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All Journal E-Jurnal Medika Udayana Hearty : Jurnal Kesehatan Masyarakat PREPOTIF : Jurnal Kesehatan Masyarakat Riwayat: Educational Journal of History and Humanities
EM, Tjahya Aryasa
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Humanities Education Health Professions Medicine & Pharmacology Public Health Social Sciences Other

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Penggunaan Jarum Spinal Atraumatic dalam Menurunkan Kejadian Post-dural Puncture Headache: Telaah Sistematis Pragra, Maria Preicilia; Parami, Pontisomayaa; Sutawan, Ida Bagus Krisna Jaya; EM, Tjahya Aryasa; Utara Hartawan, I Gusti Agung Gede
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i01.P08

Abstract

AbstrakPost-dural puncture headache (PDPH) merupakan salah satu komplikasi pasca anestesi spinal yang ditandai dengan nyeri kepala. Kejadian PDPH dipengaruhi oleh beberapa faktor salah satunya adalah jenis jarum spinal. Telaah sistematis ini bertujuan untuk mengetahui peran penggunaan jarum spinal atraumatic terhadap kejadian PDPH dibandingkan dengan jarum spinal traumatic pada pasien anestesi spinal.Pencarian literatur studi randomized controlled trial (RCT) dari tahun 2015 sampai 2020 yang membandingkan kejadian PDPH menggunakan jarum atraumatic dan jarum traumatic pada pasien anestesi spinal dilakukan melalui Google Scholar, PubMed, dan hand-searching secara manual. Seleksi studi dilakukan berdasarkan panduan diagram alir PRISMA 2009. Risiko bias masing-masing studi dinilai menggunakan Jadad Scale. Sintesis data didapatkan dari 19 studi dengan jumlah total sampel 4.414 pasien tanpa adanya batasan umur dan jenis kelamin.Berdasarkan studi yang ditemukan, seluruhnya menyatakan bahwa kejadian PDPH dengan jarum atraumatic lebih rendah dibandingkan dengan jarum traumatic dan ditemukan paling tinggi pada pasien operasi cesar. Kejadian PDPH tertinggi sebesar 22% dengan jarum traumatic 25G quincke, sedangkan kejadian terendah sebesar 0% dengan jarum atraumatic 25G sprotte, 27G sprotte, 25G whitacre, dan 27G whitacre. Kegagalan anestesi spinal ditemukan lebih tinggi pada jarum atraumatic dibandingkan dengan jarum traumatic, akan tetapi perbedaan tersebut tidak signifikan. Oleh karena itu, penggunaan jarum atraumatic lebih direkomendasikan dalam tindakan anestesi spinal untuk mencegah terjadinya PDPH.Kata kunci : post-dural puncture headache, anestesi spinal, jarum atraumatic
Anesthesia Management For A Patient With Morbid Obesity Undergoing Laparoscopic Cystectomy And Hysteroscopic Tubal Patency Procedures: A Case Report Lusyana*, Lya; Parami, Pontisomaya; EM, Tjahya Aryasa
Riwayat: Educational Journal of History and Humanities Vol 6, No 4 (2023): Educational, Historical Studies and Humanities
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jr.v6i4.35663

Abstract

The laparoscopic surgical procedure has been proven to be highly useful for surgeries in narrow body cavities, such as pelvic surgeries. Performing laparoscopy on morbidly obese patients in the supine, lithotomy, and Trendelenburg positions during surgery presents a challenge in obstetric anesthesia. The patient is a 31-year-old female with a left dermoid ovarian cyst. During the perioperative period, the patient presented with morbid obesity (BMI of 45 kg/m2), and an intermediate risk of obstructive sleep apnea. Perioperatively, arterial blood gas analysis (ABGA) was performed to determine whether there were any ventilation issues typically associated with obesity (i.e.,Pickwickian syndrome). The ABGA results were within normal limits, with a pCO2 of 38 mmHg. General anesthesia was administered, and the patient was induced with 150 mcg of fentanyl, 150 mg of propofol, and 40 mg of atracurium. The surgery was completed without significant hemodynamic changes. After the surgery, the patient was transferred to the Intensive Care Unit for observation in case of any anesthesia-related complications. In conclusion, pre-anesthesia preparation and clear and effective intraoperative communication are crucial in managing a patient with morbid obesity undergoing laparoscopic cystectomy, hysteroscopy, and tubal patency procedures.
ANESTHETIC MANAGEMENT OF A PREGNANT PATIENT WITH WOLFF PARKINSON WHITE SYNDROME UNDERGOING CAESARIAN SECTION Wirahadi, Dhanu Enggar; EM, Tjahya Aryasa; Labobar, Otniel Adrians
HEARTY Vol 13 No 5 (2025): OKTOBER
Publisher : Fakultas Ilmu Kesehatan, Universitas Ibn Khaldun, Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/hearty.v13i5.20442

Abstract

Abnormal electrical conduction via an auxiliary channel (Kent's Bundle) causes Wolff-Parkinson-White (WPW) syndrome, a congenital cardiac preexcitation disease that can result in symptomatic and sometimes fatal arrhythmias. It occurs in 0.9-3% of the general population. Because of changes in hemodynamics, hormones, the autonomic nervous system, and emotions, pregnancy raises the risk of supraventricular tachycardia (SVT). A 29-year-old woman with G2P1001 gestational age 39 weeks, history of Caesarean Section (C-Section) 1 time with WPW Syndrome and history of SVT underwent C-Section and tubectomy with low dose spinal anesthesia. The patient has a history of palpitations and the EKG shows WPW pattern. Vital signs, physical examinations and laboratorium findings within normal limits. Echocardiography with the results of normal cardiac chamber dimensions, global normokinetic, Ejection Fraction 68%, normal diastolic function, normal right ventricle contractility TAPSE 2.0 Cm, valves within normal limits, ERAP 8 mmHg, Interatrial and interventricle septum impression intact, no PDA seen. This patient, diagnosed with WPW syndrome at moderate risk due to a history of SVT, could not undergo ablation due to limited facilities and pregnancy contraindications. Bisoprolol was used for treatment of transient palpitations. Preoperative fluids achieved a diuresis target of 1.1 cc/kg/hour to avoid hypovolemia and tachycardia. Regional anesthesia was chosen for cesarean section to reduce sympathetic activity, with careful attention to preventing high-level blocks. A subarachnoid block with low-dose bupivacaine (7.5 mg) and fentanyl (25 mcg) provided stable hemodynamics and effective anesthesia. A healthy baby was delivered with an APGAR score 8/9, and postoperative analgesia was optimized. Regional anesthesia is the choice for c-section with WPW syndrome, the use of low doses of bupivacaine heavy combined with adjuvant fentanyl produces good quality block with rapid onset and without hemodynamic instability.
PERBANDINGAN EFEKTIVITAS ANALGESIA PASCAOPERASI BLOK SUBKOSTAL TRANSVERSUS ABDOMINIS (STA) DENGAN OPIOID INTRAVENA PADA PASIEN OPERASI LAPAROSKOPI KOLESISTEKTOMI DI RSUP PROF. DR. I.G.N.G. NGOERAH DENPASAR Wardani, Dinar Kusuma; Sidemen, I.G.P.Sukrana; Hartawan , I.G.A.G. Utara; Widnyana, I Made Gede; Parami, Pontisomaya; EM, Tjahya Aryasa; Wiryana, Made; Senapathi, Tjokorda Gde Agung
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 1 (2024): APRIL 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i1.27260

Abstract

Penelitian ini bertujuan untuk membedakan efektivitas antara blok STA dengan opioid intravena sebagai analgesia pascaoperasi laparoskopi kolesistektomi di RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar. Penelitian ini merupakan sebuah uji coba prospektif, acak, terkendali dan single-centered. Sebanyak 60 subjek pasien yang menjalani tindakan operasi laparoskopi dibagi menjadi 2 kelompok denganpemberian tindakan STA dan tanpa STA. Analisis data dillakukan dengan bantuan SPSS versi 36 meliputi uji Chi Square, independent t tets dan Mann Whitney. Hasil penelitian bahwa Blok STA pascaoperasi laparoskopi kolesistektomi memiliki intensitas nyeri dengan NRS pada jam ke 6, 12 dan 24 lebih rendah dibandingkan dengan yang hanya mendapatkan opioid intravena dengan nilai p<0,001. Blok STA memiliki total waktu pemberian analgesik rescue pertama 6,67±2,39 jam dan tanpa STA 1,87±0,81 jam dengan perbedaan 4,80 jam (IK95% 3,87-5,72; p<0,001). Blok STA memiliki jumlah muntah dalam 24 jam dengan rerata 0,50±0,97 kali dan tanpa STA 3,27±1,79 kali dengan perbedaan 2,76 kali (IK95% 2,01-3,51; p<0,001). Blok STA memiliki hasil NLR dengan rerata 2,52±1,71 dan tanpa STA 4,64±2,90 dengan perbedaan 2,12 (IK95% 0,89-3,35; p=0,001). Nilai NLR antara sebelum dan sesudah kelompok STA menurun sebesar 1,27±2,64 sedangkan kelompok tanpa STA meningkat rerata 1,33±1,87 dengan perbedaan 2,61 (IK 1,43-3,80; P<0,001). Tindakan blok STA dapat menurunkan efek nyeri, mual-muntah dan durasi analgetik lebih panjang dengan nilai NLR lebih rendah pascaoperasi laparoskopi kolesistektomi dibandingkan dengan tanpa STA.
Co-Authors Hartawan , I.G.A.G. Utara I Gusti Agung Gede Utara Hartawan I Made Gede Widnyana Ida Bagus Krisna Jaya Sutawan Labobar, Otniel Adrians Lusyana*, Lya Made Wiryana Parami, Pontisomayaa Pontisomaya Parami Pragra, Maria Preicilia Sidemen, I.G.P.Sukrana Tjokorda Gde Agung Senapathi Wardani, Dinar Kusuma Wirahadi, Dhanu Enggar