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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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Keefektifan Pencegahan Post Anesthesia Shivering (PAS) pada ras Melayu: Perbandingan Antara Pemberian Ondansetron 4 mg Intravena Dengan Meperidin 0.35 mg/kgBB Intravena Nugroho, Alfan Mahdi; Harijanto, Eddy; Fahdika, Arnaz
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Post Aneshesia Shivering (PAS) adalah gerakan involunter satu otot rangka atau lebih yang biasanya terjadi padamasa awal pemulihan pascaanestesia. PAS dapat menyebabkan hipoksia arterial, meningkatnya curah jantung,risiko terjadinya infark miokard, dan mengganggu interpretasi alat-alat pemantauan tanda vital. Ondansetron danmeperidin adalah dua obat yang sering digunakan untuk mencegah PAS. Terdapat perbedaan ambang rangsangmenggigil antar ras. Penelitian ini bertujuan membandingkan keefektifan pencegahan PAS dengan pemberianondansetron 4 mg dengan meperidin 0,35 mg/kgBB intravena pada ras Melayu di Indonesia. Setelah mendapatkanizin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan ujiklinis, acak, tersamar ganda pada 92 pasien ras Melayu yang menjalani operasi elektif di RSCM Kirana. Pasien dibagidalam dua kelompok yaitu kelompok ondansetron dan kelompok meperidin. Pasien mendapatkan ondansetronatau meperidin sesaat sebelum anestesia. Semua pasien kemudian mendapatkan anestesia umum yang sama. Pascaanestesia, kekerapan dan derajat menggigil dicatat tiap lima menit selama tiga puluh menit pertama. Tidak terdapatperbedaan bermakna secara statistik (p>0,05) dalam kekerapan PAS pada kedua kelompok. Kekerapan kelompokondansetron sebesar 15,2%, sedangkan kekerapan kelompok meperidin sebesar 6,5%. Ondansetron 4 mg intravenasama efektifnya dengan meperidin 0,35 mg/kgBB dalam mencegah kejadian PAS pada ras Melayu di Indonesia. Kata kunci: Melayu, meperidin, ondansetron, post anesthesia shivering (PAS) Post Anesthesia Shivering (PAS) is the involuntary movements of one or more skeletal muscles that usually occurin the beginning of post-anesthesia recovery. PAS can cause arterial hypoxia, increased cardiac output, myocardialinfarction, and can interfere with vital sign monitoring tools interpretation. PAS is commonly prevented byondansetron and meperidine. Studies done showed that different races have different shivering thresholds. Thisstudy aims to compare the effectiveness of PAS prevention by administering ondansetron 4 mg with meperidine0,35 mg/kg, both intravenously in Malayan race patients in Indonesia. After approval from Ethics CommitteeFaculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients, this studyconducted a randomized, double-blind clinical trial on 92 Malayan race patients undergoing elective surgery in theRSCM-Kirana. Patients were divided into two groups: ondansetron and meperidine. Patients received ondansetronor meperidine shortly before anesthesia, then all patients received standardized anesthesia (premedication withmidazolam 0.05 mg/kgBW and fentanyl 2 mcg/kg, induced with propofol 1-2,5 mL/kg, intubation or LMAinsertion is facilitated with rocuronium or 0.6 mg/kg, maintenance with sevoflurane 2 vol% to compressed air: O2= 2: 1). The frequency and degree of shivering were recorded every five minutes for thirty minutes post-anesthesia.The side effects were also recorded. There was no statistically significant difference (p> 0.05) in the frequency ofPAS in both groups. Intravenous ondansetron 4 mg was as effective as meperidine 0.35 mg/kgBW in preventingthe incidence of PAS in Malayan race patients in Indonesia. Key words: Malayan, meperidin, ondansetron, post anesthesia shivering (PAS) Reference Tie Hong-Tao, Su Guang-Zhu, He Kun, Liang Shao-Rong, Yuan Hao-Wei, Mou Jun-Huan. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2014;14:12. Alfonsi P. Postanaesthetic shivering. epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol 2003;69:438–42. George YWH, Thaib MR, Harijanto E. Perbandingan keefektifan antara klonidin dan petidin untuk pencegahan menggigil pascaanestesia dengan N2O/O2/enfluran. Departemen Anestesiologi dan Terapi Intensif FKUI. 1999;2–42. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharmalogical treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 2002;94:453–60. Nurkacan A, Chandra S, Mahdi A. Keefektifan mengurangi insiden menggigil pascaanestesia: perbandingan antara ajuvan fentanyl 25 mcg intratekal dengan ajuvan sufentanyl 2,5 mcg intratekal pada pasien seksio sesarea dengan anestesia spinal.Departemen Anestesiologi dan Terapi Intensif FKUI. 2012;48:6–33. Kogsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al., Predictor of core hypothermia and the surgical intensive care unit Anesth Analg 2003; 96(4):826–33. Witte J D., Sessler D I. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002;96(2):467–84. de Brito Poveda V, Galvão CM, dos Santos CB. Factors associated to the development of hypothermia in the intraoperative period. Rev Latino-am Enfermagem. 2009;17(2): 228–33. Simatupang RDE, Dahlan R, Harijanto E Pencegahan menggigil pascaanestesia dengan N2O/O2/enfluran: perbandingan antara ondansetron 8 mg dan petidin 0.35 mg/kgBB intravena. Departemen Anestesiologi dan Terapi Intesif. FKUI 2003:5–23 Bakker LEH, Boon MR, van der Linden RAD, Arias-Bouda LP, van Klinken JB, Smit F, et al. Brown adipose tissue volume in healthy lean south asian adults compared with white caucasians: a prospective, case controlled observational study. The Lancet Diabetes & Endocrinology. 2014;2(3): 210–7.
Feokromositoma: Seri Kasus Rachmat, Linda; Djaja, Anne Suwan; Tantri, Aida Rosita
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
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Feokromositoma adalah tumor penghasil katekolamin yang berasal dari sistem simpatoadrenal. Feokromositoma dapat mengakibatkan hipertensi dan dapat berakibat fatal. Terapi definitif untuk feokromositoma adalah pembedahan. Anestesia dan tatalaksana perioperatif pada kasus feokromositoma membutuhkan pendekatan dan teknik khusus yang bertujuan untuk menghindari terjadinya krisis adrenergik selama induksi anestesia, laringoskopi, dan intraoperasi. Pada pembedahan pengangkatan tumor feokromositoma juga perlu diantisipasi perubahan hemodinamik yang terjadi saat manipulasi tumor. Seri kasus ini melaporkan tiga orang pasien feokromositoma; semuanya memiliki riwayat hipertensi berat. Pada pasien pertama didapatkan peningkatan katekolamin yang signifikan dalam urin 24 jam dan variasi tekanan darah (antara 80–140/40–90 mmHg) dan laju nadi (80–100x/menit) intraoperasi. Pasien kedua mengalami peningkatan tekanan darah hingga 200/100 mmHg saat induksi. Pasien ketiga mengalami peningkatan katekolamin urin 24 jam dan peningkatan tekanan darah (220/100 mmHg) saat induksi. Setelah operasi ketiganya diekstubasi dan dirawat di ICU sebelum dipulangkan. Feokromositoma adalah salah satu tumor yang berakibat fatal apabila tidak ditatalaksana dengan baik sebelum dilakukan pembedahan. Hal ini dipicu oleh rangsang simpatis yang menyebabkan pelepasan katekolamin berlebihan saat induksi anestesia, laringoskopi, dan manipulasi tumor akibat pembedahan. Tatalaksana farmakologi sebelum operasi, pengawasan ketat selama pembedahan, dan keseimbangan antara vasodilatasi dan vasokonstriksi selama pembedahan sangat penting dalam tatalaksana perioperatif feokromositoma. Kata Kunci: Adrenergik, anestesia, feokromositoma, hipertensi, katekolamin Pheochromocytoma: Case SeriesPheochromocytoma is a catecholamine-producing tumor derived from the sympathoadrenal system. Complete tumor removal is the main therapeutic goal. The perioperative objective is to avoid adrenergic crisis during anesthesia induction, laryngoscopy, and tumor manipulation. This case series reported three patients with pheochromocytoma; in which all of them had severe hypertension history. The first patient had a significant cathecholamine increase in the 24 hours urine and a wide blood pressure range (between 80–140/40–90 mmHg). The heart rate also varied (80–100x/minute) intraoperatively. The second patient had a blood pressure increase up to 200/100 mmHg during anesthesia induction. The thirs patient had a significant cathecholamine increase in the 24 hours urine and a blood pressure increase up to 220/100 mmHg during anesthesia induction. After operation, all patients were extubated and admitted to ICU before going home. Pheochromocytoma is a catecholamine-producing tumor which may be lethal if not properly treated. Catecholamine release during anesthesia may happen during induction, laryngoscopy and tumor manipulation. Preoperative pharmacological intervention, intraoperative monitoring, and balanced between vasodilatation and vasoconstriction during surgery are essential in pheochromocytoma perioperative management. Key words: Adrenergik, anesthesia, cathecolamine, hypertension, pheochromocytoma
Manajemen Emboli Paru di Intensive Care Unit (ICU) Redjeki, Ike Sri; Satrio, Wijanarko
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Emboli paru merupakan komplikasi utama tromboemboli vena (VTE). Emboli paru termasuk dalam kegawatan kardiovaskular. Tersumbatnya pembuluh darah arterial paru dapat mengancam kehidupan disertai kegagalan ventrikel kanan yang dapat reversibel. Diagnosis (PE) yaitu adanya gejala umum dan tanda-tanda klinis seperti hipoksia, takipnea, dan takikardia. Di ICU, sebagian besar pasien memerlukan sedasi dan ventilasi mekanis sehingga manifestasi klinis tidak khas dan biasanya atipikal. Baku emas diagnosis PE adalah ditemukannya sumbatan pada angiografi paru. Diagnosis dan tatalaksana suportif menjadi sangat penting mengingat mortalitasnya yang tinggi. Oksigenasi, intubasi, dan ventilasi mekanik diperlukan untuk kegagalan pernafasan. Terapi vasopressor harus dipertimbangkan jika tekanan darah masih rendah. Terapi antikoagulan memainkan peran penting dalam pengelolaan pasien PE. Heparin dan low molecular weight heparin dapat diberi di awal. Pada kasus yang berat mungkin memerlukan trombolisis dengan obat-obatan seperti tissue plasminogen activator (tPA) atau mungkin memerlukan intervensi bedah melalui thrombectomy paru. Kata kunci: Antikoagulan, emboli paru, tromboemboli vena Pulmonary embolism is the major complication of venous thromboembolism (VTE). Pulmonary embolism is a cardiovascular emergency. By occluding the pulmonary arterial bed it may lead to acute life threatening but potentially reversible right ventricular failure. The diagnosis of (PE) is usually suspected by the presence of common symptoms and clinical signs include hypoxia, tachypnea, and tachycardia. However in ICU, the most of patients required sedation and mechanical ventilation. The clinical manifestations is usually atypical. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, once it is suspected, a diagnostic plan and supportive measures are essential. Oxygen supplementation, intubation, and mechanical ventilation are instituted as necessary for respiratory failure. Vasopressor therapy should be considered if the blood pressure is not rapidly restored. Anticoagulant treatment plays a pivotal role in the management of patients with PE. Heparin, low molecular weight heparins is administered initially. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy. Key words: Anticoagulant, pulmonary embolism, venous thrombus Reference Zochios V, Keeshan A. Pulmonary embolismin the mechanically-ventilated critically ill patient: is it different? The intensive care societty 2013. 2013;14:36–44. Marino P, penyunting. Venous thromboembolism. Philadelphia: Lipincott Williams Wilkins; 2007. Williams M, Aravindan N, Wallace M. Venous thromboembolism in the intensive care unit. Crit Care Clin 2003;19:185–207. Adam T, Arnaud P, Konstantinides S, Agnelli G, Galle N, Pruszczyk P. Guidelines on the diagnosis and management of acute pulmonary embolism. European Heart Journal. 2008;29:2276–315. Forgione A. Managing patients with suspected pulmonary embolism. JAAPA. 2006;19:22–8. Stoelting K, Dierdorf S, Penyunting. Deep vein thrombosis and pulmonary embolism. Philadelphia; 2002. Bahloul M, Chaari A, Kallel H, Abid L, Hamida C, Dammak dkk. Pulmonary embolism in intensive care unit: predictive factors, clinical manifestations and outcome. Ann Thorac Med 2010;5:97–103. Waldmann c, Vincent JL. Pulmonary Embolism the future, Optimising the prevention of PE in the critically ill patient. Journal of the intensive care society. 2014;15:2–16.
Correlation between Modified Clinical Pulmonary Infection Score with Duration of Mechanical Ventilation of Pneumonia Patient in ICU Cipto Mangunkusumo Hospital Madjid, Amir S; Sugiarto, Adhrie; Putri, Regina Prima; Alatas, Anas
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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Current extubation parameters are not entirely accurate. Therefore, weaning from mechanical ventilation is difficult, especially in pneumonia patient. One of scoring system for evaluation of pneumonia patient is modified clinical pulmonary infection score (MCPIS). This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secretion, oxygenation and chest x-ray. This study aimed to estimate the correlation between MCPIS score with duration of mechanical ventilation of pneumonia patient in ICU Cipto Mangunkusumo Hospital. This was a prospective cohort study among pneumonia patients with mechanical ventilation at ICU Cipto Mangunkusumo Hospital from October 2014 to February 2015. MCPIS were measured at the point of admission and 72 hours after admission. Date of extubation was recorded to determine the duration of mechanical ventilation. There were 48 subjects included in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant moderate correlation between MCPIS score after 72 hours with mechanical ventilation duration (p=0,000; r=0,539). This study concluded there was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patients in ICU.
Risk ratio of Delirium in crIticaly ill patient using the Confusion Assessment Method for Intensive Care Unit during admission from October to Desember 2015 in Intensive Care Unit Dr. Hasan Sadikin Hospital Rohmawanur, Tubagus Yuli; , Indriasari; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Delirium is an acute and fluctuative state marked by changes in mental, concioussness, attention, cognitive and perspective which develops within a certain time frame (usually hours to days). Delirium has a high incident on criticaly ill patients. The aim of this research is to investigate risk ratio (RR) of delirium in criticaly ill scored by the confusion assessment methode for the intensive care unit ( CAM-ICU) during admission in general intensive care unit (GICU) Hasan Sadikin Hospital. This is an observational analytic study with prospective cohort on 91 patients during 24 hours of GICU care from October to December 2015. Statistical analysis was done with chi square test which measures the percentage and RR of delirium.The result is the incidence of delirium in Hasan Sadikin Hospital GICU was 27.9 %. Analysis shows that there is a significant relationship between delirium with RR >1 to delirium based on sedation history is 3.16, ventilated patients was 2.37, electrolyrte imbalance 2.37, infectious disease 2.13, comorbid 1.86, neurological disorder 1.622, and analysis shows that there is a significant relationship between delirium delirium and history of sedation, electrolyte imbalance and ventilated patients with p value <0,05. The conclussion of this study is that the incidence of delirium in Dr. Hasan Sadikin Hospital GICU has a higher incidence on critically ill patient with risk factors involved. Highest risk factor is sedation history which increases the risk by 3.16 times more.
Mikrosirkulasi Supandji, Mia; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
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Mikrosirkulasi adalah suatu jaringan pembuluh darah yang sangat kecil dan tidak terlihat dengan mata telanjang. Mikrosirkulasi merupakan bagian dari sirkulasi yang berfungsi untuk transportasi oksigen, nutrisi ke jaringan sel dan produk pembuangan dari sel melalui pembuluh darah. Saat terjadinya suatu kondisi sepsis maka akan terjadi gangguan fungsi mikrosirkulasi disertai dengan gangguan fungsi endotel, mitokondria, degradasi, glycocalyx, kebocoran kapiler, hilangnya reaktivitas vaskular, autoregulasi dan mikrotrombosis. Hal tersebut akan menyebabkan terjadinya kondisi densitas vaskular yang heterogen disertai dengan kantung-kantung area hipoksia. Gangguan ini tidak dapat didiagnosis secara pasti menggunakan parameter hemodinamik global, namun mememrlukan advanced imaging techniques. Resusitasi dengan pemberian cairan, merupakan dasar dari resutitasi mikrosirkulasi selain terapi dengan mengguakan obat-obatan lainnya. Kata kunci: Mikrosirkulasi,oksigen, perfusi, resusitasi, sepsis MicrocirculationMicrocirculation is a network of small blood vessels that are too small to see with naked eyes; it is a very important part of the human circulation, for the transport of oxygen and nutrition to the cells and waste products form the cells to the blood vessels. In septic patient, there is an alteration of the microcirculation associated with endothelial dysfunction, mitochondria dysfunction, glycocalyx degradation, capillary leakage, loss of micro vascular reactivity and auto regulation and micro thrombosis. Moreover there are heterogeneity of vascular density associated with hypoxic pocket zones. These alterations can not be diagnosed definitely with global hemodynamic parameters,and therefore advanced imaging techniques arerequired. Fluid resuscitation is a fundamental therapy in restoring microcirculation beside a combination of agents. Key words: Microsirculation, oxygent, perfusion,resuscutation, sepsis
Tatalaksana Sulit Jalan Napas pada Pasien dengan Tumor Hipofaring Rahendra, Rahendra
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Tumor pada jalan napas bisa menyebabkan masalah dan bisa juga tidak pada manajemen jalan napas, hal ini tergantung pada lokasi, ukuran, jenis, dan karakteristik tumor tersebut. Kesulitan dalam jalan napas akan sering dihadapi oleh setiap dokter anestesia. American Society of Anestesiologists (ASA) telah membuat algoritma manajemen jalan napas sulit untuk memfasilitasi dokter anestesia dalam menghadapi kondisi ini. Laporan kasus ini membahas tentang pasien wanita berusia 56 tahun dengan tumor hipofaring yang akan menjalani operasi biopsi tumor, kemudian terjadi perdarahan saat akan dilakukan intubasi hingga diperlukan tindakan trakeostomi darurat. Pasien akhirnya dapat diselamatkan dan kembali beraktifitas normal. Perencanaan yang matang dan pelaksanaan yang tepat selama perioperatif terutama berkaitan dengan manajemen jalan napas akan menghasilkan hasil yang baik bagi kesehatan dan keselamatan pasien. Kata kunci : American Society of Anestesiologists (ASA), kesulitan jalan napas, tumor hipofaring   Management of Difficult Airway in Patient with Hypopharyngeal Tumor  Tumors in the airway may or may not cause problems on the airway management. The magnitude of the problems depend on location, size, type, and characteristics of the tumor. Difficulties in the airway are frequently encountered by every anesthesiologist. ASA and DAS have made algorithm of difficult airway management to facilitate anesthesiologist facing these conditions. This case report discusses a 56 years old female patient with hypopharyngeal tumor undergoing a biopsy surgery. Profuse bleeding was encountered during intubation attempt indicating necessary for emergency tracheostomy. Eventually patients can be saved and returned to normal activity. Careful planning and proper execution of every perioperative aspects especially airway management during perioperative period will produce good results for the health and safety of the patients. Key words : American Society of Anestesiologists (ASA), difficult airway, hypopharyngeal tumor
Perbandingan Cystatin C Serum dan Kreatinin Serum untuk Deteksi Cedera Ginjal Akut pada Pasien Sepsis di Ruang Rawat Intensif Rumah Sakit Haji Adam Malik Medan Kurniawan, Heru; Hanafie, Achsanuddin; Mursin, Chairul M
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Perubahan mendadak laju filtrasi glomerulus (LFG) pada pasien sakit kritis dengan sepsis tidak diikuti secara paralel dengan perubahan kreatinin serum. Tujuan dari penelitian ini adalah membandingkan kegunaan dari cystatin C serum dan kreatinin serum sebagai penanda biologis fungsi ginjal pada pasien sepsis di ruang rawat intensif (RRI). Sebuah studi cross-sectional dilakukan pada pasien dewasa usia 18–65 tahun di RRI RSUP Haji Adam Malik. Kreatinin serum, cystatin C serum dan creatinin clearance (CrCl) 24 jam urin diobservasi pada 24 pasien sepsis. CrCl 24 jam urin yang disesuaikan dengan luas permukaan tubuh digunakan sebagai “baku emas” untuk menentukan LFG. Kreatinin serum, cystatin C serum dan CrCl 24 jam urin (nilai rata-rata ± standar deviasi [range]) adalah 1,53 ± 1,13 mg/dL (0,3–4,2 mg/dl), 1,71 ± 1,1 mg/L (0,6–4,48 mg/L), dan 66,33 ± 37,77 ml/min/1,73 m2 (4–137 mL/min/1,73 m2). 17 dari total 24 pasien mengalami CGA. Cystatin C serum memilki nilai sensitivitas dan spesifisitas sebesar 82,4% dan 85,7%. Sedangkan kreatinin serum memiliki nilai sensitivitas dan spesifisitas sebesar 52,9% dan 85,7%. Cystatin C secara diagnostik lebih superior dibandingkan kreatinin serum dengan area under the curve (AUC) 0,874 untuk cystatin C serum dan 0,785 untuk kreatinin serum. Cystatin C serum dengan nilai cutt-off 1,03 mg/L dan kreatinin serum dengan cutt-off 1,0 mg/dL memiliki sensitivitas dan spesifisitas yang sama yaitu 82,4% dan 85,7%. Cystatin C adalah penanda biologis yang akurat dalam mendeteksi perubahan akut pada LFG, dan terbukti lebih superior dibandingkan kreatinin serum dalam mendiagnosa CGA pada pasien sakit kritis. Kata Kunci: Cedera ginjal akut, creatinin clearance 24 jam urin, cystatin C serum, kreatinin serum, sepsis Comparative of Serum Cystatin C and Serum Creatinin for Detection Acute Kidney Injury on Septic Patients in Icu Haji Adam Malik Hospital Medan Sudden changes in glomerular filtration rate (GFR) septic critically ill patients are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to compare the utility of serum cystatin C and serum creatinin as a marker of renal function in these patients.A cross-sectional study was conducted in adult patients among 18-65 years in the intensive care unit Haji Adam Malik hospital. Serum creatinine, serum cystatin C and 24-hour creatinine clearance (CrCl) were observed in 24 critically ill patients with sepsis. Twenty-four-hour body surface adjusted CrCl was used as a control because it is the ‘gold standard’ for determining GFR.Serum creatinine, serum cystatin C and CrCl (mean ± standard deviation [range]) were 1.53 ± 1.13 mg/dL (0.3–4.2 mg/dl), 1.71 ± 1.1 mg/l (0.6–4.8 mg/l), and 66.33 ± 37.77 mL/min per 1.73 m2 (4–137 mL/min per 1.73 m2), respectively. Of the total 24 patients, 17 patients had AKI. Serum cystatin C has a sensitivity of 82,4% and spesificity value of 85,7%. Serum creatinin has a sensitivity and spesificity value of 52,9% and 85,7%. Cystatin C was diagnostically superior to creatinine (area under the curve [AUC] for cystatin C 0.874 and for creatinine 0,785. Serum cystatin C with cutt-off value 1,03 mg/L and serum creatinin with cutt-off value 1,0 mg/dl has the same sensitivity and spesificity of 82,4% and 85,7%, respectively. Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients. Key words: Acute kidney injury, serum creatinin, serum cystatin C, sepsis24-hour creatinine clearance Reference 1. Bagshaw SM, George C, Bellomo R. Changes in the incidence and outcome forearly acute kidney injury in a cohort of Australian intensive care units. Crit Care.2007;11:R68.2. Hoste EA, Clermont G, Kersten A. RIFLE criteria for acute kidney injury areassociated with hospital mortality in criticallyill patients: A cohort analysis. CritCare. 2006;10:R73.3. Mehta RL, Pascual MT, Soroko S. Spectrum of acute renal failure in the intensivecare unit: The PICARD experience. Kidney international. 2004; 66:, 1613–21.4. Uchino S, Kellum JA, Bellomo R.Acute renal failure in critically ill patients:A multinational, multicenter study. JAMA. 2005;294:813–8.5. Uchino S, Bellomo R, Goldsmith D: Anassessment of the RIFLE criteria for acuterenal failure in hospitalized patients. Critcare. 2006;34:1913–7.6. Doi K, Peter ST, Eisner C. Reduced production of creatinine limits its use as a marker of kidney injury in sepsis. J Am Soc Nephrol. 2009;20:1217–21.7. Abrahamson M, Olafsson I, Palsdottir A, Ulvsback M, Lundwall A,Jensson O, dkk. Structure and expression of the humancystatin C gene. Biochem J. 1990;268:287–94.8. Spahillari A, Parikh CR, Sint K, Koyner JL, Patel UD, Edelstein CL, dkk. Serum cystatin C- versus creatinine-based definitions of acute kidney injury following cardiac surgery: a prospective cohort study. Am J Kidneys Dis. 2012;60:922–9.9. Slort PR, Ozden N, Pape L, Offner G, Tromp WF, Wilhelm AJ, dkk. Comparing cystatin C and creatinine in the diagnosis of pediatric acute renal allograft dysfunction. Pediatr Nephrol. 2012;27:843–9.10. Chung MY, Won Jun D, Sung SA. Diagnostic value of cystatin C for predicting acute kidney injury in patients with liver cirrhosis. KASL. 2010; 16: 301–7.11. Le Bricon T, Leblanc I, Benlakehal M, Gay-Bellile C,Erlich D, Boudaoud S. Evaluation of renal function inintensive care: plasma cystatin C vs. creatinine andderived glomerular filtration rate estimates. Clin Chem. 2005;43:953–7.
Manajemen Anestesia pada Operasi Reseksi Malformasi Arteri Vena Otak Januarrifianto, Desy; Auerkari, Aino Nindya; Firdaus, Riyadh
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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AbstrakMalformasi arteri-vena otak, atau cerebral arteriovenous malformation (AVM) merupakan kondisi yang jarang, namun morbiditas neurologis dan mortalitasnya bermakna. Salah satu pilihan terapi untuk AVM adalah operasi reseksi dengan bedah mikro. Perhatian khusus untuk ahli anestesia pada operasi ini adalah upaya mencegah iskemia sekunder jaringan otak dengan mempertahankan hemodinamik stabil agar tekanan perfusi otak sedekat mungkin dengan nilai normal, mengupayakan agar tidak terjadi pembengkakan otak dan mengantisipasi perdarahan. Di laporan ini, kami menjabarkan manajemen anestesia pada laki-laki 22 tahun dengan AVM simtomatik yang menjalani operasi reseksi AVM pada tanggal 10 April 2012 di Instalasi Bedah Pusat RS dr. Cipto Mangunkusumo, dan mengalami perdarahan akibat ruptur arteri intraoperasi. Kata kunci: Anestesia, AVM, malformasi arteri-vena, operasi reseksi Cerebral arteriovenous malformation (AVM) is a rare vascular condition carrying significant neurologic morbidity and mortality. Among the treatment options are surgical resection using microsurgery technique. Special anesthetic consideration in this type of surgery is on preventing secondary ischemia of brain tissue by maintaining stable haemodynamics to achieve as normal cerebral perfusion pressure as possible, preventing cerebral edema and anticipating hemorrhage. In this report, we describe the anaesthetic management of a 22 year-old male presenting with symptomatic AVM, who underwent surgical resection on April 10th 2012 in Central Operating Theater of RS dr. Cipto Mangunkusumo, and experienced intraoperative bleeding from an arterial rupture. Key words: Anesthesia, arteriovenous malformation, AVM, surgical resection
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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Abstract

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.

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