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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Bali Journal of Anesthesiology Jurnal Anestesi Obstetri Indonesia
Made Wiryana
Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Udayana University, Indonesia
Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Other

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Efektivitas Magnesium Sulfat 30 mg/kgBB Intravena Dibanding dengan Fentanil 2 mcg/kgBB Intravena dalam Menekan Respons Kardiovaskular pada Tindakan Laringoskopi dan Intubasi Yehezkiel, -; Wiryana, Made; Sujana, Ida Bagus Gde; Sidemen, I Gusti Putu Sukrana
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1298.474 KB)

Abstract

Laringoskopi dan intubasi merupakan tindakan rutin yang berisiko menyebabkan respons kardiovaskular berupa peningkatan tekanan darah dan laju denyut jantung terutama pada pasien risiko tinggi seperti kelainan jantung. Penelitian ini bertujuan mengetahui efektivitas MgSO4 30 mg/kgBB intravena dibanding dengan fentanil 2 mcg/kgBB  intravena dalam menekan respons kardiovaskular pada  tindakan laringoskopi dan intubasi sehingga dapat menjadi obat altenatif. Penelitian ini dilakukan secara uji klinis  acak terkontrol tersamar ganda terhadap 42 pasien dengan status fisik American Society of Anesthesiologist (ASA) I–II yang dilakukan operasi dengan anestesi umum intubasi trakea di RSUP Sanglah Denpasar Bali pada Agustus–September 2014. Subjek dibagi menjadi dua kelompok, MgSO4 30 mg/kgBB (n=21) dan fentanil 2 mcg/kgBB (n=21) secara acak. Perubahan tekanan darah dan laju denyut jantung yang terjadi sebelum dan setelah tindakan dicatat sebagai data penelitian. Data penelitian dianalisis dengan uji repeated ANOVA, dengan p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak terdapat perbedaan bermakna antara kedua kelompok perlakuan. Simpulan, pemberian MgSO4 30 mg/kgBB sama efektif dengan fentanil 2 mcg/kgBB dalam menekan respons kardiovaskular pada tindakan laringoskopi dan intubasi.Kata kunci: Fentanil, intubasi, laringoskopi, magnesium sulfat, respons kardiovaskularComparison of Intravena Magnesium Sulfate 30 mg/kgBW and Intravena Fentanil 2 mcg/kgBW  Effectiveness for Attenuating Cardiovascular Response in Laryngoscopy and Tracheal IntubationLaryngoscopy and intubation are routine actions which cause the risk of cardiovascular responses, including increased blood pressure and heart rate, especially in high-risk patients such as patients with heart disorders. The aim of this study was to determine the effectiveness of intravenous MgSO4 30 mg/kgBW compared to that of intravenous fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation to assess its possibility as an alternative drug. This study was a clinical trial with randomized double-blind controlled to 42 patients with physical status of the American Society of Anesthesiologists (ASA) I–II who underwent tracheal intubation under general anesthesia in Sanglah Denpasar Hospital Bali in the period of  August–September 2014. Subjects were divided into two groups, MgSO4 30 mg/kgBW (n=21) and fentanyl 2 mcg/kgBW (n=21) groups. Changes in blood pressure and heart rate that occured before and after the action were recorded as research data. Data were analyzed with repeated ANOVA test, with p<0.05 considered significant. Statistical analysis showed that there was no significant difference between the two treatment groups. it is concluded that the administration of MgSO4 30 mg/kgBW is as effective as fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation.Key words: Cardiovascular response, fentanyl, intubation, laryngoscopy, magnesium sulfate DOI: 10.15851/jap.v3n2.574
Efficacy of Subcutaneous Morphine Patient Controlled Analgesia Compared to Intravenous Morphine Patient Controlled Analgesia on Cesarean Section Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gde; Aribawa, I Gusti Ngurah Mahaalit; Nainggolan, Elisma
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.v1i3.27

Abstract

Background: Cesarean section causes moderate to severe pain in the first 48 hours postoperatively, thus requiring an adequate perioperative pain management, not only so that the mother can be quickly discharged but also to perform daily activities after surgery such as breastfeeding and nurse the baby.Objective: To determine the efficacy of subcutaneous morphine patient controlled analgesia (SC-PCA) in lowering VAS (visual analogue score), total morphine consumption and postoperative side effect on cesarean section compared with intravenous morphine patient controlled analgesia (IV- PCA).Methods: This study is an experimental clinical trial using consecutive sampling technique. Sixty-four subjects were allocated into two groups of PCA morphine subcutaneously (SC-PCA) and the group PCA morphine intravenously (IV-PCA), each consisting of 32 subjects using permuted block randomization. Morphine concentration was 5 mg/ml (group SC-PCA) or the concentration of 1mg/ml (group IV-PCA). Both groups were then analyzed for VAS ratings, total morphine consumption, and adverse effects, post operatively at 4th, 8th, and 24th hour. Statistic analysis using repeated ANOVA test and t-test with p <0.05 onsidered significant.Result: Morphine consumption in IV-PCA group showed lower needs than SC-PCA (9.41 mg vs 4,9mg) p <0.001 24 at 24 hours postoperatively. The VAS at resting at 4th hours statistically significantly lower in IV-PCA group (1.06 ± 0.71 vs 0.81 ± 1.40, p=0.029) and at 8th hours (1.03 ± 0.59 vs 0.94 ± 0,9, p=0.048). The moving VAS at 4th hours statistically significant lower in IV-PCA group (2.31 ± 0.47 vs 1.45 ± 2.06, p=0.019) but the static or VAS at moving are not different clinically. Side effects of nausea and vomiting are more common in IV-PCA group. We conclude that SC-PCA provide analgesia more effective and decreases side effects in patients undergo sectio cesarea with spinal anesthesia.
Programmed intermittent epidural bolus improves efficacy of patient controlled epidural analgesia in postoperative pain management Agung Senapathi, Tjokorda Gde; Gede Widnyana, I Made; Wiryana, Made; Mahaalit Aribawa, I Gusti Ngurah; Surya Panji, Putu Agus; Soetjipto, Sonni; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.14

Abstract

Background: Postoperative acute pain will have negative impacts if not handled properly so it must be treated effectively. Patient Controlled Epidural Analgesia (PCEA) allows the patient to have an active role in determining the need of analgesia personally. Programmed Intermittent Epidural Bolus (PIEB) is a new method which proven better than Continuous Epidural Infusion. Ropivacaine has similar characteristic to Bupivacaine but with minimal cardiotoxic effect. Fentanyl as an adjuvant can accelerate the onset of action of local anesthetics in epidural analgesia. The purpose of this study was to compare the efficacy of PCEA+PIEB with PCEA as a modality of postoperative analgesia. Methods: Total 54 patients undergoing major surgery of the abdomen and lower extremities were divided into 2 groups randomly: PIEB+PCEA and PCEA. Then we did an evaluation of VAS, PCA demand, and total consumption of solution Ropivacaine 0.1% + Fentanyl 2  mcg/mL at 4 hours, 8 hours, and 24 hours postoperative. Results: VAS at resting and at moving in both groups were found clinically comparable, although statistically, VAS at moving at 4 hours and 24 hours postoperative were lower in PCEA+PIEB group (p < 0.01). PCA attempted and PCA given were lower in PCEA+PIEB group (p ≤ 0.05). Total consumption of solution until 8 hours postoperative was comparable in both groups but at 24 hours postoperative it was much greater in PCEA+PIEB group (p < 0.01). Conclusions: PCEA+PIEB have greater efficacy than PCEA. VAS (at resting and at moving), PCA attempted, and PCA given were lower in PCEA+PIEB group. Total consumption of solution RopivacaineFentanyl until 8 hours postoperative was comparable, but at 24 hours postoperative it was much greater in PCEA+PIEB group. In orthopedic surgery, VAS at resting was obtained below 30 mm in PCEA+PIEB group but VAS at moving was obtained in the category of moderate pain in both groups.
Non-Convulsive Status Epilepticus (NCSE) in ICU Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Ryalino, Christopher; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.5

Abstract

Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long,  associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes of. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended asthe first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis.  This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response.
Anesthesia on Pediatric Laproscopy Wiryana, Made; Sinardja, I Ketut; Kurniyanta, Putu; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Darma Junaedi, I Made; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.1

Abstract

Laparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patients age, cardiovascular function, and anesthetic agents are used. Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by insufflation gas or penetration laparoscopic and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery.
Central Venous Pressure Correlates with Inferior Vena Cava Collapsibility Index in Patient Treated in Intensive Care Unit Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Mahaalit Aribawa, I Gusti Ngurah; Gede Utara Hartawan, I Gusti Agung; Parami, Pontisomaya; Perangin Angin, Emkel
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.2

Abstract

Background: Intravascular volume status is an important parameter in monitoring the patients treated at intensive care unit (ICU), so accuracy and strict monitoring of fluid volume is one factor that influence patient’s health status. Amongst others, two ways to monitor body fluid volume status is central venous pressure (CVP) and collapsibility index of inferior vena cava (IVC) diameter. The purpose of this study is to determine the correlation between CVP with the IVC collapsibility index in patients treated in ICU Sanglah Hospital in Denpasar. Method: Seventy patients treated at Sanglah Hospital ICU with already inserted CVC for appropriate indication, were measured for CVP, then followed by examination the diameter of IVC with ultrasound to measure the maximum and minimum collapsibility index. Spearman’s correlation coefficients was used to assess the correlation between CVP and collapsibility index of the IVC. Results: In 70 patients, we found a very strong negative correlation between CVP and IVC’s collapsibility index (Spearmans rho = -0.854; p <0.001). Conclusion: This study found that there is a very strong negative correlation between CVP and collapsibility index of IVC. This finding indicates that the collapsibility index of the IVC may substitute CVP in determining the status of the intravascular volume.
The effectiveness of Patient Controlled Analgesia (PCA) morphine-ketamine compared to Patient Controlled Analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery Mahaalit Aribawa, I Gusti Ngurah; Agung Senapathi, Tjokorda Gde; Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Gede Widnyana, I Made; Aryabiantara, I Wayan; Parami, Pontisomaya; Nyoman Kurniasari, Pande; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.11

Abstract

Background: Laparotomy may cause moderate to severe after surgery pain, thus adequate pain management is needed. The addition of ketamine in patient controlled analgesia (PCA) morphine after surgery can be the option. This study aims to evaluate the effectiveness of PCA morphine-ketamine compared to PCA morphine in patient postoperative laparotomy surgery to reduce total dose of morphine requirement and pain intensity evaluated with visual analog scale (VAS). Methods: This study was a double-blind RCT in 58 patients of ASA I and II, age 18-64 years, underwent an elective laparotomy at Sanglah General Hospital. Patients were divided into 2 groups. Group A, got addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) and patients in group B received morphine (1mg/ml) by PCA. Prior to surgical incision both group were given a bolus ketamine 0,15mg/ kg and ketorolac 0,5mg/kg. The total dose of morphine and VAS were measured at 6, 12, and 24 hours postoperatively. Result: Total dose of morphine in the first 24 hours postoperatively at morphine-ketamine group (5,1±0,8mg) is lower than morphine only group (6,5±0,9mg) p<0,001. VAS (resting) 6 and 12 hour postoperative in morphine-ketamine group (13,4±4,8 mm) and (10,7±2,6 mm) are lower than morphine (17,9±4,1mm) p≤0,05 and (12,8±5,3mm) p≤0,05. VAS (moving) 6, 12, and 24 hour postoperative morphineketamine group (24,8±5,1mm), (18±5,6mm) and (9±5,6mm) are lower than morphine (28,7±5,2mm) p≤0,05, (23,1±6,0mm) p≤0,05, and (12,8±5,3mm) p≤0,05. Conclusions: Addition of ketamine in PCA morphine for postoperative laparotomy surgery reduces total morphine requirements in 24 hours compared to PCA morphine alone.
Effectiveness of Infusion Warmer Use to Prevent the Occurrence of Hypothermia and Shivering After General Anesthesia Action in General Hospital Center Sanglah Denpasar Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Kusuma Wijaya, Andi; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.3

Abstract

Introduction: Shivering and hypothermia after general anesthesia is a common complication in the recovery room. Heating methods and drugs  widely used, but not yet effective. The purpose of this study was to evaluate the effectiveness of using the infusion warmer in maintaining normal core temperature and prevent shivering. Materials and Methods: The study was a non blindnes randomized control trial study. This study aimed to compare the effectiveness of the use of infusion warmer in preventing the incidence of hypothermia and shivering after general anesthesia. Research conducted at the Sanglah Hospital in October 2016, with sample calculations 58 people who meet the inclusion and exclusion criteria. Both were divided into 2 groups, 29 groups of infusion warmer and 29 people without the infusion warmer Recording the results of assessing multiple parameters vital signs, hemodynamic, aldrette score, body temperature, and shivering from the beginning, after induction, and minutes to 5, 15, 30 , 60 in the recovery room. The data obtained were analyzed with SPSS software with a significance level of p <0.005 expressed significantly, with a relative risk <1 as a preventive. Results: From a comparative picture of events shivering and hypothermia in minutes to 5, 15, 30, 60 in the recovery room seen that the treatment group based on the group lower warmer than in the non warmer. This shows that the use of warmer can prevent the incidence of shivering and hypothermia in patients after general anesthesia. In test statistically significant with p <0.05. Conclusions: The use of infusion warmer can help reduce the incidence of hypothermia and shivering after general anesthesia action.
ANESTHESIA MANAGEMENT OF ESOPHAGEAL ATRESIA REPAIR SURGERY: A CASE REPORT Putra, Kadek Agus Heryana; Kurniyanta, Putu; Wiryana, Made; Sinardja, Ketut; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Cindryani, Marilaeta; Kurnia, Prajnaariayi Prawira
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.v2i2.31

Abstract

ABSTRACTEsophageal Atresia (EA)is a congenital anomaly commonly found with TracheoesophagealFistula (TEF) of neonates in the first week oflife. This anomaly can cause several complications includingaspiration, reduction in respiration, and other complication from other concomitant congenital anomaly, mostly from heart origin. The treatment for this anomaly is surgery.Intraoperatively, thepatient may develop hypoxia due to lung retraction and hemodynamic instability from bleeding or hypothermia. Anesthesiologists play important role in the management of EA during theperioperative period. Careful examination of the preoperative period must be done to discover any other concomitant anomaly and complication. Good anticipation of any complication during surgery and continuous monitoring post surgery can elevate the prognosis of the patient.
Low Dose Ketamin Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Novita Pradnyani, Ni Putu; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.4

Abstract

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Low-dose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psikomimetik like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.
Co-Authors - Yehezkiel - Yehezkiel, - Adinda Putra Pradhana Andi Kusuma Wijaya, Andi Christopher Ryalino Demoina, I Gede Patria Devina Martina Bumi Dewa Ayu Mas Shintya Dewi Elisma Nainggolan, Elisma Emkel Perangin Angin, Emkel Gede Semarawima, Gede Hari Bagianto I Gede Budiarta I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit Aribawa I Gusti Putu Sukrana Sidemen I Ketut Sinardja I Ketut Suastika I Made Agus Kresna Sucandra I Made Bakta I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Subagiartha I Nyoman Budi Hartawan I Nyoman Hariyasa Sanjaya I Putu Agus Surya Panji I Putu Fajar Narakusuma I Wayan Aryabiantara, I Wayan Ida Bagus Alit Saputra Ida Bagus Gde Sujana Ida Bagus Gde Sujana, Ida Bagus Gde Ida Bagus Krisna Jaya Sutawan Ida Bagus Okta IGNA Putra Arimbawa, IGNA Putra Kadek Agus Heryana Putra, Kadek Agus Ketut Semara Jaya, Ketut Semara Kristian Felix Wundiawan Kurnia, Prajnaariayi Prawira Made Adi Kusuma Made Agus Kresna Sucandra, Made Agus Kresna Made Widnyana Marilaeta Cindryani, Marilaeta Millenia Marting Ni Nyoman Sri Budayanti Ni Putu Novita Pradnyani, Ni Putu Ni Putu Wardani Pande Nyoman Kurniasari, Pande Pontisomaya Parami Putu Kurniyanta Putu Pramana Suarjaya Raka-Sudewi A. A. Sonni Soetjipto, Sonni Stefanus Taofik Tjahya Aryasa Tjokorda Gde Agung Senapathi Tjokorda Gde Agung Senapathi