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Perbandingan Efek Pemberian Analgesia Pre-emtif Parecoxib dengan Parasetamol terhadap Nyeri Pascaoperasi Radikal Mastektomi Menggunakan Numeric Rating Scale Kartapraja, Roni D.; Fuadi, Iwan; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 4, No 2 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Mastektomi merupakan prosedur operasi pengangkatan kanker payudara yang dapat menimbulkan nyeri akut pascaoperasi, bahkan pada 20â30% pasien berlanjut menjadi sindrom nyeri kronik pascamastektomi sehingga diperlukan penatalaksanaan nyeri secara adekuat agar pasien tidak mengalami episode nyeri yang dapat mengganggu produktivitas. Tujuan penelitian ini membandingkan efek pemberian analgesia pre-emtif parecoxib dengan parasetamol dalam menurunkan nyeri pascaoperasi radikal mastektomi. Penelitian dilakukan secara prospektif single blind randomized controlled trial terhadap 30 pasien dewasa yang menjalani operasi radikal mastektomi di Rumah Sakit Dr. Hasan Sadikin Bandung periode SeptemberâNovember 2014. Subjek dibagi dalam dua kelompok, analgesia pre-emtif parasetamol 1 g dan parecoxib 40 mg diberikan 30 menit sebelum sayatan pertama dilakukan. Setelah operasi selesai dicatat skala nyeri berdasarkan numeric rating scale (NRS) hingga 12 jam pascaoperasi di ruang perawatan. Analisis data menggunakan uji-t dan diolah dengan program statistical package for social science (SPSS) versi 21.0 for windows. Kelompok analgesia pre-emtif parecoxib 40 mg lebih lama membutuhkan analgetik pertolongan dan menurunkan NRS lebih rendah dibanding dengan kelompok analgesia preemtif parasetamol 1 g (p<0,05). Simpulan, parecoxib 40 mg lebih baik dibanding dengan analgesia pre-emtif parasetamol 1 g dalam menurunkan nyeri pascaoperasi radikal mastektomi berdasarkan NRS.Kata kunci: Analgesia pre-emtif, numeric rating scale, nyeri pascaoperasi, parasetamol, parecoxib, radikal mastektomiComparative Effect of Preemptive Analgesia Parecoxib with Paracetamol against Postoperative Radical Mastectomy Pain Using Numeric Rating ScaleMastectomy is a breast cancer surgery procedure that can lead to acute postoperative pain with 20â30% of patients may progress to postmastectomy chronic pain syndrome (PMPS). Therefore, it is necessary provide an adequate pain management so patients will not experience episodes of pain that can disrupt their productivity. The purpose of this study was to compare the effect of preemptive analgesia parecoxib with paracetamol in reducing radical mastectomy postoperative pain.The study was a prospective single blinded randomized controlled clinical trials on 30 adult patients who underwent radical mastectomy surgery in Dr. Hasan Sadikin General Hospital between September and November 2014. Subjects were divided randomly into two groups, 1 gram paracetamol preemptive analgesia and 40 miligram parecoxib which given 30 minutes before the first incision has been made. After the surgery was completed, we record the pain scale using the numeric rating scale (NRS). The data were recorded starting from the recovery room to 12 hours postoperative in the ward. Statistical analysis was performed using the t-test with statistical package for social science (SPSS) version 21.0 for Windows software. The results showed that the 40 miligram parecoxib preemptive analgesia group required longer rescue analgesics and lowerNRS than 1 gram paracetamol preemptive analgesia (p<0.05). In conclusion, 40 miligram parecoxib preemptive analgesia is better than 1 gram paracetamol preemptive analgesia in reducing radical mastectomy postoperative pain according to numeric rating scale.Key words: Numeric rating scale, paracetamol, parecoxib, postoperative pain, preemptive analgesia, radical mastectomyÂ DOI:Â 10.15851/jap.v4n2.825

Perbandingan Bupivakain Infiltrasi Subkutis dengan Kombinasi Bupivakain Intramuskular Rectus Abdominis dan Subkutis terhadap Mulai Pemberian dan Kebutuhan Analgetik Rescue Pascaoperasi Laparatomi Ginekologi Falah, Said Badrul; Oktaliansah, Ezra; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Penanganan nyeri pascaoperatif kurang baik akan membuat pasien trauma terhadap pembedahan dan menimbulkan komplikasi lain. Penelitian ini bertujuan membandingkan pemberian bupivakain secara kombinasi intramuskular (IMSK) dan subkutis dengan pemberian subkutis saja (SK) terhadap mulai pemberian dan kebutuhan analgetik rescue pascaoperasi laparatomi ginekologi. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung bulan SeptemberâDesember 2014 terhadap 46 wanita (18â60 tahun) status fisik American Society of Anesthesiology (ASA) IâII yang menjalani pembedahan laparatomi ginekologi secara uji acak terkontrol buta ganda dalam anestesi umum. Pasien dibagi menjadi dua, yaitu 23 orang menerima bupivakain kombinasi pada otot rectus abdominis dan subkutis dan 23 orang menerima bupivakain infiltrasi subkutis saja. Penilaian skala nyeri menggunakan nilai numeric rating scale dan dilakukan pencatatan pada jam ke-1, 2, 3, 4, 5, 6, 8, 12, dan 24 pascaoperasi. Pemberian analgetik rescue dilakukan bila nilai NRS â¥4. Data dianalisis dengan uji-t, chi-kuadrat, dan Mann-Whitney. Pada penelitian ini ditemukan waktu mulai pemberian analgetik rescue pada kelompok IMSK lebih lama (p<0,01) dan kebutuhan analgetik tambahan dalam 24 jam lebih sedikit (p<0,01) dibanding dengan kelompok SK. Simpulan, pemberian bupivakain secara kombinasi intramuskular dan subkutis lebih baik dibanding dengan pemberian subkutis saja terhadap waktu mulai pemberian dan kebutuhan analgetik rescue dalam 24 jam pascaoperasi laparatomi ginekologi.Kata kunci: Bupivakain, numeric rating scale, otot rectus abdominisComparison between Subcutis Bupivacaine Infiltration and Combined Intramuscular Rectus Abdominal and Subcutis Bupivacaine to on Total Need of Rescue Analgesics after Gynecologic LaparatomyAbstractInappropriate management of post-operative pain will cause trauma to the patient regarding the surgical experience and may possibly cause other complications. This study aimed to compare the administration of intramuscular and subcutis bupivacaine to subcutis only bupivacaine on the start and need for rescue analgesics. This study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of SeptemberâDecember 2014 on 46 females aged 18â60 years old with American Society of Anesthesiology (ASA) IâII who underwent gynecological laparatomy under general anesthesia. This was a randomized controlled study. Patients were dividedinto two groups of 23 patients with the first group received combination infiltration and the other received only subcutis administration. The pain scale used was the numerical rating scale measured -1, 2, 3, 4, 5, 6, 8, 12, and 24 hours after surgery. Rescue analgesics was given if NRS was more than 4. Data were analyzed using t-test, chi-square test, and Mann-Whitney test. Observations were performed on time span until there was a need for analgesics for the first time and additional analgesic needed in 24 hours. In this study, the time span until the first dose analgesics was needed was longer and the amount of required analgesics during 24 hours was lower in the combination group (p<0.01). In conclusion, the combination strategy has a better outcome regarding the time span to the start of rescue analgetic and 24 hours analgesic needs.Key words: Bupivacaine, numeric rating scale, abdominal recti muscleÂ

Gambaran Pola Kuman pada Bilah Laringoskop di Ruang Operasi Rumah Sakit Dr. Hasan Sadikin Bandung Martua, Edwin Haposan; Suwarman, -; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 4, No 3 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Kebiasaan cara membersihkan bilah laringoskop dapat menyebabkan komplikasi karena potensial kontak dengan mikro-organisme patogen dan dapat menyebabkan infeksi nosokomial. Tujuan penelitian adalah mengetahui gambaran kuman pada bilah laringoskop dengan metode pembersihan yang dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung. Penelitian dilakukan menggunakan metode deskriptif observasional dengan cara melakukan pemeriksaan kultur kuman pada 19 bilah laringoskop sebelum digunakan dan yang sudah dibersihkan sesudah tindakan laringoskopi, serta 14 sumber air untuk membersihkan bilah laringoskop di ruang operasi RSHS Bandung pada tanggal Desember 2014âJanuari 2015. Hasil penelitian ini ditemukan gambaran pola kuman komensal pada bilah laringoskop yang digunakan sebelum tindakan laringoskopi, yaitu Bacillus spp. 10 dari 19. Ditemukan gambaran pola kuman patogen pada bilah laringoskop yang sudah dibersihkan setelah tindakan laringoskopi di ruang operasi, yaitu Candida non albicans 1 dari 19, Acinobacter baumanii dan Staphylococcus haemolyticus 1 dari 19, serta Klebsiella pneumoniae dan Pseudomonas aeruginosa 1 dari 19. Simpulan, ditemukan kuman patogen pada bilah laringoskop yang sudah dibersihkan sesudah tindakan laringoskopi dan air yang digunakan untuk membersihkan bilah laringoskop di Rumah Sakit Dr. Hasan Sadikin Bandung.Kata kunci: Bilah laringoskop, infeksi nosokomial, laringoskopi, pola kumanBacterial Mapping of Laryngoscope Blade at the Operating Theater of Dr. Hasan Sadikin General Hospital BandungAbstractThe habit of cleaning laryngoscope blades can cause complications due to potential contact with patogenic microorganisms that may cause nosocomial infections. The aim this study was to determine the microbial patterns on the laryngoscope blades cleaned using the cleaning methods applied in Dr. Hasan Sadikin General Hospital (RSHS) Bandung. This study was conducted using the descriptive observational method by taking samples of bacterial culture from 19 laryngoscope blades before laryngoscopy procedures and 19 cleaned laryngoscope after laryngoscopy, as well as from the 14 water sources that were used for cleaning laryngoscope blades in the operating theaters of RSHS Bandung in December 2014âJanuary 2015. The results of this study revealed a commensal microbial pattern of Bacillus spp. on 10 of 19 laryngoscope blades before they were used in laryngoscopy precedures. It was revealed that among the laryngoscopes blade that had been cleaned after laryngoscopy in the operating room. 1 of 19 was found to have a non-Candida albicans pattern, 1 of 19 had Acinobacter baumannii and Staphylococcus haemolyticus pattern, and 1 of 19 had Klebsiella pneumoniae and Pseudomonas aeruginosa pattern. Hence, it can be concluded that pathogenic germs are found in laryngoscope bplades that have been cleaded after laryngoscopy and water that is used to clean them in Dr. Hasan Sadikin General Hospital Bandung.Key words: Bacterial mapping, direct laryngoscopy, laryngoscope blades, nosocomial infectionsÂ DOI:Â 10.15851/jap.v4n3.899

Korelasi antara Panjang Garis Sternoakromion dan Titik Penyuntikan Blokade Pleksus Brakialis pada Anestesi Vertical Infraclavicular Block Menggunakan Pencitraan Ultrasonografi pada Pria Dewasa Yadi, Dedi Fitri; Redjeki, Ike Sri; Bisri, Tatang
Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Anestesi regional untuk operasi di daerah lengan bawah dapat dilakukan blokade pleksus brakialis vertikal infraklavikula. Penelitian ini bertujuan menemukan korelasi antara panjang garis sternoakromion dan letak penyuntikan menggunakan pencitraan ultrasonografi untuk vertical infraclavicular block (VIB) pada pria dewasa. Penelitian potong lintang dengan mengukur titik tengah garis antara fosa jugularis dan akromion pada 48 pria dewasa. Pencitraan ultrasonografi dilakukan menggunakan probe linear untuk menentukan letak penyuntikan. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober 2011âJanuari 2012. Hasil pengukuran didapatkan panjang garis sternoakromion kanan rata-rata 18,35Â±1,16 cm. dan kiri 18,39Â±1,22 cm. Titik tengah sternoakromion kanan rata-rata 9,18Â±0,59 cm dan kiri 9,19Â±0,61 cm. Jarak letak titik penyuntikan menggunakan ultrasonografi kanan 9,41Â±0,7 cm dan kiri 9,46Â±0,72. Terdapat korelasi positif (r kanan=0,874 dan r kiri=0,862) antara garis sternoakromion dan jarak letak titik penyuntikan menggunakan pencitraan ultrasonografi.Kata kunci: Blokade vertikal infraklavikular, letak penyuntikan blokade infraklavikular, pencitraan ultrasonografiÂ Correlation between the Sternoacromion Line Length and Plexus Brachialis Vertical Infraclavicular Block Injection Site Using Ultrasonography Scan on Adult MalesAbstractSurgery on the lower part of the arm can be managed by brachial plexus vertical infraclavicular block. Needle placement for vertical infraclavicular block is not always at the midpoint of the sternoacromion line. The aim of this study was to find the correlation between sternoacromion length and needle placement using ultrasond scan for vertical infraclavicular block on adults males. This was a cross sectional study measuring the midlle point of sternoacromion line on 48 adult male volunteers whom never had any injury or operation on shoulder areas. Linear probe ultrasound was used to determine the needle placement. This study was conducted in Dr. Hasan Sadikin General Hospital Bandung within the period of October 2011âJanuary 2012. Pearson correlation test and linear regression were used to analyze the data. Result of this study showed an average right strernoacromion length of 18.35Â±1.16 cm, an average left sternoacromion leght of 18.39Â±1.22 cm, an average midpoint right sternoacromion of 9.18Â±0.59 cm, and an average midmpoint left sternoacromion of 9.19Â±0.61. The average ultrasound right point was 9.41 cm and 9.46 cm for the left point. Hence, thereare significant correlations (r right=0.874, r left=0.862) between sternoacromion length and ultrasound injection point for vertical infraclavicular block.Key words: Injection site for infraclavicular block, ultrasound scan, vertical infraclavicular blockÂ DOI:Â 10.15851/jap.v4n1.739

Perbandingan antara Penggunaan Asam Amino dan Ringer Laktat terhadap Penurunan Suhu Inti Pasien yang Menjalani Operasi Laparotomi Ginekologi dengan Anestesi Umum Hujjatulislam, Agung; Pradian, Erwin; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Pemberian asam amino intravena merangsang metabolisme oksidatif sekitar 20% dan mengurangi komplikasi hipotermia pascaoperasi. Tujuan penelitian ini mengetahui efek penggunaan asam amino preoperatif terhadap suhu inti tubuh. Penelitian menggunakan metode kuantitatif intervensi dengan rancangan uji klinis acak terkontrol buta tunggal pada 40 orang pasien berusia 18â57 tahun dengan status fisik American Society of Anesthesiologists (ASA) I dan II yang menjalani operasi laparotomi ginekologi di Rumah Sakir Dr. Hasan Sadikin Bandung periode FebuariâMei 2014. Subjek dibagi menjadi 2 kelompok secara acak, yaitu kelompok yang mendapat asam amino 2 mL/kgBB/jam selama 2 jam preoperasi dan kelompok kontrol yang mendapat infus Ringer laktat. Pencatatan suhu timpani dilakukan setiap 10 menit dari awal induksi hingga akhir anestesi. Data hasil penelitian diuji dengan Uji Mann-Whitney. Hasil penghitungan statistika, didapatkan suhu inti rata-rata selama anestesi pada kelompok asam amino bermakna lebih tinggi dibanding dengan kelompok kontrol (p<0,05). Penurunan suhu rata-rata pada kelompok kontrol (0,11C) bermakna, lebih besar dibanding dengan kelompok asam amino (0,08C; p<0,05). Simpulan, pemberian cairan asam amino dua jam preoperasi dapat mencegah penurunan suhu yang lebih besar dibanding dengan kelompok kontrol selama operasi ginekologi laparotomi.Kata kunci: Asam amino, hipotermia, suhu inti tubuhÂ Comparison between Amino Acids and Ringer Lactate Infusion on Body Core Temperature Decline in Patients Undergo Gynaecological Laparotomy Surgery under General AnesthesiaIntravenous administration of amino acids stimulates about 20% oxidative metabolism and reduces postoperative complications of hypothermia. The aim of this study was to determine the effects of preoperative amino acid infusion to core temperature. This was an observational analytic study with cross-sectional design to compare the reliability using the inter-rater reliability method. Subjects were 40 patients aged 18â57 years old with physical status ASA I and II who underwent gynaecological laparotomy at Dr. Hasan Sadikin General Hospital Bandung during FebruaryâMay 2014. Subjects were devided randomly into 2 groups; one group was given 2 mL/kgBW/hour amino acid infusion for 2 hours before laparotomy and another group was the control group given ringer lactate infusion. Tympani membrane temperature was taken every 10 minutes throughout the anesthetic procedure. Data were statistically analyzed using Mann-Whitney test.The result of this study was the average of core temperature during anesthesia in amino acid group was significantly higher than control group (p<0.05). The average of temperature decline in the control group (0.11oC) was significantly higher (p<0.05) than the amino acid group (0.08oC).Â This study concludes that amino acid infusion two hours before surgery will prevent greater decrease in temperature compared to the control group during gynecological laparotomy surgery.Key words: Amino acids, body core temperature, hypothermiaÂ DOI:Â 10.15851/jap.v3n3.606

Korelasi antara Lama Pintas Jantung Paru dan Lama Bantuan Ventilasi Mekanis pada Pasien Pascabedah Pintas Arteri Koroner di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung Redjeki, Ike Sri; Setiari, Tias Diah; Sudjud, Reza Widianto
Jurnal Anestesi Perioperatif Vol 5, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Pintas jantung paru (PJP) diperlukan untuk sebagian besar prosedur bedah pintas arteri koroner (BPAK). Fungsi paru dan oksigenasi menurun sekitar 2â90% pada pasien pascabedah jantung dengan PJP. Ketergantungan terhadap ventilator setelah BPAK secara signifikan berhubungan dengan morbiditas dan mortalitas. Tujuan penelitian ini adalah mengorelasikan waktu PJP dengan lama bantuan ventilasi mekanis pada pasien BPAK. Penelitian ini merupakan analisis kohort retorospektif pada 43 pasien yang menjalani BPAK dengan PJP yang dirawat di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Januari 2014 sampai Juni 2015. Lama PJP dibagi menjadi â¤90 menit dan >90. Lama bantuan ventilasi mekanis terbagi menjadi â¤12 jam dan >12 jam. Parameter yang dicatat pada penelitian ini adalah usia, berat badan, tinggi badan, indeks massa tubuh, lama PJP, waktu klem aorta, dan lama bantuan ventilasi mekanis. Analisis stastistik menggunakan uji korelasi Lambda, signifikan jika nilai p<0,05. Penelitian ini menunjukkan korelasi yang cukup kuat antara waktu PJP dan lama bantuan ventilasi mekanis setelah BPAK dengan korelasi positif (0,545) dan signifikan (p<0,05). Simpulan penelitian ini adalah semakin lama waktu PJP berkorelasi dengan memanjangnya lama bantuan ventilasi mekanis. Kata kunci: Bedah pintas arteri koroner, pintas jantung paru, ventilasi mekanis Correlation between Cardiopulmonary Bypass Time and Duration of Mechanical Ventilation after Coronary Artery Bypass Graft at Cardiac Intensive Care Unit of Dr. Hasan Sadikin General Hospital BandungCardiopulmonary bypass (CPB) is necessary for majority of procedures in coronary artery bypass grafting (CABG) surgery. Lung function and oxygenation are impaired in 20% to 90% of CPB cardiac surgery patients. Ventilator dependency following CABG is often associated with significant morbidity and mortality. This study aims to correlate the CPB time and duration of mechanical ventilation after coronary artery bypass graft. This was a retrospective analysis cohort study on 43 consecutive patients undergoing CABG on CPB who admitted to cardiac intensive care unit between January 2014 and June 2015 in Dr. Hasan Sadikin General Hospital Bandung. The CPB time divided into <90 minutes and â¥90 minutes. Duration of mechanical ventilation was defined as â¤12 hours and â¥12 hours ventilation. Parameters recorded in this study were age, weight, height, body mass index, CPB time, aortic cross-clamp time and duration of mechanical ventilation. Statistical analysis was performed using Lambda correlation, significanti if p value <0.05. This study showed moderate correlation between CPB time and duration of mechanical ventilation after CABG surgery with a positive (0.545) and significant correlation (p<0.05). Conclusion of this research is longer CPB timed correlated with prolonged mechanical ventilationKey words: Cardiopulmonary bypass time, coronary artery bypass grafting, mechanical ventilation

Perbandingan Ketinggian Bantal 4,5 cm dan 9 cm terhadap Visualisasi Glotis Saat Laringoskopi di Rumah Sakit Dr. Hasan Sadikin Bandung Alam, Mohamad Deny Saeful; Suwarman, Suwarman; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 5, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Intubasi ialah prosedur baku mempertahankan patensi jalan napas dengan melihat secara langsung glotis melalui alat laringoskop. Visualisasi glotis akan lebih jelas pada saat tindakan laringoskopi langsung pada sniffing position. Ketinggian bantal yang berbeda akan memberikan visualisasi glotis yang berbeda pula. Penelitian ini merupakan penelitian eksperimen kuasi. Jumlah sampel penelitian 30 orang dengan 2 perlakuan berbeda, yaitu bantal dengan ketinggian 4,5 cm dan 9 cm. Pemilihan subjek penelitian dilakukan secara consecutive sampling dengan mengambil setiap subjek penelitian yang memenuhi kriteria inklusi. Subjek penelitian semua pasien yang menjalani operasi elektif dengan anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli 2015 yang memenuhi kriteria inklusi. Tujuan penelitian ini adalah mengetahui pengaruh pemakaian bantal 4,5 cm dibanding dengan bantal 9 cm terhadap nilai visualisasi glotis.Â Visualisasi glotis dengan ketinggian bantal yang berbeda pada saat tindakan laringoskopi langsung dinilai menggunakan skala kelas CormarckâLehane (CL) dan skor percentage of glotic opening (POGO). Distribusi data dengan uji Shapiro Wilks, nilai p ditentukan menggunakan uji Wilcoxon dan bermakna jika p<0,05. Hasil penelitian ini menunjukkan bahwa nilai skala CL modifikasi kedua bantal berada pada kisaranÂ skala 1 hingga 2c (p=0,007). SkorÂ POGO bantal ketinggian 4,5 cm berada pada kisaranÂ 20â100% dengan rata-rata 69,33Â±21,48%. Bantal ketinggian 9 cm skor POGO berada pada kisaran 30,00â80,00% dengan nilai rata-rata 58,333Â±15,33% (p=0,001). Simpulan, penggunaan bantal ketinggian 4,5 cm memberikan visualisasi glotis yang lebih baik saat laringoskopi langsung dibanding denganÂ bantal ketinggian 9 cm.Comparison of 4.5 cm and 9 cm Pillow Height in Glottis Visualization on Laryngoscopy at Dr. Hasan Sadikin General HospitalIntubation is a standard procedure to maintain patency of the airway byÂ directly visualizing glottis with a laryngoscope. Visualization of the glottis will be clearer when direct laryngoscopy is performed in sniffing position. Different pillows heights will provide different visualization of the glottis. This study was a quasi-experimental study on 30 subjects who were divided into 2 experimental groups of 4.5 cm and 9 cm pillow heights. Subjects were sampled consecutively according to the inclusion and exclusion criteria. The population was all patients underwent elective surgery with general anesthesia at Dr. Hasan Sadikin Hospital Bandung during the period of July 2015. The purpose of this study was to determine the effect of using a pillow height of 4.5 cm when compared to 9 cm pillow height on glottis visualization based on an assessment using CormarckâLehane (CL) scale and percentage of glotic opening (POGO) scores. Data distribution was tested by Shapiro Wilks while the p values were determined using Wilcoxon test and was considered meaningful if p<0.05. The results showed that the value of modified CLâclass scale for both pillow heights were in the range scale of 1 to 2c (p=0.007). The POGO scores of the 4.5 cm pillow height was in the range of 20â100% with an average percentage of 69.33Â±21.48%, while the POGO scores of the 9 cm pillow height were in the range of 30.00â80.00% with an average score of 58.333Â±15.33% (p=0.001). Therefore, the use of 4.5 cm pillow height gives better glottis visualization in direct laryngoscopy compared to the 9 cm pillow height.

Initiation Time and Time Needed to Achieved Ideal Nutrition Level in Mechanically Ventilated Patient admitted to Intensive Care Unit of Dr. Hasan Sadikin Hospital Bandung Irawati, Dian; , Suwarman; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Enteral nutrition need to be given in first 24–48 hour after the patient admitted to the ICU, while ideal nutritional level need to be achieved in 48–72 hours after the patient admitted. Both time are “window opportunity” which influence morbidity and mortality. The aim of this study was to identify the initiation time and the time needed for ideal nutrition achieved in patient with mechanical ventilation. This prospective descriptive-observational study was done from June until September 2015 in ICU of Dr. Hasan Sadikin hospital to 39 subject. Result showed initiation time in 38 subject was done in ≤24 hour. In 24 subject, ideal nutrition level was achieved in more than 72 hour. Reason for delay in initiation rescusitation. Reason for ideal nutrition not fullfiled in less 72 hour was gradual nutrition procedure, intolerance, hemodinamic disturbance, absence of small bowel sound, and high glucose level. In conclusion the intiation time of enteral nutrition in almost all patient of Dr. Hasan Sadikin Hospital from June until September 2015 was done in less than 48 hour. After 72 hour of observation, 58,87% subject cannot achieved ideal nutrition in less than 72 hour.

Manajemen Emboli Paru di Intensive Care Unit (ICU) Redjeki, Ike Sri; Satrio, Wijanarko
Majalah Anestesia dan Critical Care Vol 32 No 2 (2014): Juni
Publisher : Perdatin Pusat

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Emboli paru merupakan komplikasi utama tromboemboli vena (VTE). Emboli paru termasuk dalam kegawatan kardiovaskular. Tersumbatnya pembuluh darah arterial paru dapat mengancam kehidupan disertai kegagalan ventrikel kanan yang dapat reversibel. Diagnosis (PE) yaitu adanya gejala umum dan tanda-tanda klinis seperti hipoksia, takipnea, dan takikardia. Di ICU, sebagian besar pasien memerlukan sedasi dan ventilasi mekanis sehingga manifestasi klinis tidak khas dan biasanya atipikal. Baku emas diagnosis PE adalah ditemukannya sumbatan pada angiografi paru. Diagnosis dan tatalaksana suportif menjadi sangat penting mengingat mortalitasnya yang tinggi. Oksigenasi, intubasi, dan ventilasi mekanik diperlukan untuk kegagalan pernafasan. Terapi vasopressor harus dipertimbangkan jika tekanan darah masih rendah. Terapi antikoagulan memainkan peran penting dalam pengelolaan pasien PE. Heparin dan low molecular weight heparin dapat diberi di awal. Pada kasus yang berat mungkin memerlukan trombolisis dengan obat-obatan seperti tissue plasminogen activator (tPA) atau mungkin memerlukan intervensi bedah melalui thrombectomy paru. Kata kunci: Antikoagulan, emboli paru, tromboemboli vena Pulmonary embolism is the major complication of venous thromboembolism (VTE). Pulmonary embolism is a cardiovascular emergency. By occluding the pulmonary arterial bed it may lead to acute life threatening but potentially reversible right ventricular failure. The diagnosis of (PE) is usually suspected by the presence of common symptoms and clinical signs include hypoxia, tachypnea, and tachycardia. However in ICU, the most of patients required sedation and mechanical ventilation. The clinical manifestations is usually atypical. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, once it is suspected, a diagnostic plan and supportive measures are essential. Oxygen supplementation, intubation, and mechanical ventilation are instituted as necessary for respiratory failure. Vasopressor therapy should be considered if the blood pressure is not rapidly restored. Anticoagulant treatment plays a pivotal role in the management of patients with PE. Heparin, low molecular weight heparins is administered initially. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy. Key words: Anticoagulant, pulmonary embolism, venous thrombus Reference Zochios V, Keeshan A. Pulmonary embolismin the mechanically-ventilated critically ill patient: is it different? The intensive care societty 2013. 2013;14:36–44. Marino P, penyunting. Venous thromboembolism. Philadelphia: Lipincott Williams Wilkins; 2007. Williams M, Aravindan N, Wallace M. Venous thromboembolism in the intensive care unit. Crit Care Clin 2003;19:185–207. Adam T, Arnaud P, Konstantinides S, Agnelli G, Galle N, Pruszczyk P. Guidelines on the diagnosis and management of acute pulmonary embolism. European Heart Journal. 2008;29:2276–315. Forgione A. Managing patients with suspected pulmonary embolism. JAAPA. 2006;19:22–8. Stoelting K, Dierdorf S, Penyunting. Deep vein thrombosis and pulmonary embolism. Philadelphia; 2002. Bahloul M, Chaari A, Kallel H, Abid L, Hamida C, Dammak dkk. Pulmonary embolism in intensive care unit: predictive factors, clinical manifestations and outcome. Ann Thorac Med 2010;5:97–103. Waldmann c, Vincent JL. Pulmonary Embolism the future, Optimising the prevention of PE in the critically ill patient. Journal of the intensive care society. 2014;15:2–16.

Risk ratio of Delirium in crIticaly ill patient using the Confusion Assessment Method for Intensive Care Unit during admission from October to Desember 2015 in Intensive Care Unit Dr. Hasan Sadikin Hospital Rohmawanur, Tubagus Yuli; , Indriasari; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Delirium is an acute and fluctuative state marked by changes in mental, concioussness, attention, cognitive and perspective which develops within a certain time frame (usually hours to days). Delirium has a high incident on criticaly ill patients. The aim of this research is to investigate risk ratio (RR) of delirium in criticaly ill scored by the confusion assessment methode for the intensive care unit ( CAM-ICU) during admission in general intensive care unit (GICU) Hasan Sadikin Hospital. This is an observational analytic study with prospective cohort on 91 patients during 24 hours of GICU care from October to December 2015. Statistical analysis was done with chi square test which measures the percentage and RR of delirium.The result is the incidence of delirium in Hasan Sadikin Hospital GICU was 27.9 %. Analysis shows that there is a significant relationship between delirium with RR >1 to delirium based on sedation history is 3.16, ventilated patients was 2.37, electrolyrte imbalance 2.37, infectious disease 2.13, comorbid 1.86, neurological disorder 1.622, and analysis shows that there is a significant relationship between delirium delirium and history of sedation, electrolyte imbalance and ventilated patients with p value <0,05. The conclussion of this study is that the incidence of delirium in Dr. Hasan Sadikin Hospital GICU has a higher incidence on critically ill patient with risk factors involved. Highest risk factor is sedation history which increases the risk by 3.16 times more.

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