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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Neuroanestesi Indonesia

Avidar, Yoppie Prim

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Author-ID : 2222738

Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

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EuroSCORE II as Predictor of Mortality and Morbidity in Post-CABG Patient in Dr. Soetomo General Academic Hospital Rianda, Rama Azalix; Semedi, Bambang Pujo; Subagjo, Agus; Avidar, Yoppie Prim
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 1 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a scoring system to predict mortality risk after cardiac surgery. EuroSCORE II was introduced to replace and show superiority over EuroSCORE I which tends to overestimate the risk of heart surgery procedures and have a low discrimination ability. Meanwhile, this is the first study to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Objective: This study aims to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Methods: This is a retrospective study using medical records of CABG patients in Dr. Soetomo General Academic Hospital from January 2016 to December 2017. Results: Out of 39 Patients who have performed CABG surgery, most were male (89.7%) with the highest age range of 46-65 years (59%). Deceased patients had an average EuroSCORE II of 22.36% and SD±26.97%7%, while 27 patients who survived had an average EuroSCORE II of 6.78% and SD±6.4%. Based on morbidity assessment, EuroSCORE II only accurately predicted the risk of kidney failure and did not properly assess the length of inotropic use, vasopressors, hospitalization time, the risk of arrhythmias, low cardiac output syndrome, Durante-operative bleeding, and the need for blood transfusion. These inaccuracies occurred because the samples that were included varied based on their standard deviation and pattern-less graph. Conclusion: EuroSCORE II is inadequate to predict morbidity and mortality in postoperative patients, therefore, it is considered less effective.

Effectiveness and Safety of Prolonged Needle Decompression Procedures in Tension Pneumothorax Patients with COVID-19 Koeshardiandi, Mirza; Wicaksana, Zulfikar Loka; Semedi, Bambang Pujo; Avidar, Yoppie Prim
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 1 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Introduction: Coronavirus disease-19 (COVID-19) has become a pandemic that is still ongoing today. This is a new challenge for health workers in handling emergency cases. Several COVID-19 patients arrived at the hospital with severe respiratory problems. Meanwhile, other pathological conditions causing respiratory failure must also be considered, such as pneumothorax. Objective: This study aimed to examine the effective emergency procedures to treat COVID-19 cases with tension pneumothorax. Case Report: A 45-year-old male patient arrived with a referral letter from a pulmonologist with a diagnosis of simple pneumothorax and pneumonia. The patient also presented a positive SARS COV-2 PCR test result. The patient complained about a worsening of shortness of breath. A symptom of dry cough for 14 days was also reported. Chest radiograph examination subsequently indicated right tension pneumothorax. In the emergency ward, needle decompression procedure connected to the vial containing sterile intravenous fluids was performed. Re-examination of the chest x-ray demonstrated right pulmonary re-expansion. The patient was monitored and after four days, needle decompression was removed and no chest tube was inserted because complete resolution of the lungs had occurred. This case illustrates that tension pneumothorax causes worsening of the patient's condition with COVID-19 diagnosis. In another case of tension pneumothorax in a COVID-19 patient, needle decompression of the 2nd intercostal space and the mid-clavicular line was performed as initial treatment followed by chest tube insertion as definitive treatment. However, in this case, chest tube approach was not carried out because the patient had demonstrated clinical and radiological improvement and a worsening condition had not occurred. Conclusion: Prolonged needle decompression connected to a vial containing sterile intravenous fluids as deep as 2 cm from the water surface is an effective procedure in the management of tension pneumothorax even without the installation of a chest tube.

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies Avidar, Yoppie Prim; Salinding, Agustina; Hamzah; Uhud, Akhyar Nur; Maulydia
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.87-97

Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.

Manajemen Anestesi pada Pasien dengan Akromegali yang Menjalani Prosedur Reseksi Tumor Adenohipofise melalui Pendekatan Sublabial Transphenoidal Hamzah, Hamzah; Farris, Muhammad; Avidar, Yoppie Prim; Rehatta, Nancy Margaritta
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Akromegali merupakan penyakit akibat produksi growth hormone secara berlebihan dan umumya disebabkan oleh adenoma kelenjar hipofisis. Insidensi akromegali pertahunnya mencapai 5 kasus per 1 juta orang dengan prevalensi 60 kasus per 1 juta orang. Manifestasi klinis pada tiap pasien berbeda, tergantung dari kadar dari growth hormone, insulin-like growth factor-1, usia pasien, ukuran tumor, dan keterlambatan diagnosis. Pasien dengan akromegali telah dilaporkan memiliki tingkat mortalitas dan morbiditas yang tinggi, peningkatan angka kematian pada umumnya terkait dengan komplikasi kelainan kardiovaskular, serebrovaskular dan masalah respirasi. Pada kasus ini, seorang laki-laki usia 57 tahun, berat badan 86 kg, dengan PS-ASA II, perawakan khas akromegali dan ditunjang dengan hasil pemeriksaan hormon. Pada pemeriksaan CT-scan ditemukan massa di ruang sella tursica. Pemeriksaan lebih lanjut menunjukkan pembesaran lidah yang menimbulkan kesulitan manajemen jalan nafas dan diklasifikasikan sebagai mallampati kelas II. Pasien akan dilakukan prosedur reseksi tumor adenohipofise melalui pendekatan sublabial transpheonidal dengan anestesi umum. Sebagian besar anestesi untuk operasi pada pasien akromegali membutuhkan perhatian khusus dibandingkan dengan tumor kepala yang lain.Anesthesia Management in Patients with Acromegaly Underlying Adenohipofise Tumor Resection Procedures Through a Transphenoidal Sublabial ApproachAcromegaly and gigantism are clinical abnormalities due to excessive growth hormone production, usually resulted from pituitary adenoma. The incidence of acromegaly is 5 cases per 1 million people per year while the prevalence is 60 cases per 1 million people. Clinical manifestations in each patient is depending on the levels of growth hormone, insulin-like growth factor-1, age of the patient, tumor size and the delay in diagnosis. Increased of morbidity and mortality have been reported in acromegaly patients predominantly caused by complications of cardiovascular, cerebrovascular and respiratory problem. A 57 year old male, 86 kgs, ASA physical status II. His appearance suggested acromegaly, diagnosis then confirmed with hormonal examination and imaging of the pituitary mass. Further examination presented tongue enlargement which cause airway management difficulty and classified as mallampati class II. The patient will undergo adenohipofise tumor resection procedures through a transphenoidal sublabial approach with general anaesthesia. Most of anaesthesia in acromegaly patient surgery require special attention compared with other head tumors.

Co-Authors Agustina Salinding Farris, Muhammad Hamzah Hamzah Hamzah Koeshardiandi, Mirza Maulydia Rehatta, Nancy Margaritta Rianda, Rama Azalix Semedi, Bambang Pujo Subagjo, Agus Uhud, Akhyar Nur Wicaksana, Zulfikar Loka

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