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All Journal Jurnal Anestesiologi Indonesia Jurnal Ilmu Kedokteran dan Kesehatan Cermin Dunia Kedokteran
Rusli, Joseph
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Asidosis Laktat pada Ketoasidosis Diabetik Berat di Instalasi Perawatan Intensif Roostati, Rina Lizza; Rusli, Joseph
Cermin Dunia Kedokteran Vol 43, No 7 (2016): Kulit
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (339.033 KB) | DOI: 10.55175/cdk.v43i7.83

Abstract

Pendahuluan: Asidosis laktat merupakan komplikasi yang jarang terjadi pada pasien kritis yang mengalami ketoasidosis diabetik (KAD). Kasus: Seorang pria 76 tahun masuk ke ICU dengan gagal napas dan henti jantung. Pasien didiagnosis dengan penyakit bronkopneumonia bilateral dan diabetes melitus tidak terkontrol. Setelah resusitasi jantung paru, sirkulasi spontan pasien dapat kembali. Pemeriksaan klinis dan laboratorium pasien menunjukkan kondisi berat, yaitu asidosis laktat pada KAD, syok tahap keempat disertai gangguan elektrolit berat. Setelah EGDT (Early Goal-directed Treatment) klinis stabil pada hari ketiga dan kadar laktat turun bermakna (2,7 mmol/L). Ringkasan: Asidosis laktat dapat terjadi pada pasien kritis KAD akibat hipoperfusi jaringan dan gangguan metabolisme glukosa. Pada umumnya pasien dengan hiperlaktatemia berat, asidosis, syok tahap keempat, sepsis dan riwayat henti jantung jarang bertahan hidup. Namun, dengan penatalaksanaan terarah pasien berhasil bertahan dan kadar laktat turun bermakna. Kadar laktat dalam darah dapat digunakan sebagai parameter keberhasilan terapi pasien sakit kritis.
Asidosis Laktat pada Ketoasidosis Diabetik Berat di Instalasi Perawatan Intensif Roostati, Rina Lizza; Rusli, Joseph
Cermin Dunia Kedokteran Vol 43, No 7 (2016): Kulit
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v43i7.83

Abstract

Pendahuluan: Asidosis laktat merupakan komplikasi yang jarang terjadi pada pasien kritis yang mengalami ketoasidosis diabetik (KAD). Kasus: Seorang pria 76 tahun masuk ke ICU dengan gagal napas dan henti jantung. Pasien didiagnosis dengan penyakit bronkopneumonia bilateral dan diabetes melitus tidak terkontrol. Setelah resusitasi jantung paru, sirkulasi spontan pasien dapat kembali. Pemeriksaan klinis dan laboratorium pasien menunjukkan kondisi berat, yaitu asidosis laktat pada KAD, syok tahap keempat disertai gangguan elektrolit berat. Setelah EGDT (Early Goal-directed Treatment) klinis stabil pada hari ketiga dan kadar laktat turun bermakna (2,7 mmol/L). Ringkasan: Asidosis laktat dapat terjadi pada pasien kritis KAD akibat hipoperfusi jaringan dan gangguan metabolisme glukosa. Pada umumnya pasien dengan hiperlaktatemia berat, asidosis, syok tahap keempat, sepsis dan riwayat henti jantung jarang bertahan hidup. Namun, dengan penatalaksanaan terarah pasien berhasil bertahan dan kadar laktat turun bermakna. Kadar laktat dalam darah dapat digunakan sebagai parameter keberhasilan terapi pasien sakit kritis.
Anesthetic Management Of Peritonitis And Septic Shock In Colorectal Cancer: A Case Report Rusli, Joseph; Sugiaman, Angela Mulyana; Gunadi, Julia Windi
Jurnal Ilmu Kedokteran dan Kesehatan Vol 12, No 9 (2025): Volume 12 Nomor 9
Publisher : Prodi Kedokteran Fakultas Kedokteran Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jikk.v12i9.22461

Abstract

A 64-year-old male presented with signs of peritonitis, including severe abdominal pain, distension, and dehydration. Laboratory findings showed elevated inflammatory markers (leukocyte count: 19,500/mm³, C-reactive protein: 25 mg/dL), impaired renal function (serum creatinine: 2.1 mg/dL), and metabolic acidosis (pH: 7.25, lactate: 4.5 mmol/L). Imaging revealed a perforated rectal tumor with extensive peritoneal contamination. Emergency exploratory laparotomy was performed, involving tumor resection, colostomy formation, and peritoneal lavage. Hemodynamic instability due to septic shock was managed with norepinephrine to maintain blood pressure. Dobutamine was used to enhance cardiac output, while nitroglycerin supported coronary perfusion to prevent ischemic complications. Postoperatively, the patient required intensive care, including ventilatory support, fluid resuscitation, and tailored antibiotic therapy. Despite complications such as transient paralytic ileus, the patient was extubated on day five and discharged to the general ward by day ten. This case emphasizes the importance of early diagnosis, prompt surgical intervention, and personalized hemodynamic management in malignant-associated peritonitis. Multidisciplinary collaboration is critical to optimizing outcomes. Limitations of this case include its single-patient design. Further research should focus on advanced diagnostic tools and tailored resuscitation protocols to improve the management of similar cases.
Anesthetic Management for Sternotomy in a Patient with Anterior Mediastinal Tumor: A Case Report Kurniawan, Arfian Pascalis; Rusli, Joseph; Hapdijaya, Indra; Gunadi, Julia Windi
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.72407

Abstract

Background: Anterior mediastinal masses pose significant anesthetic challenges, risking airway obstruction, cardiovascular collapse, and hemodynamic instability, especially in the supine position. Preoperative assessment, including imaging and cardiopulmonary evaluation, is crucial. Anesthetic management prioritizes spontaneous ventilation, airway patency, and hemodynamic stability, often employing awake intubation, inhalational induction, and neuromuscular blockade avoidance. A multidisciplinary, individualized anesthetic management of sternotomy approach optimizes outcomes.Case: 50-year-old male with anterior mediastinal tumor scheduled for elective sternotomy. The patient experienced chest pain and persistent cough with displacement and indentation of the aorta and inferior vena cava as observed on contrast-enhanced CT scan, indicating high surgical risk. Anesthesia induction involved fentanyl, midazolam, atracurium, and propofol, followed by intubation with a left-sided double-lumen tube for one-lung ventilation.Discussion: Mediastinal masses pose significant anesthetic risks, primarily due to the potential for mediastinal mass syndrome (MMS). Preoperative imaging and symptom-based risk stratification are critical. Anesthetic goals include maintaining spontaneous ventilation and avoiding neuromuscular blockade when possible, as loss of spontaneous ventilation is often linked to MMS onset. However, in procedures like sternotomy requiring deep anesthesia and muscle relaxation, airway control may necessitate neuromuscular agents. In such cases, preparedness for difficult ventilation is essential. We utilized a left-sided double-lumen tube to facilitate one-lung ventilation and surgical access. Postoperative ICU monitoring is advised for high-risk patients.Conclusion: This case importance lies in the complex anesthetic management of sternotomy for anterior mediastinal mass resection, requiring meticulous planning to prevent airway and cardiovascular compromise. A multidisciplinary approach and early diagnosis are key to optimizing patient safety and outcomes.
Co-Authors Gunadi, Julia Windi Hapdijaya, Indra Kurniawan, Arfian Pascalis Roostati, Rina Lizza Sugiaman, Angela Mulyana