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All Journal International Journal of Public Health Science (IJPHS) Bali Journal of Anesthesiology Majalah Anestesia & Critical Care (MACC) Jurnal Penyakit Dalam Indonesia
Aldy Heriwardito
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Jakarta, Indonesia
Health Professions Medicine & Pharmacology Other

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INCIDENCE AND RISK FACTOR OF ACUTE KIDNEY INJURY POST OPEN HEART SURGERY IN PAEDIATRIC PATIENTS Heriwardito, Aldy; Alatas, Anas; Perdana, Aries; Sutedja, Anasthasia Devina
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.65

Abstract

Introduction: Acute Kidney Injury (AKI) was a frequently complication after open heart surgery, especially in paediatric patients < 2 years old and had been related with increased mortality and adverse renal outcomes. This study aimed to know the incidence of AKI post open heart surgery in paediatric patients and its relation with duration of cardiopulmonary bypass (CPB) and patient’s age in Indonesia tertiary national hospital.Methods: This was a cohort retrospective study, using medical record and Cardiac ICU chart data, of 195 paediatric patients who underwent open heart surgery from June 2014 - June 2015 in Integrated Cardiovascular Center Cipto Mangunkusumo hospital. After ethical approval from Research Ethic Committee, data were collected and sorted by inclusion and exclusion criteria. AKI was diagnosed based on RIFLE criteria. Data were analyzed by chi-square and multivariate analysis (SPSS software 22.0 version).Results: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB > 60 min had a significant correlation with increased incidence of AKI (p 0.043; RR 1.248). Patient’s age ≤ 2 years old also had a significant correlation with increased incidence of AKI (p<0.001; RR 2.431). Multivariate analysis results showed that both duration of CPB > 60 min and patient’s age ≤ 2 years old were significant risk factors of AKI (OR 2.951, OR 5.371).Conclusion: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB duration > 60 min and patient’s age < 2 years old were significant risk factors of AKI.
The Effect of Contralateral Head Rotation on Internal Jugular Vein to Carotid Artery Distance and Overlap Ratio Heriwardito, Aldy; Dachlan, Muhammad Ruswan; Hidayat, Jefferson; Rokyama, Hadli
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (4525.866 KB) | DOI: 10.15562/bjoa.v3i2.158

Abstract

Introduction: Carotid artery puncture during central venous catheter (CVC) insertion could lead to serious complication if there was overlapping of internal jugular vein (IJV) and carotid artery (CA). IJV and CA overlap ratio and distance were determined by contralateral head rotation angle. Optimal angle of contralateral head rotation during CVC insertion can decrease the risk of CA puncture complication. This study was aimed to investigate the optimal angle of contralateral head rotation on IJV to CA distance and overlap ratio at the cricoid level by ultrasound guidance.Methods: This was a cross-sectional study of 34 patients undergoing elective surgery with CVC insertion. IJV to CA distance and overlap ratio at the cricoid level on each subject in supine position was measured by using two-dimensional ultrasound  (Sonosite® M-Turbo, 6-13 MHz probe) at 0o, 30o, 45o, 60o contralateral head rotation of insertion site. Collected data were analyzed using SPSS 21.0.Results: There were significant differences on IJV to CA distance and overlap ratio at different contralateral rotation angles (0o, 30o, 45o, 60o, p<0.001). Overlapping of IJV and CA started to occur at contralateral head rotation 30o (11.72%) and increased in line with the increasing of contralateral head rotation angle (21.21% at 45o).Conclusion: There were significant effects of contralateral head rotation to distance and overlapping IJV to CA at cricoid level. Optimal contralateral head rotation angle for CVC was less than 30o to prevent IJV and CA overlapping.
Perbandingan Keefektifan Adjuvan Inhalasi Lidokain dengan Spray Lidokain Sebagai Obat Anestetik Lokal pada Pasien Endoskopi Saluran Cerna Atas Aldy Heriwardito; Eddy Harijanto; Taufik Asri Utomo
Majalah Anestesia & Critical Care Vol 39 No 1 (2021): Februari
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 | Full PDF (332.005 KB) | DOI: 10.55497/majanestcricar.v39i1.207

Abstract

Latar Belakang: Teknik multimodal analgesia dengan menggunakan dua atau lebih obat analgesik yang berkerja pemeriksaan endoskopi saluran cerna merupakan prosedur untuk mengevaluasi berbagai gejala saluran pencernaan, namun sering ditolak pasien karena menimbulkan efek samping nyeri dan rasa tidak nyaman karena gag reflex. Penggunaan adjuvan inhalasi lidokain sebagai obatanestetik lokal dapat menurunkan angka kejadian gag reflex sehingga dapat menjadi pilihan untuk sedasi pada endoskopi saluran cerna atas. Penelitian ini bertujuan untuk membandingkan keefektifan dari spray lidokain dan inhalasi lidokain sebagai adjuvan pada endoskopi saluran cerna atas. Metode: Penelitian ini menggunakan metode uji klinis acak tersamar tunggal pada150 pasien yang menjalani endoskopi saluran cerna atas dengan sedasi di RSUPN Cipto Mangunkusumo. Pasien dibagi menjadi dua kelompok sama besar untuk adjuvan inhalasi yang berbeda. Sebanyak 75 orang pada kelompok pertama diberikan 0,5 mg/kgBB spray lidokain sedangkan 75 orang pada kelompok kedua diberikan 1,5 mg/kgBB inhalasi lidokain. Penilaian efek sedasi diukur menggunakan Skala Sedasi Ramsay. Data yang terkumpul dianalisa lebih lanjut secara statistik. Hasil: Gag reflex terjadi sebanyak 1,3 % dari total subjek pada kelompok inhalasi lidokain dan 30,7% subjek pada kelompok spray lidokain (P<0,001). Rerata rescue dose propofol yang didapatkan pada kelompok inhalasi lidokain adalah 0,67 ± 5,77 mg/kgBB dan pada kelompok spray lidokain adalah 11 ± 17,9 mg/kgBB (P < 0,001). Simpulan: Inhalasi lidokain lebih efektif sebagai anestetik lokal dibandingkan spray lidokain sebagai adjuvan pada endoskopi saluran cerna atas.
Comparison of C-MAC® Video Laryngoscope and Macintosh Conventional Laryngoscope for Nasotracheal Intubation Convenience in Adult Malay Race Population Aldy Heriwardito; Rahendra; Ananto Wiji Wicaksono
Majalah Anestesia & Critical Care Vol 39 No 2 (2021): 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 | Full PDF (592.923 KB) | DOI: 10.55497/majanestcricar.v39i2.209

Abstract

Background: Nasotracheal intubation is a widely used airway management method, especially in oral surgeries. Various devices were found to perform intubation techniques, such as video laryngoscopes. C-MAC® video laryngoscope enables better glottis visualization compared to the Machintosh conventional laryngoscope. C-MAC® demonstrates higher success rates of orotracheal intubation especially in difficult airway cases. However, this device has not been commonly used in nasotracheal intubation yet. Methods: A single blinded randomized clinical trial study of 86 subjects were done to compare the use of C-MAC® video laryngoscope and Macintosh conventional laryngoscope with reference to their success rates of intubation and duration of nasotracheal intubation in adult Malay patients. Patients with difficult airway, pregnancy, acute ischemic heart disease, heart failure, second- or third-degree block, uncontrolled hypertension, Guillen Barre syndrome, Myasthenia Gravis, and contraindications to nasotracheal intubation were excluded. Results: C-MAC® demonstrated a higher success rate at first attempt of intubation (RR 1,265, 95% CI (1,084-1,475)) and required a shorter duration of intubation (p value <0.001) compared to the Macintosh conventional laryngoscopes in adult Malay. Conclusion: In adult Malay patients, nasotracheal intubation is better performed with the C-MAC® video laryngoscope compared to the Macintosh conventional laryngoscope. High rate of successful first attempt and shorter duration of the process indicate more convenient and easier intubation.
Validation of ARISCAT Model Score to Predict PostoperativePulmonary Complications in Tertiary Referral Hospital inIndonesia Alkaff, Muhammad; Pitoyo, Ceva Wicaksono; Heriwardito, Aldy; Koesnoe, Sukamto
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 1
Publisher : UI Scholars Hub

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

Abstract

Introduction. There are several prediction model score instruments that can help to assess pulmonary preoperative evaluation and it is believed that ARISCAT model score is very simple to do and have good performance, but not widely used. This score has not been yet validated in Indonesia. This study aimed to assess the performance of discrimination and calibration of ARISCAT score in predicting postoperative pulmonary complication who underwent surgery in a tertiary referral hospital in Indonesia. Methods. A retrospective cohort study was conducted to assess the external validation of ARISCAT scores in the Indonesian population. This study involved patients underwent surgery at Cipto Mangunkusumo Hospital in 2017. Several variables were collected such as age, oxygen saturation, history of pulmonary infection, anemia, type of surgery, duration of operation, emergency surgery, and PPC that observed within 30 days after surgery. Discrimination was assessed by the area under the curve (AUC). Calibration was assessed by the Hosmer-Lemeshow test and calibration plot. Results. Of 428 patients studied, PPC was observed in 32% of patients. Discrimination of ARISCAT score was shown by AUC value of 88.2% (CI 95%; 84.1-92.2%). Hosmer-Lemeshow test showed p=0.052 and calibration plot revealed coefficient Jurnal Penyakit Dalam Indonesia | Vol. 6, No. 1| Maret 2019 | 3 Uji Validasi Skor ARISCAT dalam Memprediksi Komplikasi Paru Pascaoperasi di RS Rujukan Tersier di Indonesia r=0.968. Conclusion. ARISCAT model score has good discrimination and calibration performance and can be applied in the Indonesian population.
Skor Kelelahan pada Peserta Didik Anestesiologi dan Terapi Intensif dan Faktor-Faktor yang Mempengaruhi Heriwardito, Aldy; Sugiarto, Adhrie; Setiadi, Bakti; Dwiputra, Anggara Gilang; Hafidz, Noor; Ramlan, Andi Ade Wijaya
Majalah Anestesia & Critical Care Vol 40 No 1 (2022): Februari
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 | Full PDF (618.993 KB) | DOI: 10.55497/majanestcricar.v40i1.252

Abstract

Latar Belakang: Prevalensi kelelahan secara global bervariasi antara 2,36-75,7%. Kelelahan merupakan konsekuensi yang dapat dialami oleh peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitasi Indonesia (FKUI) selama menjalami proses pendidikan. Penelitian ini dilakukan untuk mengetahui tingkat kelelahan pada PPDS Anestesiologi dan Terapi Intensif FKUI/RSCM setelah bertugas selama 24 jam di RSCM dengan menggunakan penilaian FAS, serta faktor-faktor yang memengaruhinya. Metode: Metode penelitian adalah studi potong lintang dan acak. Analisis dilakukan terhadap 36 subjek peserta PPDS Anestesiologi dan Terapi Intensif FKUI tahap paripurna, mandiri dan magang selama periode penelitian. Subjek diberikan kuesioner berisi pertanyaan mengenai faktor yang dapat memengaruhi tingkat kelelahan. Kelelahan secara subjektif diukur dengan Fatigue Assessment Scale (FAS) setelah peserta PPDS bekerja di Rumah Sakit dr.Cipto Mangunkussumo (RSCM) selama ≥ 24 jam. Hasil: Sebanyak 55,6% peserta PPDS Anestesiologi dan Terapi Intensif mengalami kelelahan seetelah bekerja di RSCM selama > 24 jam, dengan rerata skor kelelahan berdasarkan FAS adalah 23,6±4,2 yang berada diatas titik potong skor kelelahan dari FAS yaitu > 22. Kelelahan fisik memiliki rerata nilai yang lebih besar (15,19±2,7) dibandingkan dengan kelelahan mental (10,61±2,2) dengan perbedaaan yang bermakna (p<0.01). Kelelahan pada peserta PPDS Anestesiologi dan Terapi Intensif FKUI tidak dipengaruhi oleh karakteristik, gaya hidup dan karakteristik pekerjaan. Kesimpulan: PPDS Anestesiologi dan Terapi Intensif mengalami kelelahan fisik pasca bekerja selama >24 jam di RSCM. Kelelahan tersebut tidak dipengaruhi oleh faktor gaya hidup dan pola kerja.
The Accuracy of Yoon’s Formula for Predicting Central Venous Catheter Depth in Indonesian Pediatric CHD Patients: A Cross Sectional Study Meidisa Akhmad, Adinda; Soenarto, Ratna Farida; Heriwardito, Aldy; Nathania, Eloisa
Majalah Anestesia & Critical Care Vol 43 No 1 (2025): Februari
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.v43i1.419

Abstract

Introduction: A central venous catheter is a routinely inserted tool by anesthesiologists in open-heart surgery. However, incorrect central venous catheter placement depth may lead to complications or suboptimal usage. Yoon’s research in 2006 was done in paediatrics with congenital heart disease in Asia and developed a prediction formula for the depth of central venous catheter. This study aims to prove if Yoon’s formula can be applied to pediatric patients with congenital heart disease in Indonesia. Methods: This analytic observational study, with a cross-sectional design, involved 38 patients undergoing open-heart surgery in RSCM. Yoon’s formula determines the depth of central venous catheter placement. Transesophageal echocardiography assessed the position of the tip of the central venous catheter from the cavoatrial junction to confirm the depth’s accuracy. Results: Yoon’s formula can predict the optimal depth of the central vein catheter 63.16% of the time. There was no complication before central venous catheter placement. This study is limited to right internal jugular vein placements, reducing its generalizability to other insertion sites. Further research with a larger sample and varied approaches is needed to enhance accuracy and develop a more suitable formula. Conclusion: Yoon’s formula is inappropriate for predicting the depth of central vein catheters in pediatric patients with congenital heart disease in Indonesia, but it can still be applied clinically.
Influencing factors of patient safety in anesthesia services in a low- and middle-income country Heriwardito, Aldy; Ramlan, Andi Ade Wijaya; Zahra, Raihanita; Martira, Amelia; Pramodana, Bintang; Bintartho, Agung; Sukmono, Raden Besthadi; Lasanudin, Joshua Eldad Frederich
International Journal of Public Health Science (IJPHS) Vol 14, No 4: December 2025
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v14i4.26631

Abstract

Patient safety in anesthesia remains a concern in low- and middle-income countries due to workforce shortages, limited equipment, and inconsistent protocols. In Jakarta, where demand for anesthesia is rising, baseline data on these parameters are lacking. This study aimed to identify gaps in human resources, equipment availability, and safety protocol adherence. A cross-sectional survey of all actively practicing anesthesiologists in Jakarta was conducted in January 2024, yielding 115 responses. The questionnaire, developed and face-validated through a focus group with senior anesthesiologists, covered three domains: human resources, facilities and equipment, and protocols. Internal reliability was assessed using Cronbach’s alpha. Participation was voluntary, responses were anonymous, and data were analyzed using descriptive statistics. Prolonged work hours were reported by a minority of respondents (6.1-7%), with 22.7% agreeing that anesthesiologists' workload is too high. Most rated human resource parameters positively (median 4/5), but access to basic monitoring devices for oxygenation, ventilation, circulation, and temperature was limited. Protocol adherence was generally high (median 4-5/5), though a small minority of institutions lacked incident reporting pathways, patient risk assessment, and post-surgical recovery rooms. Improving patient safety in Jakarta requires ensuring essential monitoring equipment, optimizing staffing to manage workload, and mandating full perioperative safety protocols across facilities.
Co-Authors Agung Bintartho Alatas, Anas Ananto Wiji Wicaksono Arif H. M. Marsaban Ceva W. Pitoyo Dachlan, Muhammad Ruswan Dwiputra, Anggara Gilang Hafidz, Noor Harijanto, Eddy Jefferson Hidayat Lasanudin, Joshua Eldad Frederich Martira, Amelia Meidisa Akhmad, Adinda Muhammad Alkaff Muhammad Alkaff Nathania, Eloisa Perdana, Aries Pramodana, Bintang Rahendra Ramlan, Andi Ade Wijaya Ratna Farida Soenarto Rokyama, Hadli Setiadi, Bakti Sugiarto, Adhrie Sukamto Koesnoe Sukamto Koesnoe Sukmono, Raden Besthadi Sutedja, Anasthasia Devina Taufik Asri Utomo Yundha, I G.N.A.D. Zahra, Raihanita