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All Journal Jurnal Anestesiologi Indonesia Jurnal Anestesi Obstetri Indonesia Jurnal Neuroanestesi Indonesia Jurnal Komplikasi Anestesi
Ratih Kumala Fajar Apsari
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Kesehatan Masyarakat Dan Keperawatan, Universitas Gadjah Mada, Yogyakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Panjang Tulang Belakang dan Indeks Massa Tubuh sebagai Prediktor Terjadinya Hipotensi Pascaanestesi Spinal pada Ibu Hamil yang Menjalani Seksio Sesarea Wirawan, Angga Aditya; Uyun, Yusmein; Apsari, Ratih Kumala Fajar
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.v8i3.8374

Abstract

Background: Hypotension is one of the neuraxial anesthesia complications, whereas if not properly managed, might diminish the uteroplacental perfusion, cause fetal hypoxia, acidosis, and neonatal injury. Vertebral column length and body mass index are believed to have a role in predicting the incidence of hypotension after spinal anesthesia in parturients undergoing cesarean section because some research wasmentioned the correlation between vertebral column length and body mass index with sensory block height and vasopressor needs. Methods: This research uses prospective observational, cross-sectional as the design. The sample size is 72parturient of physical status ASA 1 and 2 who will undergo caesarean section with spinal anesthesia. Hypotension is defined as a decrease in systolic blood pressure >20% compared with baseline measurement on the table before spinal anesthesia is given up to 20 minutes after spinal anesthesia. Results: The mean vertebral column length in the hypotension group is 36,1 cm and no hypotension group is 33,6 cm. Statistically, this condition doesn’t show a significant difference (p=0,076). While in body mass index, mean body mass index in hypotension group is 32,7 kg/m2 and no hypotension group is 27,6 kg/m2. Statistically, this shows significant difference (p=0,0001). Conclusion: Vertebral column length was not significant in predicting incidence of hypotension after spinal anesthesia in pregnant women undergoing caesarean section. Whereas, body mass index has significant difference so it can be used to predict the incidence of hypotension after spinal anesthesia in pregnant women undergoing caesarean section.
Manajemen Intensif Peripartum pada Pasien COVID-19 Apsari, Ratih Kumala Fajar; Wisudarti, Calcarina Fitriani Retno; Negara, Adista Yugadhyaksa Gupta
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.v9i1.8521

Abstract

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Pregnant women in the third trimester and after delivery are at risk for severe COVID19. Intensive management of pregnant women with COVID-19 consists of a variety of steps. Key points of intensive management include fluid management, steroids, thromboprophylaxis, antibiotics, monoclonal antibodies, and ventilation management. Laboratory, radiological, and clinical examination monitoring should be carried out as needed. In pregnant women with severe COVID-19, there are critical targets that must be achieved. Patient management must be adjusted to achieve these targets. This case report discusses a 23-year-old woman who was 30 weeks pregnant who experienced severe COVID-19 and eventually died. There is much to be learned about the intensive management of pregnant women with COVID19 from this case.
Luaran Klinis Maternal pada Pasien Obstetri Dengan Covid – 19 yang Menjalani Seksio Sesarea di RSUP Dr. Sardjito Hadiwinoto, Bambang; Apsari, Ratih Kumala Fajar; Sudadi, Sudadi
Jurnal Komplikasi Anestesi Vol 11 No 2 (2023)
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.v11i2.12571

Abstract

Background : COVID-19 is a global pandemic with pregnant women is one of the affected populations. Physiological changes in pregnant women, coupled with the pathological conditions of COVID-19, impact maternal outcomes, including the amount of intrapartum hemorrhage, the requirement for mechanical ventilation, and mortality in patients undergoing cesarean section. Objective : To analyze the impact of OCVID – 19 on the maternal outcomes of obstetric patients undergoing cesarean section at Dr. Sardjito General Hospital. Methods : This research employ a retrospective descriptive study. Secondary data were obtained from medical records of COVID – 19 obstetric patient who underwent a cesarean section at Dr. Sardjito General Hospital from January to December 2021. The data were analyze using descriptive data analysis with SPSS software version 26. Results : The study resulting in a total sample size of 89 patients. The median age of the study subjects was 32 years, with a mean body mass index (BMI) of 28.3 kg/m^2. There was 7% incidence of hemorrhage exceeding 1000 cc , mortality rate was 25,8 %, and 20,2% from the population sample need mechanical ventilation pregnant women undergoing cesarean sections with COVID-19 at Dr. Sardjito General Hospital. Conclusion : There was no significant increase in the incidence of hemorrhage exceeding 1000 cc (7% vs. 18.4%), However there was a noticeable rise in mortality rates (25.8% vs. 0.34%, 1.3%) and an increased need for mechanical ventilation (20.2% vs. 0.071%, 0.01%) when compared to descriptive studies conducted on pregnant women undergoing cesarean sections without COVID-19. Keywords : COVID-19 , clinical outcome, cesarean section
Faktor Risiko Perioperatif Terhadap Kejadian Delirium Saat Pulih Sadar Setelah Anestesi Umum Pada Pasien Dewasa Yang Menjalani Operasi Elektif Di RSUP Dr Sardjito Dewi, Wahyu Jati Paramita; Widodo, Untung; Apsari, Ratih Kumala Fajar
Jurnal Komplikasi Anestesi Vol 10 No 3 (2022)
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.v10i3.13021

Abstract

Background. Emergence delirium in anesthesia is a common problem after anesthesia especially in recovery room,but the incidence and risk were unclear. Emergence delirium makes serious complication and impact in morbidity and mortality were no treated properly. So this study built. Objective. To determine the perioperative risk factors of emergence delirium after general anesthesia of elective surgery at Dr Sardjito Hospital. Method. Ninety-nine patients who have surgery under general anesthesia were prospectively observed and variables were potentials perioperative risk factors for delirium at recovery room were dated. The data were statistically analyzed by bivariate and multivariate analysis based on the incidence of delirium after recovery. Results. Total sample of the study were 99 patients who had delirium 55 (55.6%). The results of multivariate analysis showed risk factor of emergence delirium were age 18-25 years old (p=0,045, OR 5,54, 95%CI 1,02-15,189), smoker (p=0,06, OR 6,83, 95%CI 1,769-21,069), alkoholism (p=0,018, OR 10,34, 95%CI 2,09-78,98), ophthalmology (p=0,005, OR 5,43, 95%CI 1,86-32,266), alprazolam premedication (p=0,045, OR 4.035, 95%CI = 1.029-15.819), general anesthesia/ET (p=0,024, OR 5,23, 95%CI 1,697-21,792), duration of surgical procedure > 2 jam (p=0,025, OR 10.320, 95% CI 1.331-79.987), duration 1-2 jam (p=0.023, OR 6.554, 95% CI 1.291-33.266), opioid analgetic (p=0,019, OR 4,15, 95%CI 1,028-17,819) epidural cath (p=0,021, OR 5,83, 95%CI 1,981-20,069), artery line/CVC (p=0,043, OR 9,79, 95% CI 1,08-89,32), DC (p=0.010, OR 0.074. 95%CI 0.010-0.529), blood transfusion and vasopressors (p=0.004, OR 10,38, 95% CI = 2.11-51,08), pain scale/NRS >7 (p=0.049, OR 10.598, 95%CI 0.933-120.386), and NRS 3-7 (p=0.039, OR 5.465, 95%CI 1.091-27.372), PONV dan shivering (p=0.006, OR 3,77, 95% CI = 1.47-9,67). Conclusions. Age 18-25 years old, smoking and alcoholism, ophthalmology surgery, alprazolam premedication, general anesthesia/ET, duration surgery > 1 hour, opioid and epidural catheter analgesia, artery line/CVC, DC, blood transfusion and vasopressor, post operative pain with NRS >3, PONV/shivering have increased risk for emergence delirium.
Layanan Painless Labor dan Jaminan Kesehatan Nasional di Indonesia Kumala Fajar Apsari, Ratih
Jurnal Anestesi Obstetri Indonesia Vol 7 No 3 (2024): November
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v7i3.197

Abstract

Persalinan dikenal sebagai salah satu pengalaman paling menyakitkan bagi wanita, dengan derajat nyeri ringan hingga sangat berat. Nyeri persalinan disebabkan oleh faktor fisiologis (seperti kontraksi uterus, dilatasi dan penipisan serviks), serta faktor psikologis (seperti stress dan kecemasan), dan diketahui dapat menimbulkan dampak yang membahayakan baik bagi kesehatan ibu maupun bayi. Nyeri persalinan menyebabkan peningkatan stimulasi simpatis, hiperventilasi, hipoksemia, alkalosis respiratorik, penurunan perfusi uteroplasental, nyeri kronik, serta gangguan psikis jangka panjang. Painless labor (persalinan tanpa rasa sakit) dengan teknik analgesia neuraksial, seperti epidural labor analgesia, dianggap sebagai solusi efektif untuk mengurangi nyeri persalinan dan mencegah komplikasi. Beberapa kondisi klinis dan komorbiditas dalam kehamilan dapat diuntungkan dengan penggunaan painless labor, misalnya kondisi penyakit kardiovaskular, karena dinilai mampu menjaga stabilitas hemodinamik. Konsensus internasional pun menyepakati bahwa permintaan pasien saja sudah cukup menjadi indikasi dilakukannya tindakan painless labor. Namun, implementasi painless labor di Indonesia menghadapi tantangan besar, seperti keterbatasan cakupan pembiayaan kesehatan. Jaminan Kesehatan Nasional (JKN) dapat menanggung biaya prosedur ini hanya untuk kasus-kasus dengan komorbiditas tingkat sedang hingga berat. Kebijakan ini berbeda dengan asuransi swasta yang menawarkan cakupan lebih luas. Mengingat manfaat analgesia persalinan terhadap kesehatan ibu dan bayi, peningkatan akses dan penggunaan prosedur painless labor dapat menjadi tindakan yang efektif biaya di Indonesia.
Left Ventricular Ejection Fraction (LVEF) dan Klasifikasi New York Heart Association (NYHA) sebagai Prediktor Mortalitas Pascaanestesi untuk Persalinan dengan Penyakit Jantung Hartono, Pinter; Yusmein Uyun; Ratih Kumala Fajar Apsari; Rahma, Aulia Zuhria
Jurnal Anestesi Obstetri Indonesia Vol 8 No 1 (2025): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v8i1.201

Abstract

Latar Belakang: Klasifikasi New York Heart Association (NYHA) mengkategorikan pasien berdasarkan tingkat keparahan gejala jantung. Fraksi ejeksi ventrikel kiri Left Ventricular Ejection Fraction (LVEF) juga penting, sebagai prediktor luaran bagi wanita hamil dengan penyakit jantung. Hingga kini, penelitian mengenai hubungan antara LVEF, klasifikasi NYHA, dan luaran anestesi obstetri masih terbatas, terutama di negara berkembang. Tujuan: Menilai apakah LVEF dan klasifikasi NYHA dapat memprediksi mortalitas pasca analgesia dan anestesi pada ibu hamil dengan penyakit jantung.Subjek dan Metode: Studi kohort retrospektif dari data sekunder pasien hamil, penyakit jantung tahun 2019–2022 menggunakan analisis deskriptif dan bivariat untuk mengetahui hubungan variabel bebas dengan luaran mortalitas.Hasil: Pemeriksaan rekam medis antara tahun 2019–2022 terhadap 74 subjek menunjukkan rerata usia 29,3 tahun. Terdapat 6 subjek meninggal. Hubungan signifikan antara klasifikasi NYHA dan mortalitas pasca analgesia atau anestesi (p=0,045), terutama NYHA Kelas IV (p=0,031; OR 16,5; CI95% 1,82 – 149,591). LVEF abnormal (p=0,031; OR 9,167; CI 95% 1,012 – 83,051) juga menunjukkan hubungan positif dengan mortalitas pasca analgesia atau anestesi dibandingkan dengan LVEF normal (LVEF 50–70%). Simpulan: Klasifikasi NYHA dan LVEF dapat memprediksi bermakna mortalitas pasca analgesia atau pasca anestesi pada persalinan ibu hamil dengan penyakit jantung
Persalinan Menggunakan Dural Puncture Epidural Analgesia pada Pasien Hamil dengan Pirau Jantung Anasy, Naufal; Ikhwandi, Arif; Apsari, Ratih Kumala Fajar
Jurnal Anestesi Obstetri Indonesia Vol 8 No 2 (2025): Juli
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v8i2.222

Abstract

Manajemen nyeri persalinan penting untuk mengurangi komplikasi pada ibu hamil dengan penyakit jantung atrial septal defect (ASD). Perubahan hemodinamik dalam kehamilan dan persalinan dapat meningkatkan risiko komplikasi yang memperburuk kondisi jantung ibu. Dural Puncture Epidural (DPE) merupakan salah satu teknik analgesia neuraksial yang digunakan untuk mengurangi nyeri persalinan. Penatalaksanaan anestesi pada pasien dengan kelainan jantung bawaan memerlukan pendekatan yang terindividualisasi dengan evaluasi risiko dekompensasi kardiovaskular secara menyeluruh. Optimalisasi teknik analgesia neuraksial, seperti DPE, bertujuan untuk menurunkan aktivasi simpatis berlebihan yang dapat menyebabkan peningkatan tekanan paru dan memperburuk pirau intrakardiak. Dengan demikian, pemilihan DPE bukan hanya mempertimbangkan kontrol nyeri yang efektif, tetapi juga mendukung stabilitas hemodinamik dengan menghindari fluktuasi tekanan darah dan perubahan resistensi vaskular sistemik yang signifikan.Pasien usia 26 tahun G2P1A0 kehamilan 37 minggu dengan ASD pirau kiri ke kanan dan kemungkinan hipertensi pulmonal menjalani persalinan spontan. Setelah proses persalinan, ditemukan komplikasi perdarahan akibat laserasi portio serviks. DPE berhasil memberikan analgesia efektif tanpa fluktuasi hemodinamik yang membahayakan. Teknik DPE memungkinkan pengelolaan nyeri dengan blok sensorik yang optimal serta stabil secara hemodinamik.DPE adalah teknik yang aman dan efektif untuk ibu hamil dengan kondisi jantung bawaan seperti ASD.
Total Intra Venous Anesthesia (TIVA) Target Controlled Infusion (TCI) Propofol Remifentanil untuk Seksio Sesarea Emergensi pada Pasien Meningioma dengan Peningkatan Tekanan Intrakranial Aryasa, Tjahya; Fajar Apsari, Ratih Kumala; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 1 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2536.971 KB) | DOI: 10.24244/jni.v9i1.251

Abstract

Meningioma sangat jarang ditemukan pada kehamilan, tapi kehamilan dapat memicu pertumbuhan meningioma. Ibu hamil yang menjalani seksio sesarea dengan penyulit tumor otak merupakan indikasi anestesi umum dengan kombinasi Target Controlled Infusion (TCI) propofol dan remifentanil. Propofol pada seksio sesarea dapat mengatasi respons simpatis akibat laringoskopi. Remifentanil berhubungan dengan hasil luaran lebih baik pada neonatus dari opioid lainnya. Perempuan 34 tahun, hamil 37 minggu datang dengan keluhan utama nyeri perut hilang timbul disertai kebutaan dan tanda peningkatan tekanan intrakranial tanpa penurunan kesadaran. Tidak dilakukan CT-Scan kepala karena direncanakan seksio sesarea emergensi. Dilakukan seksio sesarea dengan teknik anestesi umum menggunakan TCI propofol mode Marsh dengan target efek 34 mcg/ml dan TCI remifentanil dengan target 23 ng/ml, dan rocuronium dengan dosis 0,7 mg/kgBB. Pada menit kesepuluh, lahir bayi laki-laki, dengan berat badan 2000 gram dan skor APGAR 78. Selama operasi hemodinamik stabil dan tidak ada komplikasi. pascabedah dilakukaan pemeriksaan CT-scan dan ditemukan meningioma yang besar. Teknik ini memberikan hasil luaran pada neonatal dan ibu yang baik.Total Intra Venous Anethesia (TIVA) Target Controlled Infusion (TCI) with Propofol Remifentanil for Emergency Caesarean Section in Meningioma Patient with Increase Intracranial PressureAbstractMeningiomas are very rare in pregnancy, but pregnancy triggers the growth of meningiomas. Pregnant women who undergo cesarean section complicated with brain tumor are an indication of general anesthesia with Target Controlled Infusion (TCI) propofol and remifentanil. Propofol can blunt sympathetic response due to laryngoscopy. Remifentanil has a better outcomes in neonates than other opioids. A 34-year-old woman, 37-weeks pregnant presented with uterine contractions accompanied with blindness and signs of increased intracranial pressure without decreased consciousness. Head CT scan was not performed because an emergency cesarean section was planned. Caesarean section was performed with general anesthesia using Target Controlled Infusion (TCI) Marsh mode propofol with a target effect of 3-4 mcg/ml and remifentanil TCI with a target of 2-3 ng/ml, and rocuronium 0.7 mg/kg. At the tenth minute, a male baby was born, weighing 2000 grams and an APGAR score of 7-8. During surgery, the hemodynamic was stable without complications. Postoperatively, a CT scan was performed and a large meningioma was found. This technique provided good neonatal and maternal outcome outcomes.
Co-Authors Adi, Danis Woro Kuncoro Adrin, Olga Elenska Akhmad Yun Jufan Anasy, Naufal Apriyanto Arif Ikhwandi Atmadja, Linda Stefanie Bambang Suryono Bambang Suryono Suwondo Bambang Suryono, Bambang Calcarina Fitriani Retno Wisudarti Dede Frits Manambual Sinaga Dewi, Wahyu Jati Paramita Ekuarianto, Donny Erna Fitriana A Fadinie, Wulan Fitriati, Mariza Gunawan, Fanny Hadiwinoto, Bambang Hartono, Pinter Hendra, Maijoni Hermawan, Hendra Ikhwandi, Arif Juni Kurniawaty Muhdar Abubakar Djayanti Sari Kuncoro, Kusuma Edhi Mahmud Mahmud Negara, Adista Yugadhyaksa Gupta Nurdiansyah, Elba Nurul Ulfah Hayatunnisa Oktavian Rizki Ilahi Prayunanto A.N, Eko Rahma, Aulia Zuhria Sari, Dhanty Dwita Satrio Adi Wicaksono SATRIYAS ILYAS Shinta Shinta Sri Rahardjo Sri Rahardjo Sudadi Suharso, Pamungkas Hary Suryasaputra, Wahyu Tjahya Aryasa Untung Widodo, Untung Utomo, Wandito Gayuh Wirawan, Angga Aditya Yoga Pranata Yunita Widyastuti Yusmein Uyun