Andi Ade Wijaya
Departemen Anestesiologi dan Intensive Care Fakultas Kedokteran Universitas Indonesia/RSUPN Cipto Mangunkusumo

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Efektivitas Pemberian Cairan Praoperatif Ringer Laktat 2 mL/kgBB/jam Puasa untuk Mencegah Mual Muntah Pascaoperasi Wijaya, Andi Ade; Fithrah, Bona A.; Marsaban, Arif H. M.; Hidayat, Jefferson
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Teknik nonfarmakologi yang dapat dilakukan untuk menurunkan angka kejadian mual muntah pascaoperasi adalah pemberian cairan praoperatif. Tujuan penelitian ini untuk mengetahui efektivitas pemberian cairan praoperatif Ringer laktat 2 mL/kgBB/jam puasa untuk menurunkan angka kejadian mual muntah pascamastektomi. Penelitian ini merupakan uji klinis acak yang dilakukan pada bulan Maret–April 2013 di Rumah Sakit Kanker Dharmais, Rumah Sakit Persahabatan, Rumah Sakit Fatmawati, dan Rumah Sakit Cipto Mangunkusumo Jakarta, pada pasien status fisik American Society of Anesthesiologist (ASA) 1–2. Sebanyak 102 pasien diacak ke dalam kelompok hidrasi dan kelompok kontrol. Analisis data dilakukan menggunakan uji chi-kuadrat. Terdapat perbedaan yang signifikan dalam kejadian mual pada 0–1 jam pascaoperasi (kelompok hidrasi 20% vs kelompok kontrol 39%) dan pada 0–24 jam pascaoperasi (kelompok hidrasi 22% vs kelompok kontrol 41%). Walaupun tidak berbeda secara statistik, angka kekerapan mual pada 1–24 jam pascaoperasi lebih rendah pada kelompok hidrasi 12% (6) dibandingkan dengan kelompok kontrol 23% (12). Tidak ada perbedaan secara statistik pada angka kekerapan muntah di kedua kelompok penelitian. Pemberian cairan praoperatif Ringer laktat 2 mL/kgBB/jam puasa efektif untuk menurunkan angka kejadian mual pascaoperasi mastektomi pada 1 jam pertama pascaoperasi.  Kata kunci: Cairan praoperatif, mastektomi, mual muntah pascaoperasi Effectiveness of Pre-operative Lactated Ringer’s Solution 2 mL/kgBW/h in Fasting Patients to Prevent Post-operative Nausea and Vomiting Non pharmacologic approaches to overcome post operative nausea and vomiting include giving pre-operative hydration. The objective of this study was to learn the efficacy of pre-operative lactated Ringer’s solution (2 mL/kgBW/hour) in fasting patients to overcome the post-operative nausea and vomiting in mastectomy surgery. This study was a randomized clinical trial that conducted in March to April 2013 in Dharmais Hospital-National Cancer Center,  Persahabatan Hospital, Fatmawati Hospital, and Rumah Sakit Cipto Mangunkusumo Jakarta to patients with  American Society of Anesthesiologist (ASA) physical status 1–2. A total of 102 patients were randomized into the hydration group and control group. Data analysis was performed using chi-square test or appropriate test using SPSS ver. 15. There were statistically significant differences in the incidence of nausea at 0–1 hour post-operative (19.6% in hydration group vs. 39.2% in control group) and at 0–24 hours post-operative (21.6% in hydration group vs. 41.2% control group). The incidence of 1–24 hours PONV, although not statistically significant, was higher in the control group (11.8% in hydration group vs. 23.5% in control group). There was no difference in vomiting incidence between the two groups. Pre-operative lactated Ringer’s solution 2 mL/kgBW/hour in fasting patients effectively reduces the incidence of post-operative nausea one hour after operation. Key words: Mastectomy, post-operative nausea and vomiting pre-operative hydration DOI: 10.15851/jap.v2n3.332
Deksametason Intravena dalam Mengurangi Insidens Nyeri Tenggorok Pascabedah Wijaya, Andi Ade; Garditya, Rama; Marsaban, Arif H. M.
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Anestesia umum dengan pipa endotrakeal digunakan untuk memberikan ventilasi tekanan positif dan mencegah aspirasi, namun penggunaannya dapat menimbulkan komplikasi nyeri tenggorok pascabedah. Penelitian ini dilakukan membandingkan efektivitas deksametason intravena dengan triamsinolon asetonid topikal dalam mengurangi nyeri tenggorok pascabedah. Penelitian ini merupakan uji klinis acak tersamar ganda yang dilakukan selama bulan Maret–April 2013 di Rumah Sakit Cipto Mangunkusumo pada pasien yang menjalani pembedahan dalam anestesia umum menggunakan pipa endotrakeal. Subjek dibagi menjadi dua kelompok, kelompok deksametason sebanyak 61 orang dan kelompok triamsinolon sebanyak 60 orang. Sebelum induksi, pasien dalam grup deksametason diberikan 10 mg deksametason intravena dan pasta plasebo dioleskan pada balon pipa endotrakeal. Pasien dalam grup triamsinolon diberikan 2 mL NaCl 0,9% intravena dan pasta triamsinolon asetonid dioleskan pada balon pipa endotrakeal. Skor nyeri tenggorok pascabedah dievaluasi sesaat setelah pembedahan berakhir, 2 jam dan 24 jam pascabedah. Hasil penelitian, tidak didapatkan perbedaan bermakna pada kedua kelompok  kejadian nyeri tenggorok pascabedah sesaat setelah pembedahan berakhir (27,9% pada kelompok A dan 18,3% pada kelompok B, p=0,214). Triamsinolon asetonid topikal memiliki efektivitas yang sama dengan deksametason intravena dalam mengurangi insidens nyeri tenggorok pascabedah.  Kata kunci:  Deksametason, intubasi endotrakeal, nyeri tenggorok pascabedah, pasta triamsinolon asetonidComparison between Topical Triamcinolone Acetonide and Intravenous Dexamethasone in Reducing Postoperative Sore Throat IncidenceTracheal intubation is often used to give positive-pressure ventilation and prevent aspiration during general anesthesia. However, the use of this airway device can cause postoperative sore throat (POST). This study was conducted to compare the effectiveness of prophylactic intravenous dexamethasone and triamcinolone acetonide paste in reducing POST. This study was a double-blind randomized clinical trial conducted during April–May 2013 in Cipto Mangunkusumo General Hospital on patients scheduled for surgery under general anesthesia using endotracheal tube. Subjects were randomly allocated into two groups; 61 patients in dexamethasone group and 60 patients in triamcinolone group. Before induction, the dexamethasone group received 10 mg of intravenous dexamethasone and placebo paste on the endotracheal tube cuff. Triamcinolone group received 2 mL of intravenous normal saline and triamcinolone acetonide paste on the endotracheal tube cuff. POST scores were evaluated immediately after the operation, 2-hours, and 24-hours after the operation. There was no significant difference in the incidence of POST immediately after the operation between the two groups (27.9% in group dexamethasone vs 18.3% in group triamcinolone, p=0.214). Topical triamcinolone acetonide is equally effective compared to prophylactic intravenous dexamethasone in reducing the incidence of POST.  Key words: Dexamethasone, endotracheal intubation, posts operative sore throat, triamcinolone acetonide paste
Uji Kesahihan dan Keandalan QoR-40 versi Indonesia sebagai Instrumen untuk Menilai Kualitas Pemulihan Pasca-anestesia Umum Harijanto, Eddy; Wijaya, Andi Ade; Handayani, Dini
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Quality of Recovery-40 (QoR-40) adalah salah satu instrumen yang telah digunakan luas di dunia untuk menilai kualitas pemulihan pasca-anestesia umum. Saat ini belum ada instrumen spesifik yang menilai kualitas pemulihan pasca-anestesia di Indonesia. Hasil terjemahan akan diujikan pada 115 subjek yang menjalani anestesia umum satu hari praoperasi dan satu hari pascaoperasi. Uji kesahihan isi menggunakan koefisien Aiken v, uji kesahihan konstruksi (analisis faktor dan uji korelasi pearson), konsitensi internal (Chronbach α), ketanggapan (responsiveness) dengan standard respons mean (SRM). Uji kesahihan isi formula Aiken V didapatkan bahwa QoR-40 versi Indonesia sahih dengan nilai ≥0,5. Uji kesahihan konstruksi dengan analisis faktor menunjukan semua faktor memiliki korelasi yang tinggi (korelasi≥0,5). Uji korelasi Pearson didapatkan 3 item pertanyaan dari dimensi dukungan tehadap pasien yang tidak sahih (mendapat dukungan dari dokter Rumah Sakit, ρ=0,252), (mampu memahami arahan dan nasehat ρ=1,98), (merasa bingung ρ=0,202). Standart respons mean (SRM) pada uji ketanggapan adalah 1,06. Terdapat hubungan negatif antara skor QoR-40 versi Indonesia dengan lama masa rawatan. QoR -40 versi Indonesia menunjukkan kesahihan dan keandalan yang memuaskan. Dimensi dukungan terhadap pasien dengan koefisien kesahihan terendah dan tiga pertanyaan yang tidak memiliki kesahihan konstruksi. Instrumen Qor-40 versi Indonesia sensitif untuk menilai perubahan klinis pascanestesia umum. Kata Kunci: Indonesia, kesahihan dan keandalan, kualitas pemulihan, QoR-40 Validity and reliability test Qor -40 version of Indonesia to assess the quality of recovery after general anesthesiaQuality of Recovery-40 (Qor-40) is one of the instruments that have been used widely in the world to assess quality of recovery after general anesthesia. There is no specific instrument tot assesses the quality of recovery after general anesthesia in Indonesia up to now. The translation was tested on 115 subjects undergoing general anesthesia on one day preoperative and one day postoperative. Validity test of the content was done by coefficient Aiken V, Construction validity (factor analysis and Pearson correlation), Internal consistency (Chronbach α), and responsiveness test with Standard response mean (SRM).The content validity of Aiken V formula showed that Qor-40 Indonesian version was valid with ≥0.5 value. Construction validit ytest by factor analysis showed high correlations for all factors (correlation ≥0.5). Pearson correlation test item found 3 questions that were not valid ( Getting support from Hospital doctors, ρ=0.252), (Able to understand the direction and advice of ρ=1.98), (Feeling confused ρ=0.202). SRM on the responsiveness test was 1,06. There was a negative correlation between the scores Qor-40 version Indonesia with long term care. QoR-40 Indonesian version showed a satisfactory validity and reliability. Patients support dimension had the lowest validity coefficient with three questions that did not have valid construction. Indonesian version of Qor-40 wa ssensitive to assess clinical changes after general anesthesia. Key words: Indonesia, Qor-40, quality of recovery, validity and reliability
Post-operative Emergence Agitation in Children Undergoing Inhalation General Anesthesia in Cipto Mangunkusumo Hospital: Study on Incidence and Affecting Factors Wijaya, Andi Ade; Kapuangan, Christopher; Aktara, Betardi
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Emergence agitation (EA) during recovery from general anesthesia is often found among pediatric population. The etiology of EA in children is not fully understood. Possible risk factors include pre-school age, recent inhalation anesthetics, poor adaptability, and parental presence during recovery. The aim of the present study was to assess the incidence of EA and the affecting factors in children undergoing inhalation anesthesia in Cipto Mangunkusumo Hospital. There were 78 samples, aged 2–12 years undergoing inhalation anesthesia. Behavior during induction of anesthesia was assessed with Pediatric Anesthesia Behavior (PAB) score. In post anesthesia care unit (PACU) the incidence of EA was assessed with Aono’s four-point scale upon admission (T0), after 5 min (T5), 15 min (T15) and 30 min (T30). The incidence of EA in children undergoing inhalation anesthesia in this study was 39,7%. The incidence was higher in 2–5 years old children with PAB score 2 or 3. Midazolam, type of inhalation anesthetic agents and parental presence during recovery do not appear to have any bearing on the incidence of EA. Age of the children and the behavior during induction of anesthesia have a strong correlation with the incidence of EA.
Ketepatan Modul Triase IGD RSUPN Cipto Mangunkusumo dalam Memprediksi Angka Mortalitas Wijaya, Andi Ade; Firdaus, Riyadh; S. R. Tonda, Thomas Aquinas
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Kegagalan mengenali dengan risiko mortalitas tinggi pada pasien dapat menyebabkan luaran yang buruk. penilaian yang cepat dan tepat terhadap perubahan tanda vital sangat penting untuk menghindari keterlambatan penanganan. Beberapa modul triase telah dirancang untuk mendukung pengambilan keputusan bagi perawat/dokter triasePenelitian meneliti ketepatan modul triase IGD RSCM dalam memprediksi mortalitas untuk luaran 24 jam dan 7 hari. Dilakukan studi kohort retrospektif pada 529 s pasien triase di Instalasi Gawat Darurat RSCM. Luaran mortalitas pasien dibagi menjadi mortalitas 24 jam dan mortalitas 7 hari. Area under the curve modul triase untuk luaran 24 jam adalah 0,787 (IK 95%: 0,690–0,885), lebih besar daripada area under the curve modul triase untuk luaran 7 hari yaitu 0,662 (IK 95%: 0,597–0,726). Hal ini berarti modul triase IGD RSCM lebih akurat dalam memprediksi mortalitas 24 jam daripada mortalitas 7 hari. Rasio kemungkinan positif (PLR) yang terbesar ialah untuk kategori resusitasi, yaitu 11,36. Performa modul triase IGD RSCM lebih baik dalam memprediksi mortalitas 24 jam daripada untuk memprediksi mortalitas 7 hari. Kata kunci: Akurasi, instalasi gawat darurat, modul triase, mortalitas, tanda vital The AmLuracy of Triage Module of Cipto Mangunkusumo Hospital’s Emergency Department in Predicting Mortality RateFailure to identify high risk patients leads to poor outcomes. quick and precise assessment of vital signs changes is very important to help the triage doctors/nurses in making prompt decisions. This study analyzed the amLuracy of the triage modules in the ED of RSCM inpredicting the mortality outcome in 24 hours and 7 days. a retrospective cohort study was done on 529 patientswho underwent the triage procedure in the ED of RSCM. The patients’ mortality outcomes were divided into 24-hours mortality and 7-days mortality. The area under the curve for the 24-hours outcome was 0.787 (95% CI: 0.690 to 0.885) greater than the area under the curve for 7-days outcomes(0,662, CI 95%: 0.597 to 0.726), thus the triage module in the ED of RSCM was better in predicting of 24-hours mortality than 7-days mortality. The ER triage module was more amLurate in predicting 24-hours mortality than f 7-days mortality. Key words: Accuracy emergency room, mortality, Triage, vital signs