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Manajemen Anestesia pada Operasi Reseksi Malformasi Arteri Vena Otak Januarrifianto, Desy; Auerkari, Aino Nindya; Firdaus, Riyadh
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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AbstrakMalformasi arteri-vena otak, atau cerebral arteriovenous malformation (AVM) merupakan kondisi yang jarang, namun morbiditas neurologis dan mortalitasnya bermakna. Salah satu pilihan terapi untuk AVM adalah operasi reseksi dengan bedah mikro. Perhatian khusus untuk ahli anestesia pada operasi ini adalah upaya mencegah iskemia sekunder jaringan otak dengan mempertahankan hemodinamik stabil agar tekanan perfusi otak sedekat mungkin dengan nilai normal, mengupayakan agar tidak terjadi pembengkakan otak dan mengantisipasi perdarahan. Di laporan ini, kami menjabarkan manajemen anestesia pada laki-laki 22 tahun dengan AVM simtomatik yang menjalani operasi reseksi AVM pada tanggal 10 April 2012 di Instalasi Bedah Pusat RS dr. Cipto Mangunkusumo, dan mengalami perdarahan akibat ruptur arteri intraoperasi. Kata kunci: Anestesia, AVM, malformasi arteri-vena, operasi reseksi Cerebral arteriovenous malformation (AVM) is a rare vascular condition carrying significant neurologic morbidity and mortality. Among the treatment options are surgical resection using microsurgery technique. Special anesthetic consideration in this type of surgery is on preventing secondary ischemia of brain tissue by maintaining stable haemodynamics to achieve as normal cerebral perfusion pressure as possible, preventing cerebral edema and anticipating hemorrhage. In this report, we describe the anaesthetic management of a 22 year-old male presenting with symptomatic AVM, who underwent surgical resection on April 10th 2012 in Central Operating Theater of RS dr. Cipto Mangunkusumo, and experienced intraoperative bleeding from an arterial rupture. Key words: Anesthesia, arteriovenous malformation, AVM, surgical resection

Glasgow Coma Scale in Predicting the Outcome of Patients with Altered Consciousness in Emergency Department of Cipto Mangunkusumo Hospital tantri, aida; Wahyu, Ismail Hari; Firdaus, Riyadh
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Penurunan kesadaran harus ditangani dengan tepat untuk mengurangi kerusakan lebih lanjut. Glasgow coma scale (GCS) digunakan untuk menilai tingkat kesadaran pada pasien dan memprediksi outcome pasien. Penelitian ini bertujuan untuk mengetahui ketepatan Glasgow coma scale memprediksi outcome pada pasien dengan penurunan kesadaran di Instalasi Gawat Darurat RSUPN Cipto Mangunkusumo. Penelitian ini merupakan studi observasional, kohort prospektif pada 116 pasien usia ≥8 tahun dengan GCS dibawah 15 saat tiba di IGD RSCM Jakarta. Skor GCS dinilai sebanyak 1 kali ketika pasien pertama diterima. Peneliti mengevaluasi outcome dua minggu setelah perawatan dengan menggunakan kriteria GCS. Bad outcome (meninggal dan disabilitas berat) dijumpai pada 66 pasien (56,9%) dan good outcome (disabilitas sedang dan sembuh) pada 50 pasien (43,1%). Skor GCS kelompok bad outcome berbeda bermakna dengan kelompok good outcome berdasarkan analisis statistik (p<0,001). Skor GCS-E, GCS-M dan GCS-V masing-masing pasien kelompok bad outcome berbeda bermakna dengan kelompok good outcome berdasarkan analisis statistik (p<0,001). Dari hasil analisis regresi logistik, komponen GCS yang memiliki nilai prediksi terhadap outcome adalah komponen verbal dan membuka mata. Skor glasgow coma scale mampu memprediksi outcome dengan tepat pada pasien dengan penurunan kesadaran di Instalasi Gawat Darurat RSUPN Cipto Mangunkusumo. Kata kunci: Glasgow coma scale, glasgow outcome scale, penurunan kesadaran Altered consciousness must be managed immediately to reduce further damage. Glasgow Coma Scale (GCS) is used to assess the level of consciousness in citically ill patients. GCS serves as the predictor of patient outcomes. The objective of this study was to determine the accuracy of GCS in predicting outcome of patients with altered level of consciousness in Emergency Department of Cipto Mangunkusumo Hospital. This observational prospective cohort study enlisted 116 patients aged ≥18 years with GCS below 15 in the Emergency Department of Cipto Mangunkusumo Hospital. GCS was assessed at admission then it was reviewed 2 weeks after in order to assess outcome. GCS scores were classified into bad outcome (death and severe disability) and good outcome (moderate disability and good recovery). Bad outcome were found in 66 patients (56.9%) and good outcome in 50 patients (43.1%). GCS score were different significantly between both groups (p<0.001). Each of patient’s GCS-E, GCS and GCS-M-V in bad outcome groups differed significantly with good outcome group (p <0.001). Based on logistic regression analysis, verbal and eye components served a predictive value for the outcome. Glasgow Coma Scale can predict outcome in patients with altered level of consciousness. Key words: Altered consciousness, glasgow coma scale, glasgow outcome scale Reference Bhardwaj A, Kornblunth J. Evaluation of coma: a critical appraisal of popular scoring systems. Neurocrit Care. 2010;3:1−10. Jennett B. Development of Glasgow coma and outcome scale. Nepal J Neurosci. 2005;2:24−8. Maheswaran M, Adnan W, Ahmad R, Rahman A, Naing N, Abdullah J. The use of an in house scoring system scale versus Glasgow coma scale in non-traumatic altered states of consciousness patients: can it be used for triaging patients in Southeast Asian developing countries? Southeast Asian J Trop Med Public Health. 2007;38(6):1126−40. Bates D. The prognosis of medical coma. J Neurosurg Psychiatry. 2001;71:i20−3. Ting HW, Chen MS, Hseih TC, Chan CL. Good mortality prediction by Glasgow coma scale for neurosurgical patients. J Chin Med Assoc. 2010;73(3):139−43. Miah T, Hoque A, Khan R. The Glasgow coma scale following acute stroke and inhospital outcome: an observational study. J Medicine. 2009;10(1):11−4. Levati A, Farina ML, Vecchi G, Rossanda M, Morrubini M. Prognosis of severe head injuries. J Neurosurg. 1982;57:779−83. Jagger J, Jane JA, Rimel R. The Glasgowcoma scale: to sum or not to sum? Lancet. 1983;2:97. McNett M. A review of the predictive ability of Glasgow coma scale scores in head-injured patients. J Neurosci Nurs. 2007;39:68−75. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR Score. Ann Neurol. 2005;58:585−93. Budiman. Kegawatdaruratan Medik di Bidang Ilmu Penyakit Dalam: penatalaksanaan umum koma. Dalam: Aru Sudoyo, Bambang Setiyohadi, Idrus Alwi Marcellus Simadibrata, Siti Setiati, editor. Buku Ajar Ilmu Penyakit Dalam. Edisi ke-4. Jakarta: Pusat Penerbitan Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia; 2006. Hlm.161−3. Settervall CH, Sousa RM, Silva SC. Inhospital mortality and the Glasgow coma scale in the first 72 hours after traumatic brain injury. Rev Latino-Am Enfermagem. 2011;19(6):1337−43.

Perbandingan Kemudahan Pemasangan Laryngeal Mask Airway antara Teknik Baku disertai Penekanan Lidah dengan Teknik Baku Marsaban, Arif HM; Martaria, Nency; Firdaus, Riyadh; Cahyadi, Arief
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Laryngeal mask airway (LMA) merupakan suatu alat bantu jalan napas. Teknik baku pemasangan LMA disertai penekanan lidah memberikan angka keberhasilan pemasangan 100%. Penelitian ini bertujuan membandingan kemudahan dan komplikasi pemasangan LMA menggunakan teknik baku dengan penekanan lidah dibandingkan dengan teknik baku. Penelitian ini merupakan studi uji klinis acak tersamar tunggal yang dilakukan antara Mei – Juni 2013 di RSCM, pada 80 pasien dewasa yang menjalani operasi elektif dengan anestesia umum menggunakan LMA. Pada 40 pasien mengalami pemasangan LMA dengan teknik baku disertai penekanan lidah dan 40 pasien dengan teknik baku. Upaya pemasangan dan kemudahan dicatat dan dinilai. Pemasangan mudah bila ≤2 kali. Komplikasi pemasangan berupa noda darah, nyeri menelan dan nyeri tenggorokan dicatat dan dinilai. Analisis statistik dilakukan dengan uji chi-kuadrat dan eksak fisher. Batas kemaknaan untuk semua uji adalah p <0,05. Perbandingan proporsi keberhasilan upaya pemasangan pertama dan kedua antara kelompok teknik baku disertai penekanan lidah dan teknik baku adalah 87,5% banding 65% dan 100% banding 97,5%, secara berurutan. Pemasangan LMA dengan teknik baku disertai penekanan lidah tidak lebih mudah dibanding dengan teknik baku. Kekerapan komplikasi yang berbeda bermakna berupa noda darah 0% pada teknik baku disertai penekanan lidah dan 6,2% pada teknik baku. Kata kunci: Kemudahan pemasangan, komplikasi, laryngeal mask airway, teknik baku disertai penekanan lidah, teknik baku LMA is one of the airway management device. Novel technique of LMA insertion combined with tongue supression technique resulted in 100% succes rate of insertion. The objective of this study was to compare easiness and complications of inserting LMA using classic approach combined with tongue supression and classic approach. This study was a single-blind randomized clinical trial conducted from May ̶June 2013 in RSCM on 80 adult patients who underwent elective surgery with general anesthesia using LMA. In 40 patients underwent LMA insertion with classic approached combined with tongue supression technique and 40 patients with classic approached. Effort and success rate was noted and evaluated. Insertion was considered easy if the insertion was attempted maximally twice. Complications such as blood stains, sore throat, and dysphagia was noted and evaluated. Statistical analysis conducted by Chi-square Test and Fischer Exact. P <0,05 was considered significant. Proportion of first and second attempt LMA insertion between both technique was 87,5% compared with 65% and 100% compared with 97,5%, respectively. LMA insertion with classic approached combined with tongue supression technique was not easier than with classic approached technique. Complication which statistically significant different was blood stains 0% with classic approached combined with tongue supression technique compared with 6,2% classic approached technique. Key words: Classic approached combined with tongue supression, classic approached technique easy installation complications, laryngeal mask airway Reference Sinha PK, Misra S. Supraglottic airway devices other than LMA and its prototypes. Indian J anaesth. 2005;49(4):281–92. Hein C, Owen H, Plummer J. Randomized comparison of the SLIPA and the SS-LM by medical students. Emergency Medicine Australasia. 2006;18:478–83. Basket PJF, Brain AIJ, Handbook of the use of LMA in CPR. Intavent. 1998:1–14. Hein C. The Prehospital practitioner and the LMA: are you keeping Up?. J Emerg Primary Health Care. 2004:2; 1–2. Brimacombe JR, Berry AM, Daves SM, The LMA, Airway Management. Dalam: Hanowel LH, Penyunting Lippincott: Raven Publishers, Philadelphia;1996. Hlm.195–221. Rieger A, Brunne B, Striebel W. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events, a prospective randomize trial. Anesthesiol. 2010; 112:652–7. Park PG, Choi GJ, Kim WJ, Yang SY, Shin HY, Kang H, dkk, A comparative study among normal saline, water soluble gel and 2% lidocaine gel as a SLIPA lubricant, Korean J Anesthesiol. 2014 February; 66(2): 105–111. Hein C. The prehospital practitioner and the laryngeal mask airway: “Are you keeping up?”. Austral Jo Paramed. 2004:2 (1) Vaida S. Airway management-Supraglotic Airway Devices. Timisoara. 2004. Strydom C, Le Roux. A clinical comparison of disposable airway devices. SAJAA. 2008; 14(6):31–36. Andre AZ. Comparison of the LMA-Classic with the new disposable soft seal laryngeal mask in spontaneously breathing adult patients. Anesthesiology. 2003;99:1066–71. Keijzer C, Buitelaar D. A Comparison of postoperative throat and neck complaints after the use of I-gel and the La Premiere Disposable laryngeal mask: a double-blinded, randomized, controlled trial. Anaesth Analg 2009; 109(4);1092–4. Cook TM, Gatward et al. A Cohort evaluation of the I-Gel airway in 100 elective patients. J Association Anaesthetists Great Britain Ireland 2008;63:1124–30. Roodneshin F, Agah M, Novel technique for placement of LMA in difficult pediatric airways. Tanaffos.2011;10(2):56–8. Mun’im A. Perbandingan dua macam teknik pemasangan sungkup laring pada penderita operasi elektif di RSUPN-CM tahun 1997. [Tesis]. Jakarta: Departemen Anestesiologi dan Terapi Intensif FKUI/RSCM. 1997. Payne FB, Wilkes NC. A prospective study of two insertion techniques of the laryngeal mask airway. Anesthesiol. 1996;85:3A. Malayanti. Keberhasilan pemasangan sungkup laring: perbandingan antara teknik baku dengan teknik putar 180o pada pasien operasi elektif. [Tesis]. Jakarta: Departemen Anestesiologi dan Terapi Intensif FKUI/ RSCM. 2002. Brimacombe J, Berry AM, Insertion of the LMA A Prospective Study of Four Techniques. Anaesth Intens Care. 1993;21:89–92 (4).

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

Perbandingan Efektivitas Tablet Hisap Amylmetacresol-dibenal dengan Profilaksis Deksametason Intravena Sebelum Pemasangan Pipa Endotrakeal untuk Mengurangi Kekerapan Nyeri Tenggorok Pascaoperasi Harijanto, Eddy; Firdaus, Riyadh; Kurnia, Dedy
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Nyeri tenggorok pascaoperasi post-operative sore throat (POST) merupakan salah satu komplikasi yang sering muncul pada anestesia umum dengan teknik intubasi. Tujuan penelitian ini ialah untuk membandingkan antara efektivitas tablet hisap amylmetacresol-dibenal dengan profilaksis deksametason intravena sebelum pemasangan pipa endotrakeal untuk mengurangi kekerapan POST. Setelah mendapatkan izin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan uji klinis prospektif yang diacak dan tersamar ganda pada 121 pasien yang menjalani operasi dalam anestesia umum menggunakan pipa endotrakeal. Pasien dibagi menjadi dua kelompok, yaitu Grup A 61 orang dan grup B 60 orang. Sebelum induksi, pasien dalam grup A diberikan tablet hisap amylmetacresol-dibenal dan suntikan NaCl 0,9% 2 mL dan grup B diberikan Deksametason 10 mg intravena dan tablet hisap plasebo. Nyeri tenggorok pascaoperasi dievaluasi dengan numerical rating scale (NRS) sebanyak 3 kali, yaitu setelah operasi saat Alderette skor 10, 2 jam pascaoperasi dan 24 jam pascaoperasi.  Kekerapan dan derajat nyeri tenggorok pascaoperasi dicatat dan dianalisis dengan uji chi-kuadrat. Tidak didapatkan perbedaan kekerapan nyeri tenggorok pascaoperasi bermakna pada kedua kelompok sesaat setelah operasi berakhir, jam ke-2 dan jam ke-24 pascaoperasi. Derajat nyeri tenggorok pascaoperasi tidak berbeda bermakna di antara kedua kelompok. Tablet hisap amylmetacresol-dibenal sebelum pemasangan pipa endotrakeal memiliki efektivitas yang sama dengan profilaksis deksametason intravena dalam mengurangi kekerapan nyeri tenggorok pascaoperasi. Kata kunci: Amylmetacresol-dibenal, deksametason, intubasi endotrakeal, nyeri tenggorok pascaoperasi, Strepsils® Comparison between Amylmetacresol-dibenal Lozenges and Prophylactic Intravenous Dexamethasone Before Intubation to Reduce the Incidence of Postoperative Sore Throat (POST) Post-operative sore throat (POST) is one of the complications that often arise in the general anesthesia with intubation techniques. The purpose of this study was to compare the effectiveness of amylmetacresol-dibenal lozenges with prophylactic intravenous dexamethasone before intubation to reduce the incidence of POST. After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients,a prospective randomized clinical,double-blind trial was done in 121 patients that would undergo surgery under general anesthesia using endotracheal tube. Patients were divided into two groups randomly; Group A 61 people and group B 60 people. Before induction, patients in group A was given amylmetacresol - dibenal lozenges and injection of 2 mL of 0.9% NaCl, while group B was given intravenous dexamethasone 10 mg and placebo lozenges. POST was evaluated by the numerical rating scale (NRS) 3 times, after surgery when Alderette score of 10, 2 hours postoperatively and 24 hours postoperatively. The frequency and degree of POST were recorded and analyzed with Chi-Square test. There were no significant difference in the incidence of POST in both groups after surgery when Alderette score of 10  , h 2, and the 24th hour postoperatively. The degree of POST was not significantly different between the two groups. Amylmetacresol - dibenal lozenges before intubation tube has the same effectiveness of prophylactic intravenous dexamethasone in reducing the incidence of POST. Key words: Amylmetacresol-dibenal lozenges, dexamethasone, endotracheal intubation, postoperative sore throat (POST), Strepsils®

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