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Perbandingan Pemberian Deksametason 10 mg dengan 15 mg Intravena sebagai Adjuvan Analgetik terhadap Skala Nyeri Pascabedah pada Pasien yang Dilakukan Radikal Mastektomi Termodifikasi M. Erias Erlangga; Ruli Herman Sitanggang; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Deksametason merupakan kortikosteroid yang memiliki efek anti-inflamasi paling kuat. Penelitian ini bertujuan membandingkan deksametason 10 mg dengan deksametason 15 mg intravena prabedah terhadap nyeri pascabedah dan kebutuhan analgetik opioid. Penelitian ini merupakan uji acak terkontrol buta ganda pada 60 wanita dengan status fisik American Society of Anesthesiologist (ASA) I–II yang menjalani pembedahan radikal mastektomi termodifikasi dalam anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung periode Desember 2013–April 2014. Pasien dibagi menjadi dua kelompok, yaitu 30 orang menerima deksametason 10 mg dan 30 orang menerima deksametason 15 mg yang diberikan 30 menit prabedah. Penilaian skala nyeri menggunakan nilai numeric rating scale (NRS) pada saat istirahat dan mobilisasi, pada jam ke-1, 2, 4, 12, dan 24 pascabedah. Pemberian analgetik tambahan opioid dilakukan bila nilai NRS>3. Analisis statistika data hasil penelitian menggunakan uji-t, chi-kuadrat, dan Mann-Whitney. Hasil penelitian menunjukan nilai NRS saat istirahat pada kelompok deksametason 10 mg dengan deksametason 15 mg tidak berbeda bermakna (p>0,05), sementara nilai NRS saat mobilisasi pada kelompok deksametason 10 mg lebih tinggi dibanding dengan kelompok deksametason 15 mg (p<0,05). Pemberian analgetik tambahan pascabedah tidak terdapat perbedaan secara bermakna antara kedua kelompok (p>0,05). Simpulan penelitian ini adalah pemberian deksametason 15 mg dapat diberikan karena mempunyai efek analgesia yang lebih baik.Kata kunci: Deksametason, numeric rating scale, nyeri pascabedahComparison between 10 mg and 15 mg of Intravenous Dexamethasone as Analgesia Adjunct on Post Operative Pain in Patients Undergo Modified Radical Mastectomy Dexamethasone is a glucocorticoid with the strongest anti-inflammatory property. The aim of this study was to compare the effect of 10 mg and 15 mg of intravenous dexamethasone on post operative pain and opioid analgetic need. This was a randomized double-blind study involving 60 females with physical status ASA I–II whom underwent modified radical mastectomy under general anesthesia at Dr. Hasan Sadikin General Hospital during December 2013–April 2014. Patients were divided into 2 groups where 30 patients received 10 mg dexamethasone and 30 patients received 15 mg dexamethasone 30 minutes prior to surgery. Pain assessment was performed using numeric rating scare (NRS) at rest and during activity, documented on the 1st, 2nd, 4th, 12th and 24th hour post operative. Additional analgesia was given if NRS >3. Data were analyzed statistically using Student’s t test, chi-square and Mann Whitney U test. Result showed that the difference between NRS at rest for 10 mg and 15 mg dexamethasone (p>0.05) was not significant, while the difference in NRS during activity at all time measurements were statistically significant (p<0.05). There was no statistical significant difference in additional opioid administered between the two groups (p>0.05). This study concludes that 15 mg dexamethasone has a better analgesia effect to reduce analgesic dose.Key words: Dexamethasone, numeric rating scale, post operative pain DOI: 10.15851/jap.v3n3.607

Perbandingan Parasetamol dengan Ketorolak Intravena Sebagai Analgesia Pre-emtif terhadap Skala Nyeri Pascabedah Labioplasti pada Pasien Pediatrik Muhamad Adli Boesoirie; Ezra Oktaliansah; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Parasetamol dan ketorolak merupakan analgetik yang biasa digunakan pada tatalaksana nyeri ringan hingga sedang. Penelitian ini bertujuan membandingkan efek analgesi pre-emtif parasetamol 20 mg/kgBB dengan ketorolak 0,5 mg/kgBB pada pasien pediatrik pascabedah labioplasti yang diukur menggunakan skala nyeri face, legs, activity, crying, consolability (FLACC). Penelitian eksperimental secara uji acak tersamar buta ganda terhadap 66 pasien pediatrik usia 6 bulan–12 tahun dengan status fisik American Society of Anesthesiology (ASA) I–II. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober 2013–Mei 2014. Pasien dibagi menjadi dua kelompok perlakuan, yaitu kelompok parasetamol (P) dan ketorolak (K) yang diberikan 15 menit prabedah. Analisis statistika diuji menggunakan uji-t independen, Mann-Whitney, dan Eksak Fisher. Hasil penelitian menunjukkan bahwa skala FLACC pada kelompok ketorolak pada jam ke-1, 2, 4, 6, dan 24 lebih rendah secara bermakna (p<0,05) dibanding dengan kelompok parasetamol. Simpulan, skala FLACC pemberian ketorolak 0,5 mg/kgBB prabedah pada pasien labioplasti lebih rendah dibanding dengan parasetamol 20 mg/kgBB.Kata kunci: Analgetik, analgesia pre-emtif, ketorolak, labioplasti, parasetamol, skala FLACCComparison between Intravenous Paracetamol and Ketorolac as Preemptive Analgesia on Postoperative Pain Scale in Pediatric Patients Undergo LabioplastyKetorolac and paracetamol are common analgetics used to treat mild to moderate pain. This study compared the efficacy of preemptive analgesia measured using face, legs, activity, crying, consolability (FLACC) scale between groups receiving 20 mg/kgBW paracetamol (P) and 0.5 mg/kgBW ketorolac (K) for pediatric labioplasty procedure. This experimental study is a are double-blind randomized trial against 66 pediatric patients aged 6 months–12 years with the physical status of the American Society of Anesthesiology (ASA) I–II. The study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of October 2013–May 2014. The P and K groups received 20 mg/kgBW paracetamol and 0.5 mg/kgBW ketorolac, respectively, 15 minutes preoperatively. Data were analyzed statistically using independent-t, Mann-Whitney, and Fischer’s Exact Test. Results showed that the difference between FLACC scale in P and K groups was statistically significant (p<0.05). In conclution, FLACC scale in patients who received ketorolac 0.5 mg/kgBW is lower than patients who received paracetamol 20 mg/kgBW.Key words: Analgetics, FLACC scale, ketorolac, labioplasty, paracetamol, preemptive analgesia DOI: 10.15851/jap.v3n1.573

Pengaruh Tes Elevasi Tungkai Secara Pasif terhadap Variasi Pletismograf untuk Penilaian Responsivitas Cairan pada Pasien yang Dilakukan Pembedahan dengan Anestesi Umum Bahtiar Susanto; Erwin Pradian; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 4, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Penilaian responsivitas terhadap cairan sangat berguna untuk optimalisasi cairan perioperatif. Variasi pletismograf (respiratory variations in the pulse oximetry plethysmographic waveform amplitude; ∆POP) dan elevasi tungkai secara pasif (passive leg raising; PLR) merupakan parameter dinamis yang akurat dalam menilai responsivitas terhadap cairan. Tujuan penelitian ini adalah menilai pengaruh elevasi tungkai secara pasif terhadap variasi pletismograf untuk menilai responsivitas terhadap cairan pada pasien setelah induksi anestesi umum. Penelitian ini merupakan uji klinis pada 30 pasien yang menjalani operasi dengan anestesi umum, usia 18–60 tahun, dan status fisik American society of anesthesiologist (ASA) I atau II pada bulan Februari–Maret 2015 di Instalasi Bedah Sentral Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian ini diuji dengan uji-t berpasangan, Wilcoxon, dan uji ANOVA. Setelah dilakukan induksi anestesi umum, variasi pletismograf dicatat sebelum, saat, dan sesudah elevasi tungkai secara pasif. Hasil penelitian menunjukkan efek elevasi tungkai secara pasif akan menurunkan variasi pletismograf. Penurunan variasi pletismograf yang signifikan pada responden yang memiliki responsivitas terhadap cairan 6/30 dengan variasi pletismograf >13% sebelum dilakukan elevasi tungkai secara pasif. Perbedaan ini bermakna secara statistik (p<0,05). Elevasi tungkai secara pasif akan menurunkan variasi pletismograf yang dapat digunakan untuk menilai responsivitas terhadap cairan pada pasien yang menjalani operasi dengan anestesi umum.Kata kunci: Anestesi umum, elevasi tungkai secara pasif, responsivitas terhadap cairan, variasi pletismografEffect of Passive Leg Raising Test on Respiratory Variations in Pulse Oximetry Plethysmographic Waveform in Assessing Fluid Responsiveness of Surgery Patients under General AnesthesiaFluid responsiveness assessments have shown to be an important matter in perioperative fluid optimization. Respiratory variations in pulse oximetry plethysmographic waveform amplitude (∆POP) and passive leg raising have been shown as promising indicators due to the ability to predict fluid responsiveness. The aim of this study was to assess the effect of passive leg raising (PLR) on ∆POP to predict fluid responsiveness in mechanically ventilated patients after induction of general anesthesia. This was a trialon 30 patients referred for surgery under general anesthesia, aged 18–60 years and ASA physical status I or II, during the period of February–March 2015 at the Central Surgical Installation of Dr. Hasan Sadikin General Hospital Bandung. Patients were studied immediately after the induction of general anesthesia. This trial use the paired t test, Wilcoxon test, and ANOVA for statistical analysis. Vital signs and ∆POP were recorded at baseline, before, and after PLR. PLR induced changes in ∆POP with a ∆POP greater than 13% compared to the initial PLR allowed discrimination between responders and nonresponders to 6/30. There was a significant decrease in ∆POP in responders when compared to the nonresponders(p<0.05). ∆POP can be reduced by PLR and fluid responsiveness can be predicted noninvasively in mechanically ventilated patients during general anesthesia.Key words: Fluid responsiveness, general anesthesia, passive leg raising, respiratory variations in the pulse oximetry plethysmographic waveform amplitude DOI: 10.15851/jap.v4n2.821

Perbandingan Antiseptik Chlorhexidine Alkohol dengan Povidone Iodine terhadap Penurunan Pertumbuhan Koloni Bakteri pada Kateter Epidural yang Dipasang di Kamar Operasi Rumah Sakit Dr. Hasan Sadikin Bandung Andie Muhari Barzah; Erwin Pradian; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Chlorhexidine alkohol dan povidone iodine digunakan sebagai zat antiseptik pada anestesi epidural. Aseptik dan antiseptik sebelum tindakan epidural harus dilakukan secara optimal untuk menurunkan komplikasi infeksi pascatindakan. Tujuan penelitian ini menilai perbedaan penurunan pertumbuhan koloni bakteri pada kateter epidural di Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian single blind randomized controlled trials pada 76 pasien yang dilakukan anestesi epidural di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan November 2014–Februari 2015. Subjek penelitian dibagi menjadi 2 kelompok, yaitu chlorhexidine alkohol dan povidone iodine. Dilakukan pemeriksaan kultur apus kulit sebelum dan sesudah tindakan aseptik dan antiseptik kemudian dilakukan pemeriksaan kultur kateter epidural pada hari ke-3 setelah pemasangan. Data hasil penelitian dianalisis dengan menggunakan uji-t, chi-kuadrat, dan Uji Mann-Whitney. Hasil penelitian ini didapatkan kultur positif bakteri dari pemeriksaan sebelum tindakan aseptik dan antiseptik 33 dari 38 pada chlorhexidine alkohol dan 35 dari 38 pada povidone iodine. Kultur positif bakteri menjadi 4 dari 38 pada chlorhexidine alkohol dan povidone iodine setelah pemberian aseptik dan antiseptik. Kultur pascapemasangan kateter epidural positif bakteri 7 dari 38 pada chlorhexidine alkohol dan 5 dari 38 pada povidone iodine (p<0,05). Simpulan penelitian ini menunjukkan zat antiseptik chlorhexidine alkohol lebih lebih rendah pertumbuhan kumannya bila dibanding dengan povidone iodine pada kateter epidural.Kata kunci: Antiseptik, chlorhexidine alkohol, povidone iodineComparison between Chlorhexidine-Alcohol and Povidone Iodine in Reducing Catheter Tip Bacterial Colonization in Dr. Hasan Sadikin General Hospital BandungAbstractChlorhexidine-alcohol and povidone iodine are commonly used as antiseptic solutions in epidural anesthesia. Aseptic and antiseptic procedures must be performed before any epidural procedure to lower infection complications after the procedure. The objective of this study was to investigate the lowest bacterial growth on epidural catheter after chlorhexidine-alcohol or povidone iodine application as the antiseptic solution in Dr. Hasan Sadikin General Hospital Bandung. This was a single blind randomized controlled trial on 78 patients underwent epidural anesthesia in the period of November 2014–February 2015. The subjects were divided in to 2 groups, each consisted of 38 patients. Aseptic and antiseptic procedures were performed using chlorhexidine-alcohol or povidone iodine with skin swab culture collected before and after the procedure. Epidural catheter culture was performed in the 3rd days after the installment. Data were analyzed using t-test, chi-square test, and Mann Whitney test. The result of this study showed positive bacterial cultures prior to aseptic and antiseptics, 33 from 38 in chlorhexidine-alcohol and 35 from 38 in povidone iodine. Positive bacterial cultures became 4 from 38, both in chlorhexidine-alcohol and povidone iodine. Positive bacterial culture on the 3rd days after epidural catheter placement was 7 from 38 after chlorhexidine-alcohol and 5 from 38 after povidone iodine (p< 0.05). It is concluded that the ability of chlorhexidine-alcohol to reduce bacterial growth on epidural catheter is lower than povidone-iodine with regards to reducing infection after catheter epidural installment.Key words: Antiseptic, chlorhexidine-alcohol, povidone iodine DOI: 10.15851/jap.v4n1.742

Efek Penggunaan Leg Wrapping terhadap Kejadian Hipotensi Selama Anestesi Spinal pada Pasien Seksio Sesarea Yunita Susanto Putri; Iwan Fuadi; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 4, No 3 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Hipotensi merupakan komplikasi tersering selama anestesi spinal dengan insidensi >80% meskipun telah diberikan cairan preloading, posisi ibu left lateral tilt, dan penggunaan vasopresor. Terdapat teknik lain untuk mencegah terjadi hipotensi, yaitu penggunaan leg wrapping yang dapat memperbaiki aliran balik vena dengan meningkatkan volume darah sentral. Penelitian ini bertujuan menilai efek penggunaan leg wrapping terhadap kejadian hipotensi selama anestesi spinal pada pasien seksio sesarea. Penelitian bersifat eksperimental acak terkontrol buta tunggal dengan randomisasi secara acak sederhana yang melibatkan 40 ibu hamil American Society of Anesthesiologists (ASA) II yang menjalani seksio sesarea dengan anestesi spinal di Central Operating Theatre (COT) lantai 3, Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Juni–Juli 2015. Subjek penelitian dikelompokkan menjadi dua, yaitu 20 subjek dengan leg wrapping dan 20 subjek tanpa leg wrapping. Tekanan darah dan laju nadi diperiksa setiap dua menit sampai bayi lahir. Data dianalisis dengan uji-t tidak berpasangan dan chi-kuadrat, nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan kejadian hipotensi pada kelompok tanpa leg wrapping 95% (19 orang) dan 0% pada kelompok dengan leg wrapping dengan perbedaan bermakna (p<0,05). Secara keseluruhan, hemodinamik kelompok dengan leg wrapping lebih stabil dibanding dengan kelompok tanpa leg wrapping. Simpulan, penggunaan leg wrapping sebelum dilakukan anestesi spinal pada pasien yang menjalani seksio sesarea menurunkan angka kejadian hipotensi.Kata kunci: Anestesi spinal, hipotensi, leg wrapping, seksio sesareaEffect of Leg Wrapping on Hypotension Incidence in Cesarean Section with Spinal AnesthesiaAbstractHypotension is the most common complication of spinal anesthesia. The incidence remains high despite adequate fluid preloading, left lateral tilt positioning, and vasopressors use. There is a technique that can be used to prevent hypotension, which is referred as leg wrapping. Leg wrapping can improve venous return by increasing central blood volume. This study aimed to compare the hypotension incidence between with and without leg wrapping during spinal anesthesia for caesarean section. The method used was single blind randomized controlled trial with simple randomization, involving 40 pregnant women ASA II, who underwent cesarean section with spinal anesthesia in COT 3rd floor Dr. Hasan Sadikin General Hospital Bandung during the period of June–July 2015. Subjects were grouped into with leg wrapping and without leg wrapping groups with 20 subjects in each group. Blood pressure and heart rate were recorded every two minutes until the baby was born. Data were then analyzed using t-test and chi-square test with p values <0.05 considered significant. The statistical analysis showed that there were significant differences in the incidence of hypotension (p<0.05) in the group without leg wrapping , i.e. 95% (19 people), and the group with leg wrapping, i.e. 0%. Overall, hemodynamics of the leg wrapping group was more stable than the group without leg wrapping. In conclusion, leg wrapping prior to spinal anesthesia in patients undergoing cesarean section will reduce incidence of hypotension.Key words: Cesarean section, hypotension, leg wrapping, spinal anesthesia DOI: 10.15851/jap.v4n3.903

Perbandingan Penambahan Klonidin Intratekal 15 µg dan 30 µg pada 12,5 mg Bupivakain 0,5% terhadap Kejadian Menggigil Pascaanestesi Spinal pada Seksio Sesarea Iman Muhammad Yusup Mansur; Erwin Pradian; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 3, No 1 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Menggigil pascaanestesi spinal merupakan efek samping yang sering terjadi. Penelitian ini bertujuan untuk membandingkan penambahan klonidin intratekal antara 15 µg dan 30 µg pada 12,5 mg bupivakain. Penelitian adalah eksperimental dengan uji klinis rancangan acak lengkap terkontrol buta tunggal pada 80 wanita yang menjalani seksio sesarea dengan anestesi spinal, status fisik American Society of Anesthesiologist (ASA) II, berusia 18–42 tahun, dibagi secara random menjadi dua kelompok, kelompok I menggunakan 12,5 mg bupivakain 0,5 % dan klonidin 15 µg, sedangkan kelompok II mendapat penambahan klonidin 30 µg. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada periode Oktober–Desember 2011. Perbandingan proporsi kejadian kedua kelompok dianalisis secara statistik menggunakan uji chi-kuadrat, sedangkan derajat menggigil dengan Uji Mann-Whitney. Hasil penelitian menunjukkan bahwa kejadian menggigil pascaanestesi pada kelompok II sebanyak 2 pasien, sedangkan pada kelompok I adalah 10 pasien. Simpulan, penambahan klonidin intaratekal 30 µg pada bupivacain 0,5% untuk mencegah menggigil pascaanestesi spinal lebih baik dibandingkan dengan klonidin intratekal 15 µg. Kata kunci: Klonidin intratekal, menggigil pascaanestesi, mencegah menggigil, suhu intiComparison of 15 µg and 30 µg Intrathecal Clonidine in 12.5 mg 0.5% Bupivacain for Post Spinal Anesthesia Shivering in Caesarean SectionAbstractShivering is a frequently experienced side effect of post-subarachnoid block. This study aimed to determine the which of 15 µg dose and 30 µg dose of intrathecal Clonidine is better prevents Post anaesthesia shivering. The research was conducting by clinical trials of a single blind randomized controlled design. Eighty pregnant female patients with ASA physical status II, aged 18–42 years, who underwent a caesarean section were randomly divided into two groups, spinal anesthesia performed by using 12.5 0.5% mg bupivacain and 15 µg clonidine in Group I and the same dose of bupicavain but with 30 µg clonidine in group II. The incidence proportion of both groups were statistically compared using chi square test, while the degree of shivering was analyzed using Mann-Whitney test. The results showed that the characteristics of patient data and the core temperature did not statistically different between the two groups. The incidence and degree of shivering were different between the two groups, with were 2 patients experienced shivering incidence in group II and 10 patients experienced the incidence in group I. It is concluded that the addition of intrathecal 30 µg clonidine to 0.5% bupivacain prevents post-subarachnoid spinal block shivering better than in trathecal clonidine 15 µg. Key words: Core temperature, intrathecal clonidine post anaesthesia shivering, prevent shivering

Perbandingan Efek Pencegahan Magnesium Sulfat dengan Petidin Intravena terhadap Kejadian Menggigil Selama Operasi Reseksi Prostat Transuretra dengan Anestesi Spinal Mariko Gunadi; Iwan Fuadi; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Gangguan termoregulasi berupa menggigil sering terjadi selama operasi dengan anestesi spinal. Tujuan penelitian ini membandingkan efek pencegahan kejadian menggigil selama operasi reseksi prostat transuretra dalam anestesi spinal antara MgSO4 dan petidin. Penelitian ini merupakan uji klinis acak terkontrol tersamar ganda pada 42 pasien dengan status fisik American Society of Anesthesiologist (ASA) II atau III, usia 60−70 tahun yang menjalani operasi reseksi prostat transuretra di kamar operasi bedah sentral Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret–September 2014. Pasien dibagi dalam kelompok MgSO4 dan kelompok petidin. Data karakteristik, kejadian menggigil, suhu tubuh inti, monitoring tanda vital, dan efek samping dicatat. Hasil penelitian menunjukkan efek pencegahan kejadian menggigil kelompok MgSO4 lebih baik dibanding dengan kelompok petidin dan kejadian menggigil di kamar operasi 4/21 vs 9/21, sedangkan di ruang pemulihan kejadian menggigil sama pada kedua kelompok (1/21). Simpulan penelitian ini menunjukkan pemberian MgSO4 intravena sebelum anestesi spinal secara klinis mengurangi kejadian menggigil selama operasi dan memiliki efek pencegahan menggigil yang lebih baik dibanding dengan petidin.Kata kunci: Anestesi spinal, menggigil, MgSO4, petidinComparison of Anti-Shivering Effect of Intravenous Magnesium Sulfate with Pethidine during Transurethral Resection of the Prostate under Spinal AnesthesiaShivering, as a result of impaired thermoregulatory, is frequent during surgery under spinal anesthesia. The purpose of this study was to compare the anti-shivering effect between intravenous MgSO4 and pethidine during transurethral resection of the prostate under spinal anesthesia.This study was a randomized double-blind controlled trial in 42 patients with American Society of Anesthesiologist (ASA) physical status II or III, aged 60−70 years who underwent transurethral resection of the prostate at the central operating theater of Dr. Hasan Sadikin General Hospital Bandung within March–September 2014. The patients were divided into MgSO4 group and pethidine group. Characteristics of data, the incidence of shivering, body core temperature, vital signs monitoring, and adverse events were recorded. Antishivering effect of MgSO4 was better compared to pethidine, with the incidence of shivering in operating theatre was 4/21 vs 9/21. However, in the recovery room, the incidence of shivering was the same for both groups (1/21). It is concluded that the administration of intravenous MgSO4 before spinal anesthesia clinically reduces the incidence of shivering during surgery and has a better anti-shivering effect compared to intravenous pethidine.Key words: MgSO4, pethidine, shivering, spinal anesthesia DOI: 10.15851/jap.v3n3.609

Efek Lidokain Intravena terhadap Nilai Numeric Rating Scale dan Kebutuhan Fentanil Pascaoperasi dengan Anestesi Umum Theresia C. Sipahutar; Iwan Fuadi; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Lidokain intravena mempunyai efek analgesia, antihiperalgesia, dan antiinflamasi. Penelitian ini bertujuan untuk mengetahui efek pemberian lidokain intravena terhadap nilai numeric rating scale (NRS) dan kebutuhan fentanil pascaoperasi eksisi fibroadenoma mammae. Penelitian ini merupakan uji klinis acak terkontrol buta ganda terhadap 40 orang pasien wanita usia 18–60 tahun dengan status fisik ASA I–II yang dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode September 2011–Februari 2012. Sampel dikelompokkan random menjadi kelompok lidokain dan kontrol. Penilaian nyeri menggunakan numeric rating scale. Data dianalisis menggunakan uji chi-kuadrat, uji-t, dan Mann Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila p<0,05. Hasil penelitian menunjukkan nilai NRS kelompok lidokain lebih rendah dan berbeda bermakna pada 30 menit (p<0,001), 60 menit (p<0,001), 90 menit (p=0,003), dan 120 menit (p=0,011) pascaoperasi, penggunaan fentanil pertolongan pada kelompok lidokain adalah 0–25 µg dan pada kelompok kontrol 25–75 µg selama 3 jam pascaoperasi. Simpulan penelitian adalah lidokain intravena 1,5 mg/kgBB bolus sebelum induksi dilanjutkan dosis rumatan 1 mg/kgBB/jam sampai 1 jam pascaoperasi mampu menurunkan nilai numeric rating scale dan mengurangi kebutuhan fentanil pascaoperasi.Kata kunci: Kebutuhan fentanil pascaoperasi, lidokain intravena, numeric rating scaleThe Effect of Intravenous Lidocaine on Numeric Rating Scale Value and Postoperative Fentanyl Requirement in General AnesthesiaAbstractLidocain has analgesic, antihyperalgesic and antiinflamatory properties. This was a double blind randomized controlled trial study on 40 female patients, aged 18–60 years old with ASA physical status I–II who underwent excisional biopsy for fibroadenoma mammae at Dr. Hasan Sadikin General Hospital Bandung between September 2011–February 2012. The samples randomly divided into the lidocaine and the control group. Quality of postoperative pain was assessed using the numeric rating scale (NRS). The result were analyzed with chi-square test, t-test, and Mann Whitney Test with 95% confidence interval and considered significant if the p value <0.05. The result showed that in comparison to the control group, the NRS values obtained from the lidocaine group was significantly different in postoperative measurement time, 30 minutes (p<0.001), 60 minutes (p<0.001), 90 minutes (p=0.003) and 120 minutes (p=0.011) and the dose range of fentanyl as a rescue analgesic in 3 hours postoperative period for the lidocaine group was 0–25 µg and 25–75 µg for the control group. This study concluded that administration of 1,5 mg/kgBW lidocaine intravenous before induction and continued with 1 mg/kgBW/hour as maintenance dose until 1 hour postoperative is able to reduce the NRS score and the requirement of postoperative fentanyl.Key words: Intravenous lidocaine, numeric rating scale, post operative fentanyl requierement DOI: 10.15851/jap.v1n3.195

Korelasi antara Panjang Garis Sternoakromion dan Titik Penyuntikan Blokade Pleksus Brakialis pada Anestesi Vertical Infraclavicular Block Menggunakan Pencitraan Ultrasonografi pada Pria Dewasa Dedi Fitri Yadi; Ike Sri Redjeki; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Anestesi regional untuk operasi di daerah lengan bawah dapat dilakukan blokade pleksus brakialis vertikal infraklavikula. Penelitian ini bertujuan menemukan korelasi antara panjang garis sternoakromion dan letak penyuntikan menggunakan pencitraan ultrasonografi untuk vertical infraclavicular block (VIB) pada pria dewasa. Penelitian potong lintang dengan mengukur titik tengah garis antara fosa jugularis dan akromion pada 48 pria dewasa. Pencitraan ultrasonografi dilakukan menggunakan probe linear untuk menentukan letak penyuntikan. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober 2011–Januari 2012. Hasil pengukuran didapatkan panjang garis sternoakromion kanan rata-rata 18,35±1,16 cm. dan kiri 18,39±1,22 cm. Titik tengah sternoakromion kanan rata-rata 9,18±0,59 cm dan kiri 9,19±0,61 cm. Jarak letak titik penyuntikan menggunakan ultrasonografi kanan 9,41±0,7 cm dan kiri 9,46±0,72. Terdapat korelasi positif (r kanan=0,874 dan r kiri=0,862) antara garis sternoakromion dan jarak letak titik penyuntikan menggunakan pencitraan ultrasonografi.Kata kunci: Blokade vertikal infraklavikular, letak penyuntikan blokade infraklavikular, pencitraan ultrasonografi Correlation between the Sternoacromion Line Length and Plexus Brachialis Vertical Infraclavicular Block Injection Site Using Ultrasonography Scan on Adult MalesAbstractSurgery on the lower part of the arm can be managed by brachial plexus vertical infraclavicular block. Needle placement for vertical infraclavicular block is not always at the midpoint of the sternoacromion line. The aim of this study was to find the correlation between sternoacromion length and needle placement using ultrasond scan for vertical infraclavicular block on adults males. This was a cross sectional study measuring the midlle point of sternoacromion line on 48 adult male volunteers whom never had any injury or operation on shoulder areas. Linear probe ultrasound was used to determine the needle placement. This study was conducted in Dr. Hasan Sadikin General Hospital Bandung within the period of October 2011–January 2012. Pearson correlation test and linear regression were used to analyze the data. Result of this study showed an average right strernoacromion length of 18.35±1.16 cm, an average left sternoacromion leght of 18.39±1.22 cm, an average midpoint right sternoacromion of 9.18±0.59 cm, and an average midmpoint left sternoacromion of 9.19±0.61. The average ultrasound right point was 9.41 cm and 9.46 cm for the left point. Hence, thereare significant correlations (r right=0.874, r left=0.862) between sternoacromion length and ultrasound injection point for vertical infraclavicular block.Key words: Injection site for infraclavicular block, ultrasound scan, vertical infraclavicular block DOI: 10.15851/jap.v4n1.739

Korelasi Antara Kadar Laktat, Base Deficit Dan Saturasi Vena Sentral Dengan Skor Multiple Organ Dysfunction Hari Ke-3 Pada Pasien Pascabedah Dengan Hemodinamik Stabil Di Ruang Perawatan Intensif Rumah Sakit Dr. Hasan Sadikin Bandung Ruby Satria Nugraha; Ike Sri Redjeki; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Hingga kini belum ada indikator yang untuk menilai perfusi global yang adekuat. Pasien dengan hemodinamik stabil masih mungkin terjadi perubahan kadar laktat, base deficit, dan saturasi vena sentral, yang dapat digunakan untuk menilai adanya suatu hipoksia jaringan. Penelitian ini bertujuan mencari korelasi yang paling baik diantara ketiga parameter tersebut terhadap skor MOD hari ke-3 pada pasien pascabedah dengan hemodinamik stabil yang dirawat di Ruang Perawatan Intensif (RPI). Penelitian ini suatu penelitian observasional dengan desain potong lintang. Penelitian ini dilakukan pada 50 orang pasien risiko tinggi yang dirawat di RPI, laki-laki dan wanita, usia 18 – 65 tahun yang telah menjalani laparotomi eksplorasi dengan anestesi umum. Semua pasien dilakukan pemeriksaan kadar laktat darah, gas darah arterial dan gas darah vena sentral ketika pasien masuk, dan jam ke-24. Selanjutnya pada hari ke-3 dilakukan skoring MOD yang mencakup fungsi neurologis, kardiovaskular, respirasi, ginjal, hematologis, dan hepar. Pada penelitian ini didapatkan koefisien korelasi rank Spearman antara laktat 1 dan skor MOD hari ke-3 adalah 0,579 dengan p<0,001, base deficit 1 dengan skor MOD hari ke-3 adalah 0,811 dengan p<0,001, sedangkan yang tidak bermakna adalah antara saturasi vena sentral 1 dengan skor MOD hari ke-3, dan antara saturasi vena sentral 2 dengan skor MOD hari ke-3, dengan koefisien koreasi rank Spearman masing-masing adalah 0,328 dan 0,260. Koefisien korelasi yang baik terdapat pada laktat dan base deficit dengan skor MOD hari ke-3, sedangkan saturasi vena sentral memiliki koefisien korelasi yang lemah. Laktat dan base deficit dapat digunakan untuk mendeteksi secara dini adanya gangguan perfusi jaringan pada pasien risiko tinggi pascabedah dengan hemodinamik stabil.Kata kunci: laktat, base deficit, saturasi vena sentral, hipoksia jaringan, disfungsi organ.Correlation Between Lactate Level, Base Deficit, And Central Vein Saturation With Third-Day Multiple Organ Dysfunction Score On Haemodynamically Stable Postoperative Patient In Intensive Care Unit Dr. Hasan Sadikin Bandung HospitalUntil now, there is no precise indicator to evaluate adequate global perfussion yet. On haemodynamically stable patient is possible to experience change in lactate value, base deficit, and central vein saturation, which can be used to assess tissue hypoxia. The aim of this study is to find the best parameter among those three parameters toward day-third-MOD (Multiple organ dysfunction) score on hemodinamically stable post surgery patients whose been hospitalized in ICU (Intensive care unit).This is a cross-sectional observational study. The subject of this study were 50 high-risk patients whose hospitalized in RPI, male and female between 18 – 65 years old who had been done explorative laparatomy procedures under general anesthesia. Blood lactate, arterial blood gas analysis and central vein blood gas analysis had been analysis on all subjects on admissions and on the 24th hours. On the third day, MOD score that covered neurologic, cardiovascular, respiration, renal, hematologic and liver function had been assessed. This study yielded rank Spearmen coeffisien correlation between blood lactate 1 and day-third-MOD score 0,572 (p<0,001), and base deficit 1 and day-third-MOD score was 0,811 (p<0,001). The value between central vein saturation 1 and day-third-MOD score, and central vein saturation 2 and day-third-MOD score were unsignificant, with rank Spearmen coeffisien correlation were 0,328 and 0,260. Good coeffisien correlation was found between blood lactate and base deficit with MOD score on third day, whilst central vein saturation had weak coeffisien correlation. Blood lactate level and base deficit can be used to evaluate early tissue perfusion disturbances on hemodinamically stable high risk post surgery patients.Key words: lactate, base deficit, central vein saturation, tissue hypoxia, MOD score. DOI: 10.15851/jap.v1n1.154

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