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Majalah Anestesia dan Critical Care
Published by Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif Indonesia
ISSN : -     EISSN : 25027999     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Majalah ANESTESIA & CRITICAL CARE (The Indonesian Journal of Anesthesiology and Critical Care) is to publish peer-reviewed original articles in clinical research relevant to anesthesia, critical care, and case report . This journal is published every 4 months (February, June, and October) by Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif Indonesia (PERDATIN).
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Search results for , issue " Vol 32 No 3 (2014): Oktober" : 10 Documents clear
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
Publisher : Perdatin Pusat

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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. An audit of nausea and vomiting in a post anaesthetic care unit. British Journal of Anaesthetic & Recovery Nursing. 2005;6:4–6.
Koksidinia Kronis dengan Keterlibatan Sendi Facet Hariyanto, Hori; Yahya, Corry Quando; Tantra, Andi Husni
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Koksidinia atau nyeri tulang ekor merupakan sebuah kondisi yang sering dicetuskan oleh subluksasi atau fraktur tulang coccyx. Akibatnya, inflamasi kronis akan menimbulkan nyeri yang sangat hebat pada daerah tersebut. Pada laporan kasus ini, kami menemukan gangguan sendi facet dalam menimbulkan koksidinia kronis. Meskipun literatur menyarankan coccygectomy pada penanganan kasus koksidinia kronik, ada baiknya jika Facet Block dipikirkan sebagai alternatif pengobatan nyeri sebelum beralih pada pembedahan. Laporan kasus ini membahas koksidinia kronis pada pasien wanita berusia 25 tahun dengan riwayat trauma. Terapi Ganglion Impar Block dengan 96% alkohol gagal dalam menghilangkan rasa nyeri. Blok dilakukan lagi dengan menggunakan 96% alkohol, bupivakain 0.25% and Triamcinolone, namun nyeri masih tetap dirasakan. Pasien tetap merasakan sulit untuk berjalan akibat nyeri, maka Facet blok pada L2–L4 kanan dilukakan dengan Radio Frequency (RF). Terapi tersebut menyebabkan nyeri tulang ekor menghilang secara permanen. Kasus ini menunjukkan bahwa nyeri muskuloskeletal kronik tidak berdiri sendiri, nyeri akan menyebabkan gangguan mobilisasi yang mengakibatkan perubahan pada otot, ligamen dan sendi sekitarnya. Kata kunci: Blok ganglion impar, koksidinia kronik, nyeri sendi facet Coccygodynia or tailbone pain is a chronic condition most commonly caused by subluxations and fractures of the coccyx. Intense pain is thought to arise from continuous inflammation within the coccygeal area. In this case report, we have discovered the development of lumbar facetogenic pain syndrome as a sequel to untreated chronic coccygodynia. Treatments should therefore be aimed at eliminating facet pain before resorting to operative procedures of the coccyx. In this report, we present the case of a 25 year old woman with chronic coccyx pain due to trauma. Ganglion Impar block had been given but failed to relieve the patient’s symptoms within one week post therapy. Blocks were later changed to 96% alcohol, bupivacaine 0.25% and Triamcinolone. Nevertheless, the pain continued to recur two weeks post-treatment. Due to presenting complaints of pain at standing and failure of blocks at the coccygeal level, facet blocks at L2-L4 was performed on the basis of lumbar facetogenic pain. This resulted in complete relief of symptoms including a 2 month follow-up report. Coccygodynia pain may not be a single disease entity. Intense chronic musculoskeletal pain will cause problems in mobilization thereby inflicting changes to the musculoskeletal, ligament and joint structures which may extend to other regions in the body. Key words: Chronic coccygodynia, facet joint pain, ganglion impar block Reference Fogel GR, Cunningham PY, Esses SI. Coccygodynia: Evaluation and Management. J am acad orthop surg. 2004;12(1):49 ̶ 54. Maigne JY, Chatellier G, Faou ML, Archambeau M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine. 1976;31(18):E621 ̶ 7. Grgic V. Coccygodynia: etiology, pathogenesis, clinical characteristics, diagnosis and therapy. Lijec Vjesn. 2012;134(1-2):49 ̶ 55. Sehirlioglu A, Ozturk C, Oguz E, Emre T, Bek D, Altinmakas M. Coccygectomy in the surgical treatment of traumatic coccygodynia. Injury. 2007;38(2):182 ̶ 7. Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician. 2007;10(6):775 ̶ 8. Foye PM, Buttaci CJ, Stitik TP, Yonclas PP. Successful Injection for Coccyx Pain. Am J Phys Med Rehabil.2006;85(9):783 ̶ 410.1097/01.phm.0000233174.86070.63. Ianuzzi A, Little JS, Chiu JB, Baitner A, Kawchuk G, Khalsa PS. Human lumbar facet joint capsule strains: I. During physiological motions. Spine J. 2004;4(2):141 ̶ 52. Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI. Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Biomech. 1996;29(9):1117 ̶ 29. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591 ̶ 614. Helbig T, Lee CK. The lumbar facet syndrome. Spine. 1976;13(1):61 ̶ 4.
Pengaruh Pemberian Lidokain 2% sebelum Ekstubasi terhadap Penurunan Kejadian Batuk saat Proses Ekstubasi Suryaningrat, IGB; Bisri, Tatang; Oktaliansah, Ezra
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Batuk saat ekstubasi pada pasien dengan anestesi umum dan endotrakeal merupakan masalah klinis yang dihadapi. Angka kejadian berkisar 38%−96%. Pemberian lidokain sebelum ekstubasi secara laringotracheal instilation of topical anesthesia endotracheal tube (ETT LITA) dapat mengurangi kejadian batuk saat ekstubasi. Tujuan penelitian adalah menilai efek pemberian lidokain 2% 1,25 mg/kgBB endotrakeal sebelum ekstubasi terhadap kejadian batuk saat ekstubasi. Penelitian kuantitatif intervensi dengan uji klinis acak terkontrol buta tunggal dengan subjek penelitian: 50 pasien laki-laki, usia 18−60 tahun, status fisik American Society of Anesthesiologists I dan II, operasi elektif dengan endotrakeal. Subjek dibagi menjadi 2 kelompok, yaitu kelompok I yang mendapat lidokain 2% 1,25 mg/kgBB endotrakeal 5 menit sebelum ekstubasi dan kelompok kontrol yang tanpa perlakuan. Data diuji dengan uji chi-kuadrat dan uji t. Penelitian dilakukan periode Februari−April 2014 di Rumah Sakit Dr. Hasan Sadikin Bandung. Kejadian batuk rata-rata saat ekstubasi pada kelompok lidokain lebih rendah dibanding dengan kelompok kontrol dengan hasil yang bermakna (p<0,05). Derajat batuk 5 menit pascaekstubasi antara kedua kelompok menunjukkan berbeda bermakna (p=0,00046). Simpulan penelitian ini menunjukkan bahwa pemberian lidokain 2% 1,25 mg/kgBB endotrakeal sebelum ekstubasi dapat menurunkan kejadian batuk saat ekstubasi. Kata kunci: Anestesi umum, batuk, ekstubasi, lidokain endotrakeal Cough during extubation under general anesthesia with endotracheal intubation is a clinical problem that encountered. The Incidence rates ranged from 38%−96%. Lidocaine spray given before extubation through instillation process into the laringotracheal instilation of topical anesthesia endotracheal tube (ETT LITA) significantly lower the incidence of coughing during extubation. The goal of this research is to see the effect of lidocaine 2%, 1,25 mg/kgbw through endotracheal before extubation toward cough incidence during extubation of endotracheal tube process. In our prospective, single-blind randomized controlled clinical trial, we enrolled 50 male patients aged 18−60 years, ASA physical status I and II underwent elective surgery with generalwith endotracheal tube insertion. The subject was then divided into 2 groups, first group had lidocaine 2% 1,25 mg/kgBW endotracheal 5 minute before extubation and the control group without any intervention. The data result was tested statistically with chi-square and t-test. This study was conducted from February ̶ April 2014 in the operating room Dr. Hasan Sadikin Hospital, Bandung.Tthe statistic result, cough incidence was found at extubation process in the group that had lidocain 2% 1.25 mg/kgbw is lower than control group with significant result (p<0.05). the cough degree 5 minutes post extubation in the grup that had lidocain 2% 1.25 mg/kgbw compare to control group in significantly different (p=0.00046). The conclusion is shows lidocaine 2% 1.25 mg/kgbw effect through endotracheal before extubation significantly lower cough incidence throughout extubation process. Key words: Cough, endotracheal lidocaine, extubation, general anesthesia Reference Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004;99:1253−7. Jee D, Park SY. Lidocaine sprayed down the endotracheal tube attennuates the airwaycirculatory reflexes by local anesthesia during emergence and extubation. Anesth Analg. 2003;96(1):293−7. Ki YM, Kim NS, Lim SH, Kong MH, Kim HZ. The effect of lidocaine spray before endotracheal intubation on the incidence of cough and hemodynamics during emergence in children. Korean J Anesthesiol .2007;53:1−6. Morgan EG, Mikhail MS, Murray MJ. Management airway. Dalam: Morgan EG, Mikhail MS, Murray MJ, penyunting. Clinical anesthesiology. Edisi ke-4. New York: McGraw-Hill;2006. Hlm. 91−116. Henderson J. Airway management in adult. Dalam: Miller RD, penyunting. Miller’s Anesthesia. Edisi ke-7. Philadelphia: Elsevier Churcill Livingstone; 2010. Hlm.1573−610. Karmarkar S, Varshney S. Tracheal extubation. Continuing education in anaesthesia, Crit are & Pain 2008;8(6):214−20 Gonzalez RM, Bjerke RJ, Drobycki T. Prevention of endotracheal tube-induced coughing during emergence from general anesthesia. Anesth Analg. 1994;79:792−5. Diachun CD, Tunink BP, Brock-Utne JG. Suppression of cough during emergence from general anesthesia: laryngotracheal lidocaine through a modified endotracheal tube. J Clin Anesth 2001;13:447−57 Nishino T, Hiraga K, Sugimori K. Effects of intravena lignocaine on airway reflexes elicited by irritation of the tracheal mucosa in humans anesthetized with enflurane. Br J Anaesth. 1990;64:682−7. Hamaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of responses by lidocaine. Anesthesiol.2000;93(1):95−103 Orandi AN, Hajimohammadi F. Post-Intubation Sore Throat and Menstrual Cycles. Anesth Pain. 2013;3(2):243−9. Liu J, Zhang X, Gong W, Li S, Wang F, FuS, dkk. Correlations between Controlled endotracheal tube pressure and postprocedural comploication: a multicenter study. Anesth Analg 2010;111;1133−7 Jaicbandran VV, Bhanulaksmi IM, Jagadeesh V. Intracuff buffered lidocaine versus saline or air-A comparati.v.e study for smooth extubation in patients with hyperactive airways undergoing eye surgery. SAJAA .2009;15(2):114 Navarro LHC, Lima RM, Aguiar AS, Braz JR, Carness JM, Modolo NS. The effect of intracuff alkalinized 2% lidocaine on emergence coughing, sore throat, and hoarseness in smokers. Rev Assoc Med Bras. 2012;58(2):248−53. Canning BJ. Anatomy and neurophysiology of the cough reflex. Chest. 2006;129:Suppl:33−47. Widdicombe JG. A brief overview of the mechanisms of cough. Dalam: Chung KF, Widdicombe JG, Boushey HA, penyunting. Cough: Causes, mechanism and therapy. Massachusetts: Blackwell Publishing: 2003.hlm.17−25.
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.
Sedasi dan Analgesia di Ruang Rawat Intensif Sudjud, Reza Widianto; , Indriasari; Yulriyanita, Berlian
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Pasien sakit kritis, khususnya yang mendapatkan ventilasi mekanik, seringkali mengalami nyeri dan kecemasan. Prinsip utama dari perawatan di ruang rawat intensif (ICU) adalah memberikan rasa nyaman sehingga pasien dapat mentoleransi lingkungan ICU yang tidak bersahabat. Pengelolaan sedasi dan analgesia yang adekuat dapat mempersingkat penggunaan ventilasi mekanik dan lama perawatan di ICU. Hal ini dapat dilakukan dengan mengidentifikasi dan mengatasi penyakit dasar dan faktor pencetus, menggunakan metode nonfarmakologi untuk meningkatkan rasa nyaman, pemberian terapi sedasi dan analgesia dengan memilih obat yang tepat, serta pemantauan secara rutin untuk menghindari terapi yang berlebihan dan berkepanjangan. Kata kunci: Analgesia, cemas, nyeri, ruang rawat intensif, sedasi Critically ill patients, especially those who receive mechanical ventilation, oftenexperience pain and anxiety. The main principle of treatment in the intensive care unit (ICU) is to provide a sense of comfort so that the patient can tolerate the ICU environment.Management of adequate sedation and analgesia can shorten the use of mechanical ventilation and length of ICU care. This can be done by identifying and correcting the underlying disease and precipitating factors, use of non-pharmacological methods to improve comfort, sedation and analgesia therapy with choosing the right drug, as well as regular monitoring to avoid excessive and prolonged therapy. Key words: Analgesia, anxiety, intensive care unit, pain, sedation Reference Rathmell.P.James. Bonica’s Management of Pain. Pain management in the intensive care unit. Lippincott Williams 2012;112:1590–01. Sessler CN, Wilhem W. Analgesia and sedation in the intensive care unit: an overview of the issues Crit Care. 2008;12(Suppl 3): S1. Young J. Sedation. Dalam: Core topics in critical care medicine. New York: Cambridge university press; 2010:77–88. Singer M WAR. Oxford handbook of critical care. Pain and post operative intensive care. Oxford University Press Inc; 2005:530–35. Marino P L. The ICU book: Analgesia and Sedation. Lippincott williams & wilkins; 2007;49:938–66. McConachie I. Handbook of ICU therapy. Analgesia for the high risk patient. New York: Cambridge University Press; 2006;4:51–64. Sessler CN VK. Patient-Focused Sedation and Analgesia in The ICU. Chest 2008;133:552–65. Mitchell E. Pain control. Dalam : Core topics in critical care medicine. New York: Cambridge university press; 2010:72–6. Peitz J Gregory, Olsen M Keith. Top 10 Myths Regarding Sedation and Delirium in the ICU. J Critical Care Medicine 2013;41:S46–56. Reade C Michael, Finfer Simon. Sedation and Delirium in the Intensive Care Unit. J New England 2014:444–54. Riessen.R, Pech.R. Comparison of the ramsay score and the richmond agitation sedation score for the measurement of sedation depth. Crit Care 2012.16 (Suppl 1):326. Recommended standards for short latency auditory evoked potentials.American clinical neurophysiology society.2008:12-9. Stern. TA. Manual of intensive care medicine. Diagnosis and treatment of agitation and delirium in the intensive care unit patient. Lippincott williams.2000; 179:871–75.
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
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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).
Pengaruh Magnesium Sulfat Intravena terhadap Kebutuhan Fentanil dan Propofol Intraoperatif pada Pasien yang Dilakukan Histerektomi dengan Anestesi Umum Thayeb, Srilina; Bisri, Tatang; Oktaliansah, Ezra
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Pemberian adjuvan analgetik dan sedatif intraoperatif bisa mengurangi pemakaian fentanil dan propofol sehingga akan mengurangi efek samping. Magnesium sulfat (MgSO4) mempunyai efek analgetik dan sedatif dengan bekerja sebagai antagonis reseptor N-Methyl D-Aspartat (NMDA) dan menghambat saluran kalsium (Ca-channel blocker). Penelitian ini bertujuan untuk mengetahui efektivitas pemberian MgSO4 untuk mengurangi penggunaan fentanil dan propofol intraoperatif. Penelitian dilakukan di Central Operating Theatre (COT) Rumah Sakit Dr. Hasan Sadikin Bandung sejak bulan Agustus−Oktober 2013 dengan uji klinis acak tersamar ganda pada 58 pasien yang menjalani histerektomi dengan anestesi umum. Pasien dibagi dalam 2 kelompok, masing-masing 29 orang. Kelompok MgSO4 mendapatkan MgSO4 30 mg/kgBB sebelum induksi anestesi dilanjutkan 10 mg/kgBB/jam sampai akhir operasi. Kelompok kontrol mendapatkan NaCl 0,9% dengan jumlah yang sama. Anestesi yang adekuat dinilai dengan patient response to surgical stimulus (PRST) dan bispectral index (BIS). Data hasil penelitian diuji dengan uji-t dan Uji Mann-Whitney. Hasil penelitian didapatkan bahwa dengan pemberian MgSO4 untuk mempertahankan nilai BIS 40−60 dan PRST 2−4 menggunakan fentanil dan propofol yang lebih sedikit dibanding dengan kelompok kontrol, dengan pebedaan sangat bermakna (p<0,01). Simpulan penelitian ini adalah pemakaian MgSO4 bisa mengurangi kebutuhan fentanil dan propofol intraoperatif. Kata kunci: Bispectral index, fentanil, propofol, patient response to surgical stimulus Administration of intraoperative analgetic adjuvant will reduce major fentanyl requirement dose, in consideration of increasing fentanyl dose denotes more side effects. Magnesium sulphate (MgSO4 )acts as NMDA receptor – antagonist and blocks calcium channel (Ca channel blocker) and give effect analgesia and anesthesia. The aim of this study is to understand effectiveness of magnesium sulphate administration to reduce fentanyl and propofol requirement intraoperative.This study was conducted with double blind randomized controlled trial method to 58 patients who underwent hysterectomy in general anesthesia and divided into two groups of 29 persons .The MgSO4 group was administered 30mg/kgBW MgSO4 intravenously before induction and 10 mg/kgBW during surgery. The NaCl group was administered NaCl 0,9% intravenous. In both groups, PRST and BIS was assessed. This test results in administration of magnesium sulphate to maintain BIS score 40−60 and PRST 2–4 could reduce dose fentanyl and propofol requirement dose the lower in magnesium group (p<0,01). The Conclusion of this study is there is MgSO4 can reduce fentanyl and propofol intraoperatif. Key words: Bispectral index, fentanyl, propofol, patient response to surgical stimulus Reference Chin KJ, Yeo SW. Bispectral index values at sevoflurane concentrations of 1% and 1.5% in lower segment cesarean delivery. Anesth Analg. 2004;98:1140–4. Barbosa FT, Barbosa LT, Jucá MJ, Cunha RMd. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol. 2010;60:481–97. Nurrochmad A, Masahiko O, Narita M, Suzuki T. The advantages of fentanyl for the treatment of pain: studies of pharmacological profiles and fentanyl related side effects. Majalah Farmasi Indonesia. 2004;15:185. Ray M, Bhattacharjee DH, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoprative recovery: a comparative study. Indian J Anaesth.2010;54:137–41. Kothari D, Mehrotra A, Choudhary B, Mehra A. Effect of intravenous magnesium sulfate and fentanyl citrate on circulatory changes during anaesthesia and surgery: a clinical study. Br J Anesth.2008;52:800–4. Na HS, Lee JH, Hwang JY, Ryu JH, Han SH, Jeon YT, dkk. Effect of magnesium sulphate on intraoperative neuromuscular blocking agent requrements and postoperative analgesia in children with cerebral palsy. Br J Anesth. 2010;104:344–50. Jee H, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anesth. 2009;103:484–9. Lee DH, Kwon IC. Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for caesarean section. Br J Anesth.2009;103:861–6. Choi JC, Yoon KB, Um DJ, Kim C, Kim JS, Lee SG. Intravenous magnesium sulfate administration reduces propofol infusion requirements during maintenance of propofol–N2O anesthesia. Anesthesiology 2002;97:1137–41. Levaux CB, Dewandre PY. Effect of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopedic surgery. Anaesthesia 2003;58:131–5. Širvinskas E, Laurinaitis R. Use of magnesium sulfate in anesthesiology. Medicina.2002;38:695. Dube LG, JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anesth. 2003;50:732–46. Rao M. Acute postoperative pain. Indian JAnaesth 2006;50:340–4. Koinig H, Wallner T, Marhofer P, Andel H, Rauf KH, Mayer N. Magnesium sulfate reduces intra and postoperative analgesic requirements. Anesth Analg. 1998;87:206–10. Morgan JM, Murray MJ. Pain management. Dalam: Morgan JM, Murray MJ, penyunting. Clinical Anesthesiology. Edisi ke-4. New York: McGraw Hill Companies; 2006. Hlm.359–411. Seyhan TO, Tugrul M, Sungur MO, Kayachan S, Telci L, Pembeci K, dkk. Effect of three diffrent dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. Br J Anaesth. 2006;96:247–52.
Penatalaksanaan Aspirasi Benda Asing pada Pasien Pediatrik wullur, caroline; Rasman, Marsudi
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Aspirasi benda asing adalah kejadian yang sering terjadi terutama pada populasi anak-anak. Kejadian ini dapat membahayakan nyawa sehingga diperlukan tindakan ekstraksi benda asing tersebut dengan segera. Diagnosis pasti dapat terhambat terutama bila dari anamnesa tidak spesifik, ketika orang tua tidak mampu menyadari pentingnya gejala, atau bahkan ketika temuan klinis dan radiologis tidak spesifik atau terlewatkan oleh dokter. Aspirasi bahan organik dapat menyebabkan peradangan mukosa saluran napas berat. Jika bahan organik tidak segera diekstraksi, peradangan kronis akan menyebabkan terbentuknya jaringan granulasi di sekitar benda asing, yang pada akhirnya dapat menyebabkan infeksi paru-paru, baik pneumonia maupun abses. Pada kejadian aspirasi benda asing, tidak jarang pasien datang dengan komplikasi sekunder, seperti demam terus-menerus, “asma”, atau pneumonia berulang untuk waktu yang lama. Pada tulisan ini akan diulas mengenai kejadian aspirasi-benda asing, berbagai samaran klinisnya, tata laksana ekstraksi dan anestesi yang tersedia, serta langkah-langkah yang dapat dilakukan untuk mencegah aspirasi. Kata kunci: Aspirasi, benda asing, bronkoskopi Foreign-body aspiration is a relatively common occurrence in children. It may present as a life-threatening event that necessitates prompt removal of the aspirated material. However, the diagnosis may be delayed when the history is atypical, when parents fail to appreciate the significance of symptoms, or when clinical and radiologic findings are misleading or overlooked by the physician. Aspiration of organic matter causes severe airway mucosal inflammation. If the organic matter is not promptly removed, chronic inflammation leads to the development of granulation tissue around the foreign body, which may ultimately present as a lung infection. In this setting, it is not uncommon to treat patients for secondary complications, such as persistent fever, “asthma,” or recurrent pneumonia for long periods. Here we review the incidence of foreign-body aspiration, its various clinical presentations, its management including anesthesia techniques, and measures we can do to prevent future aspirations. Key words: Aspiration, foreign body, bronchoscopy Reference Kalyanappago VT, Kulkarni NH, Bidri LH. Management of tracheobronchial foreign body aspirations in paediatric age group – A 10 year retrospective analysis. Indian J. Anaest 2007; 51(1): 20–23 Fidkowski C.W, Zheng H, Firth PG, The anaesthetic considerations of tracheobronchial foreign body in children: a literature review of 12.979 cases. Anaest Analg. 2010; 111(4): 1016–25 Roberts S and Thomington RE, Pediatric bronchoscopy. Contin educ anaesth crit care pain. 2005; 5 (2): 41 ̶ 44 Cote C, Lerman J, Anderson B. Otolaryngiologic procedure. Chapter 31 Page 657 ̶ 681. In: A practice of anesthesia for infants and children. 5th edition. Philadephia: Saunders Elsevier Publishing; 2013. Weir PM. Foreign Body Aspiration. Chapter 27, Pages 163–166. In: Problems in Anaesthesia: Paediatric Anaesthesia. Stoddart PA, Lauder GR (editors). London: Taylor and Francis Books Ltd; 2004 Naragund AI, Mudhol RS, Harugop AS, Patil PH, Hajare PS, Metgudmath VV. Indian J Otolaryngol Head Neck Surg. 2014; 66(S1): 180–5 A-Kader HH. Foreign body ingestion: children like to put objects in their mouth. World J Pediatr. 2010, 6(4): 301 ̶ 310 Seth D, Kamat D, Pansare M. Foreign body aspiration, a guide to early detection, optimal therapy. Consultant 360 for Pediatricians. 2007; 6(1) Farrell PT. Rigid Bronchoscopy for foreign body removal: anaesthesia and ventilation. Paediatric Anaesthesia 2005; 14: 84–89. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Pediatric Basic Life Support. Circulation. 2005;112:156–166
Luas Kolaps Paru pada Anestesia Umum dengan Penilaian Electrical Impedance Tomography Durasi Kurang dari 2 Jam dan Lebih dari 2 Jam chandra, Susilo; Nashella, Nazalia; Harijanto, Eddy; , Rahendra
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Anestesia dan pembedahan dapat menyebabkan atelektasis intraoperasi, penurunan volume paru dan atelektasis akan menyebabkan komplikasi paru pascaoperasi. Electrical impedance tomography (EIT) merupakan alat pencitraan noninvasif untuk menilai distribusi ventilasi paru. Tujuan penelitian ini adalah untuk membandingkan luas kolaps paru yang terjadi pada anestesia umum dengan durasi kurang dari 2 jam dan lebih dari 2 jam dengan menggunakan EIT dan algoritma Costa dkk, dengan sebelumnya menghilangkan faktor komorbid dan faktor prediktor yang lain. Penelitian ini merupakan uji klinis prospektif yang dilakukan di RSCM Kirana selama bulan Maret sampai Mei 2013 pada 42 pasien dewasa usia 18–59 tahun, ASA 1–2 dan IMT <30 kg/m2 yang menjalani operasi mata elektif dengan anestesia umum. Pengamatan dilakukan selama operasi dengan menggunakan EIT. Pasien dibagi ke dalam dua kelompok berdasarkan durasi anestesia lebih dari 2 jam dan kurang dari 2 jam. Dilakukan pengukuran variasi tidal regional, volume tidal, peak inspiratori presure ,dan positive end-expiratory pressure. Hasil pengukuran dihitung sesuai algoritme Costa dkk untuk mencari luas kolaps yang terjadi. Pada kelompok anestesia umum dengan durasi lebih dari 2 jam didapatkan luas kolaps 16,83±8,47 % dan pada durasi kurang dari 2 jam didapatkan luas kolaps 16,16±11,93 % (p>0,05). Tidak terdapat perbedaan bermakna antara luas kolaps yang terjadi pada anestesia umum dengan durasi lebih dari 2 jam dan kurang dari 2 jam. Kata kunci: Electrical impedance tomography, kolaps paru, komplikasi paru pascaoperasi Anesthesia and surgery can cause intraoperative atelectasis, whereas decreased lung volume, and atelectasis can lead to postoperative pulmonary complications. Electrical impedance tomography (EIT) is a noninvasive imaging to assess lung distribution of ventilation. The aim of this study was to compare lung collapse in patients without co morbid and other predictor of PPCs that undergone general anesthesia with duration more than 2 hours and less than 2 hours using EIT and Costa algorithm. This study was a prospective clinical trial conducted in RSCM Kirana during March to May 2013 on 42 patients aged 18–59 years, physical status ASA 1–2, and BMI < 30 kg/m2 underwent elective eye surgery under general anesthesia. The EIT was used intraoperatively. At the end of anesthesia, the patients were divided into two groups based on the duration of anesthesia more than 2 hours and less than 2 hours. The regional tidal variation, tidal volume, peak inspiratory pressure, and positive end-expiratory pressure were observed then. Costa algorithm was used to calculate the lung collapse. In duration of anesthesia more than 2 hours group the lung collapse was 16,83 ± 8,47 %. In duration of anesthesia less than 2 hours group the lung collapse was 16,16±11,93 % (p>0,05). There was no significant difference between lung collapse in anesthesia duration more than 2 hours and less than 2 hours group. Key words: Electrical impedance tomography, lung collapse, postoperative pulmonary complications Reference Degani-Costa LH, Faresin SM, Falcao LF. Preoperative evaluation of the patient with pulmonary disease. Brazilian J Anesthesiol. 2014;64:22–34. Hedenstierna G. Respiratory physiology. Dalam:Miller’s Anesthesia, edisi ke-7. Philadelphia: Churchill Livingstone Elsevier: 2010, hlm. 361-89. Tusmana G, Bohm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anesthesiol. 2012; 25: 1–10 Pelosi P, Gregoretti C. Perioperative respiratory Complications and the Postoperative qonsequences-atelectasis and risk factors. Euro Crit Care and Emerg Med 2009. Maceiras PR. Peri-Operative Atelectasis andAlveolar Recruitment Manoeuvres. ArchBronconeumol. 2010;46(6):317–324 Scholes RL, Browning L, Sztendur EM, Denehy L. Duration of anesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Austral J f Physiotherapy. 2009;55: 191–8. Sogame LCM, Vidotto MC, Jardim JR, Faresin SM. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008 Aug;109(2):222–7. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, dkk. Prediction of Postoperative Pulmonary Complications in a Populationbased Surgical Cohort. Anesthesiology 2010; 113(6):338–50. Talab HF, Zabani IA, Abdelrahman HS, Bukhari WL, Mamoun I, Ashour MA, Sadeq B, Sayed SIE. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoinglaparoscopic bariatric surgery. Anesth Analg. 2009; 109 (5): 1511–16. Reinius H, Jonnson L, Gustaffson S, Sundborn M, Duvernoy O, Pelosi P, dkk. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis–a computarized tomography study. Anesthesiology. 2009;111:979–87. Costa ELV, Borges JB, Melo A, Sipman FS, Junior CT, Bohm SH dkk. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedancetomography. Intens Care Med. 2009;35:1132–7. Moerer O, Hahn G, Quintel M. Lung impedance measurements to monitor alveolar ventilation. Curr Opin Crit Care. 2011;17:260–7. Blankman P, Gommers D. Lung monitoring at the bedside in mechanically ventilated patients. Curr Opin Crit Care 2012;18: 261–6. Muders T, Luepschen H, Putensen C. Impedance tomography as a new monitoring technique. Curr Opin Crit Care 2010; 16: 269–75. Stoelting RK, Hiller SC. The lungs. Dalam: Penyunting. Brown B, Murphy F. Pharmacology and physiology in anesthetic practice,edisi ke- 4. Philadelphia: Lippincott Williams and Wilkins; 2006, hlm. 771–82. Davison R, Cottle D. The effect of anesthesia on respiratory function. ATOTW. 2010
Penatalaksanaan Anestesi pada Operasi Seksio Caesarea Pasien G4p3a0 dengan Trombositopenia, Presentasi Bokong Murni dan Bayi Besar prabandari, dita; Erlangga, M. Erias
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Trombositopenia adalah penurunan jumlah trombosit dibawah normal. Umumnya terjadi pada 7 ̶ 8% kehamilan. Trombositopenia dapat terjadi pada beberapa kondisi, beberapa diantaranya adalah kehamilan. Trombositopenia merupakan kelainan hemotologis umum kedua setelah anemia pada kehamilan. Perdarahan pada kasus obstetri berperan besar terhadap kematian ibu, yaitu sekitar 127.000 kematian setiap tahun di dunia. Perdarahan post partum merupakan mayoritas penyebabnya dan penyebab umum dari perdarahan post partum adalah gangguan koagulasi dan koagulopati. Seorang wanita, G4P3A0 parturien aterm kala I fase aktif, trombositopenia, presentasi bokong murni, TBBJ >3.500 gr direncanakan seksio caesarea (SC). Hasil laboratorium didapatkan Trombosit 7.000 mm3. Pemeriksaan didapatkan ekimosis di keempat extremitas. Penatalaksanaan anestesi pada pasien ini dilakukan dalam anestesi umum. Kondisi pasien pasca operasi, tidak didapatkan defisit neurologis maupun perdarahan aktif. Setelah diobservasi di ruang pemulihan, pasien dipindahkan ke ruang perawatan. Kata kunci: Kehamilan, seksio caesaria, trombositopenia Trombositopenia is a term of decrease in platelet count below normal value. 7 ̶ 8% happens in pregnancy. Trombositopenia can happen in several conditions, one of them was pregnancy. Trombositopenia is a hemotologic disorder that commonly happen secondary after anemia in pregnancy. Hemorrhage in obstetri cases play major role in mother’s death, around 127,000 mother died each year. Post partum hemorrhage is the major cause and the general cause of post partum hemorrhage was coagulation disorder and coagulopathy. A woman G4P3A0 in parturient at term phase I, trombositopenia, frank breech presentation, prediction baby body weight >3500 plan for cesarian section (c-section). The lab result shows platelet count 7000 mm3. From physical examination shows echimosis in both extremity. We performed the c-section in general anesthesia. Post operative condition, no sign of defisit neurologis nor active bleeding. After close monitoring in the recovery room, the patient then transferred to regular ward. Key words: C-seksion, pregnancy, trombositopenia Reference Anestesi obstetri, Bisri T, Wahjoeningsih S, Suwondo B. Anestesi Obstetri; komisi pendidikan spesialis anestesiologi konsultan anestesi obstetri kolegium anestesiologi dan terapi intensif Indonesia. 2013. Grensheimer T, James A, Stasi R. How I treat trombositopenia in pregnancy, journal of the American society of hematology, nov 2012 Thompson SA, Liew ACS, Kam P.C.A. Anesthesia university of St. George Hospital, Australia, 2004, 59, pages 255–264 Butterworth John F., Mackey David C. Morgan and Mikhail’s clinical anesthesiology maternal and fetal physiologi and anesthesiology: Newyork;McGraw Hill, 2013. Chestnut David H. Obstetri anesthesia principles and practice 3rd edition. Elseveir mosby: Philadeplphia; 2004. Bravemen Ferne R. Obstetri and gynecologic anesthesia the requisites in anesthesiology, Mosby. Philadelphia, 2006. Sanjay D, Bhavani S,Scott S. Obstetri anesthesia handbook. 5th edition, springer New York, 2006. The American Society of Anesthesiologist. Practice guidelines for obstetri anesthesia, an updated report by the American society of anesthesiologist task force on obstetri anesthesia, anesthesiology, lippincott wiliams and wilkins, inc;2007;106:843–63. Lyons Gordon, Platelet Counts and Obstetric Analgesia and Anaesthesia, National Blood Transfusion Committee, London Simon L, Santi TM, Sacquin P, Hamza J., Pre-anaesthetic assessment of coagulation abnormalities in obstetric patiens: usefulness, tiing and clinical implication; BJA 1997;78;678–683 Gemsheimer T., James H. Andra, Stasi R., How I Treat Thrombocytopenia in Pregnancy. United Kingdom. Blood. 2013;121(1); 38

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