PERBANDINGAN LUARAN SEKSIO SESAREA DENGAN ANESTESI UMUM DAN SPINAL: PERUBAHAN KADAR HEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYI

Abstract

PERBANDINGAN LUARAN SEKSIO SESAREA DENGAN
ANESTESI UMUM DAN SPINAL: PERUBAHAN KADAR
HEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYI

Ifrinda Giantari, Ibnu Pranoto, Risanto Siswosudarmo

ABSTRACT

Background: Cesarean section is the most common surgical procedure in obstetrics. In 2008, nearly a third of
deliveries was done by cesarean section. Two types of anestesi are used in cesarean section i.e., general and
regional anestesi with their advantages and disadvantages. General anestesi is often used in emergency cases
but is often associated with greater risk of blood loss during surgery and depression of central nervous system of
the newborn. Based on these facts, the decision of the type of anesthesia for cesarean section is still debated.
Objective: To compare the effects between general and spinal anestesi in the alteration of maternal hemoglobin
and hematocrit levels and the neonatal Apgar score.
Method: This study was conducted at Setjonegoro Hospital Wonosobo, Banjarnegara, and Sardjito Hospital
Yogyakarta between September to December 2010. Patients undergoing cesarean section, who met inclusion
and exclusion criteria were included in this study. Hemoglobin and hematocrit levels before and 6-12 hours after
surgery were recorded, as well as the first minute Apgar score. Chi-square and t-test were used for statistical
analysis.
Results and Discussion: A total of 114 patients consisting of 59 cases for general anestesi and 55 for spinal
groups were recruited. They were comparable in terms ofmaternal age, age of gestation, parity, BMI and indication
of operation. Hemoglobin and hematocrit levels before surgery were also comparable.
The decrease of hemoglobin level after operation in the group of general anesthesia was greater than in the
spinal group (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d; p=0,00). The same was seen in the decrease of hematocrit
level (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). There were 28 cases of asphyxia in the group of general compared
to 22 cases in the group of spinal anestesi, but it was not statistically different (RR 1,16; 95% CI 0,81-1,65).
Conclusion: The decreased level of hemoglobin and hematocrit after cesarean section in general anesthesia were
higher than spinal anesthesia group, although the difference was not clinically significant. There was no significant
difference in the incidence of asphyxia at first minute in both groups.

Keywords: general anestesi, spinal anesthesia, cesarean section, hemoglobin, hematocrit, Apgar score

ABSTRAK

Latar belakang: Seksio sesarea merupakan prosedur operatif obstetri yang paling sering dilakukan. Pada tahun
2008, hampir sepertiga dari persalinan dilakukan dengan cara seksio sesarea. Dua jenis anestesi sering digunakan
yakni anestesi umum dan spinal yang masing-masing mempunyai kelebihan dan kekurangannya. Anestesi umum
sering digunakan pada kasus kedaruratan meskipun sering dikaitkan dengan risiko kehilangan darah yang lebih
besar dan penekanan pada susunan syaraf pusat bayi. Anestesi spinal sering dikaitkan dengan keadaan hipotensi
maternal.
Tujuan: Membandingkan penurunan kadar hemoglobin dan hematokrit ibu dan skor Apgar bayi pada seksio
sesarea dengan anestesi umum dan spinal.

Metode: Kohort prospektif.Penelitian dilakukan di RS Setjonegoro Wonosobo, RS Banjarnegara, dan RS Sardjito
pada bulan September sampai Desember 2010. Pasien yang menjalani seksio sesarea dan memenuhi kriteria
inklusi dan eksklusi dimasukkan dalam penelitian ini. Sampel penelitian diikuti sesuai dengan kelompok jenis
anestesi. Kadar hemoglobin dan hematokrit sebelum operasi dan 6-12 jam sesudah operasi serta skor Apgar 1
menit dicatat. X-square dan t-test dipakai untuk analisis data.
Hasil dan Pembahasan: Sebanyak 114 kasus seksio sesarea memenuhi kriteria kelayakan, yang terdiri dari 59
kasus kelompok anestesi umum dan 55 kasus anestesi spinal. Kedua kelompok komparabel dalam hal umur,
umur kehamilan, paritas BMI dan indikasi operasi. Demikian juga kadar hemoglobin dan hematokrit sebelum
operasi, tidak menunjukkan perbedaan yang bermakna. Penurunan kadar hemoglobin setelah operasi pada
kelompok anestesi umum lebih besar dibanding kelompok spinal (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d;
p=0,00), demikian juga penurunan kadar hematocrit (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). Pada penilaian
menit pertama terdapat 28 kasus asfiksia (skor Apgar < 6) pada kelompok anestesi umum dan 22 kasus pada
kelompok anestesi spinal (RR 1,16, 95%CI 0,81-1,65), tetapi tidak bermakna secara statistik (p=0,42).
Kesimpulan: Terdapat penurunan kadar hemoglobin dan hematokrit ibu yang bermakna pada kelompok yang
menjalani seksio sesarea dengan anestesi umummeskipun secara klinis tidak bermakna. Tidak terdapat perbedaan
bermakna secara statistik pada kejadian asfiksia pada menit pertama.

Kata kunci: anestesi umum, anestesi spinal, seksio sesarea, hemoglobin, hematokrit, skor Apgar