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Single-Shot Anestesi Spinal Segmental Thoracic Atau Thoracic Spinal Anesthesia (TSA) Untuk Operasi Embolectomy Pada Pasien Dengan Acute Limb Ischemia (ALI) Stadium IIB : Laporan Kasus Imam Ghozali; Tasrif Hamdi; Rizki Arisandi; Alda Putri Rahmadilla
Medula Vol 12 No 4 (2022): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v12i4.530

General anesthesia is the most widely used anesthetic and is the standard for most surgeries. However, general anesthesia has several disadvantages, including side effects of the drugs used, longer recovery time, and inadequate pain control. Therefore, the use of regional anesthesia is an alternative option to reduce the adverse effects of general anesthesia, one of which is spinal segmental thoracic anesthesia. In this case report, a 52-year-old woman that diagnosed with Stage IIb Acute Limb Ischemia (ALI) underwent embolectomy under thoracic spinal segmental anesthesia. The patient presented with ASA III physical status with type II DM, CHF, CAD3VD and increased coagulation factors. Thoracic spinal anesthesia with a paramedian approach at the level of the T10-11 vertebrae using a regimen of levobupivacaine 5 mg and bupivacaine 2.5 mg. The adjuvants used were dexmedetomidine 5 mcg, ketamine 15 mg, and fentanyl 25 mg. During the operation there were no hemodynamic fluctuations. Post-operative monitoring of the patient's condition was stable, pain control was good, and there were no complaints of headache, nausea, and vomiting. Segmental thoracic spinal anesthesia has several advantages such as the need for lower anesthetic doses, safer than lumbar spinal anesthesia, good pain control, faster recovery, and avoiding the side effects of general anesthesia. Therefore, this anesthetic technique can be an effective alternative choice for general anesthesia

HUBUNGAN ANTARA SKOR APACHE II, SOFA, EWS TERHADAP KEJADIAN PROLONGED MECHANICAL VENTILATOR DI ICU RSUP H. ADAM MALIK MEDAN T. Abdurrahman Johan; Tasrif Hamdi; Rr. Sinta Irina
Jurnal Anestesi Perioperatif Vol 12, No 1 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v12n1.3676

Pasien yang dirawat di ICU sekitar 30−60% membutuhkan ventilasi mekanik. Penelitian sebelumnya memperkirakan bahwa 3−7% pasien dengan ventilasi mekanis memerlukan prolonged mechanical ventilator (PMV). Prevalensi individu yang membutuhkan ventilator assisted individuals (VAI) berkisar 6,6 hingga 23 per 100.000 pasien. Individu dengan VAI meningkat mengindikasikan peningkatan kebutuhan ventilasi mekanik yang lama/prolonged mechanical ventilation (PMV) dan prognosis yang lebih buruk. Penelitian ini dilakukan untuk menganalisis apakah penilaian skor APACHE II, SOFA, dan NEWS memiliki hubungan dengan penggunaan ventilator mekanik yang memanjang selama Januari–Desember 2022 di ICU RSUP H. Adam Malik Medan. Desain penelitian ini menggunakan uji analitik retrospektif dengan rancangan cohort. Subjek yang memenuhi kriteria inklusi dan tidak termasuk eksklusi dipilih dengan metode total sampling. Jumlah sampel 96 pasien yang dinilai skor APACHE, SOFA, NEWS, dan apakah pasien mengalami PMV. Hasil penelitian ini pasien dengan PMV didapatkan skor APACHE dengan nilai median 18, pada skor SOFA 7 dan pada skor NEWS 12, dengan nilai p=0,001 pada ketiga penilaian ditemukan hubungan yang signifikan. Simpulan penelitian ini didapatkan hubungan skor APACHE II, SOFA, dan NEWS dengan kejadian PMV.

Perbandingan Efektivitas Kombinasi Ketamin dan Bupivakain terhadap Bupivakain Tunggal pada Anestesi Spinal Kanugrahan, Dicko; Tasrif Hamdi; Rommy Fransiskus Nadeak
Majalah Anestesia & Critical Care Vol 43 No 2 (2025): Juni
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.v43i2.405

Latar Belakang: Anestesi spinal memblok saraf di ruang subarakhnoid menggunakan obat anestetik lokal. Durasi anestesi lokal diperpanjang dengan menambahkan adjuvan seperti ketamin. Ketamin dapat mempercepat mula kerja dan mengurangi dosis obat anestesi lokal yang diperlukan. Metode: Penelitian ini bertujuan untuk menganalisis perbandingan efektivitas kombinasi ketamin 10 mg dan bupivakain 0,5% 15mg dengan bupivakain 0,5% 15mg pada anestesi spinal, dengan menggunakan desain Randomized Clinical Trial dengan double blind. Sampel dibagi menjadi: kelompok A (adjuvan ketamin) mendapatkan Bupivakain hiperbarik 0,5% 15mg dengan adjuvan Ketamin 10mg dan kelompok B (Bupivakain) mendapatkan Bupivakain 0,5% 15mg. Data dianalisis dengan uji T tidak berpasangan atau uji Mann-Whitney. Hasil: Terdapat 54 sampel dengan distribusi 27 sampel pada setiap kelompok. Terdapat perbedaan yang signifikan pada onset sensorik dan motorik (p<0,001) serta durasi sensorik, motorik, dan analgesia (p<0,001) antara kelompok A dan B. Tidak dijumpai perbedaan pada TDS (p=0,483), TDD (p=0,710), HR (p=0,505), RR (p=0,328), dan SpO2 (p=0,290) pada pemeriksaan awal (T0). Pada pemeriksaan menit ke-5 (T1), didapati perbedaan signifikan TDS dan HR (p<0,001), namun tidak pada TDD (p=0,169), RR (p=0,842), dan SpO2 (p=0,142). Pada pemeriksaan menit ke-10 (T2), didapati perbedaan signifikan TDS, TDD, dan HR (p<0,001), namun tidak pada RR (p=0,898), dan SpO2 (p=0,423). Diketahui efek samping dijumpai lebih banyak pada kelompok B (n=28), dengan kejadian efek samping terbanyak adalah hipotensi, sedangkan pada kelompok A (n=8) kejadian efek samping terbanyak adalah sedasi. Simpulan: Kombinasi ketamin 10 mg dengan bupivakain 15 mg lebih baik daripada bupivakain 15 mg tunggal untuk anestesi spinal bedah ekstremitas bawah dalam hal onset, durasi, dan hemodinamik.

The Prognostic Utility of Immature Platelet Fraction (IPF) in Adult Sepsis: A Correlation Analysis with SOFA Score and Conventional Platelet Indices Nico Dana Saputra; Ricke Loesnihari; Tasrif Hamdi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1419

Background: Sepsis is a leading cause of mortality, driving the search for biomarkers that can accurately reflect its severity. The immature platelet fraction (IPF) measures real-time thrombopoiesis, which is profoundly stressed during sepsis. Its clinical utility relative to conventional platelet indices (MPV, PDW) in predicting organ dysfunction remains to be fully elucidated. This study aimed to explore the relationship between these platelet parameters and the Sequential Organ Failure Assessment (SOFA) score in adult sepsis patients. Methods: An observational, cross-sectional study was conducted on 32 adult patients diagnosed with sepsis at a tertiary hospital in Medan, Indonesia. Upon admission, platelet indices and IPF were measured using a Sysmex XN-1000 hematology analyzer. The SOFA score was calculated to quantify organ dysfunction. The relationships between variables were assessed using Pearson or Spearman correlation analysis. Results: The analysis revealed a statistically significant but weak positive correlation between IPF and the SOFA score (r=0.354, p=0.047). In contrast, conventional indices like MPV (r=0.219, p=0.228) and PDW (r=0.190, p=0.297) showed no significant association with the SOFA score. Mechanistically, strong positive correlations were confirmed between IPF and both MPV (r=0.768, p<0.001) and PDW (r=0.775, p<0.001), reflecting a coordinated bone marrow response. Conclusion: This study reveals a critical paradox in sepsis: while the bone marrow mounts a robust thrombopoietic response, evidenced by the tight correlation between markers of platelet production, this response is poorly coupled with clinical outcomes. The weak association between IPF and organ dysfunction severity suggests that IPF's primary utility may not be as a standalone prognostic tool, but rather as a biomarker of a high-turnover, "futile thrombopoiesis." This highlights the complexity of platelet kinetics in sepsis and warrants further investigation into its role within a multi-marker prognostic strategy.

The Prognostic Utility of Immature Platelet Fraction (IPF) in Adult Sepsis: A Correlation Analysis with SOFA Score and Conventional Platelet Indices Nico Dana Saputra; Ricke Loesnihari; Tasrif Hamdi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1419

Background: Sepsis is a leading cause of mortality, driving the search for biomarkers that can accurately reflect its severity. The immature platelet fraction (IPF) measures real-time thrombopoiesis, which is profoundly stressed during sepsis. Its clinical utility relative to conventional platelet indices (MPV, PDW) in predicting organ dysfunction remains to be fully elucidated. This study aimed to explore the relationship between these platelet parameters and the Sequential Organ Failure Assessment (SOFA) score in adult sepsis patients. Methods: An observational, cross-sectional study was conducted on 32 adult patients diagnosed with sepsis at a tertiary hospital in Medan, Indonesia. Upon admission, platelet indices and IPF were measured using a Sysmex XN-1000 hematology analyzer. The SOFA score was calculated to quantify organ dysfunction. The relationships between variables were assessed using Pearson or Spearman correlation analysis. Results: The analysis revealed a statistically significant but weak positive correlation between IPF and the SOFA score (r=0.354, p=0.047). In contrast, conventional indices like MPV (r=0.219, p=0.228) and PDW (r=0.190, p=0.297) showed no significant association with the SOFA score. Mechanistically, strong positive correlations were confirmed between IPF and both MPV (r=0.768, p<0.001) and PDW (r=0.775, p<0.001), reflecting a coordinated bone marrow response. Conclusion: This study reveals a critical paradox in sepsis: while the bone marrow mounts a robust thrombopoietic response, evidenced by the tight correlation between markers of platelet production, this response is poorly coupled with clinical outcomes. The weak association between IPF and organ dysfunction severity suggests that IPF's primary utility may not be as a standalone prognostic tool, but rather as a biomarker of a high-turnover, "futile thrombopoiesis." This highlights the complexity of platelet kinetics in sepsis and warrants further investigation into its role within a multi-marker prognostic strategy.

Clinical Predictors of Functional Disability in Knee Osteoarthritis: Risk Stratification Approach as Implications of Nursing Practice Yannis, Nafi; Tanjung, Dudut; Dedi Ardinata; Tasrif Hamdi; Nur Asnah Sitohang
Caring: Indonesian Journal of Nursing Science Vol. 7 No. 1 (2025): Vol. 7 No. 1 (2025): Caring: Indonesian Journal of Nursing Science
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijns.v7i1.21284

Osteoarthritis (OA) of the knee is one of the most common musculoskeletal disorders and a leading cause of disability in the elderly. The severity of osteoarthritis can be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which is a widely used tool to measure pain, stiffness, and physical dysfunction in patients with OA. This study aimed to analyze the relationship between the demographic and clinical characteristics of patients with knee osteoarthritis and their WOMAC scores. The study used a quantitative, cross-sectional observational design. The relationship between functional disability (measured by the WOMAC score) and various factors was analyzed. The independent variables included age, sex, occupation, body mass index (BMI), OA grade, and duration of OA to the WOMAC score. Significant correlations were found between the WOMAC score and both OA grade (p=0.049) and OA duration (p=0.030). Furthermore, the multiple linear regression analysis revealed that OA duration (p=0.038) and OA grade (p=0.036) were significant predictors of the WOMAC score, collectively explaining 13.0% of its variance (R² value = 0.130). The findings of this study indicate that OA grade and duration of illness are significant predictors of the level of disability as measured by the WOMAC scores. OA levels and disease duration were the primary predictors of functional disability, explaining 13.0% of the WOMAC score variance. Nursing interventions should focus on risk stratification based on these clinical markers, prioritizing early intervention for newly diagnosed patients, irrespective of their age or BMI.

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