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All Journal Cermin Dunia Kedokteran Jurnal Neuroanestesi Indonesia
Umar, Nazaruddin
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Perbandingan Efek Inflasi Cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml dengan Lidokain HCl 1,5 mg/kgbb. intravena Terhadap Kejadian Batuk dan Hemodinamik Sebelum dan Sesudah Ekstubasi pada Anestesia Umum Bangun, Chrismas Gideon; Solihat, Yutu; Umar, Nazaruddin
Cermin Dunia Kedokteran Vol 42, No 6 (2015): Malaria
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (125.529 KB) | DOI: 10.55175/cdk.v42i6.995

Abstract

Latar belakang dan Objektif : Batuk dan gejolak hemodinamik saat ekstubasi merupakan problem klinis yang sering pada anestesi umum. Lidokain intravena diketahui dapat mengurangi refleks batuk dan kenaikan hemodinamik bila diberikan beberapa saat sebelum ekstubasi, namun durasinya singkat dan menyebabkan sedasi yang dapat menunda pemulihan. Cuff pipa endotrakea terbuat dari polyvynilchloride memungkinkan difusi lidokain hidrofobik untuk bekerja topikal pada mukosa trakea. Alkalinisasi memungkinkan difusi lidokain pada konsentrasi lebih rendah. Sebuah penelitian in vitro menyebutkan pH optimal lidokain untuk berdifusi paling baik setelah 90 menit adalah pH 7,4 dengan campuran Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml. Penelitian ini bertujuan untuk membandingkan efektifitas campuran lidokain dan bikarbonat tersebut untuk mengurangi kejadian batuk dan peningkatan hemodinamik saat ekstubasi dibandingkan lidokain intravena. Metode Sejumlah 70 sampel pria dan wanita, 18- 50 tahun, status fisik ASA 1 menjalani pembedahan elektif, perkiraan lama operasi diatas 90 menit dengan anestesi umum dengan intubasi endotrakea di Rumah Sakit H. Adam Malik Medan dan rumah sakit jejaring. Sampel dibagi acak menjadi 2 kelompok. Kelompok I mendapat inflasi cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml dan suntikan Plasebo intravena 3 menit sebelum ekstubasi. Kelompok II mendapat inflasi cuff dengan Plasebo dan suntikan Lidokain HCl 1,5 mg/kgBB intravena 3 menit sebelum ekstubasi. Kejadian batuk dicatat pada 1 menit sebelum, 2, 4 dan 8 menit sesudah ekstubasi. Tekanan darah sistolik, tekanan darah diastolik, MAP dan laju nadi dicatat saat jahit kulit (baseline), ekstubasi, 2,4, dan 8 menit setelah ekstubasi. Semua data dianalisis menggunakan uji Crosstab dan Chi square. Hasil : Inflasi cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml lebih mengurangi kejadian batuk dan kenaikan tekanan darah dan laju nadi dibanding Lidokain HCl 1,5mg/kgBB intravena. Simpulan : Inflasi cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml dapat digunakan sebagai alternatif untuk mengurangi kejadian batuk dan kenaikan hemodinamik saat ekstubasi pada anestesi umum.Background and Objective : Cough and hemodynamics turmoil during extubation in general anesthesia is a common clinical problem. Intravenous lidocaine is generally administered just before extubation to reduce the risk. However, short duration (5-20 minutes), and sedation risk can delay recovery. Endotracheal tube cuff made of polyvynilchloride allows diffusion of hydrophobic lidocaine, and acts topically on tracheal mucosa. Alkalinization allow diffusion of lidocaine in smaller concentrations. An in-vitro study stated that optimal pH of lidocaine for diffusion was 7.4 by mixing 6 ml Lidocaine HCl 2% with 0,6 ml Sodium Bicarbonate 7.5%. This study is to compare the effectiveness of lidocaine and bicarbonate mixture with intravenous lidocaine in reducing cough incidence and to improve hemodynamics during extubation.Methods : Samples were 70 patients, aged 18-50 years, ASA 1, underwent elective surgery with approximate duration more than 90 minutes under general anesthesia with endotracheal intubation in Adam Malik Hospital in Medan and network hospitals. The sample was divided randomly into 2 groups. Group I got cuff inflation with 6 ml Lidocaine HCl 2% + 0,6 ml Sodium Bicarbonate 7,5% and intravenous injection of placebo 3 minutes before extubation. Group II received cuff inflation with placebo and intravenous lidocaine HCl 1.5 mg / kg 3 minutes before extubation. Cough events recorded at one minute before, 2, 4 and 8 minutes after extubation. Systolic blood pressure, diastolic blood pressure, MAP and pulse rate are recorded at wound closure (baseline), extubation, 2, 4, and 8 minutes after extubation. All data were analyzed using Chi square test and Crosstab.Result : Cuff inflation with 6 ml Lidocaine HCl 2% + 0.6 ml Sodium Bicarbonate 7.5% reduced the incidence of cough and increase in blood pressure and pulse rate better compared to intravenous Lidocaine HCl 1.5 mg / kg. Conclusion : Cuff inflation with 6 ml Lidocaine HCl 2% + 0.6 ml Sodium Bicarbonate 7.5% can be used as an alternative in reducing the incidence of cough and hemodynamics increase during extubation in general anesthesia. 
Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma Widiastuti, Monika; Rachman, Iwan Abdul; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (346.391 KB) | DOI: 10.24244/jni.v11i2.449

Abstract

Cedera otak traumatik pada geriatri memiliki insiden 734% dengan penyebab utama adalah jatuh. Perdarahan subdural merupakan jenis cedera yang paling sering terjadi pada populasi geriatri. Hal ini sesuai dengan proses penuaan yang terjadi pada jaringan otak sehingga menyebabkan populasi ini sering mengalami perdarahan subdural jika mengalami cedera. Pasien perempuan berusia 72 tahun datang dengan keluhan nyeri kepala pasca terjatuh 6 hari sebelum masuk rumah sakit. Dari pemeriksaan fisik ditemukan kesadaran E3M5V6, tanpa adanya kelainan dan defisit neurologis dan hemodinamika stabil. Dari pemeriksaan penunjang Computed Tomography (CT) scan ditemukan subdural hematoma di regio frontotemporoparietalis dextra dan regio frontalis et temporalis sinistra yang menyebabkan midline shift ke arah sinistra, perdarahan subarahnoid di regio frontalis sinistra, perdarahan intraserebral di lobus temporalis sinistra. Operasi kraniotomi evakuasi hematoma dilakukan selama 3 jam dengan anestesi umum. Pertimbangan anestesi pada pasien ini adalah neuroanestesi dan anestesi geriatri dengan memperhatikan proses penuaan yang mempengaruhi perubahan fisiologi dan farmakologi pada pasien geriatri, riwayat komorbiditas dan polifarmasi. Tatalaksana perioperatif yang baik penting untuk mencegah cedera sekunder pada jaringan otak.Anesthetic Management of Geriatri Patient with Subdural, Intracerebral, and Subarachnoid Hemorrhage Underwent Craniotomy for Hematoma EvacuationAbstractWorldwide, the incidence of traumatic brain injury in geriatrics is 734%, with falls as the most common cause. Subdural hemorrhage is the most common injury that occur and is associated with the aging process of the brain, making geriatric patients prone developing subdural hemorrhage. A 72-years-old female came with a headache after fell to the ground 6 days before hospital admission. Physical examination revealed E3M5V6 without neurologic deficits and hemodynamically stable. A computed tomography scan resulted in subdural hematoma in right frontotemporoparietal region causing midline shifting to the left, subarachnoid hemorrhage in the left frontal region, intracerebral hemorrhage in the left temporal lobe. The patient underwent craniotomy evacuation of hematoma and lasted for 3 hours under general anesthesia. Anesthetic concerns are neuroanesthesia and geriatric patient considering the aging process affects physiologic and pharmacologic changes, comorbidities and polypharmacy. Comprehensive perioperative management is essential to prevent secondary brain injury and improve the outcome.
Tatalaksana Anestesi Pasien Adenoma Hipofisis dengan Riwayat Hipotiroid Maharani, Nurmala Dewi; Bisri, Dewi Yulianti; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (292.476 KB) | DOI: 10.24244/jni.v11i2.469

Abstract

Adenoma hipofisis merupakan tumor otak dengan gejala klinis tergantung hormon yang dihasilkan oleh sel tumor, ukuran, dan invasi lokal. Perempuan 50 tahun dengan adenoma hipofisis dengan riwayat hipotiroid. Pada pemeriksaan prabedah GCS E4M6V5, tekanan darah 114/76 mmHg, denyut nadi 81x/menit, pernafasan 18x/menit, dan saturasi 99%. Pada pemeriksaan fisik berat badan dan visus mata kanan menurun. Pemeriksaan fungsi tiroid kesan hipotiroid, lalu pasien diterapi levotiroksin natrium 100 g perhari tablet selama 14 hari sampai dengan eutiroid. Tatalaksana lanjutan yang dilakukan adalah kraniotomi reseksi adenoma hipofisis. Premedikasi hidrokortison 100 mg dan midazolam 0,1mg/kgbb intravena. Induksi propofol 1 mg/kgbb, fentanyl 2g/kgbb, rocuronium 1 mg/kgbb, lidokain 1 mg/kgbb dan propofol pengulangan dosis 0,5 mg/kgbb. Manitol diberikan 0,5 mg/kgbb dan dexamethason 10 mg. Rumatan anestesi sevoflurane 0,5% dan propofol 50100 g/kgbb/menit. Pasca operasi pasien di ICU diberikan dexmedetomidine 0,2 g/kgbb/jam dan suplemen steroid H-1 diberikan 25 mg hidrokortison setiap 12 jam. Pada H-2 diberikan 20 mg hidrokortison pagi hari dan 10 mg sore hari kemudian dapat dihentikan. Pasien dirawat di ICU 3 hari sebelum pindah ruang rawat biasa. Manajemen perioperatif adenoma hipofisis dengan riwayat hipotiroid adalah mengoptimalkan pra operasi pasien sehingga pasien mencapai eutiroid, menjaga stabilitas hemodinamik, mengoptimalkan oksigenasi serebral, mencegah serta mengatasi komplikasi.Anesthesia Management of Patient with Pituitary Adenoma with Hystory of HypothyroidismAbstractPituitary adenoma is a brain tumor has clinical symptoms depending on hormones produced by tumor cells, size, and local invasion. A 50-year-old woman with pituitary adenoma with history of hypothyroidism. On preoperative, GCS E4M6V5, blood pressure was 114/76 mmHg, pulse was 81x/minute, respiration was 18x/minute, and saturation was 99%. On physical examination, body weight and the visual acuity in the right eye decreased. Examination of thyroid function suggests hypothyroidism before surgery, patient was treated with levothyroxine sodium 100 g per day tablets for 14 days until euthyroid. The next treatment was resection craniotomy of the pituitary adenoma. Premedicated with hydrocortisone 100 mg and midazolam 0.1 mg/kg body weight. Induction propofol 1 mg/kg body weight, fentanyl 2 g/kg body weight, rocuronium 1 mg/kg body weight, lidocaine 1 mg/kg body weight and repeated doses of 0.5 mg/kg body weight propofol. Mannitol was given 0.5 mg/kgbw and dexamethasone 10 mg. Maintenance anesthesia with sevoflurane 0.5% and propofol 50-100 g/kgbw/min. Postoperative the patient in the ICU was given dexmedetomidine 0.2 g/kgbw/hour and steroid supplement day-1 was given 25 mg hydrocortisone every 12 hours. On day-2, 20 mg of hydrocortisone in the morning and 10 mg in the evening, then can be discontinued. The patient was admitted to the ICU for 3 days before moving to the ward. Perioperative management of pituitary adenoma with a history of hypothyroidism is optimizing preoperatively the patient reaches euthyroid, maintaining hemodynamics, optimizing cerebral oxygenation, preventing and treatment if there are complications.
Co-Authors Bangun, Chrismas Gideon Dewi Yulianti Bisri Iwan Abdul Rachman Maharani, Nurmala Dewi Widiastuti, Monika Yutu Solihat