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All Journal International Journal of Public Health Science (IJPHS) Jurnal Anestesiologi Indonesia Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Anestesi Perioperatif Jurnal Eduscience (JES) Journal of Community Empowerment for Health Journal of Anesthesiology and Clinical Research Jurnal Yudistira Jurnal Komplikasi Anestesi
Djayanti Sari
Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Public Health And Nursing, Universitas Gadjah Mada, Jogjakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Library & Information Science Medicine & Pharmacology Neuroscience Nursing Public Health Other

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Manajemen Jalan Nafas pada Pasien dengan Sindroma Crouzon Sari, Djayanti; Widyastuti, Yunita; Hidayat, Fachsyar
Jurnal Komplikasi Anestesi Vol 8 No 3 (2021): Volume 8 Number 3 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v8i3.8369

Abstract

Crouzon syndrome is a congenital disorder that prevents premature closure of the coronal suture (synostosis), or, less commonly, the sagittal or lambdoidal suture of the cranium. This results in a skull dysmorphic appearance of the skull and face, with a high forehead, flattened occiput, and brachycephaly. Inaddition to craniosynostosis, affected children may also experience an abnormal fusion of the skull base and central bones, resulting in maxillary hypoplasia, high arched palate, and shallow orbits, causing protruding exophthalmos. These abnormalities in facial features can have implications for managing a difficult airway. A 4-year-old woman with a head complaint from the age of 1 year. The patient has a history of being diagnosed with Crouzon syndrome
Hubungan Kadar Interleukin-6 terhadap Luaran Mortalitas dan Hari Rawat serta Hari Penggunaan Oksigenasi Tekanan Positif Pasien COVID-19 di RSUP Dr. Sardjito Kuncoro, Kusuma Edhi; Sudadi; Sari, Djayanti; Wisudarti, Calcarina Fitriani Retno
Jurnal Komplikasi Anestesi Vol 9 No 1 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v9i1.8518

Abstract

Background: COVID-19 is a disease caused by the SARS-CoV-2 virus with the main clinical manifestations of respiratory disorders. Patients with severe and critical symptoms require oxygenation therapy during treatment. Interleukin-6 (IL-6) plays a role in the course of the disease and is associated with the clinical severity of COVID-19. IL-6 has the potential as one of the test parameters to estimate the outcome of COVID-19 patients. Objective: To know the relationship between IL-6 levels and the outcome of mortality, length of stay (LOS) and positive pressure oxygenation days of COVID-19 patients during hospitalization at Dr. Sardjito hospital. Methods: The study design was a retrospective observational cohort by taking secondary data from the medical records of hospitalized COVID-19 confirmed patients who were examined for serum IL-6 during April 2020- March 2021 at dr.Sardjito Hospital. Data collection was carried out at the Medical Records Instalation of Dr. Sardjito Hospital. The relationship of the IL-6 variable to the outcome was tested by logistic regression method and further analyzed with Kaplan-Meier and Cox regression analysis of survival. Results: There were 302 research subjects with a mean age of 55.45 (+14.79) years, 183 male (60.6%) and 119 female (39.4%). Subjects with IL-6 >80 pg/mL had a higher risk of death than those with IL-6 <80 (p=0.000, HR=4.68). As many as 87.4% of the subject required oxygenation therapies during hospitalization. Group of subjects with an IL-6 value >80 was significantly required more positive pressure oxygenation therapy (p=0.000) and require longer (p=0.005) duration of positive pressure oxygenation (9.36(+5,9) days) compared to the group of subjects with IL-6 <80 (6(+2,98) days). The difference in LOS was significantly different between groups of subjects, with the median LOS for subjects with IL-6 >80 was 25 days, while for subjects with IL-6 <80 was 13 days (p= 0.000). Conclusion: There was a significant relationship of IL-6 levels >80 pg/mL with increased risk of mortality, LOS and the requirement of positive pressure oxygenation therapies in COVID-19 patients.
Sebuah COST EFFECTIVENESS ANALYSIS Adiyatma, Krisna Hario; Mahmud; SUDADI; Calcarina Fitriani Retno Wisudarti; Djayanti Sari; Diah Ayu Puspandari
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i1.15618

Abstract

Background : One of the frequent post-operative complications is pain, which is experienced by more than 80% of patients and 75% of them experience post-operative pain of moderate to severe intensity. Major abdominal surgery is a surgical procedure with moderate to severe postoperative pain intensity. Analgesic approach strategies that are often used are intravenous opioids and epidural analgesia. Epidural analgesia is considered the analgesic therapy of choice for post-major abdominal surgery, but at a higher cost when compared with intravenous opioids. The differences in route of administration, efficacy and side effect profiles make it important to assess the cost effectiveness between the two approaches as part of hospital quality control and cost management.Objective : To determine the cost effectiveness of epidural analgesia compared with intravenous opioids as analgetic after major abdominal surgery.Method : This study used a descriptive analytical design with decision tree analysis to assess clinical outcomes and estimated costs for two alternative therapies. Research samples were taken retrospectively from September – December 2022 at RSUP Dr. Sardjito Yogyakarta, using simple random sampling. The Incremental Cost Effectiveness Ratio (ICER) value was assessed and Probabilistic Sensitivity Analysis (PSA) was carried out with Monte Carlo simulation using Microsoft Excel®.Results : Epidural analgesia as anti-pain after major abdominal surgery has an Incremental Cost Effectiveness Ratio (ICER) value of IDR 20,857,416/pain free days. Probabilistic Sensitivity Analysis (PSA) produces data distribution with dominance in quadrant 3 of the CEA Plane. Conclusion : The epidural analgesia strategy for pain relief after major abdominal surgery is a cheaper strategy but with slightly lower effectiveness than intravenous opioids at RSUP Dr. Sardjito. Epidural analgesia has an ICER value of IDR 20,857,416/pain free days, has the opportunity to be an alternative choice for post-major abdominal analgetic management that is cost effective.
PENGARUH SEVERE CRITICAL EVENT PERIANESTESI TERHADAP MORTALITAS PASIEN PEDIATRI YANG MENJALANI PEMBIUSAN DI RSUP DR. SARDJITO Napitu, Annika; Widyastuti, Yunita; Sari, Djayanti
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i1.15625

Abstract

Background: severe critical events or unwanted and preventable incidents associated with anesthesia in pediatrics have a higher incidence rate compared with adults. It could be due to the immature anatomy, physiology, pharmacology, emotional, and social aspects of pediatric patients. In addition to the higher incidence, the mortality rate of severe critical events in pediatric patients is also higher than in adults. In general, severe critical events in pediatric patients include difficult airway, cardiovascular events, and medical negligence. Based on the time of occurrence, those events can happen pre-anesthesia, during anesthesia, or post-anesthesia with different incidence numbers. Purpose: To assess the impact of critical events during peri-anesthesia on the mortality rate of pediatric patients. Such events include bronchospasm, laryngospasm, pulmonary aspiration, stridor, croup, desaturation, hypotension, arrhythmia, hemorrhage, cardiac arrest, anaphylaxis, neuro injury, delayed emergence, and medication errors. Method: This is a prospective cohort study. All pediatric patients who underwent anesthesia for surgical and non-surgical procedures at RSUP Dr. Sardjito hospital are consecutively included in this study. The inclusion criteria for this study are pediatric patients less than 18 years of age who underwent anesthesia procedures at RSUP Dr. Sardjito hospital. The exclusion criteria are patients who have no complete medical records. The severe critical events included in this study are bronchospasm, laryngospasm, pulmonary aspiration, stridor, croup, desaturation, hypotension, arrhythmia, hemorrhage, cardiac arrest, anaphylaxis, neuro injury, delayed emergence, and medication errors. To statistically assess the relationship between severe critical events and mortality outcomes, bivariate analysis using chi-square was used. Multivariate analysis was then conducted using logistic regression on the variables that had a p-value of less than 0.25 on the bivariate analysis. A p-value of less than 0.05 indicates statistical significance. Result: From the 425 research participants, 70 severe critical events happened in 39 patients, in which 14 cases resulted in mortality were recorded. The multivariate analysis showed that severe critical events of cardiac arrest (p=0,004; OR= 52,259; 95%CI= 3,505 – 779,081) and laryngospasm (p=<0,001; OR= 46,394; 95%CI= 6,001 – 358,640) significantly associated with patient mortality. Patient's demographic of ASA status (p=0,016; OR= 6,056; 95%CI= 1,403-26,139) and prematurity history (p=0,011; OR= 7,730; 95%CI= 1,607-37,193) are shown to be significantly associated with patient mortality. Conclusion: There is a statistically significant relationship between severe critical events of cardiac arrest and laryngospasm with the mortality of pediatric patients who undergo anesthesia in RSUP Dr. Sardjito hospital.
EFFICACY OF PREEMPTIVE ANALGESIC KETAMINE ON POSTOPERATIVE PAIN AT UNIVERSITAS GADJAH MADA ACADEMIC HOSPITAL Ferdiansyah, David; Mahmud; Sari, Djayanti
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i1.15968

Abstract

Background: Postoperative pain remains a problem in anesthesia services. Preemptive analgesics are known to reduce postoperative pain due to noxious stimuli during the perioperative period. Ketamine can be used as a preemptive analgesic because it has the ability to prevent central sensitization. However, studies on ketamine as a preemptive analgesic have not reached a conclusion. So further research is needed to prove the effectiveness of ketamine as a preemptive analgesicObjective: This study aims to evaluate the efficacy of preemptive intravenous ketamine 0.5 mg/kgBW in reducing postoperative pain.Method: This research is an experimental study with double-blind randomized controlled trials. The inclusion criteria for this study are oncology surgery patients, aged 18-65 years, ASA physical status 1 or 2, BMI 18-30, and willing to sign informed consent. Exclusion criteria include patients with contraindications to ketamine, chronic pain, long-term analgesic consumption, hypertension, diabetes mellitus, cerebrovascular disease, and a history of recurrent malignancy. Meanwhile, withdrawal criteria include withdrawing from the study and experiencing ketamine hypersensitivity. The research sample is randomly divided into 2 groups, namely Group A (ketamine preemptive) and Group B (control). Both groups receive the same anesthesia procedure, namely premedication with intravenous midazolam 0.05 mg/kg body weight (BW), fentanyl 2 mcg/kg BW intravenously, rocuronium 0.6 mg/kg BW intravenously (if intubation is performed), then after a confirmed onset, the LMA (laryngeal mask airway) or ETT (endotracheal tube) airway device is inserted. After that, for Group A, preemptive analgesic ketamine 0.5 mg/kg BW intravenously is administered 10 minutes beforesurgical incision. The assessment performed is pain scale using the numerical rating scale (NRS) at rest and with movement, total intraoperative rescue fentanyl, total postoperative rescue fentanyl requirement, onset of postoperative rescue fentanyl requirement, and side effects. Observation is conducted for up to 12 hours postoperatively. All variables except side effects are analyzed with independent t-tests, but if the data distribution is not evenly spread, the Mann-Whitney test is conducted. The confidence interval in this study is 95%, with significance set at p < 0.05.Results: A total of 65 subjects were studied, but 3 subjects dropped out of the study. Therefore, 62 subjects remained, with 31 subjects in each Group A and B. Statistically, Group A had lower NRS pain scores at rest compared to Group B at hours 0, ½, 1, and 2 postoperatively (p<0.05). For NRS on movement, Group A had lower NRS pain scores compared to Group B at hours 0, ½, 1, 2, 6, and 12 postoperatively (p<0.05). Group A had a longer onset of postoperative rescue fentanyl requirement compared to Group B (p<0.05). However, there was no significant difference in total intraoperative rescue fentanyl and total postoperative rescue fentanyl requirement (p>0.05).Conclusion: Preemptive ketamine analgesic dose of 0.5 mg/kgBW intravenously is effective in reducing postoperative pain better than the control group. This is evidenced by lower NRS pain scores at rest and on movement, as well as a longer onset of postoperative rescue fentanyl requirement compared to the control group.
Co-Authors AA Sudharmawan, AA Adi Wibowo Adi, Danis Woro Kuncoro Adiyatma, Krisna Hario Akhmad Yun Jufan Andreasta Meliala Anggraini, Diana Anwar, Yusuf ‘Alim Musthofa Atmojo, Danang Dwi Bagir, Muhamad BAGUS RAHMAD WIJAYA Bambang Suryono, Bambang Beta Ahlam Gizela Bhirowo Yudo Pratomo Bowo Adiyanto Calcarina Fitriani Retno Wisudarti Calcarina Fitriani Retno Wisudarti Dwi A, Novi Fadhilah Zulfa Fauzi, Rizqi Ahmad Febrianti, Skolastika Rani Ferdiansyah, David Frisianto, Rinaldi Tri Givano, Muhamad Randy Gunawan, Fanny Hanafi, Irham Handayani, Donna Harianto, Widi Yuli Hernandes, Crodia Hernawan, Agung Diky Hidayat, Fachsyar IG Ngurah Rai Artika Indah Setyowardhani Juni Kurniawaty Muhdar Abubakar Djayanti Sari Khoeri, Fatkhur Roofi Kuncoro, Kusuma Edhi Kurniawati, Juni Laksono Trisnantoro Lukman Ade Chandra Mahardieni, Karlina Mi’raj, Geza Getar Mochamat Helmi Mochammad Imron Awalludin Muhammad Brian Ristianto Muhammad Mufti Sofyanoor Muhdar Abubakar Napitu, Annika Nova Estu Harsiwi Nugraha, Achmad Fauzani Nur Hesti Kusumasari Nurholis Majid Ramayani, Julita Rizki, Gilar Sarosa, Pandit Stephanie Audrey Handrianto Sudadi Suryaman, Rifandi Susi Handayani Tony Irawan Ulfa, Dinda Umik Hanik Untung Widodo, Untung Wicaksono, Galih Sahid Yunita W Yunita Widyastuti