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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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Articles 91 Documents
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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.
Anestesi Epidural Thorakal pada Operasi Shapp Plate pada Pasien dengan Fraktur Kosta Tertutup Multipel Fardian, Dedy; Laksono, Ristiawan Muji
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Teknik anestesi epidural thorakal banyak digunakan dengan atau tanpa anestesi umum pada operasi daerahthoraks, abdomen dan retroperitoneal. Penggunaan kombinasi dengan anestesi umum akan mengurangi kedalamananestesi dan hemodinamik lebih stabil, serta pulih lebih cepat. Laporan kasus ini, wanita usia 65 tahun, dengandiagnosis fraktur tertutup costae 3–7 sebelah kanan yang menjalani operasi SHAPP klipping kosta dengan anestesiumum dikombinasi epidural thorakal. Status isik pasien ASA 3 dengan geriatri, hipertensi terkontrol, iskemiaanteroekstensif. Anestesi epidural dengan pendekatan median setinggi vertebra T7-8, teknik loss of resistance padakedalaman 3,5 cm dan kateter sedalam 5 cm. Setelah test dose negatif, dilakukan intubasi endotrakeal. Bupivakain0,25% 8 mL+fentanil 50 μg didiberikan ke dalam kateter epidural. Operasi berlangsung stabil dengan tingkatsedasi ringan anestesi inhalasi. Penatalaksanaan nyeri pascaoperasi dengan bupivakain 0,125%+morin 1 mg totalvolume 8 mL, VAS score 0–1. Pada hari ke-4, kateter epidural dicabut diganti obat NSAID oral. Pasien dipulangkanpada hari ke-5. Anestesi epidural thorakal merupakan teknik anestesi yang mempunyai beberapa kelebihan efekanalgesianya, efek perubahan hemodinamik minimal serta menurunkan risiko komplikasi pascaoperasi sehingga berperan utama dalam anestesi bedah thoraks pada geriatri termasuk penatalaksanaan nyeri pascaoperasinya. Kata kunci: Anestesi epidural thorakal, geriatri, hemodinamik stabil, komplikasi pascaoperasi, penatalaksanaan nyeri pascaoperasi Thoracic epidural anesthesia has become widely used with or without general anesthesia for thoracic, abdominal,and retroperitoneal procedures. Combined with general anesthesia, it decreases the need for deep level of anesthesiaand provides more hemodynamically stable operative course and faster emergence of general anesthesia. In thiscase report, an elderly woman, 64 years old, suffered from right 3rd–7th closed rib fracture undergo SHAPP clippingrib surgery under general anesthesia combined with thoracic epidural anesthesia. The physical status was ASA 3with geriatric, controlled hypertension, anteroextensive ischemia. Epidural anesthesia was performed with medianapproach in level T7-8, loss of resistance technique had been used to ind epidural space at 3.5 cm depth, and 5cm catheter was inserted. After the test dose showed negative result, the endotracheal intubation was performed.Bupivacaine 0.25% 8 mL+fentanyl 50 μg was injected intra epidural catheter. The operation went stable with lowlevel sedation of inhalation anesthetics agent. For post operative pain management we used regimen bupivacaine0.125%+morphine 1 mg total volume 8 mL, VAS score 0–1. On the day 4 after surgery, the epidural catheter wasremoved and switched to oral NSAID and the patient discharged on day 5. Thoracic epidural anesthesia is oneof regional anesthesia technique with many advantages such as superiority of pain relief, minimally changes inhemodynamic also lowering risk of postoperative complication, so it plays a major role providing anesthesia inthoracic surgery especially in geriatric, including post operative pain management.Key words: Geriatric, hemodynamically stable, post operative complication, post operative pain management, thoracic epidural anesthesia Reference Yilmaz M, Wong CA. Technique of neuraxial anesthesia. Dalam: Wong CA, penyunting. Spinal and Epidural Anesthesia. New York: McGraw-Hill, Inc; 2007. hlm. 56–9. Hadzic A. Epidural blockade. Dalam: Hadzic A, penyunting. Textbook of regional anesthesia and acute pain management. New York: McGraw-Hill; 2007. hlm. 253–56, 267–70. Brown, DL. Spinal, epidural and caudal anesthesia. Dalam: Miller RD, penyunting. Miller’s Anesthesia. Edisi ke-7. Philadelphia: Churcill Livingstone; 2009. hlm.1611–38, 2261–76. Xie Z, Lanahan J. Anesthesia for geriatric patients. Dalam: Dunn, PF, penyunting. Clinical anesthesia procedures of the massachusetts general hospital. Edisi ke-7. Philadelphia: Lippincott Williams and wilkins; 2007.hlm. 487–91. Akhtar S. Ischemic heart disease. Dalam: Stoelting’s Anesthesia and co-existing disease. Edisi ke-5. Philadelphia: Churcill livingstone; 2009. hlm.11–20. Wu CL, Hurley RW. Post operative pain management and patient outcome. Dalam: Post operative pain management: an evidencebased guide to practice. Philadelphia: Saunders; 2006. hlm. 50, 75–9. Strebel BM, Ross S. Chronic postthoracotomy pain syndrome. CMAJ 2007177: 1029. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101:77–86. Gerner P. Post-thoracotomy pain management problems. Anesthesiol Clin. 2008;26(2):355. Sokouti M, Aghdam BA, Golzari SEJ, Moghadaszadeh M. A comparative study of post operative pulmonary complications using fast track regimen and conservative analgesic treatment: a randomized clinicaltrial. Tanaffos 2011;10(3):12–9 Kettner SC , Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? Br J of Anaesth. 2011;107(S1):i90–5.
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
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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.
Initiation Time and Time Needed to Achieved Ideal Nutrition Level in Mechanically Ventilated Patient admitted to Intensive Care Unit of Dr. Hasan Sadikin Hospital Bandung Irawati, Dian; , Suwarman; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Enteral nutrition need to be given in first 24–48 hour after the patient admitted to the ICU, while ideal nutritional level need to be achieved in 48–72 hours after the patient admitted. Both time are “window opportunity” which influence morbidity and mortality. The aim of this study was to identify the initiation time and the time needed for ideal nutrition achieved in patient with mechanical ventilation. This prospective descriptive-observational study was done from June until September 2015 in ICU of Dr. Hasan Sadikin hospital to 39 subject. Result showed initiation time in 38 subject was done in ≤24 hour. In 24 subject, ideal nutrition level was achieved in more than 72 hour. Reason for delay in initiation rescusitation. Reason for ideal nutrition not fullfiled in less 72 hour was gradual nutrition procedure, intolerance, hemodinamic disturbance, absence of small bowel sound, and high glucose level. In conclusion the intiation time of enteral nutrition in almost all patient of Dr. Hasan Sadikin Hospital from June until September 2015 was done in less than 48 hour. After 72 hour of observation, 58,87% subject cannot achieved ideal nutrition in less than 72 hour.
Perbandingan Pemberian Kombinasi Haloperidol 0,5 mg dan Deksametason 5 mg dengan Ondansetron 4 mg terhadap Kejadian Mual Muntah Pascaoperasi Modified Radical Mastectomy dengan Anestesi Umum Rahmadsyah, Teuku; Fuadi, Iwan; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Mual muntah pascaoperasi dapat meningkatkan morbiditas dan memperpanjang masa rawat pascaoperasi.Haloperidol adalah obat tranquilizer major golongan dari butirofenon yang mempunyai efek reseptor D2 antagonis.Penggunaan kombinasi haloperidol dan deksametason sebagai antiemetik profilaksis dapat menguntungkan.Penelitian ini bertujuan untuk membandingkan kombinasi haloperidol 0,5 mg dan deksametason 5 mg denganondansetron 4 mg terhadap kejadian mual muntah pascaoperasi pada operasi modified radical mastectomy.Penelitian dilakukan terhadap 42 wanita (kurang dari 50 tahun) status fisik ASA I-II yang menjalani operasimodifikasi mastektomi radikal secara uji acak terkontrol buta ganda dalam anestesi umum. Pasien dibagi menjadidua kelompok yaitu 21 orang menerima haloperidol 0,5 mg ditambah deksametason 5 mg dan 21 orang menerimaondansetron 4 mg yang diberikan setelah intubasi dilakukan. Pasien diberikan analgetik ketorolak dan petidinintravena secara kontinu pascaoperatif. Evaluasi yang dinilai adalah tekanan darah, laju nadi, dan saturasioksigen. Hasil dari penelitian menunjukan terdapat kecenderungan keluhan mual muntah pascaoperasi lebihbanyak terjadi pada kelompok ondansetron 4 mg (38,1%) dibanding dengan kelompok kombinasi haloperidol0,5 mg dan deksametason 5 mg (4,8%). Pada analisis statistik yang dilakukan dengan uji Chi-Square didapatkanhasil perbedaan yang bermakna (p kurang dari 0,05). Simpulan dari penelitian ini adalah pemberian kombinasihaloperidol 0,5 mg dan deksametason 5 mg intravena lebih baik dibandingkan dengan ondansetron 4 mg intravenadalam menurunkan kejadian mual muntah pascaoperasi modified radical mastectomy. Kata kunci: deksametason, haloperidol, modified radical mastectomy, mual muntah, ondansetron Postoperative nausea and vomiting can lead to increase morbidity and lengthened postoperative hospital stay.Haloperidol is a major tranquilizer with a D2 receptor antagonist effect. A combination of haloperidol anddexamethasone is also effective to prevent postoperative nausea and vomiting, which offers beneficial effectssuch as lower cost, longer duration and are easy to find. The aim of this study is to compare a combination ofhaloperidol 0,5 mg and dexamethasone 5 mg with ondansetron 4 mg in managing postoperative nausea andvomiting following modified radical mastectomy. The study was done by conducting a double blind randomizedcontrolled trial of 42 subjects, women aged under 50 years old, who underwent modified radical mastectomy undergeneral anesthesia, with physical status ASA I-II. Patients were divided into two groups: 21 patients receivedcombination of haloperidol 0,5 mg and dexamethasone 5 mg, and 21 patients received ondansetron 4 mg, afterintubation. Intravenous ketorolac and pethidine were given as postoperative analgesia. Blood pressure, heartrate, oxygen saturation and length of surgery was recorded.The result of this study was postoperative nausea andvomiting occurs more frequent in the ondansetron 4 mg group (38,1%) compared to combination of haloperidol0,5 mg and dexamethasone 5 mg group (4,8%). In statistical analysis performed with Chi-Square test showedthere was significant difference between the two groups (p<0,05). As a conclusion of this study is intravenouscombination of haloperidol 0,5 mg and dexamethasone 5 mg better than ondansetron 4 mg in lowering theincidence of postoperative nausea and vomiting after modified radical mastectomy. Key words: Dexamethasone, haloperidol, modified radical mastectomy, nausea and vomiting, ondansetron Reference Daabiss MA. Ephedrine-dexamethasone combination reduces postoperative nauseaand vomiting in patients undergoing laparoscopic cholecystectomy. Internet Anesthesiol. 2008;18(1):1092 ̶ 100. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting. Can J Anesth. 2004;51:326 ̶ 41. Watcha MF, White PF. Postoperative Nausea and Vomiting, lts Etiology, Treatment, and Prevention. Anesthesiology. 1992;77:162–84. Gan TJ. Risk factors of postoperative nausea and vomiting. Anaesth Analg. 2006;102:1884 ̶ 98. Islam S, Jain PN. Postoperative nausea and vomiting (PONV): a review article. Indian J Anesth. 2004;48:253 ̶ 8. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999;91:109 ̶ 18. Ho KY, Chiu JW. Multimodal antiemetic therapy and emetic risk profiling. Ann Acad Med Singapore. 2005;34:196 ̶ 205. Matthew TV, Chan, Chui PT, Ho WS, King WK. Single dose tropisetron for preventing post operative nausea and vomiying after breast surgery. Anesth Analg. 1998;87:931 ̶ 5. McQuaid KR. Drugs used in the treatment of gastrointestinal diseases. Dalam: Basic & clinical pharmacology. Edisi ke-9. Boston: The McGraw-Hill Companies. 2004. hlm. 1045 ̶ 60. Raman S, Kaul TK, Anju G, Aprajita S. Postoperative nausea and vomiting. Anesth Clin Pharmacology. 2007;23:341 ̶ 56. Ku CM, Ong BC. Postoperative nausea and vomiting: a review of current literature. Singapore Med J. 2003;44(7):366 ̶ 74. Splinter WM, Roberts DJ. Dexamethasone decreases vomiting by children after tonsillectomy. Anesth Analg. 1996;83:913 ̶ 6. O’Brien C. Nausea and vomiting. J Can Family Physician. 2008;54:861 ̶ 3. Zarate E, et.al. A Comparison of The Cost and Efficacy of Ondansetron versus Dolasetron for Antiemetic Prophylaxis. Anaesth Analg. 2000;90:1352 ̶ 8. Rosow CE, et.al. Haloperidol versus Ondansetron for Prophylaxis of Post operative Nausea and Vomiting. Anesth Analg. 2008; 106:1407 ̶ 9. Azwar. Pencegahan mual dan muntah pascaoperasi pada anestesi umum: Perbandingan haloperidol 1mg iv dengan ondansetron 4 mg iv [Jakarta: Universitas Indonesia. 2009. Adipraja K, Himendra A, Bisri T. Pengaruh premedikasi haloperidol (serenace®) terhadap efek samping ketamine pada penderita rawat Intensif Fakultas Kedokteran UNPAD/RSHS Bandung. 1992; hlm. 1 ̶ 9. Smith JC, Wright EL. Haloperidol: An Alternative Butyrophenon for Nausea and’ Vomiting Prophylaxis in Anesthesia. AANA journal. 2005;75:273 ̶ 5. Digregio GJ. Anti Psichotic Drugs and Lithium. Dalam: Basic Pharmacology in Medicine. Edisi ke-3. New York: Mc Graw-Hill. 1990. hlm. 261 ̶ 2. Moorselli PL. Haloperidol: Clinical Pharmacokinetics and Significance of Theurapeutic Drug Monitoring. Dalam: Theurapeutic Drug Monitoring. Churchill Livingstone. 1981. hlm. 296 ̶ 301. Khan MP, Singh V, Kumar M, Singh B, Kapoor R, Bhatia VK. Prophylactic antiemetic therapy using combinations of granisetron, dexamethasone and droperidol in patients undergoing laparoscopic cholecystectomy. The Internet Journal of Anesthesiology. 2009;21(1):1092 ̶ 102.
Terapi Inhalasi Pada Tatalaksana Hipertensi Pulmonal Hadinata, Yudi; Parmana, I Made Adi
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
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Hipertensi pulmonal didefinisikan sebagai kelompok penyakit dengan karakteristik peningkatan resistensi pembuluh paru yang dapat menyebabkan gagal jantung kanan. Ketika kondisi tersebut tidak ditangani maka dapat menyebabkan perburukan kondisi hingga kematian. Kemajuan dalam pemahaman patofisiologi terkait dengan kondisi tersebut memberikan kesempatan bagi praktisi untuk mengobati pasien hipertensi pulmonal, yang dapat menurunkan angka mortalitas dan morbiditas, serta meningkatkan kualitas hidup pasien. Vasodilator paru yang ideal untuk digunakan bersifat spesifik untuk sirkulasi paru, bebas dari efek samping, murah, dan nyaman untuk dilakukan. Pemberian vasodilator melalui inhalasi merupakan salah satu strategi yang efektif untuk mengurangi tekanan arteri pulmonal dan juga menghindari efek samping sistemik seperti hipotensi. Tinjauan pustaka ini akan mengulas tentang terapi perioperatif hipertensi pulmonal dengan menggunakan vasodilator inhalasi. Kata Kunci: Hipertensi pulmonal, inhalasi vasodilator pulmonal, vasodilator pulmonal Inhalation Therapy In Pulmonary Hypertension ManagementPulmonary hypertension is defined as a group of diseases characterized by a progressive increase of pulmonary vascular resistance leading to right ventricular failure. When the condition is untreated this may lead to potentially devastating disease and premature death. The remarkable improvements for the understanding of the pathology associated with the condition provides an opportunity for practitioner to treat patients with pulmonary hypertension, thereby improving overall mortality, morbidity, and quality of life associated with the disease. The ideal pulmonary vasodilator for perioperative use which should be highly specific for the pulmonary circulation,free of side effects, inexpensive, and convenient to implement. Administration of vasodilators via inhalation is an effective strategy for reducing pulmonary artery pressure while avoiding systemic side effects such as hypotension. This paper will review on the perioperative therapy of pulmonary hypertension using inhaled vasodilators. Key words: Pulmonary hypertension, inhaled pulmonary vasodilator, pulmonary vasodilator
Comparison of Agitation Incidence in Adult Ambulatory Patients who Underwent Surgery by General Anesthesia Using Desflurane or Sevoflurane Putri, Andika C.; Nawawi, A. Muthalib; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Abstract

Postanesthesia agitation is a problem that sometimes occurs in patients who underwent general anesthesia. Thisstudy aims to compare the magnitude of the incident postanesthesia agitationin patienambulatory surgery performedunder general anesthesia with desflurane or sevoflurane use. Research single blinde randomized controlled trial in94 ambulatory surgical patients ASA I. Subjects divided into two groups: group I received desfluran and group IIreceived sevoflurane. Both groups at induction with propofol 2 mg/kg, fentanyl 2 μg/kgBW, atrakurium 0,1 mg/kg, then do laringeal mask airway (LMA) installation. Agitation in patiens assesed since the LMA is removed,the use of anesthetic drugs has beeb stoped, then at minute 5, 10, 15, 20, 25, 30, every five minutes after usingagitation-sedation scale riker. Statistic analysis using Chi-square and Mann-Whitney Test. The results obtainedindicate that the ratio of the incidence of agitation in the recovery room between the desflurane with sevofluranegroups were not statistically significant. Obtained 7 patients experiencing agitation pascaanestesi desflurane groupof 47 samples (14.9%), whereas only 5 patients with agitation of 47 samples sevoflurane group (10.6%). Onepatient from group desflurane assessed his agitation scale 6 (very agitated). The result of comparative magnitudeof the incidence of agitation in the group performed under general anesthesia using desflurance with sevofluranegroup using there is not a statistically significant difference.
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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Abstract

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 Kejadian Post Dural Puncture Headache pada Pasien Seksio Sesarea dengan Anestesi Spinal Menggunakan Teknik Median dan Paramedian , Rizki; , Suwarman; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Abstract

spinal (LCS) berpengaruh terhadap timbulnya PDPH. Berbagai faktor yang memengaruhi insidensi kejadian PDPH, meliputi jenis kelamin, usia, kehamilan, riwayat PDPH sebelumnya, ukuran dan bentuk jarum, arah jarum, jumlah percobaan tusukan, teknik penusukan median atau paramedian, dan keahlian ahli anestesi. Tujuan penelitian adalah membandingkan kejadian PDPH wanita hamil yang dilakukan seksio sesarea dengan anestesi spinal menggunakan teknik median dan paramedian di RS Dr. Hasan Sadikin Bandung, periode Maret–April 2014. Penelitian ini dilakukan secara uji klinis acak terkontrol tersamar tunggal terhadap 44 pasien wanita hamil aterm dengan status fisik American Society of Anesthesiologists (ASA) I dan II yang menjalani seksio sesarea dengan anestesi spinal. Subjek dibagi menjadi dua, kelompok paramedian (P) dan kelompok median (M). Kelompok P dilakukan penusukan menggunakan teknik paramedian dan kelompok M menggunakan teknik median dengan m jarum spinal ukuran 25-gauge tipe Quincke. Data hasil penelitian dianalisis menggunakan metode chi-kuadrat Hasil penelitian menunjukkan tidak ada perbedaan yang bermakna pada kedua kelompok (p=0,351), terdapat 2 kejadian (9%) PDPH pada kelompok median (n=22) dan tidak ditemukan kejadian pada kelompok paramedian (n=22). Simpulan penelitian ini adalah tidak ada pengaruh teknik penusukan menggunakan teknik paramedian atau median terhadap kejadian PDPH pada wanita hamil yang dilakukan seksio sesarea Kata kunci: Anestesi spinal, teknik paramedian, post dural puncture headache, teknik median Post dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Cerebro spinal fluid (LCS) leak have effect on the incidence of PDPH. Various factors affect the incidence of PDPH include gender, age, pregnancy, history of previous PDPH, the size and shape of the needle, the needle direction, the number of attempted punctures, median or paramedian puncture technique, and skill of the operator. The purpose of this study was to compare the incidence of PDPH in pregnant women who performed caesarean section under spinal anesthesia using median and paramedian techniques in Dr. Hasan Sadikin Hospital Bandung at April-May 2014. This research was conducted in single-blind randomized controlled clinical trial on 44 at term pregnant women with American Society of Anesthesiologists (ASA) physical status I and II undergoing cesarean section with spinal anesthesia. Subjects were divided into two groups paramedian (P) and the median (M). Group P performed using paramedian puncture technique and M groups using the median technique. Both of technique using a 25- gauge Quincke needle. The data were analyzed using chi-square method The results of this study showed no significant difference in both groups (p=0.351) , with 2 incidences of PDPH (9 % ) in the group median (n=22) and not found in the paramedian group (n=22). Conclusions there is no difference between median and paramedian techniques on the incidence of PDPH in pregnant women who performed caesarean section. Key words: Median, paramedian, post dural puncture headache, spinal anesthesia Reference Paech MJ, Whybrow T. The prevention of anaesthesiology. Asean J Anaesth.2007;8:86–95. Amorim JA, Gomes de Barros MV, Valenca MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012 Sep;32(12):916−23. Singh J, Ranjit S, Shrestha S, Limbu T, Marahatta SB. Post dural puncture headache. J Inst Med. 2010;32(2):30−2. Mosaffa FK, Madadi F, Khoshnevis SH, Besheli LD, Eajazi A. Post-dural puncture headache: a comparison between median and paramedian approaches in orthopedic patients. Anesth Pain. 2011;1(2):66–9. Wu CL, Christo P, Richman JM, Hsu W. Postdural puncture headache: an overview. Int J Pain Med Pall Care. 2004;3(2):53–9. Turnbull DK, Shepherd DB. Postdural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003 Nov;91(5):718−29. Ghaleb A, Khorasani A, Mangar D. Postdural puncture headache. Intern J General Med. 2012;5:45–51 Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needle in obstetric patients. Anesth Analg. 2000;91:916−20. Lybecker H, Moller JT, May O, Nielsen HK. Incidence and prediction of post dural puncture headache: a prospective study of 1021 anesthesia. Anesth Analg. 1990;70:389–94. Haider SZ, Aziz MA., Qasim M. Post dural puncture headache - a comparison of midlineand paramedian approaches. Biomedica. 2005;21:90−2. Valenca MM, Amorim JA, Moura TP. Why don't all individuals who undergo dura mater/arachnoid puncture develop postdural puncture headache? Anesth Pain. 2012;1(3):207–9. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Canadian J Anesth. 2003;50(5):460–9. Jabbari A, Alijampour E, Mir M, Hashem NB, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013;4(1):595–602. Kempen P, Mocek C. Bevel direction, dura geometry, and hole size in membrane puncture: laboratory report. Reg Anesth. 1997;22(3):267–72. Fink BR, Walker S. Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. Anesth Analg. 1989 Dec;69(6):768–72. Hatfalvi B. Postulated mechanisms for postdural puncture headache and review of laboratory models. Clinical experience. Reg Anesth. 1995;20(4):329−36.
Clinical Manifestations of Iscehaemic and Reperfusion Injury Pradian, Erwin; , Rizki; Maskoen, Tinni Trihartini
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Abstract

Although restoration of blood low to an ischaemic organ is essential to prevent irreversible tissue injury, reperfusionper se may result in a local and systemic inlammatory response that may augment tissue injury in excess of thatproduced by ischaemia alone. Cellular damage after reperfusion of previously viable ischaemic tissues is deinedas ischaemia-reperfusion (I-R) injury. I-R injury is characterized by oxidant production, complement activation,leucocyte endothelial cell adhesion, platelet-leucocyte aggregation, increased microvascular permeability anddecreased endothelium-dependent relaxation. In its severest form, I-R injury can lead to multiorgan dysfunctionor death. Although our understanding of the pathophysiology of I-R injury has advanced signiicantly in the lastdecade, such experimentally derived concepts have yet to be fully integrated into clinical practice. Treatment ofI-R injury is also confounded by the fact that inhibition of I-R-associated inlammation might disrupt protectivephysiological responses or result in immunosuppression. Thus, while timely reperfusion of the ischaemic areaat risk remains the cornerstone of clinical practice, therapeutic strategies such as ischaemic preconditioning,controlled reperfusion, and anti-oxidant, complement or neutrophil therapy may signiicantly prevent or limit I-Rinducedinjury in humans.

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