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Perbandingan Gabapentin 600 mg dengan 1.200 mg per Oral Preoperatif terhadap Nilai Visual Analogue Scale dan Pengurangan Kebutuhan Petidin Pascaoperasi pada Modifikasi Mastektomi Radikal Zulfariansyah, Ardi; Nawawi, A. Muthalib; Bisri, Tatang
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Gabapentin mempunyai efek antihiperalgesia, antialodinia, dan antinosiseptif. Penelitian ini bertujuan untuk menilai efek gabapentin 600 mg dan 1.200 mg per oral preoperatif terhadap nilai visual analogue scale (VAS) dan pengurangan kebutuhan petidin pascaoperatif. Penelitian dilakukan secara uji acak terkontrol buta ganda terhadap 38 orang pasien di Rumah Sakit Dr. Hasan Sadikin Bandung pada MeiâSeptember 2010. Pasien dibagi menjadi dua kelompok yaitu kelompok gabapentin 600 mg dan gabapentin 1.200 mg. Penilaian skala nyeri dilakukan dengan menggunakan nilai VAS. Data hasil penelitian dianalisis menggunakan Uji Mann-Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila nilai p<0,05. Hasil penelitian didapatkan nilai VAS saat diam dan saat mobilisasi berbeda bermakna (p<0,05). Kelompok gabapentin 1.200 mg lebih sedikit diberikan analgetik petidin tambahan (10,5% vs 15,8%), tetapi perbedaan tersebut tidak bermakna (p=0,631). Simpulan penelitian ini adalah gabapentin 1.200 mg per oral preoperatif lebih baik bila dibandingkan dengan 600 mg dalam mengurangi nilai VAS pasca operatif pada operasi modifikasi radikal mastektomi, namun tidak mengurangi kebutuhan petidin.Kata kunci: Gabapentin 600 mg, Gabapentin 1.200 mg, visual analogue scale, kebutuhan petidin The Comparison between 600 mg and 1,200 mg Gabapentin per Oral Preoperatively on Visual Analog Scale and Reduction of Postoperative Pethidine Requirement on Modified Radical MastectomyAbstract Gabapentin is a GABA analog which has the effect of anti hyperalgesia, anti allodynia, and anti nociceptive. This research was conducted in order to assess the effect of 600mg and 1,200 mg gabapentin given preoperatively to assess visual analogue scale (VAS) score and reduction of pethidine requirement. The study was done by conducting a double blind randomized controlled trial on 38 patients, aged 18â65 years, with ASA physical status IâII. Patients were divided into two groups: 600 mg gabapentin and 1,200 mg gabapentin group. The quality of pain was assessed using VAS score. The results were statistically analyzed using Mann-Whitney Test with 95% confidence interval and considered significant if p value <0.05. From the results, the VAS values obtained at rest and during mobilization were significantly different (p<0.05). The 1,200 mg gabapentin group received less additional pethidine (10.5% vs 15.8%), although no significant difference was shown (p=0.631). The conclusion of this study is that administration of 1,200 mg gabapentin per oral pre operatively is better when compared to 600 mg in reducing post operative visual analog scale score in modified radical mastectomy. However, it do not reduce the need for analgesic significantly.Key words: 600 mg Gabapentin, 1.200 mg Gabapentin, post operative pethidine requirement, visual analog scaleÂ DOI: 10.15851/jap.v1n3.196

Penatalaksanaan Anestesi Pasien Transposition of the Great Arteries pada Operasi Mouth Preparation Nugraha, Ade Arya; Suwarman, -; Zulfariansyah, Ardi
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Transposition of the great arteries (TGA) disebabkan kegagalan pemisahan trunkus arteriosus, sehingga aorta keluar dari bagian anterior ventrikel kanan dan arteri pulmonal keluar dari ventrikel kiri. TGA termasuk kelainan jantung bawaan tipe sianotik. Seorang anak perempuan berusia 4 tahun datang untuk perawatan dan pencabutan gigi sebagai persiapan untuk operasi koreksi TGA di Rumah Sakit Dr. Hasan Sadikin Bandung pada Januari 2014. Anamnesis didapatkan riwayat kebiruan sejak bayi dan pada pemeriksaan fisis didapatkan anak yang tampak sianosis, SpO2 70â80%, murmur sistol, dan jari tabuh. Pada pemeriksaan ekokardiografi didapatkan kelainan TGA. Manajemen anestesi pada pasien ini dilakukan dengan menggunakan ketamin dan vekuronium untuk induksi serta pemeliharaan dengan O2 dan air, serta sevofluran. Manajemen anestesi dilakukan dengan target mencegah penurunan miring systemic vascular resistance (SVR) dibandingkan dengan pulmonary vascular resistance (PVR). Simpulan, prinsip pengelolaan perioperatif pembedahan nonkardiak pada pasien TGA adalah menjaga agar tidak terjadi penurunan SVR dan peningkatan PVR.Kata kunci: Kelainan jantung kongenital sianotik, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), transposition of the great arteries (TGA)Management of Anesthesia in Patients Transposition of the Great Arteries which Undergo Mouth PreparationTransposition of the great arteries (TGA) results from failure of the truncus arteriosus to spiral, so that the aorta arises from the anterior portion of the right ventricle and the pulmonary artery arises from the left ventricle. TGA which is the type of cyanotic congenital heart disease. A girl of 4 years came for treatment and tooth extraction as preparation for the surgical correction ofÂ TGA at the Dr. Hasan Sadikin Hospital âBandung within January 2014. Patient with a history of blue when she was a baby and on physical examination found the child looking cyanosis, SpO2 70â80%, sistolic murmur and clubbing finger. Abnormalities on echocardiography obtained TGA.Â Anesthetic management of this patients was performed using ketamine and vecuronium for induction and maintenance with O2, N2O, and sevoflurane. Cyanotic attacks can occur preoperative, intraoperative, and post operative, which was treated by increasing systemic vascular resistance (SVR) compared to pulmonary vascular resistance. In conclusions, perioperative management principal for non cardiac surgery on transposition of the great arteries (TGA) is to keep SVR from decline andÂ increase on PVR.Key words: Cyanotic congenital heart defects, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), transposition of the great arteries (TGA) âÂ DOI: 10.15851/jap.v2n2.320

Quality Assesment of Antibiotic Prescription for Sepsis Treatment in Intensive Care Unit at Top Referral Hospital in West Java, Indonesia Zulfariansyah, Ardi; Radhiyanti Santoso, Putri Teesa; Adani, Shadrina Dinan
Althea Medical Journal Vol 4, No 2 (2017)
Publisher : Althea Medical Journal

Background: Sepsis is a common disease in intensive care unit (ICU) with high mortality rate. Administration of antibiotic has an important role to determine the outcome of sepsis patient. This study aimed to evaluate the quality of antibiotic prescription for sepsis treatment in intensive care unit (ICU). Methods: This descriptive study was conducted by retrieving data from 48 medical records of patients with sepsis, severe sepsis, and septic shock admitted to ICUÂ Dr. Hasan Sadikin General Hospital (RSHS) in 2013. The study was conducted from August to October 2014. Empiric therapy in the ICUat RSHS and Surviving Sepsis Campaign (SSC) guidelines in 2012 were used as a standard for antibiotic prescription. The quality of antibiotic prescription was assessed then categorized based on Gyssens criteria. The collected data were analyzed in the form of frequency and percentage and presented in tables.Results: This study discovered that most of the patients had severe sepsis and septic shock. Based on Gyssens criteria, 35% antibiotic uses were included into category 0 (proper); 1.4% category I (improper timing); 10.5% category IIA (improper dosage); 9.1% category IIB (improper interval); 3.5% category IIC (improper route); 12.6% category IIIA (improper duration; too long); 1.4% category IIIB (improper duration; too short); 16.8% category IVA (improper; other antibiotics were more effective); 4.2% category IVD (improper; other antibiotics had narrower spectrum); and 5.6% category V (improper; no indication).Conclusions: There are still improper uses of antibiotic for sepsis, severe sepsis, and septic shock patients in the ICU.Â DOI:Â 10.15850/amj.v4n2.1088

Gambaran Tata Cara dan Angka Keberhasilan Penyapihan Ventilasi Mekanik di Ruang Perawatan Intensif Rumah Sakit Dr. Hasan Sadikin Bandung Sitorus, Richard Pahala; Fuadi, Iwan; Zulfariansyah, Ardi
Jurnal Anestesi Perioperatif Vol 4, No 3 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Penyapihan ventilasi mekanik adalah suatu proses pelepasan bantuan ventilator yang dilakukan secara bertahap atau langsung oleh seorang dokter Intensive Care Unit (ICU). Penelitian ini bertujuan mengetahui gambaran tata cara dan angka keberhasilan penyapihan ventilasi mekanik yang dilakukan di ICU Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung. Metode penelitian ini adalah deskriptif observasional prospektif dan merupakan studi cross sectional. Penelitian ini melibatkan 50 pasien yang dirawat di ICU RSHS Bandung pada bulan JuliâSeptember 2015. Data dicatat dan dikelompokkan sesuai dengan variabel karakteristik tata cara dan angka keberhasilan penyapihan ventilasi mekanik. Hasil penelitian ini menunjukkan tata cara penyapihan ventilasi mekanik yang paling banyak dilakukan adalah once daily trial of T piece sebanyak 22 pasien (44%) kemudian continous positive airway pressure (CPAP) sebanyak 40%, intermittent trial of T-piece sebanyak 10%, dan pressure support ventilation (PSV) 6%. Angka keberhasilan penyapihan ventilasi mekanik sebanyak 44 orang (88%) dan angka kegagalan penyapihan ventilasi mekanik adalah sebanyak 6 orang (12%) sehingga harus dilakukan re-intubasi. Tata cara penyapihan ventilasi mekanik yang paling banyak digunakan di ICU RSHS Bandung adalah once daily trial of T piece dan angka keberhasilan penyapihan ventilasi mekanik sebesar 88%.Kata kunci: Angka keberhasilan, tata cara penyapihan, ventilasi mekanikProcedures and Success Rate of Mechanical Ventilation Weaning in Intensive Care Unit of Dr. Hasan Sadikin General Hospital BandungAbstractMechanical ventilation weaning is a process of withdrawing ventilator assistance gradually or immediately by Intensive Care Unit (ICU) physicians. This study aimed to describe the procedure and the success rate of mechanical ventilation weaning performed at the ICU of Dr. Hasan Sadikin General Hospital (RSHS) Bandung. This was a cross-sectional descriptive prospective observational and study involving 50 patients treated at the ICU of RSHS Bandung during the period of July to September 2015. Data were recorded and classified in accordance with the variable characteristics of the procedure and the success rate of mechanical ventilation weaning. The results indicated that the most widely used mechanical ventilation weaning procedures were T-piece once daily trial in 22 patients (44%), continous positive airway pressure (CPAP) in 40%, T-piece intermittent trial in 10%, and pressure support ventilation (PSV)in 6%. Mechanical ventilation weaning success rate was 88% and the failure rate was 12% (6 patients) which required re-intubation. The most widely used procedure for mechanical ventilation weaning at the ICU of Dr. Hasan Sadikin General Hospital Bandung is T-piece once daily trial and the mechanical ventilation weaning success rate is 88%.Key words: Mechanical ventilation, success rate, weaning procedureÂ Â

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

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 JanuariâDesember 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 OktoberâDesember 2017. Hasil penelitian jumlah kematian akibat pneumonia nosokomial masih tinggi, yaitu 60% terutama pada pasien laki-laki usia â¥ 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 meropenemâlevofloxacin (40%), terapi tunggal meropenem (34,3%), dan kombinasi ceftazidime-levofloxacin (20%). Simpulan, pola pneumonia nosokomial di ICU RSUP Dr. Hasan Sadikin Bandung periode JanuariâDesember 2017 masih diperlukan perbaikan program penanganan terhadap infeksi ini untuk mencapai pelayanan yang baik.Kata kunci: Mikrob, mortalitas, pneumonia nosokomial, unit perawatan intensifÂ 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.Â 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 â¥ 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 meropenemâlevofloxacin combination (40%), meropenem (34.3%), and ceftazidimeâlevoflocacin 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 pneumoniaÂ

Perbandingan Angka Kejadian Batuk Pascabronkoskopi pada Kelompok Premedikasi Kombinasi Kodein 10 mg dan Klorfeniramin Maleat 4 mg dengan Premedikasi Tunggal Kodein 10 mg Saputra, Maulidar; Zulfariansyah, Ardi; Rismawan, Budiana
Majalah Kedokteran Bandung Vol 50, No 4 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v50n4.1512

Bronkoskopi merupakan tindakan esensial dalam penegakan diagnosis maupun terapetik pada saluran pernapasan. Beberapa penelitian menunjukkan kejadian batuk yang tinggi baik selama tindakan maupun setelah bronkoskopi. Saat ini belum ada konsensus tentang pemberian premedikasi yang optimal mengurangi kejadian batuk pada pasien yang menjalani bronkoskopi. Tujuan penelitian ini adalah mengetahui perbedaan efektivitas pemberian premedikasi kodein dengan kombinasi kodein-klorfeniramin maleat (CTM) dalam mengurangi batuk setelah bronkoskopi. Penelitian ini merupakan penelitian eksperimental yang dilakukan secara prospektif terhadap 52 subjek penelitian yang menjalani bronkoskopi di Rumah Sakit Paru Rotinsulu pada bulan Desember 2017â€“Februari 2018. Pada penelitian ini data numerik diuji dengan uji t tidak berpasangan, untuk data kategorik diuji dengan uji chi-square. Hasil penelitian ini didapatkan angka kejadian batuk pascabronkoskopi pada kelompok pasien yang diberikan premedikasi dengan kombinasi kodein 10 mg dan CTM 4 mg lebih rendah dibanding dengan kelompok yang diberikan premedikasi tunggal dengan kodein 10 mg pada semua pengukuran dengan perbedaan bermakna (p<0,05). Simpulan penelitian ini adalah pemberian premedikasi dengan kombinasi kodein 10 mg dan CTM 4 mg lebih efektif menurunkan kejadian batuk pascabronkoskopi dibanding dengan premedikasi tunggal Kodein 10 mg.Kata kunci: Batuk pascabronkoskopi, premedikasi kodein, premedikasi kodein-CTMÂ Comparison of Postbronchoscopic Cough Incidence betweeb Patients Premedicated with 10 mg CodeineÂ and 4 mg Chlorpheniramine Maleate Combination and premedicated with 10 mg Codeine OnlyBronchoscopy is an essential airway procedure for diagnostic and therapeutic purposes that could cause discomfort and complications. Some studies have shown that cough complaint is often made during and after the procedure. There is no consensus that explains how to optimally premedicate a patient to reduce cough. The objective of this study was to understand the difference in the effectiveness of codeine and codeine and chlorpheniramine maleat (CTM) combination as a premedication to prevent coughing after bronchoscopy. This was a double blind, prospective experimental study in Rotinsulu Pulmonary Hospital from December 2017 to February 2018. Fifty two patients who were undergoing bronchoscopy under general anesthesia were randomly allocated to codeine group (n=26) andÂ Codeine-CTM Group (n=26). It was showed that the incidence of cough after bronchoscopy in the group using combination of 10 mg Codeine and 4 mg CTM premedication was lower than in the group with 10 mg Codeine premedication in all measurements. Therefore, premedication using 10 mg codeine and 4 mg CTM combination is more effective to reduce the incidence of cough after bronchoscopy when compared to the single premedication with codeine 10 mg.Key words: Postbronchoscopic cough, premedication with codeine, premedication with codeine-CTM

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