3ith nitrous o4ide (829- (@0,- and iso/urane in

o4ygen.

• Patients 3ere gi'en intermittent positi'e pressure 'entilation to maintain end tidalcarbon dio4ide (B92- bet3een !0 and !@ mm6g.

• Parameters monitored at appropriate inter'als included heart rate (6R-% EP% B92%

Sp92% central 'enous pressure (BP- (3here indicated- and urine output (<9-.

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• $entanyl 2 Hg?kg intra'enous (D- 3as gi'en initially and supplemented3ith &entanyl 1 Hg?kg D hourly.

• Analgesia 3as supplemented 3ith inIltration o& the incision site 3ith0.2@, bupi'acaine both at the start and the end o& surgery and in.diclo&enac sodium intramuscular (D#- at dural closure.

•

#annitol 1 g?kg D 3as trans&used (o'er 1@*20 min- at the start o&surgery.

• Dsotonic /uids 3ere gi'en as maintenance and replacement /uids.

• Bolloids like 6ydro4y ethyl starch and blood 3ere gi'en as per the losses.

• At the time o& dura closure% patients 3ere randomly assigned to one o&the three groups using en'elope method to recei'e:

• Group G: Granisetron 1 mg D% Group 9: 9ndansetron 1 mg D or Group F:8S D.

• All patients 3ere monitored &or P98 &or ); h post*operati'ely a&tere4tubation.

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Analisa statistik

• Analisa data menggunakan SPSS 1

• 8ilai p>0%0@ adalah signiIkan

• 8ilai p>0%001 sebagai signiIkantinggi

Statistik deskri ti& 9ne 3a analisis den an PoBhi suare den an Isher e4a

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Results

• A total o& +@ eligible patients 3ereenrolled in the study% 2@ in eachgroup. here 3ere no signiIcant

di5erences in demographic proIle J able 1K% intra*operationalcharacteristics J able 2K% type and

anatomical location o& intracranialtumors among the three groups

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Fiscussion

• Fe4amethasone% in neurosurgical patients% reduces perilesional edema and istraditionally used in craniotomy. e there&ore took group F as our control group.

Pada pasien neurosurgical% Fe4amethason mengurangi edem perilesi dan secaratradisional digunakan. Sehingga kelompok F digolongkan kelompok kontrol.

•  his prospecti'e randomized study demonstrated that combination o& Dgranisetron or ondansetron 3ith de4amethasone signiIcantly reduces the

incidence and &reuency o& P98 episodes% RA and number o& RA reuiredcompared 3ith de4amethasone alone in patients undergoing electi'ecraniotomies.

=ombinasi granisetron D atau ondansetron dengan de4amethasoon secarasigniIkan menurunkan insiden P98 dan RA pada pasien yang menalanicraniotomy

• Granisetron 3ith de4amethasone 3as more e5ecti'e in pre'enting P98 as

compared to ondansetron but the results did not reach statistical signiIcance.

Granisetron dengan de4amethason lebih e&ekti& pada pencegahan P98 biladibandingkan dengan ondansetron tetapi secara statistik tidak bermakna.

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Bonclusion

• Bombination regimen o& granisetron or ondansetron indoses o& 1 and ) mg 3ith de4amethasone respecti'elypro'ide superior and e5ecti'e antiemetic prophyla4iscompared 3ith Fe4amethasone alone in adult patientsundergoing electi'e craniotomy 3ithout producing anysigniIcant side*e5ects or a5ecting neurocogniti'emonitoring 3hich is so essential in post*operati'eneurosurgical care.

• =ombinasi granisetron atau ondan setron dosis 1 dan ) mgdengan de4amethason merupakan proIlaksis antiemetik ika dibandingkan dengan hanya de4amethason padapasien de3asa yang menalani craniotomy tanpamenimbulkan e&ek samping atau memberikan e&ek padaneurocogniti&.

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• http:??333.ncbi.nlm.nih.go'?pmc?articles?P#B)1+!@+1?MreportNreaderOpoN).)2;