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All Journal Medicina E-Jurnal Medika Udayana Bali Journal of Anesthesiology Bisma: Jurnal Bisnis dan Manajemen ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Putu Kurniyanta
Department Of Anesthesiology And Reanimation, Faculty Of Medicine, Udayana University, Sanglah General Hospital Denpasar Bali
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Physics Other

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MANAGEMENT OF EXTRIMITY FRACTURE IN EMERGENCY DEPARTMENT Putu Sukma Parahita; Putu Kurniyanta
E-Jurnal Medika Udayana vol 2 no 9 (2013):e-jurnal medika udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (194.771 KB)

Abstract

Fracture injuries in the extremities are accounted for 40% of the incidence of fractures in the United States and causes high morbidity (physical suffering, lost time, and mental stress). High-energy fractures of the lower limbs can also cause life threatening condition like major vascular injury, crush syndrome, and compartment syndrome. Initial treatment in the emergency room is essential to save lives and to save the fractured extremities. Primary survey (securing the airway, breathing and circulation) and the secondary survey will be able to quickly and accurately identify dangerous early complication of fractures, such as major arterial injury, crush syndrome and compartment syndrome.
A sore throat after endotracheal intubation in Sanglah General Hospital 2017 Sobhana Shanmuganathan; Kadek Agus Heryana Putra; I Made Agus Kresna Sucandra; Putu Kurniyanta
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (307.141 KB) | DOI: 10.15562/ism.v11i3.292

Abstract

Background: Cuff volume additionally impacts a postoperative sore throat and dysphagia. The rate of a sore throat has likewise been discovered to be higher in the event of Laryngeal Mask Airway (LMA) than that of endotracheal intubation (ETT).Aim: To know the duration of a sore throat and level of severity of a sore throat after endotracheal intubation among patients of Sanglah General Hospital.Method: This cross sectional study was conducted on patients of Sanglah General Hospital. There were 100 students were participated in this study. They were asked to fill up a self-administered questionnaire. The variables assessed were their duration towards patients who have used anesthetic during surgery.Result: About 54% of 100 patient of Sanglah General Hospital, respectively had a sore throat for 4 to 6 days after endotracheal intubation. However, 28% of patients had a sore throat from day one to day three after the endotracheal intubation method. For the severity of a sore throat over 50% of the patients have experienced pain in eating, drinking, talking and for some people it has given them an enormous side effect towards their daily activity. Though the overall duration and severity of a sore throat among the patient, lasted less than a week and for the severity patient have voted respectively high. Patients with good diet control after the surgery tend to heal faster.
Hubungan antara kadar albumin dengan penyembuhan luka pada pasien pasca bedah di Rumah Sakit Umum Pusat Sanglah Denpasar Ni Luh Gede Apsari Pararesthi; Kadek Agus Heryana Putra; Putu Kurniyanta
Intisari Sains Medis Vol. 10 No. 3 (2019): (Available online: 1 December 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (249.388 KB) | DOI: 10.15562/ism.v10i3.450

Abstract

Introduction: Wound healing is influenced by various factors, one of which is nutritional status. Nutritional status itself is often detected by one of the important signs of serum albumin. Albumin is a protein in human plasma that is soluble in water and high in concentration in blood plasma. Low albumin levels as an estimate of the causes of malnutrition and also associated with increased complications and postoperative death. Serum albumin less than 3.5g / dL is recognized by the patient as hypoalbuminemia.Methods: This research was conducted with the aim of analyzing the relationship between albumin levels and wound healing in postoperative patients. This study used a cross sectional observational analytic method by taking secondary data from medical records of postoperative patients (disgestif surgery, neurosurgery, orthopedic surgery, oncology surgery) at Sanglah General Hospital.Result: Of the 60 patients involved in this study, patients with abnormal albumin levels were 36.7% and patients with normal albumin levels were 63.3%. The chi-square test results showed that postoperative patients who had the last abnormal albumin level before surgery 5.1 times more with unrecover wound compared to patients with normal albumin levels (PR = 5.182; 95% CI = 2.181-12.310, p = 0.00001).Conclusion: There is a significant relationship between albumin levels and wound healing.Latar Belakang: Penyembuhan luka dipengaruhi oleh berbagai faktor, salah satunya adalah faktor status nutrisi. Status nutrisi sendiri sering dideteksi oleh salah satu tanda penting yaitu serum albumin. Albumin merupakan protein dalam plasma manusia yang larut dalam air dan tinggi konsentrasinya dalam plasma darah. Kadar albumin yang rendah sebagai perkiraan penyebab malnutrisi dan juga berhubungan dengan peningkatan komplikasi serta kematian postoperasi. Serum albumin yang kurang dari 3.5g/dL diakui pasien tersebut hipoalbuminemia.Metode: Penelitian ini dilaksanakan dengan tujuan untuk menganalisis hubungan kadar albumin dengan penyembuhan luka pada pasien pasca bedah. Penelitian ini menggunakan metode observasional analitik cross sectional dengan mengambil data sekunder dari rekam medis pasien pasca bedah (bedah disgestif, bedah saraf, bedah ortopedi, bedah onkologi) di RSUP Sanglah.Hasil: Dari 60 pasien yang terlibat dalam penelitian ini didapatkan pasien dengan kadar albumin tidak normal sebesar 36.7% dan pasien dengan kadar albumin normal sebanyak 63.3%. Hasil uji chi-square menunjukkan bahwa pasien pasca bedah yang sebelum operasi memilki kadar albumin terakhir tidak normal 5.1 kali lebih banyak mengalami luka tidak sembuh dibanding pasien dengan kadar albumin normal (PR=5.182; 95% CI=2.181-12.310, p=0.00001).Simpulan: Terdapat hubungan yang signifikan antara kadar albumin dengan penyembuhan luka.
INDEKS KOLAPSIBILITAS (CI) SEBAGAI PREDIKTOR HIPOTENSI PADA PASIEN DENGAN ANESTESI UMUM Pranata, I Made Harry; Adi, Made Septyana Parama; Suarjaya, I Putu Pramana; Kurniyanta, Putu
E-Jurnal Medika Udayana Vol 12 No 10 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i10.P02

Abstract

Intraoperative hypotension (IOH) is important to identify early because it is associated with high morbidity and mortality in old age. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) can detect volume responsiveness in circulatory shock. The purpose of this study was to examine the collapsibility index (CI) as a predictor of hypotension in patients under general anesthesia. This study was an observational cross-sectional design in adult patients who underwent elective surgery under general anesthesia at Sanglah General Hospital from December 2021 to January 2022 using a consecutive sampling technique. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVC CI as a diagnostic tool for predicting hypotension (systolic pressure?<?90?mmHg or a???30% drop from the baseline) was evaluated by ROC curve analysis. At the point of collapsibility index (CI) ? 47, there were 29 patients (96.7%) with hypotension. At the point of collapsibility index (CI) < 47, there was 1 patient (3.3%) with hypotension and 24 patients (100%) without hypotension. The cut-off level of collapsibility index (CI) is obtained with the Receiver Operating Curve (ROC) curve, below 0.985. The cut-off CI level for hypotension was 47.0 with a sensitivity of 96.7% and specificity of 100%. There is a significant relationship between IVC CI with a decrease in MAP before and after induction at 4,8, and 10 minutes (p<0,05). The collapsibility index (CI) 50 can be used as a predictor of the incidence of hypotension in patients under general anesthesia. Keywords : hypotension, collapsibility index, general anesthesia.
EFEKTIVITAS TEKNIK ANESTESI LOW FLOW DIBANDINGKAN TEKNIK ANESTESI INHALASI STANDAR PADA ANAK USIA 1-6 TAHUN YANG MENJALANI OPERASI DI PROF. DR. I.G.N.G. NGOERAH DENPASAR Kurniyanta, Putu; Suarjaya, Putu Pramana; Narakusuma, Fajar
E-Jurnal Medika Udayana Vol 12 No 6 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i06.P04

Abstract

Since the discovery of sevoflurane, it has been commonly used due to its many advantages, including its safety profile for pediatric anesthesia practice. However, currently no ideal recommendation for how much gas flow should be used during induction in children. High fresh gas flow (FGF) causes waste of anesthetic and oxygen gases, making it both uneconomical and environmentally polluting. To date, there have been very few studies on low FGF in children, so there is no best and efficient method for reducing the need for large amounts of induction gas. The aim of this study is to determine the effectiveness of the low low anesthesia (LFA) technique in reducing sevoflurane volume, induction time, and hemodynamics during surgery in children undergoing surgery. This is a case-control study conducted at Prof. Dr. I.G.N.G Ngoerah Hospital in Denpasar. Forty-six children aged 1 - 6 years underwent elective surgery and were anesthetized with sevoflurane and randomly divided into two groups: the case group using the low-flow anesthesia technique and the control group using the standard anesthesia technique. The case and control groups were statistically similar in terms of demographic data. However, the volume of sevoflurane used from the time of premedication to intubation was significantly different (p > 0.05) between the two groups (35.5 ml vs 44.5 ml). The induction times were not significantly different (209s vs 201s, p<0.05). Additionally, no significant difference was observed regarding hemodynamic stability during anesthesia. Keywords : anesthesia induction, hemodynamic stability, low flow anesthesia, sevoflurane
Managemen Anestesi pada Congenital Diapragmatic Hernia dengan Ventrikel Septal Defek dan Atrium Septal Defek pada Pasien Pediatrik : Laporan Kasus Mauritius Septa; Adinda Putra Pradhana; I Putu Kurniyanta; Ketut Wibawa Nada; Novandi Kurniawan; Tjokorda Gde Agung Senapathi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 2 (2025): JATI Agustus 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/JATI.2025.v01.i02.p06

Abstract

Congenital diaphragmatic hernia (CDH) merupakan kelainan kongenital pada diafragma yang terjadi pada pediatri. Insiden terjadinya hernia tipe Borchdalek lebih sering terjadi pada sisi kiri dari pada sisi kanan. Penyulit lain pada CDH adalah hipoplasia paru, hipertensi paru dan kelainan pada jantung. Pada kasus ini kami mendiskusikan bayi 12 hari dengan kelainan CDH sisi kanan dengan kelainan jantung berupa ventrikel septal defek (VSD) dan atrium septal defek (ASD) yang dilakukan operasi laparotomi hernia. Manajemen anestesi pada pasien ini menggunakan  inhalasi sevoflurane, fentanil, volume tidal rendah, obat inotropik dengan kondisi hemodinamik yang stabil selama pembedahan. Kami melaporkan management anestesi dengan  sevoflurane yang dikombinasi dengan volume tidal rendah dan inotropik dobutamine pada operasi congenital diaphragmatic herdia dengan VSD dan ASD membantu dalam keberhasilan intraoperatif. Setelah operasi, pasien dilakukan perawatan di NICU untuk  perawatan secara ketat.
Cochlear Implantation with Fontan Circulation: A Rare Case of Non-Cardiac Pediatric Surgery I Putu Kurniyanta; Adiyana, I Made Bhasma
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 1 (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.v8i1.912

Abstract

Background: Fontan circulation is a cardiac circulation following the Fontan procedure in patients with a single ventricle congenital heart defect. This circulation depends on the difference in pressure between pulmonary capillaries and central venous pressure to achieve optimal cardiac output. This case report aims to discuss intraoperative anesthesia management in a patient with Fontan circulation undergoing a non-cardiac surgical operation. Case presentation: The patient is a 7-year-old male with a history of congenital heart disease who has undergone the Fontan circulation procedure and is now undergoing Cochlear implantation surgery. The patient was managed with general anesthesia - endotracheal intubation and controlled ventilation during the operation, following the principle of minimizing intrathoracic positive pressure, low PEEP, and low tidal volume with a target peripheral saturation > 95%. Cardiac output monitoring during the intraoperative period is done using intra-arterial blood pressure. After 5 hours of surgery, the patient was extubated with stable hemodynamics. Conclusion: The primary goal of intraoperative anesthesia management in patients with Fontan circulation is to maintain an optimal transpulmonary gradient by ensuring optimal transpulmonary blood flow, thus preserving cardiac output.
Anesthesia Approach for Nephrectomy in Full-Term Neonate with Suspected Wilms Tumor and Patent Foramen Ovale: A Case Report Katarina, Ida; Otniel Adrians Labobar; I Putu Kurniyanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (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.v8i2.919

Abstract

Background: Nephrectomy for Wilms tumor presents a considerable challenge in pediatric anesthesia. This study aimed to describe the anesthesia approach for nephrectomy in a full-term neonate with suspected Wilms tumor and patent foramen ovale. Case presentation: A 25-day-old male neonate was referred with a longstanding intraabdominal mass present since birth. Echocardiography revealed a patent foramen ovale with a diameter of 2.7 mm and a left-to-right shunt. The patient also had a diagnosis of partial ileus obstruction, likely caused by the tumor's pressure on the left kidney. Preoperative fasting adhered to a "6-4-3-1" regimen. Normoglycemia was maintained throughout the perioperative period. The case was managed under general anesthesia without the use of the rapid sequence induction technique. Caudal analgesia was administered using 1.14 ml of 0.175% bupivacaine. Vigilant monitoring of blood loss, prevention of hypothermia, and effective pain management are vital aspects of the surgical procedure. For postoperative pain management, analgesia and morphine infusion were employed. The patient was then transferred to the neonatal intensive care unit (NICU) for observation for any signs of complications related to anesthesia and surgery. Conclusion: Nephrectomy in neonates is one of the challenges of pediatric anesthesia. Pre-anesthesia preparation in relation to hypertension control, analgesia plan and postoperative care site, transfusion strategy, and management of intravascular extension.
Difficult Airway Management of Reconstructive Surgery for Noma (Cancrum oris): A Rare Neglected Disease Supono, Benny; Adinda Putra Pradhana; I Gusti Putu Sukrana Sidemen; Putu Kurniyanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (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.v8i3.937

Abstract

Background: Noma is a rare necrotizing gangrenous stomatitis that occurs due to poor oral hygiene and chronic malnutrition. Noma’s survivors usually had significant facial deformities that needed reconstructive surgery as its definitive treatment. However, this facial deformity can result in a difficult airway that is very challenging for anesthesiologists. Case presentation: A 22-year-old male patient had a significant deformity on his left face due to Noma. Preoperative evaluation revealed a potentially difficult airway due to deformity of the maxilla and mandible, malocclusion, inadequate mask seal, and incomplete dentition. Nasal fiberoptic intubation was chosen as the management of a difficult airway in this patient. A tracheostomy was prepared as the emergency invasive airway in the event of failed intubation attempts. Intubation attempts were limited to three times, and the nasal fiberoptic intubation in this patient was successful on the third attempt. The patient was stable, and the airway was safely maintained during the surgery. Conclusion: Detailed and careful perioperative evaluation had vital role assessing potential difficult airway and planning the optimal airway management for patient with facial deformity. Nasal fiberoptic intubation is still the safest choice with high success rate for Noma patient with significant facial deformity.
Anesthetic Management of a Single Ventricle in Pediatric Patient Undergoing Open Duodeno–Duodenostomy Surgery: A Case Report Lesmana, Pita Mora; I Putu Kurniyanta; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1045

Abstract

Background: Duodenal atresia is a rare congenital disorder characterized by blockage of the small intestine. Open duodeno-duodenostomy is the surgery of choice to correct this condition. Case presentation: We report the case of a three-day-old baby girl with duodenal atresia and a functional single ventricle who underwent open duodeno-duodenostomy. The patient was born via caesarean section due to indications for a previous caesarean section in the mother and congenital abnormalities in the fetus. At birth, the patient showed signs of intestinal obstruction and cyanosis. Preoperative physical and laboratory examinations confirmed duodenal atresia and cardiac abnormalities. The patient underwent an open duodeno-duodenostomy without complications. The patent ductus arteriosus must be kept open to maintain systemic perfusion by maintaining PaO2 at 40 to 45 mmHg and SaO2 at 70% to 80%, along with the administration of prostaglandin agents. Good perioperative management and improvements in surgical procedures will increase the life expectancy of patients with single ventricle problems, especially hypoplastic left heart syndrome. The use of low-dose fentanyl induction agent, 1 MAC sevoflurane, and atracurium has been proven to produce favorable outcomes in these patients. Conclusion: Open duodeno-duodenostomy is a safe and effective operation for duodenal atresia. The patient in this case recovered well after surgery. Open duodeno-duodenostomy should be considered as the primary treatment option for duodenal atresia.
Co-Authors Adi, Made Septyana Parama Adinda Putra Pradhana Adiyana, I Made Bhasma Ahmad Roziq Christopher Ryalino Damayanti, Elok Eka Nantha Kusuma, Putu Elizeus Hanindito Estrada, Ronald Gde Agung Senapathi, Tjokorda I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit I Gusti Putu Sukrana Sidemen I Ketut Sinardja I Made Agus Kresna Sucandra I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Subagiartha I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan Jeremy Jonathan Kadek Agus Heryana Kadek Agus Heryana Putra, Kadek Agus Katarina, Ida Ketut Wibawa Nada Kurnia, Prajnaariayi Prawira Kusuma, Dian Reginalda Lesmana, Pita Mora Made Wiryana Marilaeta Cindryani, Marilaeta Mauritius Septa Narakusuma, Fajar Ni Luh Gede Apsari Pararesthi Ni Made Supradnyawati, Ni Made Novandi Kurniawan Otniel Adrians Labobar Pontisomaya Parami Pranata, I Made Harry Putu Herdita Sudiantara, Putu Herdita Putu Pramana Suarjaya Putu Sukma Parahita Raden Andi Sularso, Raden Andi Sobhana Shanmuganathan Supono, Benny Thius, Adi Dharma Tjokorda Gde Agung Senapathi Utariani, Arie