Ruli Herman Sitanggang
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung

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Pola Pneumonia Nosokomial di Unit Perawatan Intensif Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung Periode Januari–Desember 2017 Salukanan, Ronald Tikuali; Zulfariansyah, Ardi; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (249.88 KB) | DOI: 10.15851/jap.v6n2.1337

Abstract

Pneumonia merupakan salah satu jenis infeksi nosokomial dengan jumlah kasus tertinggi dibanding dengan infeksi nosokomial lain di unit perawatan intensif (ICU) disertai jumlah morbiditas dan mortalitas yang tinggi. Pola pneumonia nosokomial merupakan suatu karakteristik pneumonia nosokomial yang digunakan untuk mengidentifikasi masalah dan dapat menjadi indikator untuk perbaikan terapi. Penelitian bertujuan menggambarkan pola pneumonia nosokomial di unit perawatan intensif RSUP Dr. Hasan Sadikin Bandung periode Januari–Desember 2017. Metode penelitian menggunakan deskriptif observasional yang dilakukan secara retrospektif terhadap 70 objek penelitian yang diambil dari rekam medis dan dilakukan dalam waktu 3 bulan, yaitu Oktober–Desember 2017. Hasil penelitian jumlah kematian akibat pneumonia nosokomial masih tinggi, yaitu 60% terutama pada pasien laki-laki usia ≥ 65 tahun. Komorbid terbanyak pada pneumonia nosokomial, yaitu hipertensi (31,4%) diikuti penyakit neuromuskular (15,7%). Mikrob terbanyak penyebab HAP adalah A. baumannii (38,1%), P. aeroginosa (30,4%), dan K. pneumoniae (15,2%), sedangkan mikrob penyebab terbanyak ventilator associated pneumonia (VAP) adalah A. baumannii (32%), P. aeroginosa (30,5%), dan K. pneumoniae (22%). Mikrob A. baumannii juga menjadi penyebab mortalitas tertinggi dengan persentase 45,4% dan terapi empirik yang sering digunakan adalah kombinasi meropenem–levofloxacin (40%), terapi tunggal meropenem (34,3%), dan kombinasi ceftazidime-levofloxacin (20%). Simpulan, pola pneumonia nosokomial di ICU RSUP Dr. Hasan Sadikin Bandung periode Januari–Desember 2017 masih diperlukan perbaikan program penanganan terhadap infeksi ini untuk mencapai pelayanan yang baik.Kata kunci: Mikrob, mortalitas, pneumonia nosokomial, unit perawatan intensif Nosocomial Pneumonia Pattern in Intensive Care Unit (ICU) of Dr. Hasan Sadikin General Hospital Bandung from January to December 2017Pneumonia is the most common nosocomial infection in intensive care unit with high morbidity and mortality rates. Pattern of nosocomial pneumonia is an infection characteristic that helps the identification of a phenomenon or problem and serves as an indicator or model for predicting future behaviors. These patterns can be used for making a standardized therapy management for the disease. The aim of this study was to describe nosocomial pneumonia pattern in Intensive Care Unit (ICU) in Dr.  Hasan Sadikin Bandung from January to December 2017. A retrospective observational descriptive method on 70 samples from medical records with an observation period of three months starting from October to December 2017. It was shown that the mortality rate of nosocomial pneumonia was 60% with male patients aged ≥ 65 years old as the most affected group. The most common comorbid was hypertension (31.4%) followed by neuromuscular diseases (15.7%). The most common HAP-causing microbes were A. baumannii (38.1%), P. aeroginosa (30.4%), and K. pneumoniae (15.2%) and the most common microbes for VAP were A. baumannii (32%), P. aeroginosa (30.5%), and K. pneumoniae (22%). Acinetobacter baumannii caused most deaths (45.4%). The most common empirical therapy was meropenem–levofloxacin combination (40%), meropenem (34.3%), and ceftazidime–levoflocacin combination (20%). In conclusion, pattern of nosocomial pneumonia in ICU of Dr. Hasan Sadikin General Hospital Bandung reflects a situation that therapy management for this infection needs to be improved for a proper service.Key words: Intensive care unit, microbes, mortality, nosocomial pneumonia 
Perbandingan Analgesia Epidural Menggunakan Bupivakain 0,125% dengan Kombinasi Bupivakain 0,0625% dan Fentanil 2 μg/mL terhadap Nyeri dan Blok Motorik pada Persalinan Normal Mose, Oktofina K.; Sabarudin, Udin; Sitanggang, Ruli Herman; Boom, Cindy E.
Jurnal Anestesi Perioperatif Vol 1, No 2 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Analgesia epidural merupakan standar emas untuk memfasilitasi persalinan normal tanpa nyeri. Tujuan penelitian ini adalah untuk membandingkan analgesia epidural bupivakain 0,125% dengan bupivakain 0,0625% ditambah fentanil 2 μg/mL yang diukur dengan numeric rating scale (NRS) dan blok motorik yang dinilai dengan skala bromage selama persalinan normal. Penelitian dilakukan sebagai uji klinis acak terkontrol buta ganda terhadap 34 parturien primigravida dengan status fisik ASA II yang direncanakan melahirkan normal di ruang bersalin Rumah Sakit Dr. Hasan Sadikin Bandung pada Desember 2011–Juni 2012. Subjek dikelompokkan menjadi 2, kelompok bupivakain (B) dan kelompok bupivakain fentanil (BF). Hasil penelitian dianalisis memakai uji chi-kuadrat dan uji t-independent dengan tingkat kepercayaan 95% dan dianggap bermakna bila p<0,05 dan sangat bermakna jika p<0,001. Hasil penelitian didapatkan nilai NRS kelompok B vs BF tidak berbeda bermakna dengan nilai p>0,05. Nilai bromage kelompok B vs BF berbeda bermakna dengan nilai p<0,05 pada menit ke-90. Simpulan penelitian ini adalah analgesia yang dihasilkan pada kombinasi bupivakain 0,0625% + fentanil 2 μg/mL sama dengan bupivakain 0,125% dan mengurangi kejadian blok motorik selama persalinan normal yang diberikan analgesia epidural.Kata kunci: Bromage score, bupivakain, epidural, fentanil, numeric rating scale (NRS), parturien, primigravida Comparison of Epidural Analgesia Bupivacaine 0.125% with Combination of 0.0625% Bupivacaine and Fentanyl 2 μg /mL to the Pain and Motoric Block in Normal Labor Epidural analgesia became the gold standard to facilitate normal labor without pain. The purpose of this study was to compare bupivacaine 0.125% versus bupivacaine 0.0625% + fentanyl 2 μg/mL epidural analgesia in the reduction of pain during labor as measured by the numeric rating scale (NRS) and motor block was assessed using the bromage score. A randomized double blind controlled clinical trial was conducted on 34 primigravida parturien with ASA physical status II planned for vaginal birth at delivery in delivery room Dr. Hasan Sadikin Hospital-Bandung within December 2011–June 2012. Subjects were randomly assigned into two groups. The research data were analyzed using of the chi-square and independent ttest with 95% confidence level and considered significant when p<0.05 and highly significant if p<0.001. The results of this study showed that the NRS B vs BF group was not significantly different with p value >0.05. Bromage score B vs BF group significantly different with p value <0.05 at 90 minutes. This study concluded that the combination of 0.0625% bupivacaine + fentanyl 2 μg/mL produce analgesia similar to that provided by infusion of 0.125% bupivacaine and reduce the incidence of motor block during labor.Key words: Bupivacaine, bromage score, epidural, fentanyl, numeric rating scale (NRS), parturien, primigravida DOI: http://dx.doi.org/10.15851/jap.v1n2.120
Pengaruh Penambahan Petidin 0,25 mg/kgBB pada Bupivakain 0,25% untuk Blok Infraorbital terhadap Lama Analgesia Pascabedah pada Operasi Labioplasti Anak Ritonga, Anthon Vermana; Sitanggang, Ruli Herman; Oktaliansah, Ezra
Jurnal Anestesi Perioperatif Vol 1, No 2 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Nyeri pascabedah labioplasti dapat dicegah dengan regional blok infraorbital bilateral. Bupivakain 0,25% biasa digunakan untuk blok infraorbital dan penambahan petidin akan memperpanjang lama kerjanya. Penelitian telah dilakukan dengan uji klinis acak terkontrol tersamar tunggal terhadap 40 pasien ASA II usia 3 bulan–1 tahun yang menjalani operasi labioplasti di ruang operasi bedah sentral Rumah Sakit Dr. Hasan Sadikin Bandung pada Maret–Mei 2012. Setelah randomisasi secara blok permutasi, subjek dikelompokkan >menjadi dua, yaitu 20 subjek menggunakan bupivakain 0,25% 1 mL pada tiap sisi (kelompok B) dan 20 subjek menggunakan kombinasi bupivakain 0,25% dan petidin 0,25 mg/kgBB 1 mL pada tiap sisi (kelompok >BP) yang diberikan setelah induksi anestesi. Data tentang lama analgesi diuji dengan Mann-Whitney. Analisis statistik menunjukkan bahwa perbedaan lama analgesia antara kedua kelompok sangat bermakna (p<0,0001). Simpulan, peningkatan lama analgesia kombinasi bupivakain 0,25% dan petidin 0,25 mg/kg BB menghasilkan masa bebas nyeri sampai 36 jam, sedangkan pada bupivakain 0,25% lebih singkat sekitar 18 jam. Tidak dijumpai efek samping dalam penelitian ini.Kata kunci: Blok infraorbital, bupivakain, labioplasti, petidinComparison Between the Addition of Pethidine 0.25 mg/kgBW in Bupivacain 0.25% with Bupivacain 0.25% for Infraorbital Blockade in Labioplasty Surgery in Children to the Length of Post Operative AnalgesiaLabioplasty postoperative pain can be prevented by bilateral infraorbital regional block. Bupivacaine 0.25% is usually used in infraorbital block and pethidine as an adjuvant can prolong the postoperative analgesic. The research was a single-blind randomized clinical trial included 40 children ASA II aged 3 months–1 year underwent labioplasty surgery in central operating theatre Dr. Hasan Sadikin Hospital-Bandung during March–May 2012. After block of permutation randomization, the subjects were grouped into two, 20 subjects (group B) using bupivacaine 0.25% 1 mL on each side and 20 subjects (group of BP) using combination of pethidine bupivacaine 0.25% and 0.25 mg/kgBW 1 mL on each side after the induction of anesthesia. Measurement data of length of analgesia were tested with the Mann-Whitney Test. Statistical analysis showed that the difference of the length of analgesia between two groups analgesia was highly significant (p<0.0001). The conclusion of this study is that the increase of the length of analgesia in combination of bupivacaine 0.25% and pethidine 0.25 mg/kgBW produce pain-free period to 36 hours, whereas bupivacaine 0.25% is shorter, about 18 hours. The incidence of adverse effect was not found in this study.Key words: Bupivacaine, infraorbital block, labioplasty, pethidine DOI: http://dx.doi.org/10.15851/jap.v1n2.121
Perbandingan Efektivitas Pemberian Efedrin Oral Dosis 25 mg dengan 50 mg Preoperatif terhadap Kejadian Hipotensi Pascaanestesi Spinal pada Seksio Sesarea Rosita, Selly Oktarina; Pradian, Erwin; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Tablet efedrin dapat mencegah hipotensi dengan efek samping lebih kecil. Penelitian ini bertujuan mengkaji dosis efektif tablet efedrin yang diberikan 30–45 menit sebelum dilakukan anestesi spinal untuk menurunkan kejadian hipotensi. Penelitian bersifat eksperimental acak tersamar tunggal dengan 32 ibu hamil ASA II yang menjalani operasi sesar dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret–Mei 2012. Subjek penelitian dikelompokkan menjadi dua, yaitu kelompok 25 mg dan 50 mg. Data dianalisis dengan Uji Mann Whitney dan chi-kuadrat, nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa kejadian hipotensi pada kelompok 25 mg dan kelompok 50 mg berbeda bermakna (p=0,049). Pada kelompok tablet efedrin 25 mg kebutuhan efedrin intravena pascaanestesi spinal lebih besar (p=0,040). Simpulan penelitian ini adalah pemberian tablet efedrin 50 mg 30–45 menit sebelum anestesi spinal dapat mencegah hipotensi pascaanestesi spinal lebih baik dibandingkan dengan tablet efedrin 25 mg. Kelompok tablet efedrin 25 mg memerlukan jumlah pemberian efedrin intravena lebih banyak dibandingkan dengan kelompok tablet efedrin 50 mg.Kata kunci: Anestesi spinal, efedrin tablet 25 mg, efedrin tablet 50 mg, seksio sesarea, hipotensi Comparison of the Effectiveness of Preoperative Oral 25 mg and 50 mg Ephedrine on Postspinal Anaesthesia Hypotension in Caesarean SectionAbstractOral ephedrine is one alternative to prevent hypotension with less adverse effects. The purpose of this study was to determine the effective dose of oral ephedrine given 30–45 minutes before spinal anesthesia to reduce incidence of hypotension. The research was a single-blind randomized experimental study involving 32 pregnant women, ASA II, who underwent caesarean section with spinal anesthesia at Dr. Hasan Sadikin Hospital Bandung from March to May 2012. Subjects were divided into two groups, 25 mg ephedrine and 50mg ephedrine groups. Data was analyzed using Mann Whitney and chi-square test, p<0.05 was considered significant. Statistical analysis showed there was a significant difference (p=0.049) in incidence of hypotension between 25 mg group and 50mg group. 25mg group required more intravenous ephedrine after spinal anesthesia (p=0.040). The conclusion of this study was that oral 50mg ephedrine given 30–45 minutes before performing spinal anesthesia will reduce the incidence of hypotension after spinal anesthesia in comparison to oral 25mg ephedrine. In 25mg group, the amount of ephedrine intravenous administered is higher compared with 50mg group.Key words: Spinal anesthesia, 25mg oral ephedrine, 50mg oral ephedrine, caesarean section, hypotension DOI: 10.15851/jap.v1n3.192
Perbandingan Lama Analgesia antara Kombinasi Bupivakain 0,125% dan Tramadol 1 mg/kgBB dengan Bupivakain 0,125% Melalui Blokade Kaudal pada Pasien Anak Pascaoperasi Hipospadia Wijayanti, Viana; Sitanggang, Ruli Herman; Wargahadibrata, A. Himendra
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Blokade kaudal merupakan teknik anestesi regional yang paling banyak dilakukan pada operasi anak. Penelitian ini bertujuan mengetahui perbandingan lama analgesia kombinasi bupivakain dan tramadol dengan bupivakain melalui blokade kaudal pada pasien anak balita pascaoperasi hipospadia. Penelitian dilakukan terhadap 30 pasien, usia 1–5 tahun, status fisik American Society of Anesthesia (ASA) I di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret hingga Mei 2010. Tipe penelitian ini adalah eksperimental, rancangan acak lengkap terkontrol, tersamar tunggal. Kelompok BT menggunakan kombinasi bupivakain 0,125% dan tramadol 1 mg/kgBB  dan kelompok B menggunakan bupivakain 0,125%.  Data hasil penelitian diuji dengan uji-t. Lama analgesia pascaoperasi pada kelompok BT lebih panjang dibandingkan dengan kelompok B dengan hasil yang sangat bermakna (p<0,01). Kelompok BT dengan lama analgesia 531,33 (SD 42,86) menit dan kelompok B, 370,00 (SD 37,37) menit.  Simpulan penelitian ini adalah penggunaan kombinasi bupivakain 0,125% dan tramadol 1 mg/kgBB (0,5 mL/kgBB) untuk blokade kaudal  sebagai analgetik pascaoperasi hipospadia, menghasilkan lama analgesia yang lebih panjang bila dibandingkan dengan bupivakain 0,125%.  Kata kunci: Blokade kaudal, bupivakain, operasi hipospadia, tramadolComparison of the Duration of Analgesia between Combination of 0.125% Bupivacaine Mixed with Tramadol 1 mg/kgBW and 0.125% Bupivacaine Through Caudal Blockade in Toddlers after Hypospadia Surgery Caudal block is the most common regional anesthetic technique performed in pediatric surgery. This study was designed to compare the duration of analgesia of caudal block between combination of bupivacaine with tramadol and bupivacaine in toddler with hypospadia repair. Thirty American Society of Anesthesia (ASA) I toddlers, aged 1–5 years old at Dr. Hasan Sadikin General Hospital Bandung, runs from March to May, 2010. Patients in group BT, received 0.125% bupivacaine mixed with tramadol 1 mg/kgBW  0.5 mL/kgBW and group B, received plain 0.125% bupivacaine in the same total volume. This type of research is experimental. It was  a single blind randomized controlled trial. Duration of postoperative analgesia were noted. The t-test was used for analysing the data of this study. The duration of analgesia in group BT 531.33 (SD 42.86) was significantly longer than in group B 370.00 (SD 37.37) minutes with p value<0.001. Caudal administration of 0.125% bupivacaine mixed with tramadol 1 mg/kgBW resulted in longer duration of analgesia compared with 0.125% of bupivacaine.  Key words: Bupivacaine, caudal block, hypospadia repair, tramadol DOI: 10.15851/jap.v2n2.307
Perbandingan Efek Pregabalin 150 mg dengan 300 mg Dosis Tunggal terhadap Nilai Numeric Rating Scale dan Kebutuhan Analgetik Pascabedah pada Pasien Histerektomi Abdominal Elvidiansyah, -; Fuadi, Iwan; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Pregabalin memiliki efek antihiperalgesia, antialodinia, dan antinosiseptif. Penelitian bertujuan untuk membandingkan pregabalin 150 mg dengan 300 mg dosis tunggal 1 jam prabedah terhadap nyeri pascabedah dan kebutuhan opioid pada operasi histerektomi abdominal dalam anestesi umum. Uji klinik acak terkontrol buta ganda dilakukan terhadap 60 wanita (18–60 tahun) status fisik American Society of Anesthesiologist (ASA) I–II di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Mei–Agustus 2013. Pasien dibagi menjadi dua kelompok yang menerima pregabalin 150 mg atau 300 mg. Analisis statistik data hasil penelitian menggunakan uji-t, chi-kuadrat, dan Uji Mann-Whitney. Pada penelitian ini ditemukan nilai numeric rating scale (NRS) saat mobilisasi pada kelompok pregabalin 150 mg dan pregabalin 300 mg  berbeda bermakna (p<0,05). Pemberian analgetik tambahan pascabedah antara kedua kelompok tidak berbeda bermakna (p>0,05). Simpulan penelitian adalah pregabalin dosis 150 mg memiliki efek analgesia dan penambahan opioid yang tidak jauh berbeda dibandingkan dengan dosis 300 mg.Kata kunci: Histerektomi abdominal, numeric rating scale, nyeri pascabedah, pregabalinComparison Between the Effect of Single Dose 150 mg and 300 mg Pregabalin of Numeric Rating Scale Value and Post operative Analgesia Requirement  in Abdominal Hysterectomy PatientsPregabalin has the effect of anti hyperalgesia, anti allodynia, and anti nociception. This study aimed to compare single dose of 150 mg pregabalin with 300 mg pregabalin given 1 hour preoperatively in regards to postoperative pain and opioid requirements in abdominal hysterectomy patients. Double blind randomized controlled trial has been conducted on 60 women (18–60 years),  American Society of Anesthesiologist (ASA) physical status I-II, who underwent abdominal hysterectomy in a double-blind randomized controlled trial under general anesthesia in Dr. Hasan Sadikin Hospital-Bandung within May to August 2013. Patients were divided into two groups whose received 150 mg pregabalin or 300 mg pregabalin pre operatively. Statistical analysis of research data is performed using the student’s t-test, chi square, and Mann-Whitney U-test. This study found that numeric rating scale (NRS) scores during mobilization in the 150 mg pregabalin group and 300 mg pregabalin were significantly different (p<0.05). There was no significant differences in postoperative supplemental analgesic administration between the two groups (p>0.05). The conclusion of the study is preoperative pregabalin dosage 150 mg and 300 mg has insignificant differences in its therapeutic effect and supplemental opioid.Key words: Abdominal hysterectomy, numeric rating scale, postoperative pain, pregabalin DOI: 10.15851/jap.v2n2.308
Perbandingan Numeric Rating Scale antara Infiltrasi Analgesia Tramadol 1 mg/kgBB dan Bupivakain 0,25% Pascaoperasi Hernia Inguinalis Reponibel Mulyawan, Dadang; Suwarman, -; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 2, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Pencegahan dan penatalaksanaan nyeri akut pascaoperasi merupakan faktor yang menentukan untuk mengurangi kemungkinan terjadinya nyeri kronik. Penelitian ini bertujuan untuk membandingkan tramadol 1 mg/kgBB dengan bupivakain 0,25% yang diberikan secara infiltrasi subkutan sebelum penutupan kulit terhadap nyeri pascaoperasi hernia inguinalis reponibel. Penelitian dilakukan terhadap 32 orang yang terbagi secara acak ke dalam 2 kelompok dengan usia 18–65 tahun, status fisik American Society of Anesthesiologist (ASA) I–II yang menjalani operasi hernia inguinalis reponibel secara uji acak terkontrol buta ganda dalam anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Juni 2012. Penilaian skala nyeri dilakukan pada jam ke-0, 1, 2, 3, 4, 5, 6, 8, 10, dan selanjutnya sampai tercapainya nilai NRS>4. Analisis statistik menggunakan independent t-test dan chi-kuadrat. Hasil penelitian ini mendapatkan nilai NRS kelompok tramadol yang lebih rendah pada jam ke-3 dan jam ke-4 dibandingkan dengan kelompok bupivakain. Pada kelompok tramadol ditemukan durasi analgesi yang lebih panjang daripada kelompok bupivakain dengan perbedaan bermakna (p<0,05). Simpulan penelitian ini adalah pemberian infiltrasi subkutan tramadol 1 mg/kgBB menurunkan nilai NRS lebih baik daripada bupivakain 0,25% pascaoperasi hernia inguinalis reponibel dan durasi analgesi yang lebih panjang tanpa ada perbedaan efek samping yang bermakna.Kata kunci: Bupivakain, infiltrasi subkutan, numeric rating scale, nyeri pascaoperasi, tramadolNumeric Rating Scale Comparison between 1 mg/kgBW Tramadol and 0.25% Bupivacaine Infiltration Analgesia after Reducible Inguinal Hernia SurgeryPrevention and management of acute postoperative pain is an essential factor contributing to the likelihood of chronic pain development. The objective of this study is to compare 1 mg/kgBW tramadol and 0.25% bupivacaine administered as a subcutaneous infiltration prior to wound closure for post operative pain after reducible inguinal hernia surgery. Study was conducted on 32 patients (18–65 years) ASA I–II who underwent reducible inguinal hernia surgery at Dr. Hasan Sadikin Hospital Bandung during June 2012. Pain scale assessment was done using a numeric rating scale (NRS) and were recorded at 0, 1, 2, 3, 4, 5, 6, 8, 10, hours and thereafter until it reaches the value of NRS >4. NRS on the tramadol group was significantly lower during the 3rd and 4th hour compared to the bupivacaine group. Duration of analgesia was longer in the tramadol compared to bupivacaine group. In conclusions, the subcutaneous infiltration of tramadol 1 mg/ kgBW is better compared to bupivacaine 0.25% in reducing postoperative NRS value in reducible inguinalhernia surgery and provides a longer duration of analgesia, with no significant differences in side effects.Key words: Bupivacain, post operative pain, subcutaneous infiltration, tramadol, visual analogue scale DOI: 10.15851/jap.v2n1.235
Lama Pengerjaan, Volume Anestetik Lokal, dan Angka Keberhasilan Blokade Aksilar dengan Panduan Pencitraan Ultrasonografi pada Prosedur Arterio-Venous Shunt Guntara, Ara; Yadi, Dedi Fitri; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kunci keberhasilan melakukan blokade aksilar adalah mendistribusikan secara optimal anestetik lokal ke sekeliling saraf, hal ini tercapai dengan panduan pencitraan ultrasonografi. Penelitian ini bertujuan menilai lama pengerjaan, volume  anestetik lokal, dan angka keberhasilan blokade aksilar dengan panduan pencitraan ultrasonografi. Metode penelitian adalah deskriptif prospektif. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret–April tahun 2014 terhadap 40 pasien (21‒60 tahun), status fisik American Society of Anesthesilogist (ASA) II, menjalani pembedahan dalam blokade aksilar dengan panduan pencitraan ultrasonografi. Fungsi sensorik dan motorik dinilai setiap 5 menit selama 15 menit. Keberhasilan blokade dinilai dari hilangnya fungsi sensorik dan motorik pada saraf medialis, radialis, ulnaris, dan muskulokutaneus. Hasil penelitian didapatkan lama pengerjaan blokade aksilar rata-rata dengan panduan pencitraan ultrasonografi 548 detik (9,1 menit), volume anestetik lokal dibutuhkan 10 mL dan angka keberhasilan blokade aksilar sebesar 97,5%. Penelitian lain lama pengerjaan dengan bantuan alat stimulasi saraf tepi selama 11,2 menit, volume total anestetik lokal dibutuhkan 30‒40 mL, dan angka keberhasilan 60‒85%.  Simpulan, panduan pencitraan ultrasonografi dapat mempersingkat pengerjaan, mengurangi volume obat anestesi lokal, dan meningkatkan keberhasilan blokade aksilar.Kata kunci: Arterio-venous shunt, blokade aksilar, panduan ultrasonografiProcedure Time, Local Anaesthetic Volume, and Success Rate of Axillary Block with Ultrasound Guidance in Arterio-Venous Shunt ProcedureThe key requirement for successful axillary block is to ensure optimal distribution of local anesthetic around the nerve structure. This goal is most effectively achieved under sonographic visualization. This study aimed to assess block procedure time, minimum volume of local anesthetic required, and success rate of axillary brachial plexus block under ultrasound guidance. This study was conducted between March and April 2014 in Dr. Hasan Sadikin General Hospital, Bandung. This was an observational prospective study involving 40 patients (21‒60 years old) with American Society of Anesthesiologist (ASA) physical status II who underwent arterio-venous shunt under axillary brachial plexus block. Sensory and motor functions were assessed every five minutes for 15 minutes. A successful block was defined as complete sensoric and motoric loss in median, radial, ulnar, and musculocutaneus nerve distributions by 15 minutes. Results showed average block procedure time of 548 seconds (9.1 min), total volume of local anesthetic of 10 mL, and  block success rate of 97.5%. This study concludes that ultrasound guidance can reduce block procedure time and required local anesthetic volume as well as improving the success rate of axillary brachial plexus block. Key words: Arterio-venous shunt, axillary block, ultrasound guidance DOI: 10.15851/jap.v2n3.329
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 Lidokain dengan Magnesium Sulfat Intravena terhadap Nilai Numeric Rating Scale dan Kebutuhan Analgesik Pascabedah Kolesistektomi Perlaparoskopi Lewi, Ratu; Suwarman, Suwarman; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (387.787 KB) | DOI: 10.15851/jap.v4n1.741

Abstract

Lidokain dan magnesium sulfat mempunyai efek antihiperalgesia yang dapat digunakan sebagai obat tambahan untuk mengurangi nyeri pascaoperasi dan mengurangi kebutuhan analgesik opioid. Tujuan penelitian ini membandingkan efek lidokain dan magnesium sulfat intravena nilai numeric rating scale (NRS) dan kebutuhan analgesik pertolongan. Penelitian eksperimental dengan double blind randomized controlled trial dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Januari–Maret 2015 terhadap 30 pasien yang menjalani kolesistektomi per laparoskopi. Pasien dikelompokkan menjadi 2. Kelompok lidokain mendapatkan 1 mg/kgBB intravena dilanjutkan dengan 1 mg/kgBB/jam dan kelompok magnesium sulfat mendapatkan 30 mg/kgBB intravena dilanjutkan dengan 10 mg/kgBB/jam. Data hasil penelitian dianalisis menggunakan Uji Mann-Whitney, uji-t, dan dianggap bermakna bila p<0,05. Hasil analisis statistik menunjukan bahwa lidokain mengurangi nilai NRS secara bermakna dibanding dengan magnesium sulfat pada jam ke-4 pascaoperasi (p<0,05), dengan kebutuhan analgesik pertolongan fentanil pada kelompok lidokain rata-rata 66,4±15,2 µg dan pada kelompok magnesium sulfat rata-rata 86,0±7,8 µg. Simpulan, lidokain intravena mengurangi NRS pascaoperasi lebih baik dan mengurangi kebutuhan opioid lebih banyak dibanding dengan magnesium sulfat pada pasien operasi kolesistektomi per laparoskopi.Kata kunci: Kebutuhan analgesik opioid, lidokain, magnesium sulfat, nyeri pascaoperasi, numeric rating scale Comparison between the Effect of Intravenous Lidocaine and Magnesium Sulphate on Numeric Rating Scale and Postoperative Analgetic Requirement for Laparoscopic CholecystectomiAbstractPostoperative pain management after laparoscopic cholecystectomy is one measure of successful anesthesia and surgery. Lidocaine and magnesium sulphate have anti-hyperalgesia effects applicable as an additional medication to attenuate postoperative pain and reduce the need for opioid analgesics. A total of 30 of patients aged 18–65 years with ASA physical status I–II who underwent laparoscopic cholecystectomy in Dr. Hasan Sadikin General Hospital Bandung were included in a double-blind, randomized, controlled clinical trial. Patients were randomly assigned into 2 groups. The L group, treated with 1 mg/kgBW intravenous followed by 1 mg/kgBW/h intravenous, and M group, treated with 30 mg/kgBW intravenous followed by 10 mg/kgBW/h. Data were analyzed using Mann-Whitney Test and t-test, p<0.05 was considered significant. Statistical analysis showed that lidocaine significantly reduced NRS value compared to magnesium sulphate at 4 hours postoperatively (p<0.05), with the average rescue analgesic fentanyl requirement in the lidocaine group and the magnesium sulphate group of 66.4±15.2 mg and 86.0±7.8 g, respectively. In conclusions, intravenous lidocaine administration may reduce the postoperative NRS value and opioid analgetic requirement more than the intravenous magnesium sulphate administration in patients undergoing laparoscopic cholecystectomy.Key words: An opioid analgetic rescue, lidocaine, magnesium sulphate postoperative pain, numeric rating scale DOI: 10.15851/jap.v4n1.741