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Anesthesia in Low Ejection Fraction Patient : Case Report Gemawan, Taufiq; Handoko, Adelia; Misturiansyah, Nurrul Izza
Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan Vol 17 No 2 (2023): Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan
Publisher : Fakultas Kedokteran UPN Veteran Jakarta Kerja Sama KNPT

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33533/jpm.v17i2.6198

Abstract

Ejection fraction (EF) is the percentage of the difference between the end-diastolic volume and the end-systolic volume divided by the end-diastolic volume. This measurement is important in determining how well the heart is pumping out blood and in diagnosing heart failure (HF). Normally the percentage of EF is above 50%. A decrease in EF will make it difficult to perform anesthesia during surgery due to life-threatening irregular heartbeats, leading to sudden cardiac arrest and sudden death. Patients with a very low ejection fraction require identification of risk factors, preoperative evaluation and optimization, medical therapy, monitoring, and appropriate anesthetic technique and drugs. In this report, we present a 67-year-old woman with HFmrEF (estimated ejection fraction 46%) and coronary artery disease who underwent partial hip replacement surgery under general anesthesia. General anesthesia was performed on the patient and induction used fentanyl, midazolam, and atracurium. Management of patients is aimed at maintaining cardiac output and avoiding myocardial depression by maintaining a balance between oxygen supply and demand. Therefore good anesthetic management is needed to maintain the hemodynamic stability of the patient.
A Meta-Analysis of Dextrose Infusion as Perioperative Strategy on Preventing Postoperative Nausea and Vomiting Nabiel Erisadana, Rifaldy; Pratama, Muhamad Rizal Hadi; Muhammad, Faliqul Bahar; Gemawan, Taufiq; Fatmarita, Lia; Ekawaty, Uli Artha; Danar Sumantri, Syahrul Mubarak
Majalah Anestesia & Critical Care Vol 42 No 2 (2024): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v42i2.384

Abstract

Introduction: Dextrose infusion was introduced as a non-pharmacological perioperative strategy to decrease the PONV incidence. However, current published studies reported remain inconsistent and debatable results regarding the efficacy. This research was conducted to improve the evidence-based perioperative strategies of administering dextrose infusion to prevent PONV. Method: A literature search was conducted for randomized controlled trial studies (RCTs) in patients who administered dextrose infusion compared to other infusion fluid perioperatively. A quantitative analysis using Review Manager 5.4 was performed with a 95% confidence interval that was visualized in the forest plot graph using the fixed-effects or random-effects model based on the heterogeneity. Results: A total of 18 RCTs studies analyzed demonstrated there were significant differences in composite PONV (RR, 0.66, 95% CI 0.60, 0.74; P < 0.00001; I2=46%), patients with postoperative antiemetic rescue requirements (RR, 0.67, 95% CI 0.53, 0.86; P < 0.001; I2=68%), and postoperative blood glucose levels (SMD, 2.63, 95% CI 1.76, 3.50; P < 00001; I2=97%). However, there were insignificant results in PONV severity (SMD, -0.94, 95% CI -2.20, 0.31; P = 0.14; I2=97%), patients with analgesic requirements (RR, 0.84, 95% CI 0.60, 1.19; P = 0.33; I2=81%), dose of analgesic requirements (SMD, -2.31, 95% CI -5.76, 1.14; P = 0.19; I2=99%), and PACU stay (MD, -24.73, 95% CI -66.07, 16.61; P < 0.24; I2=99%). Conclusion: This meta-analysis demonstrated that administering dextrose infusion perioperatively prevents both the PONV incidence and postoperative rescue antiemetic requirements, and also increase postoperative blood glucose levels. However, dextrose infusion is not associated with reducing the PONV severity, postoperative analgesic requirements, a dose of postoperative analgesic use, and PACU stay. .
Perioperative Management on Septic Condition et Causa General Peritonitis: Case Report Handoko, Adelia; Gemawan, Taufiq; Muhammad Rizal Hadi Pratama; Kristianingrum Dian Sofiana; Amien, Muhammad Isryad
Jember Medical Journal Vol. 2 No. 2 (2023)
Publisher : Faculty of Medicine, University of Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19184/jembermedicaljournal.v2i2.474

Abstract

Sepsis is a life-threatening systemic pathological condition. Based on WHO, there were 48.9 million cases with 11 million related deaths worldwide in 2017, which is almost 20% of all deaths from disease. Nearly half of all sepsis cases globally occurred in children, with an estimated 20 million cases and 2.9 million deaths. One of the conditions that can cause sepsis is generalized peritonitis. This study is a case report. Primary data was obtained through anamnesis, physical examination, laboratory test and radiology examination. In this case report, a 13-year-old child patient with generalized peritonitis was found due to obstructive ileus causing intestinal perforation, accompanied by sepsis, and underwent laparotomy and colostomy. Appropriate perioperative management is necessary to maintain hemodynamic stability and adequate oxygenation given the presence of sepsis in the patient.
Anesthetic Management of Laparoscopic Surgery on a Pediatric Patient: Case Report Handoko, Adelia; Gemawan, Taufiq; Lubis, Arinie Awindya
Jember Medical Journal Vol. 3 No. 2 (2024): .
Publisher : Faculty of Medicine, University of Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19184/jembermedicaljournal.v3i2.1160

Abstract

Inguinal hernia is an opening on myofascial oblique muscle and transversal muscle or the failure of Nuck canal or processus vaginalis during the gestation week which allows herniation of intra-abdominal or extraperitoneal organ. A 5-year-old child was diagnosed with a left lateral inguinal hernia. The results of the inguinal ultrasound showed movement and movement of the intestines in the left inguinal area through a defect measuring approximately 2.96 centimeters. The patient was planned to undergo laparoscopic high ligation hernia. Laparoscopic technique in adult commonly applied with special consideration. However, the practice in pediatric patient could be more challenging for anesthesiologist. Although laparoscopic surgery is less invasive it could cause more stress due to the pressure of the intra-abdominal pneumoperitoneum by CO2 that is done during the procedure, which then causes hypercapnea due to the absorption of CO2, the decrease of tidal volume, and the decrease of end-tidal volume. Considering pediatric’s different physiology compared to adult and the risks of laparoscopic surgery, special anesthesia management should be conducted. 
Ischemic Stroke Induced by Bee Sting in Agricultural Society – A Rare Complication of Bee Sting: A Case Report Navadz, Eqiel; Aprilianto Handoko, Eko; Taufiq, Kamilka; Gemawan, Taufiq; Hakiim, Arsyzilma; Handoko, Adelia; Fortuna Sari, Putri
Journal of Agromedicine and Medical Sciences Vol. 11 No. 2 (2025)
Publisher : Faculty of Medicine, Universitas Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19184/ams.v11i2.53705

Abstract

Abstract Introduction: Ischemic stroke is one of the highest causes of morbidity and mortality. One of the factors that triggers ischemic stroke which is quite rare is a bee sting. Pathomechanism of this condition remain unclear. This case report will describe a rare complication of bee sting and discuss it from a pathomechanism perspective. Case Report: A 40-year old woman came to the emergency room at Dr. Koesnadi Bondowoso with the main complaint of weakness in the right face. Referral patients from community health centers. The patient's complaint occurred 7,5 hours ago after being stung by a bee on the middle finger of his left hand. Physical examination showed facial angioedema, edema of digiti manus III sinsitra, and others normal. On neurological examination, it was found: Parasis Nervus XII and VII sinistra UMN type and hemiparasis sinistra. Laboratory examination showed increased neutrophils (90.4%) and eosinophilia (0.1%). A non-contrast CT scan examination showed a hypodense lesion in the right hemisphere. The patient was given antiplatelet, antihistamin, and neuroprotectan. Discussion: One of the rare complications of bee stings is ishemic stroke. This occurs due to the toxin from bee stings which contain vasoactive, pro-inflammatory agents, thrombogenic peptides, thromboxane A2, and leukotrienes which trigger platelet aggregation and vasoconstriction. This condition can trigger trombus formation and lead to ischemic stroke. Medical personnel, especially neurologists, must be aware of pathomechanism from the quite rare complications of ischemic stroke induced by bee stings, especially in rural areas Keywords: Ischemic Stroke, Bee sting, rural area.
A Systematic Review and Meta-Analysis of Paracervical Blocks as A Perioperative Strategy in Reducing Postoperative Pain in Patients Undergoing Laparoscopic Hysterectomy Nabiel, Rifaldy; Suseno, Daniel Alexander; Hadisubroto, Yonas; Gemawan, Taufiq; Anindito Putri, Aurellia Nuraini; Salsabila, Syadza; Sari, Eprila Darma
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I22023.112-121

Abstract

Introduction: Perioperative strategies to reduce postoperative pain are important for enhancing patient satisfaction. However, further research and trials has sparked ongoing debates of various strategies regarding efficacy and safety. Objective: This study aims to improve evidence-based strategies regarding the effect of paracervical anaesthetic blocks in patients undergoing laparoscopic hysterectomy. Methods: A systematic literature search was conducted through PubMed, Google Scholar, and ScienceDirect for RCTs in laparoscopic hysterectomy patients administered paracervical blocks and those given placebos. The quantitative analysis of pooled relative risk and mean difference with a 95% confidence interval were performed using the Review Manager 5.4 software in the random-effects model or fixed-effects model forest plot. Results: Based on four RCTs included in the analysis, there were significant differences in overall postoperative pain scores assessed by VAS (Visual Analogue Scale) [MD = -0.82, 95%CI (-1.47 to -1.06), p = 0.01]. The subgroup analysis also showed significant differences in VAS pain scores at 30 min and 1 hour post-operation [MD = -2.13, 95% CI (-3.09 to -1.16), p = 0.0001] and [MD = -2.55, 95% CI (-4.29 to -0.81), p = 0.004]. However, there were insignificant results in adequate pain control [RR = 7.90, 95%CI (0.39 to 158.67), p = 0.18], length of hospital stay [MD = 0.01, 95%CI (-0.52 to 0.54), p = 0.96], additional analgesics requirement at 24 hours [RR = 0.88, 95%CI (0.55 to 1.39), p=0.58], and perioperative complications [RR = 0.90, 95%CI (0.56 to 1.47), p = 0.68].Conclusion: This meta-analysis provides evidence that the administration of paracervical block in patients undergoing laparoscopic hysterectomy is associated with a reduction of postoperative VAS pain score but not associated with the length of hospital stay, adequate pain control, additional analgesics requirement at 24 hours, and perioperative complications.
PROFIL HEMODINAMIK PASIEN PRE OPERATIF, INTRA OPERATIF, DAN PASCA OPERATIF DENGAN HIPOALBUMIN Gemawan, Taufiq; Handoko, Adelia; Rachmania, Sheilla; Hasya, Aghnia; Aisy, Rihadatul; Pratama, Muhamad Rizal Hadi
Medika Kartika : Jurnal Kedokteran dan Kesehatan Vol 7 No 4 (2024): Medika Kartika : Jurnal Kedokteran dan Kesehatan
Publisher : Fakultas Kedokteran Universitas Jenderal Achmad Yani

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Albumin serum (SA) dibutuhkan dalam tubuh sebagai protein yang multifungsi. Peran penting albumin adalah untuk menekan respons inflamasi dalam tubuh dan menjaga permeabilitas vaskuler terutama saat proses inflamasi. Hal ini menjadi perhatian penting bagi pasien yang akan melakukan tindakan operatif untuk menjaga hemodinamik vaskuler. Berikut ini adalah serial kasus mengenai dua pasien dengan diagnosis canal stenosis lumbal dan hernia sikatrikalis. Hasil laboratorium albumin kedua pasien tersebut adalah <3,5 g/dL. Kedua pasien tersebut dipantau kondisi hemodinamik praoperatif, intraoperatif, dan pascaoperatif di Rumah Sakit Daerah dr. Soebandi, Jember, Indonesia. Semua pasien dengan hipoalbuminemia pada penelitian ini mengalami kondisi komorbid hipertensi. Kondisi hemodinamik praoperatif dan pascaoperatif relatif sama, sedangkan saat intraoperatif tekanan darah pasien mengalami penurunan. Albumin memiliki peran dalam mempertahankan permeabilitas vaskuler. Pemeriksaan albumin pada pasien praoperatif penting dilakukan untuk menimbang apakah hemodinamik intraoperatif dan pascaoperatif pasien dapat stabil. Kata Kunci: heart rate, hipoalbumin, mean arterial pressure (MAP), tekanan darah DOI : 10.35990/mk.v7n4.p432-441