Tinni T. Maskoen
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung

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Pemberian Bolus 7,5 mL Poligelin pada Ruang Epidural untuk Menurunkan Kejadian Postdural Puncture Headache pada Anestesi Spinal Jaya Sutawan, I. B. Krisna; Pradian, Erwin; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Post dural puncture headache (PDPH) mengakibatkan morbiditas pada ibu yang menjalani seksio sesarea dengan anestesi spinal. PDPH disebabkan karena penurunan tekanan intratekal akibat kebocoran cairan serebrospinalis. Bolus poligelin pada ruang epidural diharapkan secara sementara meningkatkan tekanan ruang epidural dan mengurangi kebocoran cairan serebrospinalis sehingga dapat menurunkan kejadian PDPH. Penelitian dilakukan dengan uji klinis single blind randomized controled trial pada 90 wanita hamil yang menjalani seksio sesarea dengan anestesi spinal pada Oktober sampai Desember 2011 Rumah Sakit Dr. Hasan Sadikin Bandung. Sampel dikelompokkan secara random menjadi kelompok bolus 7,5 mL poligelin dan kelompok kontrol, selanjutnya dilakukan penilaian PDPH sampai hari kelima pascaanestesi spinal. Analisis statistik berdasarkan Uji Eksak Fisher, memperlihatkan bahwa angka kejadian PDPH pada kedua kelompok perlakuan menunjukkan perbedaan bermakna secara statistik (p<0,05). Simpulan dari penelitian ini adalah bolus poligelin pada ruang epidural dapat menurunkan angka kejadian PDPH pada pasien yang menjalani operasi seksio sesarea dengan anestesi spinal.Kata kunci: Anestesi spinal, poligelin, post dural puncture headache, ruang epidural  Bolus 7.5 mL Polygeline into the Epidural Space in Reducing the Incidence of Postdural Puncture Headache on Spinal AnesthesiaAbstractPost dural puncture headache (PDPH) may cause morbidity in women undergoing caesarean section with spinal anesthesia. PDPH is caused by a reduction of intrathecal pressure due to leakage of cerebrospinal fluid. Polygeline bolus into the epidural space is expected to temporarily increase the pressure of the epidural space therefore reduces cerebrospinal fluid leakage so that it may reduce the incidence of PDPH. The study conducted was a single-blind randomized clinical trial on 90 pregnant women undergoing caesarean section with spinal anesthesia from October until December 2011 in Dr. Hasan Sadikin Hospital Bandung. Samples were randomly divided into the bolus of 7.5 mL polygeline group and the control group. Evaluation of PDPH was performed until 5th day post-spinal anesthesia. Statistical analysis using Fishers Exact Test, showed that the incidence of PDPH in both treatment groups showed a statistically significant difference (p<0.05). The conclusion of this study is polygeline bolus into the epidural space may decrease the incidence of PDPH in patients undergoing caesarean section with spinal anesthesia.Key words: Epidural space, polygeline, post dural puncture headache, spinal anesthesia DOI: 10.15851/jap.v1n3.193
Perbandingan Pemberian Cairan Ringerfundin Saat Anestesi Spinal (Coload) Dengan Cairan HES Sebelum Anestesi Spinal (Preload) Terhadap Hemodinamik Ibu Dan Skor APGAR BayiPada Seksio Sesarea Efendi, Erik; Herman Sitanggang, Ruli; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Hipotensi merupakan komplikasi yang paling sering ditemukan pada anestesi spinal yang dilakukan pada bedah sesar. Salah satu usaha pencegahan yang dilakukan adalah dengan cara pemberian cairan kristaloid secara coloading atau cairan koloid dengan cara preloading. Penelitian ini bertujuan untuk mengetahui pengaruh jenis cairan dan teknik pemberian mana yang paling baik dalam menjaga hemodinamik ibu dan pengaruhnya terhadap bayi. Penelitian ini dilakukan dengan desain eksperimental acak tersamar tunggal mengikutsertakan42 ibu hamilASA II, yang menjalani operasi bedah sesardengan anestesi spinal. Setelah dilakukan randomisasi secara blok permutasi, subyek penelitian dikelompokkan menjadi dua yaitu 21 subyek masuk dalam kelompok kontrol mendapat preloading HES 6%sebanyak 7,5 cc/kgbb dan 21 subyek masuk dalam kelompok perlakuan mendapat coloading Ringerfundin sebanyak 20 cc/kgbb mL. Tekanan darah danlaju nadi diperiksa setiap satu menit sampai 15 menit setelah anestesia spinal. Setelah itu diperiksa tiap 3 menit sampai operasi selesai. Setelah bayi lahir dilakukan penilaian skor APGAR 1 menit dan 5 menit. Data hasil penelitian dianalisis dengan uji statistik yaitu uji t test, uji Mann Whitney dan uji Kolmogorov-Smirnov, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak ada perbedaan yang bermakna antara tekanan darah sistolik, tekanan diastolik, tekanan darah rerata dan laju nadi antara pemberian cairan ringerfundin secara coloading dibandingkan pemberian cairan HES 6% secara preloading (p>0,05). Tidak terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap skor APGAR 1 menit (p=0,309) dan 5 menit (p=0,154). Terdapat perbedaan bermakna terhadap jumlah pemakaian efedrin antara kedua kelompok (p=0,047). Simpulan dari penelitian ini adalah pemberian coloading ringerfundin dapat mencegah terjadinya hipotensi pasca anestesi spinal sama baiknya dengan pemberian preloading HES 6%. Tidak terdapat perbedaan skor APGAR antara preloading HES 6% dengan coloading ringerfundin. Terdapat perbedaan jumlah pemberian efedrin antara preloading HES 6% dan coloading ringerfundin.Kata Kunci:anestesi spinal, coloading, preloading, ringerfundin, seksio sesarea Comparison of Maternal Hemodynamic and APGAR Outcome between Ringerfundin Coload And HES Preload on Spinal Anesthesia for Sectio CesareaHypotension is the most common complication inspinal anesthesia in cesarean sections performed. One of the prevention neffort is made by way of a coloading crystalloid fluid administration or by preloading colloid fluid. This study aims to determine the effect of fluid types and techniques of which the most excellent in maintaining hemodynamic effects on mother and baby. The research was conducted with a single-blind randomized experimental design included 42 pregnant women ASAII, who underwent cesarean section surgery with spinal anesthesia. After randomization in blocks of permutations, subjects are grouped into two, 21 subjects included in the control group received. 6% HES preloading by 7.5 cc/kg and 21 subjects included in the treatment group received coloading Ringerfund in as much as 20 cc/kg. Blood pressure and pulse rate examined everyone minute until 15 minutes after spinal anesthesia. After it examined every 3 minutes until the operation is complete. After the baby is born an assessment of Apgar score 1 minute and 5 minutes. Data were analyzed with the results of statistical tests that test, Mann Whitney test and Kolmogorov – Smirnov test, where pvalues<0.05 were considered significant. Statistical analysis showed that there was no significant difference between the systolic blood pressure, diastolic pressure, mean blood pressure and pulse rate between the coloading ringer fund in than preloading HES 6% (p>0.05). There were no significant differences between the two treatment group sof1-minute Apgarscore (p =0.309) and 5 minutes (p=0.154). There is a significant difference to the amount of ephedrine usage between the two groups (p =0.047). The conclusions of this study is the provision of coloading ringer fundin can prevent hypotension after spinal anesthesia as well as HES 6% preloading. No difference between the Apgar scores of 6% HES preloading with coloading ringer fundin. There is a difference between the amount of ephedrine administration preloading HES 6% and coloading ringer fundin. Keyword: coloading, preloading, ringerfundin, sectio sesarea, spinal anesthesia DOI: 10.15851/jap.v1n1.157
Perbandingan Pemberian Ondansetron 8 mg dengan Tramadol 1 mg/ kgBB Intravena untuk Mencegah Menggigil Pascaanestesi Umum pada Operasi Mastektomi Radikal atau Modifikasi Oktavian, Mirza; Nawawi, A. Muthalib; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 2, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Menggigil pascaanestesi merupakan komplikasi anestesi umum yang dapat dicegah menggunakan berbagai jenis obat. Tujuan penelitian ini adalah membandingkan ondansetron 8 mg intravena dengan tramadol 1 mg/kgBB dalam mencegah menggigil pascaanestesi umum. Penelitian dilakukan menggunakan metode prospektif, terkontrol, tersamar buta ganda pada 38 pasien berusia 30–60 tahun yang menjalani operasi mastektomi radikal atau modifikasi di Rumah Sakit Dr. Hasan Sadikin Bandung periode Maret–April 2012, status fisik American Society of Anesthesiologist (ASA) I dan II. Sampel dibagi menjadi 2 kelompok secara acak, masing-masing kelompok menerima ondansetron 8 mg atau tramadol 1 mg/kgBB sebelum penutupan luka operasi. Analisis hasil penelitian menggunakan uji chi-kuadrat menunjukkan kejadian menggigil kelompok tramadol lebih sedikit (15,8%) dibandingkan dengan kelompok ondansetron (52,6%) dengan perbedaan bermakna (p<0,05). Simpulan, pemberian tramadol 1 mg/kgBB lebih baik dibandingkan dengan ondansetron 8 mg intravena untuk mencegah kejadian menggigil pascaanestesi umum pada operasi mastektomi radikal atau modifikasi.Kata kunci: Menggigil pascaanestesi umum, ondansetron, tramadolComparison Between Intravenous 8 mg Ondansetron and Tramadol 1 mg/kgBW in Preventing Post Anesthetic Shivering after General Anesthesia in Radical or Modified MastectomyPost anesthetic shivering is a common complication of general anesthesia and preventable with several types of drugs. The aim of this study was to compare the efficacy of intravenous 8mg ondansetron versus tramadol 1 mg/kgBW in preventing post anesthetic shivering after general anesthesia. The research is a prospective, randomized double-blind controlled study involving 38 female patients aged 30–65 years at Dr. Hasan Sadikin Hospital Bandung period March–April 2012, American Society of Anesthesiologist (ASA) physical status I–II, who underwent radical or modified mastectomy. Subjects were randomly divided into two groups. One group was given ondansetron 8 mg and the other group was given tramadol 1 mg/kgBW before surgical wound closure. Research results showed that incidence of post anesthetic shivering was less on tramadol group (15.8%) compared to ondansetron (52.6%) group, which is statistically significant (p<0.05). In conclusion, administration of tramadol 1 mg/kgBW intravenously is more effective in preventing post anesthetic shivering in radical or modified mastectomy.Key words: General anesthesia, ondansetron, post anesthetic shivering, tramadol DOI: 10.15851/jap.v2n1.231
Reliabilitas dan Validitas Penilaian Skala Sedasi Richmond Agitation Sedation Scale (RASS) dan Ramsay pada Pasien Kritis dengan Ventilasi Mekanik di Ruang Perawatan Intensif Suhandoko, -; Pradian, Erwin; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penggunaan secara rutin skala subjektif untuk nyeri, agitasi, dan sedasi akan mendorong penatalaksanaan yang lebih efektif pada pasien untuk mencapai titik akhir yang spesifik. Setiap metode subjektif skala sedasi harus dievaluasi dalam hal reliabilitas dan validitas. Tujuan penelitian untuk mengetahui reliabilitas dan validitas skala Richmond Agitation Sedation Scale (RASS) dan Ramsay pada pasien kritis yang dirawat dengan ventilasi mekanik di ruang perawatan intensif. Jumlah subjek penelitian 82 pasien yang dinilai dengan skala sedasi RASS dan Ramsay setelah diberikannya obat analgesia dan sedasi. Penelitian observasional deskriptif yang dilakukan berdasarkan urutan datang pasien selama 4 bulan penelitian dari Mei–Agustus 2014. Metode Alpha Cronbach untuk menentukan reliabilitas dan Rank Spearman untuk menentukan validitas. Hasil penelitian ini didapatkan Skala RASS dengan nilai reliabilitas tertinggi Alpha Cronbach (α):0,951, serta nilai validitas tertinggi dengan Rank Spearman (rs):0,743. Skala Ramsay dengan nilai reliabilitas tertinggi Alpha Cronbach (α):0,921, serta nilai validitas tertinggi dengan Rank Spearman (rs):0,922. Simpulan dari penelitian ini adalah skala RASS menunjukkan keandalan dan koefisien validitas lebih tinggi daripada skala Ramsay. Kata kunci: Penilaian skala sedasi, reliabilitas, validitasRichmond Agitation Sedation Scale (RASS) and Ramsay Assessment Reliability and Validity in Critically Ill Patients with Mechanical Ventilation Support in Intensive Care Unit Routine use of subjective scales for pain, agitation, and sedation promotes more effective patient management in order to reach specific end-points. Each subjective sedation scale method should be evaluated in terms of its reliability and validity. The purpose of this study was to fassess the reliability and validity of Richmond Agitation Sedation Scale (RASS) and Ramsay scale. Subjects were 82 (eighty two) patients assessed using RASS and Ramsay sedation scale after receiving analgesia and sedation drug. This study was an observational study with cross sectional descriptive sampling conducted in consecutive patients sampling within a period of 4 months during May–August 2014. The results of the assessment were analyzed using Alpha Cronbach to determine the reliability and Rank Spearman to test the validity. It was revealed that  RASS scale had the highest reliability value with Alpha Cronbach (α):0.951 and the highest validity with Rank Spearman (rs):0.743 while the highest reliablity value achieved using the Ramsay scale was Alpha Cronbach (α):0.921 with Rank Spearman (rs): 0.922 as the highest validity score. It is concluded, therefore, that the RASS scale shows higher reliability and validity coefficients than the Ramsay scale. Key words: Assessment sedation scale, reliability, validity DOI: 10.15851/jap.v2n3.330
CO2 Gap Sebagai Prediktor Tingkat Mortalitas Pasien Sepsis Berat di Intensive Care Unit Wiraatmaja, Immanuel; Oktaliansah, Ezra; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Tingkat mortalitas pasien sepsis berat di Intensive Care Unit (ICU) dihitung dengan menggunakan skor Acute Physiology and Chronic Health Evaluation (APACHE) II dan memerlukan pemeriksaan yang banyak serta kompleks. Peningkatan p (vena-arteri)CO2 (CO2 gap) berhubungan dengan penurunan indeks jantung, karena itu diharapkan CO2 gap memiliki kemampuan untuk menentukan tingkat mortalitas pasien sepsis berat. Penelitian ini bertujuan untuk mengetahui kegunaan CO2 gap sebagai prediktor tingkat mortalitas pasien sepsis berat di ICU Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung yang lebih mudah serta murah.Penelitian ini dilakukan secara prospektif observasional terhadap 50 orang. Penelitian dilakukan di ICU RSHS Bandung dari bulan Agustus 2013–Januari 2014. Setiap subjek penelitian diperiksa nilai CO2 gap. Subjek dibagi ke dalam 2 kelompok berdasarkan nilai CO2 gap menjadi kelompok nilai CO2gap tinggi (nilai CO2 gap ≥6) dan nilai CO2 gap  rendah (nilai CO2 gap<6). Penilaian ulang dilakukan pada hari ke-28 untuk masing-masing kelompok untuk menilai adakah pasien dalam kelompok tersebut yang meninggal. Hasil penelitian menunjukan bahwa CO2 gap memiliki sensitivitas 94,7%; spesifisitas 90,3%; positive predictive value 85,7%; negative predictive value 96,5%; likelyhood ratio positive CO2 gap 9,76; dan likelyhood ratio negative CO2 gap adalah 0,05. Simpulan penelitian adalah CO2 gap dapat digunakan untuk melakukan prediksi tingkat mortalitas pasien sepsis berat.Kata kunci: CO2 gap, mortalitas, sepsisCO2 Gap as a Mortality Incidence Predictor for Severe Sepsis Patient  in Intensive Care Unit The mortality rate of severe sepsis patients in Intensive Care Unit (ICU) is measured by using the Acute Physiology and Chronic Health Evaluation (APACHE) II score, which need various complex examinations. Increased p(venous-arterial) CO2(CO2 gap) relates to decreased cardiac index; therefore, it is expected that CO2 gap can be used to predict mortality incidence in severe sepsis patients in the ICU of Dr. Hasan Sadikin General Hospital (RSHS).This study was a prospective study on 50 patients who met severe sepsis criteria conducted in the ICU of RSHS Bandung from August 2013 to January 2014. The CO2 gap was be measured in all the patients. Subjects were divided into two groups according to the CO2 gap value, i.e. high CO2 gap (≥6) and low CO2 gap (<6). Subjects were then assessed on the 28th day to observe the mortality incidence the respective group. It was shown that a CO2 gap value had a sensitivity of 94.7%, specificity of 90.3%, positive predictive  value of 85.7%, and the negative predictive value of 96.5%. The likelihood ratio of  positive CO2 gap  and negative CO2 gap were 9.76 and 0.05, respectively. In conclusion, CO2 gap can be used to predict the mortality incidence in severe sepsis patients in the ICU of RSHS Bandung. Key words: CO2 gap, mortality, sepsis DOI:10.15851/jap.v2n3.331
Perbandingan Pemberian Parecoxib Na 40 mg Intravena Preoperatif dengan Pascaoperatif dalam Penatalaksanaan Nyeri Pascaoperatif pada Operasi Laparotomi Ginekologis Anom Yuswono, Ardhana Risworo; Maskoen, Tinni T.; Fuadi, Iwan
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Multimodal analgesia dan preemptive analgesia menjadi terapi yang efektif dalam penatalaksanaan nyeri pascaoperatif. Tujuan penelitian ini adalah untuk menganalisis perbandingan pemberian parecoxib Na 40 mg intravena preoperatif dengan pascaoperatif terhadap nilai NRS. Penelitian ekperimental dengan rancangan analisis komparatif dilaksanakan dari Maret–Juni 2013. Subjek adalah wanita usia 18-60 tahun yang menjalani operasi laparatomi ginekologis dengan anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung. Subjek terdiri atas 18 orang pada masing masing kelompok. Parecoxib Na 40 mg diberikan pada dua kelompok perlakuan, yaitu pre atau pascaoperatif. Tramadol 200 mg diberikan pascaoperatif pada semua kelompok dan dilakukan penilaian NRS di ruang pemulihan. Nilai NRS 1 lebih banyak ditemukan pada kelompok I, nilai NRS 3 lebih banyak didapatkan pada kelompok II. Nilai NRS pada kelompok I didapatkan nyeri ringan 15 orang dan nyeri sedang 3 orang. Pada kelompok II didapatkan nyeri ringan 15 orang dan nyeri sedang 3 orang, berdasarkan analisis uji chi-kuadrat tidak terdapat perbedaan nilai NRS kedua kelompok. Tidak didapatkan subjek yang memerlukan analgetik tambahan. Simpulan penelitian ini adalah bahwa tidak terdapat perbedaan antara pemberian parecoxib Na 40 mg preoperatif dan pascaoperatif dalam penatalaksanaan nyeri pascaoperatif. Efek analgetik yang lebih baik didapatkan pada pemberian parecoxib Na preoperatif dengan nilai NRS yang lebih rendah. Kata kunci: Laparatomi ginekologis, numerical rating scale, parecoxib Na, preoperatif, pascaoperatifComparison of Pre-operative and Post-operative Intravenous 40 mg Parecoxib Na in Gynecologic Laparatomy Surgery Post-Operative Pain Management AbstractMultimodal analgesia regimens  and preemptive analgesia will improve post- operative  pain relief. The purpose of this study was to compare pre- and post- operative parecoxib 40 mg intravenous to NRS value. This experimental study with comparative analytical method was conducted in women 18 to 60 years old who underwent gynecologic laparatomy at Dr. Hasan Sadikin General Hospital Bandung during the period of March to June 2013. Subjects consisted of 18 women for each pre-operative and post-operative group. Parecoxib 40 mg were given to the two groups, pre-operative (group I) and post-operative (group II), while intravenous tramadol 200 mg was also also given to all groups post-operatively. The NRS was calculated at recovery room. NRS value 1 was more frequent in group I while the NRS value 3 more frequent in group II. NRS values  in group I: 15 with mild pain (83.3%), 3 with moderate pain (16.7%). In group II the values were 15 with mild pain (83.3%), 3 with moderate pain (16.7%), which was not significant. In conclusion, there is no difference between pre-operative and post-operative parecoxib sodium 40 mg for post operative pain management. There is a better analgetic effect in the group with pre-operative parecoxib which is apparent from lower NRS.Key words: Gynecological laparatomy, numerical rating scale, parecoxib Na, post operative, pre operative DOI: 10.15851/jap.v2n3.327
Perbandingan Pengaruh Pemberian Granisetron 1 mg Intravena dengan Plasebo (Salin) untuk Mencegah Kejadian Menggigil Pascaanestesi Spinal pada Seksio Sesarea Manunggal, Heru Wishnu; Oktaliansah, Ezra; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Menggigil pascaanestesi merupakan komplikasi yang sering terjadi pada tindakan anestesi. Tujuan penelitian ini untuk mengkaji pemberian granisetron 1 mg intravena dalam mengurangi kejadian menggigil pada pasien yang menjalani seksio sesarea dengan anestesi spinal. Metode penelitian klinis acak terkontrol tersamar ganda pada 38 pasien yang menjalani seksio sesarea di Rumah Sakit Dr. Hasan Sadikin Bandung pada April–September 2011, usia 20–35 tahun, status fisik American Society of Anesthesia (ASA)  II dan  dikelompokkan secara random menjadi  2 kelompok, yaitu kelompok yang menerima granisetron 1 mg intravena atau salin sebelum dilakukan anestesi spinal dengan bupivakain 12,5 mg. Kejadian menggigil dicatat berdasarkan derajat 0–4. Hasil penelitian menunjukan secara statistik data karakteristik pasien dan suhu tubuh inti tidak berbeda antara kedua  kelompok. Kejadian menggigil lebih sedikit pada kelompok granisetron (21,1%) dibandingkan dengan kelompok plasebo (52,6%) dengan hasil statistik bermakna (p<0,05). Simpulan penelitian ini menunjukkan bahwa pemberian granisetron 1 mg intravena sebelum anestesi spinal pada seksio sesarea mengurangi kejadian menggigil pascaanestesi yang dibandingkan dengan plasebo.                                          Kata kunci: Granisetron, menggigil, pascaanestesi spinalEffect of  Granisetron 1 mg Intravenously  to Prevent of Shivering After Spinal Anesthesia for Cesarean SectionPost anesthesia shivering is one of the complications that often occur in anesthetic action. The purpose of this study was to assess the administration of intravenous granisetron 1 mg in reducing the incidence of shivering in patients undergoing caesarean section with spinal anesthesia. Clinical research methods in double-blind randomized controlled 38 patients who underwent seksios esarea at Dr. Hasan Sadikin Hospital Bandung during April–September 2011, aged 20–35 years overall status American Society of Anesthesia (ASA) II physical and random into two groups: the group that received granisetron 1 mg intravenously or saline prior to spinal anesthesia with bupivacaine 12.5 mg. Incidence of shivering recorded by degrees 0–4. The results showed statistically significant patient characteristic data and core body temperature did not differ between the two groups. Shivering less in granisetron group (21.1%) than the placebo group (52.6%) with statistically significant results (p<0.05).The conclusions of this study indicate that administration of granisetron 1 mg intravenously before spinal anesthesia in Caesarean section reduces the incidence of shivering postanesthesia.Key words: Granisetron, shivering, post anesthesia spinal DOI: 10.15851/jap.v2n2.303
Efek Ondansetron Intravena terhadap Tekanan Darah dan Laju Nadi pada Anestesi Spinal untuk Seksio Sesarea Ismandiya, Annisa Isfandiary; Maskoen, Tinni T.; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hipotensi merupakan komplikasi anestesi spinal yang sering ditemukan pada seksio sesarea. Pencegahan hipotensi dapat dilakukan dengan pemberian cairan, vasopresor, dan memperbaiki posisi uterus ibu saat terlentang dengan mengganjal punggung. Penelitian ini bertujuan mengetahui pengaruh ondansetron 8 mg yang diberikan 5 menit sebelum spinal anestesi dalam menjaga kestabilan hemodinamik. Penelitian ini dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada Januari–Maret 2014 dengan desain eksperimental secara acak klinis terkontrol tersamar ganda yang mengikutsertakan 46 ibu hamil dengan status fisik American Society of Anesthesiologist (ASA) I−II yang menjalani seksio sesarea menggunakan anestesi spinal. Setelah randomisasi secara blok permutasi, subjek penelitian dikelompokkan menjadi 2, yaitu 23 subjek kelompok kontrol mendapat NaCl 0,9% dan 23 subjek kelompok perlakuan mendapat ondansetron intravena 8 mg. Tekanan darah dan laju nadi diperiksa setiap 1–15 menit setelah anestesia spinal, kemudian diperiksa tiap 3 menit sampai operasi selesai. Data hasil penelitian dianalisis dengan uji-t, Uji Mann-Whitney, dan Uji Kolmogorov-Smirnov. Analisis statistik menunjukkan perbedaan bermakna tekanan darah sistol, tekanan darah rata-rata, dan jumlah pemakaian efedrin antara kelompok kontrol dan kelompok ondansetron (p<0,05). Simpulan, pemberian ondansetron 8 mg dapat mengurangi hipotensi dan menurunkan jumlah pemberian efedrin pasca-anestesi spinal pada operasi seksio sesarea.Kata kunci: Anestesi spinal, hipotensi, ondansetron, seksio sesareaIntravenous Ondansetron Effect on Blood Pressure and Heart Rate in Caesarean Section under Spinal AnesthesiaHypotension is the most common complication in spinal anesthesia during cesarean sections. One of the prevention efforts includes administering a fluid vasopressor or placing a wedge under the right hip for left uterine displacement. This study aimed to determine the effect of ondansetron 8 mg, 5 minutes before spinal anesthesia, to maintain maternal hemodynamic stability. This double-blind randomized control experimental study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of January to March 2014 on 46 pregnant women, American Society of Anesthesiologist (ASA) II, who underwent cesarean section with spinal anesthesia. After randomization, the subjects were grouped into two groups: 23 subjects were included in the control group receiving Nacl 0.9% and 23 subjects were included in the ondansetron group receiving 8 mg of ondansetro. Blood pressure and pulse rate were examined every minute until 15 minutes after spinal anesthesia and then every 3 minutes until the operation was complete. Data were analyzed statistically using t test, Mann Whitney Test, and Kolmogorov-Smirnov Test. The results show that there were significant differences in systol presure, average blood pressure, and use of ephedrine between the control and ondansetron group (p<0.05). In conclusion, the provision of 8 mg ondansetron can prevent hypotension and reduce ephedrine use after spinal anesthesia in caesarean section.Key words:  Spinal anesthesia, caesarean section, hypotension, ondansetron, sectio sesareaspinal anesthesia  DOI: 10.15851/jap.v3n2.572
Perbandingan Efek Pemberian Cairan Kristaloid Sebelum Tindakan Anestesi Spinal (Preload) dan Sesaat Setelah Anestesi Spinal (Coload) terhadap Kejadian Hipotensi Maternal pada Seksio Sesarea Fikran, Zaki; Tavianto, Doddy; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 4, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pemberian cairan secara preload sebagai profilaksis sebelum anestesi spinal telah menjadi prosedur rutin untuk mencegah hipotensi ibu selama tindakan seksio sesarea. Tidak seperti koloid, waktu pemberian cairan kristaloid merupakan hal penting karena singkatnya waktu cairan kristaloid berada di ruang intravaskular. Penelitian ini bertujuan mengetahui pengaruh waktu pemberian cairan kristaloid terutama Ringerfundin yang lebih baik antara preload dibanding dengan coload dalam mencegah hipotensi maternal selama anestesi spinal pada seksio sesarea. Penelitian dilakukan di Central Operating Theatre (COT) Rumah Sakit Dr. Hasan Sadikin Bandung periode Juni−Juli 2015 dengan uji klinis acak tersamar tunggal terhadap 36 pasien yang menjalani seksio sesarea dengan status fisik American Society of Anesthesiologist (ASA) II. Kejadian hipotensi dinilai setelah pemberian anestesi spinal sampai bayi lahir. Data hasil penelitian dianalisis dengan uji-t, Uji Mann-Whitney, dan uji chi-kuadrat dengan nilai p<0,05 dianggap bermakna. Insidens hipotensi lebih rendah pada kelompok kristaloid coload dibanding dengan kelompok kristaloid preload (44,4% vs 77,8%; p=0,040). Simpulan penelitian ini menunjukkan bahwa pemberian cairan kristaloid secara coload lebih efektif daripada preload untuk pencegahan hipotensi maternal setelah anestesi spinal pada seksio sesarea.Kata kunci: Anestesi spinal, hipotensi, kristaloid, seksio sesareaComparison of the Effect of Crystalloids Fluid Provision Before Spinal Anesthesia (Preload) and Shortly after Spinal Anesthesia (Co-load) on Maternal Hypotension Incidence in Caesarean DeliveryProphylactic fluid as a preload before spinal anesthesia has been a routine procedure to prevent maternal hypotension during cesarean delivery. Unlike colloid, timing of infusion of crystalloid may be important because it has short linger time in the intravascular space. This study aimed to compare the effect of the timing of administration of crystalloid, especially Ringerfundin, which is more effective between preload and co-load in preventing maternal hypotension during spinal anesthesia for cesarean section. This study was performed at the Central Operating Theatre (COT) of Dr. Hasan Sadikin General Hospital Bandung in June−July 2015 using the single blind randomized controlled trial method on 36 patients who underwent caesarean section with American Society of Anesthesiologist (ASA) II physical status. The incidence of hypotension was observed starting from the time the spinal anesthesia was performed to the time when the baby was born. Data were analyzed statistically using t-test, Mann Whitney test, and chi-square test where a p value of <0.05 considered significant. The incidence of hypotension was lower in the co-load group when compared to the preload group (44.4% vs. 77.8%, p value=0.040). In conclusion, the use of crystalloids for cesarean delivery in co-loading manner is more effective than preloading for the prevention of maternal hypotension after spinal anesthesia.Key words: Cesarean delivery, crystalloid, hypotension, spinal anesthesia DOI: 10.15851/jap.v4n2.818
Perbandingan Efek Pemberian Eritromisin 250 mg Oral dengan Metoklopramid 10 mg Oral terhadap Jumlah dan pH Cairan Lambung pada Pasien yang Menjalani Operasi Elektif dengan Anestesi Umum Mursali, Andi; Maskoen, Tinni T.; Tavianto, Doddy
Jurnal Anestesi Perioperatif Vol 5, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (557.074 KB) | DOI: 10.15851/jap.v5n1.1000

Abstract

Aspirasi pulmonal akibat isi lambung merupakan penyebab kematian yang berhubungan dengan anestesi. Eritromisin 250 mg oral dan metoklopramid 10 mg oral digunakan untuk menurunkan jumlah dan meningkatkan pH cairan lambung. Penelitian ini bertujuan membandingkan efek eritromisin 250 mg oral dan metoklopramid 10 mg oral terhadap jumlah dan pH cairan lambung pasien yang menjalani operasi elektif dengan anestesi umum. Penelitian ini merupakan uji klinis acak buta ganda pada 42 pasien yang termasuk dalam kriteria inklusi pasien dengan American Society of Anesthesiologist (ASA) kelas I, usia 18–60 tahun, dijadwalkan operasi elektif dengan anestesi umum dan diintubasi di Rumah Sakit Dr Hasan Sadikin Bandung periode Agustus–September 2015. Pasien dibagi menjadi 2 kelompok 21 orang masing-masing. Kelompok A mendapatkan eritromisin 250 mg oral dan kelompok B metoklopramid 10 mg oral yang diberikan 1 jam sebelum induksi anestesi. Setelah dilakukan intubasi, cairan lambung diambil menggunakan spuit 50 mL melalui nasogastric tube (NGT) no 18, dimasukkan ke gelas ukur, diukur jumlah dan pH nya. Analisis statistik menggunakan uji Mann–Whitney. Hasil menunjukkan kelompok A didapatkan 90,5% pasien dengan jumlah cairan <25 mL, sedangkan kelompok B 57,1%, perbedaan bermakna secara statistik (p<0,014). Simpulan, eritomisin 250 mg oral lebih menurunkan jumlah dan meningkatkan pH cairan lambung dibanding dengan metoklopramid 10 mg oral pada pasien yang menjalani anestesi umum.Kata kunci: Eritromisin, jumlah cairan lambung, metoklopramid, pH cairan lambung Comparison of the Effect of 250 mg Oral Erythromycine and 10 mg Oral Metoclopramide on Gastric Fluid Volume and pH in Patients Undergoing Elective Operation in General AnesthesiaPulmonary aspiration caused by gastric contents is one of the leading causes of anesthesia-related deaths. Combination of >25 mL volume and a <2.5 pH is a high risk to lung damage. Oral Erythromycin 250 mg and Oral metoclopramide 10 mg can be used to reduce the gastric fluid volume and increase the gastric fluid pH. The purpose of this study was compare the effects between oral erythromycin 250 mg and oral metoclopramide 10 mg on the volume and pH of gastric fluid in patients undergoing elective general anesthesia. This study was a double blind randomized clinical trial on 42 patients who met the inclusion criteria. Patients were divided into 2 groups with 21 patients in each group. Group A received 250 mg of oral erythromycin and group B received 10 mg of metoclopramide, 1 hour before the induction of anesthesia.After intubation, gastric fluid was collected using a 50 mL syringe via the nasogastric tube (NGT). It was then placed in a beaker glass to have its volume and pH measured. A statistical analysis using the Mann–Whitney test was performed. In group A, 90.5% of patients were found to have gastric fluid volume <25 mL, while group B had 57.1%, in which the difference was statistically significant (p <0.014). Hence, the administration of erythromycin 250 mg orally is more effective in reducing the gastric fluid volume and increasing the gastric fluid pH compared to oral administration of etoclopramide 10 mg in patients undergoing general anesthesia.Key words: Erythromycin, gastric fluid volume, metoclopramid, gastric pH