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Hubungan Nyeri dengan Delirium pada Pasien yang Terintubasi di ICU RSUP Haji Adam Malik Medan Nurchotijah, Nurchotijah; Lubis, Andriamuri Primaputra; Hamdi, Tasrif
Majalah Kedokteran Indonesia Vol 74 No 5 (2024): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.74.5-2024-1494

Abstract

Introduction: Pain can sometimes trigger a stress response and stimulate adrenergic-sympathetic activity. Delirium, a serious disruption of consciousness, is characterized by fluctuating perceptions, confused thinking, and varying levels of attention. Undiagnosed pain and delirium can lead to increased infection rates, prolonged mechanical ventilation, hemodynamic instability, and delirium. This study utilizes the Critical-Care Pain Observation Tool (CPOT) to measure pain and the Confusion Assessment Method (CAM) ICU to evaluate delirium in intubated patients in the ICU of RSUP HAM to explore the connection between pain and delirium. Method: The research employed a quantitative, cross-sectional observational analytical method. It investigated the association between pain and delirium in patients who were intubated at H. Adam Malik General Hospital Medan between January and February 2023, using the CPOT and CAM ICU scales. The chi-square test was used to analyze the relationship between pain and delirium, as well as the relationship between confounding factors and both pain and delirium. Results: The association between pain and delirium had a P-value of 0.001. The association between fentanyl dosage and pain in intubated patients also had a P-value of 0.001. Confounding factors included the length of stay with pain (P-value less than 0.001) and delirium with age (P-value = 0.026), gender (P-value = 0.013), and length of stay (P-value = 0.001). However, the doses of fentanyl and midazolam showed no significant association between patients with and without delirium (P-value = 0.5). Conclusion: There is a significant associations between pain and delirium.
Anesthesia in Awake Craniotomy Patients Akim, Mhd; Bisono, Luwih; Hamdi, Tasrif; Sitepu, John Frans; Harahap, Awi Tifani Mayandisa
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.v0i0.65478

Abstract

Background: Awake craniotomy is a neurosurgical procedure performed while the patient is conscious and cooperative, commonly used to remove brain tumors or epileptic foci located close to brain regions that control in real-time critical functions such as speech, movement, or vision.Case: A 26-year-old male presented to Haji Adam Malik Hospital, Medan with progressive blurred vision in both eyes and headaches over three months diagnosed with secondary headache due to intracranial space-occupying lesions (SOL) (thalamic glioma). The patient was referred to a neurosurgical colleague for further treatment in the form of a craniotomy. The craniotomy was performed using awake anesthesia techniques for the excision of diffuse glioma in the thalamic region. The awake anesthesia technique involved intravenous premedication with 0.25 mg atropine sulfate, 5 mg dexamethasone, 50 mg phenytoin, 2.5 mg diazepam, 100 mcg fentanyl, and dexmedetomidine administered at 20 mcg/hour to achieve the desired sedation level. Prior to incision, infiltration was performed in the area to be incised using 0.75% ropivacaine 20 ml mixed with 2% lidocaine 4 ml, and before the burr hole was made in the cranium, 50 mcg fentanyl was administered intravenously. The surgery proceeded according to protocol, and the patient was transferred to the recovery room.Discussion: Awake craniotomy requires clear communication for brain mapping, making severe aphasia and respiratory disorders like sleep apnea contraindications. Dexmedetomidine is favored for sedation due to its minimal respiratory effects. Local analgesia with ropivacaine and lidocaine ensures pain control and hemodynamic stability, reducing opioid use. The lack of bispectral index monitoring to assess sedation depth is a noted limitation.Conclusion: Considering the benefits and challenges associated with awake surgery, the use of this method should be considered on an individual case basis to ensure surgical success and patient safety.
Effectiveness and safety of thoracic segmental spinal anesthesia for breast surgery: A systematic review and meta-analysis Hamdi, Tasrif; Mastari, Ekawaty S.; Lubis, Andriamuri P.; Ghozali, Imam; Kemalasari, Nadia; Harahap, Awi TM.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.1630

Abstract

General anesthesia is the standard approach for thoracic and abdominal procedures; however, it has notable limitations, particularly in high-risk patients. Regional anesthesia techniques, such as thoracic segmental spinal anesthesia, have gained popularity due to their potential to reduce these associated risks. The aim of this study was to assess the effectiveness and safety of thoracic segmental spinal anesthesia in breast cancer surgery using systematic review and meta-analysis. This study adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, conducting a comprehensive literature search across ScienceDirect, Cochrane Library, and PubMed databases up to July 4, 2024. The inclusion criteria focused on studies that provided specific information on the effectiveness (postoperative pain reduction) and safety (incidence of adverse events and complications) of thoracic segmental spinal anesthesia, as well as satisfaction among patients and surgeons. Out of 4,060 articles, six studies were included for qualitative assessment, with four further analyzed quantitatively. Meta-analysis findings indicated that thoracic segmental spinal anesthesia provided significantly better pain control at 12 hours postoperatively (SMD: -1.25; 95%CI: -1.54 to -0.96; p<0.0001), although no significant difference was noted at 0 hours (SMD: -1.07; 95%CI: -2.33 to 0.18; p=0.09). Thoracic segmental spinal anesthesia was associated with a lower incidence of postoperative vomiting (RR: 0.46; 95%CI: 0.22–0.95; p=0.04), but it presented a higher risk of hypotension (RR: 2.57; 95%CI: 1.41–4.71; p=0.002). Importantly, no anesthesia-related mortalities were reported. The technique resulted in higher satisfaction levels among both patients (SMD: 0.63; 95%CI: 0.33–0.92; p<0.0001) and surgeons (SMD: 0.81; 95%CI: 0.51–1.11; p<0.0001) compared to general anesthesia. The study highlights that thoracic segmental spinal anesthesia is a safe and effective alternative to general anesthesia for breast cancer surgery, offering superior postoperative pain control, enhanced patient and surgeon satisfaction, and a reduced incidence of postoperative vomiting.
Hubungan Kecemasan pada Visit Pre-Anestesi dengan Tekanan Darah sebelum Tindakan Anestesi di Rumah Sakit Universitas Sumatera Utara Christine, Christine; Zainumi, Cut Meliza; Hamdi, Tasrif; Albar, Husnul Fuad
Jurnal Kesehatan Andalas Vol. 10 No. 3 (2021): Online November 2021
Publisher : Faculty of Medicine, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v10i3.1860

Abstract

Preoperative anxiety is frequently correlated with anesthesia procedures, resulting in the anesthesiologist being the most suitable person to decrease the patient's anxiety through effective doctor–patient communication during pre–anesthesia visits. During anxiety, one of the body responses is the release of epinephrine to the blood vessel resulting in increased blood pressure. Objectives: To knew the correlation between pre-anesthesia visit anxiety and blood pressure before anesthesia procedure. Methods: This study used a cross-sectional design that was conducted at Universitas Sumatera Utara General Hospital from September until October 2019. The sample was collected by consecutive sampling techniques, which meet inclusion and exclusion criteria. This study used primary data then was analyzed using Fisher’s Exact Test. Results: From 67 patients going through elective surgery, there are 41 patients (61,2%) with mild anxiety, 17 patients (25,4%) with moderate anxiety, and nine people (13,4%) with severe anxiety. There is no significant correlation (p>0,05) between anxiety with sex, types of anesthesia, PS ASA and heart rate. There is a significant correlation (p<0,05) between anxiety with blood pressure and types of surgery. Conclusion: There is a correlation between anxiety during the pre-anesthesia visit with blood pressure before anesthesia procedures.Keywords:  anesthesia, anxiety, blood pressure, pre-anesthesia visit
Perbandingan Bupivakain 0,5% 15 mg dan Fentanil 25 mcg dengan Bupivakain 0,5% 15 mg dan Morfin 100 mcg terhadap Nilai Oksigenasi Serebral pada Pasien yang Menjalani Anestesi Spinal Sibarani, Nicholas Hamonangan; Irina, Sinta; Hamdi, Tasrif
Majalah Anestesia & Critical Care Vol 43 No 1 (2025): Februari
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i1.359

Abstract

Latar Belakang: Salah satu teknik pemantauan oksigenasi jaringan yaitu near-infrared spectroscopy (NIRS). Anestesi spinal menurunkan oksigenasi serebral (rSO2) pada penggunaan fentanil dan morfin sebagai adjuvan dari bupivakain. Metode: Penelitian ini merupakan penelitian randomized control trial, dengan tujuan untuk mengetahui perbandingan rSO2 dan hemodinamik pada pasien yang menjalani anestesi spinal. Didapatkan total sampel 36 pasien yang dibagi menjadi 2 kelompok, kelompok yang mendapat bupivakain 0,5% 15 mg ditambah fentanil 25 mcg dan bupivakain 0,5% 15 mg ditambah morfin 100 mcg. Nilai rSO2 dinilai pada sebelum tindakan spinal (T0), 5 menit setelah spinal (T1), dan 30 menit setelah anestesi spinal (T2). Hasil: Rerata rSO2 pada kelompok bupivakain dengan tambahan fentanil berkisar antara 68–72 pada sisi kiri dan kanan. Sementara itu, rerata rSO2 pada kelompok bupivakain dengan tambahan morfin berkisar antara 69–70 pada kedua sisi. Terdapat perbedaan signifikan pada nilai rSO2 pada T1 dan T2 kelompok bupivakain 0,5% 15 mg dengan fentanil 25 mcg dibandingkan dengan kelompok bupivakain 0,5% 15 mg dengan morfin 100 mcg. Simpulan: Pada kelompok dengan tambahan fentanil, terjadi penurunan rSO2 yang tidak signifikan pada T0 dan T1 di kedua sisi kepala, namun penurunan yang signifikan ditemukan pada T2. Sementara itu, pada kelompok dengan tambahan morfin, terjadi penurunan rata-rata rSO2 dari T0 ke T1 dengan nilai penurunan yang tidak signifikan, tetapi penurunan rSO2 yang signifikan ditemukan pada kedua sisi kepala pada T2. Secara keseluruhan, kedua kelompok obat memberikan pengaruh yang serupa terhadap perubahan rSO2.
Perbandingan Preloading Cairan 20 cc/kgBB dan 30 cc/kgBB setelah One-Hour Bundle terhadap Nilai Laktat pada Pasien Sepsis di Ruang ICU Rendi Sidiq; Hamdi, Tasrif; Bisono, Luwih; Yunanda, Yuki
Majalah Anestesia & Critical Care Vol 43 No 1 (2025): Februari
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i1.371

Abstract

Latar Belakang: Sepsis adalah disfungsi organ yang mengancam jiwa akibat respons tubuh yang tidak teratur terhadap infeksi. Kadar laktat serum sering digunakan sebagai biomarker kegagalan organ, di mana kadar yang lebih tinggi menunjukkan tingkat kerusakan yang lebih parah. Meskipun preloading cairan 20–30 cc/kgBB direkomendasikan dalam resusitasi sepsis pada periode one-hour bundle, efektivitas dosis yang berbeda masih belum jelas. Penelitian ini bertujuan menganalisis perbedaan dosis preloading cairan 20 cc/kgBB dan 30 cc/kgBB terhadap kadar laktat pada pasien sepsis di RSUP H. Adam Malik. Metode: Penelitian ini merupakan randomized clinical trial dengan metode double-blind, melibatkan 36 pasien sepsis yang dibagi menjadi dua kelompok yaitu kelompok 1 (20 cc/kgBB) dan kelompok 2 (30 cc/kgBB). Hasil: Tidak terdapat perbedaan bermakna dalam kadar laktat 6 jam setelah loading cairan (p>0,05). Namun, terdapat perbedaan signifikan pada nilai klirens laktat (p=0,002), di mana kelompok 1 (32,55 ± 30,69 mmol/L) memiliki klirens lebih tinggi dibandingkan kelompok 2 (15,62 ± 50,61 mmol/L). Simpulan: Preloading cairan 20 cc/kgBB setelah one-hour bundle meningkatkan nilai laktat klirens pada pasien sepsis.
Teknik Anestesi pada Awake Craniotomy: Sebuah Laporan Kasus Simamora, Fareza Rifki; Bisono, Luwih; Hamdi, Tasrif; Sitepu, John Frans; Harahap, Awi Tifani M
Majalah Anestesia & Critical Care Vol 43 No 1 (2025): Februari
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i1.401

Abstract

Latar Belakang: Awake craniotomy adalah prosedur bedah saraf yang dilakukan pada pasien kondisi sadar yang umumnya dilakukan pada fokal epilepsi dan pengangkatan tumor otak di daerah vital. Prosedur ini memungkinkan pengangkatan lesi sambil menilai gejala yang dialami pasien secara real-time. Ilustrasi Kasus: Laki-laki 33 tahun datang ke Instalasi Gawat Darurat (IGD) RSUP H. Adam Malik Medan dengan keluhan nyeri kepala yang dirasakan sejak satu minggu yang lalu. Gejala ini semakin memberat dalam 12 jam terakhir disertai riwayat muntah dua kali. Pasien memiliki riwayat penyakit space-occupying lesion (SOL) intrakranial, riwayat kemoterapi 11 kali, dan riwayat operasi VP shunt. Berdasarkan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang pasien didiagnosis SOL intrakranial dengan masa residu tumor. SOL ini juga mengobliterasi ventrikel lateralis bilateral. Setelah mendapat penanganan awal, pasien kemudian dirujuk ke sejawat bedah saraf untuk penanganan lebih lanjut, sejawat bedah saraf memutuskan untuk melakukan tindakan kraniotomi stereotatik biopsi. Tindakan ini difasilitasi dengan teknik anestesi awake. Tindakan anestesi pada awake craniotomy ini menggunakan premedikasi intravena yaitu sulfas atropin 0,25mg, dexamethasone 5mg, fenitoin 50mg, diazepam 2,5mg, fentanil 100mcg, dexmetomidin 20mcg/jam. Sebelum dilakukan insisi diberikan infiltrasi di daerah yang akan diinsisi menggunakan ropivikain 0,75% 20ml yang dicampur dengan lidokain 2% 4ml dan sebelum dilakukan burr-holl tengkorak di daerah kranium diberikan fentanil 50 mcg secara intravena. Simpulan: Dalam prosedur awake craniotomy, menjaga kesadaran pasien selama operasi memungkinkan tim medis untuk memantau fungsi vital di otak secara langsung, sehingga meminimalkan risiko kerusakan pada area otak yang kritis.
Comparison of Oxytocin 10 IU Intravena Dilution of 10 ml Nacl 0.9% Bolus for 15 Seconds and 60 Seconds to Hemodynamics in Sectio Caesaria Patients with Spinal Anesthesia Ricardo, Dion; Hanafie, Achsanuddin; Hamdi, Tasrif
Journal of Society Medicine Vol. 1 No. 1 (2022): October
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (397.881 KB) | DOI: 10.47353/jsocmed.v1i3.19

Abstract

Introduction: Caesarean section (SC) is defined as the birth of a baby through an incision in the abdomen (laparotomy) and uterus (hysterotomy). Spinal anesthesia is the choice for elective SC because it is considered effective and efficient considering its simple technique and ability to provide adequate surgical anesthesia, easy administration, faster onset, and safety. Spinal anesthesia also provides early skin to skin contact which increases maternal satisfaction although the hypotension risk is higher compared to epidural anesthesia which is countered by sympathomimetic vasopressors administration. The aim to research was to compare the administration of 10 IU oxytocin diluted in 10 cc of 0.9% NaCl for 15 seconds with 60 seconds on hemodynamics in sectio caesarean patients under spinal anesthesia. Method: This study used an RCT (Randomized Clinical Trial) design with double blind, meaning that neither the research subjects nor the observers were aware of the treatment or intervention given. The study sample was patients who underwent Sectio Caesaria at Haji Adam Malik General Hospital Medan, and the Universitas Sumatera Utara Hospital which fulfilled the inclusion and exclusion criteria. Results: It was found that there was not a significant difference in MAP values between the 15-second and 60-second bolus groups with p-values for the 1st, 3rd, 5th, and 10th minutes respectively 0.804, 0.692, 0.568 , 0.216, 0.754, and 0.390. In addition, it is known that there was a significant difference in pulse values between the 15-second and 60-second bolus groups at 1, 3, 5, 10 and 15 minutes, with the results of the p-value before, 1, 3, 5, 10, and 15 minutes are 0.509, 0.464, 0.805, 0.055, 0.475 and 0.857 respectively. In this study, no side effects were found in either group between 15 second and 60 second boluses. Conclusion: There were no significant hemodynamic changes in both test groups (15 second and 60 second boluses), at 1, 3, 5, 10 and 15 minutes.
Hubungan Status Gizi Dengan Lama Rawat Inap Pasien Pneumonia Balita Rizone, Alifya Shifwah; Meirina, Fathia; Hamdi, Tasrif; Aldy, Fithria
Jurnal Kesehatan Mahardika Vol. 12 No. 1 (2025): Jurnal Kesehatan Mahardika
Publisher : LPPM ITEKES Mahardika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54867/jkm.v12i1.239

Abstract

Introduction: Pneumonia is known as a primary contributor to hospital admissions among toddlers globally. Numerous factors influence the duration of hospitalization in toddlers with pneumonia, one of them is nutritional status. This study aims to ascertain the correlation between nutritional status and the duration of hospitalization in pediatric pneumonia patients. Methods: This was an analytic observational study with a cross-sectional design. The study samples were children aged 2-59 months with pneumonia who were hospitalized in the period January 2022-January 2024 selected through the consecutive method. After calculating using the Slovin formula, a minimum sample size of 67 people was required. Data were analyzed through univariate analysis and bivariate analysis through chi-square through SPSS software version 27. Results: Of the 77 patients, the majority were aged 12-59 months (61%), male (55.8%), well-nourished (62.3%), and length of stay ≤5 days (55.8%). The bivariate analysis found no relationship between nutritional status and the length of stay of pneumonia patients under five with a p-value = 0.422 (p-value > 0.05). Conclusion: There is no relationship between nutritional status and the length of stay of pneumonia patients under five.
Intrathecal Dexmedetomidine-Fentanyl Combination versus Fentanyl Alone as Adjuvant to Bupivacaine in Spinal Anesthesia: A Comparative Study at Haji Adam Malik General Hospital Saputra, Firdaus; Hamdi, Tasrif; Irina, Rr Sinta
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (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.v0i0.68960

Abstract

Background: Spinal anesthesia is a regional analgesia that blocks nerve cells in the subarachnoid space by local anesthetic drugs. Bupivacaine is the most common agent, however, the duration of analgesia is often short. However, this advantage is hampered by the limited duration of spinal anesthesia and the uncomfortable postoperative period when the effect wears off. To prolong the duration of analgesia, various drugs such as opioids and α2 adrenergic agonists can be used as adjuvants for intrathecal local anesthetics to improve the quality of spinal anesthesia. One of the most widely used opioids is fentanyl, while the α2 adrenergic agonist is dexmedetomidine.Objective: To analyze the difference in effectiveness of the combination of dexmedetomidine 5µg and fentanyl 25µg intrathecally with fentanyl 25µg as an adjuvant to bupivacaine in spinal anesthesia.Method: This study is a double-blind randomized clinical trial to assess the comparison of the combination of dexmedetomidine 5µg and fentanyl 25µg intrathecally with fentanyl 25µg as an adjuvant to bupivacaine on the onset of block, duration of action, and side effects in surgery with spinal anesthesia.Results: There were 32 samples with a distribution of 16 samples in each group. There was a significant difference in sensory and motor duration (p<0.001). The average sensory duration in the fentanyl group was 2 hours 45 minutes, and in dexmedetomidine + fentanyl, 4 hours 25 minutes. In comparison, the motor duration in the fentanyl group was 2 hours 30 minutes, and in the dexmedetomidine + fentanyl was 4 hours 2 minutes.Conclusion: There is a comparison of the effectiveness of administering dexmedetomidine 5 mcg + fentanyl 25 mcg intrathecally and fentanyl 25 mcg intrathecally as an adjuvant to 0.5% bupivacaine in the spinal, where the dexmedetomidine group had a longer duration of anesthesia than the fentanyl group.