Comparison of Magnesium Sulphate 30 mg/Kg With Lidocaine 1,5 mg/Kg in Hemodynamic Changes and Cortisol Level Post-intubation in Patient Undergoing Craniotomy
Phase: PHASE1
Conditions: Intubation Complication
Sponsor: Arsil Radiansyah

 COMPARISON OF MAGNESIUM SULPHATE 30 MG/KG WITH 
LIDOCAINE 1,5 MG/KG IN HEMODYNAMIC CHANGES AND 
CORTISOL LEVEL POST INTUBATION IN PATIENT UNDERGOING 
CRANIOTOMY 
THESIS 
Oleh: 
Arsil Radiansyah 
NIM. 197114032 
Pembimbing I : 
dr. Rr. Sinta Irina, Sp.An-TI, Subsp.NA(K) 
Pembimbing II : 
dr. Heru Kurniawan, M.Ked(An), Sp.An-TI, Subsp.AKV(K) 
PROGRAM PENDIDIKAN DOKTER SPESIALIS 
PROGRAM STUDI ANESTESIOLOGI DAN TERAPI INTENSIF 
FAKULTAS KEDOKTERAN 
UNIVERSITAS SUMATERA UTARA 
MEDAN 
2024 
date of the document: January 8, 2024

COMPARISON OF MAGNESIUM SULPHATE 30 MG/KG WITH 
LIDOCAINE 1,5 MG/KG IN HEMODYNAMIC CHANGES AND 
CORTISOL LEVEL POST INTUBATION IN PATIENT UNDERGOING 
CRANIOTOMY 
THESIS 
Diajukan Sebagai Salah Satu Syarat Untuk Memperoleh Gelar Dokter 
Spesialis Dalam Program Studi Anestesiologi dan Terapi Intensif Pada 
Fakultas Kedokteran Universitas Sumatera Utara 
Oleh: 
Arsil Radiansyah 
NIM. 197114032 
Pembimbing I : 
dr. Rr. Sinta Irina, Sp.An-TI, Subsp.NA(K) 
Pembimbing II : 
dr. Heru Kurniawan, M.Ked(An), Sp.An-TI, Subsp.AKV(K) 
PROGRAM PENDIDIKAN DOKTER SPESIALIS 
PROGRAM STUDI ANESTESIOLOGI DAN TERAPI INTENSIF 
FAKULTAS KEDOKTERAN 
UNIVERSITAS SUMATERA UTARA 
MEDAN 
2024 
date of the document: January 8, 2024

LEMBAR PENGESAHAN 
 
Judul Tesis :  
 
PERBANDINGAN PEMBERIAN MAGNESIUM SULFAT 30 MG/KGBB 
DENGAN LIDOKAIN 1,5 MG/KGBB TERHADAP PERUBAHAN 
RESPON HEMODINAMIK DAN KADAR KORTISOL PASKA  
INTUBASI PADA PASIEN YANG MENJALANI  
KRANIOTOMI 
 
Nama 
: ARSIL RADIANSYAH 
NIM 
: 197114032 
Program Studi 
: Anestesiologi dan terapi intensif 
 
 
Menyetujui, 
Komisi Pembimbing 
 
 
Pembimbing I 
Pembimbing II 
 
 
 
 
 
 
 
dr. Rr. Sinta Irina, Sp.An-TI, Subsp.NA(K) 
dr. Heru Kurniawan, M.Ked(An), Sp.An-TI, Subsp.AKV(K) 
  
 
 
Ketua Departemen  
Ketua Program Studi 
 
 
 
 
 
 
Dr. dr. Tasrif Hamdi, M.Ked(An), Sp.An, KM   N 
dr. Andriamuri P Lubis, M.Ked(An),Sp.An, KIC 
 
 
 
Dekan  
Ketua TKP PPDS 
  
 
 Prof. Dr. dr. Aldy Safruddin Rambe, Sp.S(K)  
Dr. dr. Cut Adeya Adella, Sp.O.G, Subsp.Onk 
                   
Telah diuji pada Hari /Tanggal : 8 Januari 2024 

PERBANDINGAN PEMBERIAN MAGNESIUM SULFAT  
30 MG/KGBB DENGAN LIDOKAIN 1,5 MG/KGBB TERHADAP 
PERUBAHAN RESPON HEMODINAMIK DAN KADAR KORTISOL 
PASKA INTUBASI PADA PASIEN YANG MENJALANI KRANIOTOMI 
Arsil Radiansyah1, Rr Sinta Irina1, Heru Kurniawan1, Juliandi Harahap2 
1Program Studi Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, 
Universitas Sumatera Utara 
2Program Studi/Departemen Kedokteran Komunitas, Fakultas Kedokteran, 
Universitas Sumatera Utara 
Abstrak 
Pendahuluan Pada kraniotomi, respon stres dapat terjadi dari peningkatan 
hemodinamik hingga respon stres hormonal seperti meningkatnya kadar kortisol. 
Intubasi merupakan faktor utama yang harus dipertimbangkan saat induksi 
neuroanestesi. Intubasi secara endotrakeal merupakan komponen penting dari 
anestesi umum pada tindakan operasi kraniotomi. Magnesium sulfat memiliki 
keuntungan dalam hal menjaga kestabilan autoregulasi otak dan neuroprotektif.  
Metode Magnesium sulfat memiliki keuntungan dalam hal menjaga kestabilan 
autoregulasi otak dan neuroprotektif. Dengan total sampel minimal untuk seluruh 
kelompok sebesar 30 sampel yang dibagi menjadi 3 kelompok pasien yang 
mendapat lidokain, MgSO4 dan kelompok control yang mendapatkan NaCl 
Hasil Terdapat perbedaan yang signifikan antara ketiga kelompok dengan 
hemodinamik dan kadar serum kortisol ditemukan lebih rendah pada kelompok 
lidokain 
Kesimpulan Pemberian Lidokain 1,5 mg/kgbb secara intravena paling efektif 
dalam melemahkan kejadian respon stress berupa peningkatan tekanan darah, HR 
dan kadar serum kortisol akibat tindakan laringoskopi dan intubasi pada pasien 
yang menjalani kraniotomi dibandingkan pemberian MgSO4 30 mg/kgbb secara 
intravena 
Kata Kunci Kraniotomi, Intubasi, Lidokain, MgSO4 
date of the document: January 8, 2024

Comparison of Magnesium Sulphate 30 mg/KgBW with Lidocaine 1,5 
mg/KgBW in Hemodynamic Changes and Cortisol Level post Intubation in 
Patient Undergoing Craniotomy 
Arsil Radiansyah1, Rr Sinta Irina1, Heru Kurniawan1, Juliandi Harahap2 
1Study Program of Anesthesiology and Intensive Care, Faculty of 
Medicine,Universitas Sumatera Utara, Indonesia 
2Study Program/Department of Cummunity Medicine, Faculty of Medicine, 
Universitas Sumatera Utara, Indonesia 
Abstract 
Introduction In craniotomy, stress responses can occur from increased 
hemodynamics to hormonal stress responses such as increased cortisol levels. 
Intubation is a major factor that must be considered during the induction of 
neuroanesthesia. Endotracheal intubation is an important component of general 
anesthesia in craniotomy surgery. Magnesium sulfate has advantages in terms of 
maintaining the stability of brain autoregulation and is neuroprotective. 
Method Magnesium sulfate has advantages in terms of maintaining the stability of 
brain autoregulation and is neuroprotective. With a minimum total sample for the 
entire group of 30 samples which were divided into 3 groups of patients who 
received lidocaine, MgSO4 and a control group who received NaCl 0,9% 
Results There were significant differences between the three groups with 
hemodynamic and serume cortisol values found to be lower in the lidocaine group 
Conclusion Intravenous administration of Lidocaine 1.5 mg/kgbb is most effective 
in attenuating the stress response in the form of increased blood pressure, HR and 
serum cortisol levels due to laryngoscopy and intubation in patients undergoing 
craniotomy compared to intravenous administration of MgSO4 30 mg/kgbb 
Keywords Craniotomy, Intubation, Lidocaine, MgSO4 
date of the document: January 8, 2024

KATA PENGANTAR 
 
Penulis mengucapkan puji dan syukur kehadirat Allah SWT yang telah 
memberikan berkah-Nya kepada Penulis sehingga dapat menyelesaikan tesis ini. 
Selama melakukan penelitian dan penulisan tesis, penulisan banyak memperoleh 
bantuan moril dan materil dari berbagai pihak. Oleh karenanya, pada kesempatan 
ini penulis menyampaikan ucapan terima kasih yang tulus kepada:  
1. Bapak Dr. Muryanto Amin, S.Sos., M.Si, selaku Rektor Universitas 
Sumatera Utara.  
2. Bapak Prof. Dr. dr. Aldy Safruddin Rambe, SpS(K), selaku Dekan Fakultas 
Kedokteran Universitas Sumatera Utara.  
3. Bapak dr. Andriamuri Primaputra Lubis, M.Ked(An), Sp.An-TI, 
Subsp.TI(K) dan Ibu dr. Rr. Sinta Irina, Sp.An-TI, Subsp.NA(K), selaku 
Ketua dan Sekretaris Program Studi Anestesiologi Dan Terapi Intensif 
Fakultas Kedokteran Universitas Sumatera Utara.  
4. Ibu dr. Rr. Sinta Irina, Sp.An-TI, Subsp.NA(K), Bapak dr. Heru Kurniawan, 
M.Ked(An), Sp.An-TI, Subsp.AKV (K) dan Bapak Dr. dr. Juliandi 
Harahap, MA, FISPH, FISCM, Sp.KKLP selaku Anggota Komisi 
Pembimbing yang telah membimbing dan mengarahkan penulis dalam 
menyelesaikan tesis ini.  
5. Bapak dr. Chrismas Gideon Bangun M.Ked(An)Sp.An-TI, Subsp.NA(K) 
dan Dr. dr. Bastian Lubis, M.Ked(An), Sp.An-TI, Subsp.TI(K), selaku 
Komisi Penguji atas saran dan kritik yang diberikan.  
Penulis menyadari tesis ini masih banyak memiliki kekurangan dan jauh dari 
sempurna. Namun harapan penulis semoga tesis ini bermanfaat kepada seluruh 
pembaca. Semoga kiranya Tuhan Yang Maha Esa memberkati kita semua. Amin.  
 
Medan,     April 2024 
  Penulis,  
 
 dr. Arsil Radiansyah 
date of the document: January 8, 2024

DAFTAR ISI 
 
 
LEMBAR PENGESAHAN .................................................................................. ii 
ABSTRAK ............................................................................................................ iv 
KATA PENGANTAR .......................................................................................... vi 
DAFTAR ISI ........................................................................................................ vii 
DAFTAR GAMBAR ............................................................................................. x 
DAFTAR TABEL................................................................................................. xi 
DAFTAR SINGKATAN ..................................................................................... xii 
BAB I PENDAHULUAN ...................................................................................... 1 
1.1 
Latar Belakang...........................................................................................1 
1.2 
Rumusan Masalah .....................................................................................5 
1.3 
Tujuan Penelitian .......................................................................................5 
1.3.1 
Tujuan Umum ....................................................................................5 
1.3.2 
Tujuan Khusus ...................................................................................5 
1.4 
Manfaat Penelitian .....................................................................................6 
1.4.1 
Manfaat dalam Bidang Akademik .....................................................6 
1.4.2 
Manfaat dalam Bidang Pelayanan Masyarakat ..................................7 
1.4.3 
Manfaat dalam Bidang Penelitian ......................................................7 
BAB II TINJAUAN PUSTAKA ........................................................................... 8 
2.1 
Kraniotomi .................................................................................................8 
2.2 
Intubasi ....................................................................................................11 
2.2.1 
Perubahan Fisiologi pada Intubasi ...................................................13 
2.3 
Autoregulasi Otak ....................................................................................17 
2.3.1 
Autoregulasi Terhadap Intubasi .......................................................18 
2.4 
Lidokain ...................................................................................................18 
2.4.1 
Farmakodinamik ..............................................................................19 
2.4.2 
Farmakokinetik ................................................................................20 
2.4.3 
Efek Samping ...................................................................................20 
2.5 
Magnesium Sulfat ....................................................................................21 
2.5.1 
Farmakodinamik ..............................................................................21 
2.5.2 
Farmakokinetik ................................................................................22 
date of the document: January 8, 2024

2.5.3 
Efek Samping ...................................................................................23 
2.6 
Kadar Kortisol .........................................................................................24 
2.7 
Hubungan Magnesium Sulfat Terhadap Hemodinamik & Kadar Kortisol
30 
2.8 
Hubungan Lidokain Terhadap Hemodinamik dan Kadar Kortisol .........33 
2.9 
Kerangka Teori ........................................................................................34 
2.10 
Kerangka Konsep .................................................................................35 
2.11 
Hipotesis ..............................................................................................35 
BAB III METODE PENELITIAN .................................................................... 36 
3.1 
Rancangan Penelitian ..............................................................................36 
3.2 
Tempat dan Waktu Penelitian .................................................................36 
3.3 
Populasi dan Sampel Penelitian...............................................................36 
3.4 
Besar Subjek Penelitian ...........................................................................36 
3.5 
Pemilihan Subjek Penelitian ....................................................................37 
3.6 
Kriteria Penelitian ....................................................................................37 
3.6.1 
Kriteria Inklusi .................................................................................37 
3.6.2 
Kriteria Eksklusi...............................................................................38 
3.6.3 
Kriteria Drop Out .............................................................................38 
3.7 
Variabel Penelitian ..................................................................................38 
3.8 
Definisi Operasional ................................................................................39 
3.9 
Bahan dan Cara Kerja ..............................................................................40 
3.9.1 
Alat dan Bahan .................................................................................40 
3.9.2 
Cara Kerja ........................................................................................41 
3.10 
Rancangan Analisis..............................................................................42 
3.11 
Alur Penelitian .....................................................................................43 
3.12 
Etika Penelitian ....................................................................................43 
BAB IV HASIL PENELITIAN .......................................................................... 44 
4.1 
Karakteristik Responden .........................................................................44 
4.2 
Peniliaian Tekanan Darah, MAP, dan Heart Rate ..................................45 
4.3 
Penilaian Kadar Serum Kortisol ..............................................................58 
4.4 
Penilaian Kadar Serum Magnesium ........................................................60 
BAB V PEMBAHASAN ................................................................................... 633 
date of the document: January 8, 2024

CHAPTER III 
RESEARCH METHODS 
3.1 Research Design 
This research design used a double-blind, randomized controlled clinical trial 
withpre test post test with control group design, to assess the comparison of post-
intubation hemodynamics and cortisol when administering intravenous Magnesium 
sulfate and intravenous Lidocaine. 
3.2 Place and Time of Research 
This research will be carried out at the Central Surgical Installation (IBP) of 
several hospitals, namely: 
1. Adam Malik Haji Central General Hospital Medan (RSUP HAM).
2. Teaching Hospital (RSP) Prof. Dr. Chairuddin Panusunan Lubis.
3. Rumkit Level II Putri Hijau Medan.
4. RSU Haji Medan
This research began to be carried out after its publication I from the Health
Research Ethics Committee of the University of North Sumatra and a research 
permit from each hospital. 
3.3 Research Population and Sample 
The study population was all patients who underwent craniotomy surgery. The 
sample for this study was all patients undergoing surgery who met the inclusion and 
exclusion criteria. 
3.4 Size of Research Subjects 
The formula for determining the sample size used in this research is: 
𝑛𝑛1 = 𝑛𝑛2 = 𝑛𝑛3 = 2 
(𝑍𝑍𝑍𝑍+ 𝑍𝑍𝑍𝑍)𝑠𝑠2
(𝑥𝑥1 −𝑥𝑥2)2
36 
date of the document: January 8, 2024

37 
𝑍𝑍𝑍𝑍 = value on a standard normal distribution equal to level significance of α (for 
α=0.05 it is 1.96). 
𝑍𝑍β = value in the standard normal distribution which is the same as power as 
large as desired (for β=0.20 it is 0.84). x1 
x1-x2 
= difference in cortisol levels between groups that is considered significant
10.4 µg/dl45 
s 
= standard deviation of cortisol in previous studies 5.85 µg/dl45 
𝑛𝑛1 = 𝑛𝑛2 = 𝑛𝑛3
= 2 (1,96 + 0,84)5,8
10,42
𝑛𝑛1 = 𝑛𝑛2 = 𝑛𝑛3 = 9,04 
From the results of calculations using the sample size formula above, the 
sample size for each group is 9.04 samples. Then the sample was added by 10%, 
obtaining a sample size for each group of 10. So the minimum total sample for the 
entire group was 30 samples. 
3.5 Selection of Research Subjects 
Research subjects were taken using techniques consecutive samplinguntil the 
number of research subjects is met. Randomization was carried out by volunteers 
using a computerized randomization method using a website www.randomizer.org. 
The three groups were divided into groups A (intravenous magnesium sulfate), B 
(intravenous lidocaine) and C (control). 
3.6 Research Criteria 
3.6.1 Inclusion Criteria 
1. Patients aged 18-65 years
2. Body mass index (BMI) 18.5 kg/m2– 29.9 kg/m2
3. The patient or family agrees to be a research subject
date of the document: January 8, 2024

4. Non-traumatic craniotomy cases, namely evacuation of supratentorial brain
tumors, evacuation of intracerebral hemorrhage, subdural hemorrhage,
cerebrovascular correction.
5. Patients undergoing elective non-traumatic craniotomy surgery at IBP
HAM Hospital, RSP Prof. Dr. Chairuddin Panusunan Lubis, Rumkit
Tk.II Putri Hijau Medan, and RSU Haji Medan
3.6.2 Exclusion Criteria 
1. Patients with heart problems.
2. Patients with liver disorders
3. Patients with kidney disorders
4. Patients with pregnancy
5. Patients with hypertension or hypotension before surgery
6. Patients who are known to be hypersensitive to MgSO4 and/or Lidocaine
7. Patients with chronic use of corticosteroid drugs,Calcium channel blockers, The
drug contains magnesium and opioids
8. Patients at risk of difficult intubation and ventilation according to the LEMON
score and MOANS score
criteria 
9. Patients with cortisol secretion disorders (pituitary tumors or hypothalamic
tumors or adrenal gland disorders)
10. Patients with hypocortisol or hypercortisol on T0 serum cortisol
examination 
3.6.3 CriteriaDrop Out 
1. Patients with more than 1 intubation and endotracheal intubation time of
more than 1 minute
2. The patient dies intraoperative.
3.7 Research Variables 
Independent variables: Magnesium sulfate 30 mg/kgbb, Lidocaine 1.5mg/kgbb and 
38 
date of the document: January 8, 2024

Intravenous control: 
Dependent variable 
Hemodynamics and cortisol levels 
3.9.2 How it Works 
1. Patients who have been registered for planned surgery according to the
indications of the neurosurgery department who have met the inclusion and
exclusion criteria are recruited 
to become research subjects. 
2. Patients are given an explanation of the research procedures and asked to
sign an agreement to participate in the research.
3. The sample was divided randomly into 3 groups and double-blind
randomization was carried out using an applicationrandomizer.org
4. After randomization, they were divided into 3 groups consisting of patients who
received MgSO430 mg/KgBW, Lidocaine 1.5 mg/KgBW and Control
5. The patient is prepared on the operating table in a supine position before induction.
The patient is checked for systolic blood pressure, diastolic blood
pressure, MAP, pulse and blood cortisol levels (blood sample tubes are 
given code K0) 
6. The first group of patients was given MgSO430 mg/KgBW diluted in 20 ml
with 0.9% NaCl, labeled with code A and administered within 5 minutes
withsyringe pump, The second group was given 1.5 mg/kg Lidocaine diluted 
in 20 ml with 0.9% NaCl, labeled with code B and given within 5 minutes 
with a syring pump, The third group was given 0.9% NaCl, in a 20 ml syringe 
labeled with code C and given within 5 minutes with a syring pump. With all 
three groups of patients receiving maintenance fluidsRinger Solution 
7. The patient was induced 10 minutes after intervention with:
Midazolam 
: 0.07 mg/kgBB 
Fentanyl 
: 2 mcg/kgBB 
Propofol 
: 2 mg/kgBB 
Rocuronium 
: 1 mg/kgBB 
39 
date of the document: January 8, 2024

8. After induction and intubation by PPDS anesthesiology and intensive therapy
FK USU semester 5 and above. The patient is then recorded for systolic blood
pressure, diastolic blood pressure, MAP, pulse at T1 (3 minutes), T2 (5 
minutes), T3 (7 minutes), T4 (10 minutes). At T4 a blood cortisol sample was 
also taken (the blood sample tube was given the code K1). 
9. Then record and analyze the data.
10. If hypertension occurs with TDS> 150 mmHg 5 minutes after intubation,
administeredcalcium channel blockers (titration starting from 0.25 mg/KgBW/
hourNicardipine) or Hypotension with TDS< 80 mmHg 5 minutes after
intubation given Ephedrine 5-10 mg. If HR bradycardia occurs< 50 x/minute
giveatropine sulfate 0.5 mg.
3.8 Analysis Plan 
After the required data has been collected, the data is then checked again for 
completeness before being tabulated and processed. Then the data is coded to make 
it easier to tabulate. 
Data is tabulated into a master table using software SPSS version 21. 
Normality test uses Shapiro Wilk, numerical data in mean SD (standard deviation) 
and median (minimum-maximum) values. Meanwhile, categorical data is displayed 
in numbers (percentages). The dependent t-test (if the data is not normally 
distributed, the alternative is the Wilcoxon test) is used to determine the difference 
in hemodynamic response and cortisol levels before and after intervention in each 
group, the Anova test (if the data is not normally distributed, the alternative is the 
Kruskal-Wallis test ) was used to determine differences in hemodynamic responses 
and cortisol levels in the MgSO group4, Lidocaine group and Control group. 
Statistical analysis uses a 95% confidence interval with a p value <0.05 considered 
significantly significant. 
40 
date of the document: January 8, 2024

41 
3.9 Research Flow 
   Craniotomy Patients 
         Inclusion Exclusion Criteria 
Measurement of hemodynamics and cortisol 
MgSO4 
Intravenous 
Intravenous 
Lidocaine 
Control 
30 mg/KgBW 
1.5 mg/KgBW 
NaCl 0.9% 
Intubation 
Measurement 
hemodynamics 
Content 
Measurement 
T1 (3 minutes) 
T2 (5 minutes) 
  Cortisol on T4  
  (10 minute) 
T3 (7 minutes) 
T4 (10 minutes) 
    Data 
tabulation 
Data analysis 
Figure 3.1Research Flow. 
date of the document: January 8, 2024

3.10 Research Ethics 
Research ethics were carried out after obtaining approval from the Health 
Research Ethics Committee of the University of North Sumatra and Haji Adam 
Malik Hospital Medan, Prof. Dr. Chairuddin Panusunan Lubis, and Rumkit Tk.II 
Putri Hijau Medan and RSU Haji Medan. The patient and the patient's family 
receive an explanation of the procedure to be undertaken, and state their 
willingness in writing on a sheetinformed consent 
41 
date of the document: January 8, 2024

Appendix 2 
Name : 
Birthdate 
MINISTRY OF HEALTH 
DIRECTORATE GENERAL OF HEALTH SERVICES DEVELOPMENT 
H. ADAM MALIK CENTRAL GENERAL HOSPITAL
Jl. Bunga Lau No. 17 Medan Tuntungan Km.12 Post Box 246 Tel. (061) 
8364581-8360143-8360051 Fax. 8360255 
MEDAN-20136 
RM.2.11/IC.SPenelitian/2023 
EXPLANATION SHEET 
RESEARCH TITLE: 
COMPARISON OF ADMINISTRATION OF MAGNESIUM SULFATE 
30 MG/KGBB WITH LIDOCAINE 1.5 MG/KGBB ON CHANGES IN HEMODYNAMIC 
RESPONSE AND POST-INTUBATION CORTISOL LEVELS IN PATIENTS UNDERGOING 
CRANIOTOMY 
IMPLEMENTING INSTANCE/SMF: 
SMF ANESTHESIOLOGY AND INTENSIVE THERAPY FK USU 
Dear sir or madam ............................................. ... 
First, we would like to introduce ourselves, the name is Dr. Arsil Radiansyah 
and the team in charge of the Anesthesiology and Intensive Therapy Specialist 
Medical Education Program, Faculty of Medicine, University of North Sumatra, 
we would like to convey to you that we intend to conduct research on 
"University of North Sumatra and are currently conducting research entitled: 
"COMPARISON OF ADMINISTRATION OF MAGNESIUM 
SULFATE 30 MG/ KGBB WITH LIDOCAINE 1.5 MG/KGBB ON 
CHANGES IN HEMODYNAMIC RESPONSES AND POST-
INTUBATION CORTISOL LEVELS IN PATIENTS THOSE 
UNDERGOING CRANIOTOMY.” 
date of the document: January 8, 2024

Endotracheal intubation or placement of a breathing tube has been proven 
to be a reliable method for securing the airway and is the standard 
technique for Airway management during neurosurgical surgery. 
Installation of a breathing tube stimulates hemodynamic effects and a 
stress response which can have negative 
effects on organs especially the brain and heart. Attenuation of the response to 
painful stimuli during the installation of a breathing tube can have a beneficial 
effect on organ function, especially on the cerebrovascular system before 
neurosurgical surgery. This research concerns services in the operating room for 
craniotomy surgery patients with GA-ETT anesthesia afterwards so they need drugs 
that help to 
reduce the occurrence of stress responses and hemodynamic 
changes 
This study is expected to assess the comparison of administration of magnesium 
sulfate with lidocaine on the hemodynamic response and changes in serum 
cortisol as an indicator of the stress response due to post-intubation pain in 
craniotomy surgery patients. The research procedures to be carried out are as 
follows: 
1.
The patient underwent craniotomy under general anesthesia and
underwent examination and consent.
2.
After the patient arrives in the operating room, the patient is prepared on
the
operating table in a supine position before induction. The patient is
checked for blood cortisol levels and hemodynamics are recorded.
3.
The first group of patients was given
which 
in 
MgSO4 30 
mg/KgBW 
dilute in 20 ml with 0.9% NaCl and give within 5 minutes with a 
syring pump. The second group is given 
lidocaine 1.5 
mg/kgBW 
date of the document: January 8, 2024

which is diluted in 20 ml with 0.9% NaCl and given in 5 minutes with a 
syring pump. The third group was given 0.9% NaCl, in a 20 ml syringe 
and given within 5 minutes with a syring pump With all three groups of 
patients receiving Ringer Solution maintenance fluid 
4.
After induction and intubation. The patient then
recording is carried out at T1 (3 minutes), T2 (5 minutes), T3 (7
minutes), T4 (10
minutes) hemodynamics. At T4 it is also carried out 
cortisol sampling
blood .
5.
This assessment was carried out directly by researchers who
were not involved in administering medication to the patient.
In this study there are no side effects and the confidentiality of your data will be 
maintained properly. Patients have the right to refuse to participate in research and 
have the right to withdraw from research. All funding is borne by researchers. 
Your participation in this research is voluntary and without coercion and you 
can withdraw at any time. and for my thanks to sir/madam I 
will give gifts in the form of food and drinks 
 
. Not occur 
 
changes in the quality of service from doctors to you if you are not willing to take 
part in this research. You will continue to receive routine standard health services 
in accordance with health service procedures. 
If you are willing, then we expect you to sign the Consent After Explanation (PSP) 
sheet. If you have any complaints during treatment, you can contact me on 
(085261274162). Researchers will try to help resolve your complaints. That's what 
we can say. We thank you for your attention and cooperation. 
Medan, 
2024 
Researcher 
(Dr. Arsil Radiansyah) 
date of the document: January 8, 2024

Appendix 3 
RM.2.11/IC.SPenelitian/2022NRM : 
Name : 
Gender: 
Date. Born : 
H. Adam Malik Hospital- USU FK
RESEARCH CONSENT FORM 
(INFORMED CONSENT FORM) 
Principal Researcher 
: Dr. Arsil Radiansyah 
Information Provider 
: 
Information Recipient 
: 
Subject Name 
: 
Date of Birth (age) 
: 
Gender 
: 
Address 
: 
No. Tel (Cell) 
: 
TYPE OF 
INFORMATION 
INFORMATION CONTENT 
MARK 
1 
Research Title 
“COMPARISON OF ADMINISTRATION 
OF MAGNESIUM SULFATE 30 MG/KGBB 
WITH LIDOCAINE 1.5 MG/KGBB ON 
CHANGES IN RESPONSE 
HEMODYNAMICS AND LEVELS 
POST-INTUBATION CORTISOL IN 
UNDERSTANDING PATIENTS 
CRANIOTOMY” 
2 
Objective 
To analyze the comparison of administering 
study 
magnesium sulfate 30 mg/kgBW with lidocaine 
1.5 mg/KgBW on changes in hemodynamic 
response and post-intubation cortisol levels in 
patients undergoing craniotomy 
3 
Method & 
According to research procedures 
date of the document: January 8, 2024

Procedure 
Study 
84 
 
 
4 
Number of 
Subjects 
30 Research subjects 
5 
Time 
February 2024 until the sample size is reached 
Study 
6 
Benefit 
a) improve the quality of service to the 
study 
community, especially to patients 
including 
undergoing craniotomy. 
benefits for 
b) The results of this research can be used 
subject 
in determining therapeutic optionscost 
effectivefor post-craniotomy patients. 
7 
Risks & 
effect 
In general, this research will not cause 
side 
in 
anything dangerous for you. 
study 
8 
No 
This study does not cause discomfort to the 
comfort 
patient 
subject 
study 
9 
Protection 
Consent to the research is carried out by the 
SubjectProne to 
witness/guardian if the subject cannot read and 
write, has decreased consciousness, has a 
mental 
disorder and is under 18 years of age. 
10 Compensation 
If anything undesirable happens during 
when an effect 
occurs 
the research, which is caused by the 
side 
treatment carried out in this research, you 
can contact me, Dr. Arsil Rahadiansyh (tel: 
085261274162). All costs incurred for this 
research and the consequences arising 
from this research are the full 
responsibility of the Research Supervisor 
and myself as the researcher. The 
research will be supervised and supervised 
by expert doctors in the Anesthesiology 
and Intensive Medical Therapy section of 
the University of North Sumatra. 
11 
Alternati
ve 
- 
Handling 
if there 
date of the document: January 8, 2024

12 Guarding 
All your data will be kept confidential 
Confidentiality 
regarding the results of this research. The 
Data 
data we take is the result of our research 
and related research variables 
  
13 Costs are 
All related costs outside normal procedures 
borne by 
will be borne by the researcher, research 
researcher 
costs are attached 
14 Incentives for 
Food and drink parcels 
subject 
 
 
After listening to the explanation on pages 1 and 2 regarding the research to be 
carried out by: dr. Arsil Radiansyah, I have understood this information well. 
 
By signing this form I agree, I/……………… to be included in the above 
 
research voluntarily without coercion from any party. If at any time I feel 
disadvantaged in any form, I have the right to cancel this agreement. 
date of the document: January 8, 2024

 
 
 
 
Subject's Guardian's Signature or Thumbprint 
 
 
 
 
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
 
- Name and Signature of Subject Guardian 
 
 
 
 
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
 
- - - Researcher's Signature 
 
 
 
 
- 
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
 
Name of Researcher 
date of the document: January 8, 2024

 
Appendix 4 
 
 
CONSENT SHEET AFTER EXPLANATION 
 
(INFORMED CONSENT) 
 
 
I, the undersigned, are:  
Name  
 
  : 
 
Place and date of birth ;  
Age/Gender 
: 
Age/Male/female 
 
Address 
: 
 
Phone number 
; 
 
 
Based on previous explanations from researchers, namely dr. Arsil Radiansyah, I 
have received very clear information regarding research regarding 
"COMPARISON OF ADMINISTRATION OF 30 MG/KGBB MAGNESIUM 
SULFATE WITH 1.5 MG/KGBB LIDOCAINE ON CHANGES IN 
HEMODYNAMIC RESPONSE AND POST-INTUBATION CORTISOL 
LEVELS IN PATIENTS UNDERGOING CRANIOTOMY". Therefore, I am 
hereby willing to become an informant as part of this research, this research 
voluntarily and without coercion and can resign at any time without any 
sanctions. 
 
 
 
 
 
Medan, 
2024 
 
 
Researcher 
Respondent 
 
 
 
 
(Dr. Arsil Radiansyah) 
( 
) 
 
 
 
Witness 
 
 
 
 
( 
) 
 
 
 
 
 
 
 
 
date of the document: January 8, 2024