dondy-review literature efektifitas terapi dingin setelah prosedur bedah
DESCRIPTION
presentasi dondy, peserta program pendidikan dokter gigi spesialis periodonsia universitas airlangga surabaya angkatan 2010 tentang aplikasi cryoterapi atau terapi dingin terhadap pola penyembuhan surgery pada jaringan lunak rongga mulut ...TRANSCRIPT
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(REVIEW LITERATURE)
EFEKTIFITAS TERAPI DINGIN SETELAH
PROSEDUR BEDAH INTRA ORAL
•Disusun oleh : Dondy•Peserta Program Pendidikan Dokter Gigi Spesialis
Periodonsia
Universitas Airlangga
2011
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Therapeutic efficacy of cold therapy after intraoral surgical procedures
a literature review
( journal of periodontology 2007: 78 , 790-800 )
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
CRYOTERAPI DAN RADANG Cryoterapi adalah terapi lokal,
menggunakan aplikasi dingin menurunkan suhu jaringan sub kutan
Tindakan bedah memicu respon keradangan
Tujuan respon keradanganpertahanan tubuh, menghilangkan jaringan mati, dan memicu repair dan regenerasi
Radang ? cardinal symptom
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
MEKANISME RADANG Adanya tanda -2 keradangan
bukanlah merupakan respon suatu radang (radangmelemahkan struktur jar)
Injureddamaged cell(cell out to )extra seluler spacemediator kimiawi ,(exp.)histamine bradikininregulate inflam processmigrasi leukositpaghositosispeningkatan permebailitas PD,vasodilatasi
Peningkatan sirkulasi darah pada Affected area
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
OEDEMA Alirah darah normal terganggu(letak
PD norm) antara kapiler-jaringan->cairan>>pada affected areaOEDEMA
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Oedema mempunyai arah yang berlainan krn adanya muscle attchment, fascia, dan structureas guide swelling
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
KEUNTUNGAN APLIKASI DINGIN Rasionalisasi aplikasi terapi dingin :1. Menurunkan keradangan2. Menghambat oedema3. Vasokonstriksi4. Menurunkan haemorraghie5. Menghambat kenaikan suhu6. Mengurangi perubahan
metabolismedingin me<<metab rateme<< injury skunder karena hipoksia
7. Me<<nyeri(kecepatan konduksi nervus<<)
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
8. mempercepat recovery
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
EFEK FISIOLOGI CRYOTERAPI Efek fisiology thdp jaringan Blood flowSwellingFungsi metaboliknyeri
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
PERUBAHAN SUHU Suhu tubuh norma37°C,suhu
kulit33°C Ice pack prinsip konduksi Panas ditransfer diantara molekul dari
hangat ke area dingin Sebaliknya Cryoterapi tidak memindah
dingin ke jaringanJaringan kehilangan panas oleh karena ia menghangatkan zat yang dingin
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Perubahan temperature pada area tergantung dari :
1. Perbedaan temperature antara jaringan dan cold pack
2. Lama kerja pendinginan3. Ketebalan jaringan4. Lokasi anatomi5. Pola terapi
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Lemak adalah insulator,
diperlukan durasi ice pack agar jaringan menjadi
dingin
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
SKIN AND ITS STRUCTURE
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
HEMODINAMIK ( BLOOD FLOW) Suatu studycold application
mengakibatkan :1. Vasokonstriksi2. Mengurangi pendarahan dan perfusi
cairan3. akhirnyame<< oedema Kwon et all20 menitreduce buccal
mucosal blood flow
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Hunting response(reactive hiperemia)
Penggunaan cold>>>(terjadi 20-30 menit)vasodilatasialiran
darah via arteriovenosus anastomosismekanisme
kompensasi tubuh mencegah next injuredbisa terjadi pe oedema
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Shepperd et all:cold applicationkonduksi saraf simpatis terputusnorepinefrin stopaksi penekanan kontraktilkembalinya aliran darah
Beberapa peneliti tidak menemukan hunting response walau aplikasi 30 mnt
Knighthanya artifak research
Hunting response masih menjadi perdebatan
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
EDEMA 2/3 cairan yng melewati injured
tissuedi resorb sistem vaskuler,1/3 kembali ke PD via pembuluh lymphe
injuredcairan meninggalkan sel tekanan osmotikedema
Swelling biasanya oleh karena pendarahan atau edema
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
MEKANISME DINGIN MENCEGAH EDEMA
Ice pack temperature metabolisme
jaringan dan permeabilitas free protein tekanan osmotikmenahan cairan keluar jaringantissue hipoxia bradikinin
Permeabilitas vasculer dan edema
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
PAIN REDUCTION aplikasi
dingin velositas konduksi saraf berubah Perubahan transmisi saraf pada serat
membrane Menutup saraf sensoris sebelum impuls
masuk ke serat motoris
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
PROSES METABOLIK Penurunan suhu pada jaringan yang
terluka
Menekan laju metabolis & reaksi kimiaMenekan proses enzimatik
kebutuhan ATP oksigen
HIPOKSIA excellent tissue survived
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
PERUBAHAN FISIK JARINGAN Collagen menjadi lebih kaku Pucatblood flow
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
KEUNTUNGAN PSIKOLOGI TERAPI DINGIN Patien comfort Uji placebomerubah resepsi nyeri pada
pasien
Adanya keuntungan fisiologi dan psikologi
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
KONTRA INDIKASI TERAPI DINGIN Hipertensiskunder vasokonstriksi Raynould disease extreme kontriksi
pada cold therapy pada ekstremitas Rheumatoid arthritis Local limb ischemia Riwayat gangguan vaskuler Alergi dingin ( cold urticaria) Penyakit2 lain yang menghasilkan
tekanan karena aplikasi dingin
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
>30 menit aplikasi dingin harus dihindari karena:
1. Rasa tergigit ( frossbite) Kerusakan permanen jaringan (-5˚C ) Kerusakan kapiler Kelemahan endothelial Kematian sel2. Nerve palsyFrossbite dipengaruhi oleh : metoda
pendinginan, lamanya aplikasi dingin dan bagian tubuh
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
TAHAPAN CRYOTERAPIHocutt et all4 tahap cryoterapi1. Tahap I1-3 menit sensasi dingin2. Tahap II 2-7 menitGatal/ burning
feeling3. Tahap III 5-10 menit rasa kebas/mati
rasa4. Tahap IV dilasi dalam pembuluh darah
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
PENGARUH PENGHALANG TERHADAP SUMBER DINGIN DAN KULIT Beberapa penelitiice pack sebaiknya
tidak diaplikasikan langsung ke kulit
ice burn / fros bite
Kerugian barier : mengurangi keefektifan terapi dingin
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
LAMA INTERVAL DAN DURASI TERAPI APLIKASI ES interval terapitime cold n rest periode
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
DISKUSI - KESIMPULAN Es prosedur oral surgery untk
mencegah edema, mengurangi nyeri.menurunkan trismus dan reaksi keradangan
Terdapat beberapa penelitian yang membutuhkan kajian lebih lanjut, beberapa pertanyaan dibawah ini sebagai acuan penggunaan cryoterapi
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
SUHU YANG IDEAL UNTUK CRYOTERAPI? Aliran darah >> bila suhu berkurang
17°C Velocitas saraf >> 27°C Local analgesia tercipta < 13,6°C Temperature 10°C – 15°C cell
metabolism• Temperature penghambatan response keradangan berkisar 10-15°C,
• Ice n cold pack mampu mengurangi temperature kulit pada range suku 10-15°C dalam waktu 15 menit
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
KONSEP TERAPI APLIKASI ES ? Perubahan temperature yang
diharapkan tergantung dari1. Lamanya2. Metoda3. Suhu cold agent Es harus diaplikasikan segera setelah
cell injured
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
CARA TERBAIK TERAPI APLIKASI DINGIN ? Tidak ada konsensus yang terbaik Beberapa peneliti ice pack lebih baik
dibanding gel pack ttp perbedaan kecil Ice in wet cloth better dibanding ice at
dry cloth karena konveksi
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
WAKTU IDEAL INTERVAL THERAPI DAN DURASI NYA ?
Tidak ada guidelines klinik yang jelas mengenai hal ini
Secara umum 10-20 menit interval dengan durasi waktu yang bervariasi
Respon tiap pasien berbeda para klinisi yang berperan
Assesement yang salah hunting responsepeningkatan edema
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
Swelling bisa berlanjut selama 24-72 jamwalau ada ice therapy
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
SEBERAPA KUAT BUKTI KLINIS YANG MENYOKONG CRYOTERAPI PASKA ORAL SURG.PROCEDURE ?
7 study at englandkegunaann cryoterapi pasca surgery
5 peneliti tidak menemukan manfaat Cryoterapi
2 peneliti adanya menfaat tambahan cryoterapi pasca oral surgery
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
KESIMPULAN Berdasar dari respon fisiologis terhadap
aplikasi dingin :1. Adanya keuntungan paska oral surgery2. Tehnik dan pengalaman klinis adalah
suatu seni ( pengobatan )3. Diperlukan clinical trial
definitivependekatan based evidence tentang cryoterapi setelah prosedur bedah oral
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a literature review: therapeutic efficacy of cold therapy after intraoral surgical procedure,drg.Dondy,PPDGS periodonsia UNAIR 2011
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