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Anestesia dan Thalasemia Saeful Alam, M. Deny; Sudjud, Reza Widianto; , Indriasari
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Thalasemia merupakan penyakit keturunan atau herediter menurut hukum mandel yang melibatkan penurunan produksi salah satu atau lebih rantai globin (α,β,γ,δ) dari hemoglobin sehingga terjadi gangguan sintesis hemoglobin. Gejala sudah mulai terdeteksi sejak bulan pertama kehidupan ketika level Hb fetal menurun. Gejala klinis yang dijumpai biasanya berhubungan dengan anemia yang berat, erytropoisis yang inefektif, extramedular hematopoiesis, dan gejala yang muncul karena timbunnan tranfusion dan akibat peningkatan penyerapan besi. Kulit biasanya tampak pucat karena anemia dan kuning karena jaundice dari hiperbilirubinemia. Tulang kepala dan tulang-tulang yang lainnya biasanya mengalami deformitas karena erytroid hyperplasia dengan intramedullary expansion dan penipisan tulang kortek dikenal dengan facies colley. Pasien dengan thalasemia baik intermediate atau mayor pada suatu waktu mungkin memerlukan penanganan bedah seperti misalnya cholecystectomy ataupun spleenectomi sehingga memerlukan tindakan anestesi. Permasalahan yang perlu diperhatikan saat melakukan anestesi pasien thalasemia diantaranya komplikasi akibat anemia, komplikasi akibat timbunnan besi, dan komplikasi karena terapi chelation. Kata kunci: Anemia, anestesi, hemosiderosis, splenektomi, thalasemia Anaesthesia and Thalassaemia Thalassaemia is a hereditary disorder according to Mandel’s law, involving a reduction in one of the globin chains (α,β,γ,δ) from haemoglobin resulting in impaiment of haemoglobin synthesis. Sysmptoms may present as early as one month of life when there is reduction in fetal haemoglobin. Clinical symptoms usually relates to severe anemia, ineffective erythropoiesis and symptoms that occurs as a result of transfussion and iron loading. Skin usually appears pale due to anemia and yellow due to jaundice and hyperbilirubinemia. Deformity of skull and other bones usually occurs as a result of erythroid hyperplasia with intramedually expansion and thinning of cortex known as Facies Colley. Patients with thalassaemia, either intermediate or major, may require surgery some time in their life, such as cholecystectomy or splenectomy therefore requiring anaesthesia. Issues that need to be adressed during anaesthesia include complications due to anemia, iron loading and chelation therapy. Key words: Anemia, anaesthesia, haemosiderosis, splenectomy, thalassaemia Reference Lanzkowsky P. Manual of pediatric hematology and oncology. Edisi ke-4. Burlington: Elsevier Academic Press; 2005. Yaish HM. Thalasemia [diunduh 2 Januari 2011]. Tersedia dari: http//www.emedicine. com. DeBaun MR, Vichinsky E. Hemoglobinopathies. Dalam Kliegman RM, Behrman RE, Jenson HB, Stanton BF, penyunting. Nelson Textbook of Pediatrics. Edisi ke⎯18. Philadelphia: Elsevier Saunders; 2007. h. 2025⎯38. Permono B, Ugrasena IDG. Hemoglobin abnormal: talasemia. Dalam Permono B, Sutaryo, Ugrasena IDG, Windiastuti E, Abdulsalam M, penyunting. Buku ajar hematologi-onkologi anak. Cetakan ke-2. Jakarta: Badan Penerbit IDAI; 2006. hlm. 64-97. Lekawanvijt S, Chattipakorn N. Iron overload thalassemic cardiomyopathy: iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity. Can J Cardiol. 2009;25(4):213⎯8. Kushner JP, Porter JP, Olivieri NF. Secondary iron overload. Hematology. 2001:47⎯61. Rund D, Rachmilewitz E. β-Thalasemia. N Engl J Med. 2005;353:1135-46. Olivieri NF. The β-Thalasemia. N Engl J Med. 1999:341(2):99-109. Catlin AJ. Thalasemia: the facts and the controversies. Pediatr Nursing. 2003;29(6):447⎯51. Bahador A, Banani SA, Foroutan HR, Hosseini SM, Davani SZ. A comparative study of partial vs total splenectomy in thalasemia major patients. J Indian Assoc Pediatr Surg. 2007 vol 12, page 133⎯5 Grosfeld JL, dkk. The Spleen in Pediatric Surgery edisi ke 2 dan 6. Mosby Elsevier. 2006 hlm. 1691-1702. Wood JC. Cardiac complications in thalasemia major. PMC. 2010;33:81⎯6. Colan SD. Cardiomyopathies. Dalam: Keane JF, Lock JE, Fyler D. Nadas’ pediatric cardiology. Edisi ke⎯2. Philadelphia: Saunders Elsevier; 2006. hlm. 415⎯58. Cogliandro T, Derchi G, Mancuso L, Mayer MC, Pannone B, Pepe A. Guideline recommendations for heart complications in talasemia major. Cardiology Medi. 2008;9:515⎯25. Yao Fun Sun F, Anesthesiology Problem-Oriented Patient Management. Edisi ke 6. Lippincott Williams & Wilkins. 2008:986–987. Hines RL, Marschall KE. Stoelting’s Anesthesia and Co-Existing Disease. Edisi ke 5. Saunders Elsevier. 2008:412. Barash PG, Cullen BF, Stoelting RK, Calahan MK, Stock MC. Handbook of Clinical Anesthesia. Edisi ke 6. Lippincott Williams & Wilkins. 2009:240–241. 18. Morgan GE, Mikhail MS, Murray MJ.Clinical Anesthesiology. Edisi ke 4. Mc Graw Hill. 2005:471, 476–477.
Risk ratio of Delirium in crIticaly ill patient using the Confusion Assessment Method for Intensive Care Unit during admission from October to Desember 2015 in Intensive Care Unit Dr. Hasan Sadikin Hospital Rohmawanur, Tubagus Yuli; , Indriasari; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Delirium is an acute and fluctuative state marked by changes in mental, concioussness, attention, cognitive and perspective which develops within a certain time frame (usually hours to days). Delirium has a high incident on criticaly ill patients. The aim of this research is to investigate risk ratio (RR) of delirium in criticaly ill scored by the confusion assessment methode for the intensive care unit ( CAM-ICU) during admission in general intensive care unit (GICU) Hasan Sadikin Hospital. This is an observational analytic study with prospective cohort on 91 patients during 24 hours of GICU care from October to December 2015. Statistical analysis was done with chi square test which measures the percentage and RR of delirium.The result is the incidence of delirium in Hasan Sadikin Hospital GICU was 27.9 %. Analysis shows that there is a significant relationship between delirium with RR >1 to delirium based on sedation history is 3.16, ventilated patients was 2.37, electrolyrte imbalance 2.37, infectious disease 2.13, comorbid 1.86, neurological disorder 1.622, and analysis shows that there is a significant relationship between delirium delirium and history of sedation, electrolyte imbalance and ventilated patients with p value <0,05. The conclussion of this study is that the incidence of delirium in Dr. Hasan Sadikin Hospital GICU has a higher incidence on critically ill patient with risk factors involved. Highest risk factor is sedation history which increases the risk by 3.16 times more.
Sedasi dan Analgesia di Ruang Rawat Intensif Sudjud, Reza Widianto; , Indriasari; Yulriyanita, Berlian
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Abstract

Pasien sakit kritis, khususnya yang mendapatkan ventilasi mekanik, seringkali mengalami nyeri dan kecemasan. Prinsip utama dari perawatan di ruang rawat intensif (ICU) adalah memberikan rasa nyaman sehingga pasien dapat mentoleransi lingkungan ICU yang tidak bersahabat. Pengelolaan sedasi dan analgesia yang adekuat dapat mempersingkat penggunaan ventilasi mekanik dan lama perawatan di ICU. Hal ini dapat dilakukan dengan mengidentifikasi dan mengatasi penyakit dasar dan faktor pencetus, menggunakan metode nonfarmakologi untuk meningkatkan rasa nyaman, pemberian terapi sedasi dan analgesia dengan memilih obat yang tepat, serta pemantauan secara rutin untuk menghindari terapi yang berlebihan dan berkepanjangan. Kata kunci: Analgesia, cemas, nyeri, ruang rawat intensif, sedasi Critically ill patients, especially those who receive mechanical ventilation, oftenexperience pain and anxiety. The main principle of treatment in the intensive care unit (ICU) is to provide a sense of comfort so that the patient can tolerate the ICU environment.Management of adequate sedation and analgesia can shorten the use of mechanical ventilation and length of ICU care. This can be done by identifying and correcting the underlying disease and precipitating factors, use of non-pharmacological methods to improve comfort, sedation and analgesia therapy with choosing the right drug, as well as regular monitoring to avoid excessive and prolonged therapy. Key words: Analgesia, anxiety, intensive care unit, pain, sedation Reference Rathmell.P.James. Bonica’s Management of Pain. Pain management in the intensive care unit. Lippincott Williams 2012;112:1590–01. Sessler CN, Wilhem W. Analgesia and sedation in the intensive care unit: an overview of the issues Crit Care. 2008;12(Suppl 3): S1. Young J. Sedation. Dalam: Core topics in critical care medicine. New York: Cambridge university press; 2010:77–88. Singer M WAR. Oxford handbook of critical care. Pain and post operative intensive care. Oxford University Press Inc; 2005:530–35. Marino P L. The ICU book: Analgesia and Sedation. Lippincott williams & wilkins; 2007;49:938–66. McConachie I. Handbook of ICU therapy. Analgesia for the high risk patient. New York: Cambridge University Press; 2006;4:51–64. Sessler CN VK. Patient-Focused Sedation and Analgesia in The ICU. Chest 2008;133:552–65. Mitchell E. Pain control. Dalam : Core topics in critical care medicine. New York: Cambridge university press; 2010:72–6. Peitz J Gregory, Olsen M Keith. Top 10 Myths Regarding Sedation and Delirium in the ICU. J Critical Care Medicine 2013;41:S46–56. Reade C Michael, Finfer Simon. Sedation and Delirium in the Intensive Care Unit. J New England 2014:444–54. Riessen.R, Pech.R. Comparison of the ramsay score and the richmond agitation sedation score for the measurement of sedation depth. Crit Care 2012.16 (Suppl 1):326. Recommended standards for short latency auditory evoked potentials.American clinical neurophysiology society.2008:12-9. Stern. TA. Manual of intensive care medicine. Diagnosis and treatment of agitation and delirium in the intensive care unit patient. Lippincott williams.2000; 179:871–75.
Co-Authors Ike Sri Redjeki Reza Widianto Sudjud Rohmawanur, Tubagus Yuli Saeful Alam, M. Deny Yulriyanita, Berlian