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All Journal Jurnal Pendidikan Geografi Undiksha Bali Journal of Anesthesiology WIDYA LAKSANA PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico Jambura Geo Education Journal Jurnal ENMAP JURNAL ILMIAH WAHANA LAUT LESTARI (JIWaLL)
I Gede Budiarta
Lecturer Of Department Of Anesthesiology, Pain Management, And Intensive Care, Udayana University, Sanglah General Hospital, Denpasar-Bali, Indonesia
Agriculture, Biological Sciences & Forestry Humanities Biochemistry, Genetics & Molecular Biology Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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Efficacy of Subcutaneous Morphine Patient Controlled Analgesia Compared to Intravenous Morphine Patient Controlled Analgesia on Cesarean Section Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gde; Aribawa, I Gusti Ngurah Mahaalit; Nainggolan, Elisma
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.27

Abstract

Background: Cesarean section causes moderate to severe pain in the first 48 hours postoperatively, thus requiring an adequate perioperative pain management, not only so that the mother can be quickly discharged but also to perform daily activities after surgery such as breastfeeding and nurse the baby.Objective: To determine the efficacy of subcutaneous morphine patient controlled analgesia (SC-PCA) in lowering VAS (visual analogue score), total morphine consumption and postoperative side effect on cesarean section compared with intravenous morphine patient controlled analgesia (IV- PCA).Methods: This study is an experimental clinical trial using consecutive sampling technique. Sixty-four subjects were allocated into two groups of PCA morphine subcutaneously (SC-PCA) and the group PCA morphine intravenously (IV-PCA), each consisting of 32 subjects using permuted block randomization. Morphine concentration was 5 mg/ml (group SC-PCA) or the concentration of 1mg/ml (group IV-PCA). Both groups were then analyzed for VAS ratings, total morphine consumption, and adverse effects, post operatively at 4th, 8th, and 24th hour. Statistic analysis using repeated ANOVA test and t-test with p <0.05 onsidered significant.Result: Morphine consumption in IV-PCA group showed lower needs than SC-PCA (9.41 mg vs 4,9mg) p <0.001 24 at 24 hours postoperatively. The VAS at resting at 4th hours statistically significantly lower in IV-PCA group (1.06 ± 0.71 vs 0.81 ± 1.40, p=0.029) and at 8th hours (1.03 ± 0.59 vs 0.94 ± 0,9, p=0.048). The moving VAS at 4th hours statistically significant lower in IV-PCA group (2.31 ± 0.47 vs 1.45 ± 2.06, p=0.019) but the static or VAS at moving are not different clinically. Side effects of nausea and vomiting are more common in IV-PCA group. We conclude that SC-PCA provide analgesia more effective and decreases side effects in patients undergo sectio cesarea with spinal anesthesia.
REGIONAL ANESTHESIA IN MOLAR PREGNANCY WITH THYROTOXICOSIS IN A REMOTE HOSPITAL Ryalino, Christopher; Aryasa, Tjahya; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.22

Abstract

Hydatidiform mole or molar pregnancy is a benign Gestational Trophoblastic Disease (GTD) that originates from the placenta. Treatment consists of vacuum evacuation but rarely hysterectomy may be required. One common complication of molar pregnancy is hyperthyroid. Anesthetic management is often complicated by the associated systemic complications. These complications cannot be prevented, but with a better understanding of the disease, some measurements to avoid maternal mortality can be performed.  
LOW DOSE SPINAL ANESTHESIA FOR CESAREAN SECTION IN GRAVIDA WITH RHEUMATIC HEART DISEASE Senapathi, Tjokorda Gde Agung; Budiarta, I Gede; Astuti, Mira Kusuma
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.17

Abstract

Cardiac disease in pregnancy remains an important etiology of maternal and fetal morbidity and mortality.1 Mitral stenosis is the most commonly acquired valve lesion encountered in pregnant women and is almost invariably caused by Rheumatic Heart Disease (RHD).1 Pregnancy and peripartum period represent a physiologic burden that may worsen symptoms in even moderate degrees of cardiac disease.1 Consequently, many women are first diagnosed with cardiac disease during pregnancy.1 In this case report, we describe peripartum management of a 38 years old woman with Congestive Heart Failure functional class II, severe Mitral Stenosis, moderate Mitral Regurgitation, moderate Tricuspid Regurgitation because of Rheumatic Heart Disease. She successfully underwent cesarean section in low dose spinal anesthesia using 7 mg hyperbaric bupivacaine intrathecally. This report highlights that low dose spinal anesthesia remains a good option in anesthesia management for cesarean section in gravida with rheumatic heart disease, especially with severe mitral stenosis. 
The effectiveness of Patient Controlled Analgesia (PCA) morphine-ketamine compared to Patient Controlled Analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery Mahaalit Aribawa, I Gusti Ngurah; Agung Senapathi, Tjokorda Gde; Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Gede Widnyana, I Made; Aryabiantara, I Wayan; Parami, Pontisomaya; Nyoman Kurniasari, Pande; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.11

Abstract

Background: Laparotomy may cause moderate to severe after surgery pain, thus adequate pain management is needed. The addition of ketamine in patient controlled analgesia (PCA) morphine after surgery can be the option. This study aims to evaluate the effectiveness of PCA morphine-ketamine compared to PCA morphine in patient postoperative laparotomy surgery to reduce total dose of morphine requirement and pain intensity evaluated with visual analog scale (VAS). Methods: This study was a double-blind RCT in 58 patients of ASA I and II, age 18-64 years, underwent an elective laparotomy at Sanglah General Hospital. Patients were divided into 2 groups. Group A, got addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) and patients in group B received morphine (1mg/ml) by PCA. Prior to surgical incision both group were given a bolus ketamine 0,15mg/ kg and ketorolac 0,5mg/kg. The total dose of morphine and VAS were measured at 6, 12, and 24 hours postoperatively. Result: Total dose of morphine in the first 24 hours postoperatively at morphine-ketamine group (5,1±0,8mg) is lower than morphine only group (6,5±0,9mg) p<0,001. VAS (resting) 6 and 12 hour postoperative in morphine-ketamine group (13,4±4,8 mm) and (10,7±2,6 mm) are lower than morphine (17,9±4,1mm) p≤0,05 and (12,8±5,3mm) p≤0,05. VAS (moving) 6, 12, and 24 hour postoperative morphineketamine group (24,8±5,1mm), (18±5,6mm) and (9±5,6mm) are lower than morphine (28,7±5,2mm) p≤0,05, (23,1±6,0mm) p≤0,05, and (12,8±5,3mm) p≤0,05. Conclusions: Addition of ketamine in PCA morphine for postoperative laparotomy surgery reduces total morphine requirements in 24 hours compared to PCA morphine alone.
Effectiveness of Infusion Warmer Use to Prevent the Occurrence of Hypothermia and Shivering After General Anesthesia Action in General Hospital Center Sanglah Denpasar Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Kusuma Wijaya, Andi; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.3

Abstract

Introduction: Shivering and hypothermia after general anesthesia is a common complication in the recovery room. Heating methods and drugs  widely used, but not yet effective. The purpose of this study was to evaluate the effectiveness of using the infusion warmer in maintaining normal core temperature and prevent shivering. Materials and Methods: The study was a non blindnes randomized control trial study. This study aimed to compare the effectiveness of the use of infusion warmer in preventing the incidence of hypothermia and shivering after general anesthesia. Research conducted at the Sanglah Hospital in October 2016, with sample calculations 58 people who meet the inclusion and exclusion criteria. Both were divided into 2 groups, 29 groups of infusion warmer and 29 people without the infusion warmer Recording the results of assessing multiple parameters vital signs, hemodynamic, aldrette score, body temperature, and shivering from the beginning, after induction, and minutes to 5, 15, 30 , 60 in the recovery room. The data obtained were analyzed with SPSS software with a significance level of p <0.005 expressed significantly, with a relative risk <1 as a preventive. Results: From a comparative picture of events shivering and hypothermia in minutes to 5, 15, 30, 60 in the recovery room seen that the treatment group based on the group lower warmer than in the non warmer. This shows that the use of warmer can prevent the incidence of shivering and hypothermia in patients after general anesthesia. In test statistically significant with p <0.05. Conclusions: The use of infusion warmer can help reduce the incidence of hypothermia and shivering after general anesthesia action.
Low Dose Ketamin Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Novita Pradnyani, Ni Putu; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.4

Abstract

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Low-dose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psikomimetik like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.
THE SIGNIFICANCE OF MODIFIED PIRO SCORING WITH NLR BIOMARKER ON ENHANCING MORTALITY PREDICTION OF PATIENTS WITH VENTILATORS‑ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT Senapathi, Tjokorda Gde Agung; Budiarta, I Gede; Panji, Putu Agus Surya; Aprilnita, Aida
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (226.799 KB) | DOI: 10.15562/bjoa.v2i3.94

Abstract

Ventilator-associated pneumonia (VAP) is a pulmonary infection that occurs as a mechanical ventilator-related disease which accounts for almost 80% of hospital-acquired pneumonia with of high mortality rate, lengthens the hospital-stay rate and increases health costs. To provide a description of the likelihood of the patients life expectancy, mortality, and prognosis of patients in ICU, a scoring system should be utilized in order to assess the severity of the disease and estimate mortality during hospital treatment. The PIRO scoring system is a comprehensive concept that provides good validity and derivation in predicting mortality risk in a wide range severity of the disease so that it is very useful in the selection or categorization of patients, especially those admitted to the ICU with VAP. A conjunction or integration with a simple biomarker such as Neutrophil-to-lymphocyte ratio (NLR) provides a better performance of the tool in regards to the predictive value in VAP mortality risk estimation. Since the NLR has a strong predictive value, is simple, low-cost, and easily available compared to other biomarkers, therefore it is practical and useful for prognostic indications for VAP with conjunction with the PIRO score where medical facilities are lacking.
Contact force exerted on the maxillary incisors by direct laryngoscopy with mcgrath video laryngoscope in predicted difficult intubation Doddy Setiawan; Tjokorda Gde Agung Senapathi; I Gede Budiarta; I Gusti Ngurah Mahaalit Aribawa
Neurologico Spinale Medico Chirurgico Vol 4 No 2 (2021)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v4i2.162

Abstract

Patients with difficult airways who are going to undergo surgery under general anesthesia require special consideration from an anesthesiologist. Knowing the most significant risk of morbidity and mortality is often due to difficult cases of airway management. One of the most common complications and often becomes lawsuits in the field of anesthesia is dental trauma that occurs during the intubation process due to contact from laryngoscope blade to the teeth. This descriptive study will show the measured force exerted on the maxillary incisors at the time of performing laryngoscopy using a McGrath video laryngoscope in patients with a potentially difficult intubation (LEMON criteria ≥ 3). The contact force exerted on the maxillary incisors is measured using a special instrument. The contact force exerted on the maxillary incisors in patients with a potentially problematic airway was discovered to vary.
Pemetaan Permukiman Kumuh Menggunakan Sistem Informasi Geografis (SIG) Di Kota Singaraja Ni Putu Wira Kristyani; I Gede Yudi Wisnawa; I Gede Budiarta
Jurnal ENMAP Vol. 4 No. 1 (2023): Maret, Jurnal ENMAP
Publisher : Universitas Pendidikan Ganesha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23887/enmap.v4i1.62013

Abstract

The issue of slums in urban areas is not easy to address, so it requires serious attention from the community and the Government. The development of a city is due to population growth, which increases the demand for land and consequently leads to the emergence of slums. Based on this, research is needed to assess the level of slums in Singaraja City. This study aims to map the level of slums in residential areas in Singaraja City and examine the impact of slum settlements on the Spatial Planning of Buleleng Regency. Data for this research were obtained through primary and secondary field surveys, and the data were analyzed using quantitative and qualitative analysis techniques. The findings of this study include a map of slum settlements in Singaraja City, providing information on the category of moderate slum levels in the Anyar Village District, mild slum levels in Kampung Baru Village, and areas outside these villages classified as non-slum settlements in Singaraja City. The impact of slum settlements on the spatial planning of Buleleng Regency is observed in the trade and services zone as well as the coastal border zone.
KAJIAN PENGELOLAAN WILAYAH PESISIR DAN LAUT BERBASIS SISTEM INFORMASI GEOGRAFIS DALAM UPAYA ANTISIPASI GREENHOUSE EFFECT I Gede Budiarta; I Gst Ngr Yoga Jayantara
Jurnal ENMAP Vol. 4 No. 2 (2023): September, Jurnal ENMAP
Publisher : Universitas Pendidikan Ganesha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23887/enmap.v4i2.75996

Abstract

Ketika radiasi matahari mencapai atmosfer bumi, sebagian panas akan dipantulkan oleh atmosfer dalam bentuk sinar inframerah, dan sebagian lagi akan diteruskan ke permukaan bumi memantukan kembali panas tersebut dan sebagian diserap oleh gas rumah kaca seperti Karbondioksida (CO2), Metana (CH4) dan NO di atmosfer. Gas-gas ini menyerap dan memantulkan kembali radiasi gelombang yang dipancarkan bumi dan akibatnya panas tersebut akan tersimpan di permukaan bumi. Keadaan ini terjadi terus menerus sehingga mengakibatkan efek rumah kaca. Efek rumah kaca akan berpengaruh luas terhadap fenomena di permukaan bumi, baik fenomena biotik, abiotik, maupun kultur. Pada fenomena abiotik, pengaruhnya dapat dilihat pada: Polusi Udara Pemanasan Global, Perubahan Iklim, Pencairan Es Di Kedua Kutub, Kenaikan Muka Air Laut. Efek rumah kaca dan pemanasan global mengakibatkan dampak yang luas dan serius bagi aktivitas sosial-ekonomi masyarakat meliputi : (a) gangguan terhadap fungsi kawasan pesisir dan kota pantai, (b)gangguan terhadap fungsi prasarana dan sarana seperti jaringan jalan, pelabuhan dan bandara (c) gangguan terhadap permukiman penduduk, (d) pengurangan produktivitas lahan pertanian, (e) peningkatan resiko kanker dan wabah penyakit, dan sebagainya. Adapaun langkah-langkah yang bisa kita lakukan adalah sebagai berikut: Hemat pemakaian listrik; Hemat pemakaian air; 3 R (Reduce, Reuse, Recycle); Mencegah penebangan hutan; Penghijauan/reboisasi; dan Jangan sering-sering naik kendaraan pribadi.
Co-Authors Adinda Putra Pradhana Anak Agung Gde Agung Adistaya Andi Kusuma Wijaya, Andi Aprilnita, Aida Astuti, Mira Kusuma Bharata, Ida Bagus Arya Yoga Christopher Ryalino Dewa Made Atmaja Dharma, I Gusti Bagus Wirya Doddy Setiawan Elisma Nainggolan, Elisma I Gede Yudi Wisnawa I Gede Yudi Wisnawa I Gst Ngr Yoga Jayantara I Gst Ngr Yoga Jayantara I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Made Gede Widnyana I Made Sarmita I Putu Agus Surya Panji I Wayan Aryabiantara, I Wayan I Wayan Krisna Eka Putra I Wayan Treman Ida Bagus Made Astawa Made Pasek Oka Adnyana Made Sinta Devi Dian Prativa Made Widnyana Made Wiryana Mardiana, Oriza Ni Putu Lehni Ni Putu Novita Pradnyani, Ni Putu Ni Putu Wira Kristyani Pande Nyoman Kurniasari, Pande Pontisomaya Parami Pratiwi, Elok Surya Suryana, I Gede Putu Eka Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Agung Senapathi Wayan Damar Windu Kurniawan Wayan Damar Windu Kurniawan Wulandari, Ni Ketut Catur Wulandari, Ni Nyoman Tri