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Abstrak :
Pendahuluan : Pemberian cairan jernih prabedah dapat menguntungkan pasien dalam masa perioperatif. Konsumsi cairan jernih maltodekstrin 12,5% dua jam prabedah dapat dilakukan terutama dalam ERAS ( Enhanced Recovery After Surgery). Penambahan protein dalam cairan jernih memberikan luaran yang lebih baik. Meskipun secara teoritis protein dapat memperlambat pengosongan lambung, perlu diketahui apakah cairan jernih yang mengandung kombinasi glukosa dan protein dapat mengakibatkan GRV ≥1,5 ml/kgBB ( risiko tinggi aspirasi) dua jam pasca konsumsi. Penelitian ini bertujuan untuk membandingkan GRV pasca pemberian cairan maltodekstrin 12,5% dengan cairan kombinasi glukosa dan protein. Metode: Penelitian uji klinis silang acak tersamar ini melibatkan 56 relawan berusia 25-40 tahun ( peserta didik Departemen Anestesiologi dan Terapi Intensif FKUI-RSCM). Peserta berkesempatan untuk mengkonsumsi dua jenis minuman prabedah, cairan maltodekstrin 12,5% dan cairan kombinasi glukosa dan protein (Fresubin Jucy®), dengan volume masing- masing 400 ml. Volume lambung diukur dua kali, setelah puasa selama minimal 6 jam, (GRV baseline), dan dua jam pasca konsumsi cairan. Peserta diberikan waktu washout dua minggu diantara kedua intervensi. Hasil: Tidak terdapat perbedaan bermakna pada GRV baseline sebelum pemberian kedua cairan intervensi ( p>0,05). Terdapat perbedaan yang signifikan pada GRV dua jam pasca konsumsi maltodekstrin 12,5% dengan cairan kombinasi ( p < 0,05). Secara teori protein dapat meningkatkan produksi leptin, dan menekan produksi ghrelin sehingga memperlambat waktu pengosongan lambung. Selain itu, faktor-faktor lain seperti osmolalitas dan jumlah kalori juga dapat mempengaruhi perbedaan GRV setelah puasa. Simpulan: Terdapat perbedaan signifikan pada GRV dua jam pasca pemberian cairan maltodekstrin 12,5% dengan cairan kombinasi glukosa dan protein. ......Introduction: Preoperative clear fluid administration have known for giving positive impacts for patients undergoing surgery. Drinking clear fluids containing carbohydrate, is already being a routine and many innovation on optimizing its composition are also being increasingly variative, one of them by adding protein. Theoretically, protein can slow gastric emptying, increasing gastric residual volume which can increase pulmonary aspiration risk. This study aimed to compare gastric volume after administration of 12.5% maltodextrin solution to clear fluid containing glucose and protein. Methods: This randomized, double-blinded, crossover clinical trial involving 56 trainee anesthetists aged 25-40 years. Each participant consume two types of preoperative clear drinks, 12.5% maltodextrin and clear fluid containing glucose and protein. Gastric volume was measured twice, once after fasting for at least 6 hours, and two hours after drinking fluid. Every participants were given a two-week washout period before undergoing second intervention. Results: No significant differences were found in the comparison of baseline gastric volume before intervention. Significant difference was found between gastric volume two hours after drinking maltodextrin compared to combination fluid ( p,0,05). This differences might be influenced by leptin increasing after drinking the combination fluid, along with the differences of fluid osmolarity and calories contained, affecting gastric emptying rate and residual volume. Conclusion: There was significant difference in gastric volume two hours after administration of 12.5% maltodextrin solution compared to combination of glucose and protein solution.

Abstrak :
Pendahuluan: Laparoskopi memiliki risiko intraoperatif dan pascaoperasi, termasuk instabilitas hemodinamik dan nyeri pascaoperasi. Anestesi umum sering digunakan untuk operasi ini, namun teknik ini tidak menekan peningkatan resistensi vaskular sistemik selama laparoskopi sehingga fluktuasi hemodinamik tetap terjadi. Sayatan dinding abdomen dan regangan peritoneum selama operasi juga menyebabkan nyeri somatis dan viseral yang dirasakan pascaoperasi. Penambahan blok TAP pada operasi laparoskopi belum memuaskan disamping memerlukan instrumen tambahan serta bergantung pada kemampuan operator. Anestesi spinal dapat menguntungkan karena dapat menetralkan peningkatan SVR dan menghambat nyeri selama operasi, namun penggunaannya dikaitkan dengan mobilisasi yang tertunda. Penelitian ini bertujuan untuk mengetahui apakah kombinasi anestesi umum dan anestesi spinal lebih baik dalam menjaga perubahan hemodinamik intraoperatif, nyeri pascaoperasi, dan waktu pulih dibandingkan anestesi umum dan blok TAP. Metode: Penelitian ini merupakan uji klinis acak tersamar tunggal pada 40 pasien yang dibagi menjadi 2 kelompok. Kelompok S (spinal) dilakukan anestesi spinal menggunakan bupivacaine 10 mg + morfin 50 mcg intratekal disusul anestesi umum. Kelompok T (blok TAP) dilakukan anestesi anestesi umum disusul blok TAP dengan bupivacaine 0.25% 20 ml pada kedua sisi abdomen. Perubahan tekanan darah dan nadi, NRS pascaoperasi 3 jam dan 6 jam, waktu untuk mencapai Bromage 0, serta kejadian nyeri bahu dan mual muntah pascaoperasi dicatat. Hasil: Pada kelompok S terdapat perubahan tekanan darah sistolik yang signifikan dibandingkan dengan kelompok T setelah 15 menit insuflasi (-9,35(±19,69) vs 7,65(±16,34), p<0,05). Tidak ada perbedaan nyeri pascaoperasi dan waktu pulih pada kedua kelompok. Kesimpulan: Kombinasi anestesi umum dan anestesi spinal lebih baik dalam menurunkan tekanan darah sistolik, namun tidak berbeda dalam nyeri pascaoperasi, dan waktu pulih dibandingkan kombinasi anestesi umum dan blok TAP. ......Introduction: Laparoscopy is associated with intraoperative and postoperative risks, including hemodynamic instability and postoperative pain. Although general anesthesia is often used for this procedure, hemodynamic fluctuations still occur because this technique does not suppress the increase in systemic vascular resistance during laparoscopy. Incisions in the abdominal wall and stretching of the peritoneum during surgery can also cause somatic and visceral pain after surgery. Adding TAP block to laparoscopic surgery is not satisfactory, apart from requiring additional instruments and depending on the operator’s abilities. Spinal anesthesia may be beneficial as it can counteract the increase in SVR and suppress pain during surgery, but its use is associated with delayed mobilization. The purpose of this study is to determine whether the combination of general and spinal anesthesia is superior in maintaining intraoperative hemodynamic changes, postoperative pain, and recovery time compared to general anesthesia and TAP blockade. Methods: This study is a single-blind, randomized clinical trial with 41 patients divided into two groups. Group S (spinal) received spinal anesthesia with 10 mg bupivacaine + 50 μg morphine administered intrathecally, followed by general anesthesia. Group T (TAP block) received general anesthesia followed by TAP block with 20 ml of 0.25% bupivacaine on each side of the abdomen. Intraoperative blood pressure and heart rate changes, NRS at 3 and 6 hours postoperatively, time to reach bromage 0, and occurrence of postoperative shoulder pain and nausea and vomiting were recorded. Results: In group S there was a significant change in systolic blood pressure compared to group T after 15 minutes of insufflation (-9,35(±19,69) vs 7,65(±16,34), p<0,05). There was no difference in postoperative pain and recovery time in the two groups. Conclusion: The combination of general anesthesia and spinal anesthesia is better in reducing systolic blood pressure, but does not differ in postoperative pain and recovery time compared to the combination of general anesthesia and TAP block.