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Hubungan antara Rasio Neutrofil-Limfosit dan Skor Sequencial Organ Failure Assesment pada Pasien yang Dirawat di Ruang Intensive Care Unit Nugroho, Adi; -, Suwarman; Nawawi, A. Muthalib
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Respons fisiologis sistem imunitas terhadap inflamasi sistemik adalah peningkatan jumlah neutrofil dan penurunan jumlah limfosit atau peningkatan rasio neurofil-limfosit (RNL). Penelitian ini bertujuan untuk melihat hubungan inflamasi sistemik yang ditandai peningkatan RNL terhadap kegagalan fungsi organ ditandai dengan skor Sequencial Organ Failure Assessment (SOFA) pada pasien yang dirawat di Intensive Care Unit (ICU). Penelitian ini adalah penelitian observasional dengan rancangan penelitian cross sectional. Penelitian dilakukan dengan mengobsevasi RNL dan skor SOFA pada jam ke-0, jam ke-24, dan jam ke-48 dari 78 pasien yang dirawat di ICU Rumah Sakit Dr. Hasan Sadikin Bandung periode Desember 2012âFebruari 2013 yang terbagi ke dalam 3 kategori sepsis A, B, dan C. Data penelitian dianalisis menggunakan analisis bivariabel dengan Uji Korelasi Pearson dan Spearman. Hasil penelitian menunjukkan hubungan antara RNL dan skor SOFA terhadap kategori sepsis masing-masing (p<0,001). Uji Korelasi Pearson didapatkan hubungan antara RNL dan skor SOFA (p<0,05; R=0,63). Simpulan, terdapat hubungan antara keadaan inflamasi sistemik yang ditandai dengan RNL dan kegagalan fungsi organ yang ditandai dengan skor SOFA pada pasien yang dirawat di ICU RS Dr. Hasan Sadikin Bandung.Kata kunci: Intensive care unit, rasio netrofit-limfosit, sequencial organ failure assesmentÂ Relationship between Neutrophil Lymphocyte Ratio and Sequential Organ Failure Assesment Score in the Intensive Care Unit patientsAbstractPhysiological response of immune system against systemic inflammation involves an increased level of neutrophils and a reduction of lymphocyte or an increase of neutrophil-lymphocyte ratio (RNL). The aim of this study was to identify the relationship between systemic inflammation, characterized by increasing in RNL on organ malfunction, assessed by Sequential Organ Failure Assessment (SOFA) score in Intensive Care Unit (ICU) patients. This study was a observational study with cross sectional design. This study was conducted by observing RNL and SOFA score at 0, 24th and 48th hour of 78 patients treated in the ICU Dr. Hasan Sadikin Hospital Bandung in December 2012âFebruary 2013. Patients were divided into 3 categories of sepsis A, B and C. This study showed that there was a relationship between RNL, SOFA scores and sepsis categories (p<0.001). Pearson Correlation Test showed that there was relationship between RNL and SOFA scores (p<0.05, R= 0.63). In conclusion, there is a relationship between systemic inflammatory condition, characterized by RNL and organ failure, characterized by the SOFA score, in patients treated in the ICU Dr. Hasan Sadikin Hospital Bandung.Key words: Intensive care unit, neutrophil-lymphocyte ratio, sequential organ failure assesmentÂ DOI: 10.15851/jap.v1n3.198

Penambahan Natrium Bikarbonat 8,4% pada Lidokain 2% untuk Mengurangi Nyeri Saat Infiltrasi Anestetik Lokal Rahmansyah, Doni Arief; Nawawi, A. Muthalib; Pradian, Erwin
Jurnal Anestesi Perioperatif Vol 2, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Infiltrasi anestesi lokal di daerah penyuntikan jarum epidural menggunakan lidokain menimbulkan nyeri.Â Penelitian ini bertujuan untuk mengetahui keefektifan penambahan natrium bikarbonat 8,4% pada lidokainÂ HCl 2% dengan perbandingan 1:10 untuk mengurangi nyeri saat infiltrasi. Penelitian dilakukan pada bulanÂ Juni hingga Juli 2013 di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Penelitian dilakukan dengan uji klinis acak tersamar ganda pada 44 pasien yang menjalani operasi dengan teknik anestesi epidural.Â Subjek dibagi 2 kelompok, kelompok eksperimen (LB) mendapatkan infiltrasi lidokain HCl 2% alkalin denganÂ menambahkan natrium bikarbonat 8,4% dengan perbandingan 1:10, kelompok kontrol (L) mendapatkan lidokain HCl 2%. Pada kedua kelompok dinilai numeric rating scale (NRS) saat infiltrasi lidokain HCl 2%. Hasil penelitian diuji dengan uji chi-kuadrat, uji-t, dan Uji Mann-Whitney, tingkat kepercayaan 95% dan kekuatan uji 94%, dianggap bermakna bila nilai p<0,05. Analisis statistik menunjukkan perbedaan bermakna nilai median NRS pada kelompok eksperimen dengan kelompok kontrol saat infiltrasi anestesi lokal (5 vs 3),Â dengan nilai rentang (3â6 vs 1â4) dengan nilai p<0,05. Simpulan penelitian ini adalah alkalinisasi lidokainÂ HCl 2% dengan penambahan natrium bikarbonat 8,4% dengan perbandingan 1:10 mempunyai efekÂ mengurangi nilai NRS.Kata kunci: Alkalinisasi, lidokain HCl 2%, natrium bikarbonat 8,4%Addition of 8.4% Sodium Bicarbonate to 2% Lidocaine in Reducing PainÂ During Local Anaesthetic InfiltrationLocal anesthetic infiltration in the area of epidural injections using lidocaine can cause pain. This research was done in JuneâJuly 2013, in Dr. Hasan Sadikin Hospital, to determine the effectiveness of adding 8.4%Â sodium bicarbonate to lidocaine HCl 2 % with 1:10 ratio. This was a double-blind randomized control study involving 44 patients undergoing surgery with epidural techniques. Subjects were divided into two groups, the experimental group ( LB ) was given 2% lidocaine HCl with sodium bicarbonate 8.4% 1:10 ratio as a local anestetich while the control group (L) was given lidocaine 2%. Numeric rating scale (NRS) was assessed during infiltration. Data was analyzed using chi-squere test, t-test and Mann-Whitney Test , with 95% confidence level and 94% strength tes and considered significant if p<0.05. Statistical anaylsis showed a significant difrerence in median of NRS in the experiment compared to control group during local anaesthetic infiltration (5 versus 3), with range of 3â6 versus 1â4 with p>0.05. In conclusion, alkalinization of 2% lidocaine HCl by addition of 8.4% sodium bicarbonate with 1:10 ratio has an effect in reducing NRS.Key words: Alkalinization, lidocaine HCl 2%, sodium bicarbonate 8.4%Â DOI: 10.15851/jap.v2n1.234

Perbandingan antara Kombinasi Bupivakain 0,125% dan Dexmedetomidin 1 Âµg/Kgbb dengan Bupivakain 0,125% Melalui Blok Kaudal Terhadap Lama Analgesi Pascaoperasi Hipospadia Sardinata, -; Nawawi, A. Muthalib; Wargahadibrata, A Himendra
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Blokade kaudal merupakan tehnik anestesi regional yang paling banyak dilakukan pada operasi anak . Berbagai obat anestetik lokal telah digunakan untuk tehnik ini. Bupivakain adalah salah satu obat anestetik lokal yang paling banyak digunakan karena memiliki lama kerja yang panjang. Dexmedetomidin adalah suatu Î±2 agonis yang dipergunakan sebagai adjuvant untuk memperpanjang durasi bupivakain bila diberikan melalui blokade kaudal. Untuk meningkatkan efektifitasnya maka kombinasi bupivakain dengan dexmedetomidin dalam konsentrasi dan dosis yang rendah dapat diberikan. Penelitian ini dilakukan untuk menilai lama analgesia pascaoperasi dengan Â blokade kaudal antara kombinasi Â bupivakain Â 0,125 % ditambah Â dexmedetomidin 1 Âµg/KgBB dan Â bupivakain Â 0,125 % pada pasien pediatrik yang menjalani operasi hipospadia. Penelitian dilakukan terhadap 30 pasien anak , statusÂ fisikÂ ASA I dan II,Â dan berusia 1-6 tahun yang menjalani operasi hipospadia dengan anestesi umum, yang dilakukan blokade kaudal pascaoperasi. Pasien dibagi dalam dua kelompok. Kelompok BD menggunakan kombinasi Bupivakain 0,125% dan Dexmedetomidin 1Âµg/KgBB ( 0,5 cc/KgBB ), dan kelompok B menggunakan Bupivakain 0,125 % ( 0,5 cc/KgBB ) sebagai kontrol. Dicatat lama analgesia pascaoperasi. Data hasil penelitian diuji dengan uji Mann-Whitney . Pada hasil penghitungan statistik, didapatkan lama analgesi pascaoperasi pada kelompok BD lebih panjang dibandingkan kelompok B dengan hasil yang sangat bermakana ( p < 0,001 ). Pada kelompok blokade kaudal yang menggunakan kombinasi bupivakain 0,125% dan dexmedetomidin 1 Âµg/KgBB ( BD ), menunjukkan lama analgesia yang lebih panjang dibandingkan dengan kelompok bupivakain 0,125% ( B ) yaitu [ 863,0 (36,34) menit ] terhadap Â [ 378,08 (37,87) menit ]. Simpulan penelitian ini menunjukkan bahwa penggunaan kombinasi Bupivakain 0,125% dan dexmedetomidin 1 Âµg/KgBB untuk blokade kaudal sebagai analgetik pascaoperasi hipospadia, menghasilkan lama analgesi yang lebih panjang dibandingkan dengan bupivakainÂ 0,125% .Kata Kunci: Blokade kaudal, Hipospadia, Bupivakain, DexmedetomidinÂ Comparison Of A Combined 0.125% Bupivacaine 1Âµg/Kgbw Dexmedetomidin And A 0.125% Bupivacaine In CaudalBlockage To Analgesia Duration AfterÂ Hypospadic SurgeryCaudalÂ blockage is the mostÂ frequently used regional anestesia technique in pediatric surgery.Â Various local anesthetic agents have been frequently used in this technique. Bupivacaine is one of the most used local anesthetics due to its long duration of action. Dexmedetomidin is an Î±2agonistÂ that is used as adjuvantÂ in lengthening bupivacaineÂ duration when it is administered via caudal blockage. In increasing its effectiveness, the combination of bupivacaine with dexmedetomidinÂ in low concentrationd and low dose can be given. This study was performed to assess the postoperative analgesia duration using caudal blockage between the combined 0.125% bupivacaine-1Âµg/Kg BW dexmedetomidin and 0.125% bupivacaine solely in pediatric patients having hypospadic surgery. The study was applied to 30 pediatric patients with ASA I and II physical status, andÂ aged 1-6 years that received hypospadic surgery with general anesthesia, to whom caudal blockage applied postoperatively. The patients were divided intoÂ two groups. One group (BD group) was treated using the combined 0.125% bupivacaine-1 Âµg/Kg BW dexmedetomidin (0.5 cc/kg BW), the other group (B group) was treated with 0.125% bupivacaine (0.5 cc/kb BW) as control group. Postoperative analgesia durationÂ was recorded. The data of the study results were assessed using Mann-Whitney test. PostoperativeÂ analgesia duration of BD group (863.0 [36.34] minutes)Â was very significantly (p<0.001) longer than that in B group (378.08 [37.87] minutes). The conclusion of this study indicated that the use of combined 0.125% bupivacaine-1 Âµg/Kg BW dexmedetomidin for caudal blockage as analgetic agentÂ Â after hypospadic surgery resulted longer analgesia duration than that of 0.125% bupivacaine solely.Â Â Keywords : caudal blockage, hypospadia, bupivacaine, dexmedetomidin.DOI:Â 10.15851/jap.v1n1.162

Perbandingan Granisetron 0,01 mg/KgBb dengan Ondansetron 0,08 Mg/Kg.Bb Untuk Mencegah Mual Muntah Pascaoperasi Dini Mastektomi Radikal Modifikasi Fitriyana, Budi; Pradian, Erwin; Nawawi, A. Muthalib
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Mual muntah pascaoperasi tidak hanya menyebabkan ketidaknyamanan bagi pasien, namun juga menyebabkan terjadinya gangguan keseimbangan elektrolit, regurgitasi dan aspirasi, perdarahan serta lepasnya jahitan pembedahan. Pasien yang mengalami mual muntah pascaoperasi akan membutuhkan perhatian dan pengobatan lebih lanjut yang tentu saja meningkatkan biaya pelayanan medis. Wanita yang menjalani mastektomi dengan disertai pengambilan kelenjar getah bening ketiak mempunyai resiko tinggi terjadinya mual muntah pasca operasi. Banyak anti muntah yang diberikan termasuk diantaranya antihistamin, butyrophenon, dan antagonis reseptor dopamin telah dilaporkan mempunyai efek samping yang tidak diinginkan antara lain sedasi yang berlebihan, hipotensi, mulut kering, dysphoria, halusinasi dan efek ekstrapiramidal. Antagonis reseptor 5 HT3 memberikan kemajuan yang besar sebagai penanganan mual muntah pascaoperasi karena efek sampingnya yang sedikit bila dibandingkan dengan obat-obat anti muntah sebelumnya. Penelitian ini akan membandingkan dua obat antagonis reseptor 5 HT3 yaitu granisetron dengan ondansetron dalam mencegah mual muntah pascaoperasi dini mastektomi radikal modifikasi.Â Dilakukan penelitian pada 58 pasien ASA I dan II yang dilakukan mastektomi radikal modifikasi dengan anestesi umum. Pengambilan sampel dilakukan dengan menggunakan uji klinis acak terkontrol buta ganda. Sampel dibagi menjadi dua kelompok dengan randomisasi blok. Kelompok G diberikan granisetron 0,01 gr/kg.bb dan kelompok O diberikan ondansetron 0,08 mg/kg.bb. Obat perlakuan diberikan intravena 30 menit sebelum operasi selesai Evaluasi dilakukan pada tekanan darah, denyut jantung, saturasi oksigen dan lama pembedahan. Mual muntah pascaoperasi dinilai segera setelah operasi tiap jam sampai 6 jam pascaoperasi (mual muntah pascaoperasi dini) dengan 4 skala (0-3). Data dianalisis dengan uji-t, uji Chi-square, uji Mann-Whitney, dan uji Exact Fisher pada program SPSS ver.16 Windows.Â Hasil penelitian menunjukkan terdapat kecenderungan keluhan mual muntah pascaoperasi lebih banyak terjadi pada kelompok O (27,6%) dibandingkan dengan kelompok G (6,9%). Pada analisis statistik yang dilakukan dengan uji Chi-square didapatkan hasil perbedaan yang bermakna (p <0,05). Simpulan pemberian granisetron 0,01 gr/kg.bb intravena lebih baik dibandingkan dengan ondansetron 0,08 mg/kg.bb. intravena dalam dalam menurunkan kejadian mual muntah pascaoperasi dini mastektomi radikal modifikasi.Kata kunci: Mual muntah pascaoperasi dini, granisetron, ondansetron, mastektomi radikal modifikasiÂ Comparison Granisetron 0.01 Mg / Kg.Bb With Ondansetron 0.08 Mg / Kg.BbÂ To Prevent Early Postoperative Nausea Vomiting Modified Radical MastectomyPostoperative nausea and vomiting not only cause discomfort to the patient, but also lead to electrolyte imbalance, regurgitation and aspiration, bleeding and loss of surgical sutures. Patients who experience postoperative nausea and vomiting will require further attention and treatment which of course increases the cost of medical services. Women who underwent mastectomy with accompanying decision underarm lymph nodes have a high risk of postoperative nausea and vomiting. Many anti-vomiting are given including antihistamines, butyrophenon, and dopamine receptor antagonists have been reported toÂ have undesirable side effects including excessive sedation, hypotension, dry mouth, dysphoria, hallucinations and extrapyramidal effects. 5 HT3 receptor antagonists provide a major advancement for treatment of postoperative nausea and vomiting due to fewer side effects when compared with anti-vomiting medications before. This study will compare the two drugs 5 HT3 receptor antagonist granisetron with ondansetron in preventing postoperative nausea and vomiting modified radical mastectomy early. Conducted research on 58 patients ASA I and II modified radical mastectomy is performed under general anesthesia. Sampling was carried out using double-blind randomized controlled trial. Samples were divided into two groups by block randomization. Group G is given granisetron 0.01 gr / kg.bb and group O is given ondansetron 0.08 mg / kg.bb. Drug treatment is administered intravenously 30 minutes before the surgery ended on a complete evaluation of blood pressure, heart rate, oxygen saturation and length of surgery. Postoperative nausea and vomiting shortly after surgery assessed every hour until 6 hours after surgery (early postoperative nausea and vomiting) to 4 scale (0-3). Data were analyzed by t-test, Chi-square test, Mann-Whitney test and Fishers Exact test on Windows SPSS ver.16 The results suggest there is a tendency complaints of postoperative nausea and vomiting occurs more frequently in group O (27.6%) compared with group G (6.9%). In the statistical analysis performed with Chi-square test results obtained were significant differences (p <0.05). Conclusion that the provision of granisetron 0.01 mg / kg.bb better than intravenous ondansetron 0.08 mg / kg.bb. intravenously in lowering the incidence of early postoperative nausea and vomiting modified radical mastectomy.Keywords: early postoperative nausea and vomiting, granisetron, ondansetron, modified radical mastectomyÂ DOI: 10.15851/jap.v1n1.158

Perbandingan Gabapentin 600 mg dengan 1.200 mg per Oral Preoperatif terhadap Nilai Visual Analogue Scale dan Pengurangan Kebutuhan Petidin Pascaoperasi pada Modifikasi Mastektomi Radikal Zulfariansyah, Ardi; Nawawi, A. Muthalib; Bisri, Tatang
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Gabapentin mempunyai efek antihiperalgesia, antialodinia, dan antinosiseptif. Penelitian ini bertujuan untuk menilai efek gabapentin 600 mg dan 1.200 mg per oral preoperatif terhadap nilai visual analogue scale (VAS) dan pengurangan kebutuhan petidin pascaoperatif. Penelitian dilakukan secara uji acak terkontrol buta ganda terhadap 38 orang pasien di Rumah Sakit Dr. Hasan Sadikin Bandung pada MeiâSeptember 2010. Pasien dibagi menjadi dua kelompok yaitu kelompok gabapentin 600 mg dan gabapentin 1.200 mg. Penilaian skala nyeri dilakukan dengan menggunakan nilai VAS. Data hasil penelitian dianalisis menggunakan Uji Mann-Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila nilai p<0,05. Hasil penelitian didapatkan nilai VAS saat diam dan saat mobilisasi berbeda bermakna (p<0,05). Kelompok gabapentin 1.200 mg lebih sedikit diberikan analgetik petidin tambahan (10,5% vs 15,8%), tetapi perbedaan tersebut tidak bermakna (p=0,631). Simpulan penelitian ini adalah gabapentin 1.200 mg per oral preoperatif lebih baik bila dibandingkan dengan 600 mg dalam mengurangi nilai VAS pasca operatif pada operasi modifikasi radikal mastektomi, namun tidak mengurangi kebutuhan petidin.Kata kunci: Gabapentin 600 mg, Gabapentin 1.200 mg, visual analogue scale, kebutuhan petidin The Comparison between 600 mg and 1,200 mg Gabapentin per Oral Preoperatively on Visual Analog Scale and Reduction of Postoperative Pethidine Requirement on Modified Radical MastectomyAbstract Gabapentin is a GABA analog which has the effect of anti hyperalgesia, anti allodynia, and anti nociceptive. This research was conducted in order to assess the effect of 600mg and 1,200 mg gabapentin given preoperatively to assess visual analogue scale (VAS) score and reduction of pethidine requirement. The study was done by conducting a double blind randomized controlled trial on 38 patients, aged 18â65 years, with ASA physical status IâII. Patients were divided into two groups: 600 mg gabapentin and 1,200 mg gabapentin group. The quality of pain was assessed using VAS score. The results were statistically analyzed using Mann-Whitney Test with 95% confidence interval and considered significant if p value <0.05. From the results, the VAS values obtained at rest and during mobilization were significantly different (p<0.05). The 1,200 mg gabapentin group received less additional pethidine (10.5% vs 15.8%), although no significant difference was shown (p=0.631). The conclusion of this study is that administration of 1,200 mg gabapentin per oral pre operatively is better when compared to 600 mg in reducing post operative visual analog scale score in modified radical mastectomy. However, it do not reduce the need for analgesic significantly.Key words: 600 mg Gabapentin, 1.200 mg Gabapentin, post operative pethidine requirement, visual analog scaleÂ DOI: 10.15851/jap.v1n3.196

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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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 30â60 tahun yang menjalani operasi mastektomi radikal atau modifikasi di Rumah Sakit Dr. Hasan Sadikin Bandung periode MaretâApril 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 TramadolÂ 1 mg/kgBW in Preventing Post Anesthetic Shivering after GeneralÂ 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 30â65 years at Dr. Hasan Sadikin Hospital Bandung period MarchâApril 2012, American Society of Anesthesiologist (ASA) physical status IâII, 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, tramadolÂ DOI: 10.15851/jap.v2n1.231

Jarak antara Saraf Femoralis dan Arteri Femoralis pada Daerah Lipat Inguinal Orang Dewasa dengan Menggunakan Pencitraan Ultrasonografi untuk Panduan Letak Penyuntikan Blokade Saraf Femoralis Nasution, Nur Intan; Yadi, Dedi Fitri; Nawawi, A. Muthalib
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Blokade saraf femoralis merupakan salah satu metode blokade saraf perifer yang digunakan untuk memfasilitasi operasi ekstremitas bawah. Blokade femoralis memiliki efek analgesia perioperatif yang efektif dengan sedikit efek samping sistemik, penurunan kebutuhan opioid serta mobilisasi lebih awal dan murah. Arteri femoralis digunakan sebagai penanda anatomis pada blokade saraf femoralis karena letaknya berdekatan dengan saraf femoralis. Penelitian ini bertujuan mengetahui jarak titik tengah saraf femoralis terhadap titik tengah arteri femoralis di daerah lipatan inguinal orang dewasa menggunakan pencitraan ultrasonografi untuk membantu keberhasilan blokade saraf femoralis. Metode penelitian adalah deskriptif analisis. Penelitian dilakukan terhadap 43 subjek sukarelawan berusia 18â60 tahun dengan indeks massa tubuh normal. Penelitian telah dilakukan bulan SeptemberâOktober 2014 di Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Unpad dan Central Operating Theatre (COT) lantai 4 Rumah Sakit Dr. Hasan Sadikin Bandung. Analisis data menggunakan Uji Mann-Whitney dan uji t. Hasil penelitian, jarak rata-rata titik tengah arteri femoralis terhadap titik tengah saraf femoralis pada laki-lakiÂ 1,075Â±0,13 cm dan pada perempuan 1,069Â±0,13 cm. Simpulan penelitian, jarak arteri femoralis dan saraf femoralis 1,07 cm lateral terhadap arteri femoralis. Kata kunci: Blokade saraf femoralis, saraf femoralis, ultrasonografiDistance between Femoral Nerve and the Femoral Artery at the Level of Inguinal Crease with Ultrasound as a Guid for Femoral Nerve Block InjectionAbstractThe femoral nerve block is one the peripheral nerve block methods that are used to falicitate lower extremity surgical procedures. The advantages of femoral nerve block include an effective perioperative analgesia with minimum systemic side effects, lower dosage of opioids, early mobilization and cost effective. This study aimed to measure the distance from the mid point of the femoral nerve to the mid point of the femoral artery at the level of inguinal crease of adults with ultrasound guidance that will determine the success rate of femoral nerve block. A descriptive analytic study involving 43 volunteer subjects aged 18â60 years was performed at the Anesthesiology and Intensive Care Department of the Faculty of Medicine, Universitas Padjadjaran and Central Operating Theatre (COT) of Dr. Hasan Sadikin General Hospital Bandung between September and October 2014. Statistical analysis are using Mann-Whitney test and independent t-test. Results showed that the average distance from the mid point of the femoral nerve to the mid point of the femoral artery in male was 1.075Â±0.13 cm and in female was 1.069Â±0.13 cm. This studyÂ conclude that the average distance of femoral artery to the femoral nerve is 1.07 cm lateral to the femoral artery. Key words: Femoral nerve, femoral nerve block, ultrasonographyÂ DOI:Â 10.15851/jap.v3n3.610

The Effect of Additional Magnesium Sulphate 80 mg with 0,5% Hiperbaric Bupivacaine to Onset and Duration of Action of Sensory and Motor Block Spinal Anaesthesia for Caesarean Section , Suwarman; Purwaningsih, Sriwahyuniati; Nawawi, A. Muthalib; Yuwono, Hendro Sudjono
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Addition of adjuvants to 0.5% hyperbaric bupivacaine for spinal anaesthesia performed to accelerate sensory and motor onset, minimal side effect of hemodynamics and prolongation analgesia. The aim of the study was to investigate the effect of additional 80 mg of magnesium sulphate 40% intratecal to 0.5% hyperbaric bupivacaine on onset and duration of sensory and motor block for cesarean section. The study was randomized double blind controlled study to 40 patients with American Society of Anesthesiology (ASA) physical status II whom underwent caesarean section in Dr. Hasan Sadikin General Hospital Bandung from April till May 2015. The additional 80 mg of 40% magnesium sulphate to 0.5% hyperbaric bupivacaine intratecal resulted earlier onset of sensory and motor block than group 0,9% sodium chloride (p˂0,001). The duration of sensory and motor block was longer in magnesium group than sodium chloride 0,9% group (p˂0,001). The study concluded that spinal anesthesia using 0.5% hyperbaric bupivacaine with magnesium sulphate produce faster onset and prolonged duration of sensory and motor blockade compared to 0.5% hyperbaric bupivacaine in cesarean section.

Comparison of Agitation Incidence in Adult Ambulatory Patients who Underwent Surgery by General Anesthesia Using Desflurane or Sevoflurane Putri, Andika C.; Nawawi, A. Muthalib; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Postanesthesia agitation is a problem that sometimes occurs in patients who underwent general anesthesia. Thisstudy aims to compare the magnitude of the incident postanesthesia agitationin patienambulatory surgery performedunder general anesthesia with desflurane or sevoflurane use. Research single blinde randomized controlled trial in94 ambulatory surgical patients ASA I. Subjects divided into two groups: group I received desfluran and group IIreceived sevoflurane. Both groups at induction with propofol 2 mg/kg, fentanyl 2 μg/kgBW, atrakurium 0,1 mg/kg, then do laringeal mask airway (LMA) installation. Agitation in patiens assesed since the LMA is removed,the use of anesthetic drugs has beeb stoped, then at minute 5, 10, 15, 20, 25, 30, every five minutes after usingagitation-sedation scale riker. Statistic analysis using Chi-square and Mann-Whitney Test. The results obtainedindicate that the ratio of the incidence of agitation in the recovery room between the desflurane with sevofluranegroups were not statistically significant. Obtained 7 patients experiencing agitation pascaanestesi desflurane groupof 47 samples (14.9%), whereas only 5 patients with agitation of 47 samples sevoflurane group (10.6%). Onepatient from group desflurane assessed his agitation scale 6 (very agitated). The result of comparative magnitudeof the incidence of agitation in the group performed under general anesthesia using desflurance with sevofluranegroup using there is not a statistically significant difference.

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