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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).
Arjuna Subject : -
Articles 91 Documents
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The Effect of 2% Lidocaine Intravenous 1,5 mg/kgBW Prior to Extubation on Cough and Sore Throat Incidence in Patients who Underwent Surgery with General Anesthesia , Suwarman; Redjeki, Ike Sri; Ramdhani, Vicky Muhammad
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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One of the problems that often arise in the general anesthesia is in the time of extubation of endotracheal tube. These actions can irritate the respiratory tract mucosa causing cough and sore throat. Intravenous lidocaine is one of the ways to avoid them. This study was conducted to assess the effect of 2% lidocaine intravenous 1.5 mg/kgBW before extubation to reduce the incidence of cough and sore throat in patients who underwent surgery with general anesthesia. Double blind randomized controlled trial study involved 72 patients age 18–60 years old whom underwent surgery with general anesthesia. Subjects were divided into two groups, one group using 2% lidocaine 1.5 mg/kgBW and control group using NaCl 0.9% before extubation. Data was analyzed using Chi square and Mann-Whitney test with result of p<0,05 was significant. The result showed that administration of lidocaine 1.5 mg/kgBW gave significant effects compared to 0.9% NaCl in reducing the incidence of cough with p values=0,034 and sore throat with p values=0,000 at each observation time. It can be concluded from this research that 2% lidocaine intravenous 1.5 mg/kg can reduce the incidence of cough and sore throat caused by extubation in patients who underwent surgery with general anesthesia.
Tata Laksana Anestesi pada Pasien Anak dengan Hipersplenism, Thalassemia Mayor, dan Trombositopenia yang Menjalani Splenektomi Tavianto, Doddy; Nurchaeni, Ati
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
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Thalassemia merupakan penyakit genetik pembentukan rantai globin pada hemoglobin. Operasi spelenektomi pada pasien hipersplenism dengan thalassemia mayor dan trombositopenia merupakan hal yang menantang bagi seorang ahli anestesi dikarenakan manifestasi sistemik yang timbul karena thalassemia, penumpukan kadar besi, dan komplikasi agen kelasi besi. Kasus ini mempresentasikan tentang seorang anak perempuan usia 6 tahun dengan thalasemia mayor dan trombositopenia yang menjalani operasi splenektomi dalam anestesi umum. Operasi berlangsung selama 6 jam dengan perdarahan 2.700 mL dengan transfusi 700 mL PRC, 300 mL FFP, dan 200 mL trombosit. Hemodinamik intraoperatif pernah mengalami penurunan dikarenakan perdarahan akibat terpotongnya arteri gastric brevis. Setelah operasi pasien diekstubasi dan dirawat di HCU. Kata kunci : Hipersplenism, splenektomi, thalasemia mayor, trombositopenia Anesthetic Management in Paediatric Patient with Hypersplenism, Major Thalassemia, and Trombocitopenia undergo Splenectomy Splenectomy surgery in hypersplenism patient with thalassemia major and thrombocitopenia may be challenging to anaesthesiologist because of systemic manifestations of thalassemia, iron overload, and complications of chelation therapy. This case presenting a 6-year-old girl with thalassemia and thrombocitopenia undergo splenectomy surgery in general anaesthesia. The surgery took 6 hours with 2,700 mL blood loss and was transfused with 700 mL PRC, 300 mL FFP, and 200 mL thrombocytes. Haemodynamic intra operative decreased because of bleeding cut brevis gastric artery. After surgery patient was extubated then was treated in high care unit. Key words: Hypersplenism, major thalassemia, thrombocytopenia, splenectomy
Gambaran Dokumentasi Penilaian Nyeri pada Pasien Anak di Instalasi Gawat Darurat RSUP Dr. Hasan Sadikin Bandung Afifah, Shofura; Prayoga, Stanza Uga; Yadi, Dedi Fitri
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Penilaian nyeri merupakan langkah penting dalam manajemen nyeri, tetapi dokumentasi nyeri yang tidak memadai serta oligoanalgesia pada pasien anak di Instalasi Gawat Darurat (IGD) masih dilaporkan. Tujuan penelitian ini adalah untuk menggambarkan dokumentasi penilaian nyeri pada pasien anak di IGD Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung serta menggambarkan penggunaan analgesik berdasarkan skor nyeri. Penelitian ini merupakan studi lintang potong retrospektif yang dilakukan pada subjek rekam medis 625 pasien berusia 0–18 tahun yang berkunjung ke IGD RSHS selama periode Januari–Maret 2015. Variabel yang diambil adalah usia, jenis kelamin, jenis kunjungan, alasan kunjungan, status triase, diagnosis pasien, dan pemberian analgesik. Hasil penilaian nyeri menggunakan skala Wong Baker FACES, 61,6% pasien anak didokumentasikan skor nyerinya. Pasien obstetri dan ginekologi (0,8%), pasien klasifikasi darurat (10,4%), pasien bayi (19,7%), dan pasien dengan alasan berkunjung nyeri (24,2%) menunjukkan dokumentasi skor nyeri yang lebih rendah pada kelompok kategorinya. Dari setiap pasien yang didokumentasikan nyerinya, 45,9% menerima analgesik. Pasien yang tidak didokumentasikan penilaian nyerinya menerima analgesik paling sedikit (21,2%). Analgesik yang digunakan di IGD adalah NSAID (41,6%), parasetamol (29,7%), analgesik tidak spesifik (27,6%), dan opioid (1,1%). Dokumentasi penilaian nyeri pada pasien anak IGD RSHS masih suboptimal. Perlu dilakukan peningkatan dokumentasi penilaian nyeri untuk memperbaiki manajemen nyeri. Kata kunci: Analgesia, emergensi, pediatrik, skor nyeri   Pain Assessment Documentation of Pediatric Patients in Emergency Department, Dr. Hasan Sadikin General Hospital Bandung Pain is a subjective experience and difficult to quantify in children. Pain assessment is an important step in pain management, but inadequate pain score documentation and oligoanalgesia in Pediatric emergency patients are still reported. The objective of this research was to describe pain score documentation of pediatric patients in the Emergency Department (ED) of Dr. Hasan Sadikin General Hospital and to describe analgesic use based on documented pain score. This was a retrospective cross-sectional study conducted on the medical record of 625 patients aged 0–18 years old who visited the ED during the period of January–March 2015. Variables taken were age, sex, type of visit, reason for visit, triage classification, patient diagnosis, and analgesic use. Based on pain assessment using Wong Baker FACES scale, 61.6% of visits had documented pain score. Patients visiting theobstetrics and gynecology ED (0,8%), emergency-classified patients (10,4%), infant patients (19,7%), and visits designated as painful (24,2%) exhibited lower pain score documentation in each category. Of every patient who reported pain, 45,9% received analgesics. Patients who presented with no documented pain assessment received the least amount of analgesics (21,2%). Analgesics used in the ED were NSAID (41,6%), paracetamol (29,7%), unspecified analgesics (27,6%), and opioid (1,1%). Pain assessment documentation in Dr. Hasan Sadikin General Hospital ED stands suboptimal. Inadequate analgesic prescription of pediatric patients was found. Pain score documentation needs to be improved. Key words: Analgesia, emergency, pain score, pediatrics
Tracheal Stenosis due to Trachesotomy Attaufany, Fahmi; Dewi, Yussy Afriani; Samiadi, Dindi; Permana, Agung Dinasti; Aroeman, Nurakbar
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Tracheal stenosis is a condition where there is a narrowing of the diameter of the trachea. This condition can occurin congenital or acquired. Approximately 90% due to trauma: internal (prolonged intubation, tracheostomy, etc)with remaining due to external trauma (blunt trauma or penetrating trauma).The incidence of tracheal stenosisapproximately 4%–13% in adults and 1%–8% in neonates. The incidence of tracheal stenosis in Dept ORL-HNSDr. Hasan Sadikin General Hospital Bandung from January 2012–August 2013 as much as ive cases. We presenteda a man, 27 years old, suffer with complain of dyspnea. We found tracheal stenosis grade II (Myer-Cotton) afterlexible bronchoscopic examination due to previous tracheostomy.Tracheostomy was perform followed byinstallation tracheal tube and observation. Two years later the tracheal tube removed and continued with stomalclosure.
Sakit Kepala yang dihubungkan dengan Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Sakit kepala adalah salah satu keluhan yang sering setelah cedera otak traumatik (COT) dan disebut sebagai “post-traumatic headache” sakit kepala pascatrauma. Berkisar 30–90% pasien mengalami sakit kepala setelah cedera. Sakit kepala setelah COT dapat berlangsung lama, datang dan hilang dalam waktu satu tahun, menyulitkan melakukan aktivitas sehari-hari, sulit berfikir dan mengingat sesuatu. Setelah cedera kepala berat, pasien mungkin mengalami sakit kepala akibat dari operasi pada tulang kepalanya atau masih adanya kumpulan kecil darah atau cairan di ruang intrakranial. Sakit kepala bisa setelah cedera kepala ringan, sedang dan berat. Sakit kepala ini dapat disebabkan berbagai kondisi antara lain perubahan dalam otak akibat cedera, cedera leher dan tulang kepala yang belum pulih seluruhnya, tegangan dan stres, atau efek samping pengobatan. Ada beberapa tipe sakit kepala antara lain sakit kepala tipe migraine, tension, cervicogenic, dan rebound. Terapi dapat dilakukan dengan merubah pola hidup misalnya harus cukup tidur, olah raga, hindari kopi, hindari makanan tertentu yang memicu sakit kepala seperti anggur (red wine), monosodium glutamat, keju dan terapi obat-obatan misalnya asetaminophen, gabapentin, antidepresant. Akan tetapi, lebih utama adalah pencegahan dengan cara menghindari cedera otak primer, dan apabila terjadi cedera otak primer sebaiknya menghindari dan mengobati cedera otak sekunder dengan pengelolaan perioperatif yang tepat. Kata kunci: Bedah saraf, cedera otak traumatik, neuroanestesi, sakit kepala Headache is one of the most common symptoms after traumatic brain injury (TBI) and called “post-traumatic headache”. Approximately 30–90% of people having headaches. Headaches after TBI can be long-lasting, coming and going even past one year. Headaches can make it hard for you to carry out daily activities or can cause you to have more difficulty thinking and remembering things. Right after a severe TBI, people may have headaches because of the surgery on their skulls or because they have small collections of blood or fluid inside the skull. Headaches can also occur after mild, moderate and severe TBI. These headaches can be caused by a variety of conditions, including a change in the brain caused by the injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication.There are many kinds of headaches,migraine headaches, tension-type headaches, cervicogenic headaches, and rebound headaches. Treatment a headache after TBI will depend on each individual case. They are lifestyle changes like get enough sleep, get daily exercise, avoid caffeine, avoid certain foods that may trigger a headache, like red wine, monosodium glutamate or certain cheeses, and medicine therapy as acetaminophen, gabapentin, antidepresant. But, more important is prevention with avoid primary brain injury and avoid and treatment secondary brain injury with adequate periopeative management. Key words: headache, neuroanesthesia, neurosurgery, traumatic brain injury Reference Levin M, Ward TN. Headache. Dalam: Silver JM, McAllister TW, Yudofsky SC, penyunting. Textbook of traumatic brain injury. Edisi ke-2. Washington: American Psychiatric Pub Inc;2011,343–50. Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC. Characteristics and treatment of headache after traumatic brain injury: A focused review. Am J Phys Med Rehabil 2006;85(7):619–27. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro C A. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med 2008;358(5):453–63. Mihalik JP, Stump JE. Collins MW, Lovell MR, Field M, Maroon JC. Posttraumatic migraine characteristics in athletes following sports-related cocussion. J Neurosurg 2005;102(5):850–55. Hofman JM, Lucas S, Dikmen S, Braden CA, Brown AW, Brunner R, dkk. Natural history of headache after traumatic brain injury. Journal of Neurotrauma 2011;28:1719–25. Walker WC, Seel RT, Curtiss G, Warde DL. Headache after moderate and severe traumatic brain injury: a longitudinal analysis. Arch Phys Med Rehabil 2005;86:1793–800. Sherman KB, Goldberg M, Bell KR. Traumatic brain injury and pain. Phys Med Rehabil Clin N Am. 2006;17:473–90. De Lima Martin HA, Ribas VR, Martins BBM, Ribas RMG, Valenca MM. Posttraumatic headache. Arq Neuropsiquiatr 2009;67(1):43–45. McAllister TW. Mild brain injury. Dalam: Silver JM, McAllister TW, Yudofsky SC, Penyunting. Textbook of traumatic brain injury. Edisi ke-2. Washington: American Psychiatric Pub Inc;2011. hlm. 239–57. Lew Hl, Lin Pri, Fuh JL, Wong SJ, Clark DJ, Walker WC. Characteristic and treatment of headache after traumatic Broun Injury: a focused review. Am J Phys Med Rehabil. 2006;85(7):619–27
Sedasi dan Analgesia di Ruang Rawat Intensif Sudjud, Reza Widianto; , Indriasari; Yulriyanita, Berlian
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Pasien sakit kritis, khususnya yang mendapatkan ventilasi mekanik, seringkali mengalami nyeri dan kecemasan. Prinsip utama dari perawatan di ruang rawat intensif (ICU) adalah memberikan rasa nyaman sehingga pasien dapat mentoleransi lingkungan ICU yang tidak bersahabat. Pengelolaan sedasi dan analgesia yang adekuat dapat mempersingkat penggunaan ventilasi mekanik dan lama perawatan di ICU. Hal ini dapat dilakukan dengan mengidentifikasi dan mengatasi penyakit dasar dan faktor pencetus, menggunakan metode nonfarmakologi untuk meningkatkan rasa nyaman, pemberian terapi sedasi dan analgesia dengan memilih obat yang tepat, serta pemantauan secara rutin untuk menghindari terapi yang berlebihan dan berkepanjangan. Kata kunci: Analgesia, cemas, nyeri, ruang rawat intensif, sedasi Critically ill patients, especially those who receive mechanical ventilation, oftenexperience pain and anxiety. The main principle of treatment in the intensive care unit (ICU) is to provide a sense of comfort so that the patient can tolerate the ICU environment.Management of adequate sedation and analgesia can shorten the use of mechanical ventilation and length of ICU care. This can be done by identifying and correcting the underlying disease and precipitating factors, use of non-pharmacological methods to improve comfort, sedation and analgesia therapy with choosing the right drug, as well as regular monitoring to avoid excessive and prolonged therapy. Key words: Analgesia, anxiety, intensive care unit, pain, sedation Reference Rathmell.P.James. Bonica’s Management of Pain. Pain management in the intensive care unit. Lippincott Williams 2012;112:1590–01. Sessler CN, Wilhem W. Analgesia and sedation in the intensive care unit: an overview of the issues Crit Care. 2008;12(Suppl 3): S1. Young J. Sedation. Dalam: Core topics in critical care medicine. New York: Cambridge university press; 2010:77–88. Singer M WAR. Oxford handbook of critical care. Pain and post operative intensive care. Oxford University Press Inc; 2005:530–35. Marino P L. The ICU book: Analgesia and Sedation. Lippincott williams & wilkins; 2007;49:938–66. McConachie I. Handbook of ICU therapy. Analgesia for the high risk patient. New York: Cambridge University Press; 2006;4:51–64. Sessler CN VK. Patient-Focused Sedation and Analgesia in The ICU. Chest 2008;133:552–65. Mitchell E. Pain control. Dalam : Core topics in critical care medicine. New York: Cambridge university press; 2010:72–6. Peitz J Gregory, Olsen M Keith. Top 10 Myths Regarding Sedation and Delirium in the ICU. J Critical Care Medicine 2013;41:S46–56. Reade C Michael, Finfer Simon. Sedation and Delirium in the Intensive Care Unit. J New England 2014:444–54. Riessen.R, Pech.R. Comparison of the ramsay score and the richmond agitation sedation score for the measurement of sedation depth. Crit Care 2012.16 (Suppl 1):326. Recommended standards for short latency auditory evoked potentials.American clinical neurophysiology society.2008:12-9. Stern. TA. Manual of intensive care medicine. Diagnosis and treatment of agitation and delirium in the intensive care unit patient. Lippincott williams.2000; 179:871–75.
Resuscitative Strategies in Traumatic Hemorrhagic Shock Supandji, Mia; Budipratama, Dhany; Pradian, Erwin
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Trauma and brain injury are common in young patients with a high incidence of mortality. The classic triadof death in a trauma involves hypothermia, acidosis and coagulopathy. This physiologic derangement plays animportant role in exsanguination and death of trauma patients, if it is not promptly diagnosed and aggressivelytreated. However, the optimal strategy is still debatable. Damage Control Resuscitation along with damage controlsurgery has been proven to increase patients survival. DCR is a management of patients with trauma startedfrom the emergency room up to the operating room and the intensive care unit (ICU). Five pillars of DCR are 1.Body rewarming, 2. Correction of acidosis, 3. Permissive hypotension, 4. Restrictive luids administration and 5.Hemostatic resuscitation. Early and aggressive transfusion of blood and blood products, with comparison of PRC,FFP and platelets of 1:1:1, if no whole blood available, can improve the outcome and survival of the patients.
Blok Paravertebral Lumbal Teknik Injeksi Satu Titik pada Kadaver: Penelitian Volume Zat Pewarna Metilen Biru pada Ruang Paravertebra Pryambodho, Pryambodho; Satoto, Darto; Natali, Christella
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
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Anestesia blok saraf perifer merupakan teknik anestesia untuk memfasilitasi operasi daerah ekstremitas atas atau bawah khususnya pada pasien dengan masalah medis berat. Anestesia blok saraf perifer bawah minimal memerlukan dua injeksi, yaitu pada pleksus lumbalis dan sakralis. Berdasarkan penelitian tersebut maka penelitian ini dilakukan untuk mengetahui volume metilen biru yang dapat mencapai segmen L2 sampai S3 dengan teknik sekali injeksi. Penelitian ini menggunakan metode up and down pada 5 kadaver. Volume awal yang ditentukan adalah 40 mL. Interval antar volume ditentukan 10 mL. Bila penyebaran metilen biru pada volume 40 mL mencapai ruang paravertebra L2 sampai S3 maka kadaver selanjutnya menggunakan volume metilen biru 30 mL, namun bila tidak didapatkan penyebaran ruang paravertebra L2 sampai S3 maka kadaver selanjutnya menggunakan volume 50 mL. Penelitian akan dihentikan bila memenuhi satu dari tiga ketentuan yaitu hasil konstan tercapai, tidak didapatkan penyebaran ruang paravertebra L2 sampai S3 pada volume maksimal 80 mL dan jumlah maksimal 20 kadaver tercapai. Dari kelima volume metilen biru yang diteliti, tidak didapatkan penyebaran ruang paravertebra L2 sampai S3. Segmen penyebaran tertinggi metilen biru pada ruang paravertebra L1 dengan volume 60 mL, sedangkan penyebaran terendah pada S1 dengan volume 60 mL dan 70 mL. Penyebaran kontralateral didapatkan pada volume 40 mL dan 70 mL. Teknik injeksi satu titik blok paravertebral lumbal tidak dapat menghasilkan penyebaran pada ruang paravertebra L2 sampai S3.  Kata Kunci: Blok paravertebral, injeksi satu titik, lumbal, metilen biru, up and down method   Lumbar Paravertebral Block with One Injection Technique: Methylene Blue Dye Volume in Paravertebral Space Peripheral nerve blockade is a technique for facilitating lower or upper surgery specifically in patient with severe comorbidities. Peripheral nerve blockade for lower extremity needs two injections for lumbal plexus and sacral plexus. In previous study, 30 mL methylene blue injections in paravertebra space L4, spreading in paravertebra space L1 until S2. This study aimed to determine the minimum methylene blue volume to spread from paravertebral space L2 until S3. This study  used 5 cadavers with up and down method. Starting volume was 40 mL. Interval between volume was 10 mL. If the volume 40 mL in the first cadaver can spread from L2 until S3 paravertebral space, the next volume for the next cadaver would be 30 mL. If the volume 40 mL in the first cadaver can’t spread from L2 until S3 paravertebral spcae, the next volume for the next cadaver would be 50 mL. The experiment stopped if it fulfilled one of three conditions; constant results achieved, maximum volume 80 ml that couldn’t spread from L2 until S3 paravertebral space, and maximum 20 cadavers used. From the tests of five volume sizes, none of them spreaded from L2 until S3 paravertebral space. The highest spread of methylene blue was at L1 with volume 60 mL while the lowest spreads were with volume 60 mL and 70 mL. Contralateral spread happened at volume 40 mL and 70 mL. In conclusion, One injection technique in paravertebral block could not spread the methylene blue into L2–S3 paravertebral space.  
Perbandingan Keberhasilan Insersi Kanul Intravena antara Penggunaan dan Tanpa Penggunaan Penampil Vena pada Pasien Pediatrik Perdana, Aries; Kapuangan, Christopher; Alantas, Anas; Manggala, Sidharta Kusuma; Wardhani, Yosi Dwi
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Insersi kanul intravena pada bayi, balita atau anak-anak cukup sulit karena kecilnya ukuran pembuluh darah vena dan lokasinya yang dalam di jaringan subkutis. Kesalahan insersi kanul intravena cenderung terjadi pada kasus difficult venous access (DVA). Penelitian ini membandingkan keberhasilan insersi kanul intravena dengan atau tanpa penggunaan penampil vena pada pasien pediatrik. Setelah mendapat persetujuan dari Komite Etik FKUI/RSCM dan konsen dari pasien, dilakukan penelitian uji klinis acak tidak tersamar pada 88 sampel pasien pediatrik. Pasien dirandomisasi menjadi dua kelompok, pada kelompok 1 dilakukan insersi kanul intravena tanpa penampil vena, sedangkan kelompok 2 dilakukan insersi kanul intravena dengan penampil vena. Data yang terkumpul diuji dengan uji Chi-square. Insersi kanul intravena sekali tusuk dengan penampil vena keberhasilannya 3,095 kali lebih besar dibanding dengan tanpa penampil vena (p<0,05). Insersi kanul intravena sekali tusuk pada pasien dengan status gizi kurang-buruk memiliki angka keberhasilan 0,285 kali dibanding dengan status gizi normal lebih (p<0,05). Usia memiliki hubungan signifikan terhadap insersi kanul intravena (p<0,05). Keberhasilan insersi kanul intravena sekali tusuk dengan menggunakan penampil vena lebih baik dibanding dengan tanpa penampil vena. Keberhasilan insersi kanul intravena memiliki hubungan yang signifikan dengan status gizi dan usia. Kata kunci: Difficult venous access, kanul intravena, penampil vena, status gizi Comparison of Successful Vein Cannula Insertion between Using Vein Viewer and without Vein Viewer in Pediatric Patients Vein cannula insertion in infants, toddlers, or children is quite difficult because of the size and location of their veins. Wrong vein cannula insertion are prone to happen in Difficult Venous Access (DVA) cases. This research is comparing the successful vein cannula insertion between using vein viewer and without vein viewer in pediatric patients. After obtained the ethical approval from Ethical Committee of Cipto Mangunkusumo Hospital and informed consent from patients, 88 pediatric patients were enrolled to this randomized controlled trial. Patients were randomized into 2 groups: first group was inserted without vein viewer and second group was inserted using vein viewer. Data was analyzed with Chi-square test. Successful rate in first attempt vein cannula insertion using vein viewer is 3.095 times higher than without vein viewer (p<0.05). First attempt vein cannula insertion in malnutrition patients has successful rate 0.85 times higher than good nutrition-obese patients (p<0.05). Age has significant relationship with vein cannula insertion (p<0.05). Successful rate in first attempt vein cannula insertion using vein viewer is higher than without vein viewer. Successful first attempt in vein cannula insertion has significant relationship with nutrition status and age. Key words: Difficult venous access, nutrition status, vein cannula, vein viewer
Perbandingan Efektivitas antara Kombinasi 1,5 mg/kgBB Propofol 1% + 0,5 mg/kgBB Ketamin 1% dengan 1,5 mg/kgBB Propofol 1% + 2 mg/KgBB Fentanil terhadap Nilai Bis pada Tindakan Dilatasi dan Kuretase Sinurat, Bonny Brian; Melati, Endang; Puspita, Yusni; , Theodorus
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Abstract

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

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