Perbandingan Postoperative Cognitive Dysfunction (POCD) Fase Akut Pasca Joint Arthroplasty pada Pasien Usia Lanjut Antara Anestesi Umum dan Anestesi Epidural

Abstract

Usia lanjut merupakan faktor risiko terjadinya postoperative cognitive dysfunction (POCD). Pemilihan teknik anestesi yang tepat pada usia lanjut akan menurunkan risiko kejadian POCD. Penelitian ini bertujuan untuk membandingkan angka kejadian POCD pada pasien usia lanjut yang menjalani operasi joint arthroplasty antara anestesi umum dan anestesi epidural. Penelitian berlangsung pada bulan Juli–Oktober 2019 di RSUP Dr. Hasan Sadikin Bandung. Penelitian dilakukan menggunakan metode randomized control trial dengan melibatkan 48 pasien yang menjalani tindakan joint arthroplasty. Subjek penelitian dibagi menjadi kelompok anestesi umum (GA) dan anestesi epidural (EA) menggunakan bilangan acak. Penilaian status mental pasien dilakukan menggunakan Mini mental state examination (MMSE) pada saat preoperasi dan tujuh hari pascaoperasi. Perbandingan proporsi kajadian POCD pada kedua kelompok dianalisis dengan menggunakan uji chi-square. Kejadian POCD pada kelompok GA (37,5%) lebih tinggi dari kelompok EA (8,3%) dan secara statistik perbedaan proporsi kejadian POCD pada kedua kelompok bermakna signifikan p=0,016 (p<0,05). Simpulan penelitian bahwa kejadian postoperative cognitive dysfunction (POCD) pada pasien usia lanjut yang menjalani joint arthroplasty dengan anestesi epidural lebih kecil dibanding dengan anestesi umum.   Comparison of General Anesthesia on Postoperative Cognitive Dysfunction (POCD) in Joint Arthroplasty with Epidural Anesthesia in Elderly Patients Old age is a risk factor for postoperative cognitive dysfunction (POCD). Elder people often have to undergo many surgeries, one of which is joint arthroplasty surgery. Selecting appropriate anesthetic techniques for elderly patients to reduce POCD is always controversial. The study aimedto compare the POCD incidence in elderly patients who underwent joint arthroplasty surgery using the general anesthesia and epidural anesthesia. The study was conducted in July–October 2019 at the RSUP Dr. Hasan Sadikin Bandung. This study used a randomized control trial method involving 48 elderly patients who underwent joint arthroplasty using randomized control trial method. Research subjects were divided into the General Anesthesia group (GA) and the Epidural Anesthesia group (EA) using random numbers. Both groups mental status was assessed using the mini mental state examination (MMSE) during preoperative and seven days postoperatively. A comparison of the proportion of POCD incidence in the two groups were analyzed using the chi-square test. The result showed that the proportion of POCD incidence in the GA group (37.5%) was higher than the EA group (8.3%), and the difference was statistically significant p=0.016 (p<0.05). The study concludes that epidural anesthesia in the joint arthroplasty procedure of elderly patients is superior vs. general anesthesia.