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Sugiarto, Adhrie
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran Universitas Indonesia – RSUPN Nasional Dr. Cipto Mangunkusumo, Jakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Kefektifan Sedasi antara Campuran Ketamin Propofol (Ketofol), dan Propofol Fentanil pada Prosedur Endoscopic Retrograde Cholangiopancreatography (ERCP) Sugiarto, Adhrie; Perdana, Aries; Jefrey Tuhulele, Norman Rabker
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Abstract

Sedasi adekuat diperlukan untuk menjaga kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasienselama prosedur ERCP. Propofol merupakan sedasi yang tanpa efek analgesia namun memiliki efek depresikardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan menurunkankebutuhan dosis propofol dalam mempertahankan kedalaman sedasi, analgesia, kestabilan hemodinamik danrespirasi. Penelitian ini membandingkan keefektifan sedasi antara campuran ketamin-propofol (ketofol) danpropofol-fentanil pada prosedur ERCP. Penelitian ini adalah uji klinis acak tersamar ganda, 36 pasien dewasayang menjalani prosedur ERCP, dibagi menjadi dua kelompok yaitu kelompok KF (n=18) yang mendapatkanketofol 1:4 dalam semprit 50 mL, serta kelompok PF (n=18) yang mendapatkan fentanil 1 mcg/kgBB dan propofoldalam semprit 50 mL. Kedalaman sedasi diukur dengan Ramsay Sedation Scale. Hasil penelitian didapatkan reratakonsumsi propofol permenit, kelompok ketofol lebih rendah bermakna dibanding dengan kelompok propofolfentanil (p<0.05). Jumlah kebutuhan fentanil pada kelompok ketofol lebih rendah dibanding dengan kelompokpropofol-fentanil (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol-fentanil lebih cepat dibandingdengan kelompok ketofol (p<0.05). Kejadian hipotensi pada kedua kelompok tidak berbeda bermakna (p>0.05).Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Simpulan adalah ketofol lebihefektif daripada propofol-fentanil untuk kedalaman sedasi dan analgesia serta memiliki efek samping yangminimal. Kata kunci: ERCP, Propofol, ketamin, fentanil, sedasi, analgesia The effectiveness of sedation is the ability of the drugs to maintain sedation depth and analgesia, and to controlpatients movements during ERCP procedure. Propofol is a sedative agent that has no analgesia effect and hasa dose-dependent cardiovascular and respiratory depressant effects. The addition of small dose of ketamin isexpected to reduce the required dose to maintain hemodinamic and respiratory stability. This study comparedthe effectiveness of sedation between 1:4 ketamin propofol mixtures (ketofol) and propofol-fentanyl in ERCPprocedure. This research a double blind randomised clinical trial was done in 36 adult patients who underwentERCP procedure, which were divided into two groups: KF group (n = 18), which were treated with ketofol 1:4in a 50 mL syringe, and PF group (n = 18) which were treated with fentanil 1 mcg/kgBW and propofol in a 50mL syringe. The depth of sedation was measured by Ramsay Sedation Scale (RSS). The average consumption ofpropofol per minute of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The medianfentanyl consumption of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The onsetand the recovery time in fentanyl propofol group were faster than ketofol group (p<0.05). There was no significantdifferent in the incidence of hypotension in both groups (p>0.05). There were no desaturation events or nausea/vomiting in both groups. Conclution ketofol was more effective than fentanyl-propofol mixture in maintaining thedepth of sedation and analgesia and has minimal side effects. Key words: Analgesia,ERCP, fentanyl, ketamine, propofol, sedation Reference Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62(1):1–8. Glomsaker TB. Endoscopic Retrograde Cholangiopancreatography (ERCP) in Norway, University of Bergen, 2013. Available at http://www.ivs.no/downloads/ thesis_Glomsaker.pdf, accessed on October 24, 2014 Chainaki IG, Manolarki MM, Paspatis GA. Deep sedation in gastrointestinal endoscopy, World J Gastroentero, 2011, 3 (2): 34–9. Sumaratih L. Perbandingan keluaran antara teknik pemberian propofol bolus berkala dengan Target Controlled Infusion pada pasien endoskopi saluran cerna di RSUPN Cipto Mangunkusumo, Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Indonesia, Jakarta, 2013. Wang Y, Jiang X, Pan L, Dong S, Feng Y, Prajapati SS, et al. Randomized double-blind controlled study of the efficacy of ketofol with propofolfentanyl and propofol alone in ttermination of pregnancy. Afr. J.Pharm. pharmacol.2012;6(34):2510–14. Coulter FLS, Hannam JA, Anderson BJ. Ketofol dosing simulations for procedural sedation, Pediatr Emerg Care, 2014;30(9): 621–30. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamin propofol (ketofol), Acad Emerg Med, 2010;17:194–201. Hassenein R, El-Sayed W. Ketamin/propofol versus fentanyl/propofol for sedating obese patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP), Egypt J Anesth, 2013;29:207–11. Thom G. The evolving role of ketofol and its use as sedation agent in PSA in children: systemic review, 2013. Available at http://sedationspecialists.co.za/wpcontent/uploads/2013/07/Ketofol-in-sedationnew-developments_Dr-George-Thom.pdf, accessed on October 11, 2014.
Correlation between Modified Clinical Pulmonary Infection Score with Duration of Mechanical Ventilation of Pneumonia Patient in ICU Cipto Mangunkusumo Hospital Madjid, Amir S; Sugiarto, Adhrie; Putri, Regina Prima; Alatas, Anas
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Abstract

Current extubation parameters are not entirely accurate. Therefore, weaning from mechanical ventilation is difficult, especially in pneumonia patient. One of scoring system for evaluation of pneumonia patient is modified clinical pulmonary infection score (MCPIS). This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secretion, oxygenation and chest x-ray. This study aimed to estimate the correlation between MCPIS score with duration of mechanical ventilation of pneumonia patient in ICU Cipto Mangunkusumo Hospital. This was a prospective cohort study among pneumonia patients with mechanical ventilation at ICU Cipto Mangunkusumo Hospital from October 2014 to February 2015. MCPIS were measured at the point of admission and 72 hours after admission. Date of extubation was recorded to determine the duration of mechanical ventilation. There were 48 subjects included in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant moderate correlation between MCPIS score after 72 hours with mechanical ventilation duration (p=0,000; r=0,539). This study concluded there was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patients in ICU.
Perbandingan Trapezius Squeezing Test dan Jaw Thrust Sebagai Indikator Kedalaman Anestesia pada Pemasangan Sungkup Laring Hidayat, Jefferson; Sugiarto, Adhrie; Alatas, Anas
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Abstract

Manajemen jalan napas merupakan salah satu aspek penting dalam anestesiologi. Salah satu jenis alat bantu jalannafas yang sering digunakan adalah Laringeal Mask Airway (LMA/sungkup laring). Pemasangan sungkup laringtanpa pelumpuh otot membutuhkan kedalaman anestesi yang cukup. Trapezius squeezing test dan jaw thrustadalah dua uji klinis sederhana yang digunakan untuk menguji kedalaman anestesia. Penelitian ini bertujuan untukmembandingkan trapezius squeezing test dan jaw thrust sebagai indikator klinis menilai kedalaman anestesi padapemasangan sungkup laring dengan induksi anestesia menggunakan propofol. Sebanyak 128 pasien dirandomisasimenjadi dua kelompok yaitu kelompok 1 (kelompok jaw thrust) dan kelompok 2 (kelompok trapezius squeezingtest). Setelah premedikasi dengan midazolam 0,05 mg/kgBB dan fentanil 1 μg/kgBB, untuk induksi anestesiadiberikan propofol dosis titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saatrespon motorik dari manuver hilang dilakukan pemasangan sungkup laring. Keberhasilan pemasangan padakelompok 1 dan 2 adalah 93,8% vs. 90,6% (p >0,05). Rata-rata penggunaan propofol pada kelompok 1 sebesar120,34 mg dan kelompok 2 sebesar 111,86 mg (p > 0.05). Pada kelompok 1 apnea dijumpai pada 10 pasien(15.6%) sedangkan pada kelompok 2 sebanyak 11 pasien (17.2%). Trapezius squeezing test sama baiknya denganjaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring. Kata Kunci: Jaw thrust, kedalaman anestesia, propofol, sungkup laring, trapezius squeezing test Airway management remains as one of the most important aspect in anesthesiology. Laryngeal Mask Airway(LMA) has been widely used as an airway device. Laryngeal mask insertion without muscle relaxant facilitationrequires an adequate anesthesia level. The purpose of this study was to compare trapezius squeezing test andjaw thrust maneuver as an indicator of anesthesia depth for laryngeal mask insertion, with propofol as inductionagent. There were 128 subjects who had been randomized into two groups: Group 1 (jaw thrust group) andGroup 2 (trapezius squeezing test group). All subjects received midazolam 0.05 mg/kg and fentanyl 1 μg/kg aspremedication. Propofol with titrated dose were used for anesthesia induction. Jaw thrust or trapezius squeezingtest maneuver were performed every 15 seconds in each group. When motoric responses were lost after maneuver,LMA was inserted. Succesfull LMA insertion were found in 93,8% patients (Group1) and 90,6% (Group 2) withp >0,05. Mean propofol consumptions were 120.34 mg in Group 1 and 111,86 mg in Group 2. Apnea was found in10 patients (15,6%) in Group 1 and 11 patients (17.2%) in Group 2. Trapezius squeezing test was as good as jawthrust maneuver as an adequate depth of anesthesia indicator for laryngeal mask insertion. Keywords: Departement of anesthesia, jaw thrust, laryngeal mask, propofol, trapezius squeezing test Reference Sood J. Laryngeal mask airway and its variants. Indian J Anaesth 2005;49(4):275–0. Verghese C, Berlet J, Kapila A, Pollard R. Clinical assessment of single use laryngeal mask airway the LMA Unique. Br J Anaesth 2006:80;677–9. Easley EH. The laryngeal mask airway: a review and update. J Clin Anaesth. 2005:16; 114–23. Cook TM. The classic laryngeal mask airway: a tried and tested airway. Br J Anaesth 2006; 96(2):149–52. Cressey DM, Claydon P, Bhaskaran NC, Reilly CS. Effect of midazolam pretreatment on induction dose requirement of propofol in combination with fentanyl in younger and older adult. Anaesth 2011;56:108–13. Towsend R. Jaw thrust as a predictor of insertion conditions for the proseal laryngeal mask airway. Anaesth 2009;20(1):59–62. Krishnappa S. Optimal anaesthetic depth for LMA insertion. Indian J Anaesth 2011;55(5): 504–7. Chang C. Comparison of the trapezius squeezing test and jaw thrust as indicators for laryngeal mask airway insertion in adults. Korean J Anesth 2011;61(3):201–4. Peacock JE, Lewis RP, Reilly CS, Nimmo WS. Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients. Br J Anaesth 1990;65:346–52. Peacock JE, Spiers SP, Mclauchlan GA, Edmondson WC, Berthoud BM, Reilly CS. Infusion of propofol to identify smallest effective doses for induction of anaesthesia in Yong and elderly patients. Br J Anaesth 1992; Stokes DN, Hutton P. Rate dependent induction phenomena with propofol: Implications for the relative potency of intravenous anesthetics. Anesth Analg 1991; 72:578–83. Scanlon P, Carey M, Power M. Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone. Can J Anaesth 1993;40:816–8. Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivate as a tool for predicting the depth of sedation and anesthesia induced by sevoflurance. Anesthesiology 1998;88:642–50. Rudy N. Keefektifan trapezius squeezing test sebagai indicator kedalaman anesthesia saat pemasangan sungkup laring dihubungkan dengan bispectral index. Universitas Indonesia, 2012. Drage MP, Nunez J, Vaughn RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anesth 1996; 51: 11667–70. Chang C. Optimal condition for laringeal mask airway insertion in children can be determinate by the trapezius squeezing test. J Clin Anaesth 2008;20:99–102. Reves GJ, Peter S.A, David AL, et al. Intravenous nonopiod anesthetics. In Miller’s Anesthesia. 7th ed. Philadelpia: Churchill Livingstone, 2010. p. 318–25. Morgan GA, Mikhail MS. Nonvolatile anesthetic agents: Clinical Anesthesiology. 4th ed. New York : McGraw-Hill, 2006. p.179–203 Hillier SC. monitored anesthesia Care. In: Barash’s. Clincal anesthesia. 5th ed. Philadelphia: Lippincott William & Wilkins, 2006. p . 2576–607.
Ko-infeksi Jamur pada COVID-19 dengan Terapi Steroid Septian Adi Permana; Adhrie Sugiarto; Muhammad Husni Thamrin; Purwoko Purwoko; Arifin Arifin; Eko Setijanto
JAI (Jurnal Anestesiologi Indonesia) Vol 12, No 3 (2020): 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.v12i3.34150

Abstract

Latar belakang: Ko-infeksi jamur pada pasien Corona Virus Disease 2019 (COVID-19) acapkali terjadi. Hal itu dikarenakan kegagalan sistem imun karena infeksi COVID-19 maupun karena pengobatan anti inflamasi yang diberikan.Kasus: Seorang laki-laki 39 tahun dengan acute respiratory distress syndrome (ARDS) berat akibat infeksi COVID-19 dan disertai dengan ko-infeksi jamur. Pasien ini mendapatkan pengobatan steroid dari awal masuk dan pada hari ke-6 hasil kultur sputumnya menunjukkan adanya ko-infeksi jamur. Pasien ini memiliki komorbid berupa riwayat diabetes mellitus. Dari pemeriksaan fisik ditemukan dispnea, takipnea, takikardia sejak hari pertama. Dari hasil laboratorium menunjukkan angka leukosit, high sensitivity c-reactive protein (HsCRP), serum glutamic oxaloacetic (SGOT), gula darah, d-dimmer, lactat dehydrogenase (LDH) dan limfosit netrophyl ratio (LNR) yang tinggi. Pada pasien ini didapatkan rasio PaO2 / FiO2 rendah dan procalcitonin (PCT) yang normal. Dari kultur sputum ditemukan adanya infeksi jamur dan dari hasil rontgen toraks (CXR) menunjukkan pneumonia bilateral. Pasien ini dirawat dengan terapi standar dan mendapatkan dexametason 5 mg / 8 jam, setelah kultur sputum menunjukkan infeksi jamur, pasien juga mendapat mycafungin untuk pengobatan jamurnya.Diskusi: Kecurigaan terhadap ko-infeksi jamur pada pasien COVID-19 yang mendapatkan terapi steroid dalam jangka waktu lama maupun adanya penyerta diabetes harus dipikirkan. Penggunaan terapi anti jamur empiris pun acapkali diperlukan untuk mengurangi morbiditas dan mortalitas.Kesimpulan: Infeksi COVID-19 memiliki risiko terjadinya ko-infeksi, salah satunya adalah infeksi jamur. Insiden koinfeksi jamur diperberat dengan pemberian pengobatan steroid dan riwayat diabetes mellitus. 
The Effect of Intravenous Vitamin C on Urine Neutrophil Gelatinase-Associated Lipocalin Among Septic Patients: A Randomised Control Trial Peni Yulia Nastiti; Adhrie Sugiharto; Amir S Madjid
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 3 No. 4 (2019): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v3i4.100

Abstract

Background The role of vitamin C to decrease organ dysfunction in sepsis was still controversial. This study aimed to explore the effect of intravenous (IV) vitamin C on urine NGAL (uNGAL) levels among septic patients in ICU. Methods This study was a randomized clinical trial held in Cipto Mangunkusumo Hospital from April to July 2019 with consecutive sampling method. Patients aged > 18 years with sepsis based on the criteria of sepsis-3 who were admitted to the ICU were included in this study. Exclusion criteria were those with chronic kidney problems, with kidney stones, undergo renal replacement therapy in the ICU. All subjects were divided into: Group A was treated with combination of vitamin C and thiamine while Group B was given thiamine only. The uNGAL level was measured at baseline, 24, 48 and 72 h after treatment. Anova for repeated measurement using General Linear Model for Repeated Measurement was used with level of significant at p-value <0.05. Results Total of 33 subjects were included. In Group A we found uNGAL (ng/ mL) were 74.5 (13.3-102.9), 77.3 (15.2-98.4), 67.2 (22.6-100.6), 77.2 (17.0-100.5) for baseline, 24 h, 48 h, and 72 h respectively. While in Group B uNGAL were 57.7 (11.5-94.5), 57.1 (6.4-97.7), 53.7 (13.3-99.6), 47.6 (4.5-100.9). No significant difference in terms of uNGAL between two groups at each hour was found. Conclusions This study showed that intravenous vitamin C administration had no effect on uNGAL among septic patients. Need more study to investigate approaches to improve kidney and inflammatory biomarker among septic patients.
The Effect of Ophiocephalus striatus Extract on Quantitative Measurement of Biceps Brachii and Rectus Femoris in Patients with Mechanical Ventilation: A Randomised Control Trial Hunter Design Nainggolan; Eddy Harijanto; Adhrie Sugiarto; Inge Permadhi; Thariqah Salamah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 4 No. 1 (2020): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v4i1.104

Abstract

Introduction A freshwater fish Ophiocephalus striatus (OS) or known locally to Indonesian as haruan, has potentials to retain musclemass of critically ill patients following its high content of amino acids, fatty acids, minerals, and vitamins. This study was conducted to investigate the effect of OS on quantitative measurements of biceps brachii and rectus femoris in patients with mechanical ventilation. Methods This was a double-blinded randomized controlled trial at tertiary hospital between July- September 2019. The study included patients aged 18-65 years old with mechanical ventilation whereas patients with chronic kidney disease, paraparesis, or neuromuscular disorders were excluded. Forty-two patients were divided into extract group (n=19) who received 15 g of OS extract daily and control group (n=23) who received none. Quantitative measurements of both muscles were determined by measuring cross sectional area (CSA) using ultrasonography by one radiologist. Data were collected at 1st and 7th day, while the intervention was administered in-between. Independent sample T-test, Mann-Whitney test, and multivariate study using general linear model (GLM) were used for statistical analysis. Results The changes of CSA on biceps brachii and rectus femoris muscles from before to after intervention between extract group compared to control group were 5,30 ± 2,41 to 6,09 ± 1,81 vs. 5,16 ± 2,50 to 4,16 ± 1,94 (p=0.002) and 2,45 (1,10 – 5,90) to 3,47 (1,13 – 8,18) vs 3,85 (1,09 – 9,06) to 2,78 (1,06 – 7,27) (p=0.230), respectively. Multivariate analysis showed significant differences between extract and control group for both muscles with p value of <0.001 and 0.001 respectively. Conclusion Supplementation of Ophiocephalus striatus extract was associated with a significant increase of biceps brachii and rectus femoris CSA in patients with mechanical ventilation. Keywords: Ophiocephalus striatus, ultrasonography, cross sectional area, biceps brachii muscle, rectus femoris muscle
Relationship between Neutrophil to Lymphocyte Ratio with Diaphragm Thickness in Critical Patients Agustina Haloho; Rudyanto Sedono; Adhrie Sugiarto; Zulkifli Zulkifli
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 4 No. 2 (2020): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v4i2.121

Abstract

Abstract Background: The cause of weaning failure is multifactorial. One of the causes was Ventilator Induced Diaphragm Dysfunction (VIDD) due to thinning process of the diaphragm thickness. Decreased diaphragm muscle mass might occur due to inflammatory process. Methods: The study was an observational analytic study from September 2018 to January 2019 in Mohammad Hoesin Hospital, Palembang – Indonesia. Ethical appoval for the study was obtained from Ethics Committee and subjects were recruited after signing the informed consents. Only 30 subjects were involved in the end of the study. About 6 mL of blood sample from cubital vein was withdrawn from each subject to measure neutrophils and lymphocytes. Patients’ diaphragm thickness was measured by using ultrasonography on 0th, 3rd, 5th day. Collected data were then analyzed with STATA 15. Results: The chi-square test showed that the relationship of NLR (neutophil to lymphocyte ratio) of the 0th day to the decrease in diaphragm thickness on the 3rd day was not significant (p = 0.254), while the decrease in diaphragm thickness on the 5th day was significant (p = 0.015). Subjects with initial NLR values >7 had a significant higher risk of having decreased diaphragm thickness compared to subjects with initial NLR values ​​≤7 (RR = 1.62 (0.99-2.64); p-value = 0.003). Conclusion: Neutrophil to lymphocyte ratio affected the decrease of diaphragm thickness in patients using mechanical ventilation.
Prediksi Kesulitan Penempatan Jarum Spinal Berdasarkan Gambaran Radiologis dan Penanda Anatomis pada Pasien Bedah Urologi Adhrie Sugiarto; Madeline Marpaung
Majalah Anestesia & Critical Care Vol 39 No 2 (2021): 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 | Full PDF (447.976 KB) | DOI: 10.55497/majanestcricar.v39i2.215

Abstract

Latar belakang: Penyuntikan berulang pada prosedur anestesi spinal berkaitan dengan tingginya angka komplikasi dan ketidaknyamanan pasien. Sistem prediksi pra-operatif yang akurat terhadap kesulitan penempatan jarum spinal dapat mengurangi insiden penyuntikan berulang sehingga mengurangi risiko komplikasi pada pasien. Penelitian ini bertujuan untuk mengetahui ketepatan memprediksi kesulitan penempatan jarum spinal berdasarkan gambaran radiologis dan penanda anatomis pada pasien bedah urologi. Metode: Penelitian ini bersifat observasional analitik terhadap pasien bedah urologi yang menjalani anestesi spinal di Rumah Sakit Cipto Mangunkusumo pada bulan April-Mei 2015. Sebanyak 109 subjek diambil dengan metode consecutive sampling. Data pasien (usia, jenis kelamin, indeks massa tubuh, status fisik, gambaran radiologis vertebra lumbal, dan kualitas penanda anatomis tulang belakang), jumlah penusukan kulit, dan re-direksi jarum spinal, serta angka kesulitan penempatan jarum spinal dicatat. Kesulitan penempatan jarum spinal ditentukan berdasarkan jumlah penusukan kulit dan re-direksi jarum spinal. Variabel yang signifikan ditentukan melalui uji Pearson’s Chi-square dan uji Fisher, kemudian dilanjutkan analisis multivariat dengan metode regresi logistik untuk melihat hubungan antara kesulitan penempatan jarum spinal dengan variabel-variabel yang signifikan. Hasil: Faktor usia memiliki hubungan yang bermakna pada analisis bivariat (p=0,028). Kualitas penanda anatomis dan gambaran radiologis vertebra lumbal memiliki nilai prediksi terhadap kesulitan penempatan jarum spinal (p=0,000 dan p=0,006). Hasil uji kalibrasi menunjukkan kualitas prediksi yang baik. Dari uji diskriminasi didapatkan AUC sebesar 0,84 (IK 95% 0,751-0,929). Simpulan: Kualitas penanda anatomis dan gambaran radiologis vertebra lumbal mampu memprediksi kesulitan penempatan jarum spinal dengan tepat pada pasien bedah urologi.
Perbandingan Keberhasilan dan Kemudahan Intubasi dengan Bonfils antara Teknik Pendekatan Midline dan Retromolar pada Maneken Anas Alatas; Adhrie Sugiarto; Shendy Meike Sari
Majalah Anestesia & Critical Care Vol 39 No 1 (2021): Februari
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 | Full PDF (424.703 KB) | DOI: 10.55497/majanestcricar.v39i1.216

Abstract

Latar belakang. Bonfils adalah alat fiberoptik kaku yang dapat digunakan untuk intubasi baik pada jalan nafas normal maupun sulit. Penelitian ini membandingkan teknik pendekatan midline dan retromolar dalam melakukan intubasi dengan Bonfils pada suatu pelatihan dengan subjek penelitian adalah PPDS Departemen Anestesiologi dan Terapi Intensif FKUI/RSCM tahap mandiri dan paripurna. Pelatihan pada maneken ini dilakukan di SIMUBEAR IMERI. Subjek tidak terbiasa menggunakan Bonfils, sehingga pelatihan ini menjadi kesempatan yang baik. Terdapat 10 langkah DOPS yang harus dikerjakan oleh setiap subjek untuk masing-masing teknik. Penelitian ini menilai DOPS, lama waktu intubasi dan jumlah upaya yang dilakukan untuk melakukan intubasi dengan Bonfils. Metode. Penelitian ini merupakan uji eksperimental, acak, tidak tersamar, crossover yang dilakukan pada bulan September 2018. Subjek penelitian sebanyak 45 orang yang diambil dengan metode total sampling, dibagi menjadi dua kelompok yang berbeda dalam sekuens. Kelompok 1 terdiri dari 23 orang yang melakukan intubasi dengan Bonfils pendekatan midline terlebih dahulu kemudian pendekatan retromolar dan kelompok 2 terdiri dari 22 orang yang melakukan sebaliknya. Uji statistik data kategorik berpasangan menggunakan uji McNemar dan data numerik berpasangan dengan uji Wilcoxon Signed Ranks Test. Hasil. Keberhasilan intubasi dengan Bonfils melalui pendekatan midline pada DOPS 1, DOPS 2 dan pada kasus jalan nafas sulit sebesar 71,1%, 86,7%, 88,9%, sedangkan pada pendekatan retromolar adalah 68,8%, 68,9%, 64,4%. Lama waktu intubasi yang diperlukan untuk pendekatan midlinepada jalan nafas normal dan sulit adalah 59 (18-224) detik dan 55 (24-146) detik, sedangkan pada pendekatan retromolar adalah 64 (38-200) detik dan 74,5 (26-254) detik. Kemudahan melakukan intubasi dengan Bonfils dinilai dari jumlah upaya yang dilakukan oleh subjek sebanyak 1x, yaitu pada pendekatan midline 64,4% dan retromolar 35,6% pada jalan nafas normal, dan 66,7% serta 46,7% pada jalan nafas sulit. Simpulan. Keberhasilan dan kemudahan intubasi dengan Bonfils melalui pendekatan midline lebih baik dibandingkan dengan pendekatan retromolar pada maneken.
Perbandingan Prediktor Mortalitas Pasien COVID - 19 Adhrie Sugiarto
Majalah Anestesia & Critical Care Vol 40 No 3 (2022): Oktober
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.v40i3.291

Abstract

Pandemi COVID-19 mengakibatkan dampak yang sangat besar pada dunia kesehatan akibat jumlah penderita yang sangat banyak dan beragamnya derajat keparahan penyakit yang diderita. Klasifikasi keparahan penyakit COVID-19 terbagi menjadi asimtomatik, ringan, sedang, berat (Pneumonia berat (Frekuensi nafas >30x/menit, distress nafas, desaturasi dengan SpO2 <93%) dan kritis (terdapat tanda ARDS, sepsis, dan syok sepsis).1 Tingginya pasien yang terdiagnosis COVID-19 dapat menyebabkan lonjakan permintaan perawatan di rumah sakit dan Intensive Care Unit, terutama disebabkan oleh gejala pneumonia dan gagal nafas.2 Mortilitas pasien COVID-19 cukup tinggi, terutama pada pasien dengan sakit kritis yang mengalami disfungsi organ, syok, gagal ginjal akut, kelainan jantung, bahkan kematian. Sebuah penilaian atau prediktor pada pasien kritis, seperti dibutuhkan untuk menilai prognosis pasien dan pemilihan, evaluasi pengobatan serta keputusan alokasi sumber daya rumah sakit
Co-Authors Aditya Wardhana Agustina Haloho Alatas, Anas Aldy Heriwardito Amir S Madjid Amir S Madjid Anas Alatas Arifin Arifin Asri C. Adisasmita Dita Aditianingsih Dwiputra, Anggara Gilang Eko Setijanto Fadiah Zahrina Hafidz, Noor Haloho, Agustina Br Harijanto, Eddy Heni Pujiastuti Herlina Rahmah Hunter Design Nainggolan Inge Permadhi Jefferson Hidayat Jefrey Tuhulele, Norman Rabker Madeline Marpaung Manggala, Sidharta Kusuma Mohamad Rachadian Ramadan Mufaza, Uyun Muhammad Husni Thamrin Peni Yulia Nastiti Perdana, Aries Prita Rosdiana Purwoko Purwoko Putri, Regina Prima Ramlan, Andi Ade Wijaya Rudyanto Sedono Rudyanto Sedono, Rudyanto Septian Adi Permana Setiadi, Bakti Shendy Meike Sari Sidharta Kusuma Manggala Tantri, Aida Thariqah Salamah Zulkifli