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"Dilakukan studi Kohort retrospektif untuk menilai pengaruh kelebihan cairan pasca operasi terhadap hasil akhir penatalaksanaan trauma dengan syok hemoragik di RSUPN Dr.Cipto Mangunkusumo. Data diperoleh dari rekam medik 42 penderita yang terbagi menjadi kelompok I (24 penderita) menerima cairan ~ 10.000 cc dan kelompok II (18 penderita) yang menerima cairan < 10.000 cc selama 24 jam I. Dari seluruh penderita, 18 penderita diantaranya meninggal dunia dan kelompok I mempunyai risiko kematian 6 kali lebih tinggi dibanding kelompok II dan perbedaan diantara keduanya bermakna secara statistik (p < 0,05). Timbulnya 2 atau 3 dari kematian (koagulopati, asidosis metabolik dan hipotermi) meningkatkan risiko kematian 28 kali lebih tinggi dan hubungannya bermakna (p < 0,001). Mereka yang hidup dan menerima cairan ~ 10.000 cc mempunyai lama rawat lebih panjang dibandingkan mereka yang menerima cairan <10.000 cc (P<0,05). Resusitasi cairan masih meningkatkan risiko kematian dan lama perawatan lebih panjang dan risiko kematian terutama dihubungkan dengan ditemukannya 2 atau 3 dari trias kematian. Diperlukan pemahaman kompleksitas respon tubuh yang terjadi pasca trauma dan syok hemoragik sehingga dapat melakukan resusitasi yang benar diikuti monitoring yang ketat untuk menurunkan morbiditas dan mortalitas penatalaksanaan trauma dengan syok hemoragik.

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A retrospective cohort study was conducted! to assess the effect of postoperative excess fluid on the final outcome of trauma management with hemorrhagic shock at RSUPN- Dr.Cipto Mangunkusumo. Data was obtained from the medical records of 42 patients who were divided into group I (24 patients) receiving ~ 10,000 cc of fluid and group II (18 patients) who received 10,000 cc < liquid for 24 hours I. Of all the patients, 18 of them died and group I was at risk mortality was 6 times higher than group II and the difference between the two was statistically significant (p < 0.05). The occurrence of 2 or 3 of mortality (coagulopathy, metabolic acidosis and hypothermy) increased the risk of death 28 times higher and the association was significant (p < 0.001). Those who lived and received ~10,000 cc of fluid had a longer treatment time than those who received < 10,000 cc (P <0.05). Fluid resuscitation still increases the risk of death and length of treatment longer and the risk of death is mainly associated with the discovery of 2 or 3 of the triad of death. Understanding is required the complexity of the body's response that occurs after trauma and hemorrhagic shock so that it can perform correct resuscitation followed by strict monitoring to reduce morbidity and mortality in the management of trauma with hemorrhagic shock."

"ABSTRAKLatar belakangHipoperfusi splanknik tetap terjadi pada pasca-resusitasi renjatan perdarahan. Hipoperfusi splanknik dapat menimbulkan kerusakan mukosa usus, translokasi bakteri usus ke sistemik, dan kemungkinan gagal organ multipel. Tujuan penelitian ini adalah mempelajari pengaruh anestesi epidural torasik (AEV) Iidokain terhadap perubahan perfusi splanknik pasca-resusitasi renjatan perdarahan.Metode dan Bahan Penelitian Suatu penelitian acak tersamar ganda dilakukan pada 16 ekor Macaca nemestrina, terdiri atas kelompok kontrol (n = 8) dan AET (n = 8). Kedua kelompok mendapat ketamin pada tahap persiapan, dan dilakukan pemasangan kateter epidural pada 17-8, selanjutnya diberikan anestesia-umum. Renjatan perdarahan dicapai dengan cara darah dialirkan secara pasif keluar tubuh secara bertahap sehingga tekanan arteri rerata (TAR) 40 mm Hg dan dipertahankan selama 60 menit. Resusitasi dilakukan dengan cara darah dikembalikan disertai pemberian kristaloid. Pasca-resusitasi, kelompok AET mendapatkan lidokain 2% dan kontrol salin melalui kateter epidurai. Pemantauan tekanan parsial CO2 gaster (PQCOQ), selisih tekanan CO2 gaster - arteri [P(g-a)CO2], pH mukosa gaster (pHi), parameter hemodinamik, asam basa dan Iaktat darah dilakukan secara berkala. Kadar norepinefrin dan kortisol diukur pada menit 90, kultur darah, dilakukan pada saat prarenjatan dan menit 180, biopsi usus, hati dan ginjal dilakukan saat prarenjatan, menit 60, 90, dan 270 selama penelitian.HasilNilai PgCO; lebih rendah secara bermakna pada kelompok TEA pada menit ke- 90 (11,0 (SD 8,0) vs. 19,0 (8,0) kPa; p=0,038), 150 (9,9 (8,-4) vs. (19,5 (8,6) kPa; p=0,023), dan pada akhir penelitian (270 menit) (10,1 (8,3) vs. 20,7 (10,0) kPa; p=0,041); di mana P(g-a) CO2 lebih rendah pada kelompok TEA pada menit ke-150 dan 270; and pHi lebih rendah pada kelompok TEA pada menit ke-90 and 150. Parameter Iain tidak menunjukkan perbedaan yang bermakna. Translokasi bakteri ditemukan Iebih sedikit pada kelompok AET dari pada kontrol. Histopatologi duodenum kelompok AEI' lebih sedikit mengalami perburukan dari pada kontrol (p = 0,0456).KesimpulanPerfusi splanknik kelompok AEl'|id0kBir1 pascz-rresusitasi renjatan perdarahan lebih baik dari pada kontrol.

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ABSTRACT

Background

Splanchnic hypoperfusion still exists despite of successful resuscitation of hemorrhagic shock. Studies have shown that splanchnic hypoperfusion may lead to increased permeability of gastrointestinal mucosa, bacterial translocation, and increased risk of developing multiple organ failure. The aim of this study was to assess the effect of lidocaine thoracic epidural anesthesia (TEA) on splanchnic perfusion in post-resuscitation of hemorrhagic shock.

Methods

This is a double blind randomized controlled study. Sixteen Macaca nemescrinas were randomly selected into two groups, i.e TEA group (n=8) and control (n=8). Both groups were anesthetized with ketamine during preparation, an epidural catheter was inserted at 17-8, then were given the same anesthesia procedure. Hemorrhagic shock was induced by drawing blood gradually to a mean arterial pressure (MAP) of 40 mm Hg, and maintained for 60 minutes. Animals were then resuscitated by their own blood and crystalloid solution. Post resuscitation, the control group were given salin epidurally and the TEA group Iidocaine 2%. During this study PgCO2, P(g-a)CO2, pHi, hemodynamic parameters, acid-base balance and lactate acid were monitored. Blood norepinephrine and cortisol concentrations were measured at 90 minute, blood sample at preshock and 180 minute were cultured and intestinal, liver, and kidney biopsies were done at preshock, 60 minute, 90 minute, and 270 minute during timeof study.

Results

Means of PgCO2 were consistently significantly lower in the TEA group compared to control at 90 minute (11.0 (SD 8.0) vs. 19.0 (8.0) kPa; p=0.038), 150 minute (9.9 (8.4) vs. (19.5 (8.6) kPa; p=0.023, and at the end of this study (270 minute) (10.1 (8.3) vs. 20] (10.0) kPa; p=.041); whereas P(g~a)CO, were lower in TEA group at 150 and 270 minute and pHi were lower in TEA group at 90 and 150 minute. Other parameters did not show significant difference between groups. Bacterial translocations were less in TEA group than in control group. Duodenum histopathology deterioration was less in the TEA group than in control (p = 0,0456).

Conclusion

Splanchnic perfusion in hemorrhagic shock post resuscitation in TEA Iidocaine group as better than in control group."

"ABSTRAKLatar belakangHipoperfusi splanknik tetap terjadi pada pasca-resusitasi renjatan perdarahan. Hipoperfusi splanknik dapat menimbulkan kerusakan mukosa usus, translokasi bakteri usus ke sistemik, dan kemungkinan gagal organ multipel. Tujuan penelitian ini adalah mempelajari pengaruh anestesi epidural torasik (AEV) Iidokain terhadap perubahan perfusi splanknik pasca-resusitasi renjatan perdarahan.Metode dan Bahan Penelitian Suatu penelitian acak tersamar ganda dilakukan pada 16 ekor Macaca nemestrina, terdiri atas kelompok kontrol (n = 8) dan AET (n = 8). Kedua kelompok mendapat ketamin pada tahap persiapan, dan dilakukan pemasangan kateter epidural pada 17-8, selanjutnya diberikan anestesia-umum. Renjatan perdarahan dicapai dengan cara darah dialirkan secara pasif keluar tubuh secara bertahap sehingga tekanan arteri rerata (TAR) 40 mm Hg dan dipertahankan selama 60 menit. Resusitasi dilakukan dengan cara darah dikembalikan disertai pemberian kristaloid. Pasca-resusitasi, kelompok AET mendapatkan lidokain 2% dan kontrol salin melalui kateter epidurai. Pemantauan tekanan parsial CO2 gaster (PQCOQ), selisih tekanan CO2 gaster - arteri [P(g-a)CO2], pH mukosa gaster (pHi), parameter hemodinamik, asam basa dan Iaktat darah dilakukan secara berkala. Kadar norepinefrin dan kortisol diukur pada menit 90, kultur darah, dilakukan pada saat prarenjatan dan menit 180, biopsi usus, hati dan ginjal dilakukan saat prarenjatan, menit 60, 90, dan 270 selama penelitian.HasilNilai PgCO; lebih rendah secara bermakna pada kelompok TEA pada menit ke- 90 (11,0 (SD 8,0) vs. 19,0 (8,0) kPa; p=0,038), 150 (9,9 (8,-4) vs. (19,5 (8,6) kPa; p=0,023), dan pada akhir penelitian (270 menit) (10,1 (8,3) vs. 20,7 (10,0) kPa; p=0,041); di mana P(g-a) CO2 lebih rendah pada kelompok TEA pada menit ke-150 dan 270; and pHi lebih rendah pada kelompok TEA pada menit ke-90 and 150. Parameter Iain tidak menunjukkan perbedaan yang bermakna. Translokasi bakteri ditemukan Iebih sedikit pada kelompok AET dari pada kontrol. Histopatologi duodenum kelompok AEI' lebih sedikit mengalami perburukan dari pada kontrol (p = 0,0456).KesimpulanPerfusi splanknik kelompok AEl'|id0kBir1 pascz-rresusitasi renjatan perdarahan lebih baik dari pada kontrol.

---

ABSTRACT

Background

Splanchnic hypoperfusion still exists despite of successful resuscitation of hemorrhagic shock. Studies have shown that splanchnic hypoperfusion may lead to increased permeability of gastrointestinal mucosa, bacterial translocation, and increased risk of developing multiple organ failure. The aim of this study was to assess the effect of lidocaine thoracic epidural anesthesia (TEA) on splanchnic perfusion in post-resuscitation of hemorrhagic shock.

Methods

This is a double blind randomized controlled study. Sixteen Macaca nemescrinas were randomly selected into two groups, i.e TEA group (n=8) and control (n=8). Both groups were anesthetized with ketamine during preparation, an epidural catheter was inserted at 17-8, then were given the same anesthesia procedure. Hemorrhagic shock was induced by drawing blood gradually to a mean arterial pressure (MAP) of 40 mm Hg, and maintained for 60 minutes. Animals were then resuscitated by their own blood and crystalloid solution. Post resuscitation, the control group were given salin epidurally and the TEA group Iidocaine 2%. During this study PgCO2, P(g-a)CO2, pHi, hemodynamic parameters, acid-base balance and lactate acid were monitored. Blood norepinephrine and cortisol concentrations were measured at 90 minute, blood sample at preshock and 180 minute were cultured and intestinal, liver, and kidney biopsies were done at preshock, 60 minute, 90 minute, and 270 minute during timeof study.

Results

Means of PgCO2 were consistently significantly lower in the TEA group compared to control at 90 minute (11.0 (SD 8.0) vs. 19.0 (8.0) kPa; p=0.038), 150 minute (9.9 (8.4) vs. (19.5 (8.6) kPa; p=0.023, and at the end of this study (270 minute) (10.1 (8.3) vs. 20] (10.0) kPa; p=.041); whereas P(g~a)CO, were lower in TEA group at 150 and 270 minute and pHi were lower in TEA group at 90 and 150 minute. Other parameters did not show significant difference between groups. Bacterial translocations were less in TEA group than in control group. Duodenum histopathology deterioration was less in the TEA group than in control (p = 0,0456).

Conclusion

Splanchnic perfusion in hemorrhagic shock post resuscitation in TEA Iidocaine group as better than in control group."