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All Journal Jurnal Anestesi Perioperatif Althea Medical Journal Majalah Anestesia dan Critical Care Jurnal Neuroanestesi Indonesia
Iwan Fuadi
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Journal : Majalah Anestesia dan Critical Care

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Perbandingan Pemberian Kombinasi Haloperidol 0,5 mg dan Deksametason 5 mg dengan Ondansetron 4 mg terhadap Kejadian Mual Muntah Pascaoperasi Modified Radical Mastectomy dengan Anestesi Umum Rahmadsyah, Teuku; Fuadi, Iwan; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Abstract

Mual muntah pascaoperasi dapat meningkatkan morbiditas dan memperpanjang masa rawat pascaoperasi.Haloperidol adalah obat tranquilizer major golongan dari butirofenon yang mempunyai efek reseptor D2 antagonis.Penggunaan kombinasi haloperidol dan deksametason sebagai antiemetik profilaksis dapat menguntungkan.Penelitian ini bertujuan untuk membandingkan kombinasi haloperidol 0,5 mg dan deksametason 5 mg denganondansetron 4 mg terhadap kejadian mual muntah pascaoperasi pada operasi modified radical mastectomy.Penelitian dilakukan terhadap 42 wanita (kurang dari 50 tahun) status fisik ASA I-II yang menjalani operasimodifikasi mastektomi radikal secara uji acak terkontrol buta ganda dalam anestesi umum. Pasien dibagi menjadidua kelompok yaitu 21 orang menerima haloperidol 0,5 mg ditambah deksametason 5 mg dan 21 orang menerimaondansetron 4 mg yang diberikan setelah intubasi dilakukan. Pasien diberikan analgetik ketorolak dan petidinintravena secara kontinu pascaoperatif. Evaluasi yang dinilai adalah tekanan darah, laju nadi, dan saturasioksigen. Hasil dari penelitian menunjukan terdapat kecenderungan keluhan mual muntah pascaoperasi lebihbanyak terjadi pada kelompok ondansetron 4 mg (38,1%) dibanding dengan kelompok kombinasi haloperidol0,5 mg dan deksametason 5 mg (4,8%). Pada analisis statistik yang dilakukan dengan uji Chi-Square didapatkanhasil perbedaan yang bermakna (p kurang dari 0,05). Simpulan dari penelitian ini adalah pemberian kombinasihaloperidol 0,5 mg dan deksametason 5 mg intravena lebih baik dibandingkan dengan ondansetron 4 mg intravenadalam menurunkan kejadian mual muntah pascaoperasi modified radical mastectomy. Kata kunci: deksametason, haloperidol, modified radical mastectomy, mual muntah, ondansetron Postoperative nausea and vomiting can lead to increase morbidity and lengthened postoperative hospital stay.Haloperidol is a major tranquilizer with a D2 receptor antagonist effect. A combination of haloperidol anddexamethasone is also effective to prevent postoperative nausea and vomiting, which offers beneficial effectssuch as lower cost, longer duration and are easy to find. The aim of this study is to compare a combination ofhaloperidol 0,5 mg and dexamethasone 5 mg with ondansetron 4 mg in managing postoperative nausea andvomiting following modified radical mastectomy. The study was done by conducting a double blind randomizedcontrolled trial of 42 subjects, women aged under 50 years old, who underwent modified radical mastectomy undergeneral anesthesia, with physical status ASA I-II. Patients were divided into two groups: 21 patients receivedcombination of haloperidol 0,5 mg and dexamethasone 5 mg, and 21 patients received ondansetron 4 mg, afterintubation. Intravenous ketorolac and pethidine were given as postoperative analgesia. Blood pressure, heartrate, oxygen saturation and length of surgery was recorded.The result of this study was postoperative nausea andvomiting occurs more frequent in the ondansetron 4 mg group (38,1%) compared to combination of haloperidol0,5 mg and dexamethasone 5 mg group (4,8%). In statistical analysis performed with Chi-Square test showedthere was significant difference between the two groups (p<0,05). As a conclusion of this study is intravenouscombination of haloperidol 0,5 mg and dexamethasone 5 mg better than ondansetron 4 mg in lowering theincidence of postoperative nausea and vomiting after modified radical mastectomy. Key words: Dexamethasone, haloperidol, modified radical mastectomy, nausea and vomiting, ondansetron Reference Daabiss MA. Ephedrine-dexamethasone combination reduces postoperative nauseaand vomiting in patients undergoing laparoscopic cholecystectomy. Internet Anesthesiol. 2008;18(1):1092 ̶ 100. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting. Can J Anesth. 2004;51:326 ̶ 41. Watcha MF, White PF. Postoperative Nausea and Vomiting, lts Etiology, Treatment, and Prevention. Anesthesiology. 1992;77:162–84. Gan TJ. Risk factors of postoperative nausea and vomiting. Anaesth Analg. 2006;102:1884 ̶ 98. Islam S, Jain PN. Postoperative nausea and vomiting (PONV): a review article. Indian J Anesth. 2004;48:253 ̶ 8. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999;91:109 ̶ 18. Ho KY, Chiu JW. Multimodal antiemetic therapy and emetic risk profiling. Ann Acad Med Singapore. 2005;34:196 ̶ 205. Matthew TV, Chan, Chui PT, Ho WS, King WK. Single dose tropisetron for preventing post operative nausea and vomiying after breast surgery. Anesth Analg. 1998;87:931 ̶ 5. McQuaid KR. Drugs used in the treatment of gastrointestinal diseases. Dalam: Basic & clinical pharmacology. Edisi ke-9. Boston: The McGraw-Hill Companies. 2004. hlm. 1045 ̶ 60. Raman S, Kaul TK, Anju G, Aprajita S. Postoperative nausea and vomiting. Anesth Clin Pharmacology. 2007;23:341 ̶ 56. Ku CM, Ong BC. Postoperative nausea and vomiting: a review of current literature. Singapore Med J. 2003;44(7):366 ̶ 74. Splinter WM, Roberts DJ. Dexamethasone decreases vomiting by children after tonsillectomy. Anesth Analg. 1996;83:913 ̶ 6. O’Brien C. Nausea and vomiting. J Can Family Physician. 2008;54:861 ̶ 3. Zarate E, et.al. A Comparison of The Cost and Efficacy of Ondansetron versus Dolasetron for Antiemetic Prophylaxis. Anaesth Analg. 2000;90:1352 ̶ 8. Rosow CE, et.al. Haloperidol versus Ondansetron for Prophylaxis of Post operative Nausea and Vomiting. Anesth Analg. 2008; 106:1407 ̶ 9. Azwar. Pencegahan mual dan muntah pascaoperasi pada anestesi umum: Perbandingan haloperidol 1mg iv dengan ondansetron 4 mg iv [Jakarta: Universitas Indonesia. 2009. Adipraja K, Himendra A, Bisri T. Pengaruh premedikasi haloperidol (serenace®) terhadap efek samping ketamine pada penderita rawat Intensif Fakultas Kedokteran UNPAD/RSHS Bandung. 1992; hlm. 1 ̶ 9. Smith JC, Wright EL. Haloperidol: An Alternative Butyrophenon for Nausea and’ Vomiting Prophylaxis in Anesthesia. AANA journal. 2005;75:273 ̶ 5. Digregio GJ. Anti Psichotic Drugs and Lithium. Dalam: Basic Pharmacology in Medicine. Edisi ke-3. New York: Mc Graw-Hill. 1990. hlm. 261 ̶ 2. Moorselli PL. Haloperidol: Clinical Pharmacokinetics and Significance of Theurapeutic Drug Monitoring. Dalam: Theurapeutic Drug Monitoring. Churchill Livingstone. 1981. hlm. 296 ̶ 301. Khan MP, Singh V, Kumar M, Singh B, Kapoor R, Bhatia VK. Prophylactic antiemetic therapy using combinations of granisetron, dexamethasone and droperidol in patients undergoing laparoscopic cholecystectomy. The Internet Journal of Anesthesiology. 2009;21(1):1092 ̶ 102.
Angka Kejadian dan Karakteristik Menggigil Pascaoperasi di Ruang Pemulihan COT RSHS Periode Bulan Agustus–Oktober 2015 Tantarto, Tamara; Fuadi, Iwan; Setiawan, Setiawan
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
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Menggigil pascaoperasi merupakan komplikasi dari efek anestesi yang cukup sering dijumpai. Menggigil ini dapat menimbulkan rasa tidak nyaman dan risiko yang tidak baik bagi pasien. Penelitian ini dilakukan untuk mengetahui angka kejadian dan karakteristik pasien menggigil pascaoperasi. Studi deskriptif ini melibatkan seluruh pasien pascaoperasi di ruang pemulihan COT RSUP Dr. Hasan Sadikin pada periode bulan Agustus-Oktober 2015 yang memenuhi kriteria inklusi. Data penelitian ini adalah data sekunder dari rekam medis yang berupa data lengkap mengenai pasien pascaoperasi. Dari 639 pasien, angka kejadian menggigil adalah 169 kasus (26,45%).  Menggigil pascaoperasi lebih banyak terjadi pada pria yaitu sebanyak 28,57% dan kategori usia lansia awal. Proporsi pasien menggigil yang diberikan teknis anestesi umum saat operasi hampir sama dibandingkan anestesi regional. Presentase paling tinggi 43,75% pada pasien yang menjalani operasi >2 jam dengan 44,69% diberikan cairan infus sebanyak ≥1500 mL. Menggigil pascaoperasi paling banyak terjadi pada pasien yang menjalani operasi bedah saraf dengan presentase 66,67%. Angka kejadian menggigil pascaoperasi cukup tinggi terutama pada pria, kategori usia lansia awal, operasi yang lama, pemberian cairan infus yang banyak, serta operasi bedah saraf. Kata kunci: Angka kejadian, karakteristik, menggigil pascaoperasi, ruang pemulihan Prevalence and Characteristics of Post-anesthetic Shivering in Recovery Room COT RSHS from August to October 2015Post-anesthetic shivering is a common complication of anesthetic effect. Shivering may cause discomfort and unfavorable risks towards patients.This research aims to reveal the incidence and patient characteristics of post anesthetic shivering. This descriptive study involved post-operative patients in recovery room COT Dr. Hasan Sadikin General Hospital from August to October 2015 who fulfilled the inclusion criteria. Medical records comprising complete post-operative patients’ data were used as secondary data source for this study. Among 639 patients, shivering omLurred in 169 cases (26.45%). Post-anestheric shivering omLurred more in males (28.57%) and in pre elderly age. Proportion of post-anesthetic shivering patients was relatively same in patients who weregiven general anesthesia technique compared to regional anesthesia. Highest percentage omLurred in patients who underwent >2 hours of surgery (43.75%) and administered ≥1500 mL of intravenous (IV) fluids (44.69%). Postanesthetic shivering omLurred the most to neurosurgery patients (66.67%). Post-anesthetic shivering incidence in this study is relatively high, particularly in males, pre elderly age, general, longer operation duration, more administration of (IV) fluids and neurosurgery patients. Key words: Characteristics, postanesthetic shivering, prevalence, recovery room
Fluid Management in Pediatric Craniotomy Fuadi, Iwan; Pison, Osmond Muvtilof; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Advances in pediatric neurosurgery techniques have dramatically improved the outcome in infants and children with surgical lesions of the central nervous system. However, the physiologic and developmental differences inherent in pediatric patients present challenges to neurosurgeons and anesthesiologists alike. Fluid management is critically important in pediatric craniotomy. Hemodynamic stability during intracranial surgery requires the careful maintenance of intravascular volume and electrolytes. It is imperative to secure excellent intravenous access for fluid and blood replacement and drug delivery before the start of the operation. Lack of intake or active vomiting because of changes in the ICP, preoperative fluid restriction and diuretic therapy may lead to blood pressure instability and even cardiovascular collapse if sudden blood loss occurs. Normovolemia should be maintained throughout the procedure. Normal saline used as the maintenance fluid during neurosurgery because it’s mildly hyperosmolar and should minimize cerebral edema. Maintenance rate of fluid administration depends on the weight of the patient. The maximum allowable blood loss should be determined in advance. Hyperglycemia is always best avoided because it may exacerbate neurologic injury. Fluid management in neurosurgical cases is extremely important and requires good communication between the surgeon and anesthesiologist. Especially for infants and children because of the difference in the anatomy and physiology at various stages of growth and development. The anesthesiologist must be fully cognizant of these differences in order to conduct a safe anesthetic plan.
Correction Hypocalemic Patients with Potassium Chloride in ICU of Dr. Hasan Sadikin Hospital Bandung in Januari–Februari 2014 Hidayat, Dede A; Fuadi, Iwan; Sitanggang, Ruli H.
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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Hypokalemia (Potassium plasma level <3.5 mEq/L) is the most common electrolyte imbalance found in the intensive care unit (ICU). Major etiologies of hypokalemia in ICU setting were related to low intake, gastro intestinal tract (GIT) disturbance, renal impairment, diuretic administration, insulin therapy and severe infection, which ranging from asymptomatic to the most severe symptom and causing death.This prospective observational study was conducted in the ICU of Dr. Hasan Sadikin Hospital Bandung from January to February 2014 with result 33 out of 105 admitted patients (31.4%) suffered from hypokalemia.From our observation, there was 17 patients (51.5%) with mild hypokalemia, 13 patients (39.4%) with moderate hypokalemia and 3 patients (9.1%) with severe hypokalemia. Correction with intravenous potassium chloride was given with improvement in 9 patients (53%) in mild hypokalemia group, 3 patients (23.1%) in moderate hypokalemia group but unfortunately no significant change was found in severe hypokalemia group after the correction. Complications were found mostly in geriatric patients with severe hypokalemia.The conclusion of this study is that from all patients admitted to the ICU of Dr. Hasan Sadikin Hospital Bandung from January ̶ February 2014, the incidence of hypokalemia was 31.3% (33 patients) with improvement occurred in 12 patients (36.4%) but 21 patients (63%) revealed no improvement after potassium chloride correction with worsening condition.
Glasgow Coma Scale dalam Memprediksi Outcome pada Pasien dengan Penurunan Kesadaran di Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo S, Achmad Afif; Fuadi, Iwan; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Ventilator associated pneumonia (VAP) merupakan Hospital associated pneumonia (HAP) yang paling sering terjadi di intensive care unit (ICU). Salah satu strategi pencegahan terjadinya VAP yang termasuk dalam VAP bundle adalah penghisapan sekret subglotis dengan menggunakan pipa endotrakea dengan drainase sekret subglotis. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh penggunaan pipa endotrakea dengan drainase sekret subglotis terhadap angka kejadian VAP di ICU Rumah Sakit Hasan Sadikin (RSHS) Bandung. Penelitian dilakukan dengan uji acak tersamar tunggal terhadap 26 subjek yang menggunakan ventilator lebih dari 48 jam di ICU RSHS Bandung. Setelah dilakukan randomisasi secara blok permutasi, subjek penelitian dikelompokan menjadi dua, yaitu 13 subjek kelompok kontrol menggunakan pipa endotrakea standar dan 13 subjek kelompok perlakuan menggunakan pipa endotrakea dengan drainase sekret subglotis. Sekret subglotis dihisap setiap 2 jam dan tekanan balon pipa endotrakea diperiksa setiap 4 jam. Data hasil penelitian dianalisis dengan uji statistik yaitu uji independent t, Uji Mann Whitney dan uji chi kuadrat, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap kejadian VAP (p=0,033), dimana kejadian VAP lebih sedikit pada kelompok yang menggunakan pipa endotrakea dengan drainase subglotis (0%) dibandingkan dengan kelompok yang menggunakan pipa endotrakea standar (23,1%). Simpulan dari penelitian ini adalah penggunaan pipa endotrakea dengan drainase sekret subglotis dapat menurunkan kejadian VAP di ICU RSHS Bandung. Kata kunci: Drainase sekret subglotis, pipa endotrakea, ventilator associated pneumonia The Influence of Endotracheal Tube with Subglottic Secretion Drainage on Ventilator Associated Pneumonia In Intensive Care Unit Dr. Hasan Sadikin Hospital Bandung Ventilator associated pneumonia (VAP) is the most common Hospital associated pneumonia in Intensive Care Unit (ICU). One of the strategies to prevent occurence of VAP that is part of the VAP bundle is suctioning of subglottic secretion using special endotracheal tube with subglotic secretion drainage. The aim of this study is to know the influence of using endotracheal tube with subglottic secretion drainage to the incidence of VAP in ICU RSHS Bandung. This is a single-blind randomized study involving 26 patients who use ventilator for more than 48 hours in ICU RSHS Bandung. After permuted block randomization, the subjects were divided into two groups, 13 subjects in the control group whom are using standard endotracheal tube and 13 subjects in the group whom are using endotracheal tube with subglottic secretion drainage. Subglottic secretion is drained every two hours and the pressure of the endotracheal tube cuff is checked every four hours. The result of this study is analyzed using various statistical tests, including independent t test, Mann Whitney and Chi Square test, where p value <0.05 is considered significant. Statistical analysis shows that there is a significant difference between two groups in the incidence of VAP (p=0.033) where incidence of VAP is less in the group using endotracheal tube with subglotic drainage (0%) in comparison to the group using standard endotracheal tube (23.1%). The conclusion of this study is that endotracheal tube with subglottic secretion drainage can decrease incidence of VAP in ICU RSHS Bandung. Key words: Endotracheal tube, subglotic secretion drainage, ventilator associated pneumonia 
Co-Authors - Elvidiansyah - Elvidiansyah A Himendra Wargahadibrata A Himendra Wargahadibrata A. Hmendra Wargahadibrata A. Muthalib Nawawi A. Muthalib Nawawi A.A. Ketut Agung Cahyawan W Abdul Muthalib Nawawi Abdul Muthalib Nawawi Abdul Rahman Abdul Rahman Aisyah Ummu Fahma Andre Aditya Andy Hutariyus Ardhana Risworo Anom Yuswono Ardhana Risworo Anom Yuswono Ardi Zulfariansyah Ardi Zulfariansyah Ardi Zulfariansyah Ari Saptadi Ari Saptadi Ariestian, Erick Army Zaka Anwary Arna Fransisca Arsy Felisita Dausawati Arsy Felisita Dausawati Asyer Asyer Bisri, Tatang https://scholar.google.co.id/citations?u Bona Akhmad Fithrah Bramantyo Pamugar Defri Aryu Dinata Defri Aryu Dinata, Defri Aryu Dessy Sutoyo Dewi Ramadani Dewi Ramadani Dewi Yulianti Bisri Dian Novitasari Dian Novitasari Dimas Rahmatisa Dini Handayani Putri Dzulfikar D. L. Hakim Eka Damayanti Eri Surahman Eri Surahman Eri Surahman Erick Ariestian Erwin Pradian Erwin Pradian Eva Srigita Tari Ezra Oktaliansah Fahma, Aisyah Ummu Fardian Martinus Ferra Mayasari Firdaus, Riyadh Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Fitri Sepviyanti Sumardi Hamzah Hamzah Hansen Wangsa Herman Hidayat, Dede A Hunter D. Nainggolan Hunter D. Nainggolan Ike Sri Redjeki Ike Sri Redjeki Indra Wijaya Indriasari Indriasari Iwan Abdul Rachman Jimmy Setiadinata Jimmy Setiadinata, Jimmy Kartapraja, Roni D. Lukman Hidayat M Andy Prihartono M Sofyan Harahap M. Erias Erlangga Mariko Gunadi Mariko Gunadi Martinus, Fardian Maulana Muhammad Maulana Muhammad, Maulana Mayasari, Ferra MM Rudi Prihatno Monika Widiastuti Muhammad Adjie Pratama Nency Martaria Nurmala Dewi Maharani Nyiemas Moya Zamzami Pamugar, Bramantyo Pison, Osmond Muvtilof R, Tubagus Yuli Radian Ahmad Halimi Rahmadsyah, Teuku Rahordjo, Sri Richard Pahala Sitorus Rini Rustini Riyadh Firdaus Roni D. Kartapraja Rudi Kurniadi Kadarsah Ruli Herman Sitanggang S, Achmad Afif Saleh, Siti Chasnak Setiawan Setiawan Sitanggang, Ruli H. Siti Chasnak Saleh Sitorus, Richard Pahala Sri Rahardjo Sri Rahardjo Sri Rahardjo Sri Rahardjo Sudadi Sudadi Suryadi Suryadi Suryadi Suryadi Sutoyo, Dessy Tantarto, Tamara Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Theresia C. Sipahutar Theresia C. Sipahutar Theresia Monica Rahardjo Theresia Monica Rahardjo Thomas Thomas Tinni T. Maskoen Tinni T. Maskoen Tinni T. Maskoen Tubagus Yuli R Wargahadibrata, A. Hmendra Wenny Oktivia Yunita Susanto Putri Yunita Susanto Putri Zamzami, Nyiemas Moya