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Pengaruh Premedikasi Midazolam 0,04 mg/kgBB sebelum Anestesi Spinal terhadap Respons Tubuh saat Insersi Jarum Spinal dan Kepuasan Anna Christanti; Ezra Oktaliansah; Indriasari Indriasari
Jurnal Anestesi Perioperatif Vol 8, No 2 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v8n2.2035

Conscious sedation pada pasien yang dilakukan tindakan anestesi spinal membuat pasien menjadi lebih nyaman, kooperatif selama penyuntikan, dan mengurangi respons tubuh saat insersi jarum spinal. Midazolam memiliki efek ansiolitik, sedatif-hipnotik, amnesia, melemaskan otot, dan mengurangi mual-muntah akibat pembedahan. Tujuan penelitian ini mengetahui pengaruh premedikasi midazolam 0,04 mg/kgBB yang diberikan 30 menit sebelum dilakukan anestesi spinal terhadap respons tubuh pasien saat insersi jarum spinal dan kepuasan pasien terhadap anestesi spinal. Penelitian dilakukan periode September–Desember 2019 di RSUP Dr. Hasan Sadikin Bandung. Penelitian bersifat prospektif eksperimental menggunakan uji klinis acak buta ganda terhadap 46 subjek yang dibagi acak ke dalam 2 kelompok, yaitu kelompok kontrol (kelompok K, n=23) dan kelompok premedikasi midazolam (kelompok M, n=23). Pasca- pemberian premedikasi midazolam dinilai respons tubuh pasien saat insersi jarum spinal menggunakan prick response score dan kepuasan pasien dengan numeric rating scale. Analisis statistik untuk respons penyuntikan dan kepuasan pasien diuji dengan uji chi-square. Hasil penelitian menunjukkan respons tubuh pasien saat insersi jarum spinal berkurang (p<0,01) dan kepuasan pasien meningkat (p<0,01) pada kelompok premedikasi midazolam. Simpulan, premedikasi midazolam 0,04 mg/kgBB yang diberikan 30 menit sebelum anestesi spinal menurunkan respons tubuh pasien saat insersi jarum spinal dan meningkatkan kepuasan pasien terhadap anestesi spinalThe Effect of Midazolam Premedication 0.04 mg/kgBW before Spinal Anesthesia to Body Response during Spinal Needle Insertion and Satisfaction Conscious sedation leads to a more comfortable spinal intervention for patients, making them more cooperative as well as decreasing body response during spinal needle insertion. Midazolam has anxiolytic, hypnosis-sedative, amnesia, muscle relaxation effects and ability to reduce nausea and vomiting related to a surgery. The aim of this study was to determine the effect of 0,04 mg/kgBW midazolam premedication administered 30 minutes before spinal anesthesia on body response during spinal needle insertion and patient satisfaction. The prospective experimental study with a randomized, double blinded clinical trial approach was conducted from September to December 2019 in Dr. Hasan Sadikin General Hospital Bandung. Forty-six subjects were randomly divided into 2 groups: a control group (group K, n=23), and a midazolam premedication group (group M, n=23). After premedication with midazolam, the patient`s body response during spinal needle insertion were evaluated using the prick response score and their satisfaction was assessed using the numeric rating scale. Statistical analysis used to analyze body response during needle insertion and patient satisfaction was the Chi-Square test. Results howed that patient`s body response during spinal needle insertion were reduced (p<0.01) and patient satisfaction increased (p<0.01) in the midazolam premedication group. In conclusion, 0.04 mg/kgBW midazolam premedication administered 30 minutes before spinal anesthesia reduces patient body response during spinal needle insertion and increases patient satisfaction on spinal anesthesia.

Efektivitas Analgesik Pascaoperasi pada Pasien Pediatrik di Ruang Pemulihan Rumah Sakit Dr. Hasan Sadikin Bandung Periode Juni–November 2018 Bernadeth Bernadeth; Ezra Oktaliansah; Indriasari Indriasari
Jurnal Anestesi Perioperatif Vol 7, No 1 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Nyeri merupakan pengalaman sensorik dan emosional yang tidak menyenangkan. Penyebab utama nyeri akut pada anak adalah prosedur pembedahan, trauma, dan penyakit akut. Penilaian nyeri merupakan bagian penting dari manajemen nyeri. Penelitian ini bertujuan mengetahui efektivitas analgesik pascaoperasi pada pasien pediatrik di ruang pemulihan RSUP Dr. Hasan Sadikin Bandung periode Juni-November 2018. Penelitian menggunakan metode deskriptif observasional prospektif terhadap 471 pasien pediatrik pascaoperasi di ruang pemulihan. Subjek penelitian dikelompokkan berdasar atas jenis operasi yang menyebabkan nyeri ringan, sedang, dan berat. Jenis analgesik pascaoperasi yang diberikan dan penilaian nyeri selama di ruang pemulihan dicatat untuk melihat efektivitas analgesik pascaoperasi tersebut. Dari hasil penelitian efektivitas analgesik pascaoperasi pada jenis operasi nyeri ringan sebanyak 181 pasien (99,5%), jenis operasi nyeri sedang sebanyak 231 pasien (98,7%), dan pada jenis operasi nyeri berat sebanyak 53 pasien (96,4%). Simpulan penelitian ini adalah efektivitas analgesik pascaoperasi pada pasien pediatrik di RSUP Dr. Hasan Sadikin Bandung masih kurang efektif karena belum memenuhi target rumah sakit 100% bebas nyeri dan pemberian analgesik juga belum efisien karena masih banyak terdapat ketidaksesuaian antara pilihan analgesik dan derajat nyeri.Effectiveness of Post-Operative Analgesia on Pediatric Patients in the recovery room of Dr. Hasan Sadikin General Hospital Bandung from June to November 2018Pain is an unpleasant sensory and emotional experience. Pain assessment is an important part of pain management. The main causes of acute pain in children are surgical procedures, trauma, and acute diseases. This study aimed to study the effectuIveness of postoperative analgesics in pediatric patients in the recovery room of Dr. Hasan Sadikin General Hospital Bandung from June to November 2018. This was a prospective observational descriptive study on 471 postoperative pediatric patients in recovery rooms. The research subjects were grouped based on the type of surgery pain, i.e. mild, moderate, and severe. The type of postoperative analgesics given and assessment of pain during the stay in the recovery room were recorded to see the effectiveness of the postoperative analgesic drug. From the results of the study it was identified that the of postoperative analgesics was effective for 181 patients (99.5%) in the mild pain surgery group, for 231 patients (98.7%) in the moderate pain surgery, and for 53 patients (96.4%) in severe pain surgery. It is concluded that the postoperative analgesics provided to pediatric patients at Dr. Hasan Sadikin General Hospital Bandung is still less effective because it has not met the target of 100% pain free set by the hospital and that analgesic administration is also not efficient because there are still many discrepancies in analgesic choices and the degree of pain.

Penggunaan Skor Apfel Sebagai Prediktor Kejadian Mual dan Muntah Pascaoperasi di RSUP Dr. Hasan Sadikin Bandung Rachmad Try Hendro; Erwin Pradian; Indriasari Indriasari
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Post operative nausea and vomiting (PONV) merupakan kejadian mual dan atau muntah setelah tindakan operasi menggunakan anestesi pada 24 jam pertama pascaoperasi. Kejadian PONV dilaporkan memiliki perbedaan pada berbagai bangsa dan etnis. Skor Apfel merupakan salah satu prediktor PONV yang objektif dan paling sederhana. Sebelum menggunakannya sebagai prosedur rutin di RSHS, dilakukan penelitian ini yang bertujuan menilai apakah skor Apfel dapat digunakan sebagai prediktor PONV pada pasien yang menjalani operasi dengan anestesi umum di RSHS. Dilakukan suatu studi diagnostik secara potong lintang pada 100 pasien yang menjalani operasi elektif dengan anestesi umum di RSHS pada bulan September–Oktober 2017. Subjek penelitian dikelompokkan dalam 5 kelompok skor Apfel, yaitu perempuan, tidak merokok, menggunakan opioid pascaoperasi, dan memiliki riwayat PONV sebelumnya. Hasil penelitian ini menunjukkan terdapat 42% angka kejadian PONV, terdiri atas skor Apfel 0 (8,3%), skor 1 (19,04%), skor 2 (36,6%), skor 3 (63,63%), dan skor 4 (80%) yang sesuai dengan nilai prediktif skor Apfel. Angka kejadian PONV pada skor Apfel risiko tinggi (≥3) 61,9%, bermakna secara signifikan dapat membedakan kejadian PONV dengan nilai sensitivitas 61,9%, spesifisitas 81,0%, dan nilai AUC 0,777. Hasil ini menunjukkan bahwa skor Apfel memiliki validitas yang baik untuk membedakan antara pasien yang akan mengalami PONV dan yang tidak. Simpulan penelitian ini, skor Apfel dapat dipakai untuk memprediksi kejadian PONV di RSHS. Kata kunci: Post operative nausea and vomiting, prediktor, skor Apfel, validitas Use of Apfel Score as a Predictor for Post-Post-operative Nausea and Vomiting in Dr. Hasan Sadikin General HospitalPost-operative nausea and vomiting (PONV) is defined as any nausea, retching, or vomiting that occurs during the first 24 hour after surgery. Previous studies have reported that nationality and ethnicity influence the incidence of PONV. Apfel score is one of the objective and best simplified predicting PONV scoring systems available. Until recently, no predicting PONV score is used in Dr. Hasan Sadikin General Hospital (RSHS). Before implementing any scoring system as a protocol in this hospital, validation of the clinical risk assessment score in the hospital setu is needed. This was a cross-sectional diagnostic study on 100 patients underwentpost- various elective surgeries under general anesthesia. Subjects were divided into five groups, based on the Apfel risk scoring system. Factors observed consisted of four factors: female gender, nonsmoking status, post-operative use of opioids, and history of PONV or motion sickness. The results were analyzed for total incidence of PONV in each Apfel score group. Of 100 patients assessed, a total of 42% experienced PONV. Patients in Apfel score 0, 1, 2, 3, and 4 presented a PONV incidence score of 8.3%, 19.04%, 36.6%, 63.63%, and 80%, respectively. This incidence corresponds to the previous predicted values Apfel score. The incidence of PONV in patients under high risk Apfel score (≥3) was 61.9%, showing a significant correlation with PONV. The sensitivity was 61.9%, the specificity was 81.0%, and the AUC value was 0.777. This confirms that Apfel score has good validity to predict the incidence of PONV. In conclusion, Apfel scoring system is useful for identifying patients with PONV in RSHS.Key words: Apfel score, post-post-operative nausea and vomiting, predictor, validity

Angka Kejadian dan Karakteristik Mortalitas dan Morbiditas Pada Pengelolaan Anestesi Perioperatif di RSUP Dr. Hasan Sadikin Bandung Tahun 2017-2019 Jannatin Aliya Indrina; Indriasari Indriasari; Ardi Zulfariansyah
Jurnal Anestesi Perioperatif Vol 10, No 1 (2022)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v10n1.2559

Pengelolaan anestesi perioperatif merupakan tanggungjawab dokter anestesi yang mencerminkan mutu pelayanan di rumah sakit. Tujuan penelitian ini mengetahui angka kejadian serta karakteristik mortalitas dan morbiditas pada pengelolaan anestesi perioperatif di RSUP Dr. Hasan Sadikin Bandung tahun 2017–2019. Penelitian ini merupakan penelitian deskriptif observasional retrospektif terhadap rekam medis pasien yang mengalami mortalitas dan morbiditas, perioperatif. Hasil penelitian mengungkapkan angka kejadian mortalitas dan morbiditas tahun 2017–2019 sebesar 2 kasus per 1.000 tindakan anestesi. Karakteristik pasien yang mengalami mortalitas dan morbiditas yaitu pasien usia produktif, jenis kelamin wanita, IMT normal, komorbid penyakit jantung, dan status fisik ASA 3. Karakteristik pembedahan, mortalitas ditemukan lebih banyak pada operasi digestif, waktu operasi pukul 07.00–16.00, dan lama operasi ≤3 jam, sedangkan pada morbiditas ditemukan lebih banyak pada operasi obstetri-ginekologi, waktu operasi pukul 07.00–16.00, dan lama operasi ≤3 jam. Karakteristik anestesiologi, mortalitas dan morbiditas lebih banyak terjadi pada anestesi umum, lama anestesi >3 jam, dan kegagalan penanganan jalan napas. Simpulan penelitian ini adalah kejadian mortalitas dan morbiditas pada pengelolaan anestesi perioperatif dipengaruhi oleh berbagai faktor sehingga penilaian, penatalaksanaan, dan koordinasi yang baik dari berbagai bidang dapat memberikan luaran yang baik pada pasien.Incidence Rate and Characteristics of Mortality and Morbidity in Perioperative Anesthesia Management at Dr. Hasan Sadikin Hospital Bandung 2017–2019 The anesthesiologist is responsible for managing perioperative anesthesia, which reflects the quality of care in the hospital. This study aimed to determine the incidence and characteristics of cases of mortality and morbidity in the perioperative anesthesia management at Dr. Hasan Sadikin Bandung Year 2017–2019. This study was a retrospective descriptive observational study on the medical records of perioperative morbidity and mortality patients at Dr. Hasan Sadikin Hospital Bandung Year 2017–2019. The results showed that the mortality and morbidity cases in 2017–2019 were 2 cases per 1,000 anesthetic procedures. Characteristics of patients who experienced mortality and morbidity were productive age, female gender, normal BMI, comorbid heart disease, and ASA physical status 3. The characteristics of surgery in mortality cases were digestive surgery, which was performed between 07.00–16.00 and with a duration of 3 hours. The characteristics of surgery in morbidity cases were obstetric-gynecological surgery performed between 07.00–16.00 and with a duration of 3 hours of surgery. The anesthesiological characteristics in cases of mortality and morbidity were in patients with general anesthesia, duration of anesthesia >3 hours, and failure of airway management. Various factors can influence the incidence of mortality and morbidity in perioperative anesthesia management. Appropriate assessment, management, and coordination of various fields can provide good patient outcomes.

Hiperkapnia Sebagai Prediktor Mortalitas Pasien COVID-19 di Ruang Rawat Intensif Indra Wijaya; Ezra Oktaliansah; M. Erias Erlangga; Iwan Fuadi; Erwin Pradian; Indriasari Indriasari
Jurnal Anestesi Perioperatif Vol 10, No 3 (2022)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v10n3.3048

Virus SARS-CoV-2 menyebabkan penyakit pernapasan akut yang disebut COVID-19 dan menyebabkan pandemi global. Proses aktivasi trombosis intravaskular pada COVID-19 menyebabkan komplikasi trombosis mikrovaskular dan makrovaskular sehingga terjadi peningkatan ruang mati paru dan meningkatkan kadar PaCO2. Hiperkapnia menyebabkan banyak perubahan fisiologis dalam tubuh meliputi sirkulasi paru dan sistemik dan meningkatkan risiko mortalitas pasien ARDS. Penelitian ini bertujuan mengetahui apakah hiperkapnia merupakan prediktor mortalitas pasien COVID-19. Penelitian dilakukan berdasarkan data pasien pada periode Maret 2020–Desember 2021. Penelitian ini adalah penelitian analitik observasional dengan rancangan kohort retrospektif. Data PaCO2 pasien diambil saat hari pertama pasien dirawat di ICU RSUP Dr. Hasan Sadikin dan status mortalitas pasien di hari rawat ke-7 dan 28 hari. Analisis statistik yang digunakan adalah analisis bivariabel simple regression logistic. Hasil analisis statistik diperoleh nilai p< 0,05 dengan OR = 7,07 (CI 2,519–19,850) pada mortalitas hari ke-7, dan nilai p< 0,05 OR 44,33 (CI 9,182–214,062) pada mortalitas hari ke-28. Simpulan penelitian ini menunjukkan bahwa hiperkapnia merupakan prediktor mortalitas hari ke-7 dan ke-28 perawatan pada pasien COVID-19 yang dirawat di ruang rawat intensif isolasi.Hypercapnia as Mortality Predictor in COVID-19 PatientsThe SARS-CoV-2 virus causes COVID-19, an acute respiratory illness that caused a global pandemic. The activation of intravascular thrombosis in COVID-19 results in microvascular and macrovascular thrombosis complications, which increase lung dead space and PaCO2 levels. The hypercapnia condition causes many physiological changes in the body, including pulmonary and systemic circulation. It is known to increase the mortality risk in ARDS patients admitted to the Intensive Care Unit (ICU). This study aimed to determine if hypercapnia was a mortality predictor in COVID-19 patients treated in the isolation intensive care unit at Hasan Sadikin Hospital in Bandung. This observational analytic study used an observational analytic design with a retrospective cohort. The patient's PaCO2 data was collected on the first day of hospitalization in the ICU, and the patient's mortality status was collected on the 7th and 28th days of hospitalization. According to the statistical analysis, hypercapnia was associated with higher mortality, OR 7.07 (CI 2.519–19.850) on the 7th-day mortality and 44.33 (CI 9.182–214.062) on the 28th-day mortality, P value < 0.05. In conclusion, hypercapnia is a mortality predictor on the 7th and 28th days of treatment in COVID-19 patients treated in the isolation intensive care unit.

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