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Kejadian Post Dural Puncture Headache dan Nilai Numeric Rating Scale Pascaseksio Sesarea dengan Anestesi Spinal Dino Irawan; Doddy Tavianto; Eri Surahman
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Kejadian nyeri kepala pascaanestesi spinal (post dural puncture headache; PDPH) berhubungan dengan ukuran lubang dura akibat proses penusukan. Tujuan penelitian ini untuk mengetahui kejadian PDPH pada pasien pascaseksio sesarea dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan Januari–April 2010. Penelitian dilakukan terhadap 115 wanita hamil, status fisik American Society of Anesthesiologist (ASA) II, berusia 18–45 tahun. Penelitian bersifat observasional dengan rancangan cross sectional. Hasil observasi didapatkan kejadian PDPH pada jarum tipe quincke no. 25 sebesar 68,2%, pada jarum tipe quincke no. 27 sebesar 31,8% dan tidak ditemukan pada jarum tipe pencil point no. 27. Nilai numeric rating scale (NRS) dari PDPH pada tipe jarum quincke no. 25 adalah 3–7, pada tipe jarum quincke no. 27 adalah 2–6, dan 0 pada tipe jarum spinal pencil point no. 27. Simpulan penelitian adalah bahwa kejadian PDPH pada pasien seksio sesarea dengan anestesi spinal berdasarkan tipe jarum spinal paling banyak didapatkan pada jarum tipe quincke no. 25, selanjutnya pada jarum tipe quincke no. 27 dan tidak ditemukan pada jarum tipe pencil point no. 27.Kata kunci: Anestesi spinal, numeric rating scale, post dural puncture headacheThe Incidence of Postdural Puncture Headache and Numeric Rating Scale Score After the Caesarean Section with Spinal AnesthesiaAbstractThe incidence of post dural puncture headache (PDPH) is associated with the size of duramater diameter puncture caused by the puncture itself. There are two factors related to this problem, the size of the needle and the shape of the needle’s-end. The purpose of this study was to obtain an overview of incidence of PDPH in patients undergoing caesarean section with regional spinal anesthesia in Dr. Hasan Sadikin Hospital Bandung in January–April 2010. This research was conducted on 115 pregnant woman with physical status of American Society of Anesthesiologist (ASA) II, range of age was 18 to 45 years old. This research was an observational study with cross-sectional design. The incidence of PDPH after the use of Quincke type needle no. 25 was 68.2%, while with Quincke type needle no. 27 was 31.8%, and no PDPH was found on the use of pencil point type needle no. 27. The numeric rating scale (NRS) from PDPH on the use of Quincke type needle no. 25 was 3–7, while on Quincke type needle no. 27 was 2–6, and 0 in pencil point type needle no. 27. As the conclusion, the greatest incidence of PDPH in patients undergoing caesarean section, based on spinal needle type, occurs most with no. 25 Quincke type needles, and less with no. 27 and none with no. 27.Key words: Numeric rating scale, post dural puncture headache, spinal anesthesia DOI: 10.15851/jap.v1n3.197

Gambaran Kejadian Nyeri Tenggorok dan Serak pada Pasien yang Menjalani Anestesi Umum Endotrakeal di RSUD Arifin Achmad Pekanbaru Fitri Fahriyani; Dino Irawan; Eka Bebasari
Jurnal Ilmu Kedokteran Vol 8, No 2 (2014): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Sore throat and hoarseness are common complications after endotracheal intubation. The incidence of sore throat andhoarseness after endotracheal intubation varies from 14 to 75%. Although regarded as minor complications, sorethroat and hoarseness contribute to postoperative morbidity and patient dissatisfaction. The aim of this study were todetermine the incidence of sore throat and hoarseness after endotracheal general anesthesia and to describe associatedrisk factors at Arifin Achmad Public Hospital. This study used a descriptive cross sectional method. A total of 88patients who underwent endotracheal general anesthesia were enrolled in this study. Data of the patient such asgender, age, duration of intubation and endotracheal tube size were collected from medical record and direct observationat the time of operation. All of the patients were interviewed within 24-36 hours after surgery to collect data such assmoking history, sore throat complaint and hoarseness complaint. The evaluation of sore throat degree was accomplishedwith a Capan’s scale for sore throat and hoarseness degree was accomplished with a Stout’s scale for hoarseness. Theresult showed that 18 patients (20.4%) experienced sore throat and 34 patients (38.6%) experienced hoarseness aftersurgery.

PERBANDINGAN PEMBERIAN DEXAMETHASONE 10 MG INTRAVENA DAN LIDOCAINE SPRAY PADA TINGKAT KENYAMANAN PASCA INTUBASI ENDOTRACHEAL TUBE DI RSUD ARIFIN ACHMAD PROVINSI RIAU Dino Irawan; Nopian Hidayat
Jurnal Kedokteran Syiah Kuala Vol 19, No 2 (2019): Volume 19 Nomor 2 Agustus 2019
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v19i2.18064

Abstrak. Penelitian ini berjudul perbandingan tingkat kenyamanan pasca pembiusan umum dengan endotracheal tube antara pemberian dexametasone intravena dan lidocaine spray di RSUD Arifin Achmad Provinsi Riau. Tingkat kenyamanan berupa nyeri tenggorok pada pasien yang menjalani pembiusan umum dengan intubasi endotrakeal dapat dipengaruhi oleh beberapa hal yaitu obat-obatan yang diberikan, teknik insersi, tekanan cuff dan manajemen setelah insersi.Nyeri tenggorok pada pasien yang menjalani anestesi umum dengan intubasi endotrakeal pada umumnya tidak berakibat fatal dan akan menghilang dalam 48-72 jam setelah operasi tetapi hal ini dapat menyebabkan gangguan yang cukup berarti bagi pasien, menambah lama dan biaya rawatan pasien di rumah sakit serta meninggalkan kesan buruk terhadap operasi. Penelitian ini menggunakan pendekatan randomized clinical controlled trial dengan rancangan eksperimental yang dilakukan pada 104 pasien yang menjalani anestesi umum dengan endotrakeal tube di RSUD Arifin Achmad Provinsi Riau pada bulan September-Oktober 2019. Pada hasil penelitian didapatkan bahwa pemberian dexametasone intravena sebelum tindakan intubasi endotrakeal lebih efektif dalam mencegah nyeri tenggorok pasca operasi dibandingkan lidocaine spray (19.2% untuk Dexametasone intravena dan 29.8% pada Lidocaine spray). Secara statistik, perbedaan kejadian nyeri tenggorok antara kelompok Dexametasone intravena dan Lidocaine spray adalah bermakna pada skoring 1 jam post operasi (p 0.05) dan tidak bermakna pada skoring 24 jam post operasi (p0.05). Insidensi nyeri tenggorok terbanyak berdasarkan usia adalah pada kelompok usia 46-55 tahun dan 55-65 tahun, berdasarkan jenis kelamin adalah lebih banyak pada perempuan dibandingkan laki-laki, dan lebih banyak pada pasien yang mempunyai riwayat merokok. Kata kunci: nyeri tenggorok, dexametasone intravena, lidocaine spray, RSUD Arifin Achmad Provinsi Riau Abstract. This study is about the comparison of the level of comfort after general anesthesia with an endotracheal tube between administration of intravenous dexametasone and lidocaine spray in Arifin Achmad General Hospital of Riau Province. The level of comfort in the form of sore throat in patients undergoing general anesthesia with endotracheal intubation can be influenced by several things such as administration of drugs, insertion techniques, cuff pressure and management after insertion. Sore throat in patients undergoing general anesthesia with endotracheal intubation is generally not fatal and will disappear within 48-72 hours after surgery but this can cause significant disruption to the patient, increase the length and cost of patient care in the hospital and leave bad impression from surgery. This study is a randomized clinical controlled trial with an experimental design conducted on 104 patients undergoing general anesthesia with endotracheal tube at Arifin Achmad General Hospital in Riau Province in September-October 2019. The study found that administration of intravenous dexametasone before endotracheal intubation is more effective in preventing postoperative sore throat compared to lidocaine spray (19.2% for intravenous Dexametasone and 29.8% in Lidocaine spray). Statistically, the difference in the incidence of sore throat between the intravenous Dexametasone group and Lidocaine spray was significant at 1 hour postoperative scoring (p 0.05) and not significant at 24 hour postoperative scoring (p 0.05). The highest incidence of sore throat by age is in the age group 46-55 years and 56-65 years, more frequent in women than men, and more frequent in patients who have a history of smoking. Keywords: sore throat, intravenous dexametasone, lidocaine spray, Arifin Achmad General Hospital Riau Province

Thoracic Epidural Anesthesia Facilitating Upper Abdominal Surgery in the Presence of Malignant Pleural Effusion and Hepatic Metastases: A Case Report Faisal Irwanda; Andre Azhar; Dino Irawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1343

Background: Upper abdominal surgery in patients with advanced metastatic cancer, particularly with significant pulmonary and hepatic involvement, presents substantial perioperative challenges. Malignant pleural effusion (MPE) and hepatic metastases compromise cardiorespiratory reserve, increasing the risks associated with general anesthesia and surgical stress. Thoracic epidural anesthesia (TEA) offers potential benefits by providing effective analgesia, reducing pulmonary complications, and attenuating the surgical stress response. Case presentation: We report the case of a 65-year-old male patient with metastatic breast cancer involving the lungs, liver, and spine, complicated by recurrent malignant pleural effusion. He presented with dyspnea and abdominal pain, requiring a laparotomy for liver biopsy to guide further oncological management. Given his ASA III status, significant pulmonary compromise (pre-operative SpO2 93-94% on room air, effusion requiring drainage), and the nature of the surgery, TEA was chosen as the primary anesthetic technique. An epidural catheter was successfully placed at the T9-T10 interspace, achieving a T4 sensory block using ropivacaine 0.5%. The laparotomy and liver biopsy proceeded with stable intraoperative hemodynamics and adequate surgical conditions. Conclusion: TEA provided effective anesthesia and analgesia for upper abdominal surgery in this high-risk patient with extensive metastatic disease and compromised pulmonary function. This approach facilitated the procedure while maintaining hemodynamic stability and avoiding the potential respiratory complications associated with general anesthesia and tracheal intubation. TEA should be considered a viable anesthetic option in carefully selected high-risk patients undergoing abdominal oncological surgery.

Thoracic Epidural Anesthesia Facilitating Upper Abdominal Surgery in the Presence of Malignant Pleural Effusion and Hepatic Metastases: A Case Report Faisal Irwanda; Andre Azhar; Dino Irawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1343

Background: Upper abdominal surgery in patients with advanced metastatic cancer, particularly with significant pulmonary and hepatic involvement, presents substantial perioperative challenges. Malignant pleural effusion (MPE) and hepatic metastases compromise cardiorespiratory reserve, increasing the risks associated with general anesthesia and surgical stress. Thoracic epidural anesthesia (TEA) offers potential benefits by providing effective analgesia, reducing pulmonary complications, and attenuating the surgical stress response. Case presentation: We report the case of a 65-year-old male patient with metastatic breast cancer involving the lungs, liver, and spine, complicated by recurrent malignant pleural effusion. He presented with dyspnea and abdominal pain, requiring a laparotomy for liver biopsy to guide further oncological management. Given his ASA III status, significant pulmonary compromise (pre-operative SpO2 93-94% on room air, effusion requiring drainage), and the nature of the surgery, TEA was chosen as the primary anesthetic technique. An epidural catheter was successfully placed at the T9-T10 interspace, achieving a T4 sensory block using ropivacaine 0.5%. The laparotomy and liver biopsy proceeded with stable intraoperative hemodynamics and adequate surgical conditions. Conclusion: TEA provided effective anesthesia and analgesia for upper abdominal surgery in this high-risk patient with extensive metastatic disease and compromised pulmonary function. This approach facilitated the procedure while maintaining hemodynamic stability and avoiding the potential respiratory complications associated with general anesthesia and tracheal intubation. TEA should be considered a viable anesthetic option in carefully selected high-risk patients undergoing abdominal oncological surgery.

Spontaneous Respiration Intubation as a Cornerstone of Multidisciplinary Management for Delayed Tracheoesophageal Fistula Repair in a Critically Ill Neonate Sulthoni; Dino Irawan; Novita Anggraeni; Nopian Hidayat; T Addi Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1474

Background: The perioperative management of neonates with esophageal atresia and Type C tracheoesophageal fistula (EA/TEF) is exceptionally challenging, particularly in cases of delayed diagnosis complicated by aspiration pneumonia and congenital heart disease. The primary anesthetic risk is catastrophic gastric insufflation and hemodynamic collapse from positive pressure ventilation (PPV) before fistula control. This report details a successful multidisciplinary strategy centered on an airway technique that preserves spontaneous ventilation. Case presentation: A 16-day-old, 2.5 kg female neonate with Type C EA/TEF presented for surgical repair following a delayed referral. The case was critically complicated by severe aspiration pneumonia (cultures positive for Klebsiella pneumoniae), which was managed with targeted antibiotic therapy, and hemodynamically significant congenital heart defects (2.5 mm patent ductus arteriosus, 3 mm patent foramen ovale). After 48 hours of intensive cardiorespiratory and nutritional optimization in the neonatal intensive care unit (NICU), the patient underwent surgery. To circumvent the life-threatening risks of PPV, an inhalational induction with sevoflurane was performed, maintaining spontaneous ventilation. The airway was secured via direct laryngoscopy without neuromuscular blockade. A right extrapleural thoracotomy, fistula ligation, and primary esophageal anastomosis were successfully performed. Intraoperative lung retraction-induced desaturation was managed with coordinated surgeon-anesthetist maneuvers. The postoperative course was uneventful. Conclusion: In a high-risk neonate with delayed TEF presentation and profound cardiorespiratory compromise, securing the airway while maintaining spontaneous ventilation is a cornerstone of safe anesthetic practice. This approach, integrated within a comprehensive, multidisciplinary management plan, directly mitigates the risk of gastric perforation and cardiovascular collapse, thereby enabling a successful surgical repair and favorable outcome.

Spontaneous Respiration Intubation as a Cornerstone of Multidisciplinary Management for Delayed Tracheoesophageal Fistula Repair in a Critically Ill Neonate Sulthoni; Dino Irawan; Novita Anggraeni; Nopian Hidayat; T Addi Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1474

Background: The perioperative management of neonates with esophageal atresia and Type C tracheoesophageal fistula (EA/TEF) is exceptionally challenging, particularly in cases of delayed diagnosis complicated by aspiration pneumonia and congenital heart disease. The primary anesthetic risk is catastrophic gastric insufflation and hemodynamic collapse from positive pressure ventilation (PPV) before fistula control. This report details a successful multidisciplinary strategy centered on an airway technique that preserves spontaneous ventilation. Case presentation: A 16-day-old, 2.5 kg female neonate with Type C EA/TEF presented for surgical repair following a delayed referral. The case was critically complicated by severe aspiration pneumonia (cultures positive for Klebsiella pneumoniae), which was managed with targeted antibiotic therapy, and hemodynamically significant congenital heart defects (2.5 mm patent ductus arteriosus, 3 mm patent foramen ovale). After 48 hours of intensive cardiorespiratory and nutritional optimization in the neonatal intensive care unit (NICU), the patient underwent surgery. To circumvent the life-threatening risks of PPV, an inhalational induction with sevoflurane was performed, maintaining spontaneous ventilation. The airway was secured via direct laryngoscopy without neuromuscular blockade. A right extrapleural thoracotomy, fistula ligation, and primary esophageal anastomosis were successfully performed. Intraoperative lung retraction-induced desaturation was managed with coordinated surgeon-anesthetist maneuvers. The postoperative course was uneventful. Conclusion: In a high-risk neonate with delayed TEF presentation and profound cardiorespiratory compromise, securing the airway while maintaining spontaneous ventilation is a cornerstone of safe anesthetic practice. This approach, integrated within a comprehensive, multidisciplinary management plan, directly mitigates the risk of gastric perforation and cardiovascular collapse, thereby enabling a successful surgical repair and favorable outcome.

Comparative Analysis of Early Postoperative Cognitive Decline Following Isoflurane versus Sevoflurane Anesthesia in Geriatric Patients: A Prospective Observational Study Recky Antoni; Nopian Hidayat; Dino Irawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1534

Background: As the global geriatric population expands, postoperative cognitive dysfunction (POCD) has emerged as a critical perioperative complication. While volatile anesthetics are standard for maintenance, conflicting evidence exists regarding the comparative neurotoxicity of Isoflurane and Sevoflurane, particularly in resource-limited settings where cost influences agent choice. This study aimed to evaluate and compare the magnitude of early cognitive decline associated with these two agents in an Indonesian geriatric cohort. Methods: We conducted a prospective comparative observational study involving 40 geriatric patients (aged ≥60 years, ASA II-III) undergoing elective non-cardiac surgery at Arifin Achmad Regional General Hospital, Indonesia. Patients were recruited via consecutive sampling and allocated to receive maintenance anesthesia with either Sevoflurane (n=20) or Isoflurane (n=20) according to standard clinical protocols. Cognitive function was assessed preoperatively and at 72 hours postoperatively using the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). The primary outcome was the magnitude of cognitive change (Delta score) and the incidence of cognitive decline. Results: Baseline characteristics were homogenous (p > 0.05). The Sevoflurane group exhibited a non-significant trend toward decline (Pre: 26.85 ± 1.09 vs. Post: 26.45 ± 1.28; p = 0.057) with a mean delta of 0.40. Conversely, the Isoflurane group demonstrated a statistically significant deterioration (Pre: 26.90 ± 1.07 vs. Post: 25.90 ± 1.55; p = 0.008) with a mean delta of 1.00. The magnitude of decline was significantly greater in the Isoflurane group (p = 0.026). The incidence of early cognitive decline was 25% for Isoflurane versus 10% for Sevoflurane. Conclusion: Isoflurane anesthesia is associated with a greater magnitude of early postoperative cognitive decline compared to Sevoflurane in geriatric patients. While Sevoflurane is not devoid of cognitive impact, it appears to offer a superior safety profile for early neurocognitive recovery. These findings suggest Sevoflurane may be the preferable agent for geriatric anesthesia in settings where newer agents like Desflurane are unavailable.

Comparative Analysis of Early Postoperative Cognitive Decline Following Isoflurane versus Sevoflurane Anesthesia in Geriatric Patients: A Prospective Observational Study Recky Antoni; Nopian Hidayat; Dino Irawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1534

Background: As the global geriatric population expands, postoperative cognitive dysfunction (POCD) has emerged as a critical perioperative complication. While volatile anesthetics are standard for maintenance, conflicting evidence exists regarding the comparative neurotoxicity of Isoflurane and Sevoflurane, particularly in resource-limited settings where cost influences agent choice. This study aimed to evaluate and compare the magnitude of early cognitive decline associated with these two agents in an Indonesian geriatric cohort. Methods: We conducted a prospective comparative observational study involving 40 geriatric patients (aged ≥60 years, ASA II-III) undergoing elective non-cardiac surgery at Arifin Achmad Regional General Hospital, Indonesia. Patients were recruited via consecutive sampling and allocated to receive maintenance anesthesia with either Sevoflurane (n=20) or Isoflurane (n=20) according to standard clinical protocols. Cognitive function was assessed preoperatively and at 72 hours postoperatively using the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). The primary outcome was the magnitude of cognitive change (Delta score) and the incidence of cognitive decline. Results: Baseline characteristics were homogenous (p > 0.05). The Sevoflurane group exhibited a non-significant trend toward decline (Pre: 26.85 ± 1.09 vs. Post: 26.45 ± 1.28; p = 0.057) with a mean delta of 0.40. Conversely, the Isoflurane group demonstrated a statistically significant deterioration (Pre: 26.90 ± 1.07 vs. Post: 25.90 ± 1.55; p = 0.008) with a mean delta of 1.00. The magnitude of decline was significantly greater in the Isoflurane group (p = 0.026). The incidence of early cognitive decline was 25% for Isoflurane versus 10% for Sevoflurane. Conclusion: Isoflurane anesthesia is associated with a greater magnitude of early postoperative cognitive decline compared to Sevoflurane in geriatric patients. While Sevoflurane is not devoid of cognitive impact, it appears to offer a superior safety profile for early neurocognitive recovery. These findings suggest Sevoflurane may be the preferable agent for geriatric anesthesia in settings where newer agents like Desflurane are unavailable.

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