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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.

Penanganan Hipoperfusi Pascaoperasi Esophagectomy Gastric Pull Up dengan AKI dan Malnutrisi Prasetyo, Eko Budi; Aditianingsih, Dita; George, Yohanes WH
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Pasien bedah dengan risiko tinggi adalah mereka yang menjalani pembedahan dengan resiko tinggi untuk morbiditas dan mortalitas dengan angka kejadian mortalitas lebih besar dari 5% karena adanya penyakit penyerta atau derajat pembedahan. Penelitian terakhir di Inggris menunjukan bahwa pasien yang menjalani pembedahan beresiko tinggi mencakup 12,5 % dari jumlah total pasien yang masuk ke rumah sakit tetapi lebih dari 80% kematian, dengan kurang dari 15% dari mereka yang masuk ke Intensive Care Unit (ICU) paskaoperasi. Berikut ini adalah sebuah laporan kasus dari seorang laki-laki berusia 75 tahun yang menjalani esofagektomi gastric pull up yang disebabkan oleh kanker esophagus. Sebelum operasi, pasien mengalami malnutrisi berat dan hipoalbumin. Pasien mengalami komplikasi yang mencakup hipoperfusi, cedera ginjal akut dan pneumonia di ICU. Berfokus pada penatalaksanaan hipoperfusi, pasien menjalani hemodinamik goal directed therapy dengan target metabolik akhir yaitu normalisasi laktat, ScV02 dan tingkat PC02 gap. Pasien dipindahkan ke ruang rawat dalam keadaan baik pada hari ke-9. Kata Kunci: Esofagektomi, haemodynamic goal directed therapy, hipoperfusi, pasien bedah resiko tinggi Hypoperfusion Management Post Esophagoscopy Gastric Pull Up with Acute Kidney Injury and Malnutrition High-risk surgical patient is defined as a patient, undergoing surgery, who is at a high risk for morbidity and mortality with an expected mortality greater than 5% due to the coexisting diseases and/or the severity of surgery. A recent study in the United Kingdom demonstrated that patients undergoing high-risk general surgical procedures comprised only 12.5% of surgical admissions to hospitals but over 80% of deaths, with less than 15% of these high-risk patients admitted to the ICU postoperatively. This is a case report of 75 years old male who underwent esophagectomy gastric pull up due to esophageal cancer. Preoperatively patient suffered from severe malnutrition and hypoalbuminemia. In the ICU, patient some complications such as hypoperfusion, acute kidney injury and pneumonia. Focusing on hypoperfusion management, patient was treated using haemodynamic goal-directed therapy with end point metabolic target of normalize Lactate, ScVO2 and PCO2 gap levels. Patient was transferred to the ward in good condition on the 9th day. Key words: Esophagectomy, haemodynamic goal-directed therapy, high-risk surgical patient, hypoperfusion Lee N, Hamilton M, Rhodes A.Goal-directed therapy in high risk surgical patients : clinical review. Crit Care. 2009;13:231. Pearse RM, Harrison DA, James P. Identification and characterization of the high-risk surgical population in the United Kingdom. : research. Crit Care. 2006;10:R81 Boyd O, Jackson N. How is risk defined in high-risk surgical patient management? clinical review. Crit Care. 2005;9:390–6. Kirov MY, Kuzkov VV, Molnar Z. Perioperative haemodynamic therapy. Current opinion in Crit Care. 2010;16:384–92. Park DP, Welch CA, Harrison DA. Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis is the ICNARC case mix programme database. Crit Care. 2009;13(Suppl 2). Absi A, Adelstein DJ, Rice T. Esophageal cancer. Cleveland clinic. 2010 Agu. Wikipedia.org [internet]. Esophagectomy [diperbaharui 2014 Jan 29]. Tersedia dari:http://en.wikipedia.org Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–37. Dalfino L, Giglio MT, Puntillo F.Hemodynamic goal-directed therapy and post operative infections: earlier is better. A systematic review and meta-analysis.Crit Care. 2011;15:R154. Pearse RM, Rhodes A, Grounds RM. How to optimize management of high-risk surgical patients: clinical review. Crit Care. 2004;8:503–7. Isabel M, Correia D, Waitzberg D. The impact of malnutrition on morbidity, mortality, length of hospital stay and cost evaluated through multivariate model analysis. Clinical Nutrition. 2003;22 (3):235–9. Ramanathan TS, Moppeti IK, Wenn R. POSSUM scoring for patients with fractured neck of femur. BJA. 2005;94(4):430–3. Riskprediction.org.uk [internet]. Risk prediction in surgery, Dalam; c1998–2003[diperbaharui 2010 Apr].Tersedia dari: http://www.riskprediction.org.uk Vincent JL, Moreno R. Clinical review: Scoring systems in the critically ill. Crit Care. 2010;14:207Hicereti licaescremum at, es arem dum ili sero, acibuturs culi iam faude nonocupimum stiam, Ti. Ipio egerbi patum sendum dem, quostis fec in tus vivit. Grat, puliacii conum more perit, simis fatquempor losuliisquam demena, nenatumusum stractortea me etortent? quod medetis.

Perbandingan Efek Analgesia Pascabedah dan Stabilitas Kadar Gula Darah antara Bupivakain 0,5% 7,5 mg + Klonidin 30 mg dengan Bupivakain 0,5% 7,5 mg + Fentanil 25 mg Intratekal Pasien yang Menjalani Seksio Sesarea , Masrianil; Wahab, Abdul; Gaus, Syafruddin; Ahmad, Muhammad Ramli; Seweng, Arifin
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Penelitian ini bertujuan membandingkan efek analgesia pascabedah dan stabilitas kadar gula darah antara bupivakain 0,5% 7,5 mg+klonidin 30 μg dengan bupivakain 0,5% 7,5 mg+fent anil 25 μg intratekal pada pasien yang menjalani seksio sesaria. Penelitian ini menggunakan metode uji klinis acak tersamar tunggal dengan 50 sampel di Rumah Sakit Fatimah Makassar dan jejaringnya. Pemeriksaan kadar gula darah dilakukan sebelum spinal, 10 menit setelah operasi dan 1 jam setelah operasi selesai. Data dianalisis dengan menggunakan sistem Statistical Package for the Social Scien Tu program (SPSS). Hasil penelitian menunjukkan bahwa durasi analgesia kelompok bupivakain klonidin (BK) (322,08±34,53) menit lebih lama dibandingkan kelompok bupivakain fentanil (186,72±16,45) menit, secara statistik dinyatakan bermakna (p<0,05). Perbandingan kadar gula darah (GD) kelompok BF dan BK menghasilkan kadar GD yang stabil yaitu kelompok BF menghasilkan kadar GD sebelum spinal (122,40±18,34) mg/dl, 10 menit setelah operasi dimulai (114,88±23,31) mg/dl, dan 1 jam post operatif (128,04±21,91) mg/dl, sedangkan pada kelompok BK menghasilkan kadar GD sebelum spinal (118,96±15,99) mg/dl, 10 menit setelah operasi mulai (109,48±10,08)mg/dl,1 jam setelah operasi selesai (122,24±18,14) mg/dl. Secara statistik perbandingan rata-rata GD kedua kelompok tidak bermakna pada kedua kelompok (p>0,05). Kata kunci: Bupivakain, efek analgesia pascabedah, fentanil, kadar gula darah, klonidin, seksio sesarea The Comparison of The Analgesic Post Operatif and Blood Glucose Stability Effects Between Bupivacain 0,5% 7,5 mg + Clonidin 30 mg and Bupivacain 0,5% 7,5 mg + Fentanyl 25 mg Intrathecal in Patients Undergoing Caesarean Section The study aims to compare the effect of bupivacaine 0,5% 7,5 mg+clonidin 30 μg and bupivacaine 0,5% 7,5 mg+Fentanyl 25 μg on the analgesia and blood glucose stability of the intrathecal patient during caesarean section. This study used single-blind method and 50 samples in Fatimah Maternity Hospital in Makassar and its networking maternity hospitals. Blood glucose examination was made before spinal, 10 minutes after operation and 1 hour after the operation. The data were analysed with SPSS program. The result indicates that the duration of analgesia in Bupivacaine Clonidin group (BK) (322.08±34,53) minute longer than Bupivacaine Fentanyl group (BF) (186.72±16,45) minute. The difference is statistically significant (p<0,05). The comparison of both blood glucoses indicates stable blood glucose levels (BG). In the group of BF, the glucose level before spinal (122.40±18.34) mg/dL, 10 minutes after operation (114.88±23.31)mg/dL, and 1 hour after operation (128.04±21.91) mg/dL. In the group of BK, the glucose level before spinal (118.96±15.99)mg/dl, 10 minutes after operation (109.48±10.08 )mg/dL, and 1 hour after operation (122.24±18.14) mg/dL. The comparison between the average of both groups blood glucose is statistically insignificant (p>0.05). Key words: Analgesic post operatif, blood glucose level, bupivacain, clonidine, fentanyl, caesarean section Reference Agrawal A. Comparison of intrathecal fentanyl in addition to bupivacaine for caesarean section under spinal anaesthesia. J Anaesth Clin Pharmacol. 2009;25(2):154-6. Bhure A. Kalita N, Ingley D, Gadkari CP. Comparative study of intrathecal hyperbaric bupivacaine with clonidine, fentanyl and midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section. People Journal of Sciene Research. 2012;5(1):19–23. Bhushan S B, Suresh J S, Vinayak SR , & Lakhe, J.N. Comparison of different doses of clonidine as an adjuvant to intrathecal bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing caesarian section. Anaesth, Pain & Intensive care. 2012;16(3):266–72 Bintaro A , Pryambhodo, Susilo. Keefektifan anestesi spinal menggunakan bupivakain 0,5% hiperbarik 7,5 mg ditambah fentanil 25 mcg dibandingkan dengan bupivakain 0,5% hiperbarik 12,5 mg pada bedah sesar. Anestesia & critical care. 2010;28:9–17. Biswas B N, Rudra, A, & Bose, B K. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early post-operative period. Indian J Anaesth. 2002;46(6):469–72. Bogra J, Arora N, Srivastava P. Synergis effect of intrathecal fentanil and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005;5:5. Bouwmeester N.J. Hormonal and metabolic stress responses after major surgery in children aged 0–3 years: a double-blind, randomized trial comparing the effects of continous versus intermitten morphine. Br J Anaesth.2001;87:390–9. Dobrydnjov I Axelsson, K., Matthiesen P, Klockhoff H., Holmstrom, B. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal hernioraphy: a randomized double blinded study. Anesth Analg. 2003;96:1496-503. Ganong WL. Review of medical physiology. Edisi ke-20. New York:McGraw-Hill, 2001. hlm. 322–43. Hayashi Y Maze, M. Alpha drenoceptor agonists and anaesthesia. Br J Anaesthesia.1998;71:108–18. Hocking G ,Wildsmith J.A. Intrathecal drug spread. British J Anesth. 2004; 93(4):568–78. Prasetyo A H. Efek Klonidin sebagai ajuvan anestesi spinal terhadap kadar glukosa darah [Tesis]. Surakarta. 2011. Stoelting R K,Hillier, S.C. Pharmacology & physiology in anesthetic practice. Edisi ke-4. Philadelphia: Lippincott Williams & Wilkins. Hlm.190. Vadivelu N, Whithney, C J, Sinatra R.S. Pain pathway and acute pain processing. Dalam : Sinatra R S, Leon C O, Ginsberg, B, & Viscusi, E.R., penyuntingAcute pain management. New York: Cambridge University Press, 2009. hlm. 3–12.

Perbandingan Cystatin C Serum dan Kreatinin Serum untuk Deteksi Cedera Ginjal Akut pada Pasien Sepsis di Ruang Rawat Intensif Rumah Sakit Haji Adam Malik Medan Kurniawan, Heru; Hanafie, Achsanuddin; Mursin, Chairul M
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Perubahan mendadak laju filtrasi glomerulus (LFG) pada pasien sakit kritis dengan sepsis tidak diikuti secara paralel dengan perubahan kreatinin serum. Tujuan dari penelitian ini adalah membandingkan kegunaan dari cystatin C serum dan kreatinin serum sebagai penanda biologis fungsi ginjal pada pasien sepsis di ruang rawat intensif (RRI). Sebuah studi cross-sectional dilakukan pada pasien dewasa usia 18–65 tahun di RRI RSUP Haji Adam Malik. Kreatinin serum, cystatin C serum dan creatinin clearance (CrCl) 24 jam urin diobservasi pada 24 pasien sepsis. CrCl 24 jam urin yang disesuaikan dengan luas permukaan tubuh digunakan sebagai “baku emas” untuk menentukan LFG. Kreatinin serum, cystatin C serum dan CrCl 24 jam urin (nilai rata-rata ± standar deviasi [range]) adalah 1,53 ± 1,13 mg/dL (0,3–4,2 mg/dl), 1,71 ± 1,1 mg/L (0,6–4,48 mg/L), dan 66,33 ± 37,77 ml/min/1,73 m2 (4–137 mL/min/1,73 m2). 17 dari total 24 pasien mengalami CGA. Cystatin C serum memilki nilai sensitivitas dan spesifisitas sebesar 82,4% dan 85,7%. Sedangkan kreatinin serum memiliki nilai sensitivitas dan spesifisitas sebesar 52,9% dan 85,7%. Cystatin C secara diagnostik lebih superior dibandingkan kreatinin serum dengan area under the curve (AUC) 0,874 untuk cystatin C serum dan 0,785 untuk kreatinin serum. Cystatin C serum dengan nilai cutt-off 1,03 mg/L dan kreatinin serum dengan cutt-off 1,0 mg/dL memiliki sensitivitas dan spesifisitas yang sama yaitu 82,4% dan 85,7%. Cystatin C adalah penanda biologis yang akurat dalam mendeteksi perubahan akut pada LFG, dan terbukti lebih superior dibandingkan kreatinin serum dalam mendiagnosa CGA pada pasien sakit kritis. Kata Kunci: Cedera ginjal akut, creatinin clearance 24 jam urin, cystatin C serum, kreatinin serum, sepsis Comparative of Serum Cystatin C and Serum Creatinin for Detection Acute Kidney Injury on Septic Patients in Icu Haji Adam Malik Hospital Medan Sudden changes in glomerular filtration rate (GFR) septic critically ill patients are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to compare the utility of serum cystatin C and serum creatinin as a marker of renal function in these patients.A cross-sectional study was conducted in adult patients among 18-65 years in the intensive care unit Haji Adam Malik hospital. Serum creatinine, serum cystatin C and 24-hour creatinine clearance (CrCl) were observed in 24 critically ill patients with sepsis. Twenty-four-hour body surface adjusted CrCl was used as a control because it is the ‘gold standard’ for determining GFR.Serum creatinine, serum cystatin C and CrCl (mean ± standard deviation [range]) were 1.53 ± 1.13 mg/dL (0.3–4.2 mg/dl), 1.71 ± 1.1 mg/l (0.6–4.8 mg/l), and 66.33 ± 37.77 mL/min per 1.73 m2 (4–137 mL/min per 1.73 m2), respectively. Of the total 24 patients, 17 patients had AKI. Serum cystatin C has a sensitivity of 82,4% and spesificity value of 85,7%. Serum creatinin has a sensitivity and spesificity value of 52,9% and 85,7%. Cystatin C was diagnostically superior to creatinine (area under the curve [AUC] for cystatin C 0.874 and for creatinine 0,785. Serum cystatin C with cutt-off value 1,03 mg/L and serum creatinin with cutt-off value 1,0 mg/dl has the same sensitivity and spesificity of 82,4% and 85,7%, respectively. Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients. Key words: Acute kidney injury, serum creatinin, serum cystatin C, sepsis24-hour creatinine clearance Reference 1. Bagshaw SM, George C, Bellomo R. Changes in the incidence and outcome forearly acute kidney injury in a cohort of Australian intensive care units. Crit Care.2007;11:R68.2. Hoste EA, Clermont G, Kersten A. RIFLE criteria for acute kidney injury areassociated with hospital mortality in criticallyill patients: A cohort analysis. CritCare. 2006;10:R73.3. Mehta RL, Pascual MT, Soroko S. Spectrum of acute renal failure in the intensivecare unit: The PICARD experience. Kidney international. 2004; 66:, 1613–21.4. Uchino S, Kellum JA, Bellomo R.Acute renal failure in critically ill patients:A multinational, multicenter study. JAMA. 2005;294:813–8.5. Uchino S, Bellomo R, Goldsmith D: Anassessment of the RIFLE criteria for acuterenal failure in hospitalized patients. Critcare. 2006;34:1913–7.6. Doi K, Peter ST, Eisner C. Reduced production of creatinine limits its use as a marker of kidney injury in sepsis. J Am Soc Nephrol. 2009;20:1217–21.7. Abrahamson M, Olafsson I, Palsdottir A, Ulvsback M, Lundwall A,Jensson O, dkk. Structure and expression of the humancystatin C gene. Biochem J. 1990;268:287–94.8. Spahillari A, Parikh CR, Sint K, Koyner JL, Patel UD, Edelstein CL, dkk. Serum cystatin C- versus creatinine-based definitions of acute kidney injury following cardiac surgery: a prospective cohort study. Am J Kidneys Dis. 2012;60:922–9.9. Slort PR, Ozden N, Pape L, Offner G, Tromp WF, Wilhelm AJ, dkk. Comparing cystatin C and creatinine in the diagnosis of pediatric acute renal allograft dysfunction. Pediatr Nephrol. 2012;27:843–9.10. Chung MY, Won Jun D, Sung SA. Diagnostic value of cystatin C for predicting acute kidney injury in patients with liver cirrhosis. KASL. 2010; 16: 301–7.11. Le Bricon T, Leblanc I, Benlakehal M, Gay-Bellile C,Erlich D, Boudaoud S. Evaluation of renal function inintensive care: plasma cystatin C vs. creatinine andderived glomerular filtration rate estimates. Clin Chem. 2005;43:953–7.

Perbandingan Efektivitas antara Kombinasi 1,5 mg/kgBB Propofol 1% + 0,5 mg/kgBB Ketamin 1% dengan 1,5 mg/kgBB Propofol 1% + 2 mg/KgBB Fentanil terhadap Nilai Bis pada Tindakan Dilatasi dan Kuretase Sinurat, Bonny Brian; Melati, Endang; Puspita, Yusni; , Theodorus
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Nyeri akibat prosedur dilatasi dan kuretase memerlukan suatu manajemen anestesi. Kombinasi obat anestesi yang menghasilkan efek sedasi dan analgesi adekuat, hemodinamik stabil dan efek samping minimal dibutuhkan.Penelitian untuk mengetahui perbandingan efektivitas antara kombinasi 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamin 1% dengan 1,5 mg/kgBB propofol 1%+2 μg/kgBB fentanil terhadap nilai Bispectral Index Scale (BIS) pada tindakan dilatasi dan kuretase. Uji acak terkontrol, buta ganda, dilakukan di Central Operating Theatre RSUP Dr. Mohammad Hoesin Palembang, dari bulan Juni sampai Agustus 2013. Sebanyak 66 subjek penelitian diikutsertakan dan dibagi menjadi dua kelompok. Kelompok pertama diberikan kombinasi 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamin 1% dan kelompok kedua diberikan kombinasi 1,5 mg/kgBB propofol 1% + 2μg/kgBB fentanil. Selama prosedur, kedalaman BIS dicatat setiap 3 menit. Status hemodinamik dan lama bangun juga dicatat. Data dianalisis dengan statistical product and service solution (SPSS) versi 20. Lama bangun kedua kelompok secara statistik bermakna (p<0,05), sedangkan kedalaman sedasi, dan perubahan hemodinamik tidak (p>0,05). Kedalaman sedasi pada kedua kelompok dipertahankan antara BIS 40–60 dan secara klinis perubahan hemodinamik pada kombinasi propofol–ketamin lebih stabil. Kombinasi propofol-ketamin lebih efektif dibandingkan dengan propofol-fentanil karena menghasilkan kedalaman sedasi yang adekuat, lama bangun yang lebih singkat, status hemodinamik yang lebih stabil, serta tidak menimbulkan efek samping pada prosedur dilatasi dan kuretase. Kata kunci: BIS, dilatasi, fentanil, ketamin, kuretase, propofol Comparison of The Effectiveness of The Combination 1,5 mg/KgBW Propofol 1% + 0,5 mg/kgBB Ketamine 1% And 1,5 mg/kgbw Propofol 1% + 2 Μg/kgBW Fentanyl to The Bis Score in Dilatation and Curettage Pain in dilatation and currettage procedure requires anesthesia management. Combination of anesthetic drugs to achieve sedation and analgesia adequacy, hemodynamic stability and less adverse event are needed. to compare efficacy of combination 1,5 mg/kgBB propofol 1% + 0,5 mg/kgBB ketamine 1% and 1,5 mg/kgBB propofol 1% + 2μg/kgBB fentanyl with Bispectral Index Score (BIS). A randomized controlled trials, double blind, has been conducted in Central Operating Theatre Dr. Mohammad Hoesin General Hospital Palembang from June to August 2013. A total of 66 subjects were included and divided into two groups. First group was anesthesized with propofol-ketamine and the second group with propofol-fentanyl. BIS score were noted every three minutes. Hemodynamic status and emergence time were also noted. The data were analyzed using statistical product and service solution (SPSS) version 20. Emergence time was statistically significant (p<0.05), while depth of sedation and hemodynamic status were not significantly different (p>0.05). Depth of sedation among two groups maintained between BIS 40–50 and clinically hemodynamic changes in the combination of propofol-ketamine were more stable than propofol-fentanyl. Combination of propofol-ketamine is more effective compared with propofol-fentanyl since it produces adequate depth of sedation, shorter emergence time, more stable hemodynamic status, and no side effect. Key words : BIS, currettage, dilatation, fentanyl, ketamine, propofol Reference Koulenti D, Christoforatos T. Ventilatorassociated pneumonia – epidemiology, pathogenesis, prevention and etiology. Eur Respir Dis. 2010;6:49–53. Safdar N, Crnich CJ, Maki DG. The Pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory care. 2005;50:725–39. Kollef MH. The prevention of ventilatorassociated pneumonia. N Engl J Med. 2005;340:627–4. DePew CL, McCarthy MS. Subglotticsecretion drainage. AACN Advanced Crit Care. 2007;18(4):366–79. Smulders K, Hoeven Hvd, Weers-PothoffI, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest. 2002;121:858–62. Koulenti D, Rello J. Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impacton patient care. Expert Opin Pharmacother. 2006;7:1555–69. Dezfulian C, Shojania K, Cllard H. Subglottic secretion drainage for preventing ventilatorassociate pneumonia: A meta-analysis. Am J Med. 2005;118:11–8. Bouza E, Perez MJ, Munoz P. Continuous aspiration of subglottic secretions in the prevention of ventilatorassociated pneumonia in the post-operative period of major heart surgery. Chest. 2008;134:938–45. Hunter JD. Ventilator associated pneumonia. Postgard Med J. 2006;82:172–8. Rachmayanti R, Turbawaty DK, Parwati I, Suraya N. Gambaran pola bakteri penyebab ventilator associated pneumonia (VAP) di intensive care unit Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. 2011.

Manajemen Cairan pada Operasi Jantung Kusuma Dewi, Ni Luh; Adi Parmana, I Made
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Terapi cairan merupakan salah satu topik paling kontroversial dalam manajemen perioperatif. Perdebatan yang terus berlangsung terutama mengenai jumlah dan tipe cairan resusitasi, metode monitoring dan strategi pemberian cairan pada operasi jantung. Laporan mengenai hipervolemia atau hipovolemia perioperatif semakin banyak dijumpai. Manajemen cairan perioperatif yang tidak tepat akan meningkatkan morbiditas dan mortalitas pasca pembedahan. Dalam tinjauan pustaka ini dipaparkan fisiologi cairan tubuh, respon tubuh terhadap stress pembedahan, patofisiologi kelebihan dan kekurangan cairan perioperatif pada operasi jantung, penggunaan alat monitoring, pemilihan jenis cairan serta dampak pada fungsi organ dan aplikasi klinis. Kata kunci: Cairan, koloid, kristaloid, operasi jantung Fluid Management in Cardiac Surgery Fluid therapy is one of the most controversial topics in perioperative management. There is continuing debate with regard to the quantity and the type of fluid resuscitation, the choice of parameters used in monitoring and goal directed therapy strategy used cardiac surgery. However, there are increasing reports of perioperative excessive and deficit intravascular volume leading to increased postoperative morbidity and mortality. This article aims to briefly review physiology of body fluid, stress response to surgery, pathophysiology of fluid excess and deficit during perioperative period in cardiac surgery, the use of monitoring, the fluid formula available, the effects to organ and clinical implications. Key words: Cardiac surgery, colloids, crystalloids, fluids Reference Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012;6:CD000567. Shaw A, Raghunathan K. Fluid management in cardiac surgery. Anest Clin. 2013;31:269–80. Hahn RG. Volume kinetics for infusion fluids. Anesthesiology. 2010;113(12):470–81. Rhee P. Shock, electrolytes and fluids. Dalam: Towsend CM, Penyunting. Sabiston textbook of surgery: the biological basis of modern surgical practice. Edisi ke-17. Elsevier Saunders: Philadelphia; 2012,66–119. Chappell D, Jacob M, Hofmann-Kiefer K, dkk. A rational approach to perioperative fluid management. Anesthesiology. 2008;109(4):723–40. Finfer S, Bellomo R, Boyce N, dkk. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Eng J Med. 2004;350(22):2247–56. Myburgh JA, Finfer S, Bellomo R, dkk. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Eng J Med. 2012;367(20):1901–11. Perner A, Haase N, Guttormsen AB, dkk. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Eng J Med. 2012;367(2):124–34. Woodcock TE, Woodcock TM. Revised starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012;108(3):384–94. Kozar RA, Peng Z, Zhang R, dkk. Plasma restoration of endothelial glycocalyx in a rodent model of hemorrhagic shock. Anesth Analg. 2011;112(6):1289–95. Bruegger D, Rehm M, Abicht J, dkk. Shedding of the endothelial glycocalyx during cardiac surgery: on pump versus off pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2009;138(6):1445–7. Chowdhury A, Cox E, Francis S, dkk. A randomized controlled, double blind crossover study on the effect of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012;256(1):18–24. Kellum J, Song M, Almasri E. Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest. 2006;130(4):962–7. Albahrani M, Swaminathan M, Phillips-Bute B, dkk. Postcardiac surgery complications: association of acute renal dysfunction and atrial fibrillation. Anesth Analg. 2003;96(3):637–43. Neligan P. Monitoring and managing perioperative electrolyte abnormalities, acid base disorders and fluid replacement. Dalam: Longnecker DE, Penyunting. Anesthesiology. Edisi ke -2. New York: McGraw Hill, Inc; 2012,507–45. Jarvela K, Koskinen M, Kaukinen S, dkk. Effect of hypertonic saline (7.5%) on extracellular fluid volumes compared with normal saline (0.9%) and 6% hydroxyethyl starch after aortocoronary bypass graft surgery. J Cardiothorac Vasc Anesth. 2001;15:210–5. Verheij J, van Lingen A, Beishuizen A, dkk. Cardiac response in greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Med. 2006;32:1030–8. Schortgen F, Lacherade JC, Bruneel F, dkk. Effect of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomized study. Lancet. 2001;357:911–6. Brunkhorst FM, Engel C, Bloos F, dkk. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39. Marik PE. Hemodynamic parameters to guide fluid therapy. Tansfusion Alt Transfusion Med. 2010;11(3):102–12. Habicher M, Perrino A, Spies C, dkk. Contemporary Fluid Management in Cardiac Anesthesia. J Cardiothorac Vasc Anesth. 2011;25(6):1141–53. Bennett-Guerrero E, Khan RA, Moskowitz DM, dkk. Comparison of arterial systolic pressure variation with other clinical parameters to predict the response to fluid challenges during cardiac surgery. Mt Sinai J Med. 2002;69:96–100. Wiesenack C, Prasser C, Keyl C, dkk. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J Cardiothorac Vasc Anaesth. 2001;15:584–8. Brock H, Gabriel C, Bibl D, dkk. Monitoringintravascular volumes for postoperative volume therapy. Eur J Anaesthesiol. 2001;19:288–94. Tousignant CP, Walsh F, Mazer CD. The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg.2000;90:351–5. De Backer, dkk. In: Hemodynamic monitoring using echocardiography in the critically ill. Penyunting Springer-Verlag. Berlin Heidelberg; 2011:250–8.

Troponin dan Manajemen Iskemia Miokardium Perioperatif Leksana, Ery; Purnomo, Ika Cahyo
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Penyakit jantung iskemik sering memberikan gambaran dan perkembangan yang membahayakan. Kejadian dari tahun ke tahun terus meningkat dan menyumbang angka mortalitas yang tinggi. Angina pectoris, gambaran iskemia pada EKG, dan peningkatan petanda jantung menunjukkan terjadinya infark miokard akut. Pasien dalam kondisi demikian sangat berisiko untuk menjalani proses pembiusan. Pemeriksaan troponin bersenstivitas tinggi telah diperkenalkan, namun hal ini memberikan tantangan yang baru dalam hal sensitivitas vs spesivisitas. Berbagai panduan telah diterbitkan untuk memandu dokter ahli anestesi melewati rintangan risiko pada penderita dengan iskemia miokard. Kata kunci: Anestesi, iskemia miokardium, troponin Troponin and Perioperative Management in Iskemia Myokard Troponin Ischemic heart disease often develop harmful conditions. Incidence from year to year continues to increase and accounted for high mortality rate. Angina pectoris, marked ECG changes and elevation of cardiac markers, especially troponins indicate the presence of acute myocardial infarct. Patients in this condition is very risky to undergo anesthesia process. High sensitivity troponin test were introduced, but it gave new challenge of sensitivity vs specificity. Guidelines have been published to guide the anesthesiologist through the obstacles of risks in patients with myocardial ischemia. Key words: Anesthesia, myocardial ischemia, troponin Reference Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R Jr. National Academy of Clinical Biochemistry Standards of laboratory practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem. Jul 1999;45(7):1104–21. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. Sep 2000;36(3):959–69. Antman EM. Decision making with cardiac troponin tests. N Engl J Med. Jun 27 2002;346(26):2079–82. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, dkk. National academy of clinical biochemistry laboratory medicine practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Clin Chem. Apr 2007;53(4):552–74. Hamm CW, Giannitsis E, Katus HA. Cardiac troponin elevations in patients without acute coronary syndrome. Circulation. Dec 3 2002;106(23):2871–2. Ammann P, Fehr T, Minder EI, Günter C, Bertel O. Elevation of troponin I in sepsis and septic shock.Intensive Care Med. Jun 2001;27(6):965–9. Bakshi TK, Choo MK, Edwards CC, Scott AG, Hart HH, Armstrong GP. Causes of elevated troponin I with a normal coronary angiogram. Intern Med J. Nov 2002;32(11):520–5. Nunes JP, Mota Garcia JM, Farinha RM, dkkl. Cardiac troponin I in aortic valve disease. Int J Cardiol. Jun 2003;89(2–3):281–5. Hamwi SM, Sharma AK, Weissman NJ, Goldstein SA, Apple S, Caños DA. Troponin-I elevation in patients with increased left ventricular mass. Am J Cardiol. Jul 1 2003;92(1):88–90. Velmahos GC, Karaiskakis M, Salim A, Toutouzas KG, Murray J, Asensio J. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma. Jan 2003;54(1):45–50; discussion 50–1. Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation. Jan 7 1997;95(1):163–8. Brandt RR, Filzmaier K, Hanrath P. Circulating cardiac troponin I in acute pericarditis. Am J Cardiol. Jun 1 2001;87(11):1326–8.

Pengaruh Perioperative Albumin Infusion dan Diet Normal Protein terhadap Perubahan Sitokin Proinflamsi (TNFα, IL1 and IL6) dan CRP , Utariani; Raharjo, E.; Perdanakusuma, D.S
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Malnutrisi dapat mempengaruhi sitokin proinflamasi TNF, IL1, IL6 dan CRP perioperatif, sehingga dapat meningkatkan morbiditas dan mortalitas. Sedangkan patofisiologi interaksi ini masih belum jelas. Penelitian ini dirancang untuk menganalisis peran perioperatif albumin infus dan protein diet pada perubahan sitokine proinflamasi TNFa, IL1, IL6 dan CRP. Penelitian eksperimental murni dilakukan dengan menggunakan dua puluh lima tikus Sprague Dawley diacak dan dibagi menjadi 5 kelompok; kelompok kontrol (A) yang diberi diet protein normal, kelompok hipoalbuminemia diberikan infus albumin praoperasi (B), kelompok hipoalbuminemia dengan perioperatif diet protein normal (C), kelompok hipoalbuminemia diberiinfus albumin pasca operasi (D) dan hypoabuminemia dengan diet rendah protein (E). Metode pemeriksaan Elisa digunakan untuk mengukur plasma TNF, IL1, IL6, dan CRP. Penelitian ini menunjukkan hasil diet protein rendah praoperasimeningkatkan TNF, IL1, IL6 dan CRP secara signifikan. Sedangkan pemberian infus albumin dan diet protein normal praoperasi menurunkan TNF, IL1, IL6 dan CRP secara signifikan, pemberian infus albumin praoperasi dan pasca operasi terjadi perubahan penurunan TNF, IL1, IL6, dan CRP namun tidak signifikan. Simpulan penelitian ini adalah pemberian infus Albumin dan diet protein normal menurunkan sitokin proinflamasi (TNF , IL1 , IL6), dan CRP secara signifikan. Hal ini juga berarti dapat menurunkan morbiditas dan mortalitas . Kata kunci: Diet protein, perioperatif albumin, sitokin proinflamasi Protein malnutrition may affect perioperative TNFα, IL1 ,IL6 and CRP,that increases morbidity and mortality. The pathophysiology of this interaction is still unclear. This study was designed to analyze the role of perioperative albumin infusion and protein diet on the changes of TNFα, IL1, IL6 and CRP. The laboratory experimental research with post test only-control group design was conducted. Twenty five Sprague Dawley Rats were randomized and divided into 5 groups; control group which was given normal protein diet, hypoalbuminemia group given preoperative albumin infusion, hypoalbuminemia with perioperative normal protein diet, hypoalbuminemia group given postoperative albumin infusion and hypoabuminemia with low protein diet. Four incisions were made on the rats for operation model. Elisa method was used to measure plasma TNFα, IL1, IL6 and CRP. This study showed that as the result of preoperative low protein diet, TNFα, IL1, IL6 and CRP increased significantly. The albumin infusion and normal protein diet then decreased the TNFα, IL1 and CRP significantly, whereas the changes were not significant in preoperative and postoperative albumin infusion. conclution from this research is Albumin infusion and normal protein diet significantly decrease proinflammatory cytokines (TNFα, IL1, IL6) and CRP on hypoalbuminemia state. It can be suggested that they also decrease the morbidity and mortality. Key words: Perioperative albumin, proinflammatory cytokines, protein diet Reference Stadelman W.K, Digenis A.G, Tobin G.R. Impediments to wound healing. Am J Sung 176 (suppl ZA): 1998. 395–475. Hunt TK, Hort H, Hussain Z, Physiology of wound healing. Adv skiva wound care. 2000 13 (2): 6–11. Demling RH. Nutrition, Anabolism, and the Wound Healing Process: An Overview. Plasty. 2009 .9: 65–94. Bistrian BR, Blackburn GL, Hallowell E, Heddle R, 1974. Protein status of general surgical patients. JAMA 230:858–60. Bistrian BR. Blackburn GL, Vilale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA. 1976 235:1567–70. Hill GL. Impact of nutritional support on the clinical outcome of the surgical patient.Clin Nutr. 1994.13: 331–40. Gibbs J, Cullin, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity. ARCH Surgery. 1999.134: 36–42. Pirlich M, Herbert L, Helga G, 2003. Research profile on biomedExperts. Digestive Disease. 21(3):245–251; DOI 10.1150/000073342. Shenkin AS. Serum prealbumin Serum Prealbumin: is it a Marker of Nutritional Status or of Risk of Malnutrition? Clinical Chemistry. 2006. 52: 2177–79. Doweiko JP, Nompleggi DJ. Role of Albumin in Human Physiology and pathophysiology. J Parenter Enteral Nutr. 1999 15: 207–11, 476–83. Uhing. The albumin controversy. Clinics in Perinatology. 2004; 31(3): 475–88 Gines P, Arroyo V, Rodes J. Complications of cirrhosis: ascites, hyponatremia, hepatorenal syndrome, and spontaneous bacterial and Management. Penyunting: Bacon BR, Di Bisceglie AM, Churchil Livingstone, New York. 2000 Hlm 238. Cochrane Injuries Group Albumin Reviewers, 1998. Human Albumin Administration in Critically ill Patien: Systemic review of randomized Controlled Trial. Br. Med J. 317, 235. Gabay C, Kushner I, 1999. Acut-phase protein and other systemic responses to inflammation. N Engl J Me. 340:448–54. Alfonso Martin, Cueto Manzano, 2001. Hypoalbumin in dialysis patiens a malnutrition or an inflammation marker ?. Review artikel Larevista de Inves clinica. 53(2): pp 152–8. Pei-Ra Ling, Bruce R, Bistrian, 2003. Effect of Protein malnutrition on IL6-mediated signalingin the liver and the systemic acutphase respon in rats. Am J Physiol Regul Integr comp physiol. 287: R 801–8; DOI 10.1152/ajpregu 00715. Amati L, 2003. Nutrition and Immunity :Laboratory and clinical aspects. Curr pharm.9: 1924–31. Brown P, 2003. Malnutrition Leading Cause of Death in post war Angola. Bull World Health Organ. 81: 849–50 Moldawer LL, Hamaway KT, Bistrian BR, Georgieff M, Drabik M, Dinarello CA, Blackburn GL, 1985. A therapeutic use for interleukin-1 in the protein-depleted animal. BrJ Rheumatol. 24: 220–3. Sydney Tang, Joseph CK, Leung, Abe K, Chan KW, Chan LYY, Chan TM and Lai KN, 2003. Albumin stimulates interleukin-8. Expression in proximal tubular epithelial cell. J chin invest. 15:1114(4): 515–27; DOI 10.1172/ JC 1200316079. Cooper BA, Penne EL, Bartlett LHand Pallock CA, 2004. Protein malnutrition and hypoalbuminemia as predictor of vascular events and mortality in ESRD. Am J Kidney Dis. 43: 61–6. Kadir yildirim, 2004. Association between Acut phase reactant level and Disease Activity score (DAS 28) in patient with Rheumatoid Arthritis. Annal of clinical and Laboratory Sciens. 34: 423–6. Dulger H, Arik M, Sekeroglu MR, Tarakgloglu M, Noyan T, Cesur Y, Balahoroglu R, 2002. Pro-inflammatory cytokines in Turkish children with protein-energy malnutrition. Mediators of Inflammation, 11: 363–5. DOI: 10.1080/092935021000051566. Crevel R, Ottenhoff THM, Meer JWM, 2002. Innate immunity to Mycobacterium tuberculosis. Clinical Microbiology Reviews, 15:294-309. DOI: 10.1128/CRM.15.2.294–309. 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Perbandingan Efektivitas Salin Normal dengan Udara dalam Pengembangan Balon Pipa Endotracheal untuk Mengurangi Risiko Sakit Tenggorokan Pascaintubasi Adhriyani, Dessy; Harimin, Kusuma; Saleh, Irsan
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Membandingkan efektivitas penggunaan saline normal dan udara dalam pengembangan balon pipa endotrakeal untuk mengurangi risiko sakit tenggorokan pascaintubasi pada pasien yang mendapatkan anestesi umum inhalasi dan N2O. Penelitian ini merupakan uji klinik secara tersamar buta ganda terhadap 70 pasien dengan status fisik American society of anesthesiologist (ASA) I-II yang akan menjalani anestesi umum. Pasien dibagi dalam dua kelompok dengan jumlah masing-masing 35 pasien. Kelompok pertama menggunakan udara sebagai media pengembangan balon pipa endotrakeal, sedangkan kelompok kedua menggunakan saline normal. Rasa nyeri dinilai dengan mengunakan skala VAS. Hasil dari penelitian menunjukkan bahwa rata-rata tekanan balon pipa endotrakeal pada kelompok salin normal lebih rendah dibandingkan dengan kelompok media udara dimana rata-rata tekanan balon selama operasi pada kelompok salin normal 26,71±0,92 mmHg dengan rata-rata VAS adalah 0,91±1,29 cm sedangkan pada kelompok media udara 34,63±4,81 mmHg dengan rata-rata VAS adalah 2,37±1,190 cm (p<0,0001). Penggunaan salin normal lebih efektif dibandingkan dengan media udara dalam pengembangan cuff ETT untuk mengurangi risiko sakit tenggorokan pascaintubasi pada pasien yang mendapatkan anestesi umum inhalasi dan N2O. Kata kunci: Sakit Tenggorokan, salin normal, udara Comparison between The Effectiveness of Normal Saline and Air With The Expansion of Endotracheal Tube Cuff to Reduce The Risk of Sore Throat Postintubation To compare the effectiveness of using normal saline and air medium with the expansion of endotracheal tube cuff to reduce the risk of sore throat postintubation in patients under general anesthesia using N2O.Method. This study is a randomized controlled trial with double blind method. Total patients are 70, ASA I-II status with general anestesi. Patients divided into 2 groups, where each group composed of 35 patients. The first group will be using air as a media inflation of cuff ETT, and the second group uses normal saline. The pain is examined using VAS.The result shows that mean pressure of intracuff in normal saline group is lower than media air group where there is intracuff mean pressure undergoing surgery in normal saline group is 26,71±0,92 mmHg with VAS 0,91±1,29 cm but for media air group 34,63±4,81 mmHg with VAS 2,37±1,190 cm where p<0,0001.The using of normal saline is more effective compared to air medium in the expansion of ETT cuff to reduce the risk of sore throat postintubation in patients under general anesthesia using N2O. Key words: Air, normal saline, sore throat Dullenkopf A, Gerber AC, Weiss M. Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs. Acta Anaesthesiol Scand. 2004;48:1180–40. Morgan GE, Mikhail MS, Murray MJ. Airway management. Dalam: Clinical Anesthesiology. Edisi Ke-4. McGraw-Hill Companie. 2006. Hlm. 91–116. Fine GF, Borland LM. The future of the cuffed endotracheal tube. Pediatric Anesthesia. 2004;14: 38–42. Prerana P, Shroff, Vijay P. Efficacy of cuff inflation media to prevent postintubation related emergence phenomenon: air, saline and alkalinized lignocaine. Eur J Anaesthesiol. 2008;18:458–60. Nguyen H, Saidi N, Lieutaud T, Duvaldestin P. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89:187–90. Cerqueiera JR, Camacho LH, Takata IH. Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J/Rev Paul Med. 1999;117(6):243–7. Felten ML, Schmautz E, Orliaguet GA, Carli PA. Endotracheal tube cuff pressure 2003;97:1612–16. Karasawa F, Ozhima T, Takamatsu I, Uchihashi Y dkk. The effect on intracuff pressure of various nitrous oxide concentration used for inflating an endotracheal tube cuff. Anesth Analg. 2000;91:708–13. Karasawa F, Takita A, Mori T, Takamatsu I at all. The brandtm tube system attenuates the cuff deflationary phenomenon after anesthesia with nitrous oxide. Anesth Analg. 2003;96:606–10. Fitriyadi D, King LS. A simple endotracheal tube cuff pressure measuring device: an inexpensive alternative [Thesis]. Manilla: Santo Tomas University Hospital; 2004. Devys JM, Schauvliege F, Taylor G, Plaud B. Cuff compliance of pediatric and adult cuited tracheal tubes: an experimental study. Pediatric Anesthesia. 2004;14:676–80. Karasawa S, Okuda T, Mori T, Oshima T. Maintenance of stable cuff pressure in the Brandttm tracheal tube during anaesthesia with nitrous oxide. Br J Anaesth. 2002; 89(2):271–6. Fagan C, Frizelle HP, Laffey J, dkk. The effects of intracuff lidocaine on endotracheal-tubeinduced emergence phenomena after generalanesthesia. Anesth Analg. 2001;92:1075. Bennett MH, Isert PR, Cumming RG. Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff–a randomized controlled trial. Anaesth Intensive Care. 2000;28:408–13. Raeder JC, Borchgrevink PC, Sellevold OM. Tracheal tube cuff pressures. The effects of different gas mixtures. Anaesthesia. 1985;40:444–7. Karasawa F, Tokunaga M, Aramaki Y, saizukuisai M, Satoh T. An assassment of a method of inflating cuffs with nitrous oxide mixture to prevent on increase in intracuff pressure in five different tracheal tube designs. Anesthesia. 2001;56:155–9. Morgan GE, Mikhail MS, Murray MJ. The Practice of anesthesiology. Dalam: Clinical Anesthesiology.4th ed. McGraw-Hill Companies, Dalam;2006. Hlm. 1–9. Darsch JA, Darsch SE. Tracheal tubes. In: Understanding anesthesia equipment penyunting. edisi ke 4. Williams and Wilkins Pennsylvania; 1999. Hlm. 557–635. Combes X, Schauvliege F, Peyrouset O, etal. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001;95:1120–4. Mitchell V, Adams T, Calder I. Choice of cuff inflation medium during nitrous oxide anaesthesia. Anaesthesia. 1999; 54: 32–6. Hata TM, Moyers JR. 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Glasgow Coma Scale dalam Memprediksi Outcome pada Pasien dengan Penurunan Kesadaran di Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo S, Achmad Afif; Fuadi, Iwan; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Ventilator associated pneumonia (VAP) merupakan Hospital associated pneumonia (HAP) yang paling sering terjadi di intensive care unit (ICU). Salah satu strategi pencegahan terjadinya VAP yang termasuk dalam VAP bundle adalah penghisapan sekret subglotis dengan menggunakan pipa endotrakea dengan drainase sekret subglotis. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh penggunaan pipa endotrakea dengan drainase sekret subglotis terhadap angka kejadian VAP di ICU Rumah Sakit Hasan Sadikin (RSHS) Bandung. Penelitian dilakukan dengan uji acak tersamar tunggal terhadap 26 subjek yang menggunakan ventilator lebih dari 48 jam di ICU RSHS Bandung. Setelah dilakukan randomisasi secara blok permutasi, subjek penelitian dikelompokan menjadi dua, yaitu 13 subjek kelompok kontrol menggunakan pipa endotrakea standar dan 13 subjek kelompok perlakuan menggunakan pipa endotrakea dengan drainase sekret subglotis. Sekret subglotis dihisap setiap 2 jam dan tekanan balon pipa endotrakea diperiksa setiap 4 jam. Data hasil penelitian dianalisis dengan uji statistik yaitu uji independent t, Uji Mann Whitney dan uji chi kuadrat, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap kejadian VAP (p=0,033), dimana kejadian VAP lebih sedikit pada kelompok yang menggunakan pipa endotrakea dengan drainase subglotis (0%) dibandingkan dengan kelompok yang menggunakan pipa endotrakea standar (23,1%). Simpulan dari penelitian ini adalah penggunaan pipa endotrakea dengan drainase sekret subglotis dapat menurunkan kejadian VAP di ICU RSHS Bandung. Kata kunci: Drainase sekret subglotis, pipa endotrakea, ventilator associated pneumonia The Influence of Endotracheal Tube with Subglottic Secretion Drainage on Ventilator Associated Pneumonia In Intensive Care Unit Dr. Hasan Sadikin Hospital Bandung Ventilator associated pneumonia (VAP) is the most common Hospital associated pneumonia in Intensive Care Unit (ICU). One of the strategies to prevent occurence of VAP that is part of the VAP bundle is suctioning of subglottic secretion using special endotracheal tube with subglotic secretion drainage. The aim of this study is to know the influence of using endotracheal tube with subglottic secretion drainage to the incidence of VAP in ICU RSHS Bandung. This is a single-blind randomized study involving 26 patients who use ventilator for more than 48 hours in ICU RSHS Bandung. After permuted block randomization, the subjects were divided into two groups, 13 subjects in the control group whom are using standard endotracheal tube and 13 subjects in the group whom are using endotracheal tube with subglottic secretion drainage. Subglottic secretion is drained every two hours and the pressure of the endotracheal tube cuff is checked every four hours. The result of this study is analyzed using various statistical tests, including independent t test, Mann Whitney and Chi Square test, where p value <0.05 is considered significant. Statistical analysis shows that there is a significant difference between two groups in the incidence of VAP (p=0.033) where incidence of VAP is less in the group using endotracheal tube with subglotic drainage (0%) in comparison to the group using standard endotracheal tube (23.1%). The conclusion of this study is that endotracheal tube with subglottic secretion drainage can decrease incidence of VAP in ICU RSHS Bandung. Key words: Endotracheal tube, subglotic secretion drainage, ventilator associated pneumonia 

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