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All Journal Jurnal Anestesiologi Indonesia Medical Journal of Indonesia Majalah Anestesia dan Critical Care Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia World Nutrition Journal The New Ropanasuri Journal of Surgery Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Jurnal Komplikasi Anestesi
Dita Aditianingsih
Departemen Anestesi Dan Terapi Intensif; Fakultas Kedokteran; Universitas Indonesia/ Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo; Jakarta
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Journal : Majalah Anestesia dan Critical Care

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Penanganan Hipoperfusi Pascaoperasi Esophagectomy Gastric Pull Up dengan AKI dan Malnutrisi Prasetyo, Eko Budi; Aditianingsih, Dita; George, Yohanes WH
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Abstract

Pasien bedah dengan risiko tinggi adalah mereka yang menjalani pembedahan dengan resiko tinggi untuk morbiditas dan mortalitas dengan angka kejadian mortalitas lebih besar dari 5% karena adanya penyakit penyerta atau derajat pembedahan. Penelitian terakhir di Inggris menunjukan bahwa pasien yang menjalani pembedahan beresiko tinggi mencakup 12,5 % dari jumlah total pasien yang masuk ke rumah sakit tetapi lebih dari 80% kematian, dengan kurang dari 15% dari mereka yang masuk ke Intensive Care Unit (ICU) paskaoperasi. Berikut ini adalah sebuah laporan kasus dari seorang laki-laki berusia 75 tahun yang menjalani esofagektomi gastric pull up yang disebabkan oleh kanker esophagus. Sebelum operasi, pasien mengalami malnutrisi berat dan hipoalbumin. Pasien mengalami komplikasi yang mencakup hipoperfusi, cedera ginjal akut dan pneumonia di ICU. Berfokus pada penatalaksanaan hipoperfusi, pasien menjalani hemodinamik goal directed therapy dengan target metabolik akhir yaitu normalisasi laktat, ScV02 dan tingkat PC02 gap. Pasien dipindahkan ke ruang rawat dalam keadaan baik pada hari ke-9. Kata Kunci: Esofagektomi, haemodynamic goal directed therapy, hipoperfusi, pasien bedah resiko tinggi Hypoperfusion Management Post Esophagoscopy Gastric Pull Up with Acute Kidney Injury and Malnutrition High-risk surgical patient is defined as a patient, undergoing surgery, who is at a high risk for morbidity and mortality with an expected mortality greater than 5% due to the coexisting diseases and/or the severity of surgery. A recent study in the United Kingdom demonstrated that patients undergoing high-risk general surgical procedures comprised only 12.5% of surgical admissions to hospitals but over 80% of deaths, with less than 15% of these high-risk patients admitted to the ICU postoperatively. This is a case report of 75 years old male who underwent esophagectomy gastric pull up due to esophageal cancer. Preoperatively patient suffered from severe malnutrition and hypoalbuminemia. In the ICU, patient some complications such as hypoperfusion, acute kidney injury and pneumonia. Focusing on hypoperfusion management, patient was treated using haemodynamic goal-directed therapy with end point metabolic target of normalize Lactate, ScVO2 and PCO2 gap levels. Patient was transferred to the ward in good condition on the 9th day. Key words: Esophagectomy, haemodynamic goal-directed therapy, high-risk surgical patient, hypoperfusion Lee N, Hamilton M, Rhodes A.Goal-directed therapy in high risk surgical patients : clinical review. Crit Care. 2009;13:231. Pearse RM, Harrison DA, James P. Identification and characterization of the high-risk surgical population in the United Kingdom. : research. Crit Care. 2006;10:R81 Boyd O, Jackson N. How is risk defined in high-risk surgical patient management? clinical review. Crit Care. 2005;9:390–6. Kirov MY, Kuzkov VV, Molnar Z. Perioperative haemodynamic therapy. Current opinion in Crit Care. 2010;16:384–92. Park DP, Welch CA, Harrison DA. Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis is the ICNARC case mix programme database. Crit Care. 2009;13(Suppl 2). Absi A, Adelstein DJ, Rice T. Esophageal cancer. Cleveland clinic. 2010 Agu. Wikipedia.org [internet]. Esophagectomy [diperbaharui 2014 Jan 29]. Tersedia dari:http://en.wikipedia.org Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–37. Dalfino L, Giglio MT, Puntillo F.Hemodynamic goal-directed therapy and post operative infections: earlier is better. A systematic review and meta-analysis.Crit Care. 2011;15:R154. Pearse RM, Rhodes A, Grounds RM. How to optimize management of high-risk surgical patients: clinical review. Crit Care. 2004;8:503–7. Isabel M, Correia D, Waitzberg D. The impact of malnutrition on morbidity, mortality, length of hospital stay and cost evaluated through multivariate model analysis. Clinical Nutrition. 2003;22 (3):235–9. Ramanathan TS, Moppeti IK, Wenn R. POSSUM scoring for patients with fractured neck of femur. BJA. 2005;94(4):430–3. Riskprediction.org.uk [internet]. Risk prediction in surgery, Dalam; c1998–2003[diperbaharui 2010 Apr].Tersedia dari: http://www.riskprediction.org.uk Vincent JL, Moreno R. Clinical review: Scoring systems in the critically ill. Crit Care. 2010;14:207Hicereti licaescremum at, es arem dum ili sero, acibuturs culi iam faude nonocupimum stiam, Ti. Ipio egerbi patum sendum dem, quostis fec in tus vivit. Grat, puliacii conum more perit, simis fatquempor losuliisquam demena, nenatumusum stractortea me etortent? quod medetis.
Efek Perbedaan Volume Tidal Intraoperatif terhadap Rasio Pao2/Fio2 Pascaoperasi Abdominal Mayor Aditianingsih, Dita; Jefferson, Jefferson; Mandagi, Michael
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Abstract

Komplikasi paru pascaoperasi merupakan salah satu penyebab penting morbiditas dan mortalitas pascaoperasi yang berkaitan dengan anestesia dan pembedahan. Studi ini membandingkan volume tidal 6 mL/kgBB dan 10 mL/kgBB dengan menggunakan PEEP dan pengaruhnya terhadap komplikasi paru. Setelah mendapat persetujuan dari Komite Etik Penelitian Kesehatan FKUI/RSCM, dilakukan uji klinis acak terhadap 52 pasien operasi abdominal mayor elektif di Rumah Sakit Cipto Mangunkusumo pada bulan November 2014–April 2015. Subjek diacak dalam 2 kelompok, yaitu kelompok dengan volume tidal 6 mL/kg dengan PEEP 6 cmH2O dan volume tidal 10 mL/kg dengan PEEP 6 cmH2O. Keluaran primer adalah pemeriksaan fungsi paru menggunakan rasio PaO2/FiO2. Keluaran sekunder adalah komplikasi paru (pneumonia, atelektasis, ARDS, gagal napas), komplikasi ekstraparu (SIRS, sepsis, sepsis berat), dan mortalitas dalam 28 hari pascaoperatif. Tidak ditemukan perbedaan yang bermakna rasio PaO2/FiO2 antara kelompok VT-6 mL/kg dengan VT-10 mL/kg (p>0,05), baik pada awal operasi, akhir operasi, hari pertama pascaoperasi, dan hari kedua pascaoperasi. Tidak ada perbedaan bermakna pada semua keluaran sekunder diantara kedua kelompok. Simpulan, volume tidal 6 hingga 10 mL/kg dengan PEEP 6 cmH2O aman untuk dipakai pada pasien yang menjalani operasi abdominal mayor. Kata kunci: Operasi abdominal mayor, pemeriksaan fungsi paru, ventilasi mekanis, volume tidal The Effect of Intraoperative Tidal Volume Difference against Postoperative PaO2/FiO2 Ratio for Patients undergoing Major Abdominal SurgeryPostoperative pulmonary complications are closely related to postoperative morbidity and mortality associated with anesthesia and surgery. Mechanical ventilation setting affects postoperative pulmonary complications. This study aimed to compare the effect between tidal volume of 6 mL/kgBW and 10 mL/kgBW with PEEP and its effect on pulmonary complications. After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo (RSCM) Hospital, a randomized clinical trial was done on 52 elective major abdominal surgery patients at RSCM Hospital from November 2014 to April 2015. Subjects were randomized into two groups: the group receiving tidal volume 6 mL/kgBW with PEEP 6 cmH2O (VT-6 group) and the group receiving tidal volume of 10 mL/kgBW with PEEP 6 cmH2O (VT-10 group). The primary output was the assessment of pulmonary function using the ratio of PaO2/FiO2. Secondary outputs were pulmonary complications (pneumonia, atelectasis, ARDS, respiratory failure), extrapulmonary complications (SIRS, sepsis, severe sepsis), and mortality within 28 days. Both groups showed similar baseline characteristics. There was no significant PaO2/FiO2 ratio differences between both groups (p>0,05) at the beginning of surgery, at the end of surgery, at the first postoperative day, and the second postoperative day. There was no significant difference in all secondary outcomes between both groups. The use of tidal volume of 6 to 10 mL/kg with PEEP 6 cmH2O was considered safe for patients undergoing major abdominal surgery. Key words: Major abdominal surgery, mechanical ventilation, pulmonary function tests, tidal volume
Co-Authors Achmad Noerkhaerin Putra Ahmad Imron Anindhita, Bintari Anne Suwan Djaja Ardiyan Ardiyan Baktiar, Yoshua Baktiar, Yoshua Bob Firman Djaja, Anne S. George Yohannes George, Yohanes W.H. George, Yohanes WH Hafidz, Noor Indro Mulyono Jefferson, Jefferson Kwa, Melvin D.B. Luciana Budiati Sutanto Luki Sumaratih Mandagi, Michael Manggala, Sidharta Kusuma Nurul Ratna Mutu Manikam Palu, Raphael Putra Pittara Pansawira Putra, Muhammad A Ramdhani, Aris Rudyanto Sedono, Rudyanto Rudyanto Soedono Sania, Nina Singal, Anna Maurina Soeharto, Wuryantoro Sudarsono Sugiarto, Adhrie Wahyu Ika Wardhani Yohanes W George Yulia Rosa Saharman Zahra, Raihanita