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Penatalaksanaan Anestesi Pasien Transposition of the Great Arteries pada Operasi Mouth Preparation Ade Arya Nugraha; - Suwarman; Ardi Zulfariansyah
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Transposition of the great arteries (TGA) disebabkan kegagalan pemisahan trunkus arteriosus, sehingga aorta keluar dari bagian anterior ventrikel kanan dan arteri pulmonal keluar dari ventrikel kiri. TGA termasuk kelainan jantung bawaan tipe sianotik. Seorang anak perempuan berusia 4 tahun datang untuk perawatan dan pencabutan gigi sebagai persiapan untuk operasi koreksi TGA di Rumah Sakit Dr. Hasan Sadikin Bandung pada Januari 2014. Anamnesis didapatkan riwayat kebiruan sejak bayi dan pada pemeriksaan fisis didapatkan anak yang tampak sianosis, SpO2 70–80%, murmur sistol, dan jari tabuh. Pada pemeriksaan ekokardiografi didapatkan kelainan TGA. Manajemen anestesi pada pasien ini dilakukan dengan menggunakan ketamin dan vekuronium untuk induksi serta pemeliharaan dengan O2 dan air, serta sevofluran. Manajemen anestesi dilakukan dengan target mencegah penurunan miring systemic vascular resistance (SVR) dibandingkan dengan pulmonary vascular resistance (PVR). Simpulan, prinsip pengelolaan perioperatif pembedahan nonkardiak pada pasien TGA adalah menjaga agar tidak terjadi penurunan SVR dan peningkatan PVR.Kata kunci: Kelainan jantung kongenital sianotik, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), transposition of the great arteries (TGA)Management of Anesthesia in Patients Transposition of the Great Arteries which Undergo Mouth PreparationTransposition of the great arteries (TGA) results from failure of the truncus arteriosus to spiral, so that the aorta arises from the anterior portion of the right ventricle and the pulmonary artery arises from the left ventricle. TGA which is the type of cyanotic congenital heart disease. A girl of 4 years came for treatment and tooth extraction as preparation for the surgical correction of TGA at the Dr. Hasan Sadikin Hospital –Bandung within January 2014. Patient with a history of blue when she was a baby and on physical examination found the child looking cyanosis, SpO2 70–80%, sistolic murmur and clubbing finger. Abnormalities on echocardiography obtained TGA. Anesthetic management of this patients was performed using ketamine and vecuronium for induction and maintenance with O2, N2O, and sevoflurane. Cyanotic attacks can occur preoperative, intraoperative, and post operative, which was treated by increasing systemic vascular resistance (SVR) compared to pulmonary vascular resistance. In conclusions, perioperative management principal for non cardiac surgery on transposition of the great arteries (TGA) is to keep SVR from decline and increase on PVR.Key words: Cyanotic congenital heart defects, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), transposition of the great arteries (TGA) DOI: 10.15851/jap.v2n2.320

Perbandingan Gabapentin 600 mg dengan 1.200 mg per Oral Preoperatif terhadap Nilai Visual Analogue Scale dan Pengurangan Kebutuhan Petidin Pascaoperasi pada Modifikasi Mastektomi Radikal Ardi Zulfariansyah; A. Muthalib Nawawi; Tatang Bisri
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Gabapentin mempunyai efek antihiperalgesia, antialodinia, dan antinosiseptif. Penelitian ini bertujuan untuk menilai efek gabapentin 600 mg dan 1.200 mg per oral preoperatif terhadap nilai visual analogue scale (VAS) dan pengurangan kebutuhan petidin pascaoperatif. Penelitian dilakukan secara uji acak terkontrol buta ganda terhadap 38 orang pasien di Rumah Sakit Dr. Hasan Sadikin Bandung pada Mei–September 2010. Pasien dibagi menjadi dua kelompok yaitu kelompok gabapentin 600 mg dan gabapentin 1.200 mg. Penilaian skala nyeri dilakukan dengan menggunakan nilai VAS. Data hasil penelitian dianalisis menggunakan Uji Mann-Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila nilai p<0,05. Hasil penelitian didapatkan nilai VAS saat diam dan saat mobilisasi berbeda bermakna (p<0,05). Kelompok gabapentin 1.200 mg lebih sedikit diberikan analgetik petidin tambahan (10,5% vs 15,8%), tetapi perbedaan tersebut tidak bermakna (p=0,631). Simpulan penelitian ini adalah gabapentin 1.200 mg per oral preoperatif lebih baik bila dibandingkan dengan 600 mg dalam mengurangi nilai VAS pasca operatif pada operasi modifikasi radikal mastektomi, namun tidak mengurangi kebutuhan petidin.Kata kunci: Gabapentin 600 mg, Gabapentin 1.200 mg, visual analogue scale, kebutuhan petidin The Comparison between 600 mg and 1,200 mg Gabapentin per Oral Preoperatively on Visual Analog Scale and Reduction of Postoperative Pethidine Requirement on Modified Radical MastectomyAbstract Gabapentin is a GABA analog which has the effect of anti hyperalgesia, anti allodynia, and anti nociceptive. This research was conducted in order to assess the effect of 600mg and 1,200 mg gabapentin given preoperatively to assess visual analogue scale (VAS) score and reduction of pethidine requirement. The study was done by conducting a double blind randomized controlled trial on 38 patients, aged 18–65 years, with ASA physical status I–II. Patients were divided into two groups: 600 mg gabapentin and 1,200 mg gabapentin group. The quality of pain was assessed using VAS score. The results were statistically analyzed using Mann-Whitney Test with 95% confidence interval and considered significant if p value <0.05. From the results, the VAS values obtained at rest and during mobilization were significantly different (p<0.05). The 1,200 mg gabapentin group received less additional pethidine (10.5% vs 15.8%), although no significant difference was shown (p=0.631). The conclusion of this study is that administration of 1,200 mg gabapentin per oral pre operatively is better when compared to 600 mg in reducing post operative visual analog scale score in modified radical mastectomy. However, it do not reduce the need for analgesic significantly.Key words: 600 mg Gabapentin, 1.200 mg Gabapentin, post operative pethidine requirement, visual analog scale DOI: 10.15851/jap.v1n3.196

Gambaran Tata Cara dan Angka Keberhasilan Penyapihan Ventilasi Mekanik di Ruang Perawatan Intensif Rumah Sakit Dr. Hasan Sadikin Bandung Richard Pahala Sitorus; Iwan Fuadi; Ardi Zulfariansyah
Jurnal Anestesi Perioperatif Vol 4, No 3 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Penyapihan ventilasi mekanik adalah suatu proses pelepasan bantuan ventilator yang dilakukan secara bertahap atau langsung oleh seorang dokter Intensive Care Unit (ICU). Penelitian ini bertujuan mengetahui gambaran tata cara dan angka keberhasilan penyapihan ventilasi mekanik yang dilakukan di ICU Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung. Metode penelitian ini adalah deskriptif observasional prospektif dan merupakan studi cross sectional. Penelitian ini melibatkan 50 pasien yang dirawat di ICU RSHS Bandung pada bulan Juli–September 2015. Data dicatat dan dikelompokkan sesuai dengan variabel karakteristik tata cara dan angka keberhasilan penyapihan ventilasi mekanik. Hasil penelitian ini menunjukkan tata cara penyapihan ventilasi mekanik yang paling banyak dilakukan adalah once daily trial of T piece sebanyak 22 pasien (44%) kemudian continous positive airway pressure (CPAP) sebanyak 40%, intermittent trial of T-piece sebanyak 10%, dan pressure support ventilation (PSV) 6%. Angka keberhasilan penyapihan ventilasi mekanik sebanyak 44 orang (88%) dan angka kegagalan penyapihan ventilasi mekanik adalah sebanyak 6 orang (12%) sehingga harus dilakukan re-intubasi. Tata cara penyapihan ventilasi mekanik yang paling banyak digunakan di ICU RSHS Bandung adalah once daily trial of T piece dan angka keberhasilan penyapihan ventilasi mekanik sebesar 88%.Kata kunci: Angka keberhasilan, tata cara penyapihan, ventilasi mekanikProcedures and Success Rate of Mechanical Ventilation Weaning in Intensive Care Unit of Dr. Hasan Sadikin General Hospital BandungAbstractMechanical ventilation weaning is a process of withdrawing ventilator assistance gradually or immediately by Intensive Care Unit (ICU) physicians. This study aimed to describe the procedure and the success rate of mechanical ventilation weaning performed at the ICU of Dr. Hasan Sadikin General Hospital (RSHS) Bandung. This was a cross-sectional descriptive prospective observational and study involving 50 patients treated at the ICU of RSHS Bandung during the period of July to September 2015. Data were recorded and classified in accordance with the variable characteristics of the procedure and the success rate of mechanical ventilation weaning. The results indicated that the most widely used mechanical ventilation weaning procedures were T-piece once daily trial in 22 patients (44%), continous positive airway pressure (CPAP) in 40%, T-piece intermittent trial in 10%, and pressure support ventilation (PSV)in 6%. Mechanical ventilation weaning success rate was 88% and the failure rate was 12% (6 patients) which required re-intubation. The most widely used procedure for mechanical ventilation weaning at the ICU of Dr. Hasan Sadikin General Hospital Bandung is T-piece once daily trial and the mechanical ventilation weaning success rate is 88%.Key words: Mechanical ventilation, success rate, weaning procedure

Quality Assesment of Antibiotic Prescription for Sepsis Treatment in Intensive Care Unit at Top Referral Hospital in West Java, Indonesia Shadrina Dinan Adani; Ardi Zulfariansyah; Putri Teesa Radhiyanti Santoso
Althea Medical Journal Vol 4, No 2 (2017)
Publisher : Faculty of Medicine Universitas Padjadjaran

Background: Sepsis is a common disease in intensive care unit (ICU) with high mortality rate. Administration of antibiotic has an important role to determine the outcome of sepsis patient. This study aimed to evaluate the quality of antibiotic prescription for sepsis treatment in intensive care unit (ICU). Methods: This descriptive study was conducted by retrieving data from 48 medical records of patients with sepsis, severe sepsis, and septic shock admitted to ICU Dr. Hasan Sadikin General Hospital (RSHS) in 2013. The study was conducted from August to October 2014. Empiric therapy in the ICUat RSHS and Surviving Sepsis Campaign (SSC) guidelines in 2012 were used as a standard for antibiotic prescription. The quality of antibiotic prescription was assessed then categorized based on Gyssens criteria. The collected data were analyzed in the form of frequency and percentage and presented in tables.Results: This study discovered that most of the patients had severe sepsis and septic shock. Based on Gyssens criteria, 35% antibiotic uses were included into category 0 (proper); 1.4% category I (improper timing); 10.5% category IIA (improper dosage); 9.1% category IIB (improper interval); 3.5% category IIC (improper route); 12.6% category IIIA (improper duration; too long); 1.4% category IIIB (improper duration; too short); 16.8% category IVA (improper; other antibiotics were more effective); 4.2% category IVD (improper; other antibiotics had narrower spectrum); and 5.6% category V (improper; no indication).Conclusions: There are still improper uses of antibiotic for sepsis, severe sepsis, and septic shock patients in the ICU. DOI: 10.15850/amj.v4n2.1088

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