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Review of Euthanasia as a Therapy in Terminal Condition from Health and Law Perspective Widiasa, Anak Agung Made; Nyoman Suyatna; Hartawan, I Gusti Agung Gede Utara
Babali Nursing Research Vol. 5 No. 1 (2024): January
Publisher : Babali Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37363/bnr.2024.51350

Abstract

Introduction: Terminal conditions and their treatment processes initiate actions that can be taken to relieve patients of the pain they suffer. This action is carried out by accelerating the death of patients with terminal conditions, known as euthanasia. Euthanasia is still being debated regarding the legal aspects and purpose of the act as part of the patient's treatment. This study aims to determine the perspective of euthanasia as part of the treatment or therapy of terminal conditions. Methods: This research is a literature study from several databases, including Proquest, Science Direct, SpringerLink, and Google Scholar. The article search used keywords combined with booleans. 755 articles were found according to the keywords, and 12 articles were selected using Prism analysis. Results: Euthanasia is seen as a way for terminal patients who have been resistant to treatment to be free from the misery of their illness. Euthanasia in health can be carried out if it is the patient's conscious choice without coercion and has met the medical requirements. Euthanasia can be carried out in areas, regions, or countries where there are regulations, laws, or similar regulations governing the implementation of euthanasia. Conclution: With the existence of clear rules for the implementation of euthanasia, health workers or families involved in euthanasia can provide a clear understanding of how to implement euthanasia.
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report Parama Adi, Made Septyana; I Gusti Ngurah Mahaalit Aribawa; I Gusti Agung Gede Utara Hartawan; I Putu Fajar Narakusuma; Gusti Agung Made Wibisana Kurniajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.977

Abstract

Background: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space. Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10. Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions.
Manajemen Perioperatif Pada Pasien Gravida 35 Minggu Dengan Preeklampsia Berat, Hipertensi, Dan Penyakit Jantung Kongenital ASD Sekundum: Laporan Kasus Khamandanu, Kadek Fabrian; Aryasa, Tjahya; Dewi Sinardja, Cynthia; Gede Utara Hartawan, I Gusti Agung
COMSERVA : Jurnal Penelitian dan Pengabdian Masyarakat Vol. 4 No. 11 (2025): COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/comserva.v4i11.3007

Abstract

Manajemen perioperatif pasien hamil dengan penyakit jantung bawaan dan preeklampsia memerlukan pendekatan multidisiplin yang cermat. Atrial Septal Defect (ASD) dengan shunt bidirectional dan hipertensi pulmonal meningkatkan risiko gagal jantung dan komplikasi obstetrik. Anestesi regional sering dipilih untuk mengurangi dampak hemodinamik, dengan pengawasan ketat terhadap risiko tromboemboli dan stabilitas volume cairan. Seorang perempuan dua puluh dua tahun, hamil tiga puluh lima minggu tiga hari, dengan ASD, hipertensi pulmonal, dan preeklampsia berat, mengalami sesak napas progresif dan sianosis intermiten. Pemeriksaan echocardiography menunjukkan ASD moderat dengan shunt bidirectional, hipertrofi ventrikel kiri, dan fungsi ventrikel kanan yang menurun. Pasien menjalani Sectio Caesarea Transperitoneal (SCTP) dengan anestesi spinal menggunakan Bupivakain hiperbarik tujuh koma lima miligram dan Morfin nol koma lima miligram intratekal. Hemodinamik pasien tetap stabil sepanjang prosedur dengan pemantauan ketat dan manajemen cairan yang cermat dan teliti. ASD dengan shunt bidirectional meningkatkan risiko emboli paradoks, gagal jantung kanan, dan hipoksemia, terutama saat kehamilan. Preeklampsia memperburuk kondisi dengan meningkatkan resistensi vaskular dan disfungsi endotel, yang dapat menyebabkan hipertensi pulmonal progresif dan dekompensasi jantung. Manajemen anestesi bertujuan menjaga stabilitas hemodinamik dengan anestesi spinal dosis rendah untuk menghindari hipotensi mendadak. Morfin intratekal memberikan analgesia pascaoperasi yang efektif tanpa mengganggu fungsi pernapasan dan hemodinamik. Keberhasilan manajemen perioperatif pada pasien dengan ASD, hipertensi pulmonal, dan preeklampsia berat bergantung pada pendekatan multidisiplin yang komprehensif. Penggunaan anestesi spinal dengan Bupivakain dan Morfin intratekal terbukti efektif dalam menjaga stabilitas hemodinamik serta mengurangi risiko komplikasi kardiovaskular dan neonatal.
Laporan Kasus : Tatalaksana Dengue Shock Syndrome Pada Ibu Hamil di Ruang Terapi Intensif Fikrawan, Putu Filla Jaya; Utara Hartawan, I Gusti Agung Gede; Aryasa, Tjahya; Parami, Pontisomaya; Labobar, Otniel Adrians
COMSERVA : Jurnal Penelitian dan Pengabdian Masyarakat Vol. 4 No. 12 (2025): COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/comserva.v4i12.3150

Abstract

Dengue Shock Syndrome (DSS) adalah bentuk paling berat dari infeksi virus dengue yang dapat menyebabkan syok hipovolemik, trombositopenia, dan perdarahan. Kasus DSS pada ibu hamil memerlukan penanganan yang sangat hati-hati karena dapat berdampak pada kondisi ibu dan janin. Terapi cairan yang tepat merupakan kunci utama dalam manajemen DSS, terutama untuk mengatasi kebocoran plasma yang terjadi pada fase kritis infeksi dengue. Seorang perempuan 31 tahun, hamil 39 minggu, datang dengan keluhan demam tinggi sejak 3 hari sebelumnya disertai nyeri kepala, nyeri otot, dan mual. Pada hari ketiga demam, pasien melahirkan bayi laki-laki yang kemudian meninggal dalam kondisi maserasi. Pasien kemudian mengalami penurunan kondisi berupa syok hipovolemik, penurunan kesadaran, dan hipotensi, sehingga dirawat di ruang ICU. Resusitasi cairan dilakukan dengan cairan kristaloid dan koloid, namun kondisi pasien terus memburuk dan akhirnya meninggal setelah mengalami cardiac arrest pada hari keenam demam. DSS pada ibu hamil sangat kompleks karena selain mengancam jiwa ibu, juga dapat berdampak buruk pada janin. Penurunan volume plasma yang terjadi pada DSS dapat memperburuk syok dan menyebabkan kegagalan organ. Manajemen yang tepat melibatkan pemantauan ketat terhadap cairan, elektrolit, dan kondisi hemodinamik. Pada pasien ini, penanganan difokuskan pada resusitasi cairan yang intensif dan pemantauan ketat meskipun kondisi pasien tidak menunjukkan perbaikan. DSS pada ibu hamil memerlukan penanganan yang intensif dan multidisipliner untuk mencegah komplikasi fatal. Manajemen cairan yang hati-hati sangat penting untuk mengatasi kebocoran plasma dan mempertahankan stabilitas hemodinamik. Pemantauan klinis yang ketat serta pengawasan laboratorium juga diperlukan untuk mengurangi risiko morbiditas dan mortalitas baik pada ibu maupun janin.
Solutions to Overcome Burnout Symptoms in Nurses in the Covid-19 Isolation Room Kurniawan, Sylvia Jessy; Gede Utara Hartawan, I Gusti Agung; Rusca Putra, Kuswantoro
Jurnal Kedokteran Brawijaya Vol. 33 Supplement 1 (2024)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2024.033.01.2s

Abstract

The Covid-19 pandemic has left healthcare workers working in uncertain and stressful situations to care for all patients with disabilities. The second wave of the Covid-19 pandemic that swept across the world caused many nurses in health facilities to experience fatigue in carrying out their duties. This study aims to determine the cause of burnout symptoms in isolation room nurses in the Covid-19 pandemic. The study was conducted at X Hospital in September-October 2021. The design of this study was descriptive analysis. Observations were made on the service system, data, and environment of the Covid-19 isolation room at X Hospital. Interviews and discussions were conducted with the head nurse, the head of the occupational safety and health committee, and the head of nursing medical services related to nurse burnout in the isolation room. 67.74% experienced emotional exhaustion in the medium and high categories in isolation room nurses in the second wave of the Covid-19 pandemic caused by a lack of staffing. The solution to detect and overcome burnout is to conduct mental health checks and regular medical check-up programs for further treatment by considering the comfort factor and high functional value.
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report Parama Adi, Made Septyana; I Gusti Ngurah Mahaalit Aribawa; I Gusti Agung Gede Utara Hartawan; I Putu Fajar Narakusuma; Gusti Agung Made Wibisana Kurniajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.977

Abstract

Background: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space. Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10. Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions.
Anesthetic Approach to Placenta Previa with Associated Bladder Rupture: A Case Report Putra, Made Bagus Cahya Maha; IGAG Utara Hartawan; Dewa Ayu Mas Shintya Dewi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/nqk01d22

Abstract

This case report outlines the anesthetic management of total placenta previa with high-risk features of placenta accreta spectrum (PAS) complicated by bladder rupture, representing a rare but clinically significant form of invasive placentation. A 29-year-old G2P1001 at 35+3 weeks’ gestation presented with recurrent antepartum bleeding and ultrasonographic features consistent with PAS, including grade III lacunae, bridging vessels, severe myometrial thinning, and a Placenta Accreta Indeks (PAI) score of 6. Spinal anesthesia was initiated for delivery, followed by a controlled conversion to general anesthesia to facilitate hysterectomy, two-layer bladder repair, ureteral reconstruction, and Double-J stent placement. Hemodynamic stability was maintaned using tranexamic acid, colloid co-loading, invasive arterial monitoring, and norepinephrine titration. An estimated blood loss of 2,300 mL was managed with targeted transfusion, resulting in favourable maternal recovery and neonatal outcomes (Apgar 7 and 9). This case underscores the importance of early PAS recognition, structured anesthetic planning, and coordinated multidisciplinary care, supporting the benefit of a staged neuraxial-to-general anesthesia strategy in complex PAS with urologic involvement.
Dexmedetomidine as Adjuvant in Scalp Nerve Block for Craniotomy: A Double-Blind Randomized Clinical Trial Eka Nantha Kusuma, Putu; I Putu Pramana Suarjaya; Parami, Pontisomaya; IGAG Utara Hartawan; I Gusti Ngurah Mahaalit; I Putu Kurniyanta; Ida Bagus Krisna Jaya Sutawan; Sudiantara, Putu Herdita; I Made Gede Widnyana; Gde Agung Senapathi, Tjokorda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/q23wyc88

Abstract

Introduction: Scalp nerve block (SNB) is an effective adjunct for attenuating hemodynamic responses and reducing postoperative pain in craniotomy. Dexmedetomidine (DEX), with its analgesic and anti-inflammatory properties, may enhance the quality of SNB. This study evaluated the effects of adding DEX to SNB on hemodynamic stability, postoperative pain, inflammatory response, and analgesic duration in craniotomy patients. Methods: A double-blind, parallel-group randomized clinical trial was conducted on 36 adult patients undergoing elective craniotomy (July–September 2025) at a tertiary hospital Denpasar. Participants received SNB using 0.375% ropivacaine (20 mL) with or without DEX 1 µg/kg under standardized general anesthesia. Outcomes included mean arterial pressure (MAP), Visual Analog Scale (VAS) scores at 12 and 24 hours, neutrophil-to-lymphocyte ratio (ΔNLR), and time to first rescue analgesic (TTFAR). Statistical analyses used mixed ANOVA and Mann–Whitney U tests. Ethical approval number was 2159/UN14.2.2.VII.14/LT/2025. Results: MAP was significantly lower in the DEX group at 10 minutes (Δ = 4.89 mmHg; 95% CI 1.62–8.16), 20 minutes (Δ = 4.83; 95% CI 1.57–8.10), 30 minutes (Δ = 3.67; 95% CI 0.40–6.94), and upon PACU arrival (Δ = 3.72; 95% CI 0.45–6.99) (all p < 0.05). Median VAS scores were significantly lower with DEX at 12 hours (1.50 vs 3.00; p < 0.001) and 24 hours (1.00 vs 2.00; p < 0.001). ΔNLR was reduced in the DEX group (−0.56 vs 3.08; p = 0.004). TTFAR was markedly prolonged (554 vs 257 minutes; p < 0.001). No adverse events were reported. Conclusion: Dexmedetomidine added to scalp nerve block enhances hemodynamic stability, reduces postoperative pain for up to 24 hours, suppresses early systemic inflammation, and prolongs analgesic duration in craniotomy without observed complications. DEX–SNB represents a beneficial component of multimodal analgesia in neuroanesthesia and may support enhanced recovery pathways
Anesthetic Approach to Placenta Previa with Associated Bladder Rupture: A Case Report Putra, Made Bagus Cahya Maha; IGAG Utara Hartawan; Dewa Ayu Mas Shintya Dewi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/nqk01d22

Abstract

This case report outlines the anesthetic management of total placenta previa with high-risk features of placenta accreta spectrum (PAS) complicated by bladder rupture, representing a rare but clinically significant form of invasive placentation. A 29-year-old G2P1001 at 35+3 weeks’ gestation presented with recurrent antepartum bleeding and ultrasonographic features consistent with PAS, including grade III lacunae, bridging vessels, severe myometrial thinning, and a Placenta Accreta Indeks (PAI) score of 6. Spinal anesthesia was initiated for delivery, followed by a controlled conversion to general anesthesia to facilitate hysterectomy, two-layer bladder repair, ureteral reconstruction, and Double-J stent placement. Hemodynamic stability was maintaned using tranexamic acid, colloid co-loading, invasive arterial monitoring, and norepinephrine titration. An estimated blood loss of 2,300 mL was managed with targeted transfusion, resulting in favourable maternal recovery and neonatal outcomes (Apgar 7 and 9). This case underscores the importance of early PAS recognition, structured anesthetic planning, and coordinated multidisciplinary care, supporting the benefit of a staged neuraxial-to-general anesthesia strategy in complex PAS with urologic involvement.
Dexmedetomidine as Adjuvant in Scalp Nerve Block for Craniotomy: A Double-Blind Randomized Clinical Trial Eka Nantha Kusuma, Putu; I Putu Pramana Suarjaya; Parami, Pontisomaya; IGAG Utara Hartawan; I Gusti Ngurah Mahaalit; I Putu Kurniyanta; Ida Bagus Krisna Jaya Sutawan; Sudiantara, Putu Herdita; I Made Gede Widnyana; Gde Agung Senapathi, Tjokorda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/q23wyc88

Abstract

Introduction: Scalp nerve block (SNB) is an effective adjunct for attenuating hemodynamic responses and reducing postoperative pain in craniotomy. Dexmedetomidine (DEX), with its analgesic and anti-inflammatory properties, may enhance the quality of SNB. This study evaluated the effects of adding DEX to SNB on hemodynamic stability, postoperative pain, inflammatory response, and analgesic duration in craniotomy patients. Methods: A double-blind, parallel-group randomized clinical trial was conducted on 36 adult patients undergoing elective craniotomy (July–September 2025) at a tertiary hospital Denpasar. Participants received SNB using 0.375% ropivacaine (20 mL) with or without DEX 1 µg/kg under standardized general anesthesia. Outcomes included mean arterial pressure (MAP), Visual Analog Scale (VAS) scores at 12 and 24 hours, neutrophil-to-lymphocyte ratio (ΔNLR), and time to first rescue analgesic (TTFAR). Statistical analyses used mixed ANOVA and Mann–Whitney U tests. Ethical approval number was 2159/UN14.2.2.VII.14/LT/2025. Results: MAP was significantly lower in the DEX group at 10 minutes (Δ = 4.89 mmHg; 95% CI 1.62–8.16), 20 minutes (Δ = 4.83; 95% CI 1.57–8.10), 30 minutes (Δ = 3.67; 95% CI 0.40–6.94), and upon PACU arrival (Δ = 3.72; 95% CI 0.45–6.99) (all p < 0.05). Median VAS scores were significantly lower with DEX at 12 hours (1.50 vs 3.00; p < 0.001) and 24 hours (1.00 vs 2.00; p < 0.001). ΔNLR was reduced in the DEX group (−0.56 vs 3.08; p = 0.004). TTFAR was markedly prolonged (554 vs 257 minutes; p < 0.001). No adverse events were reported. Conclusion: Dexmedetomidine added to scalp nerve block enhances hemodynamic stability, reduces postoperative pain for up to 24 hours, suppresses early systemic inflammation, and prolongs analgesic duration in craniotomy without observed complications. DEX–SNB represents a beneficial component of multimodal analgesia in neuroanesthesia and may support enhanced recovery pathways
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