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Manajemen Cairan pada Operasi Jantung Kusuma Dewi, Ni Luh; Adi Parmana, I Made
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Terapi cairan merupakan salah satu topik paling kontroversial dalam manajemen perioperatif. Perdebatan yang terus berlangsung terutama mengenai jumlah dan tipe cairan resusitasi, metode monitoring dan strategi pemberian cairan pada operasi jantung. Laporan mengenai hipervolemia atau hipovolemia perioperatif semakin banyak dijumpai. Manajemen cairan perioperatif yang tidak tepat akan meningkatkan morbiditas dan mortalitas pasca pembedahan. Dalam tinjauan pustaka ini dipaparkan fisiologi cairan tubuh, respon tubuh terhadap stress pembedahan, patofisiologi kelebihan dan kekurangan cairan perioperatif pada operasi jantung, penggunaan alat monitoring, pemilihan jenis cairan serta dampak pada fungsi organ dan aplikasi klinis. Kata kunci: Cairan, koloid, kristaloid, operasi jantung Fluid Management in Cardiac Surgery Fluid therapy is one of the most controversial topics in perioperative management. There is continuing debate with regard to the quantity and the type of fluid resuscitation, the choice of parameters used in monitoring and goal directed therapy strategy used cardiac surgery. However, there are increasing reports of perioperative excessive and deficit intravascular volume leading to increased postoperative morbidity and mortality. This article aims to briefly review physiology of body fluid, stress response to surgery, pathophysiology of fluid excess and deficit during perioperative period in cardiac surgery, the use of monitoring, the fluid formula available, the effects to organ and clinical implications. Key words: Cardiac surgery, colloids, crystalloids, fluids Reference Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012;6:CD000567. Shaw A, Raghunathan K. Fluid management in cardiac surgery. Anest Clin. 2013;31:269–80. Hahn RG. Volume kinetics for infusion fluids. Anesthesiology. 2010;113(12):470–81. Rhee P. Shock, electrolytes and fluids. Dalam: Towsend CM, Penyunting. Sabiston textbook of surgery: the biological basis of modern surgical practice. Edisi ke-17. Elsevier Saunders: Philadelphia; 2012,66–119. Chappell D, Jacob M, Hofmann-Kiefer K, dkk. A rational approach to perioperative fluid management. Anesthesiology. 2008;109(4):723–40. Finfer S, Bellomo R, Boyce N, dkk. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Eng J Med. 2004;350(22):2247–56. Myburgh JA, Finfer S, Bellomo R, dkk. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Eng J Med. 2012;367(20):1901–11. Perner A, Haase N, Guttormsen AB, dkk. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Eng J Med. 2012;367(2):124–34. Woodcock TE, Woodcock TM. Revised starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012;108(3):384–94. Kozar RA, Peng Z, Zhang R, dkk. Plasma restoration of endothelial glycocalyx in a rodent model of hemorrhagic shock. Anesth Analg. 2011;112(6):1289–95. Bruegger D, Rehm M, Abicht J, dkk. Shedding of the endothelial glycocalyx during cardiac surgery: on pump versus off pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2009;138(6):1445–7. Chowdhury A, Cox E, Francis S, dkk. A randomized controlled, double blind crossover study on the effect of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012;256(1):18–24. Kellum J, Song M, Almasri E. Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest. 2006;130(4):962–7. Albahrani M, Swaminathan M, Phillips-Bute B, dkk. Postcardiac surgery complications: association of acute renal dysfunction and atrial fibrillation. Anesth Analg. 2003;96(3):637–43. Neligan P. Monitoring and managing perioperative electrolyte abnormalities, acid base disorders and fluid replacement. Dalam: Longnecker DE, Penyunting. Anesthesiology. Edisi ke -2. New York: McGraw Hill, Inc; 2012,507–45. Jarvela K, Koskinen M, Kaukinen S, dkk. Effect of hypertonic saline (7.5%) on extracellular fluid volumes compared with normal saline (0.9%) and 6% hydroxyethyl starch after aortocoronary bypass graft surgery. J Cardiothorac Vasc Anesth. 2001;15:210–5. Verheij J, van Lingen A, Beishuizen A, dkk. Cardiac response in greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Med. 2006;32:1030–8. Schortgen F, Lacherade JC, Bruneel F, dkk. Effect of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomized study. Lancet. 2001;357:911–6. Brunkhorst FM, Engel C, Bloos F, dkk. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39. Marik PE. Hemodynamic parameters to guide fluid therapy. Tansfusion Alt Transfusion Med. 2010;11(3):102–12. Habicher M, Perrino A, Spies C, dkk. Contemporary Fluid Management in Cardiac Anesthesia. J Cardiothorac Vasc Anesth. 2011;25(6):1141–53. Bennett-Guerrero E, Khan RA, Moskowitz DM, dkk. Comparison of arterial systolic pressure variation with other clinical parameters to predict the response to fluid challenges during cardiac surgery. Mt Sinai J Med. 2002;69:96–100. Wiesenack C, Prasser C, Keyl C, dkk. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J Cardiothorac Vasc Anaesth. 2001;15:584–8. Brock H, Gabriel C, Bibl D, dkk. Monitoringintravascular volumes for postoperative volume therapy. Eur J Anaesthesiol. 2001;19:288–94. Tousignant CP, Walsh F, Mazer CD. The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg.2000;90:351–5. De Backer, dkk. In: Hemodynamic monitoring using echocardiography in the critically ill. Penyunting Springer-Verlag. Berlin Heidelberg; 2011:250–8.

Perbandingan Kemudahan Pemasangan Laryngeal Mask Airway antara Teknik Baku disertai Penekanan Lidah dengan Teknik Baku Marsaban, Arif HM; Martaria, Nency; Firdaus, Riyadh; Cahyadi, Arief
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Laryngeal mask airway (LMA) merupakan suatu alat bantu jalan napas. Teknik baku pemasangan LMA disertai penekanan lidah memberikan angka keberhasilan pemasangan 100%. Penelitian ini bertujuan membandingan kemudahan dan komplikasi pemasangan LMA menggunakan teknik baku dengan penekanan lidah dibandingkan dengan teknik baku. Penelitian ini merupakan studi uji klinis acak tersamar tunggal yang dilakukan antara Mei – Juni 2013 di RSCM, pada 80 pasien dewasa yang menjalani operasi elektif dengan anestesia umum menggunakan LMA. Pada 40 pasien mengalami pemasangan LMA dengan teknik baku disertai penekanan lidah dan 40 pasien dengan teknik baku. Upaya pemasangan dan kemudahan dicatat dan dinilai. Pemasangan mudah bila ≤2 kali. Komplikasi pemasangan berupa noda darah, nyeri menelan dan nyeri tenggorokan dicatat dan dinilai. Analisis statistik dilakukan dengan uji chi-kuadrat dan eksak fisher. Batas kemaknaan untuk semua uji adalah p <0,05. Perbandingan proporsi keberhasilan upaya pemasangan pertama dan kedua antara kelompok teknik baku disertai penekanan lidah dan teknik baku adalah 87,5% banding 65% dan 100% banding 97,5%, secara berurutan. Pemasangan LMA dengan teknik baku disertai penekanan lidah tidak lebih mudah dibanding dengan teknik baku. Kekerapan komplikasi yang berbeda bermakna berupa noda darah 0% pada teknik baku disertai penekanan lidah dan 6,2% pada teknik baku. Kata kunci: Kemudahan pemasangan, komplikasi, laryngeal mask airway, teknik baku disertai penekanan lidah, teknik baku LMA is one of the airway management device. Novel technique of LMA insertion combined with tongue supression technique resulted in 100% succes rate of insertion. The objective of this study was to compare easiness and complications of inserting LMA using classic approach combined with tongue supression and classic approach. This study was a single-blind randomized clinical trial conducted from May ̶June 2013 in RSCM on 80 adult patients who underwent elective surgery with general anesthesia using LMA. In 40 patients underwent LMA insertion with classic approached combined with tongue supression technique and 40 patients with classic approached. Effort and success rate was noted and evaluated. Insertion was considered easy if the insertion was attempted maximally twice. Complications such as blood stains, sore throat, and dysphagia was noted and evaluated. Statistical analysis conducted by Chi-square Test and Fischer Exact. P <0,05 was considered significant. Proportion of first and second attempt LMA insertion between both technique was 87,5% compared with 65% and 100% compared with 97,5%, respectively. LMA insertion with classic approached combined with tongue supression technique was not easier than with classic approached technique. Complication which statistically significant different was blood stains 0% with classic approached combined with tongue supression technique compared with 6,2% classic approached technique. Key words: Classic approached combined with tongue supression, classic approached technique easy installation complications, laryngeal mask airway Reference Sinha PK, Misra S. Supraglottic airway devices other than LMA and its prototypes. Indian J anaesth. 2005;49(4):281–92. Hein C, Owen H, Plummer J. Randomized comparison of the SLIPA and the SS-LM by medical students. Emergency Medicine Australasia. 2006;18:478–83. Basket PJF, Brain AIJ, Handbook of the use of LMA in CPR. Intavent. 1998:1–14. Hein C. The Prehospital practitioner and the LMA: are you keeping Up?. J Emerg Primary Health Care. 2004:2; 1–2. Brimacombe JR, Berry AM, Daves SM, The LMA, Airway Management. Dalam: Hanowel LH, Penyunting Lippincott: Raven Publishers, Philadelphia;1996. Hlm.195–221. Rieger A, Brunne B, Striebel W. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events, a prospective randomize trial. Anesthesiol. 2010; 112:652–7. Park PG, Choi GJ, Kim WJ, Yang SY, Shin HY, Kang H, dkk, A comparative study among normal saline, water soluble gel and 2% lidocaine gel as a SLIPA lubricant, Korean J Anesthesiol. 2014 February; 66(2): 105–111. Hein C. The prehospital practitioner and the laryngeal mask airway: “Are you keeping up?”. Austral Jo Paramed. 2004:2 (1) Vaida S. Airway management-Supraglotic Airway Devices. Timisoara. 2004. Strydom C, Le Roux. A clinical comparison of disposable airway devices. SAJAA. 2008; 14(6):31–36. Andre AZ. Comparison of the LMA-Classic with the new disposable soft seal laryngeal mask in spontaneously breathing adult patients. Anesthesiology. 2003;99:1066–71. Keijzer C, Buitelaar D. A Comparison of postoperative throat and neck complaints after the use of I-gel and the La Premiere Disposable laryngeal mask: a double-blinded, randomized, controlled trial. Anaesth Analg 2009; 109(4);1092–4. Cook TM, Gatward et al. A Cohort evaluation of the I-Gel airway in 100 elective patients. J Association Anaesthetists Great Britain Ireland 2008;63:1124–30. Roodneshin F, Agah M, Novel technique for placement of LMA in difficult pediatric airways. Tanaffos.2011;10(2):56–8. Mun’im A. Perbandingan dua macam teknik pemasangan sungkup laring pada penderita operasi elektif di RSUPN-CM tahun 1997. [Tesis]. Jakarta: Departemen Anestesiologi dan Terapi Intensif FKUI/RSCM. 1997. Payne FB, Wilkes NC. A prospective study of two insertion techniques of the laryngeal mask airway. Anesthesiol. 1996;85:3A. Malayanti. Keberhasilan pemasangan sungkup laring: perbandingan antara teknik baku dengan teknik putar 180o pada pasien operasi elektif. [Tesis]. Jakarta: Departemen Anestesiologi dan Terapi Intensif FKUI/ RSCM. 2002. Brimacombe J, Berry AM, Insertion of the LMA A Prospective Study of Four Techniques. Anaesth Intens Care. 1993;21:89–92 (4).

Effectivity of Fentanyl 1 μg/kg.weight to Prevent Emergence Agitation After General Anesthesia with Sevoflurane in Pediatric Patients Bernouli, Renny; Puspita, Yusni; Maas, Endang Melati; , Theodorus
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Emergence agitation (EA) is a postanesthetic problem that interferes a child’s recovery and presents a challenge in terms of assessment and management. Fentanyl, a potent opioid, are hypotetised can prevent emergence agitation after general anesthesia with sevoflurane in pediatric patients. In this experimental clinical trial double-blind study, 34 children (age 2–7 years old) underwent elective minor surgery under general anesthesia with sevoflurane were selected to have an intravenous fentanyl 1μg/kgweight versus placebo before the end of the surgery. On thirty minutes after anesthesia, we evaluated agitation incidence (based on WATCHA score ≥3) and side effects of fentanyl. Recovery characteristics, including awakening time, duration of agitation, pain scale using FLACC scale, and discharge time were also recorded. All datas were analised using SPSS 21 and significantly different if p<0,10. The incidence of agitation on fentanyl group are lower in fentanyl group than placebo (17,6% versus 52,9%) and statistically different (p=0,071The incidence of vomiting are similar (5,9%) and there are no significant difference in awakening time. Fentanyl 1 μg/kgweight intravenous are proven effective to prevent emergence agitation after awakening from general anesthesia with sevoflurane in pediatric patients

Antibiotik Empirik di Intensive Care Unit (ICU) Aditya, Ricky; Kestriani, Nurita Dian; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Penemuan jenis antibiotik baru diimbangi dengan penemuan resistensi dari bakteri tersebut terhadap beberapa obat.Secara garis besar, antibiotik dibagi menjadi tiga golongan berdasarkan cara kerja, spektrum, dan efek bakterisidal.Terapi antibiotik terhadap pasien kritis merupakan hal yang menjadi perhatian di dunia akibat tingginya mortalitasdan morbiditas. Aspek efektifitas terapi terus menjadi perhatian akibat peningkatan kebutuhan ruang Intensive CareUnit. Kontrol infeksi dan pemilihan antibiotik yang sesuai merupakan intervensi utama dan harus menjadi prioritasdalam manajemen pasien kritis. Pengetahuan mengenai farmakokinetik dan farmakodinamik antibiotik merupakanfaktor yang esensial karena penentuan dosis antibiotik berkaitan dengan keluaran pasien kritis. Perubahan padavolume of distribution dan clearance antibiotik pada pasien kritis mungkin berefek pada target konsentrasi obatdalam serum. Hal ini menjadi bukti bahwa parameter pharmacokinetics (PK)/pharmacodynamics (PD) berperanterhadap efek obat yang terkait dengan keluaran pasien dan resistensi. Kata kunci: Antibiotik, farmako dinamik, farmako kinetik, ICU, pasien kritis The discovery of new types of antibiotic resistance offset by the discovery of bacteria to multiple drugs. In general,antibiotics are divided into three groups based on the spectrum shape, and the bactericidal effect. Antibiotictherapy for critically ill patients is a concern in the world due to the high mortality and morbidity. Aspects of theeffectiveness of therapy remains a concern due to the increasing needs of the ICU. Pemilihian infection controland appropriate antibiotic is a major intervention and should be a priority in the management of patients in criticalcondition. Knowledge of the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics is essential todetermine the doses of antibiotics related to production factor of critically ill patients. Changes in the volumeof distribution and clearance of antibiotics in critically ill patients may have an effect on a target serum drugconcentrations. This is proof that the PK/PD parameter contribute to the effects associated with the drug and theoutput resistance of the patient. Key words: Antibiotic, Critical patients, ICU, pharmacodynamis, pharmacokinetis Reference Davies, JD. Origins and Evolution of Antibiotic Resistance. Microbiology and Molecular Biology Reviews, 2010;74(3): 417–33. Waksman, SA. What is an Antibiotic or an Antibiotic Substance?. Mycoglia. 1947; 39(5):565–9. Bruton, LL., Chabner AB., & Knollmann CB. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 12th ed. California: McGraw-Hill Education, 2010. Aminov, RI. A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future. Frontier in Microbiology. 2010;1(134). Davies, J. & Davies D. Origins and Evolution of Antibiotic Resistance. Microbiology and Molecular Biology Review.2010;74(3). Saga, T. & Yamaguchi, K. History of Antimicrobial Agents and Resistant. Research and Reviews.2009;52(2). Kohanski MA, Dwyer DJ, Collins JJ. How Antibiotics Kill Bacteria: from Target to Network. Microbiology.2010;8(1). Mitchigan State University. Antimicrobial Resistence Learnig Site Pharmacology. 2011, Diakses pada 28 Oktober 2015 dari: http://amrls.cvm.msu.edu . Roberts, JA. & Jeffrey L. Pharmacokinetic Issues for Antibiotics in the Critically Ill Patient. Continuing Medical Education Article: Concise Definite Review. 2009;37(3):540–51. McKellar, QA., SF. Sanchez Bruni, & DG. Jones. Pharmacokinetic/Pharmacodynamic Relationship of Antimicrobial Drugs Used in Veterinary Medicine. Journal of Veterinary Pharmacology and Therapeutics. 2004;27:503–14. Finberg, RW. & Guharoy R. Clinical Use of Anti-infective Agents: A Guide on How to Prescribe Drugs Used to Treat Infections. Springer Science & Business Media, LLC. 2012. p. 5–13 Maramba-Lazarte, CC. Determining Correct Dosing Regimens of Antibiotics Based on the Their Bacterial Activity. Pediatric Infectious Disease Society of the Philippines Journal, 2010;11(2):44–9. Levison, ME. & Levison JH. Pharmacokinetics and Pharmacodynamics of Antibacterial Agent. Infectious Desease Clinical North America, 2009;24(3):791–830. Bennet, PN. Brown, MJ. Clinical Phamacology, 9th ed. Spain: Elvisier, 2003.

Ketepatan Modul Triase IGD RSUPN Cipto Mangunkusumo dalam Memprediksi Angka Mortalitas Wijaya, Andi Ade; Firdaus, Riyadh; S. R. Tonda, Thomas Aquinas
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Kegagalan mengenali dengan risiko mortalitas tinggi pada pasien dapat menyebabkan luaran yang buruk. penilaian yang cepat dan tepat terhadap perubahan tanda vital sangat penting untuk menghindari keterlambatan penanganan. Beberapa modul triase telah dirancang untuk mendukung pengambilan keputusan bagi perawat/dokter triasePenelitian meneliti ketepatan modul triase IGD RSCM dalam memprediksi mortalitas untuk luaran 24 jam dan 7 hari. Dilakukan studi kohort retrospektif pada 529 s pasien triase di Instalasi Gawat Darurat RSCM. Luaran mortalitas pasien dibagi menjadi mortalitas 24 jam dan mortalitas 7 hari. Area under the curve modul triase untuk luaran 24 jam adalah 0,787 (IK 95%: 0,690–0,885), lebih besar daripada area under the curve modul triase untuk luaran 7 hari yaitu 0,662 (IK 95%: 0,597–0,726). Hal ini berarti modul triase IGD RSCM lebih akurat dalam memprediksi mortalitas 24 jam daripada mortalitas 7 hari. Rasio kemungkinan positif (PLR) yang terbesar ialah untuk kategori resusitasi, yaitu 11,36. Performa modul triase IGD RSCM lebih baik dalam memprediksi mortalitas 24 jam daripada untuk memprediksi mortalitas 7 hari. Kata kunci: Akurasi, instalasi gawat darurat, modul triase, mortalitas, tanda vital The AmLuracy of Triage Module of Cipto Mangunkusumo Hospital’s Emergency Department in Predicting Mortality RateFailure to identify high risk patients leads to poor outcomes. quick and precise assessment of vital signs changes is very important to help the triage doctors/nurses in making prompt decisions. This study analyzed the amLuracy of the triage modules in the ED of RSCM inpredicting the mortality outcome in 24 hours and 7 days. a retrospective cohort study was done on 529 patientswho underwent the triage procedure in the ED of RSCM. The patients’ mortality outcomes were divided into 24-hours mortality and 7-days mortality. The area under the curve for the 24-hours outcome was 0.787 (95% CI: 0.690 to 0.885) greater than the area under the curve for 7-days outcomes(0,662, CI 95%: 0.597 to 0.726), thus the triage module in the ED of RSCM was better in predicting of 24-hours mortality than 7-days mortality. The ER triage module was more amLurate in predicting 24-hours mortality than f 7-days mortality. Key words: Accuracy emergency room, mortality, Triage, vital signs

Troponin dan Manajemen Iskemia Miokardium Perioperatif Leksana, Ery; Purnomo, Ika Cahyo
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Penyakit jantung iskemik sering memberikan gambaran dan perkembangan yang membahayakan. Kejadian dari tahun ke tahun terus meningkat dan menyumbang angka mortalitas yang tinggi. Angina pectoris, gambaran iskemia pada EKG, dan peningkatan petanda jantung menunjukkan terjadinya infark miokard akut. Pasien dalam kondisi demikian sangat berisiko untuk menjalani proses pembiusan. Pemeriksaan troponin bersenstivitas tinggi telah diperkenalkan, namun hal ini memberikan tantangan yang baru dalam hal sensitivitas vs spesivisitas. Berbagai panduan telah diterbitkan untuk memandu dokter ahli anestesi melewati rintangan risiko pada penderita dengan iskemia miokard. Kata kunci: Anestesi, iskemia miokardium, troponin Troponin and Perioperative Management in Iskemia Myokard Troponin Ischemic heart disease often develop harmful conditions. Incidence from year to year continues to increase and accounted for high mortality rate. Angina pectoris, marked ECG changes and elevation of cardiac markers, especially troponins indicate the presence of acute myocardial infarct. Patients in this condition is very risky to undergo anesthesia process. High sensitivity troponin test were introduced, but it gave new challenge of sensitivity vs specificity. Guidelines have been published to guide the anesthesiologist through the obstacles of risks in patients with myocardial ischemia. Key words: Anesthesia, myocardial ischemia, troponin Reference Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R Jr. National Academy of Clinical Biochemistry Standards of laboratory practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem. Jul 1999;45(7):1104–21. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. Sep 2000;36(3):959–69. Antman EM. Decision making with cardiac troponin tests. N Engl J Med. Jun 27 2002;346(26):2079–82. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, dkk. National academy of clinical biochemistry laboratory medicine practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Clin Chem. Apr 2007;53(4):552–74. Hamm CW, Giannitsis E, Katus HA. Cardiac troponin elevations in patients without acute coronary syndrome. Circulation. Dec 3 2002;106(23):2871–2. Ammann P, Fehr T, Minder EI, Günter C, Bertel O. Elevation of troponin I in sepsis and septic shock.Intensive Care Med. Jun 2001;27(6):965–9. Bakshi TK, Choo MK, Edwards CC, Scott AG, Hart HH, Armstrong GP. Causes of elevated troponin I with a normal coronary angiogram. Intern Med J. Nov 2002;32(11):520–5. Nunes JP, Mota Garcia JM, Farinha RM, dkkl. Cardiac troponin I in aortic valve disease. Int J Cardiol. Jun 2003;89(2–3):281–5. Hamwi SM, Sharma AK, Weissman NJ, Goldstein SA, Apple S, Caños DA. Troponin-I elevation in patients with increased left ventricular mass. Am J Cardiol. Jul 1 2003;92(1):88–90. Velmahos GC, Karaiskakis M, Salim A, Toutouzas KG, Murray J, Asensio J. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma. Jan 2003;54(1):45–50; discussion 50–1. Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation. Jan 7 1997;95(1):163–8. Brandt RR, Filzmaier K, Hanrath P. Circulating cardiac troponin I in acute pericarditis. Am J Cardiol. Jun 1 2001;87(11):1326–8.

Effect of Vitamin C 1.000 mg Intravenous Therapy to Lactate Level, Base Deficit and Central Vein Saturation (SvO2) in Septic Patient Rahardjo,, Theresia Monica; Redjeki, Ike Sri; Kurniadi, Rudi
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Microvascular endothelial dysfunction is a major problem in sepsis patient, followed by a very high morbidity and mortality rate even optimal effort was done. Vitamin C has ability as antioxidant and can improve endothelial cell function. A prospective, randomized, placebo-controlled, and double blind study was conducted at Intensive Care Unit (ICU) Dr. Hasan Sadikin General Hospital Bandung within 6 months to evaluate the effect of vitamin C 1.000 mg intravenous on lactate level, base deficit and SvO2, in 33 septic patients, aged 17–60 years with acute physiology and chronic health evaluation II (APACHE II) score 15–23. Subjects were divided into two groups, treatment group was given an injection of 5 mL vitamin C 1000 mg and control group had a 5 mL NaCl 0.9% at first to seventh day. Measurement of lactate level, base deficit and SvO2 was done at day 1, day 3, day 5, and day 7. Result showed a significant different lactate level between two groups, a very significant decrease of lactate level and decrease of lactate level percentage occurred in treatment group at day 5. and 7 (p<0.001), a significant decrease of base deficit (p<0.002) and an unsignificant decrease of SvO2 (p>0.05). In conclusion, vitamin C 1.000 mg intravenous can improve lactate level, base deficit and SvO2 in septic patient.

Anaesthetic Management for a Patient with Uterine Perforation Due to Gestational Trophoblastic Disease with Hyperthyroidism wullur, caroline; Rismawan, Budiana
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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Gestational trophoblastic disease originates from abnormal proliferation of molar tissue and most of them are not complicated. However, life threatening condition such as hyperthyroidism may occur. Often, the diagnosis of hyperthyroid state is a retrospective one, as it can be missed in the emergency scenario of patient requiring molar evacuation. Trophoblastic hyperthyroidism poses a multiple of challenges to the anaesthesiologist. High output cardiac failure secondary to thyrotoxicosis, thyroid storm, hypertension and disseminated intravascular coagulation may occur in the perioperative period. We report a successful anaesthetic management of a patient with gestational trophoblastic disease with manifestations of hyperthyroidism whom underwent a trans-abdominal hysterectomy.

Correlation between Endoscopy Finding with Clinical Manifestations of Recurrent Abdominal Pain and Helicobacter pylori Infection Ermaya, Yudith Setiati; Prasetyo, Dwi
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Recurrent Abdominal Pain (RAP) is abdominal pain that occurs three times or more within 3 months that can interfere with daily activities for children. Prevalence of RAP 10%–30%, with functional or organic causes. Organic causes include infection with Helicobacter pylori (H. pylori). Globally >50% of the world’s population is infected with H. pylori, especially in developing countries, as the gold standard histological examination using an endoscope with anesthesia. This research to found the correlation between the endoscopic finding with clinical manifestations RAP and H. pylori infection. A cross-sectional study was conducted on 20 patients with complaints RAP children who come to the Hospital Dr. Hasan Sadikin, the period April–November 2015. Analysis using Pearson Chi-square, Spearman rho, Fisher’s exact and Mann-Whitney test. Subject as 20 children, consisting of 10 boys and 10 girls, median age 12 years, most clinical manifestations are RAP 60% and 80% erosion endoscopic finding. There were no significant correlation between the endoscopic finding with clinical manifestations, but have tendency endoscopic finding worse with severe clinical manifestations. Infection of H. pylori found positive in 90% subjects, boys 55%, there is no significant correlation between the endoscopic finding with H. pylori infection (p=0.133). Conclusions not found a significant correlation between endoscopy finding with clinical manifestations and H. pylori infection.

Waktu Pulih Anestesia Spinal pada Brakhiterapi Intrakaviter: Perbandingan Levobupivakain 5 mg Hiperbarik + Fentanil 25 mcg dengan Bupivakain 5 mg Hiperbarik + Fentanil 25 mcg Tantri, Aida Rosita; Kapuangan, Christopher; Edwin, Fahmi Agnesha
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Brakhiterapi intrakaviter merupakan terapi keganasan pada stadium lanjut yang sering digunakan pada bidang ginekologi. Pasien brakhiterapi pada umumnya dilakukan dengan pelayanan rawat jalan sehingga anestesia yang menjadi pilihan selama ini adalah anestesia spinal. Pemilihan obat yang memiliki waktu pulih anestesia spinal yang lebih cepat membuat pasien dapat pulang kerumah lebih cepat. Penelitian ini menelitiwaktu pulih anestesia spinal levobupivakain 5 mg hiperbarik + fentanil 25 mcg dibandingkan dengan bupivakain 5 mg hiperbarik + fentanil 25 mcg pada brakhiterapi intrakaviter rawat jalan. Metode: Setelah mendapatkan izin dari Komite Etik penelitian FKUI RSUPN Ciptomangunkusumo dan persetujuan dari pasien, dilakukan uji klinik acak tersamar ganda di unitradioterapi RSCM. Sebanyak 60 subyek dibagi menjadi dua kelompok perlakuan yaitu levobupivakain 5 mg hiperbarik + fentanil 25 mcg (LV) dan bupivakain 5 mg hiperbarik + fentanil 25 mcg (BV) untuk menilai waktu pulih anestesia spinal. Hasil: Pengukuran waktu pulih dilakukan dengan menilai waktu kesiapan pulang pasien, waktu ambulasi dan waktu pasien dapat miksi spontan. Pada variabel waktu ambulasi, miksi spontan, dan waktu kesiapan pulang didapatkan hasil berbeda bermakna (p<0,05). Simpulan: Waktu pulih anestesia spinal,waktu ambulasi dan waktu miksi pada kelompok levobupivakain 5 mg hiperbarik + fentanil 25 mcg lebih cepat dibandingkan dengan bupivakain 5 mg hiperbarik + fentanil 25 mcg pada brakhiterapi intrakaviter rawat jalan. Kata kunci: Brakhiterapi intrakaviter rawat jalan, levobupivakain, bupivakain, waktu pulih, anestesia spinal Spinal Anesthesia Recovery Time of Brachytherapy Outpatient Clinic: Comparison of 5 mg hyperbaric Levobupivacaine + 25 mcg Fentanyl and 5 mg Hyperbaric Bupivacaine+ 25 mcg FentanylIntracavitary brachytherapy is one modality treatment for advanced stage cervical cancer. These patients were treated in the outpatient clinic and thus the chosen anesthesia was spinal anesthesia. The regimen of spinal anesthesia influences the recovery time. The aim of the study was to compare the recovery time between two spinal anesthesia regimens, Levobupivacaine + 25 mcg fentanyl and 5 mgs Hyperbaric Bupivacaine+ 25 mcg fentanyl for brachytherapy outpatient clinic patient. Method: This was a double blind randomized control trial study. In the radiotherapy unit of RSCM. After approval from The Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients, 60 patients weredivided into two groups,Levobupivacaine + 25 mcg fentanyl group and 5 mgs Hyperbaric Bupivacaine+ 25 mcg Fentanyl group. The recovery time of both groups were recorded. Result: The spinal anesthesia recovery time was measured by discharge time, ambulation time, and spontaneous micturition time. all of these three variables were significantly different between the two groups (p<0,05). Conclusion: spinal anesthesia recovery time, ambulation time, spontaneous micturition time of Levobupivacaine + 25 mcg fentanyl group were faster than 5 mgs Hyperbaric Bupivacaine+ 25 mcg fentanyl group in intracavitary brachytherapy patients. Key words: intracavitary brachytherapy outpatient clinic, Levobupivacaine, bupivacaine, spinal anesthesia recovery time

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