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All Journal Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Journal of Anesthesiology and Clinical Research
Fredi Heru Irwanto
Department Of Anesthesiology And Intensive Therapy, Faculty Of Medicine, Universitas Sriwijaya, Palembang, Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Penutupan Defek Septum Ventrikel Secara Transtorakalis Minimal Invasif dengan Panduan Transesophageal Echocardiography (TEE) Irwanto, Fredi Heru; Puspita, Yusni; Yuliansyah, Rudy
Jurnal Anestesi Perioperatif Vol 5, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (837.819 KB) | DOI: 10.15851/jap.v5n2.1113

Abstract

Defek septum ventrikel (ventricular septal defect/VSD) merupakan penyakit jantung bawaan yang paling sering ditemukan pada bayi dan anak. Penutupan defek ini masih memberikan tantangan tersendiri.  Penanganan VSD dengan metode minimally invasive transthoracic merupakan perkembangan inovatif penutupan defek ventrikel. Laporan kasus ini bertujuan memperkenalkan metode terbaru dalam penanganan kasus VSD yang dilakukan di RSUP Dr. Mohammad Hoesin Palembang. Kami melaporkan serial kasus penutupan VSD menggunakan metode minimally invasive transthoracic dengan panduan transesophageal echocardiography (TEE). Transesophageal echocardiography digunakan selama prosedur sebagai panduan penempatan alat dan mengevaluasi hasil operasi. Empat pasien pada periode November 2015 menjalani prosedur penutupan defek, dua pasien laki-laki dan dua perempuan, usia 2 tahun sampai 4 tahun dengan berat badan 12–22 kg, dengan  diameter VSD berdasar atas pemeriksaan ekokardiografi 4–7 mm. Penutupan VSD menggunakan metode minimally invasive transthoracic dengan panduan TEE melalui mini sternotomi menunjukkan prosedur yang aman dan efektif. Penggunaan TEE memberikan informasi yang sangat berguna selama periode intraoperatif.Kata kunci: Defek septum ventrikel, minimal invasif, transesophageal echocardiography Minimally Invasive Transthoracic Ventricular Septal Defect Closure Using Transesophageal Echocardiography GuidanceVentricular septal defect (VSD) is the most common congenital heart disease found in infants and children. Up until now, management of VSD closure remains as a challenge for clinician. Ventricular septal defect closure with minimally invasive transthoracic method is an innovative development of ventricular defect closure. This case report aims to introduce the method of minimally invasive transthoracic VSD closure, which is the latest method in handling cases of VSD conducted at Dr. Mohammad Hoesin General Hospital Palembang. We report a case series VSD closure by the method of minimally invasive transthoracic with transesophageal echocardiography (TEE) guidance. Transesophageal echocardiography is used during the procedure as guidance for the placement of the device, and to evaluate the results of operations. Four patients of the period November 2015. Two girls patients and two boys, ages 2 years to 4 years old weighing 12–22 kg, with a diameter of VSD echocardiography examination between 4–7 mm. The closure of VSD using minimally invasive transthoracic under TEE guiding through mini-sternotomy indicate a safe and effective procedure. The use of TEE provides very useful information during the intraoperative period.Key words: Minimally invasive, transesophageal echocardiography, venticular septal defect
Penutupan Defek Septum Ventrikel Secara Transtorakalis Minimal Invasif dengan Panduan Transesophageal Echocardiography (TEE) Fredi Heru Irwanto; Yusni Puspita; Rudy Yuliansyah
Jurnal Anestesi Perioperatif Vol 5, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (837.819 KB) | DOI: 10.15851/jap.v5n2.1113

Abstract

Defek septum ventrikel (ventricular septal defect/VSD) merupakan penyakit jantung bawaan yang paling sering ditemukan pada bayi dan anak. Penutupan defek ini masih memberikan tantangan tersendiri.  Penanganan VSD dengan metode minimally invasive transthoracic merupakan perkembangan inovatif penutupan defek ventrikel. Laporan kasus ini bertujuan memperkenalkan metode terbaru dalam penanganan kasus VSD yang dilakukan di RSUP Dr. Mohammad Hoesin Palembang. Kami melaporkan serial kasus penutupan VSD menggunakan metode minimally invasive transthoracic dengan panduan transesophageal echocardiography (TEE). Transesophageal echocardiography digunakan selama prosedur sebagai panduan penempatan alat dan mengevaluasi hasil operasi. Empat pasien pada periode November 2015 menjalani prosedur penutupan defek, dua pasien laki-laki dan dua perempuan, usia 2 tahun sampai 4 tahun dengan berat badan 12–22 kg, dengan  diameter VSD berdasar atas pemeriksaan ekokardiografi 4–7 mm. Penutupan VSD menggunakan metode minimally invasive transthoracic dengan panduan TEE melalui mini sternotomi menunjukkan prosedur yang aman dan efektif. Penggunaan TEE memberikan informasi yang sangat berguna selama periode intraoperatif.Kata kunci: Defek septum ventrikel, minimal invasif, transesophageal echocardiography Minimally Invasive Transthoracic Ventricular Septal Defect Closure Using Transesophageal Echocardiography GuidanceVentricular septal defect (VSD) is the most common congenital heart disease found in infants and children. Up until now, management of VSD closure remains as a challenge for clinician. Ventricular septal defect closure with minimally invasive transthoracic method is an innovative development of ventricular defect closure. This case report aims to introduce the method of minimally invasive transthoracic VSD closure, which is the latest method in handling cases of VSD conducted at Dr. Mohammad Hoesin General Hospital Palembang. We report a case series VSD closure by the method of minimally invasive transthoracic with transesophageal echocardiography (TEE) guidance. Transesophageal echocardiography is used during the procedure as guidance for the placement of the device, and to evaluate the results of operations. Four patients of the period November 2015. Two girls patients and two boys, ages 2 years to 4 years old weighing 12–22 kg, with a diameter of VSD echocardiography examination between 4–7 mm. The closure of VSD using minimally invasive transthoracic under TEE guiding through mini-sternotomy indicate a safe and effective procedure. The use of TEE provides very useful information during the intraoperative period.Key words: Minimally invasive, transesophageal echocardiography, venticular septal defect
Strategi Proteksi Serebral Untuk Operasi Rekonstruksi Arkus Aorta Fredi Heru Irwanto; Rudy Yuliansyah; Chairil Gani Koto
JAI (Jurnal Anestesiologi Indonesia) Vol 9, No 2 (2017): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.848 KB) | DOI: 10.14710/jai.v9i2.20003

Abstract

Intervensi pembedahan pada pada rekonstruksi arkus aorta menyebabkan perubahan pada aliran darah ke otak yang bersifat temporer. Pasien yang menjalani ini memiliki resiko yang tinggi terhadap kelainan neurologis. Proteksi serebral harus menjadi implikasi utama pada pasien-pasien yang menjalani prosedur ini. Hipotermia mengurangi aliran darah ke otak dan menurunkan laju metabolisme oksigen di otak. Perfusi cerebral retrograde biasanya diaplikasikan bersama dengan teknik hipotermia. Perfusi cerebral antegrade secara teoritis lebih fisiologis dibanding metode hipotermia dan perfusi retrograde. Perfusi antegrade memberikan waktu proteksi yang lebih panjang dan bermafaat untuk prosedur yang komplek.
Correlation of Platelet-Lymphocyte Ratio (PLR) as 28-Days Sepsis Mortality Predictor in Intensive Care Unit of RSMH Palembang Tiara Santi Rizal; Fredi Heru Irwanto; Rizal Zainal; Mgs Irsan Saleh
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (380.02 KB) | DOI: 10.37275/jacr.v1i2.137

Abstract

Introduction. Inflammatory and anti-inflammatory response are important in pathophysiology and mortality of sepsis. Platelet as first line inflammatory marker was found increasing during early phase of infection. Decrease in lymphocyte was caused by disrupted balance between inflammatory and anti-inflammatory response. Platelet-to- lymphocyte ratio (PLR) is a cheap and accessible biomarker of sepsis mortality. This study aims to find the sensitivity and specificity of PLR as mortality predictor of sepsis in 28 days. Methods. This observational analytic study with retrospective cohort design was conducted to 91 sepsis patients in intensive care unit of Dr. Mohammad Hoesin Palembang Central Hospital between January and December 2019. Samples were secondarily collected from medical record during June-July 2020. Data was analyzed using chi-square test, cog regression test, and ROC curve analysis. Results. The result found 50 patients (54,9%) died in 28 days. Morbidity score (Charlson) was the only statistically significant mortality parameter (p=0,009). The study reported PLR cut-off point of >272,22. The sensitivity and specificity of PLR as 28-days sepsis mortality predictor are 84% and 80,49% respectively. Conclusion. PLR is alternatively reliable mortality predictor in sepsis patient, accounted to its relatively high sensitivity and specificity.
The Effects of Ketamin-Midazolam and Ketamin-Propofol on Bispectral Index Score as Sedatives During Bone Marrow Puncture Procedure Among Pediatrics Aldiar; Fredi Heru Irwanto; Andi Miarta; Irfannuddin
Journal of Anesthesiology and Clinical Research Vol. 2 No. 1 (2021): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (249.162 KB) | DOI: 10.37275/jacr.v2i1.143

Abstract

Background: Bone Marrow Puncture (BMP) is an invasive procedure associated with pain and anxiety. The ketamine-midazolam and the ketamine-propofol is an effectivecombination with minimal side effects. This study of the study aims to compare the effect of the combination of ketamine-midazolam and ketamine- propofol on sedation depth based on BIS in pediatric leukemia patients undergoing BMP. Methods: This study was a randomized controlled trial that was done single-blinded. The population was all pediatric patients diagnosed with leukemia who underwent BMP at RSMH and performed sedation. The research sample is the population that fulfill the inclusion and exclusion criteria. The sample size for each group was 25, with 50 Subjects in total. Sampling was done by block randomization. Results: This study found no differences in sex, age, and body weight between the two groups ([p=1.000], [p=0.845], and [p=0.147], respectively). In this study, there was no difference in mean MAP (p=0.592), oxygen saturation (p=0.164), heart rate (p=0.098), and respiratory rate (p=0.252) before intervention between the two groups. BIS value of the two groups had significant difference before and after the intervention where the two groups could reduce BIS to reach the optimal value of sedation <60 (p <0.05) There was no difference in BIS before intervention in the two groups (p=0.385). In this study, it was found that hypersalivation occurred more frequently in the ketamine-midazolam combination group. Conclusion: The combination of ketamine-midazolam and ketamine-propofol was equally good for sedation as indicated by a decrease in the mean BIS in patients undergoing BMP.
The Effectiveness of Mometasone Spray and Triamcinolone Acetonide Gel in Preventing Sore Throat, Cough, and Hoarse after Intubation Zentika. I. Fajri; Fredi Heru Irwanto; A Miarta; Theodorus
Journal of Anesthesiology and Clinical Research Vol. 2 No. 1 (2021): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (229.455 KB) | DOI: 10.37275/jacr.v2i1.144

Abstract

Background: Endotracheal intubation is a procedure performed by inserting an endotracheal tube into the airway. With endotracheal intubation, there can be several complications ranging from mild to severe. Sore throat, coughing, and hoarseness were several endotracheal intbation complications. From several studies, it was found that the incidence of POST was 21-65%. This study aimed to determine the efficacy between 0.1% triamcinolone acetonide gel and 100 mcg mometasone spray in reducing sore throat, cough, and hoarseness due to endotracheal intubation. Method: A Randomized Controlled Trial, Open-Label was carried out on patients undergoing endotracheal intubation with general anesthesia in RSMH operating room from September 2020 - November 2020. Seventy-two study subjects met the inclusion criteria and were divided into two groups, namely the triamcinolone acetonide gel group, and the mometasone spray group. Analyzing data was SPSS version 23. Result: There were no difference between age, sex, ASA PS classification, and length of operation between the two groups (p> 0.05). Mometasone spray 100 mcg and triamcinolone acetonide gel 0.1% had the same effectiveness to reduce endotracheal intubation such as sore throat, cough, and hoarseness within 24 hours of endotracheal intubation (p> 0.05). There was a significant difference in the incidence of sore throat between two groups in the first hour (p = 0.039). Conclusion: There was no statistically significant difference between the efficiency of mometasone spray 100 mcg and triamcinolone acetonide gel 0.1% on a sore throat, cough, and hoarseness within 24 hours of endotracheal intubation (p > 0.05).
Positive Cumulative Fluids Balance Related to Mortality Events in Sepsis Patients Treated at Intensive Care Unit, Dr. Mohammad Hoesin General Hospital Palembang Zulkifli; Fredi Heru Irwanto; Legiran; Nadia Maharni
Journal of Anesthesiology and Clinical Research Vol. 2 No. 2 (2021): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (241.64 KB) | DOI: 10.37275/jacr.v2i2.159

Abstract

Introduction. Sepsis is a syndrome that describes physiological dysfunction, pathological, and biochemistry caused by infection. Fluid balance is an indicator that can monitor input and output. This study was aimed to evaluate the relationship between positive cumulative fluid balance and the mortality rate of sepsis patients treated in the intensive care unit. Method: This study design is a retrospective study. The inclusion criteria consist of patients diagnosed with sepsis written in the medical record, 18-65 years old, and patients admitted in intensive care unit dr Moh. Hoesin General Hospital. Data were analyzed using SPSS 22.0 with the normality of data distribution, independent sample t-test, Mann-Whitney analysis, chi-square, Fisher’s Exact to measure the relationship, and using Medcalc version 14 application to measure cut-off value, ROC curve AUC, cross-sectional point, sensitivity, and specificity. Result. The result showed that characteristic between age (p=0,491), gender (p=0,703) did not differ significantly between survived and non-survived patient. Length of stay (p=0,002), balance (p=0,000), and ward unit (p=0,014) has a significant different between survived and non survived patient. In chi square analysis, p value=0,000with odds ratio 7,083. Cut-off value of ROC curve is -97 mL with AUC 0,844, sensitivity 76,1% and specificity 79,3%. Conclusion. Cumulative positive balance patient in the sepsis patient correlates with increased mortality in a sepsis patient in Dr. Mohammad Hoesin General Hospital Palembang.
Co-Authors A Miarta Aldiar Andi Miarta Chairil Gani Koto Irfannuddin Irfannuddin Legiran Mgs Irsan Saleh Nadia Maharni Puspita, Yusni Rizal Zainal Rudy Yuliansyah Rudy Yuliansyah Theodorus Tiara Santi Rizal Yuliansyah, Rudy Yusni Puspita Zentika. I. Fajri Zulkifli