Perbandingan Pengaruh Efek Dexmedetomidin dengan Propofol dan Fentanyl Terhadap Kualitas Pemulihan Anestesi Umum dengan Menggunakan Skoring Quality of Recovery-15 (Qor-15) pada Pasien Kranioplasti

Abstract

Introduction: Cranioplasty requires general anesthesia with optimal management to ensure patient safety and quality of recovery. Dexmedetomidine (DEX) provides sedative, analgesic, and hemodynamic stability, while the combination of propofol and fentanyl remains widely used. However, evidence comparing their effects on postoperative recovery quality in cranioplasty is still limited. This study aimed to compare the effects of DEX with propofol + fentanyl on the quality of recovery after general anesthesia using the QoR-15 score. Methods: This double-blind randomized controlled trial involved 42 cranioplasty patients at RSUP H. Adam Malik and RSU Haji Medan. Patients were randomized to receive either dexmedetomidine 0.5 mcg/kgBW or fentanyl 0.5 mcg/kgBW plus propofol 50 mcg/kgBW/hour. Quality of recovery was assessed using the QoR-15 questionnaire at 12 hours (T1) and 24 hours (T2) postoperatively. Hemodynamic parameters, sedation level (Ramsay Sedation Scale), side effects, rescue analgesia, and operator satisfaction were also recorded. Data were analyzed with SPSS 26, with p ≤ 0.05 considered significant. Result: A total of 42 cranioplasty patients were analyzed, and baseline characteristics were comparable between groups (p > 0.05). QoR-15 scores were higher in the dexmedetomidine group compared to propofol + fentanyl at both T1 (12 h: 140 vs 135; p = 0.045) and T2 (24 h: 138 vs 130; p = 0.003). A greater proportion of patients achieved good recovery in the dexmedetomidine group (T1: 90.5% vs 66.7%; T2: 95% vs 52%). Heart rate was more stable in the dexmedetomidine group (p = 0.02), while sedation level (RSS) and operator satisfaction did not differ significantly between groups. Conclusion: Intraoperative dexmedetomidine improves postoperative recovery in cranioplasty patients compared to propofol + fentanyl, with higher QoR-15 scores and better recovery. It also offers greater hemodynamic stability, while sedation and operator satisfaction were comparable.