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Hubungan Rasio Neutrofil Limfosit terhadap Mortalitas di General Intensive Care Unit RSUP Dr. Mohammad Hoesin Palembang Muhammad David Riandy; Bernhard Arianto Purba; Yusni Puspita; Rizal Zainal; Legiran Siswo
Jurnal Anestesi Perioperatif Vol 7, No 3 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Rasio neutrofil limfosit adalah metode yang cepat dan sederhana untuk mengevaluasi stres peradangan dan memprediksi mortalitas di ruangan intensif. Penelitian ini bertujuan mengetahui hubungan rasio neutrofil-limfosit dengan mortalitas ≤28 hari di ruangan rawat intensif. Penelitian ini menggunakan desain penelitian cross sectional berdasarkan data sekunder rekam medis dengan sampel semua pasien yang dirawat di ICU RSUP Dr. Mohammad Hoesin Palembang dari Januari–Desember 2018. Didapatkan total sampel sebanyak 562 sampel, dan sebanyak 347 yang memenuhi kriteria inklusi. Pada uji analisis regresi diagnosis, kelompok usia, jenis kelamin dan terapi terhadap nilai rasio neutrofil limfosit, didapatkan bahwa diagnosis merupakan faktor risiko yang dapat memengaruhi nilai rasio neutrofil limfosit (p=0,001). Pada distribusi subjek berdasarkan rasio neutrofil limfosit terhadap mortalitas terdapat rerata rasio neutrofil limfosit pada kelompok yang meninggal adalah 17,75±15,06 dan rerata rasio neutrofil limfosit subjek pada kelompok yang hidup adalah 13,63±10,71. Dilakukan Uji Mann-Whitney dan didapatkan bahwa terdapat perbedaan rerata antara rasio neutrofil limfosit antara kelompok yang hidup dan meninggal dengan nilai p=0,009. Simpulan, rasio neutrofil limfosit merupakan salah satu biomarker yang dapat memprediksi mortalitas pada pasien di ICU RSUP Dr. Moh. Hoesin Palembang. Relation between Neutrophil-to-Lympocyte Ratio and ≤28 day Mortality in General Intensive Care Unit of Dr. Mohammad Hoesin General Hospital PalembangNeutrophil lymphocyte ratio is a fast and simple method for evaluating inflammatory stress and predicting mortality in intensive care. The purpose of this study was to determine the relationship between the ratio of neutrophils to lymphocytes to ≤28 day mortality in the intensive care unit. This was a crosssectional study on secondary data collected from medical records of all patients treated at the ICU of Dr. Mohammad Hoesin General Hospital Palembang during the period of January–December 2018. A total sample of 562 samples was obtained and 347 of them met the inclusion criteria. When diagnosis, age group, gender, and therapy for neutrophil-lymphocyte ratio value were subjected to regression analysis, it was revealed that diagnosis was a risk factor that could affect the neutrophil-lymphocyte ratio value (p=0,001). When subject distribution was assessed based on neutrophil lymphocyte ratio to mortality, an average neutrophil lymphocyte ratio of 17.75±15.06 was observed in the deceased group while the average ratio in survived patients was 13.63±10.71. Mann-Whitney test was then performed and a difference in the neutrophil to lymphocyte ratio was found between the survived and deceased groups with a p value of 0.009. In conclusion, neutrophil to lymphocyte ratio can be used as one of the biomarkers that can predict mortality in patients treated in intensive care unit.

Korelasi Modified Nutric Score Dengan Mortalitas 28 Hari Pasien Sepsis Di Unit Perawatan Intensif Rsup Dr. Mohammad Hoesin Palembang Rieke Cahyo Budi Utami; Zulkifli Zulkifli; Rizal Zainal; Muhammad Irsan Saleh
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Malnutrisi merupakan masalah penting pada pasien sepsis karena memperburuk outcome akibat penyembuhan luka terganggu, menurunkan fungsi imun, risiko infeksi tinggi, kelemahan otot sehingga weaning ventilator mekanik lebih sulit, meningkatkan lama tinggal dan biaya tinggi di unit perawatan intensif serta peningkatan mortalitas. Skrining risiko nutrisi saat pasien masuk unit perawatan intensif dengan modified NUTRIC score dapat mengidentifikasi kelompok risiko nutrisi tinggi atau risiko rendah. Penelitian kohort retrospektif untuk mengetahui korelasi antara modified NUTRIC score dengan mortalitas pada pasien sepsis yang dirawat dari Januari‒Desember 2018 di RSUP Dr. Mohammad Hoesin Palembang. Jumlah sampel 100 orang, dibagi 2 kelompok berdasarkan mortalitas, kemudian dilakukan pengukuran modified NUTRIC score yang terdiri dari usia, skor APACHE II, skor SOFA, lama rawat sebelum masuk perawatan intensif, dan jumlah komorbid. Modified NUTRIC score memiliki nilai 0‒9. Hasil analisis ROC curve modified NUTRIC score dengan mortalitas didapatkan sensitiftas sebesar 96%, spesifisitas 71%, nilai area under the curve (AUC) 0,916 dengan nilai cut off >4. Terdapat korelasi antara modified NUTRIC score dengan mortalitas dalam 28 hari pasien sepsis dengan koefisien korelasi (r)=0,716 dan nilai p=0,0001. Correlation of Modified Nutric Score with 28-Day Mortality in Sepsis Patients at Intensive Care Unit of Dr. Mohammad Hoesin General Hospital PalembangMalnutrition is an essential problem to septic patients because it worsens the outcome due to impaired wound healing, decreases immune function, high risk of infection, and muscle weakness so that mechanical ventilator weaning is more complicated. Also, it increases the patient length of stay and costs in the intensive care unit and increases mortality. Nutrition risk screening on patients’ admission to the intensive care unit with modified NUTRIC score can identify groups of high nutritional risk or low risk. The retrospective cohort study aimed to determine the correlation between modified NUTRIC score and mortality in sepsis patients treated from January-December 2018 at dr. Mohammad Hoesin General Hospital Palembang. The total sample of 100 people was divided into 2 groups based on mortality then measured with modified NUTRIC score consisting of age, APACHE II score, SOFA score, length of stay before admission to the intensive care, and the number of comorbid based on data from medical records. Modified NUTRIC score has a value of 0‒9. The ROC curve modified NUTRIC score with mortality was 96% sensitivity, 71% specificity, area under curve (AUC) value 0.916 with a cut-off value >4. There is a correlation between the modified NUTRIC score and mortality in 28 days in sepsis patients in the Intensive Care Unit of Dr. Mohammad Hoesin General Hospital Palembang with a correlation coefficient (r) = 0,716 and p value <0,05.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia Aidyl Fitrisyah; Rizal Zainal; Edi Darwis
Archives of The Medicine and Case Reports Vol. 2 No. 3 (2021): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v2i3.24

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy. Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesiatechnique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted. Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Efficacy of Lidocaine and Ketamine Combination on Reduction of Pain Intensity, Improvement of Functional State and Central Desensitization of Chronic Low Back Pain Henry Sugiharto; Hasnawi Haddani; Yuki Fitria; Rizal Zainal
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 4 No. 4 (2020): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v4i4.167

Abstract Background: Chronic low back pain (LBP) prevalence is approximately 20% of world population. Central and peripheral sensitization are considered as the main mechanism of pain chronification. This study hypothesize that lidocaine and ketamine combination reduces pain intensity, improves functional state and central desensitization of chronic low back pain. It is by modulating central sensitization in sub-anesthetic dose, prolonging inactivation of Na-channel, blocking NMDA-receptor and preventing secondary hyperalgesia. Aim of study: To evaluate the efficacy of lidocaine and ketamine combination on the intensity of pain, functional state and central desensitization of chronic low back pain. Methods:. This double blind randomized control trial study was carried out in Mohammad Hoesin General Hospital, Palembang, Indonesia from May 2018 to January 2019. A total of 20 patients with low back pain that last for more than 3 months, aged >18 years old, of either sex who were willing to be enrolled in this study, were randomly allocated into one of the two groups of 10 each. The treatment group (n=10) received standardized therapy (analgesic and physiotherapy) + intravenous ketamine 0.5 mg/kg + lidocaine 2 mg/kg and the control group (n=10) received standardized therapy + 100 ml Nacl 0.9%. Pain intensity, functional state, and central desensitization were measured before the treatment, day 7 after treatment, and a month after treatment using Numeric Pain Rating Scale (NPRS), Functional Pain Scale (FPS), and Central Sensitization Inventory (CSI). Results: The administration of ketamine 0.5 mg/kg + lidocaine 2 mg/kg resulted in NPRS and CSI changes was effective since the 7th day post intervention (p-value=0.021 and p-value=0.001) while on FPS changes, it was effective since the 30th day post intervention (p-value=0.000) Conclusion: From the result, it could be concluded that the administration of ketamine and lidocaine is effective on decreasing pain intensity and central desensitization in chronic LBP.

Correlation of Platelet-Lymphocyte Ratio (PLR) as 28-Days Sepsis Mortality Predictor in Intensive Care Unit of RSMH Palembang Tiara Santi Rizal; Fredi Heru Irwanto; Rizal Zainal; Mgs Irsan Saleh
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. Inflammatory and anti-inflammatory response are important in pathophysiology and mortality of sepsis. Platelet as first line inflammatory marker was found increasing during early phase of infection. Decrease in lymphocyte was caused by disrupted balance between inflammatory and anti-inflammatory response. Platelet-to- lymphocyte ratio (PLR) is a cheap and accessible biomarker of sepsis mortality. This study aims to find the sensitivity and specificity of PLR as mortality predictor of sepsis in 28 days. Methods. This observational analytic study with retrospective cohort design was conducted to 91 sepsis patients in intensive care unit of Dr. Mohammad Hoesin Palembang Central Hospital between January and December 2019. Samples were secondarily collected from medical record during June-July 2020. Data was analyzed using chi-square test, cog regression test, and ROC curve analysis. Results. The result found 50 patients (54,9%) died in 28 days. Morbidity score (Charlson) was the only statistically significant mortality parameter (p=0,009). The study reported PLR cut-off point of >272,22. The sensitivity and specificity of PLR as 28-days sepsis mortality predictor are 84% and 80,49% respectively. Conclusion. PLR is alternatively reliable mortality predictor in sepsis patient, accounted to its relatively high sensitivity and specificity.

Suitability of CPOT and BPS to Assess Pain Response in Intubated Mohammad Hoesin Hospital Intensive Care Patients Dwi Darmanto; Agustina Br Haloho; Rizal Zainal; Erial Bahar
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Background. Assessing pain in mechanically ventilated patients is an important thing for leads to improved outcome and better quality life of patients in the ICU. CPOT and BPS has been developed for measuring nonverbal patients. Aims. To validate suitability the use of CPOT and BPS in ICU RSMH. Methods. Observational analytic with cross sectional design was chosen for 50 samples conducted on July 2020 in ICU RSMH. Data was collected before and after pain procedure. Result. From 50 patients mostly 27(54%) male with age majority > 30 years old 39 (78%). The lowest GCS 2 and the highest 10. Length of treatment in ICU was 1 – 20 days. Bleeding variations was 0 - 1200 cc. BPS average before painful procedure was 2 – 5 and after panful procedure was 5 – 7. CPOT average before painful procedure was 1 – 6 and after painful procedure was 3 - 8. Kappa before painful procedure are moderate (kappa=0,435) and after painful procedure are fair (kappa=0,248) with strongly correlated in Pearson correlation (r = 0,644, r = 0,610) (p < 0,05). Conclusion. This study demonstrated that CPOT more detail than BPS for measuring pain in intubated patients.

Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report Anugerah Ade Periambudi; Rizal Zainal; Mayang Indah Lestari
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH). Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care. Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

Oxycodone 5 Miligram is More Effective Than Ketorolac 30 Miligram in Suppressing Cortisol Levels During General Anesthesia Kelvin; Rizal Zainal; Irwanto FH; Erial Bahar
Journal of Anesthesiology and Clinical Research Vol. 2 No. 1 (2021): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Background: Preemptive analgesia is a developing clinical concept, which involves administering analgesics before pain stimulation occurs, to prevent the sensitization of the nervous system to further stimuli that can cause pain. Ketorolac has strong analgesic properties oxycodone is a semisynthetic opioid that is synthesized from the alkaloid thebaine opiate. Pain could induce stress hormone such as cortisol. Study to compare ketorolac and oxycodone with cortisol has not been investigated. This study aimed to assess intravenous administration of ketorolac 30 mg compared with intravenous 5 mg oxycodone for pain as measured by cortisol levels post-intervention in surgery performed under general anesthesia. Method: A study randomized controlled trial in double-blind form for patients at dr. Mohammad Hoesin Palembang, who will undergo elective surgery with general anesthesia at the Central Surgical Installation building, with the period September-October 2020. There are 24 study samples, to anticipate dropouts, an added sample size is 10%, so the sample size is 26 for each treatment group. The selection of subjects according to the purpose of the study was carried out by simple random. Data analysis using SPSS ver 22.0 software. Data were analyzed using Independent T-Test, Mann Whitney, and Chi-Square Test. Result: The results showed, there was a significant difference in the effectiveness of intravenous administration of ketorolac 30 mg and intravenous oxycodone 5 mg on pain as measured by cortisol levels in patients undergoing general anesthesia at dr. Mohammad Hoesin Palembang (p = 0.013). The value of cortisol levels in pre- operative patients who will be given general anesthesia at dr. There was no statistically significant difference between Mohammad Hoesin in the two groups (p = 0.107). The value of cortisol levels in preoperative patients who were given ketorolac 30 mg intravenously at dr. Mohammad Hoesin was 9.90 ± 4.2. The value of cortisol levels in postoperative patients who were given ketorolac 30 mg intravenously at dr. Mohammad Hoesin was 17.75 ± 6.08. The value of preoperative cortisol levels for patients who were given oxycodone 5 mg intravenously at dr. Mohammad Hoesin was 12.03 ± 5.10. The value of postoperative cortisol levels for patients who were given oxycodone 5 mg intravenously at dr. Mohammad Hoesin is 14.50 ± 4.75. Conclusion: There was a significant difference in the effectiveness of intravenous administration of ketorolac 30 mg and oxycodone 5 mg intravenously on BSS levels (p = 0.005) and VAS scores (p = 0.001) who underwent general anesthesia at dr. Mohammad Hoesin Palembang.

Preemptive Ketorolac is as Effective as Oxycodone Decreasing Plasma Cortisol Levels in Patients Undergoing Spinal Anesthesia Rizal Zainal; Nugraha Heryadi; Agustina Br Haloho; Erial Bahar
Journal of Anesthesiology and Clinical Research Vol. 2 No. 1 (2021): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction: Post-surgical pain is a complex problem, if not treated properly it can have multisystem negative effects. Hormone cortisol can be increased in stressful situations. A study on the effectiveness of ketorolac and another opioid on cortisol levels has been shown. However, a study about the effect of oxycodone on cortisol levels and its comparison with Ketorolac has never been done before. This study aimed to compare the effect of preemptive administration of 30 mg ketorolac and 5 mg oxycodone on plasma cortisol levels in patients undergoing spinal anesthesia. Methods: A double-blind randomized clinical trial was carried out between October and December 2020 in the central operating room of dr. Mohammad Hoesin Palembang. Surgical patients according to the inclusion criteria who received spinal anesthesia were randomly given 5 mg oxycodone and 30 mg ketorolac intravenously shortly after spinal anesthesia. Cortisol levels were measured before and after the intervention. Data analysis using SPSS ver. 20 Windows with a 95% confidence interval. Result: In total, 56 subjects were included. 29 samples in the ketorolac group and 27 samples in the oxycodone group. There were no significant differences in age, sex, nutritional status, blood sugar, and VAS score. There was no significant difference in the mean of cortisol levels before the intervention in the ketorolac group 12.9421 + 6.096 m/dL and the oxycodone group 14.033 + 4.315 m/dL (p = 0.446). The mean value of cortisol levels after intervention in the ketorolac group was 12.979 + 6.280 m/dL and oxycodone 15.353 + 11.704 m/dL, there was no significant difference in changes in cortisol before and after intervention in the Ketorolac group (p = 0.692) and Oxycodone (p = 0.552). The comparison level of cortisol changes between the two groups was not significantly different (p = 0.267). Conclusion: There was no difference in the comparison of the effect of preemptive administration of 30 mg IV ketorolac and 5 mg IV oxycodone on plasma cortisol levels in patients undergoing spinal anesthesia.

Efficacy of Lidocaine and Ketamine Combination on Reduction of Pain Intensity, Improvement of Functional State and Central Desensitization of Chronic Low Back Pain Henry Sugiharto; Hasnawi Haddani; Yuki Fitria; Rizal Zainal
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 4 No. 4 (2020): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v4i4.167

Abstract Background: Chronic low back pain (LBP) prevalence is approximately 20% of world population. Central and peripheral sensitization are considered as the main mechanism of pain chronification. This study hypothesize that lidocaine and ketamine combination reduces pain intensity, improves functional state and central desensitization of chronic low back pain. It is by modulating central sensitization in sub-anesthetic dose, prolonging inactivation of Na-channel, blocking NMDA-receptor and preventing secondary hyperalgesia. Aim of study: To evaluate the efficacy of lidocaine and ketamine combination on the intensity of pain, functional state and central desensitization of chronic low back pain. Methods:. This double blind randomized control trial study was carried out in Mohammad Hoesin General Hospital, Palembang, Indonesia from May 2018 to January 2019. A total of 20 patients with low back pain that last for more than 3 months, aged >18 years old, of either sex who were willing to be enrolled in this study, were randomly allocated into one of the two groups of 10 each. The treatment group (n=10) received standardized therapy (analgesic and physiotherapy) + intravenous ketamine 0.5 mg/kg + lidocaine 2 mg/kg and the control group (n=10) received standardized therapy + 100 ml Nacl 0.9%. Pain intensity, functional state, and central desensitization were measured before the treatment, day 7 after treatment, and a month after treatment using Numeric Pain Rating Scale (NPRS), Functional Pain Scale (FPS), and Central Sensitization Inventory (CSI). Results: The administration of ketamine 0.5 mg/kg + lidocaine 2 mg/kg resulted in NPRS and CSI changes was effective since the 7th day post intervention (p-value=0.021 and p-value=0.001) while on FPS changes, it was effective since the 30th day post intervention (p-value=0.000) Conclusion: From the result, it could be concluded that the administration of ketamine and lidocaine is effective on decreasing pain intensity and central desensitization in chronic LBP.

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