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Peran Rotational Tromboelastometry pada Perdarahan Postpartum Fitri Hapsari Dewi; Yusmein Uyun; Bambang Suryono
Jurnal Anestesi Obstetri Indonesia Vol 5 No 1 (2022): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v5i1.77

Abstract

Perdarahan postpartum atau postpartum hemorhage (PPH) merupakan penyebab paling tinggi dari kematian wanita di seluruh dunia. Penyebab terbanyak pada PPH adalah atonia uteri. Langkah penatalaksanaan PPH adalah mengatasi penyebab utama disertai penggantian cairan yang hilang dengan kristaloid, koloid maupun transfusi komponen darah. Tatalaksana transfusi darah masif pada PPH meningkatkan resiko reaksi transfusi seperti alergi, edema paru, dan anafilaksis. Untuk mengurangi jumlah transfusi darah diperlukan pemeriksaan yang cepat dan tepat mengenai data faktor koagulasi. Metode baru dengan point of care viskoelastik menggunakan alat Rotational Tromboelastometry (ROTEM) memungkinkan untuk menilai profil viskoelastik koagulasi darah dalam waktu yang singkat. Transfusi diberikan sesuai dengan hasil analisis ROTEM yang akan memberikan informasi mengenai jumlah platelet, fungsi platelet, dan ketersediaan fibrinogen. Penggunaan ROTEM bertujuan untuk goal directed transfusion therapy sehingga dapat menurunkan jumlah transfusi yang diberikan dan menurunkan morbiditas akibat transfusi darah. Penggunaan ROTEM pada penatalaksanaan PPH diharapkan bisa menjadi alternatif dalam panduan transfusi darah.
Perioperative Application of 2% Lidocaine Dewi, Fitri Hapsari; Nugroho, Andy; Muttaqin, Fandi Ahmad
Journal of Anaesthesia and Pain Vol 3, No 2 (2022): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.003.02.01

Abstract

Perioperative intravenous lidocaine (IVL) can help minimize opioid-related side effects that impede the postoperative recovery process. Neurological side effects were averaged at an 8 mg/kg dose, and cardiotoxicity side effects were reported at plasma values greater than 21 g/ml. Approximately 90% of lidocaine is converted to monoethylglycinexylidide (MEGX) in the liver via oxidative demethylation (dealkylation). Analysis of MEGX concentrations after lidocaine administration can be a method used to evaluate liver function. Perioperative intravenous lidocaine lowers discomfort, nausea, the duration of ileus, the need for opioids, and the length of time spent in the hospital after surgery. During injection, low blood concentrations can result in these symptoms, which may last for several hours or days after termination. Postoperative problems, such as pain and organ failure, can be caused by anti-inflammatory and pro-inflammatory components. Analgesic, anti-inflammatory, and anti-hyperalgesic are just some of the other effects of lidocaine. It also decreases the volume of the airways and the rate of breathing, prolongs the duration of exhalation, reduces the respiratory rate and tidal volume, also causes vasoconstriction at low concentrations and vasodilation at high concentrations. In clinical applications, lidocaine can prevent propofol injection pain, improve postoperative recovery, and play a role in various surgical procedures. Perioperative IVL application is proven to provide more benefits in various surgeries compared to other available anesthetic options. Very few studies have systematically analyzed the occurrence of side effects, and the quality of evidence is low. 
Central Venous Catheterization in the ICU: A Comparison of Anatomical Landmark and Ultrasound-Guided Techniques Pratiaksa, Ardian; Purwoko; Muhammad Husni Thamrin; Bambang Novianto Putro; Fitri Hapsari Dewi
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.656

Abstract

Introduction: Central venous catheterization (CVC) is frequently required in intensive care units (ICUs) for administering medications, fluids, and monitoring central venous pressure. However, CVC insertion can lead to complications such as arterial puncture, hematoma formation, and pneumothorax. Ultrasound guidance has been advocated to reduce these complications, but its effectiveness in the ICU setting remains debated. This study compared the complication rates of anatomical landmark-guided versus ultrasound-guided CVC insertion in ICU patients. Methods: A prospective cohort study was conducted in the ICU of a tertiary care hospital. Patients requiring CVC were divided into two groups: anatomical landmark-guided and ultrasound-guided insertion. The primary outcome was the incidence of complications, including arterial puncture, hematoma, and pneumothorax. Secondary outcomes included cannulation time and the number of cannulation attempts. Results: A total of 39 patients were included in the study. The incidence of complications was significantly lower in the ultrasound-guided group (2 complications) compared to the anatomical landmark group (7 complications) (p=0.017). The most common complication was arterial puncture, occurring in 7 patients in the anatomical landmark group and 2 patients in the ultrasound-guided group. Conclusion: Ultrasound guidance significantly reduces the risk of complications during CVC insertion in the ICU. This technique should be considered the standard of care for CVC insertion in this setting.
Perioperative Application of 2% Lidocaine Dewi, Fitri Hapsari; Nugroho, Andy; Muttaqin, Fandi Ahmad
Journal of Anaesthesia and Pain Vol. 3 No. 2 (2022): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.003.02.01

Abstract

Perioperative intravenous lidocaine (IVL) can help minimize opioid-related side effects that impede the postoperative recovery process. Neurological side effects were averaged at an 8 mg/kg dose, and cardiotoxicity side effects were reported at plasma values greater than 21 g/ml. Approximately 90% of lidocaine is converted to monoethylglycinexylidide (MEGX) in the liver via oxidative demethylation (dealkylation). Analysis of MEGX concentrations after lidocaine administration can be a method used to evaluate liver function. Perioperative intravenous lidocaine lowers discomfort, nausea, the duration of ileus, the need for opioids, and the length of time spent in the hospital after surgery. During injection, low blood concentrations can result in these symptoms, which may last for several hours or days after termination. Postoperative problems, such as pain and organ failure, can be caused by anti-inflammatory and pro-inflammatory components. Analgesic, anti-inflammatory, and anti-hyperalgesic are just some of the other effects of lidocaine. It also decreases the volume of the airways and the rate of breathing, prolongs the duration of exhalation, reduces the respiratory rate and tidal volume, also causes vasoconstriction at low concentrations and vasodilation at high concentrations. In clinical applications, lidocaine can prevent propofol injection pain, improve postoperative recovery, and play a role in various surgical procedures. Perioperative IVL application is proven to provide more benefits in various surgeries compared to other available anesthetic options. Very few studies have systematically analyzed the occurrence of side effects, and the quality of evidence is low.Â