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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina E-Jurnal Medika Udayana Jurnal Kedokteran Brawijaya Jurnal Administrasi Kesehatan Indonesia Bali Journal of Anesthesiology Bioscientia Medicina : Journal of Biomedicine and Translational Research Interdental Jurnal Kedokteran Gigi (IJKG) PREPOTIF : Jurnal Kesehatan Masyarakat Scientia Psychiatrica Neurologico Spinale Medico Chirurgico Babali Nursing Research JUNCTO: Jurnal Ilmiah Hukum Bioscientia Medicina : Journal of Biomedicine and Translational Research COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat Jurnal Konstruksi Hukum Journal of Anesthesiology and Clinical Research Journal of Law, Poliitic and Humanities Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
I Gusti Agung Gede Utara Hartawan
Departemen Anestesi Dan Ruang Terapi Intensif, Fakultas Kedokteran, Universitas Udayana, Bali, Indonesia
Humanities Biochemistry, Genetics & Molecular Biology Dentistry Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Other

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Non-Convulsive Status Epilepticus (NCSE) in ICU Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Ryalino, Christopher; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.5

Abstract

Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long,  associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes of. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended asthe first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis.  This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response.
Anesthesia on Pediatric Laproscopy Wiryana, Made; Sinardja, I Ketut; Kurniyanta, Putu; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Darma Junaedi, I Made; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.1

Abstract

Laparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patients age, cardiovascular function, and anesthetic agents are used. Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by insufflation gas or penetration laparoscopic and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery.
Central Venous Pressure Correlates with Inferior Vena Cava Collapsibility Index in Patient Treated in Intensive Care Unit Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Mahaalit Aribawa, I Gusti Ngurah; Gede Utara Hartawan, I Gusti Agung; Parami, Pontisomaya; Perangin Angin, Emkel
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.2

Abstract

Background: Intravascular volume status is an important parameter in monitoring the patients treated at intensive care unit (ICU), so accuracy and strict monitoring of fluid volume is one factor that influence patient’s health status. Amongst others, two ways to monitor body fluid volume status is central venous pressure (CVP) and collapsibility index of inferior vena cava (IVC) diameter. The purpose of this study is to determine the correlation between CVP with the IVC collapsibility index in patients treated in ICU Sanglah Hospital in Denpasar. Method: Seventy patients treated at Sanglah Hospital ICU with already inserted CVC for appropriate indication, were measured for CVP, then followed by examination the diameter of IVC with ultrasound to measure the maximum and minimum collapsibility index. Spearman’s correlation coefficients was used to assess the correlation between CVP and collapsibility index of the IVC. Results: In 70 patients, we found a very strong negative correlation between CVP and IVC’s collapsibility index (Spearmans rho = -0.854; p <0.001). Conclusion: This study found that there is a very strong negative correlation between CVP and collapsibility index of IVC. This finding indicates that the collapsibility index of the IVC may substitute CVP in determining the status of the intravascular volume.
Effectiveness of Infusion Warmer Use to Prevent the Occurrence of Hypothermia and Shivering After General Anesthesia Action in General Hospital Center Sanglah Denpasar Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Kusuma Wijaya, Andi; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.3

Abstract

Introduction: Shivering and hypothermia after general anesthesia is a common complication in the recovery room. Heating methods and drugs  widely used, but not yet effective. The purpose of this study was to evaluate the effectiveness of using the infusion warmer in maintaining normal core temperature and prevent shivering. Materials and Methods: The study was a non blindnes randomized control trial study. This study aimed to compare the effectiveness of the use of infusion warmer in preventing the incidence of hypothermia and shivering after general anesthesia. Research conducted at the Sanglah Hospital in October 2016, with sample calculations 58 people who meet the inclusion and exclusion criteria. Both were divided into 2 groups, 29 groups of infusion warmer and 29 people without the infusion warmer Recording the results of assessing multiple parameters vital signs, hemodynamic, aldrette score, body temperature, and shivering from the beginning, after induction, and minutes to 5, 15, 30 , 60 in the recovery room. The data obtained were analyzed with SPSS software with a significance level of p <0.005 expressed significantly, with a relative risk <1 as a preventive. Results: From a comparative picture of events shivering and hypothermia in minutes to 5, 15, 30, 60 in the recovery room seen that the treatment group based on the group lower warmer than in the non warmer. This shows that the use of warmer can prevent the incidence of shivering and hypothermia in patients after general anesthesia. In test statistically significant with p <0.05. Conclusions: The use of infusion warmer can help reduce the incidence of hypothermia and shivering after general anesthesia action.
Low Dose Ketamin Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Novita Pradnyani, Ni Putu; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.4

Abstract

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Low-dose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psikomimetik like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.
Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center Parami, Pontisomaya; Suranadi, I Wayan; Utara Hartawan, I Gusti Agung Gede; Mahaalit, I Gusti Ngurah; Ryalino, Christopher; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (175.516 KB) | DOI: 10.15562/bjoa.v3i1.116

Abstract

ABSTRACTPain is a common complaint found in the population. Inadequate knowledge about pain management is the most common reason that triggers the inadequate management of pain. Pharmacological pain management is also not without risk. Various risks from the use of pharmacological agents related to side effects that can arise may also cause new problems. Several medical intervention techniques with invasive procedures for pain have also been carried out, although they are still less popular, due to a lack of public knowledge of this technique. We conducted a cost-free, minimally invasive pain procedure in people with chronic musculoskeletal pain in a public health center in a rural area in Bali Island to alleviate their pain-associated symptoms and to introduce this minimally invasive pain management technique.
The correlation between the depth extent of Tuohy epidural needle with body mass index (BMI) to achieve loss of resistance in patients undergoing epidural anesthesia Hartawan, I Gusti Agung Gede Utara; Senapathi, Tjokorda Gde Agung; Aribawa, I Gusti Ngurah Mahaalit; Parami, Pontisomaya; Pradhana, Adinda Putra; Syamsuddin, Johanis Bosco Troy
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (172.208 KB) | DOI: 10.15562/bjoa.v3i1.119

Abstract

ABSTRACTBackground: Anesthesia management in obesity is quite challenging. Epidural anesthesia become one of the choices. The attention should be addressed in order to prevent the misidentification of epidural space. The estimation of the depth extent of epidural space becomes crucial, especially in obese patients due to an accumulation of subcutaneous and epidural adipose tissue, which consequently complicate the epidural catheter insertion. This study aimed to analyze the correlation of the depth extent of Tuohy epidural needle to achieve loss of resistance between normal-weighted and obese patients.Method: This study was conducted with 56 adult patients aged 17 to 65 years who underwent elective surgery by epidural anesthesia inserted at level L2-L3 or L3-L4 interspace. Subjects are divided into normal and obese groups. Shapiro-Wilk and chi-square tests were used in the normality test. For normally distributed data, an independent t-test was used to test the hypothesis, otherwise, we used Mann-Whitney test  Results: The results showed that the loss of resistance in epidural needle insertion procedures was 60 mm in a patient with BMI more than 30 kg/m2 and 50 mm in those with BMI <30 kg/m2 (p<0.001).Conclusion: The loss of resistance depth in epidural Tuohy needle insertion is significantly determined by BMI. 
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.
Analisis kebutuhan perawat berdasarkan pengamatan terhadap penanganan pasien dewasa dan anak-anak di Unit Gawat Darurat Rumah Sakit Bali Royal Hartawan, I G A Gede Utara; Ilyas, Yaslis
Medicina Vol 47 No 2 (2016): Mei 2016
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (503.422 KB)

Abstract

Seiring dengan berjalannya waktu, jumlah kunjungan pasien ke UGD Rumah Sakit Bali Royal semakin meningkat. Tujuan penelitian ini adalah untuk mengetahui beban kerja perawat dan kebutuhan perawat di UGD Rumah Sakit Bali Royal. Penelitian ini merupakan penelitian deskriptif kuantitatif. Pengamatan dilakukan oleh peneliti untuk mengetahui waktu yang dihabiskan oleh perawat dalam melayani pasien dengan menggunakan metode Time Motion Study. Hasil penelitian menunjukkan beban kerja untuk pasien gawat darurat sebesar 63,4 menit per hari (1,1 jam per hari), pasien gawat tidak darurat 1.585,5 menit per hari (26,4 jam per hari), dan pasien darurat tidak gawat 2.187,7 menit per hari (36,5 jam per hari) dan kebutuhan tenaga perawat di UGD Rumah Sakit Bali Royal sebesar 17 orang. Diperlukan penambahan tenaga perawat pelaksana sebanyak 3 orang. Meanwhile, patients that admitted to Emergency Unit of Bali Royal Hospital is getting more. The objective of this study was to determine the workload of nurses and nurses needs in the Emergency Unit of Bali Royal Hospital. This study was a descriptive quantitative study. Observations were made by the researcher to determine the time spent by nurses in serving patients by using the Time Motion Study. The results shown the workload for critically emergency patients was 63.4 minutes per day (1.1 hours per day), critically non emergency patients was 1,585.5 minutes per day (26.4 hours per day), and 2,187 minutes per day (36.5 hours per day) for non critical-but emergency patients and the need for nurses in the Emergency Unit of Bali Royal Hospital was 17 people. Nurses needed additional power as much as 3 people.
PREVALENSI KEMATIAN PASIEN DI RUANG TERAPI INTENSIF RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR PERIODE JANUARI – DESEMBER 2015 Ida Ayu Mas Sasmari Brahmani; I Gusti Agung Gede Utara Hartawan
E-Jurnal Medika Udayana Vol 8 No 12 (2019): Vol 8 No 12 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (373.548 KB)

Abstract

Ruang terapi intensif (RTI) merupakan salah satu unit pelayanan sentral yang berada di rumah sakit. Pasien yang dirawat di RTI adalah pasien-pasien yang dalam kondisi kritis dan mengancam nyawa. Kematian di RTI dapat dikatakan tinggi. Oleh karena itu, penting dilakukan penelitian terhadap prevalensi kematian pasien di RTI RSUP Sanglah Denpasar, karena rumah sakit tersebut merupakan rumah sakit rujukan utama di Bali.Rancangan penelitian yang digunakan adalah deskriptif retrospektif. Pengambilan sampel menggunakan teknik total sampling. Penelitian dilakukan di RTI RSUP Sanglah Denpasar. Data pasien diperoleh dari register pasien RTI RSUP Sanglah Denpasar periode Januari - Desember 2015. Pada 1531 sampel yang memenuhi kriteria inklusi dan eksklusi didapatkan sebanyak 24,8% (n=379) pasien meninggal dan 75,2% (n=1152) keluar dalam kondisi hidup. Prevalensi kematian pada pasien bedah dan bukan bedah adalah 58,3% (n=221) dan 41,7% (n=158). Prevalensi kematian pasien bedah dengan dan tanpa ventilator mekanik adalah 71,5% (n=158) dan 28,5% (n=63), sedangkan prevalensi kematian pasien bukan bedah dengan dan tanpa ventilator mekanik adalah 47,5% (n=75) dan 53,5% (n=83). Kelompok penyakit bedah terbanyak adalah pasca-kraniotomi (43,9%), sedangkan pada kelompok penyakit bukan bedah adalah gangguan pernafasan (22,2%). Kata kunci: prevalensi kematian pasien, bedah, bukan bedah, ventilator mekanik, RTI
Co-Authors Adinda Putra Pradhana Anak Agung Angga Pringga Dana Anak Agung Gde Agung Adistaya Anak Agung Sagung Laksmi Dewi Andi Kusuma Wijaya, Andi Brillyan Jehosua Toar Christopher Ryalino Cristy, Nadia Assecia Dewa Ayu Mas Shintya Dewi Dewi Sinardja, Cynthia Dewi, Dewa Ayu Mas Shintya Eka Nantha Kusuma, Putu Eka Putra, I Wayan Gede Artawan EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Fikrawan, Putu Filla Jaya Gde Agung Senapathi, Tjokorda Gede Semarawima, Gede Gusti Agung Made Wibisana Kurniajaya Gusti Ayu Putu Giti Livia Devi I Gede Budiarta I Gusti Agung Made Wibisana Kurniajaya I Gusti Ngurah Mahaalit I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Made Darma Junaedi, I Made I Made Gede Widnyana I Nyoman Sutama I Putu Fajar Narakusuma I Wayan Agus Wirya Pratama I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Ayu Mas Sasmari Brahmani Ida Bagus Aditya Mayanda Ida Bagus Fajar Manuaba Ida Bagus Krisna Jaya Sutawan Ida Bagus Udayana Hanggara IGNA Putra Arimbawa, IGNA Putra Indrastuti, Putu Shintadewi Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Ketut Semara Jaya, Ketut Semara Khamandanu, Kadek Fabrian Kurniawan, Sylvia Jessy Kuswantoro Rusca Putra Labobar, Otniel Adrians Made Agus Kresna Sucandra, Made Agus Kresna Made Oka Widyantara, Made Oka Made Septyana Parama Adi Made Widnyana Made Wiryana Mahaalit, I Gusti Ngurah Mas Shintya Dewi, Dewa Ayu Merry Ni Ketut Supasti Dharmawan Ni Putu Novita Pradnyani, Ni Putu Nyoman Ayu Anggayanti Nyoman Suyatna Parama Adi, Made Septyana Parami, Pontisomayaa Pontisomaya Parami Pragra, Maria Preicilia Putra, Made Bagus Cahya Maha Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya R. A.T. Kuswardhani Suparna, I Ketut Sutjipto, Matthew Nathanael Syamsuddin, Johanis Bosco Troy Syarifuddin Syarifuddin Sylvia Jessy Kurniawan Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Agung Senapathi Wahyuni, Ni Kadek Ayuk Ari Widiasa, Anak Agung Made Yaslis Ilyas