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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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Perbandingan Pengaruh Pemberian Bupivakain 0,25% Intraperitoneum dan Infiltrasi Kulit dengan Plasebo terhadap Nilai Skala Analog Visual Pascaoperasi Laparatomi Ginekologi dengan Anestesi Umum Ridwan, Romi; Herman, Ruli; ., Suwarman
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Nyeri pascaoperasi adalah masalah penting dalam pembedahan. Studi terbaru menyatakan bahwa pemberiananalgesik perioperatif dapat mencegah serta mengurangi nyeri pascaoperasi. Studi ini bertujuan untuk menjelaskanefek analgesik preemtif dalam penanganan nyeri pascaoperasi laparatomi ginekologi. Jenis penelitian ini adalahprospektif, uji acak terkontrol buta ganda dan uji plasebo-kontrol, dimana 46 pasien dengan American SocietyAssociation (ASA) I dan II yang menjalani operasi laparatomi ginekologi secara acak di central operating theatre(COT), RS. Dr. Hasan Sadikin pada September sampai Desember 2012 diberikan 50 mL bupivakain 0,25% denganepinefrin 5μ per mL atau 50 mL normal salin; setiap 25 mL nya dimasukkan ke dalam rongga peritoneum daninfiltrasi kulit. Skor nyeri pasien dievaluasi dengan sistem Visual Analog Scale (VAS) saat diam dan mobilisasi,dinilai 6 jam pertama, lalu dilanjutkan jam ke- 8,12 dan 24 pascaoperasi. Dihitung jumlah pemakaian analgesikpertolongan selama 24 jam pertama. Hasil penelitian menunjukkan bahwa nyeri saat mobilisasi grup plasebo (P)lebih tinggi dibandingkan dengan grup bupivakain (B). Skor nyeri grup P secara signifikan lebih tinggi daripadagrup B saat mobilisasi (p<0,05). Kombinasi bupivakain secara intraperitoneum dan infiltrasi kulit akhir operasilaparatomi ginekologi dapat mengurangi nyeri pascaoperasi saat mobilisasi. Kata kunci: Bupivakain, intraperitoneum, nilai skala analog visual, nyeri pascaoperasi. Postoperative pain is an important surgical problem. Recent studies shows that perioperative administration ofanalgesics may be possible to prevent or reduce postoperative pain. This study was planned to investigate theefficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. In thisprospective, double-blinded, randomized, and placebo-controlled trial, 46 ASA physical status I and II patientsundergoing major abdominal gynecologic surgeries were randomized to receive 50 mL of bupivacaine 0.25% withepinephrine 5μ per mL or 50mL of normal saline; each 25 mL of the treatment solution was administered into theperitoneal cavity and incision. The pain score of the patients was evaluated by the visual analogue scale (VAS) atrest and movement, and every hours untill 6h, 8, 12, and 24h after surgery. Pain on movement was significantlymore intense in the Placebo group than in the Bupivacaine group. Measurement of the quality of pain by using theVAS values during mobilization is better than at rest. Pain scores were significantly higher in the placebo groupthan in the bupivacaine group on movement (p<0.05). A combination of intraperitoneal and incisional bupivacaineinfiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on movement. Keywords: Bupivacaine, intraperitoneal, postoperative pain, visual analog scale. Reference Macres SM, Moore PG, Fishman SM. Acute Pain Management. Dalam: Barash PG, Cullen BF, Soelting RK, editor. Clinical Anesthesia. Edisi ke-6. Philadelphia: Lippincot William & Wilkins 2009. hlm.1405–40. Tsui BC, Rosenquist RW. Peripheral Nerve Blockade. Dalam: Barash PG, Cullen BF, Soelting RK, editor. Clinical Anesthesia. Edisi ke-6. Philadelphia: Lippincot William & Wilkins 2009. hlm. 718–45. Rukewe A, Fatiregun A. The use of regional anesthesia by anesthesiologists in Nigeria. Anesth Analg 2010;110:234–4. Atashkhoii S, Shobeiri MJ, Azarfarin R. Intraperitoneal and incisional bupivacaine analgesia for major abdominal/gynecologic surgery: a placebo-controlled trial. Iran: Medical Journal of The Islamic Republic of Iran 2006;20(1):19–22. Visalyaputra S, Lertakyamanee J, Pethpaisit N, Somprakit P, Parakkamodom S, Suwanapeum P. Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation. Anesth Analg. 1999;88:1077–88. Ng A, Smith G. Intraperitoneal administration of analgesia: is this practice of any utility? Br J Anaesth 2002;4:535–7. Simpson RB, Russell D. Anesthesia for daycase gynaecological laparoscopy: a survey of clinical practice in the United Kingdom. Anesthesia 1999;54:72–80. Groudine SB, Fisher HAG, Kaufman RP, Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocain speeds the return of bowel function, decrease postoperative pain and shorters hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 1998;86:235–9. Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90:899–912. Williamson KM, Cotton BR, Smith G. Intraperitoneal lignocaine for pain relief after total abdominal hysterectomy. Br J Anaesth 1997;78:675–7. Ali PB, Cotton BR, Williamson KM, Smith G. Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy. Br J Anaesth 1998;80:245–7. Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebocontrolled comparison of bupivacaine and ropivacaine. Anesth Analg 2000;91:403–7. Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine following total abdominal hysterectomy. Anesth Analg 2002;95:158–62. Morgan GE, Mikhail MS, Murray MJ. Pain Management. Dalam: Morgan GE, Mikhail MS, Murray MJ, editor. Clinical anesthesiology. Edisi ke-4. New York: McGraw-Hill;2006. hlm. 360–72. Lou L, Sabar R, Kaye AD. Local Anesthetics. Dalam : Raj PP. Textbook of Regional Anesthesia. Edisi ke-3. Philadelphia. Churchill Livingstone. 2002. hlm. 214–53 Hannibal K, Galatius H, Hansen A, Obel E, et al. Preoperative wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy. Anesth Analg. 1996;83:376–81
Angka Kejadian dan Karakteristik Menggigil Pascaoperasi di Ruang Pemulihan COT RSHS Periode Bulan Agustus–Oktober 2015 Tantarto, Tamara; Fuadi, Iwan; Setiawan, Setiawan
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
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Abstract

Menggigil pascaoperasi merupakan komplikasi dari efek anestesi yang cukup sering dijumpai. Menggigil ini dapat menimbulkan rasa tidak nyaman dan risiko yang tidak baik bagi pasien. Penelitian ini dilakukan untuk mengetahui angka kejadian dan karakteristik pasien menggigil pascaoperasi. Studi deskriptif ini melibatkan seluruh pasien pascaoperasi di ruang pemulihan COT RSUP Dr. Hasan Sadikin pada periode bulan Agustus-Oktober 2015 yang memenuhi kriteria inklusi. Data penelitian ini adalah data sekunder dari rekam medis yang berupa data lengkap mengenai pasien pascaoperasi. Dari 639 pasien, angka kejadian menggigil adalah 169 kasus (26,45%).  Menggigil pascaoperasi lebih banyak terjadi pada pria yaitu sebanyak 28,57% dan kategori usia lansia awal. Proporsi pasien menggigil yang diberikan teknis anestesi umum saat operasi hampir sama dibandingkan anestesi regional. Presentase paling tinggi 43,75% pada pasien yang menjalani operasi >2 jam dengan 44,69% diberikan cairan infus sebanyak ≥1500 mL. Menggigil pascaoperasi paling banyak terjadi pada pasien yang menjalani operasi bedah saraf dengan presentase 66,67%. Angka kejadian menggigil pascaoperasi cukup tinggi terutama pada pria, kategori usia lansia awal, operasi yang lama, pemberian cairan infus yang banyak, serta operasi bedah saraf. Kata kunci: Angka kejadian, karakteristik, menggigil pascaoperasi, ruang pemulihan Prevalence and Characteristics of Post-anesthetic Shivering in Recovery Room COT RSHS from August to October 2015Post-anesthetic shivering is a common complication of anesthetic effect. Shivering may cause discomfort and unfavorable risks towards patients.This research aims to reveal the incidence and patient characteristics of post anesthetic shivering. This descriptive study involved post-operative patients in recovery room COT Dr. Hasan Sadikin General Hospital from August to October 2015 who fulfilled the inclusion criteria. Medical records comprising complete post-operative patients’ data were used as secondary data source for this study. Among 639 patients, shivering omLurred in 169 cases (26.45%). Post-anestheric shivering omLurred more in males (28.57%) and in pre elderly age. Proportion of post-anesthetic shivering patients was relatively same in patients who weregiven general anesthesia technique compared to regional anesthesia. Highest percentage omLurred in patients who underwent >2 hours of surgery (43.75%) and administered ≥1500 mL of intravenous (IV) fluids (44.69%). Postanesthetic shivering omLurred the most to neurosurgery patients (66.67%). Post-anesthetic shivering incidence in this study is relatively high, particularly in males, pre elderly age, general, longer operation duration, more administration of (IV) fluids and neurosurgery patients. Key words: Characteristics, postanesthetic shivering, prevalence, recovery room
Fluid Management in Pediatric Craniotomy Fuadi, Iwan; Pison, Osmond Muvtilof; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
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Advances in pediatric neurosurgery techniques have dramatically improved the outcome in infants and children with surgical lesions of the central nervous system. However, the physiologic and developmental differences inherent in pediatric patients present challenges to neurosurgeons and anesthesiologists alike. Fluid management is critically important in pediatric craniotomy. Hemodynamic stability during intracranial surgery requires the careful maintenance of intravascular volume and electrolytes. It is imperative to secure excellent intravenous access for fluid and blood replacement and drug delivery before the start of the operation. Lack of intake or active vomiting because of changes in the ICP, preoperative fluid restriction and diuretic therapy may lead to blood pressure instability and even cardiovascular collapse if sudden blood loss occurs. Normovolemia should be maintained throughout the procedure. Normal saline used as the maintenance fluid during neurosurgery because it’s mildly hyperosmolar and should minimize cerebral edema. Maintenance rate of fluid administration depends on the weight of the patient. The maximum allowable blood loss should be determined in advance. Hyperglycemia is always best avoided because it may exacerbate neurologic injury. Fluid management in neurosurgical cases is extremely important and requires good communication between the surgeon and anesthesiologist. Especially for infants and children because of the difference in the anatomy and physiology at various stages of growth and development. The anesthesiologist must be fully cognizant of these differences in order to conduct a safe anesthetic plan.
Efektivitas Penambahan Sufentanil 10 mg pada Anestesi Epidural 15 mL Levobupivakain 0,5% untuk Tindakan Operasi Ekstremitas Bawah Werda Laksana, Ngurah Putu; , Zulkifli; Harimin, Kusuma; , Theodorus
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Walaupun memiliki profil keamanan yang lebih baik daripada racemic, levobupivakain tetap memiliki mula kerja lambat dan lama kerja terbatas. Kombinasi opioid lipofilik sufentanil-levobupivakain akan memberikan efek sinergistik sehingga memperbaiki kekurangan tersebut, tetapi masih sedikit penelitian yang menilai kombinasi ini. Tujuan penelitian ini adalah untuk menilai efektivitas penambahan sufentanil 10 μg pada anestesi epidural levobupivakain 0,5% 15 mL dalam hal mula dan lama kerja blokade sensorik-motorik. Uji klinik randomized control trial (RCT) telah dilakukan terhadap 44 pasien (dibagi 2 kelompok; kelompok I (sufentanil 10 μg), kelompok II (2 mL NaCl 0,9%)) yang menjalani operasi ekstremitas bawah dengan anestesi epidural levobupivakain 0,5% di RSUP Dr. Mohammad Hoesin Palembang dari bulan Mei–Agustus 2013 yang memenuhi kriteria inklusi. Dilakukan penelitian terhadap mula, lama kerja blokade sensorik-motorik. Analisis data menggunakan SPSS® versi 20.0. Mula dan lama kerja blokade sensorik kelompok sufentanil secara statistik lebih bermakna daripada kelompok NaCl (p<0,001), sedangkan mula dan lama kerja blokade motorik tidak memiliki perbedaan bermakna secara statistik. Penambahan sufentanil 10 μg pada anestesi epidural levobupivakain 0,5% 15 mL mempercepat mula dan memperpanjang durasi kerja blokade sensorik. Kata kunci: Anestesi epidural, levobupivakain, sufentanil Although levobupivacaine has better safety profile than racemic bupivacaine, it has a slow onset of action and limited blockade duration. Combination of lipophilic opioid sufentanil-levobupivakain will provide synergetic effects that improve the shortcomings, but lack of research to support this. The aim of this study is to evaluate the efficacy of additional 10 μg sufentanyl to 15 mL 0.5% levobupivacaine epidural anesthesia toward sensory-motoric blockade onset and duration. Randomized controlled trials double blind study (RCT) has been conducted to 44 patients (divided into 2 groups : group I (sufentanil 10 μg), group II (2 mL NaCl0.9%)) underwent lower extremity surgery with epidural anesthesia 15 mL 0,5% levobupivakain in Dr. Mohammad Hoesin central hospital from May–August 2013 that met inclussion criteria. Onset and duration of action sensory-motoric blockade were studied. Data analysis using SPSS® version 2.0. The onset and the duration of sensory blockade in sufentanil group is statistically significant than NaCl group (p<0.001). However the onset and duration of motoric blockade are not statistically significant. The addition of 10 μg sufentanil to 15 mL of 0.5% levobupivacaine epidural anesthesia hasten the onset and prolong the duration of sensory blockade. Key words: Epidural anesthesia, levobupivacaine, sufentanyl Reference Bajwa SJS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: a systematic review. J Anaesth Clin Pharmaco. 2013;29:530–9. Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Therapeutics and Clinical Risk Management. 2008;4(2):381–92. Casimiro C, Rodrigo J, Mendiola MA, Rey F, Barrios A, Gilsanz F. dkk. Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgery. Minerva Anestesiol. 2008;74:381–91. Liu SS, Lin Y. Local Anesthetics. Dalam: Barash PG, Cullen, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, penyunting. Clinical anesthesia. Edisi ke-6. Philadelphia: Lippincott Williams & Wilkins; 2009. hlm. 531–48. Leone S, Cianni SD, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92–105. Khangure N. Adjuvant agents in neuroaxial blockade [document on the internet]. Western Australia: World Federation of Societies of Anaesthesiologist; 2011 [diperbarui tanggal 2011 July 4; diunduh 1 Februari 2013]. Tersedia dari: http://www.totw. anaesthesiologists.org. Kaur M. Adjuvants to local anesthetics: a combination wisdom. Anesth Essays Res. 2010:4;122–3. Christiansson L. Update on adjuvants in regional anaesthesia. Periodicum Biologorum. 2009;111:161–70. Yeerdaoolaiti Y, Long W, Jian-Hua DU. Clinical effect of sufentanil combined with ropivacaine used in epidural anesthesia for abdominal hysterectomy. Modern Preventive Medicine. 2011;19:4096–103. Bachman-Mennenga B, Veit G, Stenicke B, Biscoping J, Heesen M. Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for caesarean section. Acta Anaesthesiol Scand. 2005;49:532–7. Bachman-Mennenga B, Veit G, Biscoping J, Stenicke B, Heesen M. Epidural ropivacaine 1% with and without sufentanil addition for caesarean section. Acta Anaesthesiol Scand. 2005;49:525–31. Prabowo RSE. Pengaruh penambahan fentanil 1,5 μg.kg1 pada ropivakain 0,75% terhadap mula dan lama kerja blokade anestesi epidural untuk operasi ekstermitas bawah. Dokter Spesialis Anestesi [Tesis]. Bandung: Universitas Padjajaran; 2004. Macres SM, Moore PG, Fishman SM. Acute pain management. Dalam: Barash PG, Cullen, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, penyunting. Clinical anesthesia Edisi ke-6. Philadelphia: Lippincott Williams & Wilkins; 2009. hlm. 1473–1504. NYSORA. Epidural Blockade [document on the internet]. New York: New York School of Regional Anesthesia; 2009 [diperbarui tanggal 2009 January 3; diunduh 1 Februari 2013]. Tersedia dari http://www.nysora.com. Pain Community Centre. Epidural: the mode of action of local anaesthetics and opioids in the epidural. Wales: Cardiff University; 2012[diunduh 1 Februari 2013]. Tersedia dari: http://www.paincommunitycentre.org. Vora KS, Shah VR, Patel B, Parikh GP, Butala BP. Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination. J Anaesth Clin Pharmaco. 2012;28:491–5. Visser WA, Lee RA, Gielen MJM. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Intern Anesth Research Soc. 2008;107(2):708–21. Staahl C, Olesen AE, Andreses T, Arendt- Nielsen L, Drewes AM. Assesing analgesic actions of opioids by experimental pain models in healthy volunteers-an updated review. Bri J Clin Pharmaco.2009;68(2):49–68. George MJ. The site of action of epidurally administered opioids and its relevance to postoperative paint management. Anaesthesia. 2006;61:659–64. Veering BT, Cousins MJ. Epidural neural blockade. Dalam: Cousins MJ, Bridenbaugh PO, penyunting. Neural blockade in clinical anesthesia and management of pain Edisi ke-4. Philadelphia: Lippincott–Raven Publishers; 2008. hlm. 241–95.
Correction Hypocalemic Patients with Potassium Chloride in ICU of Dr. Hasan Sadikin Hospital Bandung in Januari–Februari 2014 Hidayat, Dede A; Fuadi, Iwan; Sitanggang, Ruli H.
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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Hypokalemia (Potassium plasma level <3.5 mEq/L) is the most common electrolyte imbalance found in the intensive care unit (ICU). Major etiologies of hypokalemia in ICU setting were related to low intake, gastro intestinal tract (GIT) disturbance, renal impairment, diuretic administration, insulin therapy and severe infection, which ranging from asymptomatic to the most severe symptom and causing death.This prospective observational study was conducted in the ICU of Dr. Hasan Sadikin Hospital Bandung from January to February 2014 with result 33 out of 105 admitted patients (31.4%) suffered from hypokalemia.From our observation, there was 17 patients (51.5%) with mild hypokalemia, 13 patients (39.4%) with moderate hypokalemia and 3 patients (9.1%) with severe hypokalemia. Correction with intravenous potassium chloride was given with improvement in 9 patients (53%) in mild hypokalemia group, 3 patients (23.1%) in moderate hypokalemia group but unfortunately no significant change was found in severe hypokalemia group after the correction. Complications were found mostly in geriatric patients with severe hypokalemia.The conclusion of this study is that from all patients admitted to the ICU of Dr. Hasan Sadikin Hospital Bandung from January ̶ February 2014, the incidence of hypokalemia was 31.3% (33 patients) with improvement occurred in 12 patients (36.4%) but 21 patients (63%) revealed no improvement after potassium chloride correction with worsening condition.
Perbandingan Trapezius Squeezing Test dan Jaw Thrust Sebagai Indikator Kedalaman Anestesia pada Pemasangan Sungkup Laring Hidayat, Jefferson; Sugiarto, Adhrie; Alatas, Anas
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
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Manajemen jalan napas merupakan salah satu aspek penting dalam anestesiologi. Salah satu jenis alat bantu jalannafas yang sering digunakan adalah Laringeal Mask Airway (LMA/sungkup laring). Pemasangan sungkup laringtanpa pelumpuh otot membutuhkan kedalaman anestesi yang cukup. Trapezius squeezing test dan jaw thrustadalah dua uji klinis sederhana yang digunakan untuk menguji kedalaman anestesia. Penelitian ini bertujuan untukmembandingkan trapezius squeezing test dan jaw thrust sebagai indikator klinis menilai kedalaman anestesi padapemasangan sungkup laring dengan induksi anestesia menggunakan propofol. Sebanyak 128 pasien dirandomisasimenjadi dua kelompok yaitu kelompok 1 (kelompok jaw thrust) dan kelompok 2 (kelompok trapezius squeezingtest). Setelah premedikasi dengan midazolam 0,05 mg/kgBB dan fentanil 1 μg/kgBB, untuk induksi anestesiadiberikan propofol dosis titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saatrespon motorik dari manuver hilang dilakukan pemasangan sungkup laring. Keberhasilan pemasangan padakelompok 1 dan 2 adalah 93,8% vs. 90,6% (p >0,05). Rata-rata penggunaan propofol pada kelompok 1 sebesar120,34 mg dan kelompok 2 sebesar 111,86 mg (p > 0.05). Pada kelompok 1 apnea dijumpai pada 10 pasien(15.6%) sedangkan pada kelompok 2 sebanyak 11 pasien (17.2%). Trapezius squeezing test sama baiknya denganjaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring. Kata Kunci: Jaw thrust, kedalaman anestesia, propofol, sungkup laring, trapezius squeezing test Airway management remains as one of the most important aspect in anesthesiology. Laryngeal Mask Airway(LMA) has been widely used as an airway device. Laryngeal mask insertion without muscle relaxant facilitationrequires an adequate anesthesia level. The purpose of this study was to compare trapezius squeezing test andjaw thrust maneuver as an indicator of anesthesia depth for laryngeal mask insertion, with propofol as inductionagent. There were 128 subjects who had been randomized into two groups: Group 1 (jaw thrust group) andGroup 2 (trapezius squeezing test group). All subjects received midazolam 0.05 mg/kg and fentanyl 1 μg/kg aspremedication. Propofol with titrated dose were used for anesthesia induction. Jaw thrust or trapezius squeezingtest maneuver were performed every 15 seconds in each group. When motoric responses were lost after maneuver,LMA was inserted. Succesfull LMA insertion were found in 93,8% patients (Group1) and 90,6% (Group 2) withp >0,05. Mean propofol consumptions were 120.34 mg in Group 1 and 111,86 mg in Group 2. Apnea was found in10 patients (15,6%) in Group 1 and 11 patients (17.2%) in Group 2. Trapezius squeezing test was as good as jawthrust maneuver as an adequate depth of anesthesia indicator for laryngeal mask insertion. Keywords: Departement of anesthesia, jaw thrust, laryngeal mask, propofol, trapezius squeezing test Reference Sood J. Laryngeal mask airway and its variants. Indian J Anaesth 2005;49(4):275–0. Verghese C, Berlet J, Kapila A, Pollard R. Clinical assessment of single use laryngeal mask airway the LMA Unique. Br J Anaesth 2006:80;677–9. Easley EH. The laryngeal mask airway: a review and update. J Clin Anaesth. 2005:16; 114–23. Cook TM. The classic laryngeal mask airway: a tried and tested airway. Br J Anaesth 2006; 96(2):149–52. Cressey DM, Claydon P, Bhaskaran NC, Reilly CS. Effect of midazolam pretreatment on induction dose requirement of propofol in combination with fentanyl in younger and older adult. Anaesth 2011;56:108–13. Towsend R. Jaw thrust as a predictor of insertion conditions for the proseal laryngeal mask airway. Anaesth 2009;20(1):59–62. Krishnappa S. Optimal anaesthetic depth for LMA insertion. Indian J Anaesth 2011;55(5): 504–7. Chang C. Comparison of the trapezius squeezing test and jaw thrust as indicators for laryngeal mask airway insertion in adults. Korean J Anesth 2011;61(3):201–4. Peacock JE, Lewis RP, Reilly CS, Nimmo WS. Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients. Br J Anaesth 1990;65:346–52. Peacock JE, Spiers SP, Mclauchlan GA, Edmondson WC, Berthoud BM, Reilly CS. Infusion of propofol to identify smallest effective doses for induction of anaesthesia in Yong and elderly patients. Br J Anaesth 1992; Stokes DN, Hutton P. Rate dependent induction phenomena with propofol: Implications for the relative potency of intravenous anesthetics. Anesth Analg 1991; 72:578–83. Scanlon P, Carey M, Power M. Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone. Can J Anaesth 1993;40:816–8. Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivate as a tool for predicting the depth of sedation and anesthesia induced by sevoflurance. Anesthesiology 1998;88:642–50. Rudy N. Keefektifan trapezius squeezing test sebagai indicator kedalaman anesthesia saat pemasangan sungkup laring dihubungkan dengan bispectral index. Universitas Indonesia, 2012. Drage MP, Nunez J, Vaughn RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anesth 1996; 51: 11667–70. Chang C. Optimal condition for laringeal mask airway insertion in children can be determinate by the trapezius squeezing test. J Clin Anaesth 2008;20:99–102. Reves GJ, Peter S.A, David AL, et al. Intravenous nonopiod anesthetics. In Miller’s Anesthesia. 7th ed. Philadelpia: Churchill Livingstone, 2010. p. 318–25. Morgan GA, Mikhail MS. Nonvolatile anesthetic agents: Clinical Anesthesiology. 4th ed. New York : McGraw-Hill, 2006. p.179–203 Hillier SC. monitored anesthesia Care. In: Barash’s. Clincal anesthesia. 5th ed. Philadelphia: Lippincott William & Wilkins, 2006. p . 2576–607.
Ketepatan Rumus Peres dan Topografi Anatomi dalam Menentukan Prediksi Kedalaman CVC pada Pemasangan Subklavia Kanan Perdana, Aries; Pryambodho, Pryambodho; Kambey, Barry Immanuel
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
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Pemasangan kateter vena sentral (CVC) merupakan suatu tindakan yang cukup rutin dilakukan pada perawatan intensif maupun perioperatif. Diperlukan suatu metode atau rumus sederhana dan akurat untuk memperkirakan kedalaman kateter CVC yang tepat. Studi ini mengevaluasi posisi dan kedalaman kateter vena sentral dengan menggunakan rumus Peres ([tinggi badan/10]-2) dan pengukuran topografi anatomi, serta menilai insiden malposisi pada pemasangan CVC. Penelitian ini merupakan studi observasional analitik. Lima puluh pasien yang menjalani pemasangan kateter vena sentral (CVC) dengan pendekatan vena subklavia kanan dibagi ke dalam 2 kelompok yaitu kelompok Rumus Peres ([tinggi badan/10]-2) dan kelompok Pengukuran Topografi Anatomi.Hasil perhitungan prediksi dipakai untuk menentukan batas fiksasi kulit. Kedalaman CVC dievaluasi dengan mengukur jarak antara ujung distal kateter CVC dengan karina pada radiografi dada. Hasil pengukuran tersebut dianalisis dengan uji statistik Bland Altman. Pada kelompok Rumus Peres, rerata jarak antara karina dengan ujung distal kateter CVC adalah sebesar 1,5 cm dibawah karina (IC 95% 1,2 sampai 1,9 cm), limit agreement 0,0 sampai 3,0 cm. Rerata jarak pada kelompok pengukuran topografi anatomi sebesar 0,85 cm (IC 95% 0,5 sampai 1,1 cm) limit of agreement -0,5 sampai 2,2 cm. Pada penelitian ini insiden malposisi ditemukan sama pada kedua kelompok(masing-masing 3 insiden). Rumus Peres dan Pengukuran Topografi Anatomi tidak tepat dalam memprediksi kedalaman kateter CVC pada orang Indonesia. Kata kunci: Kateter vena sentral (CVC), subklavia kanan, metode prediksi, rumus Peres, topografi anatomi The AmLuracy of Peres formula and Landmark Technique to Predict the Depth of Central Venous Catheter with Right Subclavian Vein ApproachCentral venous catheter (CVC) insertion is a routine procedure in intensive care and perioperative care. Simple and amLurate method is needed to predict the optimal depth of CVC. This study evaluated the position and depth of central venous catheters by Peres formula ([height/10] -2) and Landmark measurement, and also assessed the incidence CVC insertion malposition. This was an analytic observational study. Fifty patients undergoing central venous catheter (CVC) with the right subclavian vein approach was divided into two groups: Formula Peres ([height / 10] -2) and Anatomy Topography Measurement group. The calculation result was used to determine the boundary prediction of skin fixation. CVC depth was evaluated by measuring the distance between the distal end of the CVC catheter with karina on chest radiographs. The measurement results were analyzed by statistical tests Bland Altman. In Peres Group, the mean of the distal CVC was 1,5 (0,82) cm under carina (IC 95% 1,2 to 1,9 cm), with the limit of agreement 0,0 cm to 3,0 cm. The mean of landmark groups was 0,85 (0,73) cm (IC 95% 0,5 to 1,1 cm) with limit of agreement -0.5 cm to 2,2 cm. The incidence of malposition was found similar in both groups. Both prediction methods were not amLurate to predict the depth of CVC insertion in Indonesian people. Key words: Central venous catheter (CVC), right subclavian, prediction methods, Peres formula, landmarks
Indeks Cadangan Oksigen Sucandra, I Made Agus Kresna
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
Publisher : Perdatin Pusat

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Pulse oximetry (PO) telah dipergunakan secara luas untuk pemantauan oksigenasi pada pasien terutama pasien dengan sakit kritis. Dengan memberikan peringatan lebih awal kepada klinisi terhadap hipoksemia, PO memberikan kesempatan tata laksana lebih cepat terhadap hipoksemia yang berat dan kemungkinan komplikasi yang menyertai. Perkembangan terbaru dari analisis signal dan teknologi reflektan meningkatkan kinerja PO pada keadaan adanya artefak gerakan dan perfusi yang rendah. Oximeter dengan panjang gelombang multipel juga terbukti berguna dalam mendeteksi dishemoglobinemia. Keuntungan lain dari oximeter panjang gelombang multipel ini adalah adanya fitur oxygen reserve index (ORI). ORI merupakan indikator relatif dari PaO2 pada rentang 100–200 mmHg. Penambahan pemantauan ini pada PO membuka peluang baru untuk pemantauan status oksigenasi yang kontinu dan non-invasif pada pasien yang mendapatkan terapi oksigen. ORI berpotensi memberikan kontrol yang lebih baik pada saat dilakukan preoksigenasi, memberikan peringatan terjadinya penurunan oksigenasi sebelum terjadi penurunan SpO2, memungkinkan titrasi oksigen yang lebih akurat, mengidentifikasi terjadinya hiperoksia dan memberikan informasi terhadap perubahan status oksigen pada rentang PaO2 100–200. Diperlukan penelitian lebih lanjut untuk melihat potensi fungsi lebih luas dari ORI untuk tatalaksana pasien sakit kritis yang memerlukan suplementasi oksigen. Kata kunci: Multiple wavelength, oxygen reserve index, pulse oximetry   Oxygen Reserve Index Pulse oximetry (PO) is ubiquitously used for monitoring oxygenation in the critical care setting. By forewarning the clinicians about the presence of hypoxemia, pulse oximeters may lead to a quicker treatment of serious hypoxemia and possibly circumvent serious complications. Recent advances in signal analysis and reflectance technology improved the performance of pulse oximetry under conditions of motion artifact and low perfusion. Multiple wavelength oximetry may prove to be useful in detecting dyshemoglobinemia. Another benefitial value of this newer multiwavelength oximetry is the feature of oxygen reserve index (ORI). The ORI is a relative indicator of the PaO 2 in the range of 100–200mmHg. Its addition to conventional pulse oximetry opens new opportunities in the continuous, non-invasive monitoring of the oxygenation status of patients who receiving oxygen. The ORI may potentially allow better control of pre-oxygenation, provide an alarm of decreasing oxygenation, before any decrease in SpO2, allow a more adequate titration of oxygen therapy, identify unintended hyperoxia, and provide information about changes in the oxygenation status in the PaO 2 range of 100–200mmHg. Further studies are needed to determine the potential role of the ORI in the management of acutely ill patients who are in need of oxygen supplementation. Key words: Multiple wavelength, oxygen reserve index, pulse oximetry
Perbandingan Kadar Kortisol dan Efek Analgesia Pascabedah Anestesi Spinal Kombinasi Bupivakain Hiperbarik 0,5% 8 mg dan Klonidin 30 μg dengan Bupivakain Hiperbarik 0,5% 8 mg dan Morfin 0,1 mg pada Pasien yang Menjalani Prosedur Seksio Sesaria Irawan, Hery; , Wahyudi; , Hisbullah
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Penurunan hormon kortisol pada masa intraoperatif dapat terjadi dengan menggunakan mekanisme penghambatan pada sistem saraf pusat. Anestesi spinal merupakan pilihan dalam mekanisme tersebut. Penelitian bertujuan untuk membandingkan kadar kortisol dan efek analgesia pascabedah pada anestesi spinal kombinasi Bupivakain hiperbarik 0,5% 8 mg+Klonidin 30 μg dan Bupivakain hiperbarik 0,5% 8 mg + morfin 0,1 mg pada seksio sesarea. Penelitian menggunakan uji klinis acak tersamar tunggal pada 50 pasien dengan kriteria inklusi, dibagi menjadi kelompok anestesi spinal kombinasi Bupivakain hiperbarik 0,5% 8 mg + Klonidin 30 μg (BK) n=25 dan kelompok kombinasi Bupivakain hiperbarik 0,5% 8 mg + morfin 0,1 mg (BM) n=25. Analisis statistik dengan Uji Mann-whitney dan uji-tes, dengan p<0,05 bermakna secara signifikan. Hasil penelitian menunjukkan pada kelompok BM sama efektif dengan kelompok BK dalam mencegah peningkatan kadar kortisol intraoperatif. Efek analgesia pascabedah anestesi spinal kombinasi kelompok BM lebih baik dibandingkan dengan kombinasi BK. Efek samping diantara kedua kelompok dinyatakan tidak bermakna. Kesimpulan penelitian adalah kelompok BM sama efektif dengan kelompok BK dalam mencegah peningkatan kadar kortisol saat pembedahann namun e fek analgesia pascabedah anestesi spinal kombinasi kelompok BM lebih baik dibandingkan dengan kombinasi BK. Kata kunci: Anestesi spinal, kortisol, klonidin, morfin, seksio sesarea The decrease of cortisol hormone level during intraoperative period may occur due to inhibitory mechanism on central nervous system. Spinal anesthesia is an option to prevent the proccess. This study aimed to compare cortisol hormone level and postoperative analgesia between spinal anesthesia combination of 0.5% hyperbaric Bupivacaine 8 mg and Clonidine 30 μg + hyperbaric 0.5 % Bupivacaine 8 mg + 0.1 mg morphine in cesarean section. The study was a single-blind randomized clinical trial in 50 patients with inclusion criteria, divided into BK group (a combination of 0.5 % Hyperbaric Bupivacaine 8 mg + 30 mg Clonidine; n=25) and BM group (a combination of 0.5 % hyperbaric Bupivacaine 8 mg + morphine 0.1 mg; n=25). Statistically analyzed using Mann-Whitney Test and t-test, with p<0.05 statistically significance. Research shows that BM group as effective as BK group in preventing the increase of cortisol level. Effect of postoperative analgesia in group BM was better than group BK. Side effects between the two groups revealed no significant difference. The conclusion of this study group BM as effective as group BK in preventing the increase of cortisol level during surgery. However, effect of postoperative analgesia in group BM was better than group BK.Key words: Cortisol, caesarean section, clonidin, morphin, spinal anesthesia. Reference Hurley RW, Wu CL. Acute post operative pain. dalam: Miller RD, Eriksson LI, Fleisher LA, Wiener JP, Young WL, penyunting. Miller’s anesthesia. Edisi ke-7. Philadelphia: Elsevier Churchill Livingstone; 2008. hlm. 321–33. Paech MJ. Anesthesia for cesarean delivery. Dalam: Palmer CM, D’Angelo R, Paech MJ, penyunting. Obstetric anesthesia. New York: Oxford University Press; 2011. hlm.79–155. Ahmad MR, Marwoto. Pengelolaan nyeri pasca seksio sesaria. Dalam: Bisri T, Wahjoeningsih S, Suryono B, penyunting. Anestesi Obstetri. Bandung: Saga Olahcitra; 2013. hlm. 301–12. Persec J, Persec Z, Zinovic H. Post operative pain and systemic inflammatory stress response after preoperative analgesia with clonidine or levobupivacaine: a randomized controlled trial. Br J Anesth. 2009;121(17–18):558–3. Bhure A, Kalita N, Ingley D, Gadkari CP. Comparative study of intrathecal hyperbaric Bupivakaine with clonidine, fentanyl and midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section. People J of Sci Research. 2012; 5(1):19–23. Bhushan SB, Suresh JS, Vinayak SR, Lakhe JN. Comparison of different doses of clonidine as an adjuvant to intrathecal Bupivakaine for spinal anesthesia and postoperative analgesia in patients undergoing caesarian section. Anaesth, Pain Intens Care. 2012;16(3):266– 72. Pongpit P. Comparison postoperative analgesic efficacy of intrathecal morphine and without intrathecal morphine in patients who underwent cesarean section with spinal anesthesia in Nakhonphanom hospital: a rectrospective observational analitycal study. Yasothon Med Jr. 2014;14(2):1–3. Rochette A, Raux O, Troncin R, Dadure C, Verdier R, Capdevila X. Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging study. Anesth Analg. 2004;98: 56–9. Kwan JW. Use of infusion devices for epidural or intrathecal administration of spinal opioids. Am J Hosp Pharm 2008;47:18–23. Tanra, AH. Nyeri pascabedah implikasi sensitisasi perifer dan sentral. Dalam: makalah simposium pengelolaan nyeri. Jakarta. 2004. Prasetyo AH. Efek klonidin sebagai ajuvan anestesi spinal terhadap hormon stress [Tesis]. Surakarta; 2011. Cianni S, Rossi M, Casta A. Spinal anesthesia: an evergreen technique. Acta Biomed. 2008; 79:9–17. Vercauteren M. Analgesia after Caesarean section: are neuraxial techniques outdated?. Jr Român de Anestezie Terapie Intensivã 2009;16(2):129–133. Kirsten M, Laura M. Bohn. Mu opiod receptor regulation and opiate responsiveness. The AAPS Journal. 2005;7(3):572–83. Tonner PH. Alpha2- adrenoceptor agonis in anaesthesia. Europ Anesth society. 2004; 35–40. Vercauteren M. Analgesia after Caesarean delivery in the 21st century. ESA Jr.2009 ;(13):1–2 Zhou H, Chen SR, Chen H, Pan HL. Opioidinduced long-term potentiation in the spinal cord is a pre synaptic event. J Neuro Sci. 2010; 30(12):4460–6. Miller RD, penyunting.Bupivakaine. Edisi ke-6. New York: Elsevier, Churchill Livingstone; 2006. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005; 101:62–9. Christiansson L. Update on adjuvant in regional anesthesia. Period boil. 2009; 111(2): 161–70.
Luas Kolaps Paru pada Anestesia Umum dengan Penilaian Electrical Impedance Tomography Durasi Kurang dari 2 Jam dan Lebih dari 2 Jam chandra, Susilo; Nashella, Nazalia; Harijanto, Eddy; , Rahendra
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Anestesia dan pembedahan dapat menyebabkan atelektasis intraoperasi, penurunan volume paru dan atelektasis akan menyebabkan komplikasi paru pascaoperasi. Electrical impedance tomography (EIT) merupakan alat pencitraan noninvasif untuk menilai distribusi ventilasi paru. Tujuan penelitian ini adalah untuk membandingkan luas kolaps paru yang terjadi pada anestesia umum dengan durasi kurang dari 2 jam dan lebih dari 2 jam dengan menggunakan EIT dan algoritma Costa dkk, dengan sebelumnya menghilangkan faktor komorbid dan faktor prediktor yang lain. Penelitian ini merupakan uji klinis prospektif yang dilakukan di RSCM Kirana selama bulan Maret sampai Mei 2013 pada 42 pasien dewasa usia 18–59 tahun, ASA 1–2 dan IMT <30 kg/m2 yang menjalani operasi mata elektif dengan anestesia umum. Pengamatan dilakukan selama operasi dengan menggunakan EIT. Pasien dibagi ke dalam dua kelompok berdasarkan durasi anestesia lebih dari 2 jam dan kurang dari 2 jam. Dilakukan pengukuran variasi tidal regional, volume tidal, peak inspiratori presure ,dan positive end-expiratory pressure. Hasil pengukuran dihitung sesuai algoritme Costa dkk untuk mencari luas kolaps yang terjadi. Pada kelompok anestesia umum dengan durasi lebih dari 2 jam didapatkan luas kolaps 16,83±8,47 % dan pada durasi kurang dari 2 jam didapatkan luas kolaps 16,16±11,93 % (p>0,05). Tidak terdapat perbedaan bermakna antara luas kolaps yang terjadi pada anestesia umum dengan durasi lebih dari 2 jam dan kurang dari 2 jam. Kata kunci: Electrical impedance tomography, kolaps paru, komplikasi paru pascaoperasi Anesthesia and surgery can cause intraoperative atelectasis, whereas decreased lung volume, and atelectasis can lead to postoperative pulmonary complications. Electrical impedance tomography (EIT) is a noninvasive imaging to assess lung distribution of ventilation. The aim of this study was to compare lung collapse in patients without co morbid and other predictor of PPCs that undergone general anesthesia with duration more than 2 hours and less than 2 hours using EIT and Costa algorithm. This study was a prospective clinical trial conducted in RSCM Kirana during March to May 2013 on 42 patients aged 18–59 years, physical status ASA 1–2, and BMI < 30 kg/m2 underwent elective eye surgery under general anesthesia. The EIT was used intraoperatively. At the end of anesthesia, the patients were divided into two groups based on the duration of anesthesia more than 2 hours and less than 2 hours. The regional tidal variation, tidal volume, peak inspiratory pressure, and positive end-expiratory pressure were observed then. Costa algorithm was used to calculate the lung collapse. In duration of anesthesia more than 2 hours group the lung collapse was 16,83 ± 8,47 %. In duration of anesthesia less than 2 hours group the lung collapse was 16,16±11,93 % (p>0,05). There was no significant difference between lung collapse in anesthesia duration more than 2 hours and less than 2 hours group. Key words: Electrical impedance tomography, lung collapse, postoperative pulmonary complications Reference Degani-Costa LH, Faresin SM, Falcao LF. Preoperative evaluation of the patient with pulmonary disease. Brazilian J Anesthesiol. 2014;64:22–34. Hedenstierna G. Respiratory physiology. Dalam:Miller’s Anesthesia, edisi ke-7. Philadelphia: Churchill Livingstone Elsevier: 2010, hlm. 361-89. Tusmana G, Bohm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anesthesiol. 2012; 25: 1–10 Pelosi P, Gregoretti C. Perioperative respiratory Complications and the Postoperative qonsequences-atelectasis and risk factors. Euro Crit Care and Emerg Med 2009. Maceiras PR. Peri-Operative Atelectasis andAlveolar Recruitment Manoeuvres. ArchBronconeumol. 2010;46(6):317–324 Scholes RL, Browning L, Sztendur EM, Denehy L. Duration of anesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Austral J f Physiotherapy. 2009;55: 191–8. Sogame LCM, Vidotto MC, Jardim JR, Faresin SM. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008 Aug;109(2):222–7. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, dkk. Prediction of Postoperative Pulmonary Complications in a Populationbased Surgical Cohort. Anesthesiology 2010; 113(6):338–50. Talab HF, Zabani IA, Abdelrahman HS, Bukhari WL, Mamoun I, Ashour MA, Sadeq B, Sayed SIE. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoinglaparoscopic bariatric surgery. Anesth Analg. 2009; 109 (5): 1511–16. Reinius H, Jonnson L, Gustaffson S, Sundborn M, Duvernoy O, Pelosi P, dkk. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis–a computarized tomography study. Anesthesiology. 2009;111:979–87. Costa ELV, Borges JB, Melo A, Sipman FS, Junior CT, Bohm SH dkk. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedancetomography. Intens Care Med. 2009;35:1132–7. Moerer O, Hahn G, Quintel M. Lung impedance measurements to monitor alveolar ventilation. Curr Opin Crit Care. 2011;17:260–7. Blankman P, Gommers D. Lung monitoring at the bedside in mechanically ventilated patients. Curr Opin Crit Care 2012;18: 261–6. Muders T, Luepschen H, Putensen C. Impedance tomography as a new monitoring technique. Curr Opin Crit Care 2010; 16: 269–75. Stoelting RK, Hiller SC. The lungs. Dalam: Penyunting. Brown B, Murphy F. Pharmacology and physiology in anesthetic practice,edisi ke- 4. Philadelphia: Lippincott Williams and Wilkins; 2006, hlm. 771–82. Davison R, Cottle D. The effect of anesthesia on respiratory function. ATOTW. 2010

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