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, Theodorus
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Sensitivity and Specificity of Neutrophil Gelatinase Associated Lipocalin as an Early Biomarker or Acute Kidney Injury Andriani, Meili; , Zulkifli; Puspita, Yusni; , Theodorus
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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in hospital. Incidence of AKI is about 60%–70% and mortality rate from those patients is 60%. AKI is diagnosed by measuring serum creatinine concentration, which is an unreliable and delayed marker of deterioration of kidney function. It’s rising occurs when a significant amount of renal function has lost. Neutrophil gelatinase associated lipocalin (NGAL) level in AKI patients can increase quickly and earlier compared to serum creatinine and could be as a marker for AKI. The purpose of this study was to assess the sensitivity and specificity plasma NGAL. A diagnostic test was conducted in ICU and high care unit (HCU) of RS Dr. Moh. Hoesin Palembang since December 2014 to February 2015. There were 53 subjects included. All samples were examined with Alere Triage® kit and serum creatinin. Data analysis were performed by receiver operating characteristic (ROC) using SPSS® version 22.0.and MedCalc version 12.7. This study shows that a cut-off point 150 ng/mL for plasma NGAL has sensitivity of 88%, specificity of 81%, positive predictive value of 88%, negative predictive value of 81% and accuracy of 85%. Examination of plasma NGAL is more sensitive and specific in determining the start time of the occurrence of AKI compared with serum creatinine examination.
Perbandingan Efektivitas antara Kombinasi 1,5 mg/kgBB Propofol 1% + 0,5 mg/kgBB Ketamin 1% dengan 1,5 mg/kgBB Propofol 1% + 2 mg/KgBB Fentanil terhadap Nilai Bis pada Tindakan Dilatasi dan Kuretase Sinurat, Bonny Brian; Melati, Endang; Puspita, Yusni; , Theodorus
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Nyeri akibat prosedur dilatasi dan kuretase memerlukan suatu manajemen anestesi. Kombinasi obat anestesi yang menghasilkan efek sedasi dan analgesi adekuat, hemodinamik stabil dan efek samping minimal dibutuhkan.Penelitian untuk mengetahui perbandingan efektivitas antara kombinasi 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamin 1% dengan 1,5 mg/kgBB propofol 1%+2 μg/kgBB fentanil terhadap nilai Bispectral Index Scale (BIS) pada tindakan dilatasi dan kuretase. Uji acak terkontrol, buta ganda, dilakukan di Central Operating Theatre RSUP Dr. Mohammad Hoesin Palembang, dari bulan Juni sampai Agustus 2013. Sebanyak 66 subjek penelitian diikutsertakan dan dibagi menjadi dua kelompok. Kelompok pertama diberikan kombinasi 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamin 1% dan kelompok kedua diberikan kombinasi 1,5 mg/kgBB propofol 1% + 2μg/kgBB fentanil. Selama prosedur, kedalaman BIS dicatat setiap 3 menit. Status hemodinamik dan lama bangun juga dicatat. Data dianalisis dengan statistical product and service solution (SPSS) versi 20. Lama bangun kedua kelompok secara statistik bermakna (p<0,05), sedangkan kedalaman sedasi, dan perubahan hemodinamik tidak (p>0,05). Kedalaman sedasi pada kedua kelompok dipertahankan antara BIS 40–60 dan secara klinis perubahan hemodinamik pada kombinasi propofol–ketamin lebih stabil. Kombinasi propofol-ketamin lebih efektif dibandingkan dengan propofol-fentanil karena menghasilkan kedalaman sedasi yang adekuat, lama bangun yang lebih singkat, status hemodinamik yang lebih stabil, serta tidak menimbulkan efek samping pada prosedur dilatasi dan kuretase. Kata kunci: BIS, dilatasi, fentanil, ketamin, kuretase, propofol Comparison of The Effectiveness of The Combination 1,5 mg/KgBW Propofol 1% + 0,5 mg/kgBB Ketamine 1% And 1,5 mg/kgbw Propofol 1% + 2 Μg/kgBW Fentanyl to The Bis Score in Dilatation and Curettage Pain in dilatation and currettage procedure requires anesthesia management. Combination of anesthetic drugs to achieve sedation and analgesia adequacy, hemodynamic stability and less adverse event are needed. to compare efficacy of combination 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamine 1% and 1,5 mg/kgBB propofol 1% + 2μg/kgBB fentanyl with Bispectral Index Score (BIS). A randomized controlled trials, double blind, has been conducted in Central Operating Theatre Dr. Mohammad Hoesin General Hospital Palembang from June to August 2013. A total of 66 subjects were included and divided into two groups. First group was anesthesized with propofol-ketamine and the second group with propofol-fentanyl. BIS score were noted every three minutes. Hemodynamic status and emergence time were also noted. The data were analyzed using statistical product and service solution (SPSS) version 20. Emergence time was statistically significant (p<0.05), while depth of sedation and hemodynamic status were not significantly different (p>0.05). Depth of sedation among two groups maintained between BIS 40–50 and clinically hemodynamic changes in the combination of propofol-ketamine were more stable than propofol-fentanyl. Combination of propofol-ketamine is more effective compared with propofol-fentanyl since it produces adequate depth of sedation, shorter emergence time, more stable hemodynamic status, and no side effect. Key words : BIS, currettage, dilatation, fentanyl, ketamine, propofol Reference Koulenti D, Christoforatos T. Ventilatorassociated pneumonia – epidemiology, pathogenesis, prevention and etiology. Eur Respir Dis. 2010;6:49–53. Safdar N, Crnich CJ, Maki DG. The Pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory care. 2005;50:725–39. Kollef MH. The prevention of ventilatorassociated pneumonia. N Engl J Med. 2005;340:627–4. DePew CL, McCarthy MS. Subglotticsecretion drainage. AACN Advanced Crit Care. 2007;18(4):366–79. Smulders K, Hoeven Hvd, Weers-PothoffI, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest. 2002;121:858–62. Koulenti D, Rello J. Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impacton patient care. Expert Opin Pharmacother. 2006;7:1555–69. Dezfulian C, Shojania K, Cllard H. Subglottic secretion drainage for preventing ventilatorassociate pneumonia: A meta-analysis. Am J Med. 2005;118:11–8. Bouza E, Perez MJ, Munoz P. Continuous aspiration of subglottic secretions in the prevention of ventilatorassociated pneumonia in the post-operative period of major heart surgery. Chest. 2008;134:938–45. Hunter JD. Ventilator associated pneumonia. Postgard Med J. 2006;82:172–8. Rachmayanti R, Turbawaty DK, Parwati I, Suraya N. Gambaran pola bakteri penyebab ventilator associated pneumonia (VAP) di intensive care unit Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. 2011.
Effectivity of Fentanyl 1 μg/kg.weight to Prevent Emergence Agitation After General Anesthesia with Sevoflurane in Pediatric Patients Bernouli, Renny; Puspita, Yusni; Maas, Endang Melati; , Theodorus
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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Emergence agitation (EA) is a postanesthetic problem that interferes a child’s recovery and presents a challenge in terms of assessment and management. Fentanyl, a potent opioid, are hypotetised can prevent emergence agitation after general anesthesia with sevoflurane in pediatric patients. In this experimental clinical trial double-blind study, 34 children (age 2–7 years old) underwent elective minor surgery under general anesthesia with sevoflurane were selected to have an intravenous fentanyl 1μg/kgweight versus placebo before the end of the surgery. On thirty minutes after anesthesia, we evaluated agitation incidence (based on WATCHA score ≥3) and side effects of fentanyl. Recovery characteristics, including awakening time, duration of agitation, pain scale using FLACC scale, and discharge time were also recorded. All datas were analised using SPSS 21 and significantly different if p<0,10. The incidence of agitation on fentanyl group are lower in fentanyl group than placebo (17,6% versus 52,9%) and statistically different (p=0,071The incidence of vomiting are similar (5,9%) and there are no significant difference in awakening time. Fentanyl 1 μg/kgweight intravenous are proven effective to prevent emergence agitation after awakening from general anesthesia with sevoflurane in pediatric patients
Efektivitas Penambahan Sufentanil 10 mg pada Anestesi Epidural 15 mL Levobupivakain 0,5% untuk Tindakan Operasi Ekstremitas Bawah Werda Laksana, Ngurah Putu; , Zulkifli; Harimin, Kusuma; , Theodorus
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Walaupun memiliki profil keamanan yang lebih baik daripada racemic, levobupivakain tetap memiliki mula kerja lambat dan lama kerja terbatas. Kombinasi opioid lipofilik sufentanil-levobupivakain akan memberikan efek sinergistik sehingga memperbaiki kekurangan tersebut, tetapi masih sedikit penelitian yang menilai kombinasi ini. Tujuan penelitian ini adalah untuk menilai efektivitas penambahan sufentanil 10 μg pada anestesi epidural levobupivakain 0,5% 15 mL dalam hal mula dan lama kerja blokade sensorik-motorik. Uji klinik randomized control trial (RCT) telah dilakukan terhadap 44 pasien (dibagi 2 kelompok; kelompok I (sufentanil 10 μg), kelompok II (2 mL NaCl 0,9%)) yang menjalani operasi ekstremitas bawah dengan anestesi epidural levobupivakain 0,5% di RSUP Dr. Mohammad Hoesin Palembang dari bulan Mei–Agustus 2013 yang memenuhi kriteria inklusi. Dilakukan penelitian terhadap mula, lama kerja blokade sensorik-motorik. Analisis data menggunakan SPSS® versi 20.0. Mula dan lama kerja blokade sensorik kelompok sufentanil secara statistik lebih bermakna daripada kelompok NaCl (p<0,001), sedangkan mula dan lama kerja blokade motorik tidak memiliki perbedaan bermakna secara statistik. Penambahan sufentanil 10 μg pada anestesi epidural levobupivakain 0,5% 15 mL mempercepat mula dan memperpanjang durasi kerja blokade sensorik. Kata kunci: Anestesi epidural, levobupivakain, sufentanil Although levobupivacaine has better safety profile than racemic bupivacaine, it has a slow onset of action and limited blockade duration. Combination of lipophilic opioid sufentanil-levobupivakain will provide synergetic effects that improve the shortcomings, but lack of research to support this. The aim of this study is to evaluate the efficacy of additional 10 μg sufentanyl to 15 mL 0.5% levobupivacaine epidural anesthesia toward sensory-motoric blockade onset and duration. Randomized controlled trials double blind study (RCT) has been conducted to 44 patients (divided into 2 groups : group I (sufentanil 10 μg), group II (2 mL NaCl0.9%)) underwent lower extremity surgery with epidural anesthesia 15 mL 0,5% levobupivakain in Dr. Mohammad Hoesin central hospital from May–August 2013 that met inclussion criteria. Onset and duration of action sensory-motoric blockade were studied. Data analysis using SPSS® version 2.0. The onset and the duration of sensory blockade in sufentanil group is statistically significant than NaCl group (p<0.001). However the onset and duration of motoric blockade are not statistically significant. The addition of 10 μg sufentanil to 15 mL of 0.5% levobupivacaine epidural anesthesia hasten the onset and prolong the duration of sensory blockade. Key words: Epidural anesthesia, levobupivacaine, sufentanyl Reference Bajwa SJS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: a systematic review. J Anaesth Clin Pharmaco. 2013;29:530–9. Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Therapeutics and Clinical Risk Management. 2008;4(2):381–92. Casimiro C, Rodrigo J, Mendiola MA, Rey F, Barrios A, Gilsanz F. dkk. Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgery. Minerva Anestesiol. 2008;74:381–91. Liu SS, Lin Y. Local Anesthetics. Dalam: Barash PG, Cullen, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, penyunting. Clinical anesthesia. Edisi ke-6. Philadelphia: Lippincott Williams & Wilkins; 2009. hlm. 531–48. Leone S, Cianni SD, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92–105. Khangure N. Adjuvant agents in neuroaxial blockade [document on the internet]. Western Australia: World Federation of Societies of Anaesthesiologist; 2011 [diperbarui tanggal 2011 July 4; diunduh 1 Februari 2013]. Tersedia dari: http://www.totw. anaesthesiologists.org. Kaur M. Adjuvants to local anesthetics: a combination wisdom. Anesth Essays Res. 2010:4;122–3. Christiansson L. Update on adjuvants in regional anaesthesia. Periodicum Biologorum. 2009;111:161–70. Yeerdaoolaiti Y, Long W, Jian-Hua DU. Clinical effect of sufentanil combined with ropivacaine used in epidural anesthesia for abdominal hysterectomy. Modern Preventive Medicine. 2011;19:4096–103. Bachman-Mennenga B, Veit G, Stenicke B, Biscoping J, Heesen M. Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for caesarean section. Acta Anaesthesiol Scand. 2005;49:532–7. Bachman-Mennenga B, Veit G, Biscoping J, Stenicke B, Heesen M. Epidural ropivacaine 1% with and without sufentanil addition for caesarean section. Acta Anaesthesiol Scand. 2005;49:525–31. Prabowo RSE. Pengaruh penambahan fentanil 1,5 μg.kg1 pada ropivakain 0,75% terhadap mula dan lama kerja blokade anestesi epidural untuk operasi ekstermitas bawah. Dokter Spesialis Anestesi [Tesis]. Bandung: Universitas Padjajaran; 2004. Macres SM, Moore PG, Fishman SM. Acute pain management. Dalam: Barash PG, Cullen, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, penyunting. Clinical anesthesia Edisi ke-6. Philadelphia: Lippincott Williams & Wilkins; 2009. hlm. 1473–1504. NYSORA. Epidural Blockade [document on the internet]. New York: New York School of Regional Anesthesia; 2009 [diperbarui tanggal 2009 January 3; diunduh 1 Februari 2013]. Tersedia dari http://www.nysora.com. Pain Community Centre. Epidural: the mode of action of local anaesthetics and opioids in the epidural. Wales: Cardiff University; 2012[diunduh 1 Februari 2013]. Tersedia dari: http://www.paincommunitycentre.org. Vora KS, Shah VR, Patel B, Parikh GP, Butala BP. 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Co-Authors , Zulkifli Andriani, Meili Bernouli, Renny Kusuma Harimin, Kusuma Maas, Endang Melati Melati, Endang Puspita, Yusni Sinurat, Bonny Brian Werda Laksana, Ngurah Putu