SUMMER COURSE

INTERPROFESSIONAL HEALTH CARE

BURN INJURY MANAGEMENT IN PEDIATRIC PATIENT AT PAKIS

PRIMARY HEALTHCARE

FACULTY OF MEDICINE, PUBLIC HEALTH, AND NURSING

FACULTY OF DENTISTRY

FACULTY OF PHARMACY

UNIVERSITAS GADJAH MADA

YOGYAKARTA

2019
 DAFTAR ISI

Halaman Judul……………………….....………….............................................. i

Halaman Pengesahan ……………………………….......................................... ii

Halaman Bebas Plagiasi …………………………..……................................... iii

Prakata ……………..…………………………................................................... iv

Daftar Isi ………………………………….......................................................... vi

Daftar Tabel ………………………………........................................................ ix

Daftar Gambar ………………………………..................................................... x

Daftar Lampiran ………………………………................................................. xi

Daftar Singkatan dan Simbol ……………………………............................... xii

Abstrak ...……………………………………………...……………………… xiii

BAB I: PENDAHULUAN ………..................................................................... 15

1. Latar Belakang ............................................................................. 15

2. Perumusan Masalah …………………..………..………….....… 16
3. Tujuan Penelitian ......................................................................... 16
4. Keaslian Penelitian ....................................................................... 17
5. Manfaat Penelitian ....................................................................... 18

BAB II: TINJAUAN PUSTAKA ...................................................................... 19

1. Emergence Delirium .................................................................... 19

1.1. Definisi ............................................................................. 19
1.2. Insidensi ........................................................................... 21
1.3. Patofisiologi ..................................................................... 22
1.4. Dampak ............................................................................ 22
1.5. Pencegahan dan Penanganan ........................................... 23

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 1.6. Macam Faktor Risiko ....................................................... 24
2. Kendala ........................................................................................ 25
2.1. Penegakan Diagnosa ........................................................ 25
2.2. Skor Cravero .................................................................... 26
2.3. Performa Skor Cravero .................................................... 27
3. Kerangka Teori …........................................................................ 28
4. Kerangka Konsep ......................................................................... 29
5. Hipotesis ....................................................................................... 29

BAB III: METODE PENELITIAN .................................................................. 30

1. Rancangan Penelitian ................................................................... 30

2. Populasi dan Subjek ..................................................................... 30
3. Variabel dan Intervensi Penelitian ................................................ 31
4. Definisi Operasional ..................................................................... 32
5. Alat dan Bahan ............................................................................. 32
6. Prosedur Penelitian ....................................................................... 33
7. Metode Analisis Data ................................................................... 34
8. Kelaikan Etik ................................................................................ 35

BAB IV: HASIL DAN PEMBAHASAN .......................................................... 36

1. Hasil ............................................................................................. 36
2. Pembahasan .................................................................................. 40
2.1. Umur ................................................................................ 41
2.2. BMI .................................................................................. 42
2.3. Jenis Kelamin ................................................................... 42
2.4. Jenis Operasi .................................................................... 43
2.5. Teknik Anestesi ................................................................ 43
2.6. Obat Pre-medikasi ............................................................ 44
2.7. Obat Induksi ..................................................................... 44
2.8. Obat Maintenance ............................................................ 45
2.9. Penggunaan Teknik Regional Anestesi ............................ 45

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 2.10. Analgesik Durante Operasi .............................................. 46
2.11. Analgesik Post-operasi ..................................................... 46
2.12. Kondisi mental pre-operasi .............................................. 47

3. Keterbatasan Penelitian ………………………………………… 47

BAB V: KESIMPULAN DAN SARAN ............................................................ 48

1. Kesimpulan ................................................................................... 48
2. Saran ............................................................................................. 48

REFERENSI ....................................................................................................... 49

LAMPIRAN ........................................................................................................ 52

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 DAFTAR TABEL
Tabel 1. Ulasan Keaslian Penelitian .................................................................... 17
Tabel 2. Klasifikasi Skoring Cravero ................................................................... 26
Tabel 3. Definisi Operasional .............................................................................. 32
Tabel 4. Hasil Analisis Univariat ......................................................................... 37
Tabel 5. Hasil Uji Regresi Logistik Univariat ..................................................... 38
Tabel 6. Hasil Uji Regresi Logistik Multivariat .................................................. 39

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 DAFTAR GAMBAR

Gambar 1. Garis Waktu Peristiwa Penting dalam Sejarah Agitasi dan ED ......... 20
Gambar 2. Kerangka Teori ................................................................................... 28
Gambar 3. Kerangka Konsep ............................................................................... 29
Gambar 4. Alur Penelitian ................................................................................... 33
Gambar 5. Receiver Operating Characteristic antara jenis kelamin ................... 40

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 DAFTAR LAMPIRAN
Lampiran 1. Informed consent ………………………………………...……..… 53
Lampiran 2. Instrumen data ………………………..………………………...… 54
Lampiran 3. Ethical Clearance …………………………....……………........… 58

vii
 DAFTAR SINGKATAN DAN SIMBOL

SINGKATAN KETERANGAN

AUC Area Under the Curve

ASA American Society of Anaesthesiologist
BMI Body Mass Index
ED Emergence Delirium
FPR False Positive Rate
HIV Human Immunodeficiency Virus
IASP International Association for the Study of
Pain
LMA Laryngeal Mask Airway
mg/kg miligram per kilogram
mcg/kg mikrogram per kilogram
mcg/kg/hr mikrogram per kilogram per hari
MRI Magnetic Resonance Imaging
PACU Post-Anesthesia Care Unit
ROC Receiver Operating Characteristic
TIVA Total Intravenous Anesthesia
VAS Visual Analog Scale

SIMBOL KETERANGAN

γ gamma
% persen
> lebih dari
< kurang dari

viii
 INTISARI

IDENTIFIKASI FAKTOR YANG BERHUBUNGAN DENGAN

EMERGENCE DELIRIUM MENGGUNAKAN METODE CRAVERO
PADA PASIEN PEDIATRIK YANG MENJALANI ANESTESI UMUM DI
RSUP DR SARDJITO

Latar Belakang: Emergence Delirium (ED) adalah gangguan selama masa

pemulihan anestesi umum, terdiri dari halusinasi, delusi, dan aktivitas fisik
involunter. Tingkat insidensi ED tertinggi ada pada pasien pediatrik dengan
rentang usia 2-7 tahun. Penyebab yang mendasari belum ditentukan dikarenakan
kurangnya studi klinis mengenai ED. Diperlukannya sebuah penelitian untuk
mengidentifikasi faktor risiko serta keefektifan alat skoring Cravero dalam
mendiagnosis ED.
Tujuan: Tujuan penelitian ini adalah untuk mengidentifikasi faktor yang
berhubungan dengan Emergence Delirium (ED) serta menghitung insidensi
terjadinya ED menggunakan alat skoring diagnosis Cravero di RSUP Dr Sardjito.
Metode: Subjek diberikan premedikasi 10 menit sebelum induksi. Parental
separation dinilai sebagai kondisi mental pre-operasi. Pencatatan dilakukan pada
tiga titik waktu per 10 menit. Hasil diolah dengan independent sample t-test dan
uji Chi-square. Hasil signifikan dilanjutkan dengan uji regresi logistik univariat
dan multivariat. Kemampuan diskriminasi diukur dengan kurva Receiver
Operating Characteristic (ROC) dan dianggap bermakna.
Hasil: Hasil ED berdasarkan skor Cravero sebesar 40,5%. Uji independent
sample t-test dan Chi square menghasilkan 5 variabel signifikan (p<0,25); umur,
jenis kelamin, teknik anestesi, analgesik durante operasi, dan kondisi mental pre-
operasi pasien. Umur dan jenis kelamin tetap dimasukkan karena memiliki
interaksi dengan variabel lain. Uji regresi logistik univariat (p<0,05); umur, jenis
kelamin, teknik anestesi, dan kondisi mental pre-operasi pasien. Uji regresi
logistik multivariat (p<0,05); jenis kelamin. Luas area ROC=0,378 pada variabel
jenis kelamin menunjukan jenis kelamin laki-laki menjadi faktor proteksi terhadap
ED.
Kesimpulan: Faktor yang berhubungan dengan terjadinya ED menggunakan
metode skoring Cravero adalah jenis kelamin pasien.
Kata Kunci: emergensi delirium, faktor risiko, pediatrik, anestesi umum, skor
cravero

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 ABSTRACT

BURN INJURY MANAGEMENT IN PEDIATRIC PATIENT AT PAKIS

PRIMARY HEALTHCARE

Background: Emergence Delirium (ED) is a disorder during the recovery period

after general anesthesia, consists of hallucinations, delusions, and involuntary
physical activity. The highest incidence of ED is pediatric patients aged 2-7 years.
The cause have not been determined due to lack of clinical studies on ED. This
study is needed to identify risk factors and the effectiveness of the Cravero
scoring tool in diagnosing ED.
Aim: The purpose of this study was to identify factors associated with Emergence
Delirium (ED) and calculate the incidence of ED using the Cravero diagnostic
scoring tool at RSUP Dr Sardjito.
Method: Subjects were given premedication 10 minutes before induction.
Parental separation was assessed as a pre-operative mental condition. Records
were taken three time every 10 minutes. The results were counted by independent
sample t-test and Chi-square test. Significant results were followed by a univariate
and multivariate logistic regression test. The discrimination ability was measured
by the Receiver Operating Characteristic (ROC) curve and considered
meaningful.
Result: The result of ED based on Cravero Score was 40,5%. Independent sample
t-test and Chi-square test showed 5 significant variables (p<0.25); age, gender,
anesthetic technique, analgesic during surgery, and the patient's pre-operative
mental condition. Age and gender are still significant because they have
interactions with other variables. Univariate logistic regression test results
(p<0.05); age, sex, analgesic during surgery, anesthesia techniques, and the
patient's pre-operative mental condition. Multivariate logistic regression test
results (p<0.05); sex. ROC area= 0.378 on the gender variable indicates that the
male is a protective factor against ED.
Conclusion: Factors that associated with ED using the Cravero scoring method
are the sex of the patient.
Keywords: emergence delirium, risk factor, pediatric, general anesthesia, cravero
score