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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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Ultrasound Guided Stellate Ganglion Block on Patient with Lung Cancer for Pain Management Prihartono, M. Andy; Yadi, Dedi Fitri; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Lung cancer is most common cancer that cause metastases. Complex regional pain syndrome (CPRS) type 1 is very severe symptoms such as pain occuring in the damaged tissue that is not caused by trauma and no nerve damage. Stellate ganglion blockade is a blockade on sympathetic nerve ganglion performed on the neck parallel to the cricoid cartilage and Chassaignac’s tubercle (C6). To determine the effectiveness of stellate ganglion block on lung cancer and complex regional pain syndrome type 1 Case report; 65 years old male with lung adenocarcinoma complained of severe pain in the lower back area of the right scapula and shoulder that radiates to the arm and fingers. For the pain, given 8mg hydromorphone (Jurnista®) 1x a day, 4x 500mg paracetamol, 10mg amitriptylin 1x and 2x 75mg pregabalin. Due to increasing pain (VAS 9), liver function and coagulopathy, the stellate ganglion blockade was performed with ultrasound guidance, pain VAS was reduced to four. Pain therapy in lung cancer accompanied with CRPS type 1 can be treated with stellate ganglion blockade in addition to pain therapy can also reduce the amount of oral medications consumed.
Efek Perbedaan Volume Tidal Intraoperatif terhadap Rasio Pao2/Fio2 Pascaoperasi Abdominal Mayor Aditianingsih, Dita; Jefferson, Jefferson; Mandagi, Michael
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
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Komplikasi paru pascaoperasi merupakan salah satu penyebab penting morbiditas dan mortalitas pascaoperasi yang berkaitan dengan anestesia dan pembedahan. Studi ini membandingkan volume tidal 6 mL/kgBB dan 10 mL/kgBB dengan menggunakan PEEP dan pengaruhnya terhadap komplikasi paru. Setelah mendapat persetujuan dari Komite Etik Penelitian Kesehatan FKUI/RSCM, dilakukan uji klinis acak terhadap 52 pasien operasi abdominal mayor elektif di Rumah Sakit Cipto Mangunkusumo pada bulan November 2014–April 2015. Subjek diacak dalam 2 kelompok, yaitu kelompok dengan volume tidal 6 mL/kg dengan PEEP 6 cmH2O dan volume tidal 10 mL/kg dengan PEEP 6 cmH2O. Keluaran primer adalah pemeriksaan fungsi paru menggunakan rasio PaO2/FiO2. Keluaran sekunder adalah komplikasi paru (pneumonia, atelektasis, ARDS, gagal napas), komplikasi ekstraparu (SIRS, sepsis, sepsis berat), dan mortalitas dalam 28 hari pascaoperatif. Tidak ditemukan perbedaan yang bermakna rasio PaO2/FiO2 antara kelompok VT-6 mL/kg dengan VT-10 mL/kg (p>0,05), baik pada awal operasi, akhir operasi, hari pertama pascaoperasi, dan hari kedua pascaoperasi. Tidak ada perbedaan bermakna pada semua keluaran sekunder diantara kedua kelompok. Simpulan, volume tidal 6 hingga 10 mL/kg dengan PEEP 6 cmH2O aman untuk dipakai pada pasien yang menjalani operasi abdominal mayor. Kata kunci: Operasi abdominal mayor, pemeriksaan fungsi paru, ventilasi mekanis, volume tidal The Effect of Intraoperative Tidal Volume Difference against Postoperative PaO2/FiO2 Ratio for Patients undergoing Major Abdominal SurgeryPostoperative pulmonary complications are closely related to postoperative morbidity and mortality associated with anesthesia and surgery. Mechanical ventilation setting affects postoperative pulmonary complications. This study aimed to compare the effect between tidal volume of 6 mL/kgBW and 10 mL/kgBW with PEEP and its effect on pulmonary complications. After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo (RSCM) Hospital, a randomized clinical trial was done on 52 elective major abdominal surgery patients at RSCM Hospital from November 2014 to April 2015. Subjects were randomized into two groups: the group receiving tidal volume 6 mL/kgBW with PEEP 6 cmH2O (VT-6 group) and the group receiving tidal volume of 10 mL/kgBW with PEEP 6 cmH2O (VT-10 group). The primary output was the assessment of pulmonary function using the ratio of PaO2/FiO2. Secondary outputs were pulmonary complications (pneumonia, atelectasis, ARDS, respiratory failure), extrapulmonary complications (SIRS, sepsis, severe sepsis), and mortality within 28 days. Both groups showed similar baseline characteristics. There was no significant PaO2/FiO2 ratio differences between both groups (p>0,05) at the beginning of surgery, at the end of surgery, at the first postoperative day, and the second postoperative day. There was no significant difference in all secondary outcomes between both groups. The use of tidal volume of 6 to 10 mL/kg with PEEP 6 cmH2O was considered safe for patients undergoing major abdominal surgery. Key words: Major abdominal surgery, mechanical ventilation, pulmonary function tests, tidal volume
Hubungan antara Kelebihan Cairan dengan Meningkatnya Angka Mortalitas Pasien Sepsis yang Dirawat di Ruang Intensive Care Unit (ICU) Lestari, Mayang Indah; Puspita, Yusni; Zulkifli, Zulkifli; Maas, Endang Melati
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Terapi cairan merupakan landasan penting dalam merawat pasien kritis di intensive care unit (ICU), termasuk pasien sepsis. Terapi liberal dan goal-directed dianjurkan untuk mencapai tekanan arteri rata-rata lebih dari 65 mmHg pada tahap awal syok. Meskipun demikian, resusitasi cairan berlebihan meningkatkan tekanan hidrostatik mikrovaskular dan dapat menyebabkan akumulasi cairan interstitial. Resusitasi cairan yang memanjang berhubungan dengan kelebihan cairan dan meningkatkan mortalitas. Penelitian ini bertujuan untuk menilai seberapa besar hubungan antara kelebihan cairan dan angka mortalitas. Melalui studi case control, data dikumpulkan secara retrospektif dari Desember 2013 berdasarkan rekam medik di ICU RSUP Dr. Mohammad Hoesin Palembang sampai jumlah sampel tercukupi. Subjek penelitian adalah pasien sepsis berat dan syok septik yang mendapat resusitasi early goal directed therapy. Enam puluh subjek yang memenuhi kriteria yang dibagi menjadi kelompok survivors dan non-urvivors. Kelompok non survivors ditemukan lebih banyak dengan kelebihan cairan ≥10% (73,3%) dibanding dengan kelebihan cairan <10% (26,7%). Sedangkan pada kelompok survivors ditemukan lebih banyak dengan kelebihan cairan <10% (66,7%) dibanding dengan kelebihan cairan ≥10% (33,3%). Pasien sepsis berat dan syok septik yang memiliki kelebihan cairan ≥10% mempunyai risiko kematian 5,5 kali lebih besar dibanding dengan kelebihan cairan <10%. Kata kunci: Kelebihan cairan, liberal, mortalitas, pasien sepsis Observational Analytic Study: Fluid Overload Increases Mortality Rate of Sepsis Patients in Intensive Care Unit (ICU) Fluid therapy is an important cornerstone of treating critically ill patients in ICU, including sepsis patients. In early stage of shock, liberal and goal-directed therapy is mandated to achive mean arterial pressure over 65 mmHg. Nevertheless, over resuscitation increases microvascular hydrostatic pressure and may promote interstitial fluid accumulation. Prolonged fluid resuscitation has a close relationship to fluid overload and high mortality rate. The aim of this study was to assess the relationship between fluid overload and mortality rate. The data were retrospectively collected using case control study since December 2013 based on medical records in ICU Dr Mohammad Hoesin General Hospital Palembang until the sample sufficient. Subjects included in this study were those who diagnosed as severe sepsis and septic shock who undergone early goal directed therapy for resuscitation. There were sixty subjects included for both survivors and non-survivors group. Non-survivors group have more fluid overload >10% (73,3%) compared with <10% (26.7%). While survivors group have have more fluid overload <10% (66.7%) compared with >10% (33.3%). Severe sepsis and septic shock patients who have fluid overload >10% has risk 5,5 times to death compared with <10%. Key words: Fluid overload, liberal, mortality, sepsis  
Sensitivity and Specificity of Neutrophil Gelatinase Associated Lipocalin as an Early Biomarker or Acute Kidney Injury Andriani, Meili; , Zulkifli; Puspita, Yusni; , Theodorus
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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in hospital. Incidence of AKI is about 60%–70% and mortality rate from those patients is 60%. AKI is diagnosed by measuring serum creatinine concentration, which is an unreliable and delayed marker of deterioration of kidney function. It’s rising occurs when a significant amount of renal function has lost. Neutrophil gelatinase associated lipocalin (NGAL) level in AKI patients can increase quickly and earlier compared to serum creatinine and could be as a marker for AKI. The purpose of this study was to assess the sensitivity and specificity plasma NGAL. A diagnostic test was conducted in ICU and high care unit (HCU) of RS Dr. Moh. Hoesin Palembang since December 2014 to February 2015. There were 53 subjects included. All samples were examined with Alere Triage® kit and serum creatinin. Data analysis were performed by receiver operating characteristic (ROC) using SPSS® version 22.0.and MedCalc version 12.7. This study shows that a cut-off point 150 ng/mL for plasma NGAL has sensitivity of 88%, specificity of 81%, positive predictive value of 88%, negative predictive value of 81% and accuracy of 85%. Examination of plasma NGAL is more sensitive and specific in determining the start time of the occurrence of AKI compared with serum creatinine examination.
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
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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.
The Effect of General Anesthesia compared to Spinal Anesthesia for Caesarean Section on Neonatal APGAR Score christiana, monica; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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For the last decades, Casearean delivery cases has increased significantly. The choice of anesthesia technique for surgical procedure consider its safety for both the mother and neonates. Neonatal APGAR scoring has been used as the parameter of neonate’s well being and success of obstetric anesthesia technique. Several previous studies have recommended the excellence of regional anesthesia compared to general one. This study was conducted to compare the effect of general anesthesia to spinal anesthesia on the APGAR score of the neonates. The objective of this study is to describe the general anesthesia and spinal anesthesia effect in Caesarean delivery on AGPAR score. Rertospective study of 64 parturient patients underwent elective Caesarean section from January to June 2015. Data were obtained from medical record of Melinda Mother and Child Hospital, Bandung. Subjects were distributed into 2 groups of 32 patients each. Group I underwent general anesthesia, while the other underwent spinal anesthesia. Parameter asessments were APGAR, blood pressure, pulse, and okxygen saturation. Data recoded were analized with t test and p<0.05 considered as significant. First minute APGAR scores were recorded unsignificantly higher (p=0.326) in Group I (8.87± 0.33) compared to Group II (8.78± 0.42). However, fifth minute APGAR scores were significantly (p=0.000) better in Group II (9.75±0.46) compared to Group I (9.25±0.44). Spinal anesthesia technique in caesarean section procedure had a significantly better effect on neonatal APGAR score compared to genaral anesthesia.
Pola Kuman Terbanyak Sebagai Agen Penyebab Infeksi di Intensive Care Unit pada Beberapa Rumah Sakit di Indonesia Taslim, Emilzon; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Tingkat penggunaan antibiotik yang tinggi di ruang perawatan intensif atau intensive care unit (ICU) telahmenyebabkan peningkatan kejadian resistensi antibiotik terhadap kuman. Penulisan tinjauan pustaka iniberdasarkan studi kepustakaan yang dikumpulkan dari berbagai sumber. Hasil penulisan ini menunjukkan bahwakuman yang paling banyak terdapat di ICU adalah Pseudomonas aeruginosa dan Klebsiella pneumonia. Selain itu,didapatkan pula peningkatan kejadian Methycillin Resistant Staphylococcus Aureus (MRSA) . Beberapa antibiotiktidak sensitif lagi terhadap kuman-kuman yang terdapat di ICU, antara lain ampicillin, cefotaxime, tetracycline,ceftazidime, chloramphenicol, dan ciprofloxacin. Disarankan agar dilakukan perputaran penggunaan antibiotik(antibiotic cycling) berdasarkan pola kepekaan bakteri dan pola sensitivitas antibiotik untuk mengurangi kejadianresistensi antibiotik. Kata kunci: Intensive Care Unit , pola kuman, resistensi antibiotik High usage of antibiotics in the Intensive Care Unit (ICU) have led to increased incidence of antibiotic resistanceto microbial agents. This paper based on the study of literature gathered from various sources. The results of thispaper show that most numerous microbial agents found in the ICU was Pseudomonas aeruginosa and Klebsielapneumonia. Besides that, there is also an increase of the incidence of MRSA (Methycilin Resistant StaphylococcusAureus). Some antibiotics that are no longer sensitive to microbial agents in the ICU are ampicilin, cefotaxime,tetracycline, ceftazidime, chloramphenicol, and ciprofloxacin. Recommended to do an antibiotic cycling basedon the antibiotics usage pattern and bacterial sensitivity patterns to reduce the incidence of antibiotic resistance. Key words: Antibiotic resistance, bacterial patterns, Intensive Care Unit Reference Undang-Undang Republik Indonesia No. 44 Tahun 2009. Widyaningsih R, Buntaran L. Pola Kuman Penyebab Ventilator Associated Pneumonia (VAP) dan Sensitivitas Terhadap Antibiotik di RSAB Harapan Kita. Sari Pediatri. 2012;13(6):384–90. Noer SF. Pola Bakteri dan Resistensinya Terhadap Antibiotik yang Ditemukan pada Air dan Udara Ruang Instalasi Rawat Khusus RSUP dr.Wahidin Sudirohusodo Makassar. Majalah Farmasi dan Farmakologi. 2012;16(2):73–8. Adisasmito AW, Hadinegoro SR. Infeksi Bakteri Gram Negatif di ICU Anak: epidemiologi Manajemen Antibiotik dan Pencegahan. Sari Pediatri. 2004;6(1):32–9. Dwiprahasto I. Kebijakan untuk Meminimalkan Risiko Terjadinya Resistensi Bakteri di Unit Perawatan Intensif Rumah Sakit. JMPK. 2005;8(4):177–81. Fauziyah S, Radji M, Nurgani A. Hubungan Penggunaan Antibiotika pada Terapi Empiris dengan Kepekaan Bakteri di RSUP Fatmawati Jakarta. Jurnal Farmasi Indonesia. 2011;5(3):150–58. Setiawan MW. Pola Kuman Pasien yang Dirawat di Ruang Rawat Intensif RSUP Dr. Kariadi Semarang. Artikel Penelitian. Semarang: Fakultas Kedokteran Universitas Diponegoro; 2010. 2–16. Saharman YR, Lestari DC. Phenotype Characterization of Beta-Lactamase Producing Enterobacteriaceae in the Intensive Care Unit (ICU) of Cipto Mangunkusumo Hospital in 2011. Acta Med Indones.2013;45(1):11–6. Peta Bakteri Terbanyak yang dapat Diisolasi dari Berbagai Spesimen di Ruang ICU di Rumah Sakit Hasan Sadikin Bandung 2012. Tyas WM, Suprapti B, Hardiono, Widodo ADW. Analysis of Antibiotic Use in VAP (Ventilator-Association Pneumonia) Patients. Folia Medica Indonesiana. 2013;49(3):168–72. Mahmudah R, Soleha TU, Ekowati CN. Identifikasi Methicillin-Resistant Staphylococcus Aureus (MRSA) pada Tenaga Medis dan Paramedis Di Ruang Intensive Care Unit (ICU) dan Ruang Perawatan Bedah Rumah Sakit Umum Daerah Abdul Moeloek. Med J Lampung Univercity. 2013;2(4):70–8.
Pengaruh Anestesi Umum dibanding dengan Anestesi Spinal untuk Seksio Sesarea terhadap Suhu Rektum Bayi Baru Lahir Rahmat, Rahmat; Pradian, Erwin; Boom, Cindy Elfira
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
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Teknik anestesi spinal dan anestesi umum keduanya mengganggu mekanisme termoregulasi. Masih kurang informasi tentang pengaruh teknik anestesi yang dipakai untuk seksio sesarea terhadap suhu tubuh bayi baru lahir. Tujuan penelitian ini untuk menentukan apakah ada perbedaan suhu rektum bayi baru lahir dengan seksio sesarea dihubungkan dengan teknik anestesi yang dipakai. Wanita hamil sebanyak 60 orang secara acak mendapat anestesi umum atau anestesi spinal. Suhu inti ibu diukur tiga kali dengan termometer membran timpani saat induksi, insisi uterus dan saat bayi lahir. Suhu rektum bayi diukur segera setelah lahir. Usia ibu, berat badan, tinggi badan, body mass index (BMI), suhu ibu sesaat sebelum induksi dan suhu ruangan tidak berbeda bermakna pada kedua kelompok. Interval waktu mulai induksi anestesi sampai bayi lahir pada kelompok anestesi spinal ratarata 18,24 menit (SD=2,862) dan kelompok anestesi umum rata-rata 6,47 menit (SD=3,082).Volume cairan pada kelompok anestesi spinal rata-rata 946,6 mL (SD=225,57) dan pada kelompok anestesi umum rata-rata 715,0 mL (SD=133,36), nilai P<0,05. Suhu rektum bayi pada kelompok anestesi spinal rata-rata 37,19oC (SD=0,256) dan pada kelompok anestesi umum rata-rata 37,59oC (SD=0,2288), nilai P<0.05. Suhu rektum bayi lebih rendah padakelompok anestesi spinal dibanding dengan kelompok anestesi umum, tetapi tidak mencapai batas hipotermi. Hal ini akibat pada anestesi spinal terjadi redistribusi panas dari inti ke perifer yang lebih besar, pada penelitian ini ditemukan pula pada anestesi spinal memerlukan lebih banyak cairan intravena dan Interval mulai anestesi sampai bayi lahir lebih panjang. Kata kunci: Anestesi spinal, anestesi umum, suhu membran timpani, suhu rektum bayi, seksio sesarea The Effect Of General Anesthesia Compared to Spinal Anesthesia in Cesarian Section on Newborn Rectal TemperatureBoth spinal anesthesia and general anesthesia interfere thermoregulation mechanism. There are less information on the effect of anesthesia technique applied in cesarean section on newborn rectal temperature. The aim of the study was to determine whether there was a different rectal temperature of the newborn babies with cesarean section in related to using different anesthesia techniques. Sixty pregnant women were randomLy assigned either to general anesthesia group or spinal anesthesia group. The maternal core temperature was measured triplicately with tympanic membrane thermometer at induction, uterine incision, and birth. The rectal temperature of thebabies was promptly measured after delivery. The age, weight, height, BMI, and temperature before induction of the mothers, as well as the room temperature were non-significantly different in both groups. The mean time interval, from anesthesia induction to infant delivery in spinal anesthesia was 18.24 (SD=2.862) minutes and that in general anesthesia was 6.47 (SD=3.082). The mean fluid volume in spinal anesthesia was 946.6 (SD=225.57) mL and that in general anesthesia was 715.0 (SD=133.36) mL, with P<0.05. The mean infant rectal temperature in spinal anesthesia was 37.19 (SD=0.256) °C and that in general anesthesia was 37.59 (SD=0.2288) °C, with p<0.05. The infant rectal temperature was lower in spinal anesthesia compared to that in general anesthesia; but it did notreach hypothermic limit. This was due to that in the spinal anesthesia, there are a greater heat redistribution from core to periphery, a need of more intravenous fluid, and a prolonged interval from anesthesia initiation to infant birth. Key words: Cesarean section, general anesthesia, newborn rectal temperature, spinal anesthesia, tympanicmembrane temperature
Efektivitas Pemberian Kombinasi Parasetamol 2 mg/kgBB dan Propofol Mct/Lct terhadap Pengurangan Nyeri Penyuntikan Fuyanto, Indra; , Zulkifli; Haloho, Agustina Br.
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Propofol adalah obat anestesi yang paling banyak digunakan dan sering menimbulkan nyeri saat penyuntikan. Nyeri ini menempati posisi ketiga kondisi yang tidak diinginkan. Ada 2 macam propofol yaitu propofol LCT dan propofol MCT/LCT. Parasetamol adalah obat analgetik yang aman untuk semua usia dan dapat mengurangi nyeri penyuntikan propofol. Penelitian ini bertujuan untuk mengetahui efektivitas penambahan parasetamol 2 mg/kgBB terhadap pengurangan nyeri penyuntikan propofol. Uji klinik acak berbanding buta ganda dilakukan di RSUP Dr. Mohammad Hoesin Palembang pada bulan Februari–April 2014. Sampel 99 orang dan dibagi dalam tiga kelompok. Penelitian pada skor nyeri, rasa nyeri, dan kualitas nyeri menggunakan skor VAS. Analisis menggunakan uji-t, One Way Anova dan post hoc dengan program SPSS versi 20. Uji-t menunjukkan sampel penelitian bersifat homogen. Uji One Way Anova menunjukkan perbedaan skor nyeri, rasa nyeri dan kualitas nyeri antar ketiga kelompok perlakuan. Uji post hoc didapatkan kelompok P memiliki skor nyeri yang lebih rendah dibandingkan dengan kelompok L dan M secara bermakna. Kelompok P tidak memiliki perbedaan rasa nyeri dan kualitas nyeri yang bermakna dibandingkan dengan kelompok M. Penambahan parasetamol 2 mg/kgBB terbukti efektif mengurangi nyeri penyuntikan propofol. Kata kunci: Nyeri, parasetamol, propofol, uji klinik acak berbanding Propofol is the most widely used as anesthetic drug in general anesthesia. Pain while propofol was given, has already ranked in third place as many patients complain of pain during the injection. There are two types of propofol which is available: propofol LCT and propofol MCT/LCT. Paracetamol is known as analgesics drug which is safe for all ages and can be used to reduce the pain of propofol injection. The aim of this study was to determine the efficacy of reducing the pain of propofol injection by the addition of paracetamol 2 mg/kgBW. Randomized controlled trial, double blind has been conducted at Dr. Mohammad Hoesin Palembang hospital from February to April 2014. There were 99 samples that divided into three groups. The groups were L group, M group and P group. The research is about pain scores, pain, and quality of pain. Measurement of pain using the VAS score. Data is analyzed with t-test, One Way Anova, and Post Hoc test using SPSS program 20.00 version. T-Test showed that the respondents were homogeneous in all groups. One Way Anova test showed the differences in pain scores, pain and quality of pain among all groups. Post Hoc test showed that P group has lower pain scores differences than L group and M group significantly. It can be concluded that the addition of paracetamol 2 mg/kgBW before propofol injection can reduce the pain caused by the injection. Reference Key words: Pain, paracetamol, propofol, randomized controlled trial Reves JG, Glass PSA, Lubarsky DA, McEvoy MD, Ruiz RM. Intravenous Anesthetics. Dalam: Miller RD, penyunting. Miller’s Anesthesia. Edisi ke-7. California: Elsevier; 2009. hlm.719–68. Evers AS, Crowder M, Balser JR. General Anesthetics. Dalam: Brunton LL, penyunting. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. Edisi ke-12. New York: McGraw-Hill; 2011. hlm. 501–36. Kumar P. Propofol. 2013 (diunduh 2 Oktober 2013). Tersedia dari: http://www.anaesthesia.co.in. Wijeysundera DN, Kavanagh BP. Prevention of pain from propofol injection: adequately studied, but inadequately managed. Br Med J. 2011.hlm. 667–8. Sethi N, Jayaraman L, Sethi M, Sharma S, Sood J. Prevention of propofol pain: a comparative study. Middle East J Anaesthesiol. 2009. hlm. 71–4. Zahedi H, Maleki A, Rustami G. Ondansentron pretreatment reduces pain on injection of propofol. Acta Med Iran. 2012. hlm. 239–43. Zhao GY, Guo Y, Bao SM, Meng LX, Zhang LH. Prevention of propofol induced pain in children: pretreatment with small doses of ketamine. J Clin Anaesth. 2012.hlm.284–8. Yadav M, Durga P, Gopinath R. Role of steroids in prevention of pain on propofol injection. J Anaesth Clinic Res. 2011. hlm.132–5. Kwak HJ, Min SK, Kim JS, Kim JY. Prevention of propofol induced pain in children: combination of alfentanil and lidocaine vs alfentanil or lidocaine alone. Br J Anaesth. 2009. hlm. 410–2. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. Euro Soc Anaesthesiol. 2010. hlm. 253–7. Ozkan S, Sen H, Sizlan A, Yanarates O, Mutlu M, Dagli G. Comparison of acetaminophen (with or without tourniquet) and lidocaine in propofol injection pain. Bullet Clin Psychopharmacol. 2011. hlm.100–4. Demir A, Aydinli B, Tezcan B, Ucar P, Ince D, Oztuna D, dkk. Influence of temperature and pH changes on propofol injection pain. Turk J Anaesth Reanim. 2013;p34–7. Beyaz S, Tufek A, Tokgor O. The effect of propofol lipuro with and without lidocaine on injection pain in children. Niger J Clin Practice. 2011. hlm. 60–4. Zahoor A, Ahmed N. The effects of duration of propofol injection on hemodynamics. M E J Anesth. 2010. hlm. 845–50. Dewhirst E, Lancaster C, Tobias JD. Hemodynamic changes following the administration of propofol to facilitate endotracheal entubation during sevoflurane anesthesia. Int J Clin Exp Med. 2013.hlm. 26–9. Nyman Y, Hofsten KV, Georgiadi A, Eksborg S, Lunnqvist PA. Propofol injection pain in children: a prospective randomized double blind trial of a new propofol formulation versus propofol with added lidocaine. Br J Anaesth. 2009. hlm. 222–5. Nyman Y, Hofsten KV, Eksborg PS, Lonnqvist PA. Etomidate-lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. Br J Anaesth. 2009. hlm. 536–9. Schaub E, Kern C, Landau R. Pain on injection: a double blind comparizon of propofol with lidocaine pretreatment versus propofol formulated with long and medium chain triglyserides. Anaesth Analg. 2009. hlm. 699–702. Canbay O, Celebi N, Arun N, Karagoz AH, Saricaoglu F, Ozgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth. 2009. hlm. 95–8. Ohmizo H, Obara S, Iwama H. Mechanism of injection pain with long and long medium chain triglyceride emulsive propofol. Canad J Anesth. 2009. hlm. 595–9.
Post-operative Emergence Agitation in Children Undergoing Inhalation General Anesthesia in Cipto Mangunkusumo Hospital: Study on Incidence and Affecting Factors Wijaya, Andi Ade; Kapuangan, Christopher; Aktara, Betardi
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Abstract

Emergence agitation (EA) during recovery from general anesthesia is often found among pediatric population. The etiology of EA in children is not fully understood. Possible risk factors include pre-school age, recent inhalation anesthetics, poor adaptability, and parental presence during recovery. The aim of the present study was to assess the incidence of EA and the affecting factors in children undergoing inhalation anesthesia in Cipto Mangunkusumo Hospital. There were 78 samples, aged 2–12 years undergoing inhalation anesthesia. Behavior during induction of anesthesia was assessed with Pediatric Anesthesia Behavior (PAB) score. In post anesthesia care unit (PACU) the incidence of EA was assessed with Aono’s four-point scale upon admission (T0), after 5 min (T5), 15 min (T15) and 30 min (T30). The incidence of EA in children undergoing inhalation anesthesia in this study was 39,7%. The incidence was higher in 2–5 years old children with PAB score 2 or 3. Midazolam, type of inhalation anesthetic agents and parental presence during recovery do not appear to have any bearing on the incidence of EA. Age of the children and the behavior during induction of anesthesia have a strong correlation with the incidence of EA.

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