Jefferson Hidayat
Departemen Anestesiologi dan Intensive Care Fakultas Kedokteran Universitas Indonesia/RSUPN Cipto Mangunkusumo

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Efektivitas Pemberian Cairan Praoperatif Ringer Laktat 2 mL/kgBB/jam Puasa untuk Mencegah Mual Muntah Pascaoperasi Wijaya, Andi Ade; Fithrah, Bona A.; Marsaban, Arif H. M.; Hidayat, Jefferson
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Teknik nonfarmakologi yang dapat dilakukan untuk menurunkan angka kejadian mual muntah pascaoperasi adalah pemberian cairan praoperatif. Tujuan penelitian ini untuk mengetahui efektivitas pemberian cairan praoperatif Ringer laktat 2 mL/kgBB/jam puasa untuk menurunkan angka kejadian mual muntah pascamastektomi. Penelitian ini merupakan uji klinis acak yang dilakukan pada bulan Maret–April 2013 di Rumah Sakit Kanker Dharmais, Rumah Sakit Persahabatan, Rumah Sakit Fatmawati, dan Rumah Sakit Cipto Mangunkusumo Jakarta, pada pasien status fisik American Society of Anesthesiologist (ASA) 1–2. Sebanyak 102 pasien diacak ke dalam kelompok hidrasi dan kelompok kontrol. Analisis data dilakukan menggunakan uji chi-kuadrat. Terdapat perbedaan yang signifikan dalam kejadian mual pada 0–1 jam pascaoperasi (kelompok hidrasi 20% vs kelompok kontrol 39%) dan pada 0–24 jam pascaoperasi (kelompok hidrasi 22% vs kelompok kontrol 41%). Walaupun tidak berbeda secara statistik, angka kekerapan mual pada 1–24 jam pascaoperasi lebih rendah pada kelompok hidrasi 12% (6) dibandingkan dengan kelompok kontrol 23% (12). Tidak ada perbedaan secara statistik pada angka kekerapan muntah di kedua kelompok penelitian. Pemberian cairan praoperatif Ringer laktat 2 mL/kgBB/jam puasa efektif untuk menurunkan angka kejadian mual pascaoperasi mastektomi pada 1 jam pertama pascaoperasi.  Kata kunci: Cairan praoperatif, mastektomi, mual muntah pascaoperasi Effectiveness of Pre-operative Lactated Ringer’s Solution 2 mL/kgBW/h in Fasting Patients to Prevent Post-operative Nausea and Vomiting Non pharmacologic approaches to overcome post operative nausea and vomiting include giving pre-operative hydration. The objective of this study was to learn the efficacy of pre-operative lactated Ringer’s solution (2 mL/kgBW/hour) in fasting patients to overcome the post-operative nausea and vomiting in mastectomy surgery. This study was a randomized clinical trial that conducted in March to April 2013 in Dharmais Hospital-National Cancer Center,  Persahabatan Hospital, Fatmawati Hospital, and Rumah Sakit Cipto Mangunkusumo Jakarta to patients with  American Society of Anesthesiologist (ASA) physical status 1–2. A total of 102 patients were randomized into the hydration group and control group. Data analysis was performed using chi-square test or appropriate test using SPSS ver. 15. There were statistically significant differences in the incidence of nausea at 0–1 hour post-operative (19.6% in hydration group vs. 39.2% in control group) and at 0–24 hours post-operative (21.6% in hydration group vs. 41.2% control group). The incidence of 1–24 hours PONV, although not statistically significant, was higher in the control group (11.8% in hydration group vs. 23.5% in control group). There was no difference in vomiting incidence between the two groups. Pre-operative lactated Ringer’s solution 2 mL/kgBW/hour in fasting patients effectively reduces the incidence of post-operative nausea one hour after operation. Key words: Mastectomy, post-operative nausea and vomiting pre-operative hydration DOI: 10.15851/jap.v2n3.332
CASE SERIES: DEEP SEDATION FOR PAEDATRIC PATIENTS WITH PERICARDIAL EFFUSION Soenarto, Ratna Farida; Hidayat, Jefferson; Zaintama, Hendy Armanda
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.33

Abstract

Background: Pericardial effusion is an abnormal fluid accumulation in the pericardial space that potentially compromises cardiovascular function, thus it needs a prompt treatment. Pericardial effusion evacuation in paediatrics can be done by subxyphoid pericardiotomy, which requires patient’s cooperation. General anaesthesia for paediatrics with pericardial effusion has been reported unfavourable. This case series reports safe anaesthesia procedures done for pericardiocentesis through both sedation and general anaesthesia. Case Presentations: Cases were taken from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 6 patients underwent sedation and 3 patients underwent general anaesthesia. Both groups used ketamine, midazolam and fentanyl. Sevoflurane was used as inhalation agent for maintenance. Blood pressure, heart rate, and SpO2 were recorded before and after pericardiocentesis. In both groups, there were no significant different between systolic and diastolic blood pressure, heart rate, and SpO2 before and after the procedure (p>0.05). Immobilization through sedation or general anaesthesia is required to perform an optimal pericardiotomy. Anaesthetic agents were chosen based on their minimal effects toward myocardial depression. Fluids balance before and after the procedure was crucial to prevent hemodynamic instability during effusion evacuation. Conclusion: Both sedation and general anaesthesia were safe for pericardiocentesis, with concern toward anaesthetic agents that were minimally depressive to myocardium, combined with opioid analgesics and other sedative agents, with balanced anaesthesia principle. Optimal intravenous fluid therapy with echocardiography monitoring is crucial. Sedation is more advantageous for patients requiring pericardiocentesis without preoperative preparation for general anaesthesia.
Effectiveness of Partial and Adjustment Neostigmine Dose as a Neuromuscular Reversal for Single Dose Rocuronium Hidayat, Jefferson; Marsaban, Arif HM; Daryono, Maria Veronica Tita Ekaputri Hadi
Bali Journal of Anesthesiology Vol 2, No 1 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i1.62

Abstract

Background: Routine reversal (neostigmine) and the use of quantitative monitoring of neuromuscular blockade (Train of Four Ratio (TOFR)) are recommended to prevent the occurrence of residual paralysis. This study attempted to determine the effectiveness between neostigmine partial dose 0.02 mg/kgbw and adjusted dose based on TOFR value in recovering neuromuscular blockade of single dose rocuronium 0.6 mg/kgbw.Methods: This randomized clinical trial was performed in the operating room of Integrated Surgical Care Unit of Cipto Mangunkusumo General Hospital and Kirana Clinic. Sixty-one patients who underwent elective surgery in general anesthesia were randomized in to 2 groups: administration of neostigmine in partial dose 0.02 mg/kgbw (group A) and adjusted dose based on TOFR value (group B). Quantitative monitoring evaluation of neuromuscular blockade was performed four times: after adequate spontaneous breathing, 5, 10, and 15 minutes after reversal.Result: The mean of TOFR values in group A and group B respectively: after spontaneous breathing 42% and 50% (p=0.436); 5 minutes after reversal 80.2% and 89.2% (p=0.083); 10 minutes after reversal 92.2% and 94% (p=0.399); 15 minutes after reversal 94.3% and 94.9% (p=0.526). After the 5 minutes of reversal, group B (80.6%) reaches TOFR value ≥ 90% many more than group A (63.3%) (p=0.132).Conclusion: Neostigmine partial dose 0.02 mg/kgbw was as effective as administering neostigmine in adjustment dose based on TOFR values to achieve complete recovery from the neuromuscular block effect of single-dose rocuronium 0.6 mg/kgbw. This study also show the complete recovery of neuromuscular block when TOFR value ≥ 90%.
Pengaruh Edukasi Pra-anestesia terhadap Tingkat Kecemasan Pasien Dewasa yang Menjalani Operasi Jantung Terbuka Marsaban, Arif H. M.; Hidayat, Jefferson; Kusumadewi, Irmia; Nainggolan, Gina Adriana
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Kecemasan praoperasi mengaktifkan stres respon  yang menyebabkan stimulasi sistem saraf simpatis (menstimulasi sistem kardiovaskular dengan meningkatkan jumlah katekolamin darah yang menyebabkan takikardi, hipertensi, iskemik dan infark miokardial). Respon tersebut merugikan sirkulasi koroner, menyebabkan peningkatan morbiditas dan mortalitas. Salah satu penanganannya adalah dengan pemberian informasi (edukasi), melalui komunikasi efektif, informatif dan empati, diharapkan terjadi penurunan tingkat kecemasan pasien sebelummenjalani pembiusan dan pembedahan. Penelitian ini menginvestigasi pengaruh edukasi pra-anestesia terhadap tingkat kecemasan pasien operasi jantung terbuka di RSUPN Cipto Mangunkusumo. Penelitian ini menggunakan uji kuasi eksperimen pada pasien operasi jantung terbuka dewasa di Instalasi PJT RSUPN Cipto Mangunkusumo pada bulan Maret 2016. Setelah mendapatkan ijin komite medik dan informed consent, pada 36 subyek dilakukan penilaian tingkat kecemasan sebelum dan sesudah edukasi dengan menggunakan instrumen APAIS. Sebelumedukasi dilakukan pengukuran tanda vital, dilanjutkan dengan pemberian edukasi dan diskusi. Terdapat penurunan bermakna rerata tingkat kecemasan sebelum edukasi dibandingkan dengan sesudah edukasi (p<0,001). Edukasi pra-anestesia menurunkan tingkat kecemasan pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo. Kata kunci: Edukasi, komunikasi efektif, tingkat kecemasan, operasi jantung terbuka The Effect of Education on the Anxiety Level of Adults Patient Undergoing Open Heart Surgery Pre-operative anxiety activates the stress response, causing stimulation of the sympathetic nervous system, which timulates cardiovascular system by increasing the blood catecholamines levels, causing tachycardia, hypertension, ischemia and myocardial infarction. The response may have detrimental effects on the coronary circulation, increasing morbidity and mortality. One of the management is by the provision of information (education) through effective and informative communication with empathy, which are expected to decrease patients’ anxiety level before undergoing anesthesia and surgery. This study aimed to determine the effect of preanesthesia education to the anxiety level in open heart surgery patients in Cipto Mangunkusumo Hospital. This was a quasi-experimental trials of adult open heart surgery patients in Integrated Cardiac Center of Cipto Mangunkusumo Hospital in March 2016. After permission from the medical committee and informed consent were obtained, the anxiety level of 36 subjects was assessed before and after the education using APAIS instrument. Before the education was given, vital signs were measured, continued by education and discussion. There was a significant decrease in the average level of anxiety before education compared with after education (p<0.001). Preanesthesia education lowers the anxiety level in adult open heart surgery patients in Cipto Mangunkusumo Hospital. Key words: Education, effective communication, the level of anxiety, opens heart surgery
Gangguan Tidur pada Peserta Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Harijanto, Eddy; Hidayat, Jefferson; Pratiwi, Astrid
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
Publisher : Perdatin Pusat

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Dokter anestesiologi adalah profesi kedokteran yang rentan mengalami kelelahan akibat jam kerja yang panjang, beban kerja dengan tingkat stress pekerjaan yang tinggi. Sebanyak 80% kesalahan medis berhubungan dengan sindrom burnout dengan gangguan tidur sebagai keluhan yang sering dialami dokter anestesiologi. Penelitian ini menggunakan 2 kuesioner yang telah divalidasi di Indonesia; Kuesioner pittsburgh sleep quality index (PSQI) untuk menilai kualitas tidur dan kuesioner epworth sleepiness scale (ESS) untuk menilai skala kantuk berlebih. Setelah mendapatkan izin komite etik dan informed consent, penelitian observasional potong lintang dengan subjek 98 orang peserta PPDS Anestesiologi dan Terapi Intensif FKUI dilakukan di RSCM selama April–Mei 2016. Sampel mengisi kedua kuesioner. Analisis deskriptif dilakukan terhadap gangguan kualitas tidur dan skala kantuk, distribusi karakteristik dan data jam kerja. Analisis bivariat dan multivariat dilakukan terhadap hasil kuesioner PSQI dan ESS. Faktor durasi tidur, keluhan tidur dan skala kantuk berlebih adalah faktor signifikan penyebab kualitas tidur kurang. Skala kantuk memiliki kecenderungan sebesar 132,8 kali sebagai faktor gangguan kualitas tidur. Faktor jumlah hari bebas tugas per bulan, tahap jaga, dan kualitas tidur subjek menjadi faktor signifikan penyebab skala kantuk berlebih. Gangguan kualitas tidur memiliki kecenderungan sebesar 38,73 kali sebagai faktor skala kantuk berlebih.70% subjek memiliki kualitas tidur kurang dan 65% subjek memiliki skala kantuk berlebih. Terdapat hubungan signifikan antara kualitas tidur dengan skala kantuk berlebih. Kata Kunci: dokter anestesiologi, gangguan kualitas tidur, skala kantuk Factors Affecting Sleep Disorder in Trainees of Anesthesiology and Intensive Care Anesthesiologists are very susceptible to fatigue due to long working hours and work load with high levels of job stress. 80% of medical errors are associated with burnout syndrome; with sleep disorders as the most common complaint from anesthesiologists. This study investigated sleep quality and sleepiness scale using 2 validated questionnaires in Indonesia; Pittsburgh Sleep Quality Indexto (PSQI) assess sleep quality and Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness. This was an observational cross sectional study of Anesthesiology and Intensive Therapy residents in Faculty of Medicine Universitas Indonesia. After obtaining permission from ethics committee and informed consent, this study was done in Cipto Mangunkusumo Hospital during April–May 2016 on 98 residents as the sample. Subjects filled PSQI and ESS questionnaires. Descriptive analysis included sleep quality and sleepiness scale, distribution characteristics and working hour. The bivariate and multivariate analysis assessed the questionnaires score results. Results, sleep duration, sleep complaints of participants and excessive daytime sleepiness caused sleep quality disorder significantly. Excessive daytime sleepiness hds 132.8 times tendency to impair the quality of sleep. Offduty days number per month, the academic level, and sleep quality caused excessive daytime sleepiness significantly. Impaired quality of sleep had 38.73 times tendency as a factor of excessive daytime sleepiness. 70% subjects had sleep quality disorder and 65% subjects had excessive daytime sleepiness. There was a significant relationship between sleep quality disorder and excessive daytime sleepiness. Key words: Anesthesiologist, excessive daytime, impaired quality of sleep, sleepiness scale
Perbandingan Trapezius Squeezing Test dan Jaw Thrust Sebagai Indikator Kedalaman Anestesia pada Pemasangan Sungkup Laring Hidayat, Jefferson; Sugiarto, Adhrie; Alatas, Anas
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Manajemen jalan napas merupakan salah satu aspek penting dalam anestesiologi. Salah satu jenis alat bantu jalannafas yang sering digunakan adalah Laringeal Mask Airway (LMA/sungkup laring). Pemasangan sungkup laringtanpa pelumpuh otot membutuhkan kedalaman anestesi yang cukup. Trapezius squeezing test dan jaw thrustadalah dua uji klinis sederhana yang digunakan untuk menguji kedalaman anestesia. Penelitian ini bertujuan untukmembandingkan trapezius squeezing test dan jaw thrust sebagai indikator klinis menilai kedalaman anestesi padapemasangan sungkup laring dengan induksi anestesia menggunakan propofol. Sebanyak 128 pasien dirandomisasimenjadi dua kelompok yaitu kelompok 1 (kelompok jaw thrust) dan kelompok 2 (kelompok trapezius squeezingtest). Setelah premedikasi dengan midazolam 0,05 mg/kgBB dan fentanil 1 μg/kgBB, untuk induksi anestesiadiberikan propofol dosis titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saatrespon motorik dari manuver hilang dilakukan pemasangan sungkup laring. Keberhasilan pemasangan padakelompok 1 dan 2 adalah 93,8% vs. 90,6% (p >0,05). Rata-rata penggunaan propofol pada kelompok 1 sebesar120,34 mg dan kelompok 2 sebesar 111,86 mg (p > 0.05). Pada kelompok 1 apnea dijumpai pada 10 pasien(15.6%) sedangkan pada kelompok 2 sebanyak 11 pasien (17.2%). Trapezius squeezing test sama baiknya denganjaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring. Kata Kunci: Jaw thrust, kedalaman anestesia, propofol, sungkup laring, trapezius squeezing test Airway management remains as one of the most important aspect in anesthesiology. Laryngeal Mask Airway(LMA) has been widely used as an airway device. Laryngeal mask insertion without muscle relaxant facilitationrequires an adequate anesthesia level. The purpose of this study was to compare trapezius squeezing test andjaw thrust maneuver as an indicator of anesthesia depth for laryngeal mask insertion, with propofol as inductionagent. There were 128 subjects who had been randomized into two groups: Group 1 (jaw thrust group) andGroup 2 (trapezius squeezing test group). All subjects received midazolam 0.05 mg/kg and fentanyl 1 μg/kg aspremedication. Propofol with titrated dose were used for anesthesia induction. Jaw thrust or trapezius squeezingtest maneuver were performed every 15 seconds in each group. When motoric responses were lost after maneuver,LMA was inserted. Succesfull LMA insertion were found in 93,8% patients (Group1) and 90,6% (Group 2) withp >0,05. Mean propofol consumptions were 120.34 mg in Group 1 and 111,86 mg in Group 2. Apnea was found in10 patients (15,6%) in Group 1 and 11 patients (17.2%) in Group 2. Trapezius squeezing test was as good as jawthrust maneuver as an adequate depth of anesthesia indicator for laryngeal mask insertion. Keywords: Departement of anesthesia, jaw thrust, laryngeal mask, propofol, trapezius squeezing test Reference Sood J. Laryngeal mask airway and its variants. Indian J Anaesth 2005;49(4):275–0. Verghese C, Berlet J, Kapila A, Pollard R. Clinical assessment of single use laryngeal mask airway the LMA Unique. Br J Anaesth 2006:80;677–9. Easley EH. The laryngeal mask airway: a review and update. J Clin Anaesth. 2005:16; 114–23. Cook TM. The classic laryngeal mask airway: a tried and tested airway. Br J Anaesth 2006; 96(2):149–52. Cressey DM, Claydon P, Bhaskaran NC, Reilly CS. Effect of midazolam pretreatment on induction dose requirement of propofol in combination with fentanyl in younger and older adult. Anaesth 2011;56:108–13. Towsend R. Jaw thrust as a predictor of insertion conditions for the proseal laryngeal mask airway. Anaesth 2009;20(1):59–62. Krishnappa S. Optimal anaesthetic depth for LMA insertion. Indian J Anaesth 2011;55(5): 504–7. Chang C. Comparison of the trapezius squeezing test and jaw thrust as indicators for laryngeal mask airway insertion in adults. Korean J Anesth 2011;61(3):201–4. Peacock JE, Lewis RP, Reilly CS, Nimmo WS. Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients. Br J Anaesth 1990;65:346–52. Peacock JE, Spiers SP, Mclauchlan GA, Edmondson WC, Berthoud BM, Reilly CS. Infusion of propofol to identify smallest effective doses for induction of anaesthesia in Yong and elderly patients. Br J Anaesth 1992; Stokes DN, Hutton P. Rate dependent induction phenomena with propofol: Implications for the relative potency of intravenous anesthetics. Anesth Analg 1991; 72:578–83. Scanlon P, Carey M, Power M. Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone. Can J Anaesth 1993;40:816–8. Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivate as a tool for predicting the depth of sedation and anesthesia induced by sevoflurance. Anesthesiology 1998;88:642–50. Rudy N. Keefektifan trapezius squeezing test sebagai indicator kedalaman anesthesia saat pemasangan sungkup laring dihubungkan dengan bispectral index. Universitas Indonesia, 2012. Drage MP, Nunez J, Vaughn RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anesth 1996; 51: 11667–70. Chang C. Optimal condition for laringeal mask airway insertion in children can be determinate by the trapezius squeezing test. J Clin Anaesth 2008;20:99–102. Reves GJ, Peter S.A, David AL, et al. Intravenous nonopiod anesthetics. In Miller’s Anesthesia. 7th ed. Philadelpia: Churchill Livingstone, 2010. p. 318–25. Morgan GA, Mikhail MS. Nonvolatile anesthetic agents: Clinical Anesthesiology. 4th ed. New York : McGraw-Hill, 2006. p.179–203 Hillier SC. monitored anesthesia Care. 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The Effect of Contralateral Head Rotation on Internal Jugular Vein to Carotid Artery Distance and Overlap Ratio Heriwardito, Aldy; Dachlan, Muhammad Ruswan; Hidayat, Jefferson; Rokyama, Hadli
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (4525.866 KB) | DOI: 10.15562/bjoa.v3i2.158

Abstract

Introduction: Carotid artery puncture during central venous catheter (CVC) insertion could lead to serious complication if there was overlapping of internal jugular vein (IJV) and carotid artery (CA). IJV and CA overlap ratio and distance were determined by contralateral head rotation angle. Optimal angle of contralateral head rotation during CVC insertion can decrease the risk of CA puncture complication. This study was aimed to investigate the optimal angle of contralateral head rotation on IJV to CA distance and overlap ratio at the cricoid level by ultrasound guidance.Methods: This was a cross-sectional study of 34 patients undergoing elective surgery with CVC insertion. IJV to CA distance and overlap ratio at the cricoid level on each subject in supine position was measured by using two-dimensional ultrasound  (Sonosite® M-Turbo, 6-13 MHz probe) at 0o, 30o, 45o, 60o contralateral head rotation of insertion site. Collected data were analyzed using SPSS 21.0.Results: There were significant differences on IJV to CA distance and overlap ratio at different contralateral rotation angles (0o, 30o, 45o, 60o, p<0.001). Overlapping of IJV and CA started to occur at contralateral head rotation 30o (11.72%) and increased in line with the increasing of contralateral head rotation angle (21.21% at 45o).Conclusion: There were significant effects of contralateral head rotation to distance and overlapping IJV to CA at cricoid level. Optimal contralateral head rotation angle for CVC was less than 30o to prevent IJV and CA overlapping.