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All Journal Jurnal Anestesiologi Indonesia Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Neuroanestesi Indonesia
Edwar, Pesta Parulian Maurid
Departemen Anestesiologi Dan Terapi Intensif; Fakultas Kedokteran; Universitas Airlangga/ RSUD Dr. Soetomo; Surabaya
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Effect of positive end-expiratory pressure value on change in end-tidal carbon dioxide as a predictor of fluid responsiveness in Patients Undergoing Passive Leg Raising Maneuver Lutfi Nur Farid; Hardiono Hardiono; Pesta Parulian Maurid Edwar
Qanun Medika - Jurnal Kedokteran FK UMSurabaya Vol 5, No 2 (2021)
Publisher : Universitas Muhammadiyah Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30651/jqm.v5i2.5458

Abstract

Abstract  Identification of patients’ fluid status in the emergency room should be made before giving fluid therapy. This study aimed to determine the effect of positive end-expiratory pressure on change in end-tidal carbon dioxide during passive leg raising maneuver to predict fluid responsiveness. Thirty subjects aged 18-65 years in the resuscitation room, all on the ventilator, were divided into three groups according to their positive end-expiratory pressure value: low (0-5 cmH2O), moderate (6-10 cmH2O), and high (>10 cmH2O). Every subject underwent passive leg raising to simulate fluid administration. Values of blood pressure, heart rate, cardiac output, and end-tidal carbon dioxide were recorded before and after the maneuver. Analysis of the three groups found a significant correlation between change in end-tidal carbon dioxide with a cut-off value of 5% and 1 mmHg with fluid responsiveness of subjects in the low (p = 0.028) and moderate (p = 0.013) but not in the high positive end-expiratory pressure group (p = 0.333). In conclusion, change in end-tidal carbon dioxide in mechanically ventilated patients undergoing passive leg raising maneuvers can be used as a predictor of fluid responsiveness, but this method cannot be used on patients with high positive end-expiratory pressure (> 10 cmH2O) Keywords             : change in end tidal carbon dioxide, fluid responsiveness, positive end-expiratory pressure, passive leg raising, cardiac output surrogateCorrespondence   : lutfithe13th@gmail.com
Kesulitan “Weaning” pada Kasus Flail Chest Akibat Fraktur Sternum yang Tidak Teridentifikasi Pesta Parulian Maurid Edwar; Prananda Surya Airlangga; Agustina Salinding; Bambang Pujo Semedi; Teguh Sylvaranto; Eddy Rahardjo
JAI (Jurnal Anestesiologi Indonesia) Vol 10, No 1 (2018): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1377.541 KB) | DOI: 10.14710/jai.v10i1.20667

Abstract

Latar Belakang:Trauma toraks menyebabkan 20% dari semua kematian akibat trauma. Salah satu yang memiliki morbiditas dan mortalitas tinggi adalah flail chestdan fraktur sternum merupakan sebagian kecil dari penyebab flail chest. Mengingat kejadiannya yang sangat jarang maka fraktur sternum sering menjadi jebakan diagnostik yang terlupakan pada flail chest.Laporan Kasus:Terdapat 2 kasus yang dilaporkan dengan trauma toraks. Kasus pertama adalah multitrauma dengan Injury Severity Score(ISS) 50, trauma kepala, trauma abdomen dan trauma ekstremitas. Setelah dilakukan stabilisasi hemodinamik selama 3 hari, pasien sulit disapih dari ventilasi mekanik. Setelah tidak ditemukan lagi sumber perdarahan dan hemodinamik stabil pasien segera disiapkan operasi daruratdan ditemukan penyebabnya adalah fraktur sternum yang tidak teridentifikasi sebelumnya. Kasus kedua adalah trauma toraks dengan ISS 17, secara klinis tampak flail chestdan foto toraks antero-posterior yang normal. Setelah dilanjutkan CT scantoraks ditemukan fraktur sternum yang menyebabkan  pernafasan tidak adekuat. Segera dilakukan fiksasi eksternal dan hasilnya  memuaskan.Diskusi: Fraktur sternum seringkali disebabkan oleh mekanisme trauma toraks anterior yang berat dan dapat menimbulkan manifestasi flail chestsehingga dapat meningkatkan morbiditas dan mortalitas terlebih lagi bila disertai adanya trauma pada sistem organ lain serta penggunaan ventilator mekanik jangka panjang dan sepsis. Kejadian fraktur sternum sangat jarang dan foto toraks lateral pada kasus trauma juga jarang dilakukan sehingga seringkali fraktur sternum tidak teridentifikasi. Dengan mengetahui mekanisme trauma, gejala klinis yang tidak sesuai dengan gambaran foto toraks antero-posterior dan sulitnya penyapihan dari ventilasi mekanik  maka penggunaan ultrasonografi untuk skrining diharapkan dapat membantu menghindari jebakan terlambatnya identifikasi fraktur sternum.Kesimpulan:Pada trauma toraks dengan adanya fail chest, diagnostik dini diikuti fiksasi eksternal akan mengurangi morbiditas dan mortalitas pada pasien fraktur sternum.
Keamanan Penggunaan Propofol Auto-Coinduction Dibandingkan Dengan Midazolam Coinduction Berdasarkan Perubahan Hemodinamik Pada Induksi Anestesi Pasien Yang Dilakukan General Anestesi I Nyoman Yesua; Puger Rahardjo; Pesta Parulian Maurid Edwar
JAI (Jurnal Anestesiologi Indonesia) Vol 11, No 1 (2019): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (118.466 KB) | DOI: 10.14710/jai.v11i1.22039

Abstract

Latar Belakang: Pemilihan obat anestesi untuk induksi bagi seorang ahli anestesi merupakan hal yang krusial dan didasarkan atas efek farmakodinamik terhadap sistem kardiovaskular.Tujuan: Menganalisa apakah penggunaan propofol auto-coinduction (pre-dosing propofol) dapat digunakan sebagai alternatif midazolam sebagai obat coinduction, dilihat dari segi keamanan pasien (perubahan hemodinamik yang terjadi) dan biaya yang dikeluarkan.Metode: Penelitian eksperimental dengan desain pre-posttest single blind group ini melibatkan 52 pasien yang menjalani operasi elektif dengan anestesi umum di Kamar Operasi Gedung Bedah Pusat Terpadu (GBPT) RSUD Dr. Soetomo Surabaya pada bulan September-Oktober 2018. Dua kelompok pasien masing-masing mendapatkan midazolam 0,03 mg/KgBB (kelompok M, n=26) dan propofol 0,4 mg/KgBB (kelompok P, n=26) 2 menit sebelum induksi dengan propofol titrasi sampai hilang kontak verbal. Dosis propofol yang digunakan, tekanan darah sebelum dan sesudah dilakukan induksi serta biaya induksi dicatat.Hasil: Rerata Arterial Pressure (MAP) pra-induksi pada kelompok M adalah 96,35 ±11,366 mmHg dan pada kelompok P 90,54 ±7.732 mmHg, sedangkan MAP pascainduksi pada kelompok M sebesar 79.96 ±9.21mmHG dan pada kelompok P adalah 73,96 ±5,03mmHg (p=0,037). Total biaya yang digunakan pada kelompok M adalah Rp. 7.890 ±1.448.89 sedangkan pada kelompok P Rp. 7.082 ±1.403.89 (p=0.047).Kesimpulan: Terdapat perbedaan bermakna pada perubahan MAP yang disebabkan oleh penggunaan propofol auto-coinduction bila dibandingkan dengan midazolam coinduction. Tidak terdapat perbedaan signifikan penurunan tekanan darah dan nadi, serta dosis propofol yang digunakan antara kedua kelompok. Biaya induksi pada kelompok auto-coinduction propofol secara signifikan lebih rendah.
Profile of Anaphylactic Reaction in Surabaya from January 2014 to May 2018 Amalia Putri Uswatun Hasanah; Ari Baskoro; Pesta Parulian Maurid Edwar
JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Vol. 11 No. 2 (2020): Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/juxta.V11I22020.61-64

Abstract

Introduction: Anaphylactic reaction is systemic hypersensitivity reaction. It is type 1 hypersensitivity reaction. The incidence can be mild to severe due to the sudden release of mediators by effector cells. This research aimed to examine the prevalence of anaphylactic reaction in Dr. Soetomo General Hospital in January 2014 until May 2018.Methods: This study was a cross-sectional and retrospective study by assessing patients’ medical records and was analyzed descriptively.Results: 22 patients were identified as anaphylactic reaction. The prevalence of anaphylactic reaction from year to year cannot be identified surely because of underdiagnose and underreporting. The most common cause of anaphylactic reaction in Dr. Soetomo General Hsopital was drugs (50%). The most drugs were antibiotics (22.73%) and the most antibiotics were groups of penicillin (40%) and cephalosporin (40%). The most common clinical manifestation was skin-related (77.27%), which includes urticaria (4.55%), angioedem (27.27%), pruritus (27.27%) cold skin (0.09%), pallor (4.55%), and cyanosis (4.55%). Most patients became better (45.54%) after getting treatment from the doctor.Conclusion: The most common cause of anaphylactic reaction was drugs, the most drugs were antibiotics and the most antibiotics were groups of penicillin and cephalosporin. The most clinical manifestation was skin-related. Most of anaphylactic reaction’s patients became better after getting treatment from the doctor. Underdiagnose and underreporting are the problem often encountered in cases of anaphylactic reaction. 
Penanganan Anestesi pada Pasien Pediatri dengan Cedera Otak Traumatik Sedang, Fraktur Impresi dan Edem Serebri Dhania A Santosa; Prihatma Kriswidyantomo; Pesta Parulian Maurid Edwar; Hamzah Hamzah
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (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 (2454.631 KB) | DOI: 10.24244/jni.vol6i1.33

Abstract

Cedera otak traumatik merupakan penyebab terbanyak kecacatan dan kematian pada anak dan orang dewasa. Di Amerika Serikat, terjadi lebih dari 510.000 kasus cedera otak traumatik per tahun pada anak-anak usia 0-14 tahun;1 dengan 2.000–3.000 di antaranya meninggal setiap tahunnya. Tujuan dari penanganan cedera otak traumatik selain menangani cedera primernya, juga untuk mencegah terjadinya cedera sekunder. Seorang anak laki-laki usia 12 tahun mengalami kecelakaan lalu lintas dan didiagnosis dengan cedera otak traumatik sedang, fraktur impresi regio temporo parietal kanan dan edema serebri dengan komorbiditas anemia, rencana akan dilakukan pembedahan darurat untuk debridement, eksplorasi duramater dan rekonstruksi tulang. Pembedahan dilakukan dengan anestesi umum intubasi endotrakeal dan berjalan selama tujuh jam. Kondisi pasien selama pembedahan relatif stabil dan setelahnya dirawat di Ruang Observasi Intensif dengan bantuan ventilator. Setelah memastikan kondisi ekstrakranial normal, pasien kemudian disapih dari ventilator dan diekstubasi keesokan harinya. Pasien dipulangkan pada hari kedelapan setelah kejadian.Anesthesia Management in Pediatric Patient with Moderate Traumatic Brain Injury, Impression Fracture and Cerebral OedemaTraumatic brain injury is the leading cause of morbidity and mortality in pediatric and adult patients. In United States, 510,000 cases of traumatic brain injury occur each year in children aged 0-14 years;1 with 2.000-3.000 pass away each year. Cure the primary insult and prevent secondary injury are the important thing in traumatic brain injury. A 12-year-old boy had a motor vehicle accident and was diagnosed with moderate traumatic brain injury, impression fracture at the right temporo parietal region and cerebral edema, with anemia, planned for emergency surgery of debridement, duramater exploration and bone reconstruction. Surgery was done under general anesthesia using endotracheal intubation and lasted for seven hours. Patient’s condition remained relatively stable during surgery and was observed with ventilator supported in Intensive Observation Ward afterward. Once extracranial factors considered normal, patient was weaned and extubated the next day. Patient was sent home on the eight day after incident. Cedera otak traumatik merupakan penyebab terbanyak kecacatan dan kematian pada anak dan orang dewasa. Di Amerika Serikat, terjadi lebih dari 510.000 kasus cedera otak traumatik per tahun pada anak-anak usia 0-14 tahun;1 dengan 2.000–3.000 di antaranya meninggal setiap tahunnya. Tujuan dari penanganan cedera otak traumatik selain menangani cedera primernya, juga untuk mencegah terjadinya cedera sekunder. Seorang anak laki-laki usia 12 tahun mengalami kecelakaan lalu lintas dan didiagnosis dengan cedera otak traumatik sedang, fraktur impresi regio temporo parietal kanan dan edema serebri dengan komorbiditas anemia, rencana akan dilakukan pembedahan darurat untuk debridement, eksplorasi duramater dan rekonstruksi tulang. Pembedahan dilakukan dengan anestesi umum intubasi endotrakeal dan berjalan selama tujuh jam. Kondisi pasien selama pembedahan relatif stabil dan setelahnya dirawat di Ruang Observasi Intensif dengan bantuan ventilator. Setelah memastikan kondisi ekstrakranial normal, pasien kemudian disapih dari ventilator dan diekstubasi keesokan harinya. Pasien dipulangkan pada hari kedelapan setelah kejadian.
The Use of O Universal Profile Within Hemorrhagic Shock Post-partum Bleeding Patients in Dr. Soetomo General Hospital’s Emergency Installation Anastasia Pearl Angeli; Soni Sunarso Sulistiawan; Jimmy Yanuar Annas; Pesta Parulian Maurid Edwar
JAI (Jurnal Anestesiologi Indonesia) Vol 14, No 1 (2022): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.41691

Abstract

Background: Hemorrhagic shock is one of the most common types of shock in trauma patients, and it is defined as acute blood volume loss. One of the causes of hemorrhagic shock is post-childbirth bleeding or post-partum bleeding. The most important management for patients who experience post-partum bleeding is blood transfusions. Type-O blood is known as a universal donor, because someone with type- O blood can transfuse theirs to recipients with blood types other than O. Giving blood transfusions to pos-tpartum bleeding patients is expected to extend their life expectancy, however it cannot be denied that there are quite a several patients who died after receiving transfusions from universal type O blood.Objective: This study aims to determine the profile and effect of universal O use on hemorrhagic shock within post-partum bleeding patients at IGS RSUD Dr. Soetomo Surabaya.Methods: This research was conducted by a descriptive retrospective method by observing the patient's medical record data in the central medical record room of Dr. Soetomo Hospital, Surabaya.Result: There were 17 patients with hemorrhagic shock due to post-partum hemorrhage who received blood transfusions from universal O donors at Dr. Soetomo Surabaya. From the obtained data, the patient age group was dominated by the 28 years old group (23,5%). Transfusion history within patients with the most hemorrhagic shock due to post-partum bleeding were patients who received transfusions with packed red cell (PRC) O + (76,5%). As for transfusion reactions that occur within patients, there are no data on transfusion reactions.Conclusion: The 28 years old group was the largest one that received transfusions from the universal group O blood. History transfusion of hemorrhagic shock due to post-partum bleeding patients shows that most of them are those who received PRC O + transfusions. There are no data regarding the transfusion reactions which occurred in these patients.
Electrolytes Profile of Critically Ill Patients Admitted To Pediatric Intensive Care Unit (PICU) Dr. Soetomo General Hospital Amalia Citra Octavia; Arina Setyaningtyas; Pesta Parulian Maurid Edwar
Indonesian Journal of Anesthesiology and Reanimation Vol. 2 No. 1 (2020): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (760.563 KB) | DOI: 10.20473/ijar.V2I12020.1-7

Abstract

Introduction: Fluid and electrolyte disorders can be affected by various conditions or diseases. Electrolyte disorders are often found in pediatric patients with critically ill conditions and are associated with increased morbidity also mortality that requires extra care in the Pediatric Intensive Care Unit (PICU). Objective: To describe the electrolyte profile of critically ill patients with electrolyte disorders admitted to the Pediatric Intensive Care Unit (PICU) Dr. Soetomo General Hospital. Materials and Methods: The study was conducted prospectively with a descriptive method in patients with electrolyte disorders aged 1 month – 18 years old admitted to PICU Dr. Soetomo General Hospital, Surabaya in a period from August to November 2018. Data on patient age, gender, electrolyte profile (sodium, potassium, calcium, chloride), and origin before PICU admission were recorded. Results and Discussion: From 37 patients with electrolyte disorders showed that patients were dominated by the male in 56.8% (n=21), in the age group of infants or 1-12 months old in 45.9% (n=17). Common main diagnosis in most patients were digestive system disorders in 27% (n=10), followed by central nervous system, respiratory system, kidney and cardiovascular disorders, and the origin before PICU admission were from Emergency Room (ER) in 62.2% (n=23). There were found 97 incidences of electrolyte disorders. Most frequent electrolyte disorders were hypocalcemia in 59.5% (n=22), hypokalemia in 54.1% (n=20), hyponatremia in 40.5% (n=15) and the least was hypochloremia in 35.1% (n=13). Mean serum sodium level was 138.18 ± 12.071, serum potassium level was 3.608 ± 1.2247, serum calcium level was 8.057 ± 1.9473 and serum chloride level was 101.45 ± 13.266. Conclusions:  Critically ill patients admitted in PICU tend to experience low electrolyte levels.
Co-Authors Agustina Salinding Amalia Citra Octavia Amalia Putri Uswatun Hasanah Anastasia Pearl Angeli Annas, Jimmy Yanuar Ari Baskoro Arina Setyaningtyas Dhania A Santosa Eddy Rahardjo Hamzah Hamzah Hardiono Hardiono I Nyoman Yesua Kriswidyantomo, Prihatma Lutfi Nur Farid Prananda Surya Airlangga Prihatma Kriswidyantomo Puger Rahardjo Santosa, Dhania A SATRIYAS ILYAS Semedi, Bambang Pujo Soni Sunarso Sulistiawan Teguh Sylvaranto