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All Journal Jurnal Anestesiologi Indonesia Majalah Anestesia dan Critical Care Jurnal Neuroanestesi Indonesia
Yudi Hadinata
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Terapi Inhalasi Pada Tatalaksana Hipertensi Pulmonal Hadinata, Yudi; Parmana, I Made Adi
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Abstract

Hipertensi pulmonal didefinisikan sebagai kelompok penyakit dengan karakteristik peningkatan resistensi pembuluh paru yang dapat menyebabkan gagal jantung kanan. Ketika kondisi tersebut tidak ditangani maka dapat menyebabkan perburukan kondisi hingga kematian. Kemajuan dalam pemahaman patofisiologi terkait dengan kondisi tersebut memberikan kesempatan bagi praktisi untuk mengobati pasien hipertensi pulmonal, yang dapat menurunkan angka mortalitas dan morbiditas, serta meningkatkan kualitas hidup pasien. Vasodilator paru yang ideal untuk digunakan bersifat spesifik untuk sirkulasi paru, bebas dari efek samping, murah, dan nyaman untuk dilakukan. Pemberian vasodilator melalui inhalasi merupakan salah satu strategi yang efektif untuk mengurangi tekanan arteri pulmonal dan juga menghindari efek samping sistemik seperti hipotensi. Tinjauan pustaka ini akan mengulas tentang terapi perioperatif hipertensi pulmonal dengan menggunakan vasodilator inhalasi. Kata Kunci: Hipertensi pulmonal, inhalasi vasodilator pulmonal, vasodilator pulmonal Inhalation Therapy In Pulmonary Hypertension ManagementPulmonary hypertension is defined as a group of diseases characterized by a progressive increase of pulmonary vascular resistance leading to right ventricular failure. When the condition is untreated this may lead to potentially devastating disease and premature death. The remarkable improvements for the understanding of the pathology associated with the condition provides an opportunity for practitioner to treat patients with pulmonary hypertension, thereby improving overall mortality, morbidity, and quality of life associated with the disease. The ideal pulmonary vasodilator for perioperative use which should be highly specific for the pulmonary circulation,free of side effects, inexpensive, and convenient to implement. Administration of vasodilators via inhalation is an effective strategy for reducing pulmonary artery pressure while avoiding systemic side effects such as hypotension. This paper will review on the perioperative therapy of pulmonary hypertension using inhaled vasodilators. Key words: Pulmonary hypertension, inhaled pulmonary vasodilator, pulmonary vasodilator
Anestesi untuk Pengangkatan Meningioma Suprasella dengan Pendekatan Supraorbita Hadinata, Yudi; Isngadi, M.; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (316.681 KB) | DOI: 10.24244/jni.vol2i3.158

Abstract

Anestesi pada kasus meningioma memiliki beberapa hal yang harus diperhatikan. Otak merupakan jaringan yang tertutup oleh tulang kranium dan memiliki jaringan pembuluh darah yang banyak sehingga beresiko untuk terjadinya pendarahan dan edema. Kondisi jaringan otak yang rileks dibutuhkan ketika akan dilakukan operasi otak melalui insisi kecil supraorbita. Tanpa penanganan anestesi yang baik maka ahli bedah saraf akan kesulitan untuk melakukan pendekatan pada tumor dan meningkatkan resiko edema otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien wanita usia 44 tahun datang dengan keluhan nyeri kepala hebat dan pusing dirasakan sejak 8 bulan sebelum masuk rumahsakit, mengalami periode kejang selama 12 menit, terjadi kurang lebih 1x/bulan, penglihatan pada mata kanan buram. Pasien didiagnosa dengan meningioma suprasellar, dan direncanakan dilakukan pembedahan dengan pendekatan subfrontal. Status fisik ASA 3 dengan riwayat asma, riwayat sepsis karena pneumonia dan infeksi saluran kemih, riwayat Steven Johnson karena phenytoin, leukositosis 10.570, defisit neurologis. Pasien dilakukan tindakan anestesi umum dengan intubasi. Induksi dengan midazolam, fentanyl, lidokain, propofol, dan vecuronium. Operasi dengan pendekatan supraorbita berlangsung selama 10 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif (Intensive Care Unit/ICU) selama 2 hari sebelum pindah ruangan. Kontrol faktor fisiologi dan perlakuan anestesi yang dilakukan selama operasi memiliki pengaruh kepada jaringan otak. Lebih lanjut lagi, seorang dokter anestesi harus memiliki pengetahuan tentang berbagai macam efek obat untuk mencapai hal tersebut dan mengetahui kondisi premorbid pasien yang dapat mempengaruhinya.Anesthesia Management for Suprasella Meningioma Removal with Supraorbital Approach Anesthesia for meningioma presents special considerations. The brain is enclosed in a rigid skull and the brain is a highly vascular organ presenting potential for massive perioperative hemorrhage and edema. A slack brain is necessary when treating neoplastic lesions through the small supraorbital approach. Without optimal anesthesia care, the neurosurgeon can not reach the operative site and the risk of brain edema due to extensive brain manipulation is increased. This case reports a 44 years old woman with severe headache and dizziness for 8 months prior to admission she suffers from 12 minutes periods of seizure once a month, and experienced a blured vision on her right eye. She was diagnosed with suprasellar meningioma, which will be removed with supraorbital surgical approach. ASA 3rd was confirmed with history of status asthmaticus, septic condition due to pneumonia and urinary tract infection, history of Steven-Johnson syndrome due to phenytoin, leucocytosis of a count of 10.570, and neurological deficits general anesthesia was performed. Induction of anesthesia was done using midazolam, fentanyl, lidocaine, propofol and vecuronium. The surgery for meningioma was conducted within 10 hours. Patient was managed in the Intensive Care Unit post operatively for 2 days prior to ward transfer. Physiologic and anesthetics factors controlled by the anesthesiologist have profound effects on the brain. Furthermore, anesthesiologists are required knowledge of the effects of various drugs on the issues mentioned above and patient conditions.
Anesthesia for ASD Closure in Robotic-Assisted Cardiac Surgery: A Case Report Rizqhan, Muhammad; Hadinata, Yudi
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.70958

Abstract

Background: Minimally invasive cardiac surgery is a surgical approach performed through small incisions in the chest without the need for a sternotomy. Robotic technology is one of the techniques that can be utilized in this type of surgery. This approach offers several advantages, including faster healing, reduced stress response, shorter hospital stays, and improved cosmetic outcomes.Case: A 51-year-old male with an atrial septal defect (ASD) secundum and a left-to-right (L-R) shunt measuring 22x29 mm, without comorbidities, was scheduled for general anesthesia. The patient was classified as ASA III. Monitors applied included ECG, nasopharyngeal thermometer, arterial line, CVP, EtCO₂, NIRS, and TEE. The patient was placed in a supine position and intubated with a 37 Fr left-sided double-lumen endotracheal tube (DLT) at a depth of 31 cm, followed by one-lung ventilation. General anesthesia was induced using midazolam 5 mg, sufentanil 10 mcg, propofol 50 mg, and rocuronium 50 mg, maintained with 1% sevoflurane and rocuronium at 10 mg/hour. A regional block was performed using a Deep Serratus Anterior Plane Block with a regimen of 10 ml of 0.5% isobaric bupivacaine (50 mg), 5 ml of 10% lignocaine (500 mg), and epinephrine 1:200,000, with a total volume of 40 ml. The surgery was performed on a beating heart with right femoral artery, right femoral vein, and right jugular vein cannulation. The procedure lasted 12 hours.Discussion: Robot-assisted minimally invasive cardiac surgery greatly aids cardiac surgeons in performing procedures with high precision. However, it is essential to consider the potential risks and complications associated with the surgery. Anesthesiologists must enhance preoperative, intraoperative, and postoperative assessments while ensuring effective communication among the surgical team.Conclusion: Robot-assisted minimally invasive cardiac surgery can be used as a primary surgical method for ASD closure. However, anesthesiologists must pay close attention to preoperative, intraoperative, and postoperative assessments to ensure patient safety and optimal outcomes.
Co-Authors I Made Adi Parmana Isngadi, M. Isngadi, M. Laksono, Buyung Hartiyo Muhammad Rizqhan