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All Journal Medicina Buletin Udayana Mengabdi INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana Bali Journal of Anesthesiology Neurologico Spinale Medico Chirurgico

I Wayan Suranadi

Department Of Anesthesiology, Pain Management, And Intensive Care, Faculty Of Medicine, Udayana University, Sanglah General Hospital, Denpasar-Bali, Indonesia

Author-ID : 394290

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Other

Published : 17 Documents Claim Missing Document

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SPONTANEOUS RUPTURE OF ARTERIOVENOUS MALFORMATION: ICU BASED BRAIN RESUSCITATION Panji, Putu Agus Surya; Aryabiantara, I Wayan; Suranadi, I Wayan; Parami, Pontisomaya; Wibisana Kurniajaya, I Gusti Agung Made
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.25

Arteriovenous malformations (AVM) is a relatively rare intracranial abnormality. Generally, it caused by congenital abnormalities that recognized after the bleeding started. Spontaneous intracranial bleeding after AVM rupture is an emergency condition and require immediate treatment to reduce mortality rate. After stabilization of intracranial bleeding due to AVM rupture, secondary injury may occur hours or even days after the inciting traumatic event. The injury may result from impairment or local declines in cerebral blood flow (CBF) after brain injury. The decrease in CBF is the result of local edema, hemorrhage, or increased intracranial pressure (ICP). An adequate brain resuscitation is needed to decrease brain edema and intracranial pressure by achieving several targets and avoid things that can interfere with CBF. A recovery phase should be given to the patient with rupture of AVM before going to definitive therapy.

Anaesthesia Management of Patient at 16 Weeks Pregnancy with Primary Malignant Bone Tumour Underwent Hemipelvectomy Surgery Sinardja, Cynthia Dewi; Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Kusuma, Oscar Indra; D.H., Asterina
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.39

Chondrosarcoma is a type of sarcoma that affects the bones and joints. It is a rare cancer that accounts for about 20% of bone tumours and is diagnosed in approximately 600 patients each year in the United States. Chondrosarcoma typically affects adults between the age of 20 and 60 years old. The disease usually starts in the bones of the arms, legs or pelvis, but it can be found in any part of the body that contains cartilage. Sometimes chondrosarcoma grows on an otherwise healthy bone or it grows on a benign bone tumour (an enchondroma or osteochondroma). Non-obstetric surgery during pregnancy is not uncommon and can have excellent outcomes with proper planning. Between 0.75% and 2% of pregnant women require non-obstetric surgery. Surgery can be required during any stage of pregnancy depending on the urgency of the indication. When caring for pregnant women undergoing non-obstetric surgery, safe anaesthesia must be provided for both the mother and the child. Thorough understanding of the physiological and pharmacological adaptations to pregnancy is required to ensure maternal safety. Fetal safety requires avoidance of potentially dangerous drugs at critical times during fetal development, assurance of continuation of adequate uteroplacental perfusion, and avoidance and/or treatment of preterm labour and delivery.Pregnant patients beyond 18â20 weeks of gestation should be positioned with a 15Â° left lateral tilt, to reduce aortocaval compression and supine hypotension syndrome. Regional anaesthesia with combined spinal epidural is an option for this case. Regional anaesthesia does reduce the exposure of foetus to potential teratogens, avoids the potential risk of failed intubation and aspiration, and provides excellent post-operative analgesia. The major concern with neuraxial anaesthesia is maternal hypotension, which may reduce placental perfusion. Â During anaesthesia and surgery, foetal well-being is best ensured by careful maintenance of stable maternal haemodynamic parameters and oxygenation. Close monitoring of foetal responses for signs of distress is strongly advocated.

CASE REPORT ANESTHETIC MANAGEMENT OF ADRENAL TUMOR RESECTION Widnyana, I Made Gede; Putra, Kadek Agus Heryana; Kurniyanta, Putu; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Hartono, Budi
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.28

ABSTRACTThe adrenal glands are secretory organs that are located above each kidney and produce hormones that play a major role in the metabolic processes. Tumors of the adrenal gland can cause metabolic abnormalities associated with hormonal disorders such as Cushings syndrome, pheochromocytoma, or Conns syndrome. To be able to give a good anesthetic management on resection of the adrenal tumor, it requires adequate preoperative evaluation. However, this will take large resources. Management of anesthesia in adrenal tumor with an unknown hormonal disorder should consider a variety of hormonal abnormalities that may present in the patient so it can be anticipated effectively.Keywords: incidentaloma, adrenalectomy, hormonal disorder, perioperative

COMBINE MIDAZOLAM-FENTANYL-KETAMIN FOR EVISERATION SURGERY IN PATIENT WITH MULTIDRUG ALERGY IN ACUTE ON CHRONIC EXCACERBATION OF HIPERSENSITIVITY REACTION Panji, Putu Agus Surya; Sudjana, Ida Bagus Gde; Suranadi, I Wayan; Tanggono, Aninda
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.35

ABSTRACTMultidrug Alergy is a relatively rare imunology abnormality. Generally, it caused by congenital genotype and influence with environment. After treated the acute on chronic exacerbation of hypersensivity tipe 1, and the inflamation can alleviate, the patient schedule of eviseration oculi dextra with general anesthesia. And the opthamologist curious about the proceddure because eviseration need antibiotic to wash the oculi, but there are no antibiotic saved for the patient. For general anesthesia, the patient has no history so we canât predicted about the anesthetic drugâs allergy. We choose combine ketamine-midazolamadn fentanyl to facilitate the anesthesia. Ketamine significantly reduces the production of inflammatory cytokines without affecting the production of anti-inflammatory cytokines. Fentanyl is the opioid which is the most rarely caused allergy and have strong potential. Midazolam can help the sedation

SURGEONS BEHAVIOR TOWARD PROPHYLAXIS ANTIBIOTICS IN SANGLAH HOSPITAL Suranadi, I Wayan; Sukrama, Dewa Made; Budayanti, Ni Nyoman Sri; Pradhana, Adinda Putra; Amin, Yusuf Sidang
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Â Background: The emergence of antibiotic resistance is a complicated problem due to many factors, especially its use and abuse. Inappropriate use of antibiotics is very common in both developed and developing countries. The goal of this study was to see the knowledge of the surgeons toward prophylaxis antibiotic at Sanglah Hospital.Methods: This is a descriptive study of 55 surgeons who performed elective surgery at Sanglah Hospital. A questionnaire was filled by the surgeons randomly without prior notice about the study. The information about their behavior toward prophylaxis antibiotics was gathered from medical record of the day.Result: Out of the 55 surgeons participated in this study, 85.5% have followed a training on rational antibiotic use. The level of knowledge about factors that can increase surgical wound infections is quite good (94.4%), while the knowledge regarding factors that can reduce surgical wound infections very low (16.4%). Almost all (92.7%) clean-surgery patients were given prophylactic antibiotics. The most given antibiotic was ceftriaxone (72.7%), the third generation of cephalosporins.Conclusion: The mean knowledge of the surgeons toward antibiotic prophylaxis was 59.8%. The most used antibiotic as pre-surgical prophylaxis was ceftriaxone. And the time of administration for prophylaxis antibiotic was 16-60 minutes prior to surgical incision.

Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center Parami, Pontisomaya; Suranadi, I Wayan; Utara Hartawan, I Gusti Agung Gede; Mahaalit, I Gusti Ngurah; Ryalino, Christopher; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTPain is a common complaint found in the population. Inadequate knowledge about pain management is the most common reason that triggers the inadequate management of pain. Pharmacological pain management is also not without risk. Various risks from the use of pharmacological agents related to side effects that can arise may also cause new problems. Several medical intervention techniques with invasive procedures for pain have also been carried out, although they are still less popular, due to a lack of public knowledge of this technique. We conducted a cost-free, minimally invasive pain procedure in people with chronic musculoskeletal pain in a public health center in a rural area in Bali Island to alleviate their pain-associated symptoms and to introduce this minimally invasive pain management technique.

Antimicrobial susceptibility patterns of Acinetobacter baumanii isolates from ICU and non-ICU wards Budayanti, Ni Nyoman Sri; Suranadi, I Wayan; Tarini, Made Adi; Violentina, Gusti Ayu Dianti; Sathya Deva, I Dewa Gde
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTIntroduction: Acinetobacter baumanii is the most common agent of hospital-acquired infection with the increasing fatality rate due to multidrug-resistant (MDR) strain infection. The magnitude of the problem in Indonesia is unknown. Here, we provide data regarding susceptibility pattern of A. baumanii isolated from a tertiary referral hospital in Bali, Indonesia between 2012 and 2014.Methods: Data were collected retrospectively from culture-based records in the Clinical Microbiology department, Sanglah General Hospital during 2012-2014. A. baumanii was isolated from clinical specimens. Identification and antimicrobial susceptibility test were conducted using micro-dilution method (Vitek-2 Compact system). Isolates that resistant to ≥ 3 antibiotic classes were categorized as multi-drug resistant (MDR) A. baumanii.Results: A. baumanii collected from sputum in intensive care unit (ICU) wards were 7.9%, 11.1%, and 7.0%, while the isolates from sputum in non-ICU wards were 13.1%, 15.6%, and 19.9% in 2012, 2013, and 2014, respectively. There was a reduced susceptibility of A. baumanii to ciprofloxacin, levofloxacin, ceftazidime, aztreonam, imipenem, ampicillin-sulbactam, and piperacillin-tazobactam in ICU ward. Meanwhile, the susceptibility of A. baumanii to Cotrimoxazole remained high in both ICU and non-ICU ward. MDR A. baumanii is found to be resistant to fluoroquinolones, cephalosporins, aztreonam, aminoglycosides, beta-lactamase inhibitors, and carbapenem. Data were analyzed and presented in a descriptive manner.Conclusion: Three years surveillance showed that the susceptibility of A. baumanii to most common antibiotics was decreasing. MDR A. baumanii was found to be resistant to all classes of common antibiotics mostly from ICU ward isolates.

Acinetobacter baumannii Is an opportunistic pathogen as an MDRO especially on intensive ward Suranadi, I Wayan; Dwi Fatmawati, Ni Nengah; Aryabiantara, I Wayan; Sinardja, Cynthia Dewi; Saputra, Darmawan Jaya
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Acinetobacter baumannii is an opportunistic bacterial pathogen that is associated with hospital acquired infections and is a major cause of nosocomial infections especially in intensive spaces; this is becoming increasingly a widespread concern in various hospitals around the world. Acinetobacter baumannii, which is resistant to many antibiotics, is now recognized as clinically very important. Reports suggest that the spread of A. baumannii in the hospital environment led to an increase in nosocomial outbreaks associated with high mortality rates. However, many other Acinetobacter spp. can also cause nosocomial infections. This review focuses on the role of Acinetobacter spp. as nosocomial pathogens, resistance patterns and epidemiology.

PERBEDAAN OSMOLALITAS DAN pH DARAH PADA TINDAKAN TRANSURETHRAL RESECTION OF PROSTATE (TURP) YANG DIBERIKAN NATRIUM LAKTAT HIPERTONIK 3 ML/KGBB DENGAN NATRIUM KLORIDA 0,9% 3 ML/KGBB Dewi, Srinami; Widnyana, Made Gede; Suranadi, Wayan
Medicina Vol 44 No 3 (2013): September 2013
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (132.169 KB)

Transurethral resection of prostate (TURP) merupakan prosedur baku dalam penatalaksanaanhiperplasia prostat yang disertai retensi urin akut berulang atau kronis. Tindakan ini dikerjakandengan fasilitas air sebagai cairan irigasi. Salah satu komplikasi tindakan ini dikenal sebagai sindromTURP. Kelebihan cairan intravaskular karena absorbsi cairan irigasi akan mengakibatkan terjadinyahiponatremia dilusional yang akan menurunkan osmolalitas plasma. Perubahan kadar Nadan Lac dapat mengakibatkan terjadinya gangguan keseimbangan asam basa yaitu asidosismetabolik. Penelitian ini merupakan uji klinik, melibatkan 22 pasien dewasa dengan status fisikASA II-III, yang menjalani operasi elektif TURP di ruang Instalasi Bedah Sentral (IBS) RSUP SanglahDenpasar dengan anestesi regional dan menggunakan air sebagai fasilitas cairan irigasinya. Sebelumtindakan TURP, saat mulai puasa, pasien diberikan cairan ringer dextrose 40 ml/kgBB/hari,sesampainya di kamar persiapan IBS dilanjutkan diberikan cairan ringer laktat 10 ml/kgBB.Randomisasi blok dilakukan untuk alokasi subyek ke dalam dua kelompok yaitu kelompok NLH(kelompok perlakuan) yang mendapatkan cairan awal natrium laktat hipertonik 3 ml/kgBB dan-kelompok NaCl (kelompok kontrol) yang mendapatkan cairan awal natrium klorida 0,9% 3 ml/kgBB.Dilakukan pemeriksaan osmolalitas dan pH darah sebelum, selama, dan sesudah tindakan TURP.Hasil penelitian mendapatkan perbedaan osmolalitas darah antara kelompok NLH dengan kelompokNaCl pada saat pra-operasi, durante operasi, dan pasca-operasi dengan nilai 285,3248 vs 283,3205,P= 0,0028; 287,0259 vs 284,6813, P= 0,045; dan 288,7668 vs 285,9444, P= 0,033. Juga terdapatperbedaan nilai pH darah antara kelompok NLH dengan kelompok NaCl pada saat pra-operasi,durante operasi dan post-operasi dengan nilai 7,4864 (0,7018) vs 7,4055 (0,5646), P= 0,07; 7,4636(0,02976) vs 7,4318 (0,03945), P= 0,045; dan 7,4791 (0,03727) vs 7,4327 (0,5569), P= 0,033. Statushemodinamik lebih baik pada kelompok NLH. Enam dari 11 pasien pada kelompok NaCl mengalamihipotensi dan membutuhkan lebih banyak efedrin intravena sedangkan pada kelompok NLH hanya 2pasien. Dari hasil penelitian ini dapat disimpulkan bahwa pemberian cairan awal natrium laktathipertonik lebih efektif dalam mempertahankan osmolalitas dan pH darah dibandingkan cairan natriumklorida 0,9% pada tindakan TURP yang menggunakan air sebagai fasilitas cairan irigasi.

The Lactate/Pyruvate Ratio of Metabolic Modulation using Glucose Insulin Kalium and Lactate Solution and their Effect on Functional Mechanical Recovery of the Isolated Perfused Heart Suranadi, I Wayan; Bakta, Made; Arhya, I Nyoman; Leverve, Xavier
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (65.787 KB)

Metabolic modulation with Glucose Insulin Kalium (GIK) solution has beenreally well known in their capacity to improve post ischemic heart function. In this regardGIK intervention on post operative Coronary Artery Bypass Graft (CABG) can improveheart function recovery on reperfusion period (Goldhaber dan Weiss, 1992; Atwell et al.,1997). Post operative CABG intervention with GIK will produce a beneficial effect onthe elevation of heart energy to prevent ionic homeostasis disturbance and reactiveoxygen species (ROS) production that become the basis of reperfusion injury (Silvermandan Stern, 1994; Cross et al., 1995; Taegtmeyer et al., 1997; Opie, 1999; Lazar, 2002;Doenst et al., 2003; Trence et al., 2003).Many efforts have been made to clarify how exactly GIK works to improve postischemic heart function as in CABG. This is crucially done in order to be able to modifythe solution concerned. Although this solution has been clearly proved to improve postischemic heart function, it is not totally free from its adverse effect. Its main side effect isthat it can provoke hyperglycemic state, which contrasts with the tight glucose control incontinuously normal range for the patients who are critically ill.In this study lactate and pyruvate level in the coronary effluent were measuredfrom the isolated heart directly perfused with GIK and lactate. It was shown that thepreischemic lactate level was low and then clearly elevated as soon as the reperfusiontook place due to anaerobic metabolism. In accordance with reperfusion time lactate leveldecreased gradually. In relation with pyruvate level, this substrate evolution looked likethe appearance of lactate but its value was lower if compared with lactate.The recovery in functional mechanical activity of the post ischemic heart seems tobe much more related to the pattern of the evolution of logarithmic lactate/pyruvate ratio(L/P ratio). Logarithmic value of L/P ratio in GIK group increased since the earlyreperfusion period (+40%, p < 0.05), followed by improvement in recovery ofmechanical activity in this group which was significantly higher if compared with thecontrol group. Similar fashion was found in lactate group in regard to the evolution of thelogarithmic value of L/P ratio in this group, where its value was significantly highercompared with the control group. The logarithmic evolution pattern on L/P ratio for thisgroup increased along the reperfusion time (+34% p < 0.05).From the present study, it can be concluded that the recovery of functionalmechanical activity of the post ischemic heart perfused with GIK is through modificationon cellular lactate metabolism.

Co-Authors Adinda Putra Pradhana Amin, Yusuf Sidang Christopher Ryalino Cynthia Dewi Sinardja D.H., Asterina Damayanti, Elok Dewa Ayu Mas Shintya Dewi Gusti Ayu Amalindasari Prabayastita Masta I Dewa Made Sukrama I Gusti Agung Gede Utara Hartawan I Gusti Agung Made Wibisana Kurniajaya, I Gusti Agung Made I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Suwiyoga I Made Agus Kresna Sucandra I Made Bakta I Made Gede Widnyana I Nyoman Arhya I Putu Agus Surya Panji I Wayan Aryabiantara, I Wayan I.W. Weta Kadek Agus Heryana Putra, Kadek Agus Kadek Dinda Pramadyanti Komang Ady Widayana Kusuma, Oscar Indra L.S. Ani Made Sindy Astri Pratiwi Mahaalit, I Gusti Ngurah N.W.A. Utami Nabilla Farha Nadia Assecia Cristy Ni Made Adi Tarini Ni Nengah Dwi Fatmawati Ni Nyoman Sri Budayanti Pontisomaya Parami Putu Kurniyanta Putu Pramana Suarjaya Saputra, Darmawan Jaya Sathya Deva, I Dewa Gde Srinami Dewi Sudjana, Ida Bagus Gde Tanggono, Aninda Tjokorda Gde Agung Senapathi Violentina, Gusti Ayu Dianti Xavier Leverve

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