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All Journal Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif E-Journal Widya Kesehatan dan Lingkungan Majalah Anestesia dan Critical Care Jurnal Komplikasi Anestesi
Ike Sri Redjeki
Departemen Anestesiologi dan Terapi intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Education Environmental Science Health Professions Medicine & Pharmacology Public Health

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Mikrosirkulasi Supandji, Mia; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Abstract

Mikrosirkulasi adalah suatu jaringan pembuluh darah yang sangat kecil dan tidak terlihat dengan mata telanjang. Mikrosirkulasi merupakan bagian dari sirkulasi yang berfungsi untuk transportasi oksigen, nutrisi ke jaringan sel dan produk pembuangan dari sel melalui pembuluh darah. Saat terjadinya suatu kondisi sepsis maka akan terjadi gangguan fungsi mikrosirkulasi disertai dengan gangguan fungsi endotel, mitokondria, degradasi, glycocalyx, kebocoran kapiler, hilangnya reaktivitas vaskular, autoregulasi dan mikrotrombosis. Hal tersebut akan menyebabkan terjadinya kondisi densitas vaskular yang heterogen disertai dengan kantung-kantung area hipoksia. Gangguan ini tidak dapat didiagnosis secara pasti menggunakan parameter hemodinamik global, namun mememrlukan advanced imaging techniques. Resusitasi dengan pemberian cairan, merupakan dasar dari resutitasi mikrosirkulasi selain terapi dengan mengguakan obat-obatan lainnya. Kata kunci: Mikrosirkulasi,oksigen, perfusi, resusitasi, sepsis MicrocirculationMicrocirculation is a network of small blood vessels that are too small to see with naked eyes; it is a very important part of the human circulation, for the transport of oxygen and nutrition to the cells and waste products form the cells to the blood vessels. In septic patient, there is an alteration of the microcirculation associated with endothelial dysfunction, mitochondria dysfunction, glycocalyx degradation, capillary leakage, loss of micro vascular reactivity and auto regulation and micro thrombosis. Moreover there are heterogeneity of vascular density associated with hypoxic pocket zones. These alterations can not be diagnosed definitely with global hemodynamic parameters,and therefore advanced imaging techniques arerequired. Fluid resuscitation is a fundamental therapy in restoring microcirculation beside a combination of agents. Key words: Microsirculation, oxygent, perfusion,resuscutation, sepsis
Ultrasound Guided Stellate Ganglion Block on Patient with Lung Cancer for Pain Management Prihartono, M. Andy; Yadi, Dedi Fitri; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Lung cancer is most common cancer that cause metastases. Complex regional pain syndrome (CPRS) type 1 is very severe symptoms such as pain occuring in the damaged tissue that is not caused by trauma and no nerve damage. Stellate ganglion blockade is a blockade on sympathetic nerve ganglion performed on the neck parallel to the cricoid cartilage and Chassaignac’s tubercle (C6). To determine the effectiveness of stellate ganglion block on lung cancer and complex regional pain syndrome type 1 Case report; 65 years old male with lung adenocarcinoma complained of severe pain in the lower back area of the right scapula and shoulder that radiates to the arm and fingers. For the pain, given 8mg hydromorphone (Jurnista®) 1x a day, 4x 500mg paracetamol, 10mg amitriptylin 1x and 2x 75mg pregabalin. Due to increasing pain (VAS 9), liver function and coagulopathy, the stellate ganglion blockade was performed with ultrasound guidance, pain VAS was reduced to four. Pain therapy in lung cancer accompanied with CRPS type 1 can be treated with stellate ganglion blockade in addition to pain therapy can also reduce the amount of oral medications consumed.
The Effect of 2% Lidocaine Intravenous 1,5 mg/kgBW Prior to Extubation on Cough and Sore Throat Incidence in Patients who Underwent Surgery with General Anesthesia , Suwarman; Redjeki, Ike Sri; Ramdhani, Vicky Muhammad
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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One of the problems that often arise in the general anesthesia is in the time of extubation of endotracheal tube. These actions can irritate the respiratory tract mucosa causing cough and sore throat. Intravenous lidocaine is one of the ways to avoid them. This study was conducted to assess the effect of 2% lidocaine intravenous 1.5 mg/kgBW before extubation to reduce the incidence of cough and sore throat in patients who underwent surgery with general anesthesia. Double blind randomized controlled trial study involved 72 patients age 18–60 years old whom underwent surgery with general anesthesia. Subjects were divided into two groups, one group using 2% lidocaine 1.5 mg/kgBW and control group using NaCl 0.9% before extubation. Data was analyzed using Chi square and Mann-Whitney test with result of p<0,05 was significant. The result showed that administration of lidocaine 1.5 mg/kgBW gave significant effects compared to 0.9% NaCl in reducing the incidence of cough with p values=0,034 and sore throat with p values=0,000 at each observation time. It can be concluded from this research that 2% lidocaine intravenous 1.5 mg/kg can reduce the incidence of cough and sore throat caused by extubation in patients who underwent surgery with general anesthesia.
Effect of Vitamin C 1.000 mg Intravenous Therapy to Lactate Level, Base Deficit and Central Vein Saturation (SvO2) in Septic Patient Rahardjo,, Theresia Monica; Redjeki, Ike Sri; Kurniadi, Rudi
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Abstract

Microvascular endothelial dysfunction is a major problem in sepsis patient, followed by a very high morbidity and mortality rate even optimal effort was done. Vitamin C has ability as antioxidant and can improve endothelial cell function. A prospective, randomized, placebo-controlled, and double blind study was conducted at Intensive Care Unit (ICU) Dr. Hasan Sadikin General Hospital Bandung within 6 months to evaluate the effect of vitamin C 1.000 mg intravenous on lactate level, base deficit and SvO2, in 33 septic patients, aged 17–60 years with acute physiology and chronic health evaluation II (APACHE II) score 15–23. Subjects were divided into two groups, treatment group was given an injection of 5 mL vitamin C 1000 mg and control group had a 5 mL NaCl 0.9% at first to seventh day. Measurement of lactate level, base deficit and SvO2 was done at day 1, day 3, day 5, and day 7. Result showed a significant different lactate level between two groups, a very significant decrease of lactate level and decrease of lactate level percentage occurred in treatment group at day 5. and 7 (p<0.001), a significant decrease of base deficit (p<0.002) and an unsignificant decrease of SvO2 (p>0.05). In conclusion, vitamin C 1.000 mg intravenous can improve lactate level, base deficit and SvO2 in septic patient.
Duration of Analgesia and Blood Pressure by Giving Midazolam 2 mg Compared to Fentanyl 25 mcg in Hyperbaric Bupivacaine 10 mg During Cesarean Delivery Sitanggang, Ruli Herman; Harniati, Siti; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Pain free episode after Cesarean deliveryis needed by the mother to take care the baby. Opioid is the most common adjuvant used in spinal anesthesia, but still has unpleasant side effects, while Midazolam 2 mg is known to prolong analgesia. This study was using randomized double-blind experimental design. The subject of this study is 40 pregnant women with ASA II who underwent Cesarean delivery with spinal anesthesia. Research subjects are divided into 2 groups of study. The first group was given a combination of Fentanyl 25 mcg + 0.5% Bupivacaine 10 mg (BF) while the second group was given Midazolam 2mg+0,5% Bupivacaine 10 mg (BM). The duration of analgesia in 2 groups was assessed using a numeric rating scale (NRS). Then the data were analyzed using T-test, Mann Whitney test and Chi square test. The results showed no significant difference in both groups in a decrease of systolic blood pressure (p>0.05). Duration of analgesia in Midazolam group is 217.5 (39.32) minutes longer than Fentanyl group 124.0 (10.83) minutes. The conclusion is additional Midazolam 2 mg may prolong analgesia compared with Fentanyl 25 mcg without a decrease in blood pressure in Caserean delivery.
Fluid Management in Pediatric Craniotomy Fuadi, Iwan; Pison, Osmond Muvtilof; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Advances in pediatric neurosurgery techniques have dramatically improved the outcome in infants and children with surgical lesions of the central nervous system. However, the physiologic and developmental differences inherent in pediatric patients present challenges to neurosurgeons and anesthesiologists alike. Fluid management is critically important in pediatric craniotomy. Hemodynamic stability during intracranial surgery requires the careful maintenance of intravascular volume and electrolytes. It is imperative to secure excellent intravenous access for fluid and blood replacement and drug delivery before the start of the operation. Lack of intake or active vomiting because of changes in the ICP, preoperative fluid restriction and diuretic therapy may lead to blood pressure instability and even cardiovascular collapse if sudden blood loss occurs. Normovolemia should be maintained throughout the procedure. Normal saline used as the maintenance fluid during neurosurgery because it’s mildly hyperosmolar and should minimize cerebral edema. Maintenance rate of fluid administration depends on the weight of the patient. The maximum allowable blood loss should be determined in advance. Hyperglycemia is always best avoided because it may exacerbate neurologic injury. Fluid management in neurosurgical cases is extremely important and requires good communication between the surgeon and anesthesiologist. Especially for infants and children because of the difference in the anatomy and physiology at various stages of growth and development. The anesthesiologist must be fully cognizant of these differences in order to conduct a safe anesthetic plan.
SUPINE HYPOTENSION SYNDROME PADA KEHAMILAN Bisri, Dewi Yulianti; Redjeki, Ike Sri; Bisri, Tatang
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Supine hypotension syndrome (SHS) dapat terjadi mulai kehamilan trimester 2 dan didefinisikan sebagai penurunan tekanan sistol ?30% pada posisi supine dibanding dengan lateral. Tujuan penelitian mengetahui insidensi SHS pada wanita hamil aterm di Indonesia. Penelitian observasional pada 200 wanita hamil aterm, kehamilan pertama dan kedua, usia 18?40 tahun, tidak memiliki penyakit sertaan, dan akan dilakukan seksio sesarea elektif di Rumah Sakit Ibu dan Anak Melinda dalam periode Maret?Juli 2012. Pasien diberikan 500 cc cairan kristaloid Ringer laktat sebagai pengganti puasa, kemudian dilakukan pemeriksaan tekanan sistol, diastol, rata-rata, laju nadi, dan saturasi oksigen selama 5 menit dengan jarak 1 menit pada posisi supine dan miring kiri 45O. Hasil pengukuran tekanan sistol supine 113,49 (13,20) mmHg, miring 105,20 (12,08) mmHg dengan nilai p=0,93. Tekanan diastol supine  69,05 (7,31) mmHg dan miring 58,58 (7,73) mmHg (p=0,51). Tekanan darah rata-rata supine 84,59 (8,38) mmHg dan miring 75,87 (8,82) mmHg (p=0,62). Laju nadi supine 88,95 (12,19) x/menit, dan miring 86,26 (11,47) x/menit, (p=0,86). SpO2 supine 99,95 (1,11)% dan miring 99,64 (0,67)% (p=0,07). Simpulan, tidak ada perbedaan tekanan sistol, diastol, rata-rata, laju nadi, dan SpO2 wanita hamil aterm pada posisi berbaring dengan posisi miring kiri 450. [MKB. 2015;47(2):102?8]Kata kunci: Posisi supine, posisi miring kekiri, supine hypotension syndrome, wanita hamil atermSupine Hypotension Syndrome in PregnanciesAbstractSupine hypotension syndrome (SHS) can occur starting from the second trimester of pregnancy and is defined as a reduction of systolic blood pressure of ?30% in the supine position compared to lateral position. The purpose of this study was to determine the incidence of SHS in full term pregnant women in Indonesia. An observational study on 200 full term pregnant women, first and second pregnancy, aged 18?40 years, no coexisting diseases, and was going to have an elective cesarean section in Melinda Woman and Child Hospital in the period of March?July 2012. Patients were given 500 cc of Ringer?s lactate crystalloid fluid instead of fasting. Systolic and diastolic blood pressure, mean blood pressure, pulse rate, and oxygen saturation for 5 minutes were then examined every  minute. The examination was conducted in the supine and left lateral position of 45O. The results show a systolic blood pressure in supine position of 113.49 (13.20) mmHg and in lateral position of 105.20 (12.08) mmHg (p=0.93). Meanwhile, the supine diastolic blood pressure was  69.05 (7.31) mmHg and lateral position was 58.58 (7.73) mmHg (p=0.51). The mean blood pressure in supine position was 84.59 (8.38) mmHg and 75.87 (8.82) mmHg (p=0.62) in lateral position . The pulse rates for supine and lateral position were 88.95 (12.19)x/min and 86.26 (11.47) x/min (p=0.86), respectively. Supine SpO­2 was 99.95 (1.11) % and lateral SpO2 was 99.64 (0.67) % (p=0.07). In conclusion, there is no differences in systolic, diastolic, mean blood pressure, pulse rate and SpO2 of full term pregnant women in supine or left lateral position of 45O. [MKB. 2015;47(2):102?8]Key words: Full term pregnant women, left lateral decubitus, supine hypotension syndrome, supine DOI: 10.15395/mkb.v47n2.461
PATOFISIOLOGI GAGAL NAPAS DAN TERAPI SUPLEMEN OKSIGEN PADA COVID-19 Daradjat, Dhady Ginanjar; Maskoen, Tinni Trihartini; Redjeki, Ike Sri
E-Journal Widya Kesehatan dan Lingkungan Vol. 2 No. 1 (2020)
Publisher : E-Journal Widya Kesehatan dan Lingkungan

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Abstract

Coronavirus Disease 19 diidentifikasi pertama kali pada Desember 2019 di Wuhan Cina dan saat ini menjadi pandemik seluruh negara di dunia. Meskipun jumlah pasien COVID 19 yang mengalami sakit kritis hanya sedikit, dimana membutuhkan perawatan di Intensive Care Unit dan tindakan ventilasi mekanik, namun jumlah populasi yang terinfeksi membuat sumber daya perawatan intensif menjadi terbatas. Gangguan sistem pernapasan berat merupakan salah satu permasalahan pada pasien COVID-19 dan menyebabkan angka mortalitas yang tinggi. Pemilihan terapi suplemen oksigen harus mempertimbangkan manfaat dan resiko infeksi yang dapat terjadi pada petugas kesehatan. Pemahaman mengenai patofisiologi gagal napas pada COVID-19 dan modalitas suplemen oksigen yang dapat diberikan akan membantu dalam penanganan pasien COVID-19. Tujuan penulisan ini untuk memberikan gambaran mengenai patofisiologi gagal napas pada pasien COVID-19 dan terapi suplemen oksigen yang dapat diberikan. Metode yang digunakan yaitu melalui studi pustaka dengan mengumpulkan dan mempelajari teori-teori serta informasi yang diperoleh dari buku serta menelaah dokumen dalam bentuk jurnal, internet dan makalah yang berhubungan dengan masalah penelitian. Kesimpulannya adalah Terapi suplemen oksigen merupakan salah satu strategi penanganan COVID-19 yang berat. Metode HFNC, NIV dan ventilasi mekanik adalah modalitas terapi untuk pasien gagal napas akibat COVID-19 yang masing-masing memiliki kelebihan dan kekurangan. Pemilihan terapi suplemen oksigen juga harus mempertimbangkan kondisi pasien dan resiko penularan penyakit terhadap petugas kesehatan.
Koagulopati pada Pasien COVID-19 Isfandiary, Annisa; Ismandiya; KSS, Nurita Dian; Redjeki, Ike Sri
Jurnal Komplikasi Anestesi Vol 7 No 3 (2020): Volume 7 Number 3 (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.v7i3.7472

Abstract

The pathogenesis theory of COVID-19 is still developing. While there are lot of theory coming up, the spotlight mostly reveal on inflamation, coagulopaty, and thrombo-infalamation. We reported an 53 years-old man arrived at the hospital with confirmed COVID-19, severe pneumonia and hypercoagulability state. Patient was referred to Hasan Sadikin Hospital and treated at COVID-19 isolation room, with the used of ventilator for 21 days. Further laboratory test found thromboelastrograph hypercoagulation from elevating level of fibrinogen and thrombocyte. SARS-CoV-2 enter host cells and cause a disruption of both epithelial and endothelial cells together with an alveolar inflammatory cell infiltrate leading to high levels of early response-proinflammatory cytokines. In severe COVID-19 patients, this immune response is excessive and thus described as a systemic “cytokine storm”. It is responsible for endotheliopathy and hypercoagulability state, leading to both systemic and macrothrombosis and microthrombosis. In this case we found hypercoagulation in thromboelastograph with increased D-dimer and fibrinogen, so that the patient was diagnosed with hypercoagulopaty Patient was given therapy of heparin. After heparin therapy patient had an improvement of clinical symptoms and laboratory result.
Co-Authors , Indriasari , Suwarman A. Himendra Wargahadibrata Agung Hujjatulislam, Agung Alam, Mohamad Deny Saeful Daradjat, Dhady Ginanjar Dedi Fitri Yadi Defri Aryu Dinata, Defri Aryu Dewi Yulianti Bisri Dhany Budipratama Dian Irawati, Dian Doddy Tavianto Erwin Pradian Ezra Oktaliansah Harniati, Siti Hunter D. Nainggolan Isfandiary, Annisa Ismandiya Iwan Fuadi Jeffry F. Longdong Kartapraja, Roni D. KSS, Nurita Dian Kurniadi, Rudi Lasmaria Flora Martua, Edwin Haposan Mira Rellytania Sabirin Pison, Osmond Muvtilof Prihartono, M. Andy Rahardjo,, Theresia Monica Ramdhani, Vicky Muhammad Reza Widianto Sudjud Rohmawanur, Tubagus Yuli Ruby Satria Nugraha Ruli Herman Sitanggang Sadli, M. Fajar Said Badrul Falah, Said Badrul Satrio, Wijanarko Setiari, Tias Diah Supandji, Mia Suwarman Suwarman Suwarman Suwarman, Suwarman Tatang Bisri Tinni Trihartini Maskoen U. Kaswiyan Vick Elmore Simanjuntak Wullur, Caroline Yovita Koswara