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Sri Rahardjo
Program Doktor Manajemen dan Bisnis (MB-IPB)- Sekolah Pascasarjana IPB Pasca Sarjana Universitas Sahid Jakarta
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Journal : Jurnal Komplikasi Anestesi

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Penatalaksanaan Guillain-Barre Syndrome di ICU Hidayat, Adi; Sudadi; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 4 No 2 (2017): Volume 4 Number 2 (2017)
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.v4i2.7293

Abstract

Telah dilakukan perawatan terhadap pasien perempuan usia 43 tahun dengan Guillain-Barre Syndrome (GBS). Selama di ICU pasien mengalami distress respirasi sehingga dilakukan intubasi pada hari kedua. Pasien juga mengalami komplikasi pneumonia. Perawatan yang dilakukan berupa monitoring pernafasan, monitoring hemodinamik dan plasmapharesis. Terapi plasmapharesis dilakukan dua kali di ICU. Setelah hari ke enam, pasien dilakukan ekstubasi Selama perawatan di ICU kondisi pasien cenderung membaik dan kembali ke bangsal setelah perawatan hari ke sepuluh.
Perbandingan Perubahan Nilai Rate Pressure Product pada Laringointubasi Endotrakea antara Premedikasi Pregabalin 225 mg dengan Clonidin 0,15 mg Per Oral Mulyono; Suryono, Bambang; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 4 No 3 (2017): Volume 4 Number 3 (2017)
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.v4i3.7300

Abstract

Latar belakang: respon hemodinamik terhadap laringointubasi merupakan stimuli noksius kuat yang dapat ditumpulkan dengan premedikasi yang tepat. Beberapa obat telah digunakan sebagai premedikasi. Penggunaan premedikasi pregabalin dan clonidin telah dilaporkan dapat menumpulkan respon hemodinamik saat laringointubasi endotrakea.Tujuan penelitian: untuk membandingkan perubahan nilai rate pressure product pada tindakan laringointubasi endotrakea antara premedikasi pregabalin 225 mg dengan clonidin 0,15 mg per oral.Metode penelitian: menggunakan percobaan acak terkontrol dengan pembutaan ganda (double blind randomized controlled trial), dengan jumlah subyek penelitian sebanyak 78 pasien, status fisik ASA I danII yang direncanakan dengan pembedahan elektif dengan anestesi umum di RS. Dr. Sardjito Yogyakarta. Subyek dibagi menjadi dua kelompok masing–masing 39 pasien. Kelompok P (kelompok yang mendapatkan pregabalin 225 mg) dan kelompok C (kelompok yang mendapatkan clonidin 0,15 mg per oral). Semua pasien diberi preoksigenasi dengan oksigen 100% selama 3 menit, fentanil 1 μg/kg iv, kemudian diinduksi dengan propofol 1,5 mg/kgbb iv dan diberi rocuronium 0,6 mg/kgbb iv. Pengukuran dilakukan terhadap tekanan darah, laju denyut jantung, dan rate pressure product sebelum premedikasi, setelah premedikasi, induksi, dan larigointubasi pada menit ke-1, 3, 5 dan 10. Nilai rate pressure product (RPP) diukur dengan mengalikan tekanan darah sistolik dan laju jantung. Data numerik dianalisis menggunakan paired sample t-test (data berpasangan), dan uji independent t-test (data tidak berpasangan). Sedangkan variabel nominal, digunakan uji chi square. Nilai p < 0,05 secara statistik dinyatakan bermakna dengan tingkat kepercayaan95%.Hasil penelitian: terdapat berbedaan signifikan secara statistik perubahan nilai rate pressure product (RPP) saat menit 90 setelah premedikasi, setelah induksi, dan menit ke-1, 3, 5, 10 setelah intubasi (p<0,05) antara kedua kelompok, dimana pregabalin menunjukkan perubahan nilai RPP yang lebih rendah dibanding clonidin. Secara klinis tidak ada perbedaan perubahan nilai rate pressure product (RPP) saat menit 90 setelah premedikasi, setelah induksi, menit ke-1, 3, dan 10 setelah intubasi, kecuali menit ke-5 setelah intubasi dimana kelompok pregabalin menunjukkan penurunan 13,3% dibanding 17,0% pada clonidin.Kesimpulan: pada penelitian ini perubahan nilai rate pressure product pada tindakan laringointubasi endotrakea dengan premedikasi pregabalin 225 mg per oral lebih rendah dibanding dengan premedikasi clonidin 0,15 mg per oral.
Manajemen Preoperatif Kehamilan Ektopik Terganggu dengan Syok Hipovolemia Budianti, Nugrahaeni; Rahardjo, Sri; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 5 No 1 (2017): Volume 5 Number 1 (2018)
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.v5i1.7320

Abstract

Had been reported a case of preoperative management for a woman 36 years old, G1P0A0, pregnant 11 weeks with ruptured ectopic pregnancy and run into hypovolemia shock. We assessed physic status patient as ASA (American Society of Anesthesia) 4E (emergency) with hypovolemia shock et causa internal bleeding and patient had been done relaparotomy. Patient had been refered from RSUD Wonosari and when she came to RSUP Sardjito, she feel pain and pale suspicious hypovolemia shock with internal bleeding then had been done laparatomy emergency surgery, dextra salphingectomy et causa ruptured ectopic pregnancy in IGD operation room for 2 hours and then she was observated in resusitation room for 6 hours and then she was transported to PACU. When in PACU, her condition compos mentis, she feel pain and the hemodynamic is blood pressure 90/ 60 mmHg, pulse 165 times/ minutes, respiration rate 32 times/ minutes on NRM 8 liters/ minutes, spO2 99 – 100 %, temperature 36,8 °C and VAS 3 – 4. In abdominal assessment, we found decreased of peristaltic, distended (+), tenderness (+), wound dressing blood seeped (-) and capilarry refill over 2 second and also radialis artery was not detected. We did evaluation to know internal bleeding, we did positive challange test with kristaloid 20 cc/ kg BB in 15 minutes and then in USG, we found free liquid intraabdomen and we planned emergency laparatomy in IGD operation room. Anesthetic technique that we used was general anesthesia. After surgery, patient was transported to ICU in sedation condition and was intubated.
Manajemen Anestesi pada Epilepsi Prayunanto A.N, Eko; Apsari, Ratih Kumala Fajar; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 2 (2018): Volume 5 Number 2 (2018)
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.v5i2.7326

Abstract

Epilepsy is a manifestation of brain disorders with a variety of clinical symptoms, caused by the release of electrical charges from brain neurons excessively and periodically, reversibel with various etiology. Seizures can be localized to specific areas of the brain or thoroughly. Focal seizures may expand into generalized seizures. Physiology epilepsy is a disorder defined cerebral balance between excitation and inhibition is the tip of the uncontrolled excitation. Seizures are also caused by potassium conduction abnormalities, ion channel damage, and ATP deficiency associated with ion transport, may cause instability of neuron membranes. The best anesthetic treatment for epilepsy is with general anesthesia. General anesthesia has therapeutic benefits for seizure patients if the patient has been treated with anti-seizure medication then should be continued until surgery.
Neurophysiology Intraoperative Monitoring (Niom) pada Operasi Deformitiy Correction at Adolesent Scoliosis Herlambang, Panji; Sudadi; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 2 (2018): Volume 5 Number 2 (2018)
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.v5i2.7330

Abstract

The use of neurophysiological intraoperative monitoring (NIOM) during spinal orthopaedic and neurosurgical procedures provides a challenge to the attending anaesthesiologist. Since all anaesthetic agents affect synaptic function, the choice of agent will be determined by the type of surgery and the NIOM modality employed. Had been performed surgery for scoliosis correction of spinal abnormalities in children aged 15 years with using of sensory and motoric NIOM. The surgery going under general anesthesia with the installation monitor invasive arterial line and central venous pressure during surgery for hemodynamic monitoring. Drugs used during anesthesia using balanced anesthesia technique with a combination of opioids, propofol and sevoflurane as inhalation. Muscle relaxants given intermittently for operator leisure and ventilation controls. Postoperative hospitalization in ICU with the aim of assessing the function of the respiratory and neurological of the patients and pain management.
Efektivitas Informasi Multimedia Video (Video Dan Lisan) untuk Menurunkan Tingkat Kecemasan Praanestesi Umum pada Pasien yang akan Dilakukan Tindakan Operasi Elektif dengan Anestesi Umum Teknik Intubasi Budianti, Nugrahaeni; Pratomo, Bhirowo Yudo; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7337

Abstract

Background. Preoperative anxiety is a problem faced by two-thirds patients who would undergo surgery.Anxiety can not be handled properly, will cause adverse pathophysiologic responses. General anesthesiaintubation techniques as one of the anesthetic techniques often lead to an increase in preoperative anxiety. To reduce the level of preoperative anxiety, we can give preoperative information. The health information provided can be well understood by patients and can be used to reduce anxiety situation experienced by the patients. Methods. This studied was Randomized Controlled Trial (RCT). Subjects were patients undergone elective surgery general anesthesia using intubation techniques. The subjects were 110 patients that divided into two groups: the video group and the verbal group. The verbal group received preoperative information verbally, while the video group received preoperative information through a video of general anesthesia intubation technique procedures. The measurement of anxiety level was measured four times, once before the treatment (the level of anxiety/ LA-1) and three times after the treatment, namely when in the ward (LA-2), when in the surgical installation acceptance (LA-3) and when in the operating room prior to general anesthesia intubation techniques (LA-4). The assessment of anxiety used Spielberger State-Trait Anxiety Inventory (STAI) questionnaire of Y-1 form.Results. The percentage of anxiety reduction in video group was bigger than in Verbal group at all measurement times in TK-2 group of 40% video and verbal group 12,7%, in TK-3 video group 41,8% and verbal group 12,7% and at TK-4 video group 41.8% and verbal group 10.9%. Statistically different in the anxiety level between video group and verbal group were obtained in LA-2, LA-3 and LA-4 (p = 0.001, p = 0.001 and p = 0.000).Conclusion. Multimedia video information (video and verbal) is more effective in reducing preanesthesia anxiety levels in patients undergoing elective surgery with general anesthesia of intubation techniques when compared with verbal information.
Manajemen Anestesi Cedera Vertebra Cervical 4,5 dengan Tindakan Laminektomi Dekompresi Stabilisasi Zaki, Wildan Arsyad; Sudadi; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7341

Abstract

Preoperative management of cervical fractures of particular concern include the level of injury, onset of occurrence and cardiorespiratory complications. Then continued the definitive management of laminectomy requiring inline position intubation positions, invasive arterial line monitors and CVC, durante vasoactive drug support in case of hemodynamic decline. Equally important is postoperative intensive care, and treatment of complications of pneumonia, DVT, sepsis due to long immobilization. Treatment of a 54-year-old male patient with a diagnosis of VC IV-V compression fracture, tetraplegi and increased transaminase enzyme. Patients were initially treated in HCU LOC 2 for 10 days with drug support and hemodynamic monitoring, then definitive elective laminectomy, decompression, stabilization. The operation lasted for approximately five hours with bleeding approximately 1200cc, urine output 2.5 cc / kgBW / hour. Post surgery patients treated in ICU with attached tracheostomy, connected with ventilator and vasoactive drug support. During treatment in ICU, hemodynamic monitoring with arterial line, ECG, pulse oximetry, temperature monitor and CVC were performed. Patients are positioned in line mobilization, ureter catheter installed and NGT. Hemodynamic, blood pressure during ICU ranged from syst 100-110 mmHg, diastole blood pressure 50-80 mmHg, pulse 90-110 x / minute and saturation 93-100%. With supportive therapy of ceftriaxone injection, methylprednisolone, fentanyl, mecobalamin, omeprazole, and dobutamine and norepinephrine continue. The patient was treated for 5 days and after stabilizing the patient was returned to the ward.
Tromboemboli pada Kehamilan Agnesha, Fahmi; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7343

Abstract

Thromboembolism is a rare event happen in pregnancy, that if not manage well would be a catastrophic and can cause fatal outcome. Venous thromboembolic event in pregnancy form are deep vein thrombosis and pulmonal thromboembolism. The pathophysiology of thromboembolism explained by Virchow triad that describe the factor contribute are vein stasis, vascular damages and hypercoagulable state. The diagnosis of the new onset thromboembolism can be made by ultrasound examination on proximal vein. Management of thromboembolism in pregnancy is including low molecular weight heparin and unfractioned heparin administration. These treatments can cause neuraxial anesthesia impact on pregnant patient as spinal and epidural hematoma. Thus many guidelines give recommendation for stopping heparin administration before procedure.
Manajemen Anestesi pada Kehamilan Sistemik Lupus Eritematosus Nuryawan, Iwan; Suryono, Bambang; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7345

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune, multisystem disease, which involves complex pathogenetic mechanisms that can occur at all ages, characterized by the presence of direct autoantibodies against the core antigen. Management of lupus in women ideally begins before pregnancy occurs. Adequate analgesia can overcome the response of the organ system due to pain. Regional anesthesia techniques are very popular pharmacological techniques and become the gold standard because they provide optimal analgesia during labor with minimal side effects on the mother and fetus when compared with systemic or inhalation analgesia.
Hubungan antara Kadar Prokalsitonin Serum dan Skor SOFA sebagai Parameter Tingkat Keparahan Disfungsi Organ Pasien Sepsis yang Dirawat di ICU RSUP Dr. Sardjito Setiandari, Kristina; Wisudarti, Calcarina Fitriani Retno; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 6 No 2 (2019): Volume 6 Number 2 (2019)
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.v6i2.7347

Abstract

Background: Sepsis causes an increase in procalcitonin level by increased secretion of proinflammatory ytokines, increased expression of CD 14 and CD 16, decrease of neutrophil phagocytic activity, suppression of blast transformation from T cells and neutrophil malfunctions. Procalcitonin secretion increase with increasing the severity of sepsis. The severity of sepsis is determined by the severity of organ dysfunction. The more severe the sepsis the more severe the organ dysfunction occurs and the higher the procalcitonin secretion.Objective: The purpose of this study was to determine if there is a relationship between procalcitonin levels and SOFA score as a severity parameter of organ dysfunction in septic patients treated in ICU Dr Sardjito Hospital.Methods: The study design was prospective observational cohort study. A total of 29 septic patients, age above 18 years old treated in ICU Dr Sardjito Hospital Yogyakarta were included in this study. Procalcitonin serum was measured and the SOFA score were calculated at the day of admission or at the day the diagnosis of sepsis was made (Day-0), within 24 hours (Day-1), at Day-3 and at day-5. Spearman correlation was used to analize the correlation between procalcitonin levels and SOFA score.Result: The overall mean of SOFA score was 10.3+3.9 while overall mean of procalcitonin level was 59.2+58.7 ng/ml. Significant positive correlation was found between overall procalcitonin level and SOFA score (r=0.663; p<0.05). The significant positive correlation was also found at Day-0 (r= 0.601; p<0.05), Day-1 (r=0.675; p<0.05), Day-3 (r=0.754; p<0.05) and Day-5 (r=0.718; p<0.05).Conclusion: There is a significant strong positive correlation between procalcitonin levels and SOFA score as a severity parameter of organ dysfunction in septic patients treated in ICU Dr Sardjito Hospital.
Co-Authors A Himendra Wargahadibrata Adi Hidayat Adi, Erman Noor Adriman, Silmi Adriman, Silmi Afra, Syeda Maria Ahmad Agnesha, Fahmi Ambarini, Ronia Anindita, Triatma Arief, Budi Arshad, Muhammad Aulyan Syah, Bau Indah Aulyan Syah, Bau Indah Ayu, Rifana Bambang Suryono, Bambang Bestari, Viqy Esha Bhirowo Yudo Pratomo Bijaksana, Gena Bimarso, Wahyono Budianti, Nugrahaeni Calcarina Fitriani Retno Wisudarti Chamsudi, Danie Hayam Mada Christanto, Sandhi Christanto, Sandhi Dewi Yulianti Bisri Dian Artanti Arubusman, Dian Artanti Diana C. Lalenoh, Diana C. Diana Lalenoh Dinar Dewi Kania Edhie Budi Setiawan, Edhie Budi Fachrial, Peppy Fadhil, Dimas Nu’man Faturachman, Muhammad Rafli Firdaus, Riyadh Firdaus, Riyadh Fithrah, Bona Akhmad Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Francis Tantri, Francis Fuadi, I Fuadi, I Gunawan, Fanny Hamzah, Hanzah Handayani, Sri Hartono, Pinter Herlambang, Panji Hisam, Muhammad Yusuf Ida Bagus Krisna Jaya Sutawan Ikhwandi, Arif Indrawan, Rully Isngadi Iwan Abdul Rachman Iwan Fuadi Jasa, Zafrullah Kany Jasa, Zafrullah Kany Kadarisman, Muh Laksono, Buyung Hartiyo Lalenh, Diana C. Larasati, Kinanthi Liza, Helda Luky Adrianto Mahmud Mahmud Malisan, Johny Mangastuti, Rebecca Sidhapramudita Manurung, Laurensius Muhammad Thamrin Mulyono Narohito, Yosapat Parningotan Nasution, Syahrial Nur, Muhammad Ikhwan Nuryawan, Iwan Oetoro, Bambang J. Oetoro, Bambang J. P, Inggita Dyah Parhusip, Veronica Permatasari, Endah Permatasari, Endah Prasadja Ricardianto, Prasadja Prasetya, Sandie Prayunanto A.N, Eko Purwa Saputra, Datep Purwanto, Erfien Puspita, Amelia Tri Putra, Bina Putri, Dini Handayani Putu Pramana Suarjaya Radian Ahmad Halimi Rahayu, Solihah Sari Ratih Kumala Fajar Apsari Restu S, Meta Rini, Isworo Ruddy Suwandi Rudita, Muhammad Rumpoko, Triaji Mudo Saleh, Siti Chasnak Saleh, Siti Chasnak Santoso, Arief Hariyadi Sectio, Devin Igel Septika, Rafidya Indah Setiandari, Kristina Setyarto, Aries Siti Helmyati Siti Maemunah Sitorus, Purbanuara Parlindungan Soeboer, Deni Achmad Subekti, Bambang Eko Subekti, Bambang Eko Sudadi Sudadi Sudadi Suhalis, Adenan Suharso, Pamungkas Hary Sujarwanto Sujarwanto, Sujarwanto Sulam, Munyati Sunartejo, Bayu Suyasa, Agus Baratha Suyasa, Agus Baratha Syafruddin Gaus Tatang Bisri Taufik Perdana Budiman, Bambang Tjahya Aryasa Widiastuti, Monika - Winarso, Achmad Wahib Wahju Winarso, Achmad Wahib Wahju Wrgahadibrata, A Himendra Yana Tatiana, Yana Yosiyanto, Robi Yunita Widyastuti Yusmein Uyun Zaki, Wildan Arsyad