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Perbandingan Efek Inflasi Cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml dengan Lidokain HCl 1,5 mg/kgbb. intravena Terhadap Kejadian Batuk dan Hemodinamik Sebelum dan Sesudah Ekstubasi pada Anestesia Umum Bangun, Chrismas Gideon; Solihat, Yutu; Umar, Nazaruddin
Cermin Dunia Kedokteran Vol 42, No 6 (2015): Malaria
Publisher : PT. Kalbe Farma Tbk.

Latar belakang dan Objektif : Batuk dan gejolak hemodinamik saat ekstubasi merupakan problem klinis yang sering pada anestesi umum. Lidokain intravena diketahui dapat mengurangi refleks batuk dan kenaikan hemodinamik bila diberikan beberapa saat sebelum ekstubasi, namun durasinya singkat dan menyebabkan sedasi yang dapat menunda pemulihan. Cuff pipa endotrakea terbuat dari polyvynilchloride memungkinkan difusi lidokain hidrofobik untuk bekerja topikal pada mukosa trakea. Alkalinisasi memungkinkan difusi lidokain pada konsentrasi lebih rendah. Sebuah penelitian in vitro menyebutkan pH optimal lidokain untuk berdifusi paling baik setelah 90 menit adalah pH 7,4 dengan campuran Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml. Penelitian ini bertujuan untuk membandingkan efektifitas campuran lidokain dan bikarbonat tersebut untuk mengurangi kejadian batuk dan peningkatan hemodinamik saat ekstubasi dibandingkan lidokain intravena. Metode Sejumlah 70 sampel pria dan wanita, 18- 50 tahun, status fisik ASA 1 menjalani pembedahan elektif, perkiraan lama operasi diatas 90 menit dengan anestesi umum dengan intubasi endotrakea di Rumah Sakit H. Adam Malik Medan dan rumah sakit jejaring. Sampel dibagi acak menjadi 2 kelompok. Kelompok I mendapat inflasi cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml dan suntikan Plasebo intravena 3 menit sebelum ekstubasi. Kelompok II mendapat inflasi cuff dengan Plasebo dan suntikan Lidokain HCl 1,5 mg/kgBB intravena 3 menit sebelum ekstubasi. Kejadian batuk dicatat pada 1 menit sebelum, 2, 4 dan 8 menit sesudah ekstubasi. Tekanan darah sistolik, tekanan darah diastolik, MAP dan laju nadi dicatat saat jahit kulit (baseline), ekstubasi, 2,4, dan 8 menit setelah ekstubasi. Semua data dianalisis menggunakan uji Crosstab dan Chi square. Hasil : Inflasi cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml lebih mengurangi kejadian batuk dan kenaikan tekanan darah dan laju nadi dibanding Lidokain HCl 1,5mg/kgBB intravena. Simpulan : Inflasi cuff Lidokain HCl 2% 6 ml + Natrium Bikarbonat 7,5% 0,6 ml dapat digunakan sebagai alternatif untuk mengurangi kejadian batuk dan kenaikan hemodinamik saat ekstubasi pada anestesi umum.Background and Objective : Cough and hemodynamics turmoil during extubation in general anesthesia is a common clinical problem. Intravenous lidocaine is generally administered just before extubation to reduce the risk. However, short duration (5-20 minutes), and sedation risk can delay recovery. Endotracheal tube cuff made of polyvynilchloride allows diffusion of hydrophobic lidocaine, and acts topically on tracheal mucosa. Alkalinization allow diffusion of lidocaine in smaller concentrations. An in-vitro study stated that optimal pH of lidocaine for diffusion was 7.4 by mixing 6 ml Lidocaine HCl 2% with 0,6 ml Sodium Bicarbonate 7.5%. This study is to compare the effectiveness of lidocaine and bicarbonate mixture with intravenous lidocaine in reducing cough incidence and to improve hemodynamics during extubation.Methods : Samples were 70 patients, aged 18-50 years, ASA 1, underwent elective surgery with approximate duration more than 90 minutes under general anesthesia with endotracheal intubation in Adam Malik Hospital in Medan and network hospitals. The sample was divided randomly into 2 groups. Group I got cuff inflation with 6 ml Lidocaine HCl 2% + 0,6 ml Sodium Bicarbonate 7,5% and intravenous injection of placebo 3 minutes before extubation. Group II received cuff inflation with placebo and intravenous lidocaine HCl 1.5 mg / kg 3 minutes before extubation. Cough events recorded at one minute before, 2, 4 and 8 minutes after extubation. Systolic blood pressure, diastolic blood pressure, MAP and pulse rate are recorded at wound closure (baseline), extubation, 2, 4, and 8 minutes after extubation. All data were analyzed using Chi square test and Crosstab.Result : Cuff inflation with 6 ml Lidocaine HCl 2% + 0.6 ml Sodium Bicarbonate 7.5% reduced the incidence of cough and increase in blood pressure and pulse rate better compared to intravenous Lidocaine HCl 1.5 mg / kg. Conclusion : Cuff inflation with 6 ml Lidocaine HCl 2% + 0.6 ml Sodium Bicarbonate 7.5% can be used as an alternative in reducing the incidence of cough and hemodynamics increase during extubation in general anesthesia.Â

PERBANDINGAN FLUOKSETIN 20 MG DENGAN AMITRIPTILIN 12,5 MG SEBAGAI ADJUVAN KOMBINASI PARASETAMOL DAN MORFIN DALAM MENGURANGI NYERI PADA PASIEN NYERI KANKER Ramud, Samawi Husein; Hamdi, Tasrif; Bangun, Chrismas Gideon; Yunanda, Yuki
Jurnal Anestesi Perioperatif Vol 12, No 3 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v12n3.3628

Data WHO menunjukkan bahwa 30–40% pasien kanker mengalami nyeri sedang atau berat. Empat kelas obat antidepresan dapat dipakai dalam pengobatan nyeri neuropatik. Penelitian ini bertujuan untuk mengetahui perbandingan fluoksetin 20 mg dengan amitriptilin 12,5 mg sebagai adjuvant kombinasi parasetamol 1000 mg dalam mengurangi gejala nyeri pada pasien nyeri kanker. Penelitian dilaksanakan sejak Juli–September 2023 di klinik nyeri Rumah Sakit Umum Pusat Haji Adam Malik Medan. Penelitian ini adalah uji klinis acak tersamar. Sebanyak 40 subjek dibagi dalam 2 kelompok. Kelompok A (n=20) mendapat fluoksetin, morfin dan parasetamol, sedangkan kelompok B (n=20) mendapat amitriptilin, morfin dan parasetamol. Skor nyeri pada subjek diukur dengan menggunakan PainDETECT. Data dianalisis secara univariat dan bivariat. Data bivariat dianalisis dengan uji Chi-Square, T-Test Independent, T-Test Paired dan Mann-Whitney. Terdapat penurunan skor numeric rating scale dan PainDETECT yang signifikan antara sebelum dan setelah pemberian fluoksetin maupun amitriptilin dengan nilai p<0,05. Kelompok fluoksetin maupun amitriptilin dapat menurunkan skor numeric rating scale dan PainDETECT secara statistik, akan tetapi tidak bermakna secara klinis.

Comparison of Fluoxetine (20 Mg) and Amitriptyline (12.5 Mg) As Adjuvants for The Combination of Paracetamol and Morphine in Cancer Patients' Pain Relief Ramud, Samawi Husein; Hamdi, Tasrif; Bangun, Chrismas Gideon; Yunanda, Yuki
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 1 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.59070

Background: Pain is one of the most common symptoms in cancer which affects 30–50% of patients on average and rises to 70–90% in cases of advanced disease. As cancer advances, so does the frequency of discomfort associated with the illness. When cancer is detected in its terminal stage, 30–40% of patients report experiencing moderate pain, and 60–100% report experiencing severe pain. Tricyclic antidepressants (TCAs), selective serotonin and norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs) are the four families of antidepressant medications that have been investigated for use in the treatment of neuropathic pain.Objective: This research was conducted at the pain clinic of Adam Malik Hospital, this study intends to compare the effectiveness of fluoxetine with amitriptyline as an adjuvant to the combination of paracetamol and morphine in reducing pain symptoms in cancer patients.Methods: This study was designed as a randomized, double-blind clinical experiment. The study was carried out in 2023 between July and September. Two groups of forty research participants receiving outpatient care at the pain clinic were formed. Fluoxetine, morphine, and paracetamol were administered to group A (n = 20), whereas amitriptyline, morphine, and paracetamol were administered to group B (n = 20). PainDETECT was used to measure the subjects' pain scores. Both univariate and bivariate data analysis was done. The Chi-Square test, Independent T-test, Paired T-test, and Mann-Whitney were used to examine the bivariate data.Result: The delivery of amitriptyline and fluoxetine resulted in a substantial reduction in PainDETECT scores, with a p-value of less than 0.05.Conclusion: This study show that PainDETECT score was statistically reduced in both the fluoxetine and amitriptyline groups but the reduction was not clinically meaningful because the target score drop was less than 4 on a scale of 0–10, or a 50% reduction in pain.

Sunscreen Effect of Andaliman Methanol Extract Nano Gel on The Amount of Melanin in Wistar Rats Exposed to UV-B Light Vera, Vera; Chiuman, Linda; Ginting, Chrismis Novalinda; Nasution, Atika Rimalda; Bangun, Chrismas Gideon; Bangun, Primta
Jurnal Kesehatan Vol 15 No 3 (2024): Jurnal Kesehatan
Publisher : Poltekkes Kemenkes Tanjung Karang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26630/jk.v15i3.4486

Excessive exposure to UV-B rays can increase melanin production, potentially causing skin damage, making it necessary to prevent this through the use of natural-based sunscreens, such as nano gel from methanol extract of andaliman, to protect the skin from the harmful effects of UV-B radiation. This study aims to evaluate the sunscreen effect of andaliman methanol extract nanogel on the amount of melanin in Wistar rats exposed to UV-B light. The method used was a laboratory experimental study with a randomized posttest only with a control group design using mice as the research subjects. The results of the study showed that the SPF values of andaliman extract at concentrations of 2%, 3.5%, and 5% were 2.11, 2.49, and 2.45, respectively, which are considered low for sunscreen protection standards. Additionally, the amount of melanin obtained from each treatment group was also categorized as small, indicating that the andaliman extract in nano gel form did not significantly reduce melanin production in Wistar rats exposed to UV-B rays. In conclusion, there is no sunscreen effect of andaliman methanol extract nanogel on the amount of melanin in Wistar rats exposed to UV-B light. This could be due to factors such as the low SPF value, the lack of stability of the active ingredients in the nano gel, or the need for an increased dosage. The implications of these findings suggest the need for further research to optimize the formulation or explore other more effective ingredients in preventing melanin production caused by UV-B exposure.

Manajemen Anestesi untuk Seksio Sesarea pada Pasien Eklampsia dengan Perdarahan Intrakranial Bangun, Chrismas Gideon; Sudadi, Sudadi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perdarahan intrakranial pada kehamilan adalah penyebab kematian utama pada pasien-pasien dengan eklampsia. Hipertensi, yang berkaitan dengan stroke iskemik dan stroke hemoragik, adalah tampilan utama. Penanganan definitif merupakan terminasi kehamilan dengan seksio sesarea. Namun, tidak tepat untuk memulai persalinan pada ibu yang tidak stabil, sekalipun terdapat gawat janin. Begitu kejang dapat dikendalikan, hipertensi berat ditangani dan hipoksia dikoreksi, persalinan dapat dimulai. Sasaran manajemen anestesia yang pertama yaitu pengendalian kejang, pengendalian tekanan darah, dan pencegahan peningkatan tekanan intrakranial. Anestesi umum merupakan pilihan pada pasien tidak sadar, atau penurunan kesadaran dengan tanda-tanda peningkatan tekanan intrakranial. Anestesia dicapai dengan inhalasi, opioid, relaksasi dan hiperventilasi secara hati-hati. Pada kasus ini seorang ibu 31 tahun, 55 kg, usia kehamilan 36-37 minggu datang ke rumah sakit dengan penurunan kesadaran dan riwayat kejang. Dijumpai sensorium E2M5V2, tekanan darah 180/100mmHg dan proteinuri 3+. Segera diputuskan dilakukan seksio sesarea dengan anestesi umum dan rapid sequence induction dengan fentanyl 50 mcg, propofol 100 mg dan rocuronium 50 mg intravena. Post operasi pasien dirawat di ICU, dilakukan head CT-Scan dan dijumpai perdarahan intrakranial di temporoparietal kanan. Penanganan perdarahan intrakranial diputuskan konservatif. Hari ke-3 pascabedah pasien diekstubasi dan pada hari ke-5 pasien dipindahkan ke ruangan dengan sensorium E3M5V2.Management of Anesthesia for Eclampsia Caesarean Section Patient with Intracranial BleedingAbstractIntracranial haemorrhage in pregnancy is the leading cause of death in eclampsia patients. Hypertension, which is associated with both ischemic and hemorrhagic strokes, is the main feature. Definitive treatment is termination of pregnancy with cesarean section. However, it is not appropriate to start labor in an unstable mother, despite fetal distress. Once seizures can be controlled, severe hypertension is treated and hypoxia is corrected, labor may begin. The first anesthesia management goals are seizure control, blood pressure control, and prevention of increased intracranial pressure. General anesthesia is an option in the unconscious patient, or decreased consciousness with signs of increased intracranial pressure. Anesthesia is achieved with inhalation, opioids, relaxation and hyperventilation techniques carefully. In this case a 31-year-old mother, 55 kg, 36-37 weeks' gestation comes to the hospital with a decrease in consciousness and a history of seizures. Found sensorium E2M5V2, blood pressure 180/100mmHg and proteinuria 3+. Immediately, a cesarean section with general anesthesia and rapid sequence induction with fentanyl 50 mcg, propofol 100 mg and rocuronium 50 mg intravenously were performed. Post surgery the patient was treated in the ICU, head CT-Scan was performed and intracranial hemorrhage in the right temporoparietal was encountered. Management of intracranial hemorrhage was decided conservatively. The 3rd day postoperative the patient was extubated and on the 5th day the patient was transferred with E3M5V2 sensorium.

Manajemen Neuroanestesi pada Operasi Carotid Endarterectomy: Pasien dengan Riwayat Stroke Berulang Bangun, Chrismas Gideon; Irina, RR. Sinta; Bisri, Dewi Yulianti; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Carotid endarterectomy (CEA) adalah prosedur bedah yang dilakukan untuk memulihkan aliran darah karotis dan mengurangi kejadian stroke embolik dan trombotik. Walaupun merupakan prosedur preventif, CEA membawa risiko komplikasi perioperatif: neurologik dan kardiak. Komplikasi mayor CEA adalah stroke intra dan postoperatif, infark miokard, dan kematian. Untuk mengurangi angka kejadian stroke intraoperatif maka dikembangkan teknologi monitoring intraoperatif salah satunya dengan elektroensefalogram (EEG). Pada kasus ini pasien laki-laki, 62 tahun, dengan riwayat stroke iskemik berulang dan kelemahan tungkai kiri direncanakan untuk CEA dengan anestesi umum. Ahli bedah memutuskan untuk menggunakan shunt secara selektif dengan menilai monitoring EEG saat dilakukan clamping. Akhirnya shunt tidak jadi dilakukan, operasi berjalan selama 6 jam, diwarnai dengan gejolak hemodinamik yang sering terjadi pada pasien dengan penyakit karotis akibat gangguan baroreseptor. Dengan penanganan anestesi yang cermat selama dan sesudah operasi, operasi berhasil dilakukan, dan hasil postoperasi kekuatan motorik kaki kiri meningkat dari 2 ke 4.Management Neuroanesthesia for Carotid Endarterectomy: Patients with a History of Recurrent StrokeAbstractCarotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.

Manajemen Anestesi untuk Tindakan Vp-Shunt pada Bayi Sindrom Crouzon dengan Hidrosefalus Bangun, Chrismas Gideon; Mafiana, Rose; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Sindrom Crouzon adalah sindrom dominan autosom yang ditandai dengan trias yaitu deformitas tengkorak, anomali wajah, dan eksoftalmus. Sindrom Crouzon memiliki prevalensi 1: 60.000 kelahiran. Sindrom ini disebabkan sinostosis dini sutura koronal dan sagital yang mengakibatkan dismorfisme wajah. Pada anestesi pasien dengan sindrom Crouzon, harus dilakukan langkah-langkah untuk antisipasi dan persiapan penanganan jalan napas yang sulit. Pada kasus ini, seorang bayi 5 bulan dengan sindrom Crouzon datang dengan keluhan kepala membesar sejak 2 bulan sebelum masuk rumah sakit. Dari CT-scan didapatkan hidrosefalus, dan dilakukan tindakan VP-shunt. Telah diantisipasi adanya kesulitan intubasi, maka dilakukan persiapan alat-alat termasuk bougie anak. Bougie tersebut kemudian ternyata sangat berguna saat dilakukan intubasi ulang karena ketidaksesuaian ukuran tube endotrakeal. Operasi VP-shunt berjalan dengan baik, pasca operasi dan anestesi pasien sadar baik, respirasi dan hemodinamik stabil dan kemudian pindah ke ruang rawat biasa. Dalam penanganan pasien ini, antisipasi, peralatan difficult airway yang lengkap, rencana alternatif, serta pendekatan multidisiplin sangat diperlukan.Anaesthetic Management for VP-Shunt in Baby Crouzon syndrome with HydrocephalusCrouzon syndrome is an autosomal dominant syndrome characterized by triad of skull deformity, facial anomalies, and exophthalmos. Crouzon syndrome has a prevalence of 1: 60,000 births. This syndrome is characterized by early synostosis of coronal and sagittal sutures which leads to facial dysmorphism. In Crouzon syndrome, steps must be taken to anticipate and prepare for difficult airway handling.In this case, a 5-month-old baby with Crouzon syndrome presents with an enlarged head complaint 2 months before being hospitalized. CT scan showed hydrocephalus was, and VP-shunt action was planned. It is anticipated that there will be difficulty in intubation, so preparations for tools including child bougie were made. Bougie then turned out to be very useful because it had to be re-intubated because of the incompatibility of the size of the endotracheal tube. VP-shunt surgery works well, surgery and anesthesia were uneventful, then patient moved to the ward. Anticipation, complete difficult airway equipment and alternative plans, as well as a multidisciplinary approach are needed in handling these patients.

Hubungan Antara Kelelahan dan Sindrom Burnout Pada Residen di Departemen Anestesiologi dan Terapi Intensif Venawati, Feni; Lubis, Andriamuri Prima; Bangun, Chrismas Gideon; Yunanda, Yuki
Jurnal Biomedika dan Kesehatan Vol 6 No 3 (2023)
Publisher : Fakultas Kedokteran Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/JBiomedKes.2023.v6.330-339

Background Anesthesiologists in Indonesia are still in high demand. The large number of patients and the heavy workload faced by residents are accompanied by quite high pressure from various aspects, this can cause anesthesia resident participants to experience fatigue so they are prone to a syndrome called burnout syndrome. This study aims to determine the relationship between fatigue and burnout syndrome among residents in the Anesthesiology and Intensive Therapy Department, Faculty of Medicine, Universitas Sumatera Utara. Methods This study was a cross-sectional study on 106 residents that was performed using a questionnaire consisting of characteristics of study samples, translated Fatigue Assessment Scale (FAS), and Maslach Burnout Inventory-Human Service Survey (MBI-HSS). Results From the analysis, it was discovered that 50% of the residents didn’t experience fatigue with a median score of FAS 21.5, and 84.9% of the residents didn’t experience burnout syndrome with a median score of MBI-HSS was 51,84 ± 19,59. There was a significant relationship between FAS and total score of MBI-HSS, emotional exhaustion, depersonalization, and personal achievement with p-value <0.001. Conclusions There was a significant relationship between FAS and total score of MBI-HSS, emotional exhaustion, depersonalization, and personal achievement.

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