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Pengaruh Penambahan Klonidin 75 mcg pada 12,5 mg Levobupivakain 0,5% Secara Intratekal terhadap Lama Kerja Blokade Sensorik dan Motorik untuk Bedah Ortopedi Ekstremitas Bawah Fadlyansyah Ramli; Doddy Tavianto; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 3, No 1 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Keterbatasan anestesi spinal antara lain ialah lama kerja blokade sensorik dan motorik terbatas. Penelitian ini bertujuan melihat pengaruh penambahan 75 mcg klonidin pada 12,5 mg levobupivakain 0,5% terhadap lama kerja blokade sensorik dan motorik pada anestesi spinal untuk bedah ortopedi ekstremitas bawah. Penelitian bersifat eksperimental prospektif dengan metode acak terkontrol tersamar ganda pada 36 sampel dengan kriteria American Society of Anesthesiologist (ASA) I-II yang menjalani operasi ortopedi ekstremitas bawah dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Juni–Agustus 2014. Kelompok levobupivakain dan klonidin (LK) mendapatkan 12,5 mg levobupivakain 0,5% ditambah klonidin 75 mcg. Kelompok levobupivakain dan salin (LS) mendapatkan 12,5 mg levobupivakain 0,5% ditambah NaCl 0,9% 0,5 mL. Data hasil penelitian diuji secara statistik menggunakan uji-t, Mann-Whitney, dan chi-kuadrat. Hasil penelitian menunjukkan lama kerja blokade sensorik kelompok LK lebih lama secara bermakna yaitu 244,44 (37,84) menit dibandingkan dengan kelompok LS, yaitu 107,89 (17,63) menit (p=0,000). Lama kerja blokade motorik kelompok LK lebih lama secara bermakna yaitu 278,72 (41,75) menit dibandingkan dengan kelompok LS, yaitu 128,39 (18,26) menit (p=0,000). Simpulan, penambahan klonidin 75 mcg pada 12,5 mg levobupivakain 0,5% secara intratekal memerpanjang lama kerja blokade sensorik dan motorik.Kata kunci: Anestesi spinal, klonidin, levobupivakain, lama kerja blokade sensorik, lama kerja blokade motorikEffect of Clonidine 75 mcg Addition to Intrathecal 12.5 mg 0.5% Levobupivacaine on Sensoric and Motoric Blockade Duration in Lower Extremity Orthopedic SurgeryAbstractSpinal anesthesia has some limitations that limits its use, such as limited duration of action in motoric and sensoric. This research aimed to provide an overview on the effect of adding clonidine 75 mcg to 12.5 mg 0.5% levobupivacaine on the motoric and sensoric blockade action duration in lower extremity orthopedic surgery spinal anesthesia. This experimental prospective research used double blind randomized controlled trial approach on 36 patients with ASA I-II physical status who underwent lower extremity orthopedic surgery using spinal anesthesia in Dr. Hasan Sadikin General Hospital during the period of June to August 2014. LC group, clonidine 75 mcg was added to 12.5 mg 0.5% levobupivacaine. On LS group, 12.5 mg 0.5% mg levobupivacaine mixed with 0.5 mL 0.9% NaCl. The data were then statistically tested using t-test, Mann-Whitney, and chi-square. The result showed that the duration of action of sensoric blockade in LK group was significantly longer, i.e. 224.44 (37.84) minutes compared to LS group, i.e. 107.89 (17.63) minutes (p=0.000). Duration of action of motoric blockade in LK group was significantly longer, i.e. 278,72 (41,75) minutes, compared to LS group, i.e. 128.39 (18.26) minutes (p=0.000). It is concluded that the additiona of clonidine 75 mcg to 12,5 mg 0,5% levobupivacaine significantly prolongs the duration of action of the motoric and sensoric blockade if given intrathecally.Key words: Clonidine, duration of action, duration of action of motoric blockade, levobupivacaine, spinal anesthesia DOI: 10.15851/jap.v3n1.374

Perbandingan Angka Keberhasilan Blokade Saraf Iskiadikus Pendekatan Parasakral dengan Labat Menggunakan Stimulator Saraf pada Operasi Daerah Kruris dan Pedis Rika Marlina; Dedi Fitri Yadi; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Blokade saraf iskiadikus digunakan pada operasi daerah kruris dan pedis. Blokade saraf iskiadikus pendekatan Labat membutuhkan rangkaian penanda anatomis, sementara parasakral menggunakan penanda anatomis sederhana. Penelitian bertujuan membandingkan angka keberhasilan blokade saraf iskiadikus pendekatan parasakral dengan Labat. Penelitian uji acak terkendali tersamar ganda dilakukan pada 32 pasien dewasa di Rumah Sakit Dr. Hasan Sadikin Bandung dan Rumah Sakit Dr. Slamet Garut selama Desember 2014–Januari 2015. Tempat penyuntikan kelompok Labat pada 4 cm distal garis proyeksi tegak lurus terhadap pertengahan trokanter mayor dan spina iliaka superior posterior. Tempat penyuntikan kelompok parasakral pada 6 cm distal garis proyeksi antara spina iliaka superior posterior dan tuberositas iskiadikus. Penyuntikan 30 mL bupivakain 0,4% dilakukan bila terdapat respons motorik pada arus 0,3 mA. Perbandingan angka keberhasilan diuji dengan Uji Eksak Fisher, bermakna jika p<0,05. Blokade saraf iskiadikus kelompok parasakral berhasil pada 15 subjek, sedangkan Labat berhasil pada 8 subjek dengan nilai p=0,015. Angka keberhasilan blokade saraf iskiadikus pendekatan parasakral lebih tinggi dibanding dengan Labat menggunakan stimulator saraf pada operasi daerah kruris dan pedis.Kata kunci: Blokade saraf iskiadikus, keberhasilan, penanda anatomis, pendekatan parasakral, pendekatan LabatComparison of Success Rates between Parasacral Approach and Labat Approach Applied in Sciatic Nerve Block Using Nerve Stimulator in Leg and Foot SurgeriesAnesthesiologist uses sciatic block in leg and foot surgeries. Labat sciatic block uses a series of anatomical landmarks, while parasacral uses simple anatomical landmarks. This study compared the success rate of parasacral approach of sciatic block to Labat approach using nerve stimulator in leg and foot surgeries. A double-blind randomized controlled trial study was conducted on 32 adult patients at Dr. Hasan Sadikin General Hospital Bandung and Dr. Slamet General Hospital Garut during the period of December 2014 to January 2015. In Labat group, a line was drawn from greater trochanter to posterior superior iliac spine. Then, from the midpoint of this line, a second line was drawn perpendicularly and extended caudally to 4 cm. The end of this line represented the needle entry. In parasacral group, a line was drawn from posterior superior iliac spine to ischial tuberosity. The needle entry was then marked on this line at 6 cm from the posterior superior iliac spine. Thirty mL of 0.4% bupivacaine was injected when a proper motor response was elicited at 0.3 mA. Comparison of success rates were analyzed using Fisher’s exact Test with p-value<0.05 considered significant. Fifteen blocks in parasacral group were successful compared to 8 blocks in Labat group, with p-value of 0.015. The success rate of parasacral approach of sciatic block is higher than in the Labat approach when using nerve stimulator in leg and foot surgeries. Key words: Sciatic nerve block, success, anatomical landmarks, parasacral approach, Labat approach DOI: 10.15851/jap.v3n3.613

Perbandingan Pengaruh Pemberian Granisetron 1 mg Intravena dengan Plasebo (Salin) untuk Mencegah Kejadian Menggigil Pascaanestesi Spinal pada Seksio Sesarea Heru Wishnu Manunggal; Ezra Oktaliansah; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Menggigil pascaanestesi merupakan komplikasi yang sering terjadi pada tindakan anestesi. Tujuan penelitian ini untuk mengkaji pemberian granisetron 1 mg intravena dalam mengurangi kejadian menggigil pada pasien yang menjalani seksio sesarea dengan anestesi spinal. Metode penelitian klinis acak terkontrol tersamar ganda pada 38 pasien yang menjalani seksio sesarea di Rumah Sakit Dr. Hasan Sadikin Bandung pada April–September 2011, usia 20–35 tahun, status fisik American Society of Anesthesia (ASA) II dan dikelompokkan secara random menjadi 2 kelompok, yaitu kelompok yang menerima granisetron 1 mg intravena atau salin sebelum dilakukan anestesi spinal dengan bupivakain 12,5 mg. Kejadian menggigil dicatat berdasarkan derajat 0–4. Hasil penelitian menunjukan secara statistik data karakteristik pasien dan suhu tubuh inti tidak berbeda antara kedua kelompok. Kejadian menggigil lebih sedikit pada kelompok granisetron (21,1%) dibandingkan dengan kelompok plasebo (52,6%) dengan hasil statistik bermakna (p<0,05). Simpulan penelitian ini menunjukkan bahwa pemberian granisetron 1 mg intravena sebelum anestesi spinal pada seksio sesarea mengurangi kejadian menggigil pascaanestesi yang dibandingkan dengan plasebo. Kata kunci: Granisetron, menggigil, pascaanestesi spinalEffect of Granisetron 1 mg Intravenously to Prevent of Shivering After Spinal Anesthesia for Cesarean SectionPost anesthesia shivering is one of the complications that often occur in anesthetic action. The purpose of this study was to assess the administration of intravenous granisetron 1 mg in reducing the incidence of shivering in patients undergoing caesarean section with spinal anesthesia. Clinical research methods in double-blind randomized controlled 38 patients who underwent seksios esarea at Dr. Hasan Sadikin Hospital Bandung during April–September 2011, aged 20–35 years overall status American Society of Anesthesia (ASA) II physical and random into two groups: the group that received granisetron 1 mg intravenously or saline prior to spinal anesthesia with bupivacaine 12.5 mg. Incidence of shivering recorded by degrees 0–4. The results showed statistically significant patient characteristic data and core body temperature did not differ between the two groups. Shivering less in granisetron group (21.1%) than the placebo group (52.6%) with statistically significant results (p<0.05).The conclusions of this study indicate that administration of granisetron 1 mg intravenously before spinal anesthesia in Caesarean section reduces the incidence of shivering postanesthesia.Key words: Granisetron, shivering, post anesthesia spinal DOI: 10.15851/jap.v2n2.303

Perbandingan Pemberian Cairan Ringerfundin Saat Anestesi Spinal (Coload) Dengan Cairan HES Sebelum Anestesi Spinal (Preload) Terhadap Hemodinamik Ibu Dan Skor APGAR BayiPada Seksio Sesarea Erik Efendi; Ruli Herman Sitanggang; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Hipotensi merupakan komplikasi yang paling sering ditemukan pada anestesi spinal yang dilakukan pada bedah sesar. Salah satu usaha pencegahan yang dilakukan adalah dengan cara pemberian cairan kristaloid secara coloading atau cairan koloid dengan cara preloading. Penelitian ini bertujuan untuk mengetahui pengaruh jenis cairan dan teknik pemberian mana yang paling baik dalam menjaga hemodinamik ibu dan pengaruhnya terhadap bayi. Penelitian ini dilakukan dengan desain eksperimental acak tersamar tunggal mengikutsertakan42 ibu hamilASA II, yang menjalani operasi bedah sesardengan anestesi spinal. Setelah dilakukan randomisasi secara blok permutasi, subyek penelitian dikelompokkan menjadi dua yaitu 21 subyek masuk dalam kelompok kontrol mendapat preloading HES 6%sebanyak 7,5 cc/kgbb dan 21 subyek masuk dalam kelompok perlakuan mendapat coloading Ringerfundin sebanyak 20 cc/kgbb mL. Tekanan darah danlaju nadi diperiksa setiap satu menit sampai 15 menit setelah anestesia spinal. Setelah itu diperiksa tiap 3 menit sampai operasi selesai. Setelah bayi lahir dilakukan penilaian skor APGAR 1 menit dan 5 menit. Data hasil penelitian dianalisis dengan uji statistik yaitu uji t test, uji Mann Whitney dan uji Kolmogorov-Smirnov, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak ada perbedaan yang bermakna antara tekanan darah sistolik, tekanan diastolik, tekanan darah rerata dan laju nadi antara pemberian cairan ringerfundin secara coloading dibandingkan pemberian cairan HES 6% secara preloading (p>0,05). Tidak terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap skor APGAR 1 menit (p=0,309) dan 5 menit (p=0,154). Terdapat perbedaan bermakna terhadap jumlah pemakaian efedrin antara kedua kelompok (p=0,047). Simpulan dari penelitian ini adalah pemberian coloading ringerfundin dapat mencegah terjadinya hipotensi pasca anestesi spinal sama baiknya dengan pemberian preloading HES 6%. Tidak terdapat perbedaan skor APGAR antara preloading HES 6% dengan coloading ringerfundin. Terdapat perbedaan jumlah pemberian efedrin antara preloading HES 6% dan coloading ringerfundin.Kata Kunci:anestesi spinal, coloading, preloading, ringerfundin, seksio sesarea Comparison of Maternal Hemodynamic and APGAR Outcome between Ringerfundin Coload And HES Preload on Spinal Anesthesia for Sectio CesareaHypotension is the most common complication inspinal anesthesia in cesarean sections performed. One of the prevention neffort is made by way of a coloading crystalloid fluid administration or by preloading colloid fluid. This study aims to determine the effect of fluid types and techniques of which the most excellent in maintaining hemodynamic effects on mother and baby. The research was conducted with a single-blind randomized experimental design included 42 pregnant women ASAII, who underwent cesarean section surgery with spinal anesthesia. After randomization in blocks of permutations, subjects are grouped into two, 21 subjects included in the control group received. 6% HES preloading by 7.5 cc/kg and 21 subjects included in the treatment group received coloading Ringerfund in as much as 20 cc/kg. Blood pressure and pulse rate examined everyone minute until 15 minutes after spinal anesthesia. After it examined every 3 minutes until the operation is complete. After the baby is born an assessment of Apgar score 1 minute and 5 minutes. Data were analyzed with the results of statistical tests that test, Mann Whitney test and Kolmogorov – Smirnov test, where pvalues<0.05 were considered significant. Statistical analysis showed that there was no significant difference between the systolic blood pressure, diastolic pressure, mean blood pressure and pulse rate between the coloading ringer fund in than preloading HES 6% (p>0.05). There were no significant differences between the two treatment group sof1-minute Apgarscore (p =0.309) and 5 minutes (p=0.154). There is a significant difference to the amount of ephedrine usage between the two groups (p =0.047). The conclusions of this study is the provision of coloading ringer fundin can prevent hypotension after spinal anesthesia as well as HES 6% preloading. No difference between the Apgar scores of 6% HES preloading with coloading ringer fundin. There is a difference between the amount of ephedrine administration preloading HES 6% and coloading ringer fundin. Keyword: coloading, preloading, ringerfundin, sectio sesarea, spinal anesthesia DOI: 10.15851/jap.v1n1.157

Perbandingan Efek Pemberian Eritromisin 250 mg Oral dengan Metoklopramid 10 mg Oral terhadap Jumlah dan pH Cairan Lambung pada Pasien yang Menjalani Operasi Elektif dengan Anestesi Umum Andi Mursali; Tinni T. Maskoen; Doddy Tavianto
Jurnal Anestesi Perioperatif Vol 5, No 1 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Aspirasi pulmonal akibat isi lambung merupakan penyebab kematian yang berhubungan dengan anestesi. Eritromisin 250 mg oral dan metoklopramid 10 mg oral digunakan untuk menurunkan jumlah dan meningkatkan pH cairan lambung. Penelitian ini bertujuan membandingkan efek eritromisin 250 mg oral dan metoklopramid 10 mg oral terhadap jumlah dan pH cairan lambung pasien yang menjalani operasi elektif dengan anestesi umum. Penelitian ini merupakan uji klinis acak buta ganda pada 42 pasien yang termasuk dalam kriteria inklusi pasien dengan American Society of Anesthesiologist (ASA) kelas I, usia 18–60 tahun, dijadwalkan operasi elektif dengan anestesi umum dan diintubasi di Rumah Sakit Dr Hasan Sadikin Bandung periode Agustus–September 2015. Pasien dibagi menjadi 2 kelompok 21 orang masing-masing. Kelompok A mendapatkan eritromisin 250 mg oral dan kelompok B metoklopramid 10 mg oral yang diberikan 1 jam sebelum induksi anestesi. Setelah dilakukan intubasi, cairan lambung diambil menggunakan spuit 50 mL melalui nasogastric tube (NGT) no 18, dimasukkan ke gelas ukur, diukur jumlah dan pH nya. Analisis statistik menggunakan uji Mann–Whitney. Hasil menunjukkan kelompok A didapatkan 90,5% pasien dengan jumlah cairan <25 mL, sedangkan kelompok B 57,1%, perbedaan bermakna secara statistik (p<0,014). Simpulan, eritomisin 250 mg oral lebih menurunkan jumlah dan meningkatkan pH cairan lambung dibanding dengan metoklopramid 10 mg oral pada pasien yang menjalani anestesi umum.Kata kunci: Eritromisin, jumlah cairan lambung, metoklopramid, pH cairan lambung Comparison of the Effect of 250 mg Oral Erythromycine and 10 mg Oral Metoclopramide on Gastric Fluid Volume and pH in Patients Undergoing Elective Operation in General AnesthesiaPulmonary aspiration caused by gastric contents is one of the leading causes of anesthesia-related deaths. Combination of >25 mL volume and a <2.5 pH is a high risk to lung damage. Oral Erythromycin 250 mg and Oral metoclopramide 10 mg can be used to reduce the gastric fluid volume and increase the gastric fluid pH. The purpose of this study was compare the effects between oral erythromycin 250 mg and oral metoclopramide 10 mg on the volume and pH of gastric fluid in patients undergoing elective general anesthesia. This study was a double blind randomized clinical trial on 42 patients who met the inclusion criteria. Patients were divided into 2 groups with 21 patients in each group. Group A received 250 mg of oral erythromycin and group B received 10 mg of metoclopramide, 1 hour before the induction of anesthesia.After intubation, gastric fluid was collected using a 50 mL syringe via the nasogastric tube (NGT). It was then placed in a beaker glass to have its volume and pH measured. A statistical analysis using the Mann–Whitney test was performed. In group A, 90.5% of patients were found to have gastric fluid volume <25 mL, while group B had 57.1%, in which the difference was statistically significant (p <0.014). Hence, the administration of erythromycin 250 mg orally is more effective in reducing the gastric fluid volume and increasing the gastric fluid pH compared to oral administration of etoclopramide 10 mg in patients undergoing general anesthesia.Key words: Erythromycin, gastric fluid volume, metoclopramid, gastric pH

Reliabilitas dan Validitas Penilaian Skala Sedasi Richmond Agitation Sedation Scale (RASS) dan Ramsay pada Pasien Kritis dengan Ventilasi Mekanik di Ruang Perawatan Intensif - Suhandoko; Erwin Pradian; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Penggunaan secara rutin skala subjektif untuk nyeri, agitasi, dan sedasi akan mendorong penatalaksanaan yang lebih efektif pada pasien untuk mencapai titik akhir yang spesifik. Setiap metode subjektif skala sedasi harus dievaluasi dalam hal reliabilitas dan validitas. Tujuan penelitian untuk mengetahui reliabilitas dan validitas skala Richmond Agitation Sedation Scale (RASS) dan Ramsay pada pasien kritis yang dirawat dengan ventilasi mekanik di ruang perawatan intensif. Jumlah subjek penelitian 82 pasien yang dinilai dengan skala sedasi RASS dan Ramsay setelah diberikannya obat analgesia dan sedasi. Penelitian observasional deskriptif yang dilakukan berdasarkan urutan datang pasien selama 4 bulan penelitian dari Mei–Agustus 2014. Metode Alpha Cronbach untuk menentukan reliabilitas dan Rank Spearman untuk menentukan validitas. Hasil penelitian ini didapatkan Skala RASS dengan nilai reliabilitas tertinggi Alpha Cronbach (α):0,951, serta nilai validitas tertinggi dengan Rank Spearman (rs):0,743. Skala Ramsay dengan nilai reliabilitas tertinggi Alpha Cronbach (α):0,921, serta nilai validitas tertinggi dengan Rank Spearman (rs):0,922. Simpulan dari penelitian ini adalah skala RASS menunjukkan keandalan dan koefisien validitas lebih tinggi daripada skala Ramsay. Kata kunci: Penilaian skala sedasi, reliabilitas, validitasRichmond Agitation Sedation Scale (RASS) and Ramsay Assessment Reliability and Validity in Critically Ill Patients with Mechanical Ventilation Support in Intensive Care Unit Routine use of subjective scales for pain, agitation, and sedation promotes more effective patient management in order to reach specific end-points. Each subjective sedation scale method should be evaluated in terms of its reliability and validity. The purpose of this study was to fassess the reliability and validity of Richmond Agitation Sedation Scale (RASS) and Ramsay scale. Subjects were 82 (eighty two) patients assessed using RASS and Ramsay sedation scale after receiving analgesia and sedation drug. This study was an observational study with cross sectional descriptive sampling conducted in consecutive patients sampling within a period of 4 months during May–August 2014. The results of the assessment were analyzed using Alpha Cronbach to determine the reliability and Rank Spearman to test the validity. It was revealed that RASS scale had the highest reliability value with Alpha Cronbach (α):0.951 and the highest validity with Rank Spearman (rs):0.743 while the highest reliablity value achieved using the Ramsay scale was Alpha Cronbach (α):0.921 with Rank Spearman (rs): 0.922 as the highest validity score. It is concluded, therefore, that the RASS scale shows higher reliability and validity coefficients than the Ramsay scale. Key words: Assessment sedation scale, reliability, validity DOI: 10.15851/jap.v2n3.330

Perbandingan Pemberian Ondansetron 8 mg dengan Tramadol 1 mg/ kgBB Intravena untuk Mencegah Menggigil Pascaanestesi Umum pada Operasi Mastektomi Radikal atau Modifikasi Mirza Oktavian; A. Muthalib Nawawi; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 2, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Menggigil pascaanestesi merupakan komplikasi anestesi umum yang dapat dicegah menggunakan berbagai jenis obat. Tujuan penelitian ini adalah membandingkan ondansetron 8 mg intravena dengan tramadol 1 mg/kgBB dalam mencegah menggigil pascaanestesi umum. Penelitian dilakukan menggunakan metode prospektif, terkontrol, tersamar buta ganda pada 38 pasien berusia 30–60 tahun yang menjalani operasi mastektomi radikal atau modifikasi di Rumah Sakit Dr. Hasan Sadikin Bandung periode Maret–April 2012, status fisik American Society of Anesthesiologist (ASA) I dan II. Sampel dibagi menjadi 2 kelompok secara acak, masing-masing kelompok menerima ondansetron 8 mg atau tramadol 1 mg/kgBB sebelum penutupan luka operasi. Analisis hasil penelitian menggunakan uji chi-kuadrat menunjukkan kejadian menggigil kelompok tramadol lebih sedikit (15,8%) dibandingkan dengan kelompok ondansetron (52,6%) dengan perbedaan bermakna (p<0,05). Simpulan, pemberian tramadol 1 mg/kgBB lebih baik dibandingkan dengan ondansetron 8 mg intravena untuk mencegah kejadian menggigil pascaanestesi umum pada operasi mastektomi radikal atau modifikasi.Kata kunci: Menggigil pascaanestesi umum, ondansetron, tramadolComparison Between Intravenous 8 mg Ondansetron and Tramadol 1 mg/kgBW in Preventing Post Anesthetic Shivering after General Anesthesia in Radical or Modified MastectomyPost anesthetic shivering is a common complication of general anesthesia and preventable with several types of drugs. The aim of this study was to compare the efficacy of intravenous 8mg ondansetron versus tramadol 1 mg/kgBW in preventing post anesthetic shivering after general anesthesia. The research is a prospective, randomized double-blind controlled study involving 38 female patients aged 30–65 years at Dr. Hasan Sadikin Hospital Bandung period March–April 2012, American Society of Anesthesiologist (ASA) physical status I–II, who underwent radical or modified mastectomy. Subjects were randomly divided into two groups. One group was given ondansetron 8 mg and the other group was given tramadol 1 mg/kgBW before surgical wound closure. Research results showed that incidence of post anesthetic shivering was less on tramadol group (15.8%) compared to ondansetron (52.6%) group, which is statistically significant (p<0.05). In conclusion, administration of tramadol 1 mg/kgBW intravenously is more effective in preventing post anesthetic shivering in radical or modified mastectomy.Key words: General anesthesia, ondansetron, post anesthetic shivering, tramadol DOI: 10.15851/jap.v2n1.231

CO2 Gap Sebagai Prediktor Tingkat Mortalitas Pasien Sepsis Berat di Intensive Care Unit Immanuel Wiraatmaja; Ezra Oktaliansah; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Tingkat mortalitas pasien sepsis berat di Intensive Care Unit (ICU) dihitung dengan menggunakan skor Acute Physiology and Chronic Health Evaluation (APACHE) II dan memerlukan pemeriksaan yang banyak serta kompleks. Peningkatan p (vena-arteri)CO2 (CO2 gap) berhubungan dengan penurunan indeks jantung, karena itu diharapkan CO2 gap memiliki kemampuan untuk menentukan tingkat mortalitas pasien sepsis berat. Penelitian ini bertujuan untuk mengetahui kegunaan CO2 gap sebagai prediktor tingkat mortalitas pasien sepsis berat di ICU Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung yang lebih mudah serta murah.Penelitian ini dilakukan secara prospektif observasional terhadap 50 orang. Penelitian dilakukan di ICU RSHS Bandung dari bulan Agustus 2013–Januari 2014. Setiap subjek penelitian diperiksa nilai CO2 gap. Subjek dibagi ke dalam 2 kelompok berdasarkan nilai CO2 gap menjadi kelompok nilai CO2gap tinggi (nilai CO2 gap ≥6) dan nilai CO2 gap rendah (nilai CO2 gap<6). Penilaian ulang dilakukan pada hari ke-28 untuk masing-masing kelompok untuk menilai adakah pasien dalam kelompok tersebut yang meninggal. Hasil penelitian menunjukan bahwa CO2 gap memiliki sensitivitas 94,7%; spesifisitas 90,3%; positive predictive value 85,7%; negative predictive value 96,5%; likelyhood ratio positive CO2 gap 9,76; dan likelyhood ratio negative CO2 gap adalah 0,05. Simpulan penelitian adalah CO2 gap dapat digunakan untuk melakukan prediksi tingkat mortalitas pasien sepsis berat.Kata kunci: CO2 gap, mortalitas, sepsisCO2 Gap as a Mortality Incidence Predictor for Severe Sepsis Patient in Intensive Care Unit The mortality rate of severe sepsis patients in Intensive Care Unit (ICU) is measured by using the Acute Physiology and Chronic Health Evaluation (APACHE) II score, which need various complex examinations. Increased p(venous-arterial) CO2(CO2 gap) relates to decreased cardiac index; therefore, it is expected that CO2 gap can be used to predict mortality incidence in severe sepsis patients in the ICU of Dr. Hasan Sadikin General Hospital (RSHS).This study was a prospective study on 50 patients who met severe sepsis criteria conducted in the ICU of RSHS Bandung from August 2013 to January 2014. The CO2 gap was be measured in all the patients. Subjects were divided into two groups according to the CO2 gap value, i.e. high CO2 gap (≥6) and low CO2 gap (<6). Subjects were then assessed on the 28th day to observe the mortality incidence the respective group. It was shown that a CO2 gap value had a sensitivity of 94.7%, specificity of 90.3%, positive predictive value of 85.7%, and the negative predictive value of 96.5%. The likelihood ratio of positive CO2 gap and negative CO2 gap were 9.76 and 0.05, respectively. In conclusion, CO2 gap can be used to predict the mortality incidence in severe sepsis patients in the ICU of RSHS Bandung. Key words: CO2 gap, mortality, sepsis DOI:10.15851/jap.v2n3.331

Perbandingan Teknik Insersi Klasik dengan Teknik Insersi Triple Airway Manoeuvre terhadap Angka Keberhasilan dan Kemudahan Pemasangan Laryngeal Mask Airway (LMA) Klasik Nelly Margaret Simanjuntak; Ezra Oktaliansah; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 4, No 3 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Beberapa penelitian telah dilakukan untuk mencari metode yang dapat meningkatkan angka keberhasilan teknik insersi laryngeal mask airway (LMA) klasik dan mengurangi komplikasi yang mungkin terjadi. Penelitian ini bertujuan mengetahui angka keberhasilan dan kemudahan pemasangan LMA klasik pada teknik triple airway manoeuvre (TAM). Penelitian ini adalah eksperimental prospektif dengan metode acak terkontrol tersamar tunggal terhadap pasien yang menjalani operasi terencana dalam anestesi umum di kamar operasi Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung pada bulan April–Juli 2015. Tiga puluh enam pasien pasien berusia 18–60 tahun, status fisik berdasarkan American Society of Anesthesiologists (ASA) kelas I–II dibagi menjadi dua kelompok, yaitu kelompok teknik insersi klasik dan teknik insersi TAM. Pada teknik TAM, seorang penolong melakukan protrusi mandibula dan membuka mulut sementara seorang melakukan insersi LMA klasik. Data hasil penelitian dianalisis dengan uji statistik Eksak Fisher dan Kolmogorov Smirnov. Hasil penelitian menunjukkan bahwa perbandingan angka keberhasilan pemasangan dan kemudahan pemasangan LMA klasik pada kedua kelompok perlakuan berbeda bermakna (p<0,05) dengan teknik insersi TAM memiliki angka keberhasilan lebih tinggi daripada teknik insersi klasik (72,2%) dan teknik insersi TAM memiliki kejadian tahanan di orofaring lebih sedikit dibanding dengan teknik klasik (83,3%). Simpulan, teknik insersi TAM memiliki angka keberhasilan yang lebih tinggi daripada teknik insersi klasik sehingga.Kata kunci: Laryngeal mask airway klasik, teknik triple airway manoeuvre, teknik insersi klasikComparison of Success Rate and Ease of Insertion of Classic Laryngeal Mask Airway when Inserted using Classic Insertion Technique and Triple Airway Maneuver TechniqueAbstractVarious studies are seeking to find new methods to improve techniques of classic laryngeal mask airway (cLMA) insertion and reduce possible complications. This is a clinical study to investigate the succesrate and ease of insertion using triple airway maneuver(TAM) technique and to compare it with the classic technique. This experimental prospective study was conducted using the single-blind randomized controlled trial approach to patients underwent elective surgery under general anesthesia in the operating teather of Dr. Hasan Sadikin General Hospital Bandung during the period of April 2015 to July 2015. Thirty six patients aged 18–60 years old with American Society of Anesthesiologists (ASA) I–II status were randomly divided into two groups receiving either triple airway maneuver (TAM) technique or classic technique. In TAM technique, jaw thrust and mouth opening are facilitated by a technician and the anesthesiologist inserts the LMA. The collected data were analyzed using Fisher Exact and Kolmogorov Smirnov. The statistical analysis showed that the ratio of success rate and the ease of insertion of cLMA between both treatment groups was significantly different (p<0.05) where the TAM technique showed a higher success rate of insertion (72.2%) and less impacts on the oropharynx compared to the classic method (83.3%). Overall , in this study, the TAM technique is associated with higher of success rate compared to the classic technique and the ease of insertion of TAM method makes it worth to be considered as a safe and effective method to establish a secure airway in anesthetized patients.Key words: Classic laryngeal mask airway, ease of insertion, success rate, triple airway manoeuvre DOI: 10.15851/jap.v4n3.900

Efek Ondansetron Intravena terhadap Tekanan Darah dan Laju Nadi pada Anestesi Spinal untuk Seksio Sesarea Annisa Isfandiary Ismandiya; Tinni T. Maskoen; Ruli Herman Sitanggang
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Hipotensi merupakan komplikasi anestesi spinal yang sering ditemukan pada seksio sesarea. Pencegahan hipotensi dapat dilakukan dengan pemberian cairan, vasopresor, dan memperbaiki posisi uterus ibu saat terlentang dengan mengganjal punggung. Penelitian ini bertujuan mengetahui pengaruh ondansetron 8 mg yang diberikan 5 menit sebelum spinal anestesi dalam menjaga kestabilan hemodinamik. Penelitian ini dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada Januari–Maret 2014 dengan desain eksperimental secara acak klinis terkontrol tersamar ganda yang mengikutsertakan 46 ibu hamil dengan status fisik American Society of Anesthesiologist (ASA) I−II yang menjalani seksio sesarea menggunakan anestesi spinal. Setelah randomisasi secara blok permutasi, subjek penelitian dikelompokkan menjadi 2, yaitu 23 subjek kelompok kontrol mendapat NaCl 0,9% dan 23 subjek kelompok perlakuan mendapat ondansetron intravena 8 mg. Tekanan darah dan laju nadi diperiksa setiap 1–15 menit setelah anestesia spinal, kemudian diperiksa tiap 3 menit sampai operasi selesai. Data hasil penelitian dianalisis dengan uji-t, Uji Mann-Whitney, dan Uji Kolmogorov-Smirnov. Analisis statistik menunjukkan perbedaan bermakna tekanan darah sistol, tekanan darah rata-rata, dan jumlah pemakaian efedrin antara kelompok kontrol dan kelompok ondansetron (p<0,05). Simpulan, pemberian ondansetron 8 mg dapat mengurangi hipotensi dan menurunkan jumlah pemberian efedrin pasca-anestesi spinal pada operasi seksio sesarea.Kata kunci: Anestesi spinal, hipotensi, ondansetron, seksio sesareaIntravenous Ondansetron Effect on Blood Pressure and Heart Rate in Caesarean Section under Spinal AnesthesiaHypotension is the most common complication in spinal anesthesia during cesarean sections. One of the prevention efforts includes administering a fluid vasopressor or placing a wedge under the right hip for left uterine displacement. This study aimed to determine the effect of ondansetron 8 mg, 5 minutes before spinal anesthesia, to maintain maternal hemodynamic stability. This double-blind randomized control experimental study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of January to March 2014 on 46 pregnant women, American Society of Anesthesiologist (ASA) II, who underwent cesarean section with spinal anesthesia. After randomization, the subjects were grouped into two groups: 23 subjects were included in the control group receiving Nacl 0.9% and 23 subjects were included in the ondansetron group receiving 8 mg of ondansetro. Blood pressure and pulse rate were examined every minute until 15 minutes after spinal anesthesia and then every 3 minutes until the operation was complete. Data were analyzed statistically using t test, Mann Whitney Test, and Kolmogorov-Smirnov Test. The results show that there were significant differences in systol presure, average blood pressure, and use of ephedrine between the control and ondansetron group (p<0.05). In conclusion, the provision of 8 mg ondansetron can prevent hypotension and reduce ephedrine use after spinal anesthesia in caesarean section.Key words: Spinal anesthesia, caesarean section, hypotension, ondansetron, sectio sesareaspinal anesthesia DOI: 10.15851/jap.v3n2.572

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