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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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Comparison of the Accuracy of Intraoperative Hemoglobin Measurement between Estimated Blood Loss and Point-of-Care Testing with Hematology Analyzer Soenarto, Ratna Farida; Nugroho, Alfan Mahdi; Fahmy, Ahmad Faishal
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Measurement of Estimated Blood Loss (EBL) based on the Allowable Blood Loss (ABL) formula with certain hemoglobin target is often used to guide intraoperative transfusion. Point of Care Testing (POCT) offers easier way to measure haemoglobin. This study aimed to compare the accuracy of the intraoperative hemoglobin measurement between EBL and POCT with Hematology Analyzer in the laboratory as the golden standard. This study used a Bland-Altman test on intraoperative hemoglobin measurement in 43 patients undergoing elective surgery, which were expected require blood transfusion in the Operating Theater of Cipto Mangunkusumo Hospital from December 2014 until March 2015. When EBL had reached ABL with Hb level target 7 g/dL before transfusion was given, blood was drawn for Hb measurement with Sysmex XE-2100® as Hematology Analyzer and HemoCue® Hb 201+ as POCT. Bland-Altman analysis of Hb EBL (7 g/dL) to Hb Hematology Analyzer with interval considered as accurate for Hb 7 g/dL was -1 to 1, revealed wide limits of agreement (-2.267 to 2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealed narrow limits of agreement (-0418 to 0372). There was a significant difference in the accuracy of intraoperative hemoglobin measurement by EBL compared to Hematology Analyzer. Additionally, the measurement by POCT device had good accuracy.
Waktu Pulih Pasien Pascavitrektomi: Perbandingan antara Rumatan Kombinasi Sevofluran 1,2 Vol% - Fentanil 1,2 Mcg/Kg/Jam dengan Rumatan Sevofluran 2 Vol% Marsaban, Arif HM.; Kapuangan, Christopher; Andria, Krisna
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
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Waktu pulih yang cepat dan lancar telah menjadi kebutuhan yang penting bagi unit pembedahan, khususnya bagi unit yang  memiliki beban jadwal operasi yang  banyak. Kecepatan waktu pulih diperlukan untuk meningkatkan turn-over-rate unit tersebut. Efek sinergis kombinasi opioid dan gas anestesi telah digunakan secara umum untuk mempertahankan kedalaman anestesia intraoperatif. Hanya saja tidak terlalu banyak data mengenai waktu pulih kombinasi opioid dan gas inhalasi, khususnya kombinasi sevofluran-fentanil.   Penelitian ini bertujuan untuk mengetahui perbedaan waktu pulih antara rumatan kombinasi sevofluran 1,2 vol% - fentanil 1,2 mcg/kg/jam dengan rumatan sevofluran 2 vol%. Penelitian ini merupakan uji klinis acak tersamar tunggal terhadap pasien yang menjalani operasi elektif vitrektomi di Rumah Sakit Cipto Mangunkusumo periode bulan Mei–Juli 2015 sebanyak 30 sampel subjek penelitian diambil dengan metode konsekutif. Waktu pulih pascaoperasi dicatat dan data waktu pulih dianalisis dengan uji independent sample t-test. Waktu pulih antara rumatan kombinasi sevofluran 1,2 vol%-fentanil 1,2 mcg/kg/jam dengan rumatan sevofluran 2 vol% memiliki perbedaan yang signifikan (p<0,005 kombinasi rumatan sevofluran 1,2 vol%-fentanil 1,2 mcg/kg/jam memiliki waktu pulih (6,47±1,727 detik) yang lebih singkat dibanding dengan rumatan sevofluran 2 vol% (11,87±1,846 detik). Waktu pulih pascavitrektomi pada kelompok rumatan kombinasi sevofluran 1,2 vol%-fentanil 1,2 mcg/kg/jam lebih singkat secara bermakna dari pada waktu pulih pada kelompok rumatan sevofluran 2 vol%. Kata Kunci: Fentanil, paskavitrektomi, sevofluran, waktu pulih   Postvitrectomy Recovery Time: The Comparison between Combination of Sevoflurane 1,2% - Fentanyl 1,2 mcg/kg/hour Maintenance and Sevofluran 2 vol% as Maintenance A fast and smooth anesthesia recovery time is desiredin  surgical units, especially in units with tight operation schedules. Faster recovery time creates  a high turn over rate. Opioid – volatile anesthetic combination has been used widely to maintain the depth of anesthesia because of their synergistic effect. But there was lack of data about recovery time of opioid-inhalation combination maintenance, particularly sevoflurane-fentanyl combination, whereas sevofluran and fentanyl has been used widely in anesthesia practice. The study aimed to compare the recovery time between combination of sevoflurane 1.2 vol% - fentanyl 1.2 mcg/kg/hour maintenance and sevoflurane 2 vol% maintenance. Methods. This was a single blind randomized study in patients underwentvitrectomy at Cipto Mangunkusumo hospital between May and July 2015. A total of 30 subjects were included in this study. The recovery time after surgery was recorded. Data was analyzed by independent sample t-test. There was a significant difference of recovery time between combination of sevoflurane 1.2 vol% - fentanyl 1.2 mcg/kg/hour as maintenance (6.47±1.727 seconds) and sevoflurane 2 vol% as maintenance (11.87±1.846 seconds)  (p<0.005. Postvitrectomy anesthesia recovery time was significantly faster in combination of sevoflurane 1,2 vol% - fentanyl 1,2 mcg/kg/hour maintenance group compared tosevoflurane 2 vol% maintenance group. Key words: Fentanyl, postvitrectomy, recovery time, sevoflurane
Hubungan antara Klorheksidin 0,2% dan Povidone Iodine 1% dengan Ventilator-Associated Pneumonia (VAP): Studi Kohort Lestari, Mayang Indah; Puspita, Yusni; Zainal, Rizal; Theodorus, Theodorus
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
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Ventilator-associated pneumonia (VAP) adalah infeksi nosokomial tersering di ruang Intensive Care Unit (ICU) RSUP Dr. Moh. Hoesin (RSMH) Palembang, angka kejadiannya pada bulan Juli 2011–Juni 2012 cukup tinggi (31,69%) dengan angka mortalitas 54,7%. Mekanisme utama dalam patogenesis VAP ialah aspirasi bakteri gram positif dan negatif patogenik yang berkoloni di daerah orofaring. Tindakan modulasi kolonisasi tersebut sangat bermakna dalam mencegah VAP. Pemberian povidon iodin 1% dan klorheksidin 0,2% sudah sering dilakukan namun belum ada penelitian mengenai hubungannya terhadap kejadian VAP. Penelitian ini bertujuan untuk mengetahui hubungan antara klorheksidin 0,2% dan povidoneiodine 1% terhadap kejadian VAP. Studi kohort telah dilakukan di ICU RSMH pada bulan Februari – Juli 2014. Terdapat 32 subjek penelitian yang memenuhi kriteria inklusi dan dibagi menjadi dua kelompok, yaitu yang mendapatkan klorheksidin 0,2% dan povidoneiodine 1%. Dilakukan uji χ2 menggunakan statistical program and service solution (SPSS) versi 21.0. Karakteristik umum subjek penelitian yang meliputi usia, jenis kelamin, skor APACHE II, diagnosis, dan lama intubasi antara dua kelompok tidak menunjukkan perbedaan bermakna (p>0,05). Terdapat hubungan antara povidoneiodin 1% dan klorheksidin 0,2% terhadap kejadian VAP (RR 1,286) namun hubungan tersebut tidak bermakna (p=0,48). Kata kunci: Klorheksidin 0,2%, kolonisasi, orofaring, povidoneiodin 1%, ventilator associated pneumonia Relationship between Chlorhexidine 0.2% And Povidone Iodine 1% with Ventilator-Associated Pneumonia: Cohort Study Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care unit (ICU) in RSUP Dr. Moh. Hoesin (RSMH) Palembang, its incidence from July 2011 to June 2012 is quite high (31.69%) with mortality rate as high as 54.7%. Major mechanism in VAP pathogenesis is oropharygeal positive and negative pathogenic colonization aspiration. Colonization modulating intervention is signifantly important in VAP prevention. Povidoneiodine 1% and chlorhexidine 0.2% has been frequently used but there is no study yet about their correlation with VAP. This study was determined the correlation is between chlorhexidine 0.2% and povidone iodine 1% to VAP. Cohort study was conducted in ICU RSMH since February to July 2014. There was 32 subjects included and divided into two groups, chlorhexidine 0,2% and povidon iodine 1%. Analysis has been done with χ2 test by using SPSS® version 21.0. General characteristics among subjects in both groups including age, sex, APACHE II score on admission, diagnosis, and duration of intubation were not significantly different (p>0.05). There was a correlation between Povidoneiodine 1% and chlorhexidine 0.2% with VAP incidence (RR 1.286) but was not statistically significant (p=0.48).  Key words: Chlorhexidine 0.2%, colonization, oropharyngeal, povidon iodine 1%, ventilator-associated pneumonia
Perbandingan Efektivitas Salin Normal dengan Udara dalam Pengembangan Balon Pipa Endotracheal untuk Mengurangi Risiko Sakit Tenggorokan Pascaintubasi Adhriyani, Dessy; Harimin, Kusuma; Saleh, Irsan
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Membandingkan efektivitas penggunaan saline normal dan udara dalam pengembangan balon pipa endotrakeal untuk mengurangi risiko sakit tenggorokan pascaintubasi pada pasien yang mendapatkan anestesi umum inhalasi dan N2O. Penelitian ini merupakan uji klinik secara tersamar buta ganda terhadap 70 pasien dengan status fisik American society of anesthesiologist (ASA) I-II yang akan menjalani anestesi umum. Pasien dibagi dalam dua kelompok dengan jumlah masing-masing 35 pasien. Kelompok pertama menggunakan udara sebagai media pengembangan balon pipa endotrakeal, sedangkan kelompok kedua menggunakan saline normal. Rasa nyeri dinilai dengan mengunakan skala VAS. Hasil dari penelitian menunjukkan bahwa rata-rata tekanan balon pipa endotrakeal pada kelompok salin normal lebih rendah dibandingkan dengan kelompok media udara dimana rata-rata tekanan balon selama operasi pada kelompok salin normal 26,71±0,92 mmHg dengan rata-rata VAS adalah 0,91±1,29 cm sedangkan pada kelompok media udara 34,63±4,81 mmHg dengan rata-rata VAS adalah 2,37±1,190 cm (p<0,0001). Penggunaan salin normal lebih efektif dibandingkan dengan media udara dalam pengembangan cuff ETT untuk mengurangi risiko sakit tenggorokan pascaintubasi pada pasien yang mendapatkan anestesi umum inhalasi dan N2O. Kata kunci: Sakit Tenggorokan, salin normal, udara Comparison between The Effectiveness of Normal Saline and Air With The Expansion of Endotracheal Tube Cuff to Reduce The Risk of Sore Throat Postintubation To compare the effectiveness of using normal saline and air medium with the expansion of endotracheal tube cuff to reduce the risk of sore throat postintubation in patients under general anesthesia using N2O.Method. This study is a randomized controlled trial with double blind method. Total patients are 70, ASA I-II status with general anestesi. Patients divided into 2 groups, where each group composed of 35 patients. The first group will be using air as a media inflation of cuff ETT, and the second group uses normal saline. The pain is examined using VAS.The result shows that mean pressure of intracuff in normal saline group is lower than media air group where there is intracuff mean pressure undergoing surgery in normal saline group is 26,71±0,92 mmHg with VAS 0,91±1,29 cm but for media air group 34,63±4,81 mmHg with VAS 2,37±1,190 cm where p<0,0001.The using of normal saline is more effective compared to air medium in the expansion of ETT cuff to reduce the risk of sore throat postintubation in patients under general anesthesia using N2O. Key words: Air, normal saline, sore throat Dullenkopf A, Gerber AC, Weiss M. Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs. Acta Anaesthesiol Scand. 2004;48:1180–40. Morgan GE, Mikhail MS, Murray MJ. Airway management. Dalam: Clinical Anesthesiology. Edisi Ke-4. McGraw-Hill Companie. 2006. Hlm. 91–116. Fine GF, Borland LM. The future of the cuffed endotracheal tube. Pediatric Anesthesia. 2004;14: 38–42. Prerana P, Shroff, Vijay P. Efficacy of cuff inflation media to prevent postintubation related emergence phenomenon: air, saline and alkalinized lignocaine. Eur J Anaesthesiol. 2008;18:458–60. Nguyen H, Saidi N, Lieutaud T, Duvaldestin P. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89:187–90. Cerqueiera JR, Camacho LH, Takata IH. Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J/Rev Paul Med. 1999;117(6):243–7. Felten ML, Schmautz E, Orliaguet GA, Carli PA. Endotracheal tube cuff pressure 2003;97:1612–16. Karasawa F, Ozhima T, Takamatsu I, Uchihashi Y dkk. The effect on intracuff pressure of various nitrous oxide concentration used for inflating an endotracheal tube cuff. Anesth Analg. 2000;91:708–13. Karasawa F, Takita A, Mori T, Takamatsu I at all. The brandtm tube system attenuates the cuff deflationary phenomenon after anesthesia with nitrous oxide. Anesth Analg. 2003;96:606–10. Fitriyadi D, King LS. A simple endotracheal tube cuff pressure measuring device: an inexpensive alternative [Thesis]. Manilla: Santo Tomas University Hospital; 2004. Devys JM, Schauvliege F, Taylor G, Plaud B. Cuff compliance of pediatric and adult cuited tracheal tubes: an experimental study. Pediatric Anesthesia. 2004;14:676–80. Karasawa S, Okuda T, Mori T, Oshima T. Maintenance of stable cuff pressure in the Brandttm tracheal tube during anaesthesia with nitrous oxide. Br J Anaesth. 2002; 89(2):271–6. Fagan C, Frizelle HP, Laffey J, dkk. The effects of intracuff lidocaine on endotracheal-tubeinduced emergence phenomena after generalanesthesia. Anesth Analg. 2001;92:1075. Bennett MH, Isert PR, Cumming RG. Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff–a randomized controlled trial. Anaesth Intensive Care. 2000;28:408–13. Raeder JC, Borchgrevink PC, Sellevold OM. Tracheal tube cuff pressures. The effects of different gas mixtures. Anaesthesia. 1985;40:444–7. Karasawa F, Tokunaga M, Aramaki Y, saizukuisai M, Satoh T. An assassment of a method of inflating cuffs with nitrous oxide mixture to prevent on increase in intracuff pressure in five different tracheal tube designs. Anesthesia. 2001;56:155–9. Morgan GE, Mikhail MS, Murray MJ. The Practice of anesthesiology. Dalam: Clinical Anesthesiology.4th ed. McGraw-Hill Companies, Dalam;2006. Hlm. 1–9. Darsch JA, Darsch SE. Tracheal tubes. In: Understanding anesthesia equipment penyunting. edisi ke 4. Williams and Wilkins Pennsylvania; 1999. Hlm. 557–635. Combes X, Schauvliege F, Peyrouset O, etal. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001;95:1120–4. Mitchell V, Adams T, Calder I. Choice of cuff inflation medium during nitrous oxide anaesthesia. Anaesthesia. 1999; 54: 32–6. Hata TM, Moyers JR. Preoperative evaluation and management. Dalam: Barash PG, Cullen BF, Stoelting RK, penyunting. Clinical Anesthesia. Edisi ke-5. Lippincott Williams and Wilkins; 2006. Hlm. 475–9.
Perbandingan Kadar Prostaglandin-E2 (PGE2) Setelah Pemberian Metamizol Intravena dengan Parasetamol Intravena pada Pasien Cedera Otak Sedang sampai Berat dengan Demam Tandiarrang, Ajutor Donny; Arif, Syafri K.
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
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Metamizol intravena dan parasetamol intravena dapat menurunkan suhu tubuh pasien cedera otak sedang sampai berat dengan menghambat produksi PGE2 sebagai mediator demam. Penelitian ini bertujuan untuk membandingkan pemberian metamizol intravena dengan parasetamol intravena terhadap kadar PGE2 plasma dalam menurunkan suhu tubuh pasien cedera otak sedang sampai berat dengan demam. Sampel penelitian adalah 44 pasien cedera otak sedang sampai berat dengan demam, dibagi dalam 2 kelompok. Kelompok M (n=22) diberikan metamizol IV 15 mg/kgBB, sedangkan kelompok P (n=22) diberikan parasetamol 15 mg/kgBB. Analisis statistik dilakukan dengan Uji Mann U-Whitney dan Uji Pearson, dengan p<0,05 bermakna secara signifikan. Hasil penelitian menunjukkan bahwa terdapat penurunan suhu dan kadar PGE2 plasma yang bermakna pada kedua kelompok (p<0,05). Hasil Uji korelasi Person memperlihatkan bahwa semakin tinggi suhu semakin tinggi pula kadar PGE2 plasma. Metamizol intravena sama efektifnya dengan parasetamol dalam menurunkan suhu tubuh dan kadar PGE2 plasma pada pasien cedera otak sedang sampai berat dengan demam. Kata kunci: Cedera otak, kadar PGE2, metamizol, parasetamol, suhu Intravenous metamizol and paracetamol can lower body temperature on moderate to severe traumatic brain injury patients with fever by inhibiting the production of PGE2 as a mediator of fever. This study aims to compare the effect between intravenous metamizol and paracetamol on the PGE2 plasma level in lowering body temperature on moderate to severe traumatic brain injury patients with fever. The study samples consist of 44 severe to moderate traumatic brain injury patients with fever divided in 2 groups: M group (n=22) was given metamizol IV of 15 mg/BW body weight and P group (n=22) was given paracetamol of 15 mg/BW body weight. Statistically analyzed was using Mann U-Whitney Test and Pearson chi-square test with p<0,05 of statistical significance. Temperature and PGE2 plasma levels significantly decrease in both groups (p<0,05). The result of the Pearson correlation test shows that the higher the temperature the higher the PGE2 plasma level. Intravenous metamizol and paracetamol have proven effective to lower body temperature and PGE2 plasma levels of moderate to severe traumatic brain injury patients with fever. Key words: Metamizol, paracetamol, PGE2 level, temperature, traumatic brain injury Reference Ryan M, Levy MM. Clinical review: fever in intensive care unit patients. Crit Care. 2007: 221–5. Dimopoulos G, Falagas ME. Approach to the febrile patient in the ICU. Infect Dis Clin N Am 23. 2009:471–84. Kothari VM. New onset fever in the intensive care unit. JAPI. 2005;33:949–53. Thompson HJ, Kirknes CJ, Mitchell PH. Intensive care unit management of fever following traumatic brain injury. Intensive Crit Care Nurs. 2007;23(2):91–6. Fischer M, Lackner P, Beer R, Helbok R, Klien S,Ulmer H, dkk. Keep the brain coolendovascular cooling in patients with severe traumatic brain injury: A case series study. Neurosurgery. 2011;68(4): 867–73. Badjatia N. Fever management. Continuum. 2009:83–99. Mrozek S, Vardon F, Geeraerts T. Brain temperature: physiology ang pathophysiology after brain injury. Anesthesiology Research and Practice. 2012. Bisri T. Penanganan neuroanestesia dan critical care cedera otak traumatik. Edisi ke-3 Bandung: Saga Olahcitra; 2012. Marion DW. Controlled normothermia in neurologic intensive care. Crit Care Med. 2004; 32 Suppl2:43–5. Torbey MT, penyunting. Neurocritical Care. Cambridge: cambridge University Press; 2010. Protheroe RT, Gwinnutt CL. Early hospital care of severe traumatic brain injury. Anaesthesia. 2011;66 :1035–47. Davies AR. Hypothermia improves outcome from traumatic brain injury. Crit Care Resus. 2005;7:238–43. Masaoka H. Cerebral flow and metabolism during mild hypothermia in patients with severe traumatic brain injury. J Med Dent Sci. 2010;57:133–38. Żukowski M, Kotfis K. Safety of metamizol and paracetamol for acute pain treatment. Anaesthesiology Intensive Therapy 2009;(3):141–145. Porat R, Dinarello CA. Pathohysiology and treatment of fever in adults. UpToDate. 2004. Dalal S, Zhukowsky DS. Pathophysiology and management of fever. J Supp Onco. 2006;4(1):9–16. Blatteis CM. The onset of fever: new insights into its mechanism. Progress in Brain Research. 2007;2007;162: 3–14 Cruz P, Garutti I, Díaz S, Fernández-Quero L. Metamizol versus pracetamol: comparative study of the hemodynamic and antipyretic effects in critically ill patients. Rev Esp Anestesiol Reanim 2002;49(8):391–6. Gozzoli V, Treggiari MM, Kleger GR, Roux-Lombard P, Fathi M, Pichard C,dkk. Randomized trial of the effect of antipyresis by metamizol, propacetamol or external cooling on metabolism, hemodynamics and inflammatory response. Intensive Care Med .2004;30(3):401–7. Honarmand H, Abdollahi M, Ahmadi A, Javadi MR, Khoshayand MR, Tabeefar H, et all. Randomized trial of the effect of intravenous paracetamol on inflammatory biomarkers and outcome in febrile critically ill adults. Daru. 2012;20(1):1–9. Vera P, Zapata L, Gich I, Mancebo J, Betbese AJ. Hemodynamic and antipyretic effects of paracetamol, metamizol and dexketoprofen in critical patients. Med Intensiva. 2013. Aranoff DM, Neilson EG. Antipyreticcs: mechanisms of action and clinical use in fever suppression. Am J Med. 2001;111: 304–15. Ivandri, Arif SK, Ahmad MR, Patellongi I. Perbandingan efek kombinasi metamizolcooling blanket dengan parasetamol-cooling blanket dalam menurunkan demam pasien cedera kepala. Bagian Anestesiologi, Perawatan Intensif, dan Manajemen Nyeri
Penatalaksanaan Anestesi pada Operasi Seksio Caesarea Pasien G4p3a0 dengan Trombositopenia, Presentasi Bokong Murni dan Bayi Besar prabandari, dita; Erlangga, M. Erias
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
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Trombositopenia adalah penurunan jumlah trombosit dibawah normal. Umumnya terjadi pada 7 ̶ 8% kehamilan. Trombositopenia dapat terjadi pada beberapa kondisi, beberapa diantaranya adalah kehamilan. Trombositopenia merupakan kelainan hemotologis umum kedua setelah anemia pada kehamilan. Perdarahan pada kasus obstetri berperan besar terhadap kematian ibu, yaitu sekitar 127.000 kematian setiap tahun di dunia. Perdarahan post partum merupakan mayoritas penyebabnya dan penyebab umum dari perdarahan post partum adalah gangguan koagulasi dan koagulopati. Seorang wanita, G4P3A0 parturien aterm kala I fase aktif, trombositopenia, presentasi bokong murni, TBBJ >3.500 gr direncanakan seksio caesarea (SC). Hasil laboratorium didapatkan Trombosit 7.000 mm3. Pemeriksaan didapatkan ekimosis di keempat extremitas. Penatalaksanaan anestesi pada pasien ini dilakukan dalam anestesi umum. Kondisi pasien pasca operasi, tidak didapatkan defisit neurologis maupun perdarahan aktif. Setelah diobservasi di ruang pemulihan, pasien dipindahkan ke ruang perawatan. Kata kunci: Kehamilan, seksio caesaria, trombositopenia Trombositopenia is a term of decrease in platelet count below normal value. 7 ̶ 8% happens in pregnancy. Trombositopenia can happen in several conditions, one of them was pregnancy. Trombositopenia is a hemotologic disorder that commonly happen secondary after anemia in pregnancy. Hemorrhage in obstetri cases play major role in mother’s death, around 127,000 mother died each year. Post partum hemorrhage is the major cause and the general cause of post partum hemorrhage was coagulation disorder and coagulopathy. A woman G4P3A0 in parturient at term phase I, trombositopenia, frank breech presentation, prediction baby body weight >3500 plan for cesarian section (c-section). The lab result shows platelet count 7000 mm3. From physical examination shows echimosis in both extremity. We performed the c-section in general anesthesia. Post operative condition, no sign of defisit neurologis nor active bleeding. After close monitoring in the recovery room, the patient then transferred to regular ward. Key words: C-seksion, pregnancy, trombositopenia Reference Anestesi obstetri, Bisri T, Wahjoeningsih S, Suwondo B. Anestesi Obstetri; komisi pendidikan spesialis anestesiologi konsultan anestesi obstetri kolegium anestesiologi dan terapi intensif Indonesia. 2013. Grensheimer T, James A, Stasi R. How I treat trombositopenia in pregnancy, journal of the American society of hematology, nov 2012 Thompson SA, Liew ACS, Kam P.C.A. Anesthesia university of St. George Hospital, Australia, 2004, 59, pages 255–264 Butterworth John F., Mackey David C. Morgan and Mikhail’s clinical anesthesiology maternal and fetal physiologi and anesthesiology: Newyork;McGraw Hill, 2013. Chestnut David H. Obstetri anesthesia principles and practice 3rd edition. Elseveir mosby: Philadeplphia; 2004. Bravemen Ferne R. Obstetri and gynecologic anesthesia the requisites in anesthesiology, Mosby. Philadelphia, 2006. Sanjay D, Bhavani S,Scott S. Obstetri anesthesia handbook. 5th edition, springer New York, 2006. The American Society of Anesthesiologist. Practice guidelines for obstetri anesthesia, an updated report by the American society of anesthesiologist task force on obstetri anesthesia, anesthesiology, lippincott wiliams and wilkins, inc;2007;106:843–63. Lyons Gordon, Platelet Counts and Obstetric Analgesia and Anaesthesia, National Blood Transfusion Committee, London Simon L, Santi TM, Sacquin P, Hamza J., Pre-anaesthetic assessment of coagulation abnormalities in obstetric patiens: usefulness, tiing and clinical implication; BJA 1997;78;678–683 Gemsheimer T., James H. Andra, Stasi R., How I Treat Thrombocytopenia in Pregnancy. United Kingdom. Blood. 2013;121(1); 38
Incidence of Post Dural Puncture Headache (PDPH) after Spinal Anesthesia at Dr. Hasan Sadikin General Hospital Bandung in February–April 2015 Period , Suwarman; Sitanggang, Rully H.; Mayasari, Ferra; Yuwono, Hendro Sudjono
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
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Post dural puncture headache (PDPH) occurs because of the cerebrospinal fluid leakage caused by dural puncture. Post dural puncture headache is a common complication after spinal anesthesia which incapacitating the patients. The purpose of our study is to describe the incidence of PDPH in patient undergone surgery with spinal anesthesia at Dr Hasan Sadikin General Hospital Bandung and obtaining the risk factor characteristics which associated with PDPH. This cross sectional observational study carried out 156 postoperative subjects with spinal anesthesia patients over February until April 2015. There were 10 subjects (6,41%) developed PDPH. The characteristics which assosciated with PDPH dan statistically significant (p value<0,05) are median and paramedian punctures technique (PR=19,722; CI 95% 6,377; 60,996), history of PDPH (PR=17,222; CI 95% 9,235; 32,469), and multiple punctures (PR=6,400; CI 95% 1,406; 29,132). Whereas, characteristic which associated independently with PDPH is the median and paramedian punctures technique (POR=29,121 CI 95% 33,842;220,745). Anesthesiologist have an important role to prevent PDPH with selection of spinal needle, selection of mastered technique, and improving anesthesiologist’s skill.
Perbandingan Kecepatan Penyuntikan Fentanil 5 Detik dan 20 Detik Terhadap Angka Kejadian Fentanyl-Induced Cough (FIC) Sedono, Rudyanto; Harijanto, Eddy; ., Safroni
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Abstract

Fentanil merupakan analgetik opioid yang hampir selalu digunakan sebagai ko-induksi di ruang operasi. Namunpenggunaan fentanil intravena bisa menimbulkan batuk yang dikenal juga sebagai fentanyl-induced cough (FIC).Batuk merupakan hal yang tidak diinginkan saat induksi karena bisa menyebabkan peningkatan tekanan intrakranial,tekanan intraokular dan tekanan intra-abdominal. Kejadian FIC salah satunya dihubungkan dengan kecepatanpenyuntikan fentanil. Penelitian ini bertujuan untuk membandingkan antara kecepatan penyuntikan fentanil 5 detikdan 20 detik terhadap angka kejadian dan derajat FIC pada pasien ras Melayu yang menjalani anestesia umum diRumah Sakit Cipto Mangunkusumo. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap 124 pasienras Melayu yang menjalani operasi dengan anestesia umum di Rumah Sakit Cipto Mangunkusumo. Subjek dibagimenjadi 2 kelompok (kelompok kecepatan 5 detik dan kecepatan 20 detik). Pasien secara acak diberikan fentanil 2mcg/kgBB sebagai co-induksi dengan kecepatan penyuntikan 5 detik atau 20 detik. Insiden dan derajat FIC dicatatpada masing-masing kelompok. Derajat FIC dibagi berdasarkan jumlah batuk yang terjadi, yaitu ringan (1–2 kali),sedang (3–5 kali) dan berat ( >5 kali). Analisis data dilakukan dengan uji Chi-square dan uji Kolmogorov-Smirnovsebagai uji alternatif. Insiden FIC pada kelompok 20 detik lebih rendah secara bermakna dibandingkan kelompok5 detik, 8,07% vs 29,03% (p<0,05). Derajat FIC antara kedua kelompok secara statistik tidak berbeda bermakna(p>0,05). Insiden dan derajat FIC lebih rendah pada kelompok 20 detik dibanding dengan kelompok 5 detik padapenggunaan fentanil 2 mcg/kgBB sebagai co-induksi. Kata kunci: Fentanil, fentanyl-induced cough (FIC), kecepatan penyuntikan Fentanyl, an analgesic opioid, is commonly used by anaesthesiologists in the operating room as co-induction.However, co-induction of intravenous fentanyl bolus is associated with coughing, known as fentanyl-inducedcough (FIC). Coughing during anesthesia induction is undesirable as it is associated with increased intracranial,intraocular, and intraabdominal pressures. Incidence of FIC is associated with injection rate of fentanyl. Thisstudy compared the incidence and severity of FIC between 5 seconds and 20 seconds fentanyl injection rate inMelayan race patients in Cipto Mangunkusumo hospital. This was a double blind randomized study in Melayanrace patients that underwent operations with general anesthesia at Cipto Mangunkusumo hospital. 124 subjectswere included in the study and divided into 2 groups (5 seconds and 20 seconds group). Subjects were randomizedto receive co-induction fentanyl 2 mcg/kgBW with either 5 second or 20 seconds injection rate. The incidenceand severity of FIC were recorded in each group. Based on the number of coughs observed, cough severity wasgraded as mild (1–2), moderate (3–5), or severe (>5). Data was analyzed by Chi-square and Kolmogorov-Smirnovtest. The incidence of FIC was significantly lower in the 20 seconds group than in the 5 seconds group, 8,07%vs 29,03% (p<0,05). The severity of FIC wast statistically not significant in both groups (p>0,05). Incidence andseverity of FIC was lower in the 20 seconds group compared with the 5 seconds group in co-induction usingfentanyl injection 2 mcg/kgBW. Key words: Fentanyl, fentanyl-induced cough (FIC), rate of injection Reference Lin CS, Sun WZ, Chan WH, Lin CJ, Yeh HM, Mok MS. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl induced cough. Can J Anesth 2004; 5: 654–9. Horng HC, Wong CS, Hsiao KN, Huh BK, Kuo CP, Cherng CH, et al . Pre-medication with intravenous clonidine suppresses fentanyl induced cough.Acta Anaesthesiol Scand 2007; 51: 862–5. Yu J, Lu Y, Dong C, Zhu H, Xu R : Premedication with intravenous dexmedetomidine–midazolam suppresses fentanyl-induced cough. Ir J Med Sci. 2012; 181:517–20. Fauzi R. Keefektifan Dilusi Fentanil 10 mcg/ml Terhadap Efek Batuk yang Ditimbulkannya. Tesis Fakultas Kedokteran Universitas Indonesia Program Studi Anestesiologi dan Terapi Intensif, Jakarta Juni 2008. Hlm. 18–23. Lin JA, Yeh CC, Lee MS, Wu CT, Lin SL, Wong CS. Prolonged injection time and light smoking decreases the incidence of fentanylinduced cough. Anesth Analg. 2005;101: 670–4. Stellato C, Cirillo R, Paulis A, Casolaro V, Patella V, Mastronardi P, et al. Human basophil/ mast cell releasability. IX. Heterogeneity of the effect of opioids on mediator release. Anesthesiology 1992;77:932–40. Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D. Salbutamol, beclomethasone, or Sodium  \ chromoglycate suppress coughing induced by i.v. fentanyl. Can J Anaesth. 2003;50:297–300. Phua WT, Teh BT, Jong W: Tussive effect of a fentanyl bolus. Can J Anaesth. 1991;38: 330–4. Bailey P: Possible Mechanism (s) of Opioid-induced Coughing. Anesthesiology. 1999;90:335. Ai Q, Hu Y, Wang YJ, Wu S, Qin Z, Wang J, et al . Pentazocine pretreatment suppreses fentanyl-induced cough. Pharmacol Rep 2010; 62: 747–50. Yu H, Yang XY, Zhang X, Li Q, Zhu T, Wang Y, et al . The effect of dilution and prolonged injection time on fentanyl-induced coughing. Anesthesia. 2007;62:919–22. Hung KC, Chen CW, Lin CH, Weng HC, Hsieh: The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing. Anaesthesia 2010; 65: 4–7. Kim JE, Min SK, Chae YJ, Lee YJ, Moon BK, Kim JY. Pharmacological and nonpharmacological prevention of fentanylinduced cough: a meta-analysis. J Anesth. 2014;28:257–66. Schaperrneier D, Hopf HB. Fentanyl-induced
Weil’s Disease dengan Perdarahan Pulmonal Harly, Patra Rijalul; Sitanggang, Ruli Herman; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Leptospirosis adalah zoonosis akibat leptospira yang banyak ditemukan di daerah tropis dengan curah hujan yang tinggi. Manifestasi klinis bervariasi mulai dari penyakit yang self-limited dengan tanda dan gejala yang tidak spesifik, meningitis aseptik benigna, Weil’s disease (ikterus, disfungsi renal, dan perdarahan), hingga perdarahan pulmonal yang memiliki mortalitas tinggi. Seorang laki – laki 18 tahun datang ke unit gawat darurat Rumah Sakit Dr. Hasan Sadikin pada bulan Juni 2016 dengan Weil’s disease yang disertai perdarahan pulmonal. Terjadi kegagalan fungsi organ multipel yang memberat, sehingga dikonsulkan ke ICU pada hari ke 2 perawatan di rumah sakit. Didapatkan APACHE II Score 17 dengan prediksi mortalitas 25% pada saat masuk ICU. Kegagalan fungsi organ yang didapatkan adalah respirasi (P/F Ratio 52,6), ginjal (Kreatinin 5,36mg/dL), dan hati (bilirubin total 26,26 mg/dL). Diagnosis leptospirosis ditegakkan dengan skor Modified Faine Criteria 31. Manajemen di ICU pada pasien ini dilakukan dengan ventilasi mekanis, hemodialisis, meropenem dan methylprednisolone. Kortikosteroid diberikan mengingat patofisiologi leptospirosis yang diperkirakan akibat reaksi autoimun. Terjadi perbaikan pada fungsi respirasi (P/F Ratio 445), ginjal (Kreatinin 0,52/dL), dan hati (bilirubin total 10,76 mg/dL). Pasien diekstubasi pada hari ke 7 perawatan di ICU dan pindah ke ruang perawatan pada hari ke 8 perawatan di ICU. Kata kunci: Weil’s disease, Perdarahan Pulmonal, Methylprednisolone Weil’s Disease with Pulmonary HemorrhageLeptospirosis is a zoonosis caused by leptospira spp. mainly found in high rainfall tropical area. Clinical manifestation greatly varies from self limited non specific disease, benign aseptic meningitis, Weil’s disease (jaundice, acute kidney injury, and hemorrhage), to a highly lethal pulmonary hemorrhage. An 18 years old male came to the Dr. Hasan Sadikin Hospital emergency department on June 2016, diagnosed as Weil’s disease with pulmonary hemorrhage. He has a worsening multiple organ failure, and consulted to the ICU at the 2nd day of hospitalization.Apache II score at ICU admission is 17 with predicted mortality 25%. Organ failure at ICU admission were respiration (P/F Ratio 52,6), kidney (Creatinine 5,36mg/dL), and liver (Total Bilirubin 26,26 mg/dL). Diagnosis of leptospirosis is made based on Modified Faine Criteria score of 31. ICU management consist of menchanical ventilation, hemodialysis, meropenem, and methylprednisolone. Rationale of corticosteroid administration is due to pathophysiology of leptospirosis, which is believed to be related to an autoimmune process. Respiration function (P/F Ratio 445), kidney function (Creatinine 0,52/dL), and liver function (Total Bilirubin 10,76 mg/dL)were resolved. Patient was extubated on the 7th day after ICU admission, and discharged to the ward on the 8th day after ICU admission. Key words: Weil’s disease, Pulmonary Hemorrhage, Methylprednisolone
Glasgow Coma Scale dalam Memprediksi Outcome pada Pasien dengan Penurunan Kesadaran di Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo S, Achmad Afif; Fuadi, Iwan; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
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Abstract

Ventilator associated pneumonia (VAP) merupakan Hospital associated pneumonia (HAP) yang paling sering terjadi di intensive care unit (ICU). Salah satu strategi pencegahan terjadinya VAP yang termasuk dalam VAP bundle adalah penghisapan sekret subglotis dengan menggunakan pipa endotrakea dengan drainase sekret subglotis. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh penggunaan pipa endotrakea dengan drainase sekret subglotis terhadap angka kejadian VAP di ICU Rumah Sakit Hasan Sadikin (RSHS) Bandung. Penelitian dilakukan dengan uji acak tersamar tunggal terhadap 26 subjek yang menggunakan ventilator lebih dari 48 jam di ICU RSHS Bandung. Setelah dilakukan randomisasi secara blok permutasi, subjek penelitian dikelompokan menjadi dua, yaitu 13 subjek kelompok kontrol menggunakan pipa endotrakea standar dan 13 subjek kelompok perlakuan menggunakan pipa endotrakea dengan drainase sekret subglotis. Sekret subglotis dihisap setiap 2 jam dan tekanan balon pipa endotrakea diperiksa setiap 4 jam. Data hasil penelitian dianalisis dengan uji statistik yaitu uji independent t, Uji Mann Whitney dan uji chi kuadrat, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap kejadian VAP (p=0,033), dimana kejadian VAP lebih sedikit pada kelompok yang menggunakan pipa endotrakea dengan drainase subglotis (0%) dibandingkan dengan kelompok yang menggunakan pipa endotrakea standar (23,1%). Simpulan dari penelitian ini adalah penggunaan pipa endotrakea dengan drainase sekret subglotis dapat menurunkan kejadian VAP di ICU RSHS Bandung. Kata kunci: Drainase sekret subglotis, pipa endotrakea, ventilator associated pneumonia The Influence of Endotracheal Tube with Subglottic Secretion Drainage on Ventilator Associated Pneumonia In Intensive Care Unit Dr. Hasan Sadikin Hospital Bandung Ventilator associated pneumonia (VAP) is the most common Hospital associated pneumonia in Intensive Care Unit (ICU). One of the strategies to prevent occurence of VAP that is part of the VAP bundle is suctioning of subglottic secretion using special endotracheal tube with subglotic secretion drainage. The aim of this study is to know the influence of using endotracheal tube with subglottic secretion drainage to the incidence of VAP in ICU RSHS Bandung. This is a single-blind randomized study involving 26 patients who use ventilator for more than 48 hours in ICU RSHS Bandung. After permuted block randomization, the subjects were divided into two groups, 13 subjects in the control group whom are using standard endotracheal tube and 13 subjects in the group whom are using endotracheal tube with subglottic secretion drainage. Subglottic secretion is drained every two hours and the pressure of the endotracheal tube cuff is checked every four hours. The result of this study is analyzed using various statistical tests, including independent t test, Mann Whitney and Chi Square test, where p value <0.05 is considered significant. Statistical analysis shows that there is a significant difference between two groups in the incidence of VAP (p=0.033) where incidence of VAP is less in the group using endotracheal tube with subglotic drainage (0%) in comparison to the group using standard endotracheal tube (23.1%). The conclusion of this study is that endotracheal tube with subglottic secretion drainage can decrease incidence of VAP in ICU RSHS Bandung. Key words: Endotracheal tube, subglotic secretion drainage, ventilator associated pneumonia 

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