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Anestesia dan Thalasemia Saeful Alam, M. Deny; Sudjud, Reza Widianto; , Indriasari
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Thalasemia merupakan penyakit keturunan atau herediter menurut hukum mandel yang melibatkan penurunan produksi salah satu atau lebih rantai globin (α,β,γ,δ) dari hemoglobin sehingga terjadi gangguan sintesis hemoglobin. Gejala sudah mulai terdeteksi sejak bulan pertama kehidupan ketika level Hb fetal menurun. Gejala klinis yang dijumpai biasanya berhubungan dengan anemia yang berat, erytropoisis yang inefektif, extramedular hematopoiesis, dan gejala yang muncul karena timbunnan tranfusion dan akibat peningkatan penyerapan besi. Kulit biasanya tampak pucat karena anemia dan kuning karena jaundice dari hiperbilirubinemia. Tulang kepala dan tulang-tulang yang lainnya biasanya mengalami deformitas karena erytroid hyperplasia dengan intramedullary expansion dan penipisan tulang kortek dikenal dengan facies colley. Pasien dengan thalasemia baik intermediate atau mayor pada suatu waktu mungkin memerlukan penanganan bedah seperti misalnya cholecystectomy ataupun spleenectomi sehingga memerlukan tindakan anestesi. Permasalahan yang perlu diperhatikan saat melakukan anestesi pasien thalasemia diantaranya komplikasi akibat anemia, komplikasi akibat timbunnan besi, dan komplikasi karena terapi chelation. Kata kunci: Anemia, anestesi, hemosiderosis, splenektomi, thalasemia Anaesthesia and Thalassaemia Thalassaemia is a hereditary disorder according to Mandel’s law, involving a reduction in one of the globin chains (α,β,γ,δ) from haemoglobin resulting in impaiment of haemoglobin synthesis. Sysmptoms may present as early as one month of life when there is reduction in fetal haemoglobin. Clinical symptoms usually relates to severe anemia, ineffective erythropoiesis and symptoms that occurs as a result of transfussion and iron loading. Skin usually appears pale due to anemia and yellow due to jaundice and hyperbilirubinemia. Deformity of skull and other bones usually occurs as a result of erythroid hyperplasia with intramedually expansion and thinning of cortex known as Facies Colley. Patients with thalassaemia, either intermediate or major, may require surgery some time in their life, such as cholecystectomy or splenectomy therefore requiring anaesthesia. Issues that need to be adressed during anaesthesia include complications due to anemia, iron loading and chelation therapy. Key words: Anemia, anaesthesia, haemosiderosis, splenectomy, thalassaemia Reference Lanzkowsky P. Manual of pediatric hematology and oncology. Edisi ke-4. Burlington: Elsevier Academic Press; 2005. Yaish HM. Thalasemia [diunduh 2 Januari 2011]. Tersedia dari: http//www.emedicine. com. DeBaun MR, Vichinsky E. Hemoglobinopathies. Dalam Kliegman RM, Behrman RE, Jenson HB, Stanton BF, penyunting. Nelson Textbook of Pediatrics. Edisi ke⎯18. Philadelphia: Elsevier Saunders; 2007. h. 2025⎯38. Permono B, Ugrasena IDG. Hemoglobin abnormal: talasemia. Dalam Permono B, Sutaryo, Ugrasena IDG, Windiastuti E, Abdulsalam M, penyunting. Buku ajar hematologi-onkologi anak. Cetakan ke-2. Jakarta: Badan Penerbit IDAI; 2006. hlm. 64-97. Lekawanvijt S, Chattipakorn N. Iron overload thalassemic cardiomyopathy: iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity. Can J Cardiol. 2009;25(4):213⎯8. Kushner JP, Porter JP, Olivieri NF. Secondary iron overload. Hematology. 2001:47⎯61. Rund D, Rachmilewitz E. β-Thalasemia. N Engl J Med. 2005;353:1135-46. Olivieri NF. The β-Thalasemia. N Engl J Med. 1999:341(2):99-109. Catlin AJ. Thalasemia: the facts and the controversies. Pediatr Nursing. 2003;29(6):447⎯51. Bahador A, Banani SA, Foroutan HR, Hosseini SM, Davani SZ. A comparative study of partial vs total splenectomy in thalasemia major patients. J Indian Assoc Pediatr Surg. 2007 vol 12, page 133⎯5 Grosfeld JL, dkk. The Spleen in Pediatric Surgery edisi ke 2 dan 6. Mosby Elsevier. 2006 hlm. 1691-1702. Wood JC. Cardiac complications in thalasemia major. PMC. 2010;33:81⎯6. Colan SD. Cardiomyopathies. Dalam: Keane JF, Lock JE, Fyler D. Nadas’ pediatric cardiology. Edisi ke⎯2. Philadelphia: Saunders Elsevier; 2006. hlm. 415⎯58. Cogliandro T, Derchi G, Mancuso L, Mayer MC, Pannone B, Pepe A. Guideline recommendations for heart complications in talasemia major. Cardiology Medi. 2008;9:515⎯25. Yao Fun Sun F, Anesthesiology Problem-Oriented Patient Management. Edisi ke 6. Lippincott Williams & Wilkins. 2008:986–987. Hines RL, Marschall KE. Stoelting’s Anesthesia and Co-Existing Disease. Edisi ke 5. Saunders Elsevier. 2008:412. Barash PG, Cullen BF, Stoelting RK, Calahan MK, Stock MC. Handbook of Clinical Anesthesia. Edisi ke 6. Lippincott Williams & Wilkins. 2009:240–241. 18. Morgan GE, Mikhail MS, Murray MJ.Clinical Anesthesiology. Edisi ke 4. Mc Graw Hill. 2005:471, 476–477.

Penyebaran Zat Pewarna Metilen Biru di Ruang Paravertebral: Penelitian Blok Paravertebral Lumbal 4 Teknik Injeksi Satu Titik pada Kadaver , Pryambodho; Prawiro, Eric; Tantri, Aida Rosita; Sukmono, R. Besthadi
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Blok paravertebral lumbal secara teori dapat dijadikan alternatif dari blok psoas dan dapat dilakukan secara blind/landmark-based. Penelitian ini bertujuan untuk mengetahui penyebaran zat pewarna pasca injeksi 1 titik di ruang paravertebral L4 terkait area pleksus lumbalis. Penelitian menggunakan kadaver segar yang tidak dikenal. Pada semua kadaver dilakukan penyuntikan 30 mL zat pewarna metilen biru 1% pada injeksi 1 titik di ruang paravertebral L4 menggunakan jarum blok standar, kemudian dilakukan diseksi untuk mengetahui penyebaran zat pewarna tersebut. Penelitian ini mengikutsertakan 16 kadaver yang memenuhi syarat. Didapatkan penyebaran terjauh ke arah sefalad mencapai level L1 (6,25%) dengan rata-rata mencapai level L3 (50%). Penyebaran terjauh ke arah kaudad mencapai level S2 (12,5%) dengan rata-rata mencapai level L5 (56,25%). Penyebaran kontralateral sebanyak 18,75%. Penyebaran segmental paling sedikit sebanyak 2 segmen (6,25%), paling banyak sebanyak 5 segmen (12,5%), dan sebaran segmental terbanyak (43,75%) ialah sebanyak 4 segmen. Injeksi 1 titik 30 mL metilen biru 1% pada blok paravertebral L4 dapat mencapai area pleksus lumbalis. Penelitian lebih lanjut diperlukan untuk mengetahui volume optimal serta lokasi injeksi teraman dan efektif untuk menghasilkan penyebaran yang lebih baik pada pleksus lumbalis maupun pleksus lumbosakral. Kata kunci: Blok paravertebral, blok psoas, kadaver, metilen biru, pleksus lumbalis Lumbar paravertebral block theoretically can be used as an alternative for psoas block, furthermore it can be done with a landmark-based technique. The object of this study was to determine the spreading of 30 ml 1% methylene blue dye after single point injection in the L4 lumbar paravertebral space, regarding the area of lumbar plexus. The study used fresh unclaimed cadavers. On all cadavers, a single dose of 30 mL 1% methylene blue injected in the L4 lumbar paravertebral space, using a standard b-bevel needle. Then the cadavers dissected on lumbar area to determine the spreading of the methylene blue. Sixteen cadavers which met the criteria were included. The most cephalad spread was at L1 level (6.25%) with average at the L3 level (50%). The most caudad spread was at the S2 level (12.5%) with average at the L5 level (56.25%). The contralateral spread was found in 18.75% of cadavers. The minimal segmental spread were 2 segments (6.25%) and the maximum segmental spread were 5 segments (12.5%), and the average segmental spread were 4 segments (43.75%). Single point injection of 30 mL 1% methylene blue in the L4 lumbar paravertebral space can cover the lumbar plexus area. Further studies are needed to determine the optimal volume, the effective and safer site for injection technique to produce better spread in the lumbar plexus and lumbosacral plexus innervation as well. Keywords: Cadaver, methylene blue, lumbar plexus, paravertebral block,psoas block Reference Hala. EA Paravertebral block : an overview. Curr Anaesth & Crit Care. 2009;20:65–70. Dodd M, Hunsley J. Thoracic paravertebral block: landmark techniques. Anaesthesia tutorial of the week 224. May 2011 [diunduh 28 Januari 2013]. Tersedia dari: http://www.frca.co.uk/Documents/224%20Paravertebral%20block,%20Landmark%20techniques.pdf Naja ZM, El Rajab M, Al Tannir MA, Zaide FM, Tayara K, Youne F, dkk. Thoracic paravertebral block: influence on the number of injections. Reg anesthesia Pain Med. 2006;31:196–201. Batra RK, Krishnan K, Agarwal A. Paravertebral block. J Anaesthesiol Clin Pharmacol. 2011 Jan–Mar;27(1):5–11. Lee EM, Murphy KP, Ben-David B. Postoperative analgesia for hip arthroscopy: Combined L1 and L2 paravertebral blocks. J Clin Anesth. 2008;20:462–5. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: a randomized doubleblind study. Anesth Analg. 2007;105:1848–51.[diunduh 11 Januari 2013] Tersedia dari: http://www.northeasternanesthesia.com/youranasthesia/peripheral.php. Hocking G, McIntyre O. Achieving change in practice by using embalmed cadavers to teach ultrasound-guided regional anaesthesia. Ultrasound. 2011;19:31–5. Azharflz. Standard IMT (indeks massa tubuh) untuk orang Indonesia. 2011.[diunduh 27 Mei 2013]. Tersedia dari: http://www.medicalera.com/3/9599/standard-imt-indeks-massatubuh-untuk-orang-indonesia. Thoraco lumbar paravertebral block. The New York School of Regional Anesthesia. 2009 [diunduh 3 Oktober 2011]. Tersedia dari: http://www.nysora.com/peripheral_nerve_blocks/classic_block_tecniques/3068-thoraco_lumbar_paravertebral_block.html. Karmakar MK, Kwok WH, Kew J. Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral body. Br J Anesth. 2000;84(2):263–5. Cheema SP, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia. 1995;50:118–21. Saito T, Den S,Tanuma K, Tanuma Y, Carney E, Carlsson C. Anatomical bases for paravertebral anesthesia block: fluid communication between thoracic and lumbar paravertebral regions. Surg Radiol Anat. 1999;21:359–63.

Acid-Base Balance: Stewart’s Approach Pradian, Erwin; Maskoen, Tinni Trihartini; Destiara, Andy Pawana
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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The Henderson-Hasselbalch approach to acid-base balance allows explanation and quantification of many disorders of acid-base phisiology and is still widely used in clinical practice. However, complex metabolic disorders, such as those present in critically ill patients, can be difficult to define and treat using this approach. Peter Stewart proposed a different approach to acid-base physiology based upon physicochemical principles, which are electrochemical neutrality, conservation of mass and law of mass action. According to Stewart, there are only three variables influence the dissociation of water. These independent variables are pCO2, total concentration of weak acid [ATot] and strong ion difference (SID). Another different is if in Henderson-Hasselbalch approach pointed on bicarbonat ion, Stewart use chloride ion as the important anion as the causatif factor so there are also known the terms hyperchloremia acidosis, dilutional acidosis and contraction alkalosis.

Kefektifan Sedasi antara Campuran Ketamin Propofol (Ketofol), dan Propofol Fentanil pada Prosedur Endoscopic Retrograde Cholangiopancreatography (ERCP) Sugiarto, Adhrie; Perdana, Aries; Jefrey Tuhulele, Norman Rabker
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Sedasi adekuat diperlukan untuk menjaga kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasienselama prosedur ERCP. Propofol merupakan sedasi yang tanpa efek analgesia namun memiliki efek depresikardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan menurunkankebutuhan dosis propofol dalam mempertahankan kedalaman sedasi, analgesia, kestabilan hemodinamik danrespirasi. Penelitian ini membandingkan keefektifan sedasi antara campuran ketamin-propofol (ketofol) danpropofol-fentanil pada prosedur ERCP. Penelitian ini adalah uji klinis acak tersamar ganda, 36 pasien dewasayang menjalani prosedur ERCP, dibagi menjadi dua kelompok yaitu kelompok KF (n=18) yang mendapatkanketofol 1:4 dalam semprit 50 mL, serta kelompok PF (n=18) yang mendapatkan fentanil 1 mcg/kgBB dan propofoldalam semprit 50 mL. Kedalaman sedasi diukur dengan Ramsay Sedation Scale. Hasil penelitian didapatkan reratakonsumsi propofol permenit, kelompok ketofol lebih rendah bermakna dibanding dengan kelompok propofolfentanil (p<0.05). Jumlah kebutuhan fentanil pada kelompok ketofol lebih rendah dibanding dengan kelompokpropofol-fentanil (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol-fentanil lebih cepat dibandingdengan kelompok ketofol (p<0.05). Kejadian hipotensi pada kedua kelompok tidak berbeda bermakna (p>0.05).Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Simpulan adalah ketofol lebihefektif daripada propofol-fentanil untuk kedalaman sedasi dan analgesia serta memiliki efek samping yangminimal. Kata kunci: ERCP, Propofol, ketamin, fentanil, sedasi, analgesia The effectiveness of sedation is the ability of the drugs to maintain sedation depth and analgesia, and to controlpatients movements during ERCP procedure. Propofol is a sedative agent that has no analgesia effect and hasa dose-dependent cardiovascular and respiratory depressant effects. The addition of small dose of ketamin isexpected to reduce the required dose to maintain hemodinamic and respiratory stability. This study comparedthe effectiveness of sedation between 1:4 ketamin propofol mixtures (ketofol) and propofol-fentanyl in ERCPprocedure. This research a double blind randomised clinical trial was done in 36 adult patients who underwentERCP procedure, which were divided into two groups: KF group (n = 18), which were treated with ketofol 1:4in a 50 mL syringe, and PF group (n = 18) which were treated with fentanil 1 mcg/kgBW and propofol in a 50mL syringe. The depth of sedation was measured by Ramsay Sedation Scale (RSS). The average consumption ofpropofol per minute of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The medianfentanyl consumption of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The onsetand the recovery time in fentanyl propofol group were faster than ketofol group (p<0.05). There was no significantdifferent in the incidence of hypotension in both groups (p>0.05). There were no desaturation events or nausea/vomiting in both groups. Conclution ketofol was more effective than fentanyl-propofol mixture in maintaining thedepth of sedation and analgesia and has minimal side effects. Key words: Analgesia,ERCP, fentanyl, ketamine, propofol, sedation Reference Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62(1):1–8. Glomsaker TB. Endoscopic Retrograde Cholangiopancreatography (ERCP) in Norway, University of Bergen, 2013. Available at http://www.ivs.no/downloads/ thesis_Glomsaker.pdf, accessed on October 24, 2014 Chainaki IG, Manolarki MM, Paspatis GA. Deep sedation in gastrointestinal endoscopy, World J Gastroentero, 2011, 3 (2): 34–9. Sumaratih L. Perbandingan keluaran antara teknik pemberian propofol bolus berkala dengan Target Controlled Infusion pada pasien endoskopi saluran cerna di RSUPN Cipto Mangunkusumo, Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Indonesia, Jakarta, 2013. Wang Y, Jiang X, Pan L, Dong S, Feng Y, Prajapati SS, et al. Randomized double-blind controlled study of the efficacy of ketofol with propofolfentanyl and propofol alone in ttermination of pregnancy. Afr. J.Pharm. pharmacol.2012;6(34):2510–14. Coulter FLS, Hannam JA, Anderson BJ. Ketofol dosing simulations for procedural sedation, Pediatr Emerg Care, 2014;30(9): 621–30. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamin propofol (ketofol), Acad Emerg Med, 2010;17:194–201. Hassenein R, El-Sayed W. Ketamin/propofol versus fentanyl/propofol for sedating obese patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP), Egypt J Anesth, 2013;29:207–11. Thom G. The evolving role of ketofol and its use as sedation agent in PSA in children: systemic review, 2013. Available at http://sedationspecialists.co.za/wpcontent/uploads/2013/07/Ketofol-in-sedationnew-developments_Dr-George-Thom.pdf, accessed on October 11, 2014.

Pengaruh Edukasi Pra-anestesia terhadap Tingkat Kecemasan Pasien Dewasa yang Menjalani Operasi Jantung Terbuka Marsaban, Arif H. M.; Hidayat, Jefferson; Kusumadewi, Irmia; Nainggolan, Gina Adriana
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Kecemasan praoperasi mengaktifkan stres respon  yang menyebabkan stimulasi sistem saraf simpatis (menstimulasi sistem kardiovaskular dengan meningkatkan jumlah katekolamin darah yang menyebabkan takikardi, hipertensi, iskemik dan infark miokardial). Respon tersebut merugikan sirkulasi koroner, menyebabkan peningkatan morbiditas dan mortalitas. Salah satu penanganannya adalah dengan pemberian informasi (edukasi), melalui komunikasi efektif, informatif dan empati, diharapkan terjadi penurunan tingkat kecemasan pasien sebelummenjalani pembiusan dan pembedahan. Penelitian ini menginvestigasi pengaruh edukasi pra-anestesia terhadap tingkat kecemasan pasien operasi jantung terbuka di RSUPN Cipto Mangunkusumo. Penelitian ini menggunakan uji kuasi eksperimen pada pasien operasi jantung terbuka dewasa di Instalasi PJT RSUPN Cipto Mangunkusumo pada bulan Maret 2016. Setelah mendapatkan ijin komite medik dan informed consent, pada 36 subyek dilakukan penilaian tingkat kecemasan sebelum dan sesudah edukasi dengan menggunakan instrumen APAIS. Sebelumedukasi dilakukan pengukuran tanda vital, dilanjutkan dengan pemberian edukasi dan diskusi. Terdapat penurunan bermakna rerata tingkat kecemasan sebelum edukasi dibandingkan dengan sesudah edukasi (p<0,001). Edukasi pra-anestesia menurunkan tingkat kecemasan pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo. Kata kunci: Edukasi, komunikasi efektif, tingkat kecemasan, operasi jantung terbuka The Effect of Education on the Anxiety Level of Adults Patient Undergoing Open Heart Surgery Pre-operative anxiety activates the stress response, causing stimulation of the sympathetic nervous system, which timulates cardiovascular system by increasing the blood catecholamines levels, causing tachycardia, hypertension, ischemia and myocardial infarction. The response may have detrimental effects on the coronary circulation, increasing morbidity and mortality. One of the management is by the provision of information (education) through effective and informative communication with empathy, which are expected to decrease patients’ anxiety level before undergoing anesthesia and surgery. This study aimed to determine the effect of preanesthesia education to the anxiety level in open heart surgery patients in Cipto Mangunkusumo Hospital. This was a quasi-experimental trials of adult open heart surgery patients in Integrated Cardiac Center of Cipto Mangunkusumo Hospital in March 2016. After permission from the medical committee and informed consent were obtained, the anxiety level of 36 subjects was assessed before and after the education using APAIS instrument. Before the education was given, vital signs were measured, continued by education and discussion. There was a significant decrease in the average level of anxiety before education compared with after education (p<0.001). Preanesthesia education lowers the anxiety level in adult open heart surgery patients in Cipto Mangunkusumo Hospital. Key words: Education, effective communication, the level of anxiety, opens heart surgery

Blood Rheology and It’s Effect in Various Clinical Conditio Rahardjo, Theresia Monica; Wargahadibrata, Himendra
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Blood ia a heterogen fluid consists of a suspension of blood cells, erythrocyte, leucocyte, thrombocyte, in a liquid plasma which contains water, proteins, mineral ions, hormones and glucose. Blood rheology is well known has an important rule in circulation. Blood viscosity depend on shear forces and determined by hematocrit, plasma viscocity, blood cells distribution and mechanical properties. Blood rheology can be altered in various pathology proccess like diorder of hematocrit, erytrocute deformability and aggregation. Hematocrit alteration contributed significantly to hemorheology variation and extreme physiologist conditions. Erytrocyte deformability sensitive to local and general homeostasis caused by endogen or exogen factors. Erythrocyte aggregation is determined by plasma protein composition and erythrocyte surface properties like acute phase of inflammation, other factors are in vivo aging, free radical and proteolitic enzymes. Rheology alteration will cause impairment of blood fluidity which is significantly affect tissue perfusion and result in organ function deteriorations, especially if disease processes also disturb vascular properties. This review will reveal blood rheology effect on various pathological conditions, like sepsis, hypertension and diabetes mellitus.

Perbandingan Efektivitas Pemberian Tropisetron 5 mg dan Ondansetron 8 mg untuk Mengurangi Efek Mual dan Muntah Pascaoperasi Ginekologis per Laparatomi Sepriwan, Tori; , Zulkifli; Harimin, Kusuma
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Salah satu efek samping pascaoperasi dengan anestesi umum adalah mual muntah. Obat 5-HT3 reseptor antagonis telah terbukti efektif mencegah terjadinya mual dan muntah pascaoperasi. Ondansetron merupakan 5-HT3 reseptor antagonis yang sering dipakai, namun memiliki efek samping nyeri kepala. Tropisetron merupakani obat alternatif untuk mencegah mual muntah pascaoperasi. Tujuan penelitian adalah membandingkan efektifitas pemberian tropisetron 5 mg dengan ondansetron 8 mg untuk mengurangi efek mual dan muntah pascaoperasi ginekologis per laparatomi. Uji klinik acak tersamar ganda dilakukan pada 66 pasien di bagi menjadi dua kelompok perlakuan, kelompok tropisetron dan kelompok ondansetron. Data hasil penelitian diuji secara statistik dengan uji t dan uji chi-kuadrat. dari data penelitian diperoleh hasil bahwa skor mual pada kelompok tropisetron berbeda bermakna dibanding kelompok ondansetron sebesar dengan p<0,05. Keluhan mual pada kelompok ondansetron yaitu sebanyak 21 subjek (63,6%) sedangkan pada kelompok tropisentron sebanyak 10 subjek (30,3%) berbeda bermakna dengan p<0,05. Tidak ada perbedaan bermakna pada kedua kelompok pada keluhan muntah dengan 2 subjek (6,1%) yang mengalami muntah. Simpulan penelitian ini adalah pemberian tropisetron 5 mg lebih efektif dibandingkan dengan ondansetron 8 mg untuk mengurangi efek mual dan muntah pascaoperasi ginekologis perlaparatomi.Kata kunci: Mual muntah, ondansetron, skor mual, tropisetron. Post operative nausea and vomitus (PONV) is one of side effect caused by general anesthesia. 5- HT3 antagonist receptor is effectively proven in preventing PONV. Ondansetron is a common antagonist 5- HT3 receptor widely used with side effect especially complaints of headache. Tropistron can be used as an alternative to prevent PONV. The aim of this study is to compare the effectiveness of 5 mg tropisetron to 8 mg ondansetron in reducing PONV. Double blind randomized control trial was delivered to 66 patients divided into 2 treatment groups, tropisetron and ondansetron. The result of the study was statistically tested with t test and chi square test. The study shows the score of nausea in tropisetron group was less than ondansetron group with p<0,05. Nausea was complained in 21 subject of ondansetron group (63,6%), while in tropisetron group was complained in 10 subject (30,3%) with p<0,05. No significance difference was found in both group with 2 subject ( 6,1%) complaining vomiting. The conclusion of this study is tropisetron 5 mg is more effective than ondansetron 8 mg in reducing PONV Key words: nausea score, nausea and vomiting, ondansetron, tropisetron Reference Tsui SL, Ng KFJ, Wong LC, Tang GW, Pun TC, Yang JC. Prevention of postoperative nausea and vomiting in gynaecological laparotomies: a comparison of tropisetron and ondansetron. Anaesthesia and Intensive Care. 1999;27:471–6. Watcha MF, White PR. Postoperative nausea and vomiting, its etiology, treatment and prevention Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth. 1992;69:24S–32S. Junger A, Klasen J, Benson M, et al. Factors determining length of stay of surgical daycase patients. Eur J Anaesthesiol. 2001;18: 14–21. Wu CL, Berenholtz SM, Pronovost PJ, et al. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology. 2002;96:994–1003. Gan T, Sloan F, Dear Gde L, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg. 2001;92:393–400. Bosek V, Hu P and Robinson LA. Acute myocardial ischemia after administration of ondansetron hydrochloride. Anesthesiology. 2000;92: 885–7. Gan TJ, Meyer TC, Christian C, Cheng F, Davis PJ, Eubank S, dkk. Consenseus guideline for managing postoperative nausea and vomiting. Anest Analg. 2003;97:62–71. Morgan GE, Mikhail MS, Murria MJ, Larson CP. Clinical Anethesiology. Edisi ke-3. California: McGraw-Hill Medical Publishing Division;2002.Hlm. 242–50. Jokela R. Prevention of postoperative nausea and vomiting-studies on different antimetic, their combination and doping regiments. Academic dissertation: Dep ofAnaesthesiology University of Oulu, Findaln; 2003. Raman Sikka, Kaul TK, Anju G, Aprajita S. Postoperative nausea and vomiting. Anesth Clin Pharmacol. 2007;23(4):341–356. Scuderi PE, James RL, Harris L, et al. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg. 2000;91:1408-14. Gautam PL. Kaul TK. PONV-an unsolved problem. J Anaesth Clin Pharmacol. 2002; 18(1):3–6. White H, Black RJ, Jones M, Mar Fan GC. Randomized comparison of two antiemetic strategies in high risk patients undergoing day cas gynecological surgery. Br J Anaesth. 2007;98:470–6. Sebastian P, Gaelle C, Christian C. A risk store Dependent antiemetic approach effectively reduce postoperative nausea and vomiting a continous quality improvement initiative Can J Anaesth. 2004;51:320–5. Rama MP, Ferreira TA, Molin N, Sanduence Y, Bautista AP. Less postoperative nausea and vomitting after propofol remifentanil versus propofol fentanyl anaesthesia during plastic surgery. Acta Anaesthesiologica Scandinavia. 2005;49:305–11. Hill RP, Lubarsky DA, Phillips-Bute B, Fortney JT, Creed MR, Glass PS, dkk. Costeffectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology. 2000;92: 958–67. Figueredo ED and Canosa LG. Ondansetron in the prophylaxis of postoperative vomiting:a metaanalysis. J Clin Anesth. 1998; 10: 211–21. Arcioni R, della Rocca M, Romano S, et al. Ondansetron inhibits the analgesic effects of tramadol: a possible 5-HT(3) spinal receptor involvement in acute pain in humans. Anesth Analg. 2002; 94: 1553–7 Deane Y, Valentine RGN. 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The Effect of Additional Magnesium Sulphate 80 mg with 0,5% Hiperbaric Bupivacaine to Onset and Duration of Action of Sensory and Motor Block Spinal Anaesthesia for Caesarean Section , Suwarman; Purwaningsih, Sriwahyuniati; Nawawi, A. Muthalib; Yuwono, Hendro Sudjono
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Addition of adjuvants to 0.5% hyperbaric bupivacaine for spinal anaesthesia performed to accelerate sensory and motor onset, minimal side effect of hemodynamics and prolongation analgesia. The aim of the study was to investigate the effect of additional 80 mg of magnesium sulphate 40% intratecal to 0.5% hyperbaric bupivacaine on onset and duration of sensory and motor block for cesarean section. The study was randomized double blind controlled study to 40 patients with American Society of Anesthesiology (ASA) physical status II whom underwent caesarean section in Dr. Hasan Sadikin General Hospital Bandung from April till May 2015. The additional 80 mg of 40% magnesium sulphate to 0.5% hyperbaric bupivacaine intratecal resulted earlier onset of sensory and motor block than group 0,9% sodium chloride (p˂0,001). The duration of sensory and motor block was longer in magnesium group than sodium chloride 0,9% group (p˂0,001). The study concluded that spinal anesthesia using 0.5% hyperbaric bupivacaine with magnesium sulphate produce faster onset and prolonged duration of sensory and motor blockade compared to 0.5% hyperbaric bupivacaine in cesarean section.

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

Pengaruh Eksorotasi Tungkai Bawah terhadap Jarak Saraf Femoralis dan Arteri Femoralis: Observasi dengan Panduan Ultrasonografi Tantri, Aida Rosita; Satoto, Darto; Hirda, Reni
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
Publisher : Perdatin Pusat

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Teknik blok saraf femoralis menggunakan stimulator saraf merupakan teknik yang sering digunakan di Indonesia. Terdapat perbedaan anatomi antara ras Melayu dengan ras Kaukasoid dan ras Mongoloid sehingga menyebabkan perbedaan landmark jarak saraf femoralis ke arteri femoralis untuk blok saraf femoralis. Penelitian ini mengobservasi pengaruh eksorotasi tungkai bawah terhadap jarak saraf femoralis dan arteri femoralis pada lipatan inguinalis dengan panduan ultrasonografi pada ras Melayu. Studi potong lintang pada pasien bedah elektif di RSUPN Cipto Mangunkusumo, Jakarta dilakukan selama Februari 2016. Ultrasonografi dua dimensi digunakan untuk mendapatkan gambaran saraf femoralis pada empat posisi kedua tungkai bawah yaitu: eksorotasi tungkai bawah 0o, 15o, 30o dan 45o. Jarak saraf ke arteri dan jarak saraf ke kulit pada setiap sudut dibandingkan. Data dianalisis dengan uji T dan uji Anova. Terdapat perbedaan bermakna jarak saraf femoralis dan arteri emoralis pada berbagai derajat eksorotasi 0o, 15o, 30o, dan 45o pada kaki kanan maupun kaki kiri (p<0,001). Tidak ada perbedaan jarak saraf femoralis ke arteri femoralis antara kaki kanan dan kaki kiri pada semua derajat eksorotasi. Tidak ada perbedaan bermakna jarak saraf femoralis ke kulit pada semua sudur eksorotasi tungkai bawah. Pada ras Melayu, semakin besar sudut eksorotasi tungkai bawah semakin jauh jarak saraf femoralis ke arteri femoralis. Kata Kunci: Arteri femoralis, eksorotasi tungkai bawah, saraf femoralis, ras melayu, ultrasonografi The Effect of Lower Extremity Exorotation on the Distance Between the Femoral Nerve and the Femoral Artery an Observational Study Using Ultrasound Guidance   Femoral nerve block with nerve stimulation guidance technique is a common technique in Indonesia. Malayan race has a different landmark anatomy used in femoral nerve block with Caucasian and Mongoloid races, thus Malayan race has a different femoral nerve-femoral artery distance from other races. This study observed the effect of lower extremity exorotation on the femoral nerve-the femoral artery Malayan race. A cross-sectional study on 30 elective surgery patients in Cipto Mangunkusumo Hospital was done in February 2016. Two-dimensional ultrasonographic images of the femoral nerve were obtained by ultrasound guidance in the inguinal crease in four positions of the bilateral lower extremities: 0°, 15°, 30°and 45° exorotation of each extremity. Nerve to artery There were significant differences of the femoral nerve-femoral artery distance at all exorotation angles (0o, 15o, 30o and 45o) in both feet (p<0.001). There was no significant difference of femoral nerve-femoral artery distance between the right foot and the left foot in all measurements. There was no significant difference of femoral nerve-skin distance at all exorotation angles.In Malayan race, the greater the degrees of lower extremity exorotation resulted in the greater  distance of the femoral nerve to the femoral artery. Key words: Femoral artery, femoral nerve, lower extremity exorotation, Malayan race, ultrasonography

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