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All Journal Jurnal Anestesiologi Indonesia Asian Australasian Neuro and Health Science Journal (AANHS-J) Solo Journal of Anesthesi, Pain and Critical Care Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Jurnal Kedokteran Ibnu Nafis The Journal of Society Medicine (JSOCMED)
Bastian Lubis
Departement Of Anaesthesiology And Intensive Therapy, Faculty Of Medicine, Universitas Sumatera Utara, Medan, Indonesia
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Perioperative Nutritional Status of Digestive Surgery Laparotomy Surgery Iqbal, Aulia; Wijaya, Dadik Wahyu; Lubis, Bastian
Journal of Society Medicine Vol. 1 No. 3 (2022): December
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (410.759 KB) | DOI: 10.47353/jsocmed.v1i3.16

Abstract

Introduction: Laparotomy is one of the most frequently performed surgical procedures. Surgery causes a stress response that increases the risk of experiencing malnutrition, especially in patients undergoing laparotomy. Malnutrition can increase the risk of adverse outcomes in postoperative patients. This study aims to evaluate perioperative nutritional status in patients who will undergo laparotomy surgery at Haji Adam Malik General Hospital Method:This research is an observational study with a prospective design. This study involved 65 research subjects withthe sampling technique was carried out by non-probability sampling, namely consecutive sampling. Results:The majority of study subjects had BMI ≥18.5, without weight loss >3.6 kg in the last 6 months, without a history of food intake <50% portion in the last 1 week, and albumin value ≥3.0 pre- and post- operative. Postoperatively. The number of subjects with PONS value ≥1 changed from 33.85% before surgery to 52.31% after surgery. There was a significant change in PONS values ​​before and after laparotomy (p = 0.001). Conclusion:Statuspost-operative nutritional study subjects decreased compared to before surgery. A significant increase in PONS scores also occurred after laparotomy.
Perbandingan Efektivitas Pemberian Antibiotik Empiris Ceftriaxone dan Levofloxacin pada Pasien Sepsis dengan Community Acquired Pneumonia (CAP) di RSUP H. Adam Malik Medan Tahun 2020-2022 Siregar, Ahmad Habibi; Lubis, Bastian; Solihat, Yutu
Majalah Anestesia & Critical Care Vol 43 No 2 (2025): 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 | DOI: 10.55497/majanestcricar.v43i2.380

Abstract

Latar Belakang: Sekitar 40-50% pasien yang dirawat di ICU dengan sepsis menunjukkan sumber infeksi pernapasan. Community acquired pneumonia (CAP) merupakan penyebab paling umum dari sepsis pada banyak kasus yang dilaporkan. Pemberian terapi antibiotik empiris yang tepat pada sepsis adalah salah satu faktor yang paling penting untuk outcome yang lebih baik dari pasien sepsis dengan CAP. Penelitian ini dilakukan untuk membandingkan efektivitas levofloxacin dan ceftriaxone pada terapi antibiotik empiris karena kedua obat ini merupakan obat yang paling sering digunakan sebagai terapi empiris sesuai pola kuman dan kepekaannya terhadap antibiotik di RSUP H. Adam Malik Medan.Metode: Penelitian dilakukan secara retrospektif dengan sumber data sekunder yang diperoleh dari rekam medis di RSUP H. Adam Malik Medan periode tahun 2020-2022. Populasi penelitian adalah semua pasien sepsis dengan CAP yang menjalani perawatan di RSUP H. Adam Malik. Pemilihan sampel berdasarkan kriteria inklusi dan ekslusi.Hasil: Tidak dijumpai adanya perbedaan nilai mortalitas subjek penelitian yang menggunakan levofloxacin dan ceftriaxone dengan p value 0,107. Tidak ada perbedaan yang signifikan pada lama rawatan antara kelompok pemberian antibiotik levofloxacin dan ceftriaxone dengan p value 0,90.Simpulan: Tidak terdapat perbedaan signifikan antara efektivitas penggunaan levofloxacin dan ceftriaxone terhadap pasien sepsis dengan CAP di RSUP H. Adam Malik.
Perbandingan Pemberian Injeksi Vitamin D dan Tiamin terhadap Kadar Prokalsitonin pada Pasien Sepsis di ICU RSUP H. Adam Malik Lubis, Bastian; Aulia Kamal Ansari; Muhammad Ihsan; Yuki Yunanda
Majalah Anestesia & Critical Care Vol 43 No 2 (2025): 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 | DOI: 10.55497/majanestcricar.v43i2.399

Abstract

Pendahuluan: Sepsis merupakan sindrom respons inflamasi sistemik yang disebabkan oleh infeksi. Kadar prokalsitonin sering digunakan sebagai biomarker untuk menilai keparahan dan respons terapi. Vitamin D dan tiamin diketahui memiliki efek imunomodulator yang dapat berperan dalam menurunkan inflamasi. Penelitian ini bertujuan untuk mengetahui efek pemberian vitamin D dan tiamin terhadap penurunan kadar prokalsitonin pada pasien sepsis yang dirawat di ICU RSUP H. Adam Malik Medan. Metode: Penelitian ini merupakan uji klinis dengan desain kuasi-eksperimental. Sebanyak 30 pasien sepsis yang memenuhi kriteria inklusi dan eksklusi dibagi menjadi dua kelompok secara acak, tiap kelompok terdiri dari 15 orang. Satu kelompok mendapatkan vitamin D dan kelompok lainnya mendapat tiamin. Kadar prokalsitonin diukur pada hari pertama (H-1) dan hari ketiga (H-3). Analisis statistik menggunakan uji Wilcoxon dan Mann-Whitney. Hasil: Rerata kadar prokalsitonin pada kelompok vitamin D menurun secara signifikan dari 17,1 ± 17,6 ng/mL pada H-1 menjadi 12,4 ± 10,6 ng/mL pada H-3 (p=0,025). Pada kelompok tiamin, kadar prokalsitonin juga menurun dari 26,3 ± 33,7 ng/mL menjadi 20,6 ± 31,1 ng/mL, namun tidak signifikan secara statistik (p=0,112). Tidak terdapat perbedaan bermakna antara kedua kelompok pada H-1 maupun H-3 (masing-masing p=0,576 dan p=0,575). Simpulan: Pemberian vitamin D menunjukkan efektivitas yang lebih baik dalam menurunkan kadar prokalsitonin dibandingkan tiamin pada pasien sepsis di ICU, meskipun tidak terdapat perbedaan yang signifikan antar kelompok. Vitamin D berpotensi menjadi terapi adjuvan dalam penatalaksanaan sepsis.
Adjunctive Micronutrient Therapy in Sepsis: Associations with Inflammation and Organ Dysfunction Prima , Agus; Lubis , Bastian
Journal of Society Medicine Vol. 5 No. 1 (2026): January
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.256

Abstract

Introduction: Despite advances in supportive care, sepsis remains a major cause of morbidity and mortality among critically ill patients. Adjunctive therapies targeting inflammation and endothelial dysfunction, such as thiamine and ascorbic acid, have gained increasing attention in recent years. Matrix metalloproteinase-9 (MMP-9) and its inhibitor TIMP-1 are key biomarkers involved in inflammatory dysregulation and organ dysfunction in sepsis. Methods: This retrospective cohort study was conducted over 12 months at Haji Adam Malik General Hospital. A total of 147 adult patients with sepsis were initially enrolled and categorized into four groups: normal saline (control), thiamine, ascorbic acid, and thiamine–ascorbic acid combination therapy. Propensity score matching was applied to achieve comparable baseline characteristics, resulting in 25 patients in each group. Serum MMP-9 and TIMP-1 levels were measured at the Integrated Laboratory, Faculty of Medicine, Universitas Sumatera Utara. The clinical outcomes included incidence rates, MMP-9/TIMP-1 ratios, and Sequential Organ Failure Assessment (SOFA) scores. Results: Combination therapy did not significantly reduce the incidence rate (OR 1.19; 95% CI 0.37–3.80) or MMP-9/TIMP-1 ratio (OR 0.34; 95% CI 0.09–1.30) compared to the control. In contrast, a single administration of ascorbic acid and thiamine significantly reduced the incidence rates and improved the MMP-9/TIMP-1 balance. Combination therapy was not associated with improved SOFA scores (OR 2.66; 95% CI 0.85–8.36). Conclusion: Combined thiamine and ascorbic acid therapies did not confer any superior clinical or biomarker benefits. Single-agent thiamine or ascorbic acid therapy demonstrated favorable effects on the incidence rate, MMP-9/TIMP-1 ratio, and organ dysfunction in patients with sepsis.
Anesthetic Management of Cavernous Sinus Meningioma with Pre-existing Cranial Nerve Deficits: A Case Report Rahmadhona, Sri; Lubis , Bastian
Journal of Society Medicine Vol. 5 No. 1 (2026): January
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.257

Abstract

Cavernous sinus meningioma poses significant neuroanesthetic challenges due to its skull base location, close proximity to critical neurovascular structures, and frequent association with pre-existing cranial nerve dysfunction. Optimal perioperative anesthetic management is essential for preserving cerebral perfusion pressure, maintaining optimal intracranial dynamics, and preventing secondary brain injury during complex skull base surgery. We report the perioperative anesthetic management of a 52-year-old woman with a right cavernous sinus meningioma who presented with a five-month history of progressive headache and multiple cranial nerve deficits, including ptosis, facial hypoesthesia, and deviation of the mouth and tongue, without limb motor weakness. The patient had long-standing poorly controlled hypertension and was classified as American Society of Anesthesiologists physical status III. Preoperative assessment demonstrated stable cardiopulmonary function, anisocoria, and preserved consciousness. Magnetic resonance imaging revealed a right cavernous sinus tumor measuring 2.4 × 1.7 × 1.9 cm. The patient underwent elective craniotomy and tumor removal under general anesthesia with endotracheal intubation. A comprehensive neuroprotective anesthetic strategy was implemented, including head-up positioning, controlled ventilation to maintain normocapnia, strict hemodynamic control to preserve cerebral perfusion pressure, and goal-directed fluid and blood management. The surgical procedure lasted six hours with an estimated blood loss of 1600 mL, managed with crystalloid, colloid, and blood component therapy. Postoperatively, the patient was managed in the intensive care unit with mechanical ventilation, adequate analgesia and sedation, osmotherapy, anticonvulsant prophylaxis, and close neurological monitoring. Despite transient metabolic acidosis, the patient remained hemodynamically stable, with preserved oxygenation and neurological improvement.
PERBANDINGAN TIAMIN DAN NACL 0,9% TERHADAP KEBUTUHAN ANALGETIK POSTOPERATIF PADA PASIEN DENGAN KECEMASAN PREOPERATIF: COMPARISON OF THIAMINE AND 0.9% NACL ON POSTOPERATIVE ANALGESIC NEEDS IN PATIENTS WITH PREOPERATIVE ANXIETY Ricksando Siregar; Bastian Lubis; Tasrif Hamdi; Muhammad Aripandi Wira; Apriandeny Haithami; Fahmi Sani
Jurnal Kedokteran Ibnu Nafis Vol. 15 No. 1 (2026): Juni 2026
Publisher : Fakultas Kedokteran Universitas Islam Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30743/jkin.v15i1.740

Abstract

Kecemasan preoperatif berhubungan dengan peningkatan nyeri dan kebutuhan analgetik postoperatif. Tiamin berperan dalam metabolisme energi, fungsi saraf, serta modulasi inflamasi dan stres oksidatif sehingga berpotensi memengaruhi respons nyeri perioperatif. Penelitian ini bertujuan membandingkan pemberian tiamin intravena dan NaCl 0,9% intravena terhadap kebutuhan analgetik postoperatif pada pasien dengan kecemasan preoperatif yang menjalani pembedahan dengan anestesi spinal. Penelitian ini merupakan uji klinis double-blind randomized controlled trial di RSUP H. Adam Malik Medan. Sebanyak 42 pasien dibagi menjadi dua kelompok, masing-masing 21 pasien menerima tiamin intravena atau NaCl 0,9% intravena. Kebutuhan analgetik postoperatif dan skor nyeri menggunakan Visual Analog Scale (VAS) dibandingkan antar kelompok. Hasil menunjukkan kebutuhan analgetik postoperatif lebih rendah pada kelompok tiamin dibandingkan kelompok NaCl 0,9% IV (52,38 ± 51,1 mg vs 61,90 ± 86,46 mg; p=0,001). Skor VAS postoperatif juga lebih rendah pada kelompok tiamin (3,38 ± 0,92 vs 4,27 ± 0,52; p=0,004). Pemberian tiamin intravena berpotensi menurunkan kebutuhan analgetik dan intensitas nyeri postoperatif pada pasien dengan kecemasan preoperatif yang menjalani pembedahan dengan anestesi spinal.
The Relationship of Renal Resistive Index and Central Venous Pressure As Predictors of Acute Kidney Injury in Critically III Patients of Intensive Care Unit Adam Malik General Hospital Medan Muhammad Apriandi Wira; Achsanuddin Hanafie; Asmin Lubis; Bastian Lubis
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 2, No 2 (2022): October 2022
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v2i2.59946

Abstract

Background: Changes in the doppler-based renal resistive index (RRI) occur prior to the changes of glomerular filtration rate (GFR) during the development of acute kidney injury (AKI) and during the healing process from AKI. Central venous pressure (CVP) is not only a marker for resuscitation, but also can determine the microcirculatory perfusion pressure as outflow obstruction.Objective: This study aims to determine the relationship between RRI and CVP as a predictor of AKI in critically ill patients admitted to the intensive care unit (ICU) of Adam Malik General Hospital.Methods: This was an observational study with prospective cohort design and diagnostic test method. This research was conducted at the Adam Malik General Hospital Medan from June to July 2020. Forty patients aging 18-65 years old who met the diagnostic criteria of sepsis and septic shock were examined for RI and CVP when admitted to the ICU.Results: RI had better sensitivity and specificity than CVP in predicting the incidence of AKI (sensitivity 68% vs 59%, specificity 77% vs 55.5%, Receiver operating characteristics (ROC) 0.870 vs 0.321 (95% confidence interval)).Conclusion: Based on the results of this study, the renal resistive index has better sensitivity and specificity than central venous pressure in predicting the incidence of AKI in critical patients in the ICU.
Bronchoscopy, Ultrasound, and Video Laryngoscopy as Guidelines for Percutaneous Dilatation Tracheostomy (PDT) in Patients with Difficult Airway Suspected of Laryngeal Tumor Sutan Syarif Muda Dalimunthe; Edi Daramawan; Rizki Taufiqurrahman; Bastian Lubis; Andriamuri Primaputra Lubis; Rommy Fransiscus Nadeak; Dis Bima Purwaamidjaja; Ferdinand Chandra
Journal of Society Medicine Vol. 5 No. 6 (2026): June
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i6.283

Abstract

Introduction: Percutaneous dilatational tracheostomy (PDT) is the preferred technique for elective tracheostomy in critically ill patients. However, a laryngeal or cervical mass is a relative contraindication because landmark puncture is unreliable, bleeding risk increases, and the airway may be lost when the endotracheal tube is withdrawn. Evidence on the safe extension of PDT to such airways is limited. Case Description: A 72-year-old man was admitted to H. Adam Malik General Hospital, Medan, Indonesia, with decreased consciousness after being struck by a motorcycle. Tracheal intubation was unexpectedly difficult and required a video laryngoscope and bougie. After eight days of ventilation, weaning failed, and tracheostomy was indicated. Pre-procedural neck ultrasound showed peritracheal soft-tissue thickening suspicious for a laryngeal tumor without compression of the tracheal lumen and identified a puncture interspace free of large vessels. Open tracheostomy was initially considered because of anticipated bleeding; however, bedside PDT was performed under triple guidance: ultrasound for site selection, video laryngoscopy to inspect the larynx and confirm endotracheal tube position, and flexible bronchoscopy through the tube for continuous intraluminal vision during needle puncture, guidewire passage, dilatation with the Ciaglia Blue Rhino system, and cannula insertion. The correct position was confirmed bronchoscopically before fixation. Conclusion: Combined ultrasound, video laryngoscopic, and bronchoscopic guidance eliminated every blind step and converted a tracheostomy that would conventionally have been performed openly into a controlled bedside intervention. This strategy may be considered an adjunct to standard PDT in selected high-risk patients provided adequate equipment and at least two trained operators are available.
The Role of Bronchoscopy as a Diagnostic and Therapeutic Modality in Critically Ill Patients with Respiratory Failure and Pneumonia in the Intensive Care Unit: A Descriptive Observational Study Edi Darmawan; Rizki Taufiqurrahman; Sutan Syarif Muda Dalimunthe; Septian Adi Permana; Arie Zainul Fatoni; Teuku Yasir; Andriamuri Primaputra Lubis; Rommy Fransiscus Nadeak; Bastian Lubis
Journal of Society Medicine Vol. 5 No. 5 (2026): May
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i5.284

Abstract

Introduction: Respiratory failure remains a major cause of intensive care unit (ICU) admission and is associated with substantial morbidity and mortality worldwide. Pneumonia frequently results in respiratory failure requiring invasive mechanical ventilation. Bronchoscopy enables direct airway visualisation and bronchoalveolar lavage (BAL), providing important diagnostic and therapeutic benefits in critically ill patients. This study evaluated the role of bronchoscopy in ICU patients with pneumonia-associated respiratory failure. Methods: This descriptive observational study was conducted in the adult ICU of RSUP H. Adam Malik Medan, Indonesia. Adult patients with pneumonia-associated respiratory failure requiring invasive mechanical ventilation who underwent bronchoscopy during ICU treatment in December 2025 were included. Data were obtained from medical records, bronchoscopy reports, laboratory investigations, and radiological examinations. Outcomes included chest radiographic findings, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), and BAL culture results. Results: Eighteen patients were included. Radiological improvement was observed in 13 patients (72%), whereas 5 patients (28%) demonstrated deterioration. Leukocyte count improvement occurred in 16 patients (89%), and NLR improvement was identified in 15 patients (83%). BAL cultures predominantly revealed Acinetobacter baumannii, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Conclusion: Bronchoscopy provides important diagnostic and therapeutic benefits in ICU patients with pneumonia-associated respiratory failure by facilitating airway clearance, improving inflammatory parameters, and supporting targeted antimicrobial therapy.
Lymph Node Enlargement as a Manifestation of Systemic Venous Congestion in Patients with High VExUS Scores: A Case Series Rizki Taufiqurrahman; Edi Darmawan; Sutan Syarief Muda Dalimunthe; Bastian Lubis; Andriamuri Primaputra Lubis; Rommy Fransiscus Nadea; Septian Adi Permana
Journal of Society Medicine Vol. 5 No. 6 (2026): June
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i6.285

Abstract

Introduction: Fluid overload in critically ill patients increases central venous pressure (CVP) and induces systemic venous congestion, a recognized contributor to organ dysfunction. The Venous Excess Ultrasound Score (VExUS) is a bedside ultrasonographic method that grades venous congestion by integrating inferior vena cava (IVC) diameter with hepatic, portal, and renal venous Doppler patterns. Because the major lymphatic vessels drain into the central venous circulation through the thoracic duct, sustained elevation of CVP may also impede lymphatic outflow and cause reactive enlargement of regional lymph nodes. To describe supraclavicular lymph node enlargement as a clinical manifestation of systemic venous congestion in critically ill patients with high VExUS scores. Methods: This case series included five mechanically ventilated patients with respiratory failure and fluid overload admitted to the intensive care unit of H. Adam Malik General Hospital, Medan. Bedside ultrasonography assessed the IVC diameter and hepatic, portal, and renal venous Doppler to determine the VExUS grade, together with the evaluation of the subclavian vein and supraclavicular lymph nodes. Results: The five patients (aged 57–77 years) had a mean IVC diameter of 2.14 ± 0.21 cm. Four patients had a VExUS grade of 3, and one had a grade of 2. All patients demonstrated supraclavicular lymph node enlargement (10.3–17.6 mm), with larger nodes tending to occur in patients with higher VExUS grades. Conclusion: Supraclavicular lymph node enlargement may represent a reactive manifestation of systemic venous congestion in critically ill patients with high VExUS scores and could serve as an adjunctive parameter for assessing fluid overload in the intensive care unit setting.
Co-Authors Achsanuddin Hanafie Ahmad Yapiz Hasby Akhyar H Nasution Akhyar H Nasution Alvin Oktomy Putra Andriamuri Primaputra Lubis Andriamuri Primaputra Lubis Andriamuri Primaputra Lubis Apriandeny Haithami Arie Zainul Fatoni Arsyad, Abdurrahman Mousa Asmin Lubis Aulia Kamal Ansari Aulia, Miftah Furqon Bejo Utomo Handayani Bellinda Magdalena Berutu, Veny Putri Bisono, Luwih Dis Bima Purwaamidjaja Dis Bima Purwaamidjaja Edi Daramawan Edi Darmawan Edi Darmawan Eka Setia Miharja Fahmi Sani Ferdinand Chandra Gema Nazri Yanni Gultom, Andrio Farel Edward Hanafie, Achsanuddin Indrawan, Jhonsen Iqbal, Aulia Irina, Rr Sinta Irina, Sinta Juliara, Faura Dwika Lubis, Andriamuri Primaputra Lubis, Asmin Lubis, Hilfan Ade Putra Muhammad Akil, Muhammad Muhammad Apriandi Wira Muhammad Aripandi Wira Muhammad Luthfi Muhibbut Thibri Nadeak, Rommy Nasution, Putra Fajar Pohan, Alfindy Maulana Prima , Agus Putri Amelia Rahmadhona, Sri Ricksando Siregar Rifani Masharto, Alegra Rizki Taufiqurrahman Rizki Taufiqurrahman Rizki Taufiqurrahman Rommy Fransiscus Nadea Rommy Fransiscus Nadeak Rommy Fransiscus Nadeak Septian Adi Permana Septian Adi Permana Siagian, Rizki Pratama Sidiq, Rendi Siregar, Ahmad Habibi Sutan Syarief Muda Dalimunthe Sutan Syarif Muda Dalimunthe Sutan Syarif Muda Dalimunthe Tambunan, Marco Audrik Silvester Tanjung, Qodri Fauzi Tasrif Hamdi Teuku Yasir Viandy, Vincent Vivienne WH George, Yohanes Wijaya, Dadik Wahyu Winata, Ade Yuki Yunanda Yutu Solihat