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Pemberian Bolus 7,5 mL Poligelin pada Ruang Epidural untuk Menurunkan Kejadian Postdural Puncture Headache pada Anestesi Spinal Jaya Sutawan, I. B. Krisna; Pradian, Erwin; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1104.434 KB)

Abstract

Post dural puncture headache (PDPH) mengakibatkan morbiditas pada ibu yang menjalani seksio sesarea dengan anestesi spinal. PDPH disebabkan karena penurunan tekanan intratekal akibat kebocoran cairan serebrospinalis. Bolus poligelin pada ruang epidural diharapkan secara sementara meningkatkan tekanan ruang epidural dan mengurangi kebocoran cairan serebrospinalis sehingga dapat menurunkan kejadian PDPH. Penelitian dilakukan dengan uji klinis single blind randomized controled trial pada 90 wanita hamil yang menjalani seksio sesarea dengan anestesi spinal pada Oktober sampai Desember 2011 Rumah Sakit Dr. Hasan Sadikin Bandung. Sampel dikelompokkan secara random menjadi kelompok bolus 7,5 mL poligelin dan kelompok kontrol, selanjutnya dilakukan penilaian PDPH sampai hari kelima pascaanestesi spinal. Analisis statistik berdasarkan Uji Eksak Fisher, memperlihatkan bahwa angka kejadian PDPH pada kedua kelompok perlakuan menunjukkan perbedaan bermakna secara statistik (p<0,05). Simpulan dari penelitian ini adalah bolus poligelin pada ruang epidural dapat menurunkan angka kejadian PDPH pada pasien yang menjalani operasi seksio sesarea dengan anestesi spinal.Kata kunci: Anestesi spinal, poligelin, post dural puncture headache, ruang epidural  Bolus 7.5 mL Polygeline into the Epidural Space in Reducing the Incidence of Postdural Puncture Headache on Spinal AnesthesiaAbstractPost dural puncture headache (PDPH) may cause morbidity in women undergoing caesarean section with spinal anesthesia. PDPH is caused by a reduction of intrathecal pressure due to leakage of cerebrospinal fluid. Polygeline bolus into the epidural space is expected to temporarily increase the pressure of the epidural space therefore reduces cerebrospinal fluid leakage so that it may reduce the incidence of PDPH. The study conducted was a single-blind randomized clinical trial on 90 pregnant women undergoing caesarean section with spinal anesthesia from October until December 2011 in Dr. Hasan Sadikin Hospital Bandung. Samples were randomly divided into the bolus of 7.5 mL polygeline group and the control group. Evaluation of PDPH was performed until 5th day post-spinal anesthesia. Statistical analysis using Fishers Exact Test, showed that the incidence of PDPH in both treatment groups showed a statistically significant difference (p<0.05). The conclusion of this study is polygeline bolus into the epidural space may decrease the incidence of PDPH in patients undergoing caesarean section with spinal anesthesia.Key words: Epidural space, polygeline, post dural puncture headache, spinal anesthesia DOI: 10.15851/jap.v1n3.193
EXTENDED GLASGOW OUTCOME SCALE AND CORRELATION WITH BISPECTRAL INDEX Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Sutawan, Ida Bagus Krisna Jaya; Arparitna, Ketut Yudi
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.9

Abstract

Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long-term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their caregivers and society as a whole. Clinicians and researchers require reliable and valid measures of long-term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high-quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we will describe the measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe) in correlation with bispectral index (BIS).
Venous Air Embolism (VAE) during Craniotomy of Supratentorial Meningioma in Supine Position Sutawan, Ida Bagus Krisna Jaya; Bisri, Tatang; Rahardjo, Sri; Lalenoh, Diana
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.26

Abstract

AbstractVenous Air Embolism (VAE) is one of the most serious complications in neuroanesthesia case. The highest number of VAE incident is during neurosurgery procedure with sitting position, even tough VAE may occur during craniotomy of supratentorial tumor in the supine position. VAE occurs due to the pressure differential between open vein in the surgical field and right atrium. A 46 years old woman underwent craniotomy for supratentorial meningioma in the supine position. Intraoperative, the patient was experiencing a decrease in end-tidal CO2 pressure about 6 mmHg in 5 minutes. Therefore, management of acute VAE was proceed to the patient, such as informed the surgeon immediately, discontinued N2O and increased flow of O2, modified the anesthesia technique, asked the surgeon to irrigate the surgical field with fluids, gave compression on jugular vein, aspirated the right atrial catheter, prepared drugs to support the hemodynamic, and changed the patient’s position if possible. 
PERIOPERATIVE EFFECTS OF CO-ADMINISTRATION OF TCI PROPOFOL COMBINED WITH CLONIDINE AND KETAMINE Aryabiantara, I Wayan; Sinardja, I Ketut; Sutawan, Ida Bagus Krisna Jaya; Sinardja, Cynthia Dewi; Parami, Pontisomaya; Ryalino, Christopher; Junaedi, Made Darma
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (371.815 KB) | DOI: 10.15562/bjoa.v2i3.69

Abstract

Background: Propofol is often used in Total Intravenous Anesthesia (TIVA). Studies found that adding clonidine and ketamine can increase the potential to achieve an adequate level of anesthesia while reducing inflammation and post-operative pain. The goal of this study is to see if the combination of Target Controlled Infusion (TCI) propofol plus clonidine and ketamine is more effective in reducing the IL-6 level, maintaining intraoperative stability, and reducing postoperative pain and morphine consumption.Methods: Forty patients planned for major oncology surgery were divided into two groups. The treatment group (Group T) received pre-medication with clonidine, induction with TCI propofol, and intraoperative ketamine. The control group (Group C) received normal saline solution.Results: The difference of IL-6 level increase between the two groups was not statistically significant (13.6 vs. 16.6 pg/mL, p>0.05). Mean systolic blood pressure (SBP) and mean arterial pressure (MAP) in group T were higher in 5 and 10 minutes after incision, but lower in minutes 30, 60, and 120 (p <0.05). Heart rate in group T was higher in minutes 5, 10, 15, 30, 60, and 120. Visual analog scale (VAS) in 4, 8, 12, and 24 hours post-surgery were lower in group T compared to group C. And post-operative morphine consumptions in group T were also lower. (3.6 ± 1.5 vs 9.9 ± 3.3, p <0.05).Conclusion: TIVA using TCI propofol combined with preoperative clonidine and intraoperative ketamine is effective in maintaining hemodynamic stability, reducing post-operative and reducing morphine consumption compared to TCI propofol alone.
Cost Minimization Analysis of Hypnotic Drug: Target Controlled Inhalation Anesthesia (TCIA) Sevoflurane and Target Controlled Infusion (TCI) Propofol Wiryana, Made; Aribawa, I Gusti Ngurah Mahaalit; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Hartawan, I Gusti Agung Gede Utara; Sucandra, Made Agus Kresna; Parami, Pontisomaya; Putra, Kadek Agus Heryana; Sutawan, IB Krisna Jaya; Arimbawa, IGNA Putra; Jaya, Ketut Semara; Semarawima, Gede
BALI MEDICAL JOURNAL Vol 5 No 3 (2016)
Publisher : BALI MEDICAL JOURNAL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.823 KB)

Abstract

Background: Cost minimization analysis is a pharmaco-economic study used to compare two or more health interventions that have been shown to have the same effect, similar or equivalent. With limited health insurance budget from the Indonesian National Social Security System implementation in 2015, the quality control and the drug cost are two important things that need to be focused. The application of pharmaco-economic study results in the selection and use of drugs more effectively and efficiently. Objective: To determine cost minimization analysis of hypnotic drug between a target controlled inhalation anesthesia (TCIA) sevoflurane and a target controlled infusion (TCI) propofol in patients underwent a major oncologic surgery in Sanglah General Hospital. Methods: Sixty ASA physical status I-II patients underwent major oncologic surgery were divided into two groups. Group A was using TCIA sevoflurane and group B using TCI propofol. Bispectral index monitor (BIS index) was used to evaluate the depth of anesthesia. The statistical tests used are the Shapiro-Wilk test, Lavene test, Mann- Whitney U test and unpaired t-test (? = 0.05). The data analysis used the Statistical Package for Social Sciences (SPSS) for Windows. Results: In this study, the rate of drug used per unit time in group A was 0.12 ml sevoflurane per minute (± 0.03) and the group B was 7.25 mg propofol per minute (±0.98). Total cost of hypnotic drug in group A was IDR598.43 (IQR 112.47) per minute, in group B was IDR703.27 (IQR 156.73) per minute (p>0.05). Conclusions: There was no statistically significant difference from the analysis of the drug cost minimization hypnotic drug in a major oncologic surgery using TCIA sevoflurane and TCI propofol.
Pemberian Bolus 7,5 mL Poligelin pada Ruang Epidural untuk Menurunkan Kejadian Postdural Puncture Headache pada Anestesi Spinal I. B. Krisna Jaya Sutawan; Erwin Pradian; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1104.434 KB)

Abstract

Post dural puncture headache (PDPH) mengakibatkan morbiditas pada ibu yang menjalani seksio sesarea dengan anestesi spinal. PDPH disebabkan karena penurunan tekanan intratekal akibat kebocoran cairan serebrospinalis. Bolus poligelin pada ruang epidural diharapkan secara sementara meningkatkan tekanan ruang epidural dan mengurangi kebocoran cairan serebrospinalis sehingga dapat menurunkan kejadian PDPH. Penelitian dilakukan dengan uji klinis single blind randomized controled trial pada 90 wanita hamil yang menjalani seksio sesarea dengan anestesi spinal pada Oktober sampai Desember 2011 Rumah Sakit Dr. Hasan Sadikin Bandung. Sampel dikelompokkan secara random menjadi kelompok bolus 7,5 mL poligelin dan kelompok kontrol, selanjutnya dilakukan penilaian PDPH sampai hari kelima pascaanestesi spinal. Analisis statistik berdasarkan Uji Eksak Fisher, memperlihatkan bahwa angka kejadian PDPH pada kedua kelompok perlakuan menunjukkan perbedaan bermakna secara statistik (p<0,05). Simpulan dari penelitian ini adalah bolus poligelin pada ruang epidural dapat menurunkan angka kejadian PDPH pada pasien yang menjalani operasi seksio sesarea dengan anestesi spinal.Kata kunci: Anestesi spinal, poligelin, post dural puncture headache, ruang epidural  Bolus 7.5 mL Polygeline into the Epidural Space in Reducing the Incidence of Postdural Puncture Headache on Spinal AnesthesiaAbstractPost dural puncture headache (PDPH) may cause morbidity in women undergoing caesarean section with spinal anesthesia. PDPH is caused by a reduction of intrathecal pressure due to leakage of cerebrospinal fluid. Polygeline bolus into the epidural space is expected to temporarily increase the pressure of the epidural space therefore reduces cerebrospinal fluid leakage so that it may reduce the incidence of PDPH. The study conducted was a single-blind randomized clinical trial on 90 pregnant women undergoing caesarean section with spinal anesthesia from October until December 2011 in Dr. Hasan Sadikin Hospital Bandung. Samples were randomly divided into the bolus of 7.5 mL polygeline group and the control group. Evaluation of PDPH was performed until 5th day post-spinal anesthesia. Statistical analysis using Fisher's Exact Test, showed that the incidence of PDPH in both treatment groups showed a statistically significant difference (p<0.05). The conclusion of this study is polygeline bolus into the epidural space may decrease the incidence of PDPH in patients undergoing caesarean section with spinal anesthesia.Key words: Epidural space, polygeline, post dural puncture headache, spinal anesthesia DOI: 10.15851/jap.v1n3.193
Efficacy of high-dose methylprednisolone and cyclophosphamide in childhood-onset systemic lupus erythematosus Putu Ayunda Trisnia; Ketut Dewi KUmara Wati; Komang Ayu Witarini; Ida Bagus Ramajaya Sutawan; Hendra Santoso
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (208.304 KB) | DOI: 10.14238/pi60.3.2020.117-24

Abstract

Background Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Untreated SLE often become progressive and lead to increased risk of mortality. Corticosteroid and cyclophosphamide remain the treatment of choice for severe SLE. Disease activity assessed with SLE Daily Activity Index (SLEDAI). Objective To compare the disease activity of childhood-onset severe SLE at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide by using SLEDAI. Methods This study was conducted in the Division of Pediatric Allergy and Immunology, Department of Child Health, Udayana University/Sanglah Hospital, Denpasar, Bali. Subjects were SLE patient aged 0-18 years who had severe clinical manifestations. Subject received therapy combination of high dose methylprednisolone and cyclophosphamide every 2 weeks for six doses. SLEDAI score was assessed at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide. Results During the study period, 51 children were diagnosed as SLE. Twenty-one subjects were included for analysis. Median SLEDAI score at the time of diagnosis was 23 (range 13-39). SLEDAI score after three months of cyclophosphamide was decreased to 2 (range 0-14). Post hoc analysis with Wilcoxon signed-rank test showed the improvement of SLEDAI score at the time of diagnosis and after three months of cyclophosphamide was statistically significant (Z=-4.016, P<0.0001). Conclusion SLEDAI score reduced after completion of high-dose methylprednisolone and three month of cyclophosphamide therapy.
Konsep Dasar Transcranial Doppler (TCD) untuk Neurocritical Care Ida Bagus Krisna J. Sutawan; Siti Chasnak Saleh; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (499.984 KB) | DOI: 10.24244/jni.vol6i3.49

Abstract

Transcranial Doppler merupakan salah satu aplikasi dari penggunaan ultrasonografi (USG) sehingga bersifat noninvasif dan mobile. Untuk dapat menggunakan TCD dengan baik maka diperlukan pemahaman mengenai doppler effect yang merupakan dasar perhitungan dari parameter TCD, acoustic window yang mana merupakan tempat dimana dilakukan isonasi sehingga menemukan arteri yang benar, anatomi dari arteri yang akan diisonasi dan tipe alat TCD yang digunakan untuk mengisonasi. Informasi mengenai keadaan sirkulasi darah otak menggunakan TCD didapatkan melalui parameter-parameter yang langsung dihitung oleh alat TCD diantaranya peak systolic velocity, end diastolic velocity, mean flow velocity, pulsatility index dan resistence index. Selanjutnya ada juga informasi-informasi lainnya yang didapatkan dengan memasukkan parameter-parameter tersebut ke sebuah rumus, seperti misalnya mean flow velocity, tekanan intrakranial, tekanan perfusi otak. Selain itu TCD juga dapat digunakan untuk menilai keutuhan autoregulasi, vasospasme, hiperemia, dan mati batang otak.Basic Concept of Transcranial Doppler (TCD) for Neuroanesthesia and Critical CareTranscranial Doppler (TCD) is one of the applicable use of ultrasonograhy (USG), so it is noninvasif and mobile. To use TCD properly, the understanding of Doppler effect as the basic to calculate the parameters of TCD, acoustic window which are the place where to isonate to find the correct arterie, the anatomy of arteries that will be isonated and type of TCD device that will be used to isonated are needed. Information about cerebral circulation using TCD can be achieved from parameters that are directly calculated by the TCD device such as peak systolic velocity, end diastolic velocity, mean flow velocity, pulsatility index and resistence index. Furthermore, there are also informations that can be archived by putting up those parameters to a formula such as mean flow velocity, intracranial pressure and cerebral perfusion pressure. Beside that TCD also can be used to evaluate autoregulation, vasospasme, hypermia, and brain death. 
Penggunaan Jarum Spinal Atraumatic dalam Menurunkan Kejadian Post-dural Puncture Headache: Telaah Sistematis Pragra, Maria Preicilia; Parami, Pontisomayaa; Sutawan, Ida Bagus Krisna Jaya; EM, Tjahya Aryasa; Utara Hartawan, I Gusti Agung Gede
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i01.P08

Abstract

AbstrakPost-dural puncture headache (PDPH) merupakan salah satu komplikasi pasca anestesi spinal yang ditandai dengan nyeri kepala. Kejadian PDPH dipengaruhi oleh beberapa faktor salah satunya adalah jenis jarum spinal. Telaah sistematis ini bertujuan untuk mengetahui peran penggunaan jarum spinal atraumatic terhadap kejadian PDPH dibandingkan dengan jarum spinal traumatic pada pasien anestesi spinal.Pencarian literatur studi randomized controlled trial (RCT) dari tahun 2015 sampai 2020 yang membandingkan kejadian PDPH menggunakan jarum atraumatic dan jarum traumatic pada pasien anestesi spinal dilakukan melalui Google Scholar, PubMed, dan hand-searching secara manual. Seleksi studi dilakukan berdasarkan panduan diagram alir PRISMA 2009. Risiko bias masing-masing studi dinilai menggunakan Jadad Scale. Sintesis data didapatkan dari 19 studi dengan jumlah total sampel 4.414 pasien tanpa adanya batasan umur dan jenis kelamin.Berdasarkan studi yang ditemukan, seluruhnya menyatakan bahwa kejadian PDPH dengan jarum atraumatic lebih rendah dibandingkan dengan jarum traumatic dan ditemukan paling tinggi pada pasien operasi cesar. Kejadian PDPH tertinggi sebesar 22% dengan jarum traumatic 25G quincke, sedangkan kejadian terendah sebesar 0% dengan jarum atraumatic 25G sprotte, 27G sprotte, 25G whitacre, dan 27G whitacre. Kegagalan anestesi spinal ditemukan lebih tinggi pada jarum atraumatic dibandingkan dengan jarum traumatic, akan tetapi perbedaan tersebut tidak signifikan. Oleh karena itu, penggunaan jarum atraumatic lebih direkomendasikan dalam tindakan anestesi spinal untuk mencegah terjadinya PDPH.Kata kunci : post-dural puncture headache, anestesi spinal, jarum atraumatic
Machine Learning as Our Weapon to Become Anesthesiologist 5.0 Ratumasa, Marilaeta Cindryani Ra; Sucandra, MA Kresna; Aryasa, Tjahya; Sutawan, IB Krisna Jaya
Majalah Anestesia & Critical Care Vol 41 No 3 (2023): Oktober
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.v41i3.319

Abstract

Machine learning is one of the most renowned things that have emerged in the last five years in medicine. The machine is made as if it has the cognitive ability to think independently, is able to distinguish incoming inputs and get the desired output. Along with the development of statistical and computer science, machine learning has evolved into a distinct subfield within the broader domain of data science, with far-reaching implications for various sectors, including healthcare. In medical science, technology and artificial intelligence are starting to take over anesthetic services. This paradigm shift necessitates a fundamental change in the role of future anesthesiologists A future anesthesiologist will need to continuously monitor and evaluate the performance of data science and artificial intelligence systems, and make adjustments when necessary to improve impact on patient care and outcomes. Anesthesiologists of the future will need to harness the power of data science and artificial intelligence to enhance patient care continually, emphasizing adaptability and collaboration as key elements in delivering improved healthcare outcomes.