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All Journal Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Althea Medical Journal Majalah Anestesia dan Critical Care Jurnal Neuroanestesi Indonesia Acta Medical and Health Sciences (AMHS) Neurona

Iwan Fuadi

Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung

Author-ID : 2386467

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Perbandingan Ketepatan Ukuran Classic Laryngeal Mask Airway antara Metode Berat Badan dan Lebar Lidah Rahman, Abdul; Fuadi, Iwan; Rachman, Iwan Abdul
Jurnal Anestesi Perioperatif Vol 6, No 3 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Classic laryngeal mask airway (CLMA) merupakan alat yang digunakan untuk manajemen jalan napas, baik untuk pengganti ventilasi sungkup wajah maupun intubasi endotrakeal. Pemilihan ukuran yang tepat penting untuk efektivitas penggunaan CLMA. Saat ini pemilihan ukuran berdasar atas metode berat badan. Menurut sebuah studi terbaru metode pengukuran lebar lidah lebik baik daripada metode berat badan. Tujuan penelitian ini adalah mengetahui ketepatan ukuran CLMA antara metode berat badan dan lebar lidah yang dinilai dengan skor fiberoptik dan oropharyngeal leak pressure di RSUP Dr. Hasan Sadikin Bandung. Penelitian ini dilakukan pada bulan Februari 2018 menggunakan uji eksperimental analitik crossection setiap subjek mendapat dua perlakuan yang berbeda antara kedua metode. Uji statistik menggunakan uji chi-square untuk skor fiberoptik dan uji t berpasangan untuk oropharyngeal leak pressure. Hasil penelitian skor fiberoptik lebih optimal daripada metode lebar lidah. Oropharyngeal leak pressure pada metode berat badan rerata 23,00±1,732 CmH20 sedangkan metode lebar lidah rerata 19,13±1,684 CmH20. Secara statistik diperoleh nilai p<0,05. Simpulan, metode pengukuran lebar lidah adalah alternatif yang mudah dan baik dalam pemilihan ukuran CLMA pasien dewasa.Kata kunci: Classic laryngeal mask airway, pemilihan ukuran CLMA, metode berat badan, metode lebar lidahComparison of Classic Laryngeal Mask Airway Size Accuracy between Body Weight Method and Tongue width MethodClassic laryngeal mask airway (CLMA) is an airway management device that can be used to replace bag valve mask ventilation or endotracheal intubation. Choosing the right size of CLMA is important for the effectiveness of CLMA. Currently, the size of CLMA is selected based on the body weight. However, a recent study suggested that tongue width is a better indicator for size selection than the body weight. The purpose of this study was to assess the accuracy of CLMA size selection using the body weight method and tongue-width method. The assessment was performed using the fiberoptic score and oropharyngeal leak pressure. This was an experimental analytic cross-sectional study conducted in Dr. Hasan Sadikin General Hospital Bandung in February 2018. Each subject in this study received two different treatments using the two methods. The results were analyzed using chi-square for the fiberoptic score and paired t test for the oropharyngeal leak pressure. The fiberoptic score was more optimum when tongue width method was used when compared to the weight method. The oropharyngeal leak pressure in the weight method group was 23.00±1.732 CmH20 while the pressure in the tongue-width method was 19.13±1.684 CmH20 (p value <0.05). In conclusion, the tongue width measurement is an easy and good alternative in the selecting the CLMA size in adult patients.Key words: Classic laryngeal mask airway, size selection CLMA, body weight method, tongue width method

Perbandingan Pemberian Kombinasi Haloperidol 0,5 mg dan Deksametason 5 mg dengan Ondansetron 4 mg terhadap Kejadian Mual Muntah Pascaoperasi Modified Radical Mastectomy dengan Anestesi Umum Rahmadsyah, Teuku; Fuadi, Iwan; Bisri, Tatang
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Mual muntah pascaoperasi dapat meningkatkan morbiditas dan memperpanjang masa rawat pascaoperasi.Haloperidol adalah obat tranquilizer major golongan dari butirofenon yang mempunyai efek reseptor D2 antagonis.Penggunaan kombinasi haloperidol dan deksametason sebagai antiemetik profilaksis dapat menguntungkan.Penelitian ini bertujuan untuk membandingkan kombinasi haloperidol 0,5 mg dan deksametason 5 mg denganondansetron 4 mg terhadap kejadian mual muntah pascaoperasi pada operasi modified radical mastectomy.Penelitian dilakukan terhadap 42 wanita (kurang dari 50 tahun) status fisik ASA I-II yang menjalani operasimodifikasi mastektomi radikal secara uji acak terkontrol buta ganda dalam anestesi umum. Pasien dibagi menjadidua kelompok yaitu 21 orang menerima haloperidol 0,5 mg ditambah deksametason 5 mg dan 21 orang menerimaondansetron 4 mg yang diberikan setelah intubasi dilakukan. Pasien diberikan analgetik ketorolak dan petidinintravena secara kontinu pascaoperatif. Evaluasi yang dinilai adalah tekanan darah, laju nadi, dan saturasioksigen. Hasil dari penelitian menunjukan terdapat kecenderungan keluhan mual muntah pascaoperasi lebihbanyak terjadi pada kelompok ondansetron 4 mg (38,1%) dibanding dengan kelompok kombinasi haloperidol0,5 mg dan deksametason 5 mg (4,8%). Pada analisis statistik yang dilakukan dengan uji Chi-Square didapatkanhasil perbedaan yang bermakna (p kurang dari 0,05). Simpulan dari penelitian ini adalah pemberian kombinasihaloperidol 0,5 mg dan deksametason 5 mg intravena lebih baik dibandingkan dengan ondansetron 4 mg intravenadalam menurunkan kejadian mual muntah pascaoperasi modified radical mastectomy. Kata kunci: deksametason, haloperidol, modified radical mastectomy, mual muntah, ondansetron Postoperative nausea and vomiting can lead to increase morbidity and lengthened postoperative hospital stay.Haloperidol is a major tranquilizer with a D2 receptor antagonist effect. A combination of haloperidol anddexamethasone is also effective to prevent postoperative nausea and vomiting, which offers beneficial effectssuch as lower cost, longer duration and are easy to find. The aim of this study is to compare a combination ofhaloperidol 0,5 mg and dexamethasone 5 mg with ondansetron 4 mg in managing postoperative nausea andvomiting following modified radical mastectomy. The study was done by conducting a double blind randomizedcontrolled trial of 42 subjects, women aged under 50 years old, who underwent modified radical mastectomy undergeneral anesthesia, with physical status ASA I-II. Patients were divided into two groups: 21 patients receivedcombination of haloperidol 0,5 mg and dexamethasone 5 mg, and 21 patients received ondansetron 4 mg, afterintubation. Intravenous ketorolac and pethidine were given as postoperative analgesia. Blood pressure, heartrate, oxygen saturation and length of surgery was recorded.The result of this study was postoperative nausea andvomiting occurs more frequent in the ondansetron 4 mg group (38,1%) compared to combination of haloperidol0,5 mg and dexamethasone 5 mg group (4,8%). In statistical analysis performed with Chi-Square test showedthere was significant difference between the two groups (p<0,05). As a conclusion of this study is intravenouscombination of haloperidol 0,5 mg and dexamethasone 5 mg better than ondansetron 4 mg in lowering theincidence of postoperative nausea and vomiting after modified radical mastectomy. Key words: Dexamethasone, haloperidol, modified radical mastectomy, nausea and vomiting, ondansetron Reference Daabiss MA. Ephedrine-dexamethasone combination reduces postoperative nauseaand vomiting in patients undergoing laparoscopic cholecystectomy. Internet Anesthesiol. 2008;18(1):1092 ̶ 100. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting. Can J Anesth. 2004;51:326 ̶ 41. Watcha MF, White PF. Postoperative Nausea and Vomiting, lts Etiology, Treatment, and Prevention. Anesthesiology. 1992;77:162–84. Gan TJ. Risk factors of postoperative nausea and vomiting. Anaesth Analg. 2006;102:1884 ̶ 98. Islam S, Jain PN. Postoperative nausea and vomiting (PONV): a review article. Indian J Anesth. 2004;48:253 ̶ 8. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999;91:109 ̶ 18. Ho KY, Chiu JW. Multimodal antiemetic therapy and emetic risk profiling. Ann Acad Med Singapore. 2005;34:196 ̶ 205. Matthew TV, Chan, Chui PT, Ho WS, King WK. Single dose tropisetron for preventing post operative nausea and vomiying after breast surgery. Anesth Analg. 1998;87:931 ̶ 5. McQuaid KR. Drugs used in the treatment of gastrointestinal diseases. Dalam: Basic & clinical pharmacology. Edisi ke-9. Boston: The McGraw-Hill Companies. 2004. hlm. 1045 ̶ 60. Raman S, Kaul TK, Anju G, Aprajita S. Postoperative nausea and vomiting. Anesth Clin Pharmacology. 2007;23:341 ̶ 56. Ku CM, Ong BC. Postoperative nausea and vomiting: a review of current literature. Singapore Med J. 2003;44(7):366 ̶ 74. Splinter WM, Roberts DJ. Dexamethasone decreases vomiting by children after tonsillectomy. Anesth Analg. 1996;83:913 ̶ 6. O’Brien C. Nausea and vomiting. J Can Family Physician. 2008;54:861 ̶ 3. Zarate E, et.al. A Comparison of The Cost and Efficacy of Ondansetron versus Dolasetron for Antiemetic Prophylaxis. Anaesth Analg. 2000;90:1352 ̶ 8. Rosow CE, et.al. Haloperidol versus Ondansetron for Prophylaxis of Post operative Nausea and Vomiting. Anesth Analg. 2008; 106:1407 ̶ 9. Azwar. Pencegahan mual dan muntah pascaoperasi pada anestesi umum: Perbandingan haloperidol 1mg iv dengan ondansetron 4 mg iv [Jakarta: Universitas Indonesia. 2009. Adipraja K, Himendra A, Bisri T. Pengaruh premedikasi haloperidol (serenace®) terhadap efek samping ketamine pada penderita rawat Intensif Fakultas Kedokteran UNPAD/RSHS Bandung. 1992; hlm. 1 ̶ 9. Smith JC, Wright EL. Haloperidol: An Alternative Butyrophenon for Nausea and’ Vomiting Prophylaxis in Anesthesia. AANA journal. 2005;75:273 ̶ 5. Digregio GJ. Anti Psichotic Drugs and Lithium. Dalam: Basic Pharmacology in Medicine. Edisi ke-3. New York: Mc Graw-Hill. 1990. hlm. 261 ̶ 2. Moorselli PL. Haloperidol: Clinical Pharmacokinetics and Significance of Theurapeutic Drug Monitoring. Dalam: Theurapeutic Drug Monitoring. Churchill Livingstone. 1981. hlm. 296 ̶ 301. Khan MP, Singh V, Kumar M, Singh B, Kapoor R, Bhatia VK. Prophylactic antiemetic therapy using combinations of granisetron, dexamethasone and droperidol in patients undergoing laparoscopic cholecystectomy. The Internet Journal of Anesthesiology. 2009;21(1):1092 ̶ 102.

Angka Kejadian dan Karakteristik Menggigil Pascaoperasi di Ruang Pemulihan COT RSHS Periode Bulan Agustus–Oktober 2015 Tantarto, Tamara; Fuadi, Iwan; Setiawan, Setiawan
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Menggigil pascaoperasi merupakan komplikasi dari efek anestesi yang cukup sering dijumpai. Menggigil ini dapat menimbulkan rasa tidak nyaman dan risiko yang tidak baik bagi pasien. Penelitian ini dilakukan untuk mengetahui angka kejadian dan karakteristik pasien menggigil pascaoperasi. Studi deskriptif ini melibatkan seluruh pasien pascaoperasi di ruang pemulihan COT RSUP Dr. Hasan Sadikin pada periode bulan Agustus-Oktober 2015 yang memenuhi kriteria inklusi. Data penelitian ini adalah data sekunder dari rekam medis yang berupa data lengkap mengenai pasien pascaoperasi. Dari 639 pasien, angka kejadian menggigil adalah 169 kasus (26,45%).  Menggigil pascaoperasi lebih banyak terjadi pada pria yaitu sebanyak 28,57% dan kategori usia lansia awal. Proporsi pasien menggigil yang diberikan teknis anestesi umum saat operasi hampir sama dibandingkan anestesi regional. Presentase paling tinggi 43,75% pada pasien yang menjalani operasi >2 jam dengan 44,69% diberikan cairan infus sebanyak ≥1500 mL. Menggigil pascaoperasi paling banyak terjadi pada pasien yang menjalani operasi bedah saraf dengan presentase 66,67%. Angka kejadian menggigil pascaoperasi cukup tinggi terutama pada pria, kategori usia lansia awal, operasi yang lama, pemberian cairan infus yang banyak, serta operasi bedah saraf. Kata kunci: Angka kejadian, karakteristik, menggigil pascaoperasi, ruang pemulihan Prevalence and Characteristics of Post-anesthetic Shivering in Recovery Room COT RSHS from August to October 2015Post-anesthetic shivering is a common complication of anesthetic effect. Shivering may cause discomfort and unfavorable risks towards patients.This research aims to reveal the incidence and patient characteristics of post anesthetic shivering. This descriptive study involved post-operative patients in recovery room COT Dr. Hasan Sadikin General Hospital from August to October 2015 who fulfilled the inclusion criteria. Medical records comprising complete post-operative patients’ data were used as secondary data source for this study. Among 639 patients, shivering omLurred in 169 cases (26.45%). Post-anestheric shivering omLurred more in males (28.57%) and in pre elderly age. Proportion of post-anesthetic shivering patients was relatively same in patients who weregiven general anesthesia technique compared to regional anesthesia. Highest percentage omLurred in patients who underwent >2 hours of surgery (43.75%) and administered ≥1500 mL of intravenous (IV) fluids (44.69%). Postanesthetic shivering omLurred the most to neurosurgery patients (66.67%). Post-anesthetic shivering incidence in this study is relatively high, particularly in males, pre elderly age, general, longer operation duration, more administration of (IV) fluids and neurosurgery patients. Key words: Characteristics, postanesthetic shivering, prevalence, recovery room

Fluid Management in Pediatric Craniotomy Fuadi, Iwan; Pison, Osmond Muvtilof; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Advances in pediatric neurosurgery techniques have dramatically improved the outcome in infants and children with surgical lesions of the central nervous system. However, the physiologic and developmental differences inherent in pediatric patients present challenges to neurosurgeons and anesthesiologists alike. Fluid management is critically important in pediatric craniotomy. Hemodynamic stability during intracranial surgery requires the careful maintenance of intravascular volume and electrolytes. It is imperative to secure excellent intravenous access for fluid and blood replacement and drug delivery before the start of the operation. Lack of intake or active vomiting because of changes in the ICP, preoperative fluid restriction and diuretic therapy may lead to blood pressure instability and even cardiovascular collapse if sudden blood loss occurs. Normovolemia should be maintained throughout the procedure. Normal saline used as the maintenance fluid during neurosurgery because it’s mildly hyperosmolar and should minimize cerebral edema. Maintenance rate of fluid administration depends on the weight of the patient. The maximum allowable blood loss should be determined in advance. Hyperglycemia is always best avoided because it may exacerbate neurologic injury. Fluid management in neurosurgical cases is extremely important and requires good communication between the surgeon and anesthesiologist. Especially for infants and children because of the difference in the anatomy and physiology at various stages of growth and development. The anesthesiologist must be fully cognizant of these differences in order to conduct a safe anesthetic plan.

Correction Hypocalemic Patients with Potassium Chloride in ICU of Dr. Hasan Sadikin Hospital Bandung in Januari–Februari 2014 Hidayat, Dede A; Fuadi, Iwan; Sitanggang, Ruli H.
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Hypokalemia (Potassium plasma level <3.5 mEq/L) is the most common electrolyte imbalance found in the intensive care unit (ICU). Major etiologies of hypokalemia in ICU setting were related to low intake, gastro intestinal tract (GIT) disturbance, renal impairment, diuretic administration, insulin therapy and severe infection, which ranging from asymptomatic to the most severe symptom and causing death.This prospective observational study was conducted in the ICU of Dr. Hasan Sadikin Hospital Bandung from January to February 2014 with result 33 out of 105 admitted patients (31.4%) suffered from hypokalemia.From our observation, there was 17 patients (51.5%) with mild hypokalemia, 13 patients (39.4%) with moderate hypokalemia and 3 patients (9.1%) with severe hypokalemia. Correction with intravenous potassium chloride was given with improvement in 9 patients (53%) in mild hypokalemia group, 3 patients (23.1%) in moderate hypokalemia group but unfortunately no significant change was found in severe hypokalemia group after the correction. Complications were found mostly in geriatric patients with severe hypokalemia.The conclusion of this study is that from all patients admitted to the ICU of Dr. Hasan Sadikin Hospital Bandung from January ̶ February 2014, the incidence of hypokalemia was 31.3% (33 patients) with improvement occurred in 12 patients (36.4%) but 21 patients (63%) revealed no improvement after potassium chloride correction with worsening condition.

Glasgow Coma Scale dalam Memprediksi Outcome pada Pasien dengan Penurunan Kesadaran di Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo S, Achmad Afif; Fuadi, Iwan; Maskoen, Tinni T.
Majalah Anestesia dan Critical Care Vol 32 No 1 (2014): Februari
Publisher : Perdatin Pusat

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Ventilator associated pneumonia (VAP) merupakan Hospital associated pneumonia (HAP) yang paling sering terjadi di intensive care unit (ICU). Salah satu strategi pencegahan terjadinya VAP yang termasuk dalam VAP bundle adalah penghisapan sekret subglotis dengan menggunakan pipa endotrakea dengan drainase sekret subglotis. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh penggunaan pipa endotrakea dengan drainase sekret subglotis terhadap angka kejadian VAP di ICU Rumah Sakit Hasan Sadikin (RSHS) Bandung. Penelitian dilakukan dengan uji acak tersamar tunggal terhadap 26 subjek yang menggunakan ventilator lebih dari 48 jam di ICU RSHS Bandung. Setelah dilakukan randomisasi secara blok permutasi, subjek penelitian dikelompokan menjadi dua, yaitu 13 subjek kelompok kontrol menggunakan pipa endotrakea standar dan 13 subjek kelompok perlakuan menggunakan pipa endotrakea dengan drainase sekret subglotis. Sekret subglotis dihisap setiap 2 jam dan tekanan balon pipa endotrakea diperiksa setiap 4 jam. Data hasil penelitian dianalisis dengan uji statistik yaitu uji independent t, Uji Mann Whitney dan uji chi kuadrat, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap kejadian VAP (p=0,033), dimana kejadian VAP lebih sedikit pada kelompok yang menggunakan pipa endotrakea dengan drainase subglotis (0%) dibandingkan dengan kelompok yang menggunakan pipa endotrakea standar (23,1%). Simpulan dari penelitian ini adalah penggunaan pipa endotrakea dengan drainase sekret subglotis dapat menurunkan kejadian VAP di ICU RSHS Bandung. Kata kunci: Drainase sekret subglotis, pipa endotrakea, ventilator associated pneumonia The Influence of Endotracheal Tube with Subglottic Secretion Drainage on Ventilator Associated Pneumonia In Intensive Care Unit Dr. Hasan Sadikin Hospital Bandung Ventilator associated pneumonia (VAP) is the most common Hospital associated pneumonia in Intensive Care Unit (ICU). One of the strategies to prevent occurence of VAP that is part of the VAP bundle is suctioning of subglottic secretion using special endotracheal tube with subglotic secretion drainage. The aim of this study is to know the influence of using endotracheal tube with subglottic secretion drainage to the incidence of VAP in ICU RSHS Bandung. This is a single-blind randomized study involving 26 patients who use ventilator for more than 48 hours in ICU RSHS Bandung. After permuted block randomization, the subjects were divided into two groups, 13 subjects in the control group whom are using standard endotracheal tube and 13 subjects in the group whom are using endotracheal tube with subglottic secretion drainage. Subglottic secretion is drained every two hours and the pressure of the endotracheal tube cuff is checked every four hours. The result of this study is analyzed using various statistical tests, including independent t test, Mann Whitney and Chi Square test, where p value <0.05 is considered significant. Statistical analysis shows that there is a significant difference between two groups in the incidence of VAP (p=0.033) where incidence of VAP is less in the group using endotracheal tube with subglotic drainage (0%) in comparison to the group using standard endotracheal tube (23.1%). The conclusion of this study is that endotracheal tube with subglottic secretion drainage can decrease incidence of VAP in ICU RSHS Bandung. Key words: Endotracheal tube, subglotic secretion drainage, ventilator associated pneumonia 

Perbandingan Chula Formula dengan Auskultasi 5 Titik terhadap Kedalaman Optimal Pipa Endotracheal pada Anestesi Umum di RSUP Dr. Hasan Sadikin Bandung Erick Ariestian; Iwan Fuadi; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 6, No 1 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Kedalaman pipa endotracheal (ETT) yang optimal menjadi salah satu perhatian utama karena komplikasi terkait dengan malposisi ETT. Auskultasi 5 titik merupakan metode yang digunakan dalam menentukan kedalaman ETT. Namun, teknik tersebut masih memiliki potensi malposisi ETT. Penggunaan chula formula terbukti dapat digunakan untuk menentukan kedalaman ETT yang optimal. Penelitian ini bermaksud menilai ketepatan kedalaman yang optimal penempatan ETT setelah dilakukan intubasi endotrakea menggunakan chula formula dibanding dengan tektik auskultasi 5 titik. Penelitian ini merupakan penelitian prospektif analitik komparatif yang dilakukan pada 48 orang pasien berusia ≥18 tahun, status fisik American Society of Anesthesiology (ASA) I–II di ruang bedah terjadwal RSUP Dr. Hasan Sadikin Bandung pada Oktober 2017. Subjek dibagi menjadi 2 kelompok perlakuan, yaitu kelompok penentuan kedalaman ETT menggunakan teknik auskultasi 5 titik dan kelompok yang dilakukan menggunakan chula formula. Dilakukan penilaian jarak ujung ETT terhadap carina menggunakan fiberoptic bronchoscope (FOB). Hasil penelitian ini menunjukkan kedalaman optimal ETT menggunakan chula formula lebih baik dibanding dengan teknik auskultasi 5 titik. Analisis statistik menggunakan uji Exact Fisher. Hasil analisis menunjukkan perbedaan signifikan secara statistik (p<0,05). Simpulan penelitian ini adalah penggunaan chula formula menghasilkan kedalaman ETT yang lebih optimal.Kata kunci: Auskultasi 5 titik, bronkoskopi fiberoptik, chula formula, intubasi endotrakea, kedalaman ETT

Insidensi dan Faktor Risiko Hipotensi pada Pasien yang Menjalani Seksio Sesarea dengan Anestesi Spinal di Rumah Sakit Dr. Hasan Sadikin Bandung Rini Rustini; Iwan Fuadi; Eri Surahman
Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Hipotensi merupakan komplikasi yang sering terjadi setelah tindakan anestesi spinal pada pasien seksio sesarea. Hipotensi terjadi akibat blokade simpatis terhadap aktivitas vasomotor pembuluh darah serta penekanan aorta dan vena kava inferior oleh uterus yang membesar terutama pada saat pasien telentang. Tujuan penelitian ini adalah mengetahui insidensi hipotensi dan faktor risiko yang berhubungan dengan kejadian hipotensi pada pasien yang menjalani seksio sesarea dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian observasional potong lintang (cross sectional) ini dilakukan pada 90 subjek pasien yang menjalani seksio sesarea dengan anestesi spinal pada periode bulan April–Mei 2015. Pengolahan data dengan analisis univariabel untuk melihat gambaran proporsi variabel masing-masing yang disajikan secara deskriptif. Hasil penelitian menunjukkan insidensi hipotensi 49%. Faktor risiko yang menyebabkan hipotensi maternal menunjukkan hasil yang tidak signifikan berhubungan dengan kejadian hipotensi (p>0,05). Perbedaan insidensi hipotensi maternal setelah tindakan anestesi spinal dan faktor risiko yang memengaruhinya dengan penelitian sebelumnya karena perbedaan jumlah sampel penelitian, perbedaan definisi hasil yang digunakan, perbedaan tempat penelitian, dan perbedaan metode pengumpulan data.Kata kunci: Anestesi spinal, faktor risiko, hipotensi, insidensi, seksio sesareaIncidence and Risk Factors of Hypotension in Patients Undergoing Cesarean Section with Spinal Anesthesia in Dr. Hasan Sadikin General Hospital BandungAbstractThe most common serious complication associated with spinal anesthesia for C-section is hypotension. These hemodynamic changes result from a blockade of sympathetic vasomotor activity that is accentuated by the compression of the aorta and inferior vena cava by the gravid uterus when the patient is in the supine position. The purpose of this study was to describe the incidence of hypotension in patients undergoing cesarean section with spinal anesthesia in Dr. Hasan Sadikin General Hospital Bandung and to obtain a description of risk factors associated with the incidence of hypotension. A cross–sectional observational study was conducted on 90 subjects consisting of patients undergoing cesarean section with spinal anesthesia during the period of April–May 2015. The data processing performed was the univariable analysis to see the picture of the proportion of each variable, which were presented descriptively. The results showed 49% incidence of hypotension. There was an insignificant association between the risk factors of maternal hypotension after spinal anesthesia for cesarean section insignificant association with the incidence of hypotension (p>0.05). Differences in the incidence of maternal hypotension after spinal anesthesia and risk factors as stated in this study when compared to previous studies are due to differences sample size, definitions, place, and data collection methods.Key words: Cesarean section, hypotension, incidence, risk factors, spinal anesthesia DOI: 10.15851/jap.v4n1.745

Perbandingan Efek Analgesia antara Fentanil dan Oksikodon Intravena untuk Pengelolaan Nyeri Pascabedah Laparotomi Kolesistektomi Thomas Thomas; Iwan Fuadi; Iwan Abdul Rachman
Jurnal Anestesi Perioperatif Vol 9, No 1 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n1.2386

Nyeri pascabedah harus diatasi dengan baik menggunakan analgetik yang memiliki efek analgesia adekuat dengan efek samping minimal. Penelitian ini bertujuan mengetahui perbedaan nyeri pascabedah laparotomi kolesistekomi yang dinilai dengan numeric rating score (NRS) antara pasien yang menggunakan continuous intravenous patient controlled analgesia (IV-PCA) fentanil dan oksikodon. Penelitian dilakukan pada periode Agustus–November 2020 di RSUP dr. Hasan Sadikin Bandung. Penelitian randomized control trial (RCT) dilakukan terhadap 32 subjek status fisik ASA I–II yang terbagi menjadi dua kelompok, yaitu kelompok yang mendapat continuous IV-PCA fentanil 0,5 µg/kgBB/jam dan kelompok dengan continuous IV-PCA oksikodon 30 µg/kgBB/jam. Nyeri pascabedah dinilai dengan NRS pada jam pertama, ke-6, ke-12, dan ke-24. Analisis statistik data numerik dengan Uji Mann-Whitney, data kategorik dengan uji chi-square dan alternatif Uji Fisher’s Exact. Nilai NRS pada kelompok oksikodon lebih rendah dibanding dengan fentanil pada jam pertama hingga jam ke-24 (p=0,001). Kebutuhan rescue analgetik pada jam pertama dan ke-6 juga lebih rendah pada kelompok oksikodon (p=0,012; p=0,022, berurutan). Penelitian dengan rasio fentanil:oksikodon 1:60 ini tidak menunjukkan perbedaan efek samping kejadian mual, muntah, pusing, sakit kepala, dan pruritus antara kedua kelompok. Pemberian analgesia oksikodon intravena pada pasien pascabedah laparotomi kolesistektomi lebih baik dibanding dengan fentanil intravena.Comparison of Analgesia Effect between Intravenous Fentanyl and Oxycodone for Postoperative Pain Management after Laparotomy CholecystectomyPostoperative pain must be addressed properly with adequate analgetic drugs and minimal side effects. This study aimed to determine the differences in postoperative cholecystecomy laparotomy pain assessed by NRS in patients receiving continuous PCA fentanyl or oxycodone. This was a randomized clinical trial on 32 subjects between August-November 2020 at dr. Hasan Sadikin Hospital Bandung. These subjects were divided into two groups: the group that received continuous intravenous infusion of PCA fentanyl 0.5 µg/kgBW/hour and the group with continuous intravenous infusion of PCA oxycodone 30 µg/kgBW/hr. Thepostoperative pain was assessed by NRS at the 1st, 6th, 12th, and 24th hours. Statistical analysis of numerical data was performed using the Mann-Whitney test while the categorical data were analyzed using Chi-Square test with alternative uji Fisher’s Exact test. Results showed that NRS was lower in the oxycodone group than in the fentanyl group at the first to 24 hours (p=0.001). The need for analgesic rescue at the first and sixth hours was also lower in the oxycodone group (p=0.012; p=0.022, respectively). The observation of opioid side effects on fentanyl:oxycodone with a ratio of 1:60 did not present any difference in the incidence of nausea, vomiting, dizziness, headache, and pruritus in both groups. The administration of intravenous oxycodone in postoperative cholecystectomy laparotomy patients gives better analgesia effect than intravenous fentanyl.

Perbandingan Aromaterapi Pepermin dengan Ondansetron Intravena sebagai Terapi Rescue Mual Muntah Pascaoperasi Mastektomi Arna Fransisca; Iwan Fuadi; Dewi Yulianti Bisri
Jurnal Anestesi Perioperatif Vol 7, No 1 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Mual muntah pascaoperasi merupakan salah satu komplikasi anestesi dan operasi yang menjadi perhatian khusus karena memengaruhi kualitas pelayanan kesehatan, memperpanjang lama perawatan, dan meningkatkan angka morbiditas perioperatif. Pascaoperasi payudara berkaitan dengan angka kejadian mual muntah pascaoperasi yang tinggi. Beberapa konsensus penatalaksanaan mual muntah pascaoperasi merekomendasikan pemberian terapi nonfarmakologi dengan aromaterapi sebagai terapi rescue untuk mengatasi mual muntah pascaoperasi. Tujuan penelitian ini adalah membandingkan aromaterapi pepermin dengan ondansetron sebagai terapi rescue dalam menurunkan kejadian mual muntah pascaoperasi mastektomi. Penelitian ini merupakan penelitian eksperimental yang dilakukan secara prospektif dengan desain penelitian double blind randomized controlled trial dan consecutive sampling terhadap 32 subjek penelitian yang menjalani operasi mastektomi elektif dan memenuhi kriteria inklusi di RSUP Dr. Hasan Sadikin Bandung pada bulan Juli–September 2018. Pada penelitian ini, data ordinal diuji dengan Uji Mann Whitney dan untuk data kategorik diuji dengan uji chi-square. Hasil penelitian ini didapatkan penurunan kejadian mual muntah pascaoperasi yang signifikan pada kelompok pepermin dibanding dengan kelompok ondansetron dengan perbedaan yang bermakna (p<0,05) pada penilaian menit kedua dan menit kelima setelah perlakuan. Simpulan, aromaterapi pepermin efektif menurunkan kejadian mual muntah pascaoperasi mastektomi dan dapat digunakan sebagai alternatif terapi atau terapi tambahan untuk penatalaksanaan mual muntah pascaoperasi.Comparison of Peppermint Aromatherapy with Ondansetron Intravenous as a Rescue for Postoperative Nausea Vomiting after Mastectomy SurgeryPostoperative nausea and vomiting are among anesthesia and surgery complications that receive special considerations as it affects the quality of healthcare services, prolongs care, and increases perioperative morbidities. The incidence of postoperative nausea and vomiting is high in patients that have undergone breast surgery. The consensus for postoperative nausea and vomiting management recommends non-pharmacological treatments, one of which is through the use of aromatherapy as a rescue to resolve postoperative nausea and vomiting. This study aimed to compare the effects of peppermint aromatherapy and ondansetron as a rescue in reducing the incidence of postoperative nausea and vomiting after elective mastectomies. This was a prospective experimental double blind randomized controlled trial study with consecutive sampling on 32 research subjects underwent elective mastectomies and met the inclusion criteria in Dr. Hasan Sadikin General Hospital in July–September 2018. The ordinal data were tested using the Mann Whitney statistics test and the categorical data using the chi square test. The results show a significant decrease in nausea and vomiting incidence in the peppermint group compared to the ondansetron group with significant difference (p<0.05) in two minutes and five minutes after treatment. In conclusion, peppermint aromatherapy is effective in reducing the incidence of postoperative nausea and vomiting after mastectomies and can be used as an alternative or additional treatment in managing postoperative nausea and vomiting.

Co-Authors - Elvidiansyah - Elvidiansyah A Himendra Wargahadibrata A Himendra Wargahadibrata A. Muthalib Nawawi A.A. Ketut Agung Cahyawan W Abdul Muthalib Nawawi Abdul Muthalib Nawawi Abdul rachman, Iwan Abdul Rahman Aisyah Ummu Fahma Aminuyati Andre Aditya Andy Hutariyus Ardhana Risworo Anom Yuswono Ardhana Risworo Anom Yuswono Ardi Zulfariansyah Ardi Zulfariansyah Ardi Zulfariansyah Ari Saptadi Ari Saptadi Ariestian, Erick Army Zaka Anwary, Army Zaka Arna Fransisca Arsy Felisita Dausawati Arsy Felisita Dausawati Asyer Asyer Bisri, Tatang https://scholar.google.co.id/citations?u Bramantyo Pamugar Dedi Fitri Yadi Defri Aryu Dinata Defri Aryu Dinata, Defri Aryu Dessy Sutoyo Dewi Ramadani Dewi Ramadani Dewi Yulianti Bisri Dian Novitasari Doddy Tavianto Dzulfikar D. L. Hakim Eka Damayanti Eko Nofiyanto Eri Surahman Eri Surahman Erick Ariestian Erwin Pradian Eva Srigita Tari Ezra Oktaliansah Fahma, Aisyah Ummu Firdaus, Riyadh Fithrah, Bona Akhmad Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Hamzah Hamzah Hansen Wangsa Herman Harahap, M Sofyan Hidayat, Dede A Hunter D. Nainggolan Hunter D. Nainggolan Ike Sri Redjeki Ike Sri Redjeki Indra Wijaya Indriasari Indriasari Iwan Abdul Rachman Jimmy Setiadinata Jimmy Setiadinata, Jimmy Kartapraja, Roni D. Lisda Amalia Lukman Hidayat M Andy Prihartono M. Erias Erlangga M. Erias Erlangga, M. Erias Maharani, Nurmala Dewi Mariko Gunadi Mariko Gunadi Martaria, Nency Martinus, Fardian Martinus, Fardian Maulana Muhammad Maulana Muhammad, Maulana Mayasari, Ferra Mayasari, Ferra Muhammad Adjie Pratama Nadya, Siti Fairuz Oktivia, Wenny Pamugar, Bramantyo Pison, Osmond Muvtilof Prihatno, M. Mukhlis Rudi Putri, Dini Handayani R, Tubagus Yuli R, Tubagus Yuli Radian Ahmad Halimi Rahmadsyah, Teuku Rahmatisa, Dimas Rahordjo, Sri Richard Pahala Sitorus Rini Rustini Riyadh Firdaus Roni D. Kartapraja Rudi Kurniadi Kadarsah Ruli Herman Sitanggang S, Achmad Afif Saleh, Siti Chasnak Saleh, Siti Chasnak Setiawan Setiawan Sitanggang, Ruli H. Sitorus, Richard Pahala Sri Rahardjo Sri Rahardjo Sudadi Sudadi Suryadi Suryadi Suryadi Suryadi Sutoyo, Dessy Tantarto, Tamara Tatang Bisri Tatang Bisri Theresia C. Sipahutar Theresia C. Sipahutar Theresia Monica Rahardjo Thomas Thomas Tinni T. Maskoen Tinni T. Maskoen Tinni T. Maskoen Wandira, Rega Dwi Wargahadibrata, A. Hmendra Wargahadibrata, A. Hmendra Widiastuti, Monika - Wildan Firdaus Yunita Susanto Putri Yunita Susanto Putri Zamzami, Nyiemas Moya Zamzami, Nyiemas Moya

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