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All Journal Jurnal Anestesiologi Indonesia Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Majalah Anestesia dan Critical Care Jurnal Plastik Rekonstruksi Indonesian Journal of Anesthesiology and Reanimation (IJAR) Bioscientia Medicina : Journal of Biomedicine and Translational Research Scientific Journal Majalah Anestesia & Critical Care (MACC) Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Jurnal Komplikasi Anestesi
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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Skor Kelelahan pada Peserta Didik Anestesiologi dan Terapi Intensif dan Faktor-Faktor yang Mempengaruhi Heriwardito, Aldy; Sugiarto, Adhrie; Setiadi, Bakti; Dwiputra, Anggara Gilang; Hafidz, Noor; Ramlan, Andi Ade Wijaya
Majalah Anestesia & Critical Care Vol 40 No 1 (2022): 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 (618.993 KB) | DOI: 10.55497/majanestcricar.v40i1.252

Abstract

Latar Belakang: Prevalensi kelelahan secara global bervariasi antara 2,36-75,7%. Kelelahan merupakan konsekuensi yang dapat dialami oleh peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitasi Indonesia (FKUI) selama menjalami proses pendidikan. Penelitian ini dilakukan untuk mengetahui tingkat kelelahan pada PPDS Anestesiologi dan Terapi Intensif FKUI/RSCM setelah bertugas selama 24 jam di RSCM dengan menggunakan penilaian FAS, serta faktor-faktor yang memengaruhinya. Metode: Metode penelitian adalah studi potong lintang dan acak. Analisis dilakukan terhadap 36 subjek peserta PPDS Anestesiologi dan Terapi Intensif FKUI tahap paripurna, mandiri dan magang selama periode penelitian. Subjek diberikan kuesioner berisi pertanyaan mengenai faktor yang dapat memengaruhi tingkat kelelahan. Kelelahan secara subjektif diukur dengan Fatigue Assessment Scale (FAS) setelah peserta PPDS bekerja di Rumah Sakit dr.Cipto Mangunkussumo (RSCM) selama ≥ 24 jam. Hasil: Sebanyak 55,6% peserta PPDS Anestesiologi dan Terapi Intensif mengalami kelelahan seetelah bekerja di RSCM selama > 24 jam, dengan rerata skor kelelahan berdasarkan FAS adalah 23,6±4,2 yang berada diatas titik potong skor kelelahan dari FAS yaitu > 22. Kelelahan fisik memiliki rerata nilai yang lebih besar (15,19±2,7) dibandingkan dengan kelelahan mental (10,61±2,2) dengan perbedaaan yang bermakna (p<0.01). Kelelahan pada peserta PPDS Anestesiologi dan Terapi Intensif FKUI tidak dipengaruhi oleh karakteristik, gaya hidup dan karakteristik pekerjaan. Kesimpulan: PPDS Anestesiologi dan Terapi Intensif mengalami kelelahan fisik pasca bekerja selama >24 jam di RSCM. Kelelahan tersebut tidak dipengaruhi oleh faktor gaya hidup dan pola kerja.
CLINICAL IMPACTS OF BURNOUT SYNDROME AMONG ANESTHESIOLOGY RESIDENTS: AN OBSERVATIONAL STUDY Tantri, Aida; Sugiarto, Adhrie; Mufaza, Uyun
Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Vol 12, No 4 (2023): Desember
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jpki.80904

Abstract

Background: Anesthesiology residents have enormous responsibilities and pressure in the workplace that could lead to burnout syndrome. Burnout can be categorized into emotional exhaustion, depersonalization, and reduced personal accomplishment dimension. Burnout can affect clinical performance and patients' safety. This study examined the relationship between burnout level and clinical performance in anesthesiology residents.Methods: This was a prospective analytic observational study with a cross-sectional design. The sample size was estimated using the analytical hypothesis test formula with an unpaired numerical measurement scale and an estimated dropout of 10%. Burnout level was determined using Maslach Burnout Inventory and negative clinical performance was measured with the Anesthesiology Residents' Self-Reported Errors and Quality of Care Questionnaire. Data were analyzed using chi-square and unpaired T-Test.Results: Nineteen subjects (34.5%) suffered from moderate-high burnout levels in the emotional exhaustion dimension. In the depersonalization dimension, 51 subjects (92,7%) suffered from a moderate-high burnout level, and in the reduced personal accomplishment dimension, 28 subjects (50,9%) suffered from a moderate-high burnout level. Mean negative clinical performance scores in subjects with moderate and high burnout level were significantly different from subjects with none and low burnout subjects (26.86 ± 3.63 vs 28.79 ± 2.58, p = 0.045).Conclusion: Burnout was highly prevalent among anesthesiology residents. In anesthesiology residents, moderate and high burnout levels were significantly correlated with negative clinical performance scores.
Hubungan Rasio Netrofil Limfosit dengan Ketebalan Dinding Diafragma pada Pasien Kritis Haloho, Agustina Br; Sedono, Rudyanto; Sugiarto, Adhrie; Zulkifli
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v7i2.7449

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. This study was aimed to find the relationship between neutrophil to lymphocyte ratio (NLR) with diaphragm thickness of critical patients in ICU. Methods: This 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.
Analgesia For Dressing Changes In Burns: A Systematic Review Ramadan, Mohamad Rachadian; Wardhana, Aditya; Sugiarto, Adhrie
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (352.367 KB) | DOI: 10.14228/jpr.v5i1.249

Abstract

Background: Intense and prolonged pain often caused by burn injuries. The greatest pain is mostly experienced during dressing changes to maintain healing and banish the infection. This review is conducted to assess the effectiveness and safety of different analgesia agents or methods for dressing changes in burn patients. Method: Searches of studies conducted from 4 electronic databases, using keywords “Analgesia”, “Dressing”, “Bandages”, “Changes” and “Burns”. We included randomized and quasi-randomized trials assessing and comparing the effects of different analgesia agents, analgesia methods for dressing changes in burns patients. We excluded trials reporting only pharmacokinetic and physiological outcomes, comparing drug dosages, with exception for those using different drugs in the same class. Result: Multiple databases search retrieved 144 studies. 17 trials are eligible involving 700 patients. Analgesia using pharmacological agents in 7 trials; 5 trials elaborating primary treatments and 2 trials as the adjunct treatment complementing the major analgesia. Two primary analgesia treatments were studying the role of patient-controlled analgesia (PCA), while 3 trials using caregiver delivered. Ten trials were observing the role of non-pharmacological analgesia. Conclusion: There was inadequate evidence from comparisons tested in randomized trials to confirm the dependent effectiveness of various techniques of analgesia, individual methods, or to assess the administration of different drug adjuncts for providing analgesia during dressing changes. Given the unresolved questions about the management of these conditions, we suggest that preference should be focused on the large scale, optionally, multi-center randomized observations of the primary methods.
Developing “do it yourself” Phantom for Teaching Seldinger Technique in Vascular Access Placement to General Practitioners Hafidz, Noor; Sedono, Rudyanto; Aditianingsih, Dita; Sugiarto, Adhrie; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 7 No. - (2023): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v7i-.201

Abstract

Establishing a vascular access is a crucial aspect in managing critically ill patients in the Intensive Care Unit (ICU). The skill in placing vascular access varies among healthcare professionals. Clinical experience and level of training among nurses, general practitioners, and intensivists are the determinants of skill in placing vascular access. Training to establish vascular access using the Seldinger technique needs practice using a vascular phantom or a cadaver. Commercially sold phantoms are difficult to get, and an alternative training phantom is needed. We built a simple “do-it-yourself” model of a vascular phantom using “easy-to-find” material that can be used to practice the Seldinger technique. We used a synthetic polyurethane sponge 16x16 cm in size as a base and a polyvinyl alcohol sheet of the same size. We used 22 F urinary catheters trimmed to 12 to represent blood vessels. The final product is a piece of the urinary catheter embedded in the sponge and then covered by polyvinyl alcohol to simulate the epidermis. The phantom can be used in training programs to improve the skill of general practitioners in placing advanced vascular access. 13 general practitioners were involved in this training, and 100% said that this phantom could simulate the experience. “Do-it-yourself” phantom for vascular access training can be used ro practice the Seldinger technique and can simulate the real experience.
Association Between Shock Index and Post-Emergency Intubation Hypotension in Patients Who Called the Rapid Response Team at Dr. Cipto Mangunkusumo Hospital Rahmah, Herlina; Adisasmita, Asri; Manggala, Sidharta Kusuma; Sugiarto, Adhrie; Zahrina, Fadiah; Rosdiana, Prita
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I12023.27-36

Abstract

Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p <0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.
The Dual Effect of Tolvaptan on Diuresis and Azotemia in a Case of Acute Kidney Injury with Furosemide Resistance After Coronary Artery Bypass Grafting: A Case Report Supriyadi, Eddo; Karseno Dibyosubroto, Iradewi; Sugiarto, Adhrie
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 9 No. - (2025): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v9i-.313

Abstract

Background: Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) affects up to 30% of patients, increasing morbidity and mortality. Increasing Furosemide dose, by blocking sodium, potassium, and chloride reabsorption, paradoxically increases urea reabsorption to maintain medullary osmolarity. This increased urea retention reduces Furosemide’s effectiveness and can elevate urea levels. Tolvaptan, a V2 receptor antagonist, indirectly inhibits Urea Transporter A1 (UT-A1), potentially opposing this effect. Case Presentation: A 67-year-old man post-CABG developed inadequate diuresis despite high-dose Furosemide (20 mg/hour). Post-extubation, he experienced worsening dyspnea, positive fluid balance, elevated Central Venous Pressure (CVP), and a sharp rise in creatinine (0.97 to 4.74 mg/dL). Dialysis was planned on Day 3 but deferred for observation after initiating Tolvaptan. Following Tolvaptan administration, diuresis improved, CVP decreased, and Creatinine fell to 2.11 mg/dL. The patient recovered without further events. Discussion: This case describes the potential use of Tolvaptan as an adjunct to Furosemide to improve diuresis and decrease urea reabsorption. Furosemide improves diuresis by blocking electrolyte reabsorption, but this effect is often counteracted by a compensatory increase in urea reabsorption to maintain peritubular tissue osmolarity, which lowers the overall potency of the diuretic. This water retention, coupled with increased sodium chloride in the tubule, triggers the macula densa and juxtaglomerular feedback, thus lowering GFR. Conclusion: Tolvaptan's potential to augment diuresis and improve urea removal is beneficial to reduce the need for dialysis. Further study is needed to confirm this theoretical application in other clinical settings.
Tracheal Stenosis in Neuro Myelitis Optica Spectrum Disorders: Airway Management in the ICU Nugraha, Taufiqo; Sugiarto, Adhrie
Jurnal Komplikasi Anestesi Vol 13 No 2 (2026)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i2.16469

Abstract

Background: A woman, 32 years old, with Neuro Myelitis Optica Spectrum Disorder (NMOSD) came to the emergency department complaining dyspnea, productive cough, wheezing and low oxygen levels. She was intubated using an uncuff endotracheal tube (ETT) size. 5. Subsequently, an inadvertent dislodgement of the ETT in the intensive care unit (ICU). A Thoracic CT imaging showed tracheal narrowing at the thoracic 1-2 level, approximetely 58% of the lumen width. A Multidisciplinary case conference was convened to plan balloon dilatation bronchoscopy with a bedside tracheostomy as a backup crash airway protocolCase: NMOSD attacks can be life-threatening, leading to respiratory failure requiring orotracheal intubation (OTI). Patient with a history of prolonged and repeated intubation in the ICU may develop post-intubation tracheal stenosis (PITS). Discussion: The patient experienced ETT dislodgement, prompting reintubation with ETT cuffs number 4 and 6 using a video laryngoscope and an adult bougie. Reintubation with a larger ETT size was is necessitated by reduced mucosal edema following adequate steroid, inhalation, and antibiotic therapy. Balloon dilatation bronchoscopy of mucosal stenosis via LMA was successfully performed, followed by intubation using ETT cuff no. 8 with guided bronchoscopy. The patient was successfully weaned from mechanical ventilation with a leak test before extubation.Conclusion: Airway management by considering the location and degree of stenosis as well as the patient's general condition. Balloon dilatation with bronchoscopy offers good results in patients with tracheal stenosis who are not eligible for surgery.
One-Hour Sepsis Bundle Compliance on Serial SOFA Scores and 28-Day Mortality: A Prospective Investigation in Bekasi Regency Referral ICUs Marina S.A, Mega Ayu M; Sugiarto, Adhrie; Soenarto, Ratna Farida; Irfan, Ahmad
Scientific Journal Vol. 5 No. 3 (2026): SCIENA Volume V No 3, May 2026
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/sciena.v5i3.348

Abstract

Background: Sepsis mortality remains high in intensive care units (ICUs). This study aims to evaluate compliance with the implementation of the One hour sepsis bundle and changes in SOFA scores to predict 28-day mortality rates, knowing the 28-day mortality rate and to identify strong mortality factors mortality in sepsis patients in the ICU two of Type B Hospital, Bekasi Regency. Methods: A prospective observational cohort study was conducted in the ICUs of two Type B hospitals in Bekasi Regency in 2025. Sixty adult sepsis patients with with characteristics, SOFA score, One hour sepsis bundle compliance, Temperature, Respiratory rate (RR), Capillary refill time (CRT), Lactate level examination on admission, 24th hour and 5th day. Data were analysed using bivariate analysis.Results: The 28-day mortality rate was 81.7%. Bundle compliance showed no significant correlation with SOFA score changes or 28-day mortality rates. Bivariate analysis proved that 24-hour and 5-day SOFA, 24-hour and 5-day ΔSOFA, GCS components and renal function in 5-day SOFA scoring were significantly correlated with 28-day mortality rates. Conclusion: Compliance with the One hour sepsis bundle did not significantly affect the 28-day mortality rate. 24-hour and 5-day CRT examinations, 24-hour and 5-day SOFA scoring, 24-hour and 5-day SOFA ∆, day-5 temperature examination, day-5 lactate and Δ lactate levels, SOFA GCS scoring components and renal function can affect the 28-day mortality rate of sepsis patients in the ICU of Type B Hospital, Bekasi Regency.
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 Hafidz, Noor Haloho, Agustina Br Harijanto, Eddy Heni Pujiastuti Hunter Design Nainggolan Inge Permadhi Irfan, Ahmad Jefferson Hidayat Jefrey Tuhulele, Norman Rabker Karseno Dibyosubroto, Iradewi Madeline Marpaung Manggala, Sidharta Kusuma Marina S.A, Mega Ayu M Mohamad Rachadian Ramadan Mufaza, Uyun Muhammad Husni Thamrin Nugraha, Taufiqo Peni Yulia Nastiti Perdana, Aries Purwoko Purwoko Putri, Regina Prima Rahmah, Herlina Ramlan, Andi Ade Wijaya Ratna Farida Soenarto Rosdiana, Prita Rudyanto Sedono Rudyanto Sedono, Rudyanto Septian Adi Permana Setiadi, Bakti Shendy Meike Sari Supriyadi, Eddo Tantri, Aida Thariqah Salamah Zahrina, Fadiah Zulkifli