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All Journal Jurnal Anestesiologi Indonesia Universa Medicina Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) eJournal Kedokteran Indonesia Journal of Global Pharma Technology Frontiers on Healthcare Research
Riyadh Firdaus
Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Universitas Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Menyeimbangkan Efisiensi dan Keselamatan: Re-evaluasi Intubasi Tanpa Pelumpuh Otot pada Operasi Berdurasi Singkat Riyadh Firdaus
Majalah Anestesia & Critical Care Vol 44 No 2 (2026): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v44i2.528

Abstract

Praktik anestesi modern dituntut untuk mempercepat alur kerja kamar operasi pada prosedur singkat seperti ekstraksi gigi impaksi. Penggunaan rutin pelumpuh otot berisiko menunda pemulihan akibat efek sisa blokade neuromuskular, sementara alternatif seperti sugammadex terkendala biaya. Sebagai solusi, kombinasi propofol dan remifentanil tanpa pelumpuh otot mulai dieksplorasi. Evaluasi ini mengulas bukti klinis dari studi retrospektif terhadap 43 pasien yang menjalani prosedur pencabutan gigi. Kombinasi remifentanil (rerata 3,08 µg/kg) dan propofol (2,06 mg/kg) memberikan kondisi intubasi adekuat dengan durasi emergence yang sangat cepat, yaitu rerata 5,88 menit. Sebanyak 65,1% subjek melewati fase pasca-intubasi tanpa komplikasi berarti. Meski efisien, teknik ini mengorbankan stabilitas hemodinamik; tercatat adanya penurunan denyut jantung sebesar 16%, tekanan darah sistolik 20%, dan diastolik 26%. Selain itu, ditemukan insiden batuk atau pergerakan tubuh pasien sebesar 27,9%. Intubasi tanpa pelumpuh otot merupakan opsi yang logis, praktis, dan efisien untuk pasien muda berisiko rendah (ASA I atau II) pada operasi minor singkat. Namun, klinisi harus tetap berhati-hati karena risiko kolaps hemodinamik tetap mengintai. Bagi populasi rentan seperti pasien geriatri, obesitas morbid, atau dengan penyulit vaskular, penggunaan pelumpuh otot berdurasi singkat tetap menjadi pilihan paling aman demi menjaga keselamatan pasien.
Effectiveness of Subcutaneous Bupivacaine–Ketamine Wound Infiltration in Reducing Post-Cesarean Section Pain: A Randomized, Double-Blind, Controlled Trial Nadra Septiadi; Riyadh Firdaus; Besthadi Sukmono; Rafidya Indah Septica
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p12-21.2026

Abstract

Background: Effective postoperative analgesia supports maternal recovery after cesarean delivery, yet subcutaneous local anesthetic infiltration, a simple technique well suited to resource-limited settings, typically provides only 3–6 hours of relief. Ketamine, an NMDA-receptor antagonist with analgesic activity at subanesthetic doses, may extend this window, but evidence in cesarean delivery remains limited.Objective: To determine whether adding subcutaneous ketamine to bupivacaine infiltration reduces rescue opioid requirement after cesarean delivery. Methods: In this randomized, double-blind, controlled trial at Tangerang Regional General Hospital, Indonesia, 60 women undergoing cesarean delivery under spinal anesthesia were allocated 1:1 to subcutaneous infiltration of 0.25% bupivacaine with ketamine 0.9 mg/kg (Group A, n = 30) or 0.25% bupivacaine alone (Group B, n = 30) before wound closure. The primary outcome was total rescue fentanyl requirement in the first 24 postoperative hours. Results: The median 24-hour fentanyl requirement was lower with ketamine (30 [0–90] vs 90 [0–150] mcg; p < 0.001), and fewer participants required rescue fentanyl at all (56.7% vs 76.7%), with a lower cumulative group dose (840 vs 2240 mcg). Group A also had lower pain scores from hour 7 onward, a longer interval to the first rescue request (810 vs 420 min; p = 0.019), and earlier first mobilization (585 vs 810 min; p < 0.001). No serious adverse events occurred in either group. Conclusion: Adding subcutaneous ketamine to bupivacaine infiltration lowered the rescue opioid requirement and supported faster recovery after cesarean delivery, offering a practical, low-cost addition to multimodal analgesia in resource-limited settings.
Co-Authors A Himendra Wargahadibrata A. Hmendra Wargahadibrata Adrian Reynaldo Sudirman Adrian Reynaldo Sudirman Ahmad Pasha Natanegara Aivi Mujono Amir Sjarifuddin Madjid Andi A. Wijaya Andi Ade Wijaya Ramlan Andy Omega Ani Retno Prijanti Annisaa Yuneva Arief Cahyadi Arif HM Marsaban Arni Diana Fitri Auerkari, Aino Nindya Avisa Cetta Cresma Bambang J. Oetoro Beryliana Maya Anisa Beryliana Maya Anisa Besthadi Sukmono Caren Andika Surbakti Caren Andika Surbakti Cindy Rahardja Claudia Lunaesti Darto Satoto Dewi Yulianti Bisri Dita Aditianingsih Ekowati Handharyani Ferry Valentino Franciscus D. Suyatna Hana F. Herianti Hansen Angkasa Hasna Ibadurrahmi Hasna Ibadurrahmi Ignatia Novianti Tantri Indah Nur Rachmah Indah Nur Rachmah Indonesia Emergency Knowledge and Attitude Evaluator Team Indonesia Emergency Knowledge and Attitude Evaluator Team Lintang Sekar Sari Lintang Sekar Sari Lisda Amalia Luther Holan Parasian Luther Holan Parasian Luther Holan Parasian M. Sopiyudin Dahlan M. Sopiyudin Dahlan Manggala, Sidharta Kusuma Maria Y. Tita Meliani Anggreni Moch Yasin Friansyah Muhammad A. I. Maulana Muhammad Arief Fadli Nadra Septiadi Nela Lutfiana Nela Lutfiana Noor Hafidz Novi Jamilah Nur’aini Alamanda Perdana, Aries Radea Renoza Rafidya Indah Septica Rani Tiara Rania Zahra Rania Zahra Ratna Farida Soenarto Rinal Effendi Roniza Basri Ryan Austin Sandy Theresia Sandy Theresia Siti Chasnak Saleh Solly Aryza Sri Rahardjo Sri Rejeki Sugiarto, Adhrie Syafruddin Gaus Tantri, Aida Rosita Tasya Claudia Pardede Tatang Bisri Tesha Monika Tommy Supit Vito Filbert Jayalie, Vito Filbert Yetty Ramli Yoan Devina