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All Journal Jurnal Anestesiologi Indonesia Journal of Anaesthesia and Pain
Taufiq Agus Siswagama
Departemen Anestesiologi Dan Terapi Intensif; Fakultas Kedokteran; Universitas Brawijaya/RSUD Dr. Saiful Anwar; Malang
Health Professions Medicine & Pharmacology Public Health

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Efek Pemberian Pre-emptive Fentanyl 25 μg terhadap Kejadian Batuk Setelah Bolus Fentanyl 2 μg/kg IV (Fentanyl Induced Cough) Taufiq Agus Siswagama; Hari Bagianto; Ristiawan Muji Laksono
JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 1 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (656.784 KB) | DOI: 10.14710/jai.v5i1.6419

Abstract

Latar belakang: Fentanyl merupakan opioid sintetik yang poten, dengan berbagai kelebihannya sehingga fentanyl dijadikan pilihan utama agen premedikasi dan induksi anestesi umum. Kejadian batuk setelah pemberian bolus fentanyl intravena/ fentanyl induce cough (FIC) merupakan sesuatu yang tidak diharapkan pada kasus pembedahan tertentu sehingga pencegahan FIC haruslah dilakukan. Beberapa penelitian telah dilakukan namun kurang efisien, oleh karenanya pada penelitian ini dilakukan pemberian pre-emptive fentanyl dosis 25 μg untuk menurunkan FIC.Tujuan: Mengetahui efek pemberian pre-emptive fentanyl 25 μg intravena terhadap insiden batuk setelah bolus fentanyl 2 μg/kgBB intravena.Metode: Empat puluh pasien yang menjalani operasi dengan anestesi umum dipilih secara acak untuk diikutkan dalam penelitian. Dibagi menjadi dua kelompok, kelompok pertama (20 pasien) mendapat injeksi intravena normal salin 0,5 ml dan diikuti fentanyl 2 μg/kgBB dalam 2 detik, dan kelompok sisanya mendapatkan injeksi intravena fentanyl 25 μg sebelum fentanyl induksi. Digunakan tes Mann-Whitney dan uji korelasi Spearman untuk membandingkan dan menilai hubungan variabel.Hasil: Pemberian pre-emptive fentanyl menunjukkan nilai signifikansi 0.183 pada timbulnya batuk dibandingkan kelompok yang mendapat normal saline namun berkorelasi negatif. Hubungan insiden batuk diantara kedua kelompok bernilai tidak signifikan (p=0,08). Dari derajat batuknya, berbeda signifikan (p=0,043), dengan nilai koefisien korelasi negatif (-0,326) dan nilai yang signifikan (p=0,04).Simpulan: Pemberian pre-emptive fentanyl 25 μg dapat menurunkan insiden FIC namun secara statistik tidak bermakna.Perlu penelitian selanjutnya untuk mengetahui rentang dosis pre-emptive fentanyl yang tepat serta teknik lainnya sebagai alternative untuk menurunkan insiden FIC 
Early Percutaneous Dilatational Tracheostomy pada Pasien COVID-19 dengan Gagal Napas: Laporan Kasus Ahmad Feza Fadhlurrahman; Rudy Vitraludyono; Taufiq Agus Siswagama; Arie Zainul Fatoni
JAI (Jurnal Anestesiologi Indonesia) Vol 13, No 3 (2021): Jurnal Anestesiologi Indonesia (Issue in Progress)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.37286

Abstract

Latar belakang: Pasien kritis dengan infeksi coronavirus disease 2019 (COVID-19) memiliki kecenderungan untuk perawatan ventilasi mekanik dalam waktu yang lama. Perawatan dengan translaryngeal intubasi dalam waktu lama beserta penggunaan sedasi dan tindakan lainnya di intensive care unit (ICU) dapat memunculkan beberapa komplikasi lebih lanjut.Kasus: Pasien perempuan pascaoperasi sectio caesaria dengan gagal napas akibat infeksi COVID-19.  Pasien mendapat support high flow nasal canule (HFNC) di awal perawatan di ICU. 4 hari perawatan, kondisi distress napas pasien memberat dan dilakukan intubasi translaryngeal. Dari evaluasi kondisi pasien selama 4 hari perawatan dengan ventilasi mekanik, tim ICU memutuskan melakukan tracheostomy melalui pendekatan dilatasi perkutan. Prosedur dilakukan di ruang bertekanan negatif dengan penggunaan alat pelindung diri (APD) level 3. Kondisi pasien berangsur mengalami perbaikan selama 7 hari perawatan dengan tracheostomy. Support ventilasi yang minimal, kebutuhan fraksi oksigen yg menurun dan perbaikan kondisi umum menjadi pertimbangan dilakukan dekanulasi. 3 hari pasca dekanulasi pasien dipindah rawat ke ruangan dengan kondisi stabil.Selama perawatan di ICU, pasien mendapat standar terapi berupa antiviral, antibiotik, antikoagulan, analgesik, steroid, dan obat penunjang lainnya.Pembahasan: Tindakan tracheostomy berhubungan dengan insiden pneumonia yang lebih rendah, penurunan penggunaan obat sedasi dan percepatan masa lepas rawat dari ventilasi mekanik. Early tracheostomy dilakukan sebelum hari ke-10 intubasi. Teknik dilatasi perkutan memiliki kelebihan atas efektifitas dan efisiensi biaya dan alat pendukung. Tindakan percutaneous dilatational tracheostomy (PDT) pada pasien COVID-19 harus dilakukan dengan proteksi tenaga medis yang optimal.Kesimpulan: Early tracheostomy dapat dipertimbangkan dalam tatalaksana pasien kritis COVID-19. Penilaian kondisi klinis pasien dan proteksi tenaga medis merupakan faktor utama menentukan tindakan early tracheostomy pada pasien COVID-19.
Anestesi Epidural Thorakal pada Operasi Thorakotomi Dekortisasi pada Pasien dengan Tuberkulosis Pyopneumothorax Dendy Dwi Ramadhani; Taufiq Agus Siswagama
Journal of Anaesthesia and Pain Vol 2, No 1 (2021): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.002.01.07

Abstract

Latar belakang: Tuberkulosis pyopneumothorax adalah kejadian yang mengarah pada komplikasi parah dan serangkaian tantangan pengobatan terutama dalam manajemen anestesi. Penggunaan teknik epidural thorakal telah mengalami peningkatan seiring dengan perkembangan operasi abdomen, thorakal dan kardiovaskuler. Tujuan dari penggunaan anestesi epidural thorakal tidak semata untuk menghalangi rangsangan nyeri melalui serabut saraf afferent luka operasi tetapi juga simpatektomi yang selektif pada daerah thorakal. Kombinasi dengan teknik anestesi umum akan mengurangi kedalaman anestesi, kondisi hemodinamik yang lebih stabil dan pemulihan lebih cepat. Kasus: Seorang laki-laki usia 52 tahun, dengan diagnosis pyopneumothorax spontan dan tuberculosis paru, menjalani operasi thorakotomi dekortikasi dengan anestesi umum dikombinasi epidural thorakal. Anestesi epidural dilakukan dengan cara pendekatan median setinggi vertebra T7-T8 dengan target blok T2-T6, dan insersi dengan cara loss of resistancepada kedalaman 3,5 cm dan kateter sedalam 6 cm. Setelah dilakukan test dose negatif, dilanjutkan dengan intubasi endotrakeal menggunakan double lumen tube. Ropivacaine 0,375 % 6 ml+ fentanil 50 µg diberikan ke dalam kateter epidural. Selama operasi ditemukan kondisi yang stabil dengan tingkat sedasi cukup dalam. Kesimpulan: Teknik anestesi epidural thorakal memiliki efek yang menguntungkan seperti analgesia, kejadian perubahan hemodinamik yang minimal dan risiko komplikasi pascaoperasi yang lebih rendah. Hal tersebut bermanfaat dalam tindakan bedah thoraks dan tatalaksana nyeri pascaoperasi.
Manajemen Nyeri pada Kasus Complex Regional Pain Syndrome (CRPS) di Tangan Kiri Disertai Nyeri Bahu dan Leher Taufiq Agus Siswagama; Ristiawan Muji Laksono
Journal of Anaesthesia and Pain Vol 1, No 1 (2020): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2020.001.01.05

Abstract

 Latar belakang: Nyeri dan edema lengan pasca operasi mammae cukup sering terjadi dan menimbulkan permasalahan yang pelik bagi pasien dan tenaga kesehatan. Gejala dan tanda berupa nyeri progresif yang tidak sebanding dengan penyebabnya diikuti edema, perubahan warna kulit dan suhu serta gangguan fungsi gerak merupakan tanda dan gejala Complex Regional Pain Syndrome (CRPS). Diperlukan pemahaman tentang penegakan diagnosis dan terapi yang tepat agar pasien CRPS mendapatkan tatalaksana yang baik. Kasus: Pasien dengan nyeri dan edema lengan kiri yang progresif pasca operasi mammae aberant kiri, tidak memberikan hasil memuaskan dengan terapi konservatif selama sepuluh tahun, dilakukan terapi intervensi nyeri dengan stellate ganglion block, facet cervical-3 median branch block dan suprascapullar nerve block dilanjutkan dengan program fisioterapi menunjukkan hasil yang baik. Kesimpulan: Tatalaksana CRPS pada ekstremitas atas dengan terapi konservatif yang tidak menunjukkan hasil yang baik memerlukan terapi intervensi nyeri dikombinasi dengan fisioterapi agar memberikan hasil yang memuaskan.
Dextrose Prolotherapy for Occipital Neuralgia Management Taufiq Agus Siswagama; Buyung Hartiyo Laksono; Mirza Koeshardiandi
Journal of Anaesthesia and Pain Vol 2, No 3 (2021): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.002.03.02

Abstract

Background: Occipital neuralgia defined as a pain such as being stabbed in the skin according to the dermatomes of the greater occipital nerves (GON) and lesser occipital nerves (LON).Case: An 80-year-old male patient diagnosed with occipital neuralgia. Previously, patients were diagnosed with lung cancer six months ago and planned for follow-up chemotherapy. Patient already receive medications including paracetamol, Non-steroidal anti-inflammatory drugs (NSAIDs), minor tranquilizers, and antidepressants, but the pain still exist. Patient then scheduled to receive blocks of GON and LON-ultrasound-guided using plain lidocaine 2% and steroids dexamethasone 10 mg. Fifteen days later, patient receive perineural deep injection along with prolo-hydrodissection in GON and LON using dextrose 15% and local anesthesia lidocaine plain 2% with a volume of 3 cc each nerve.  The intervention give a positive outcomes, pain is reduced with NRS rest 0-1, NRS motion 2-3, hearing improves, and the noise in the ear disappears. The patient can sleep using a pillow. Conclusion: Block GON and LON, perineural deep injection along with prolo-hydrodissection  provides a positive outcome for occipital neuralgia pain management. This case showed an opportunity for pain specialist to develop pain intervention based on prolotherapy.  
Comparison of Intermittent Epidural Bolus and Continuous Epidural Infusion for Postoperative Pain Management in Abdominal Surgery Patients Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk; Subagyo, Houdini Pradanawan; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol 5, No 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.02

Abstract

Background: Abdominal surgery often leads to high postoperative pain scores, which are commonly managed using epidural analgesia through either continuous infusion or intermittent bolus administration. This study aimed to compare the effectiveness of intermittent epidural bolus and continuous epidural infusion in managing postoperative pain among patients who underwent abdominal surgery.Methods: This cross-sectional study included 90 patients who underwent abdominal surgery and were randomly assigned to two groups. Group one received intermittent epidural bolus analgesia with ropivacaine 0.1875% and fentanyl 50 µg, administered as 10 cm³ every 8 hours (n=45). Group two received continuous epidural infusion analgesia with ropivacaine 0.1875% and fentanyl 100 µg, in a total volume of 50 cm³ at a rate of 3 cm³/hour (n=45). Pain levels were assessed using the numerical rating scale (NRS) at rest and during movement, measured every 12 hours for 84 hours. Statistical analysis was conducted using the independent t-test with a significance level of α=0.05 and a 95% confidence interval.Result: At 24 hours postoperatively, the NRS at rest was significantly lower in the continuous infusion epidural (0.15 ± 0.36) compared to the intermittent bolus (0.91 ± 0.35) (p=0.000), and this trend persisted at subsequent time points (36, 48, 60, 72, and 80 hours postoperatively). For movement, the NRS at 36 hours was also lower in the continuous infusion epidural (1.00 ± 0.00) compared to the intermittent bolus (1.29 ± 0.45) (p=0.000), with similar differences observed at other time points.Conclusion: Continuous epidural infusion provides superior analgesia to intermittent epidural bolus administration in abdominal surgery patients. This method is associated with faster and sustained reductions in pain intensity at rest and during movement.
Supraclavicular Block in Neglected Closed Fracture of the Intercondylar Humerus Imunu, Naim Ismail; Siswagama, Taufiq Agus
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: The supraclavicular block is used in upper extremity surgery, offering the advantages of easy access, reliability, and low risk, with the added benefit of ultrasound guidance to enhance safety and effectiveness. The aim of this case study was to evaluate the effectiveness and role of the supraclavicular block with ultrasound as the primary anesthetic and analgesic technique in the surgical management of neglected closed intercondylar humeral fractures. Case: A 57-year-old woman presented with an intra-articular fracture of the distal third of the left humerus according to the osteosynthesefragen and the orthopedic trauma association (AO/OTA) classification, type C2, with soft tissue swelling on the dorsal aspect of the left elbow. The patient had diabetes and hypertension, American Society of Anesthesiologists (ASA)  III, and a BMI of 27.8 kg/m2. The patient received a supraclavicular block with 0.5% ropivacaine and 10 mg dexamethasone in a total volume of 20 cm3. Needle placement was performed using ultrasound. During surgery, the patient received dexmedetomidine 0.3 µg/kg/hour plus intermittent fentanyl. Postoperatively, the patient was given ketorolac 3 x 30 mg and paracetamol 500 mg orally three times a day. One day after the procedure, the patient's numerical rating scale at rest was approximately 0 to 1, and a score of 1-2 was recorded during movement. Conclusion: A supraclavicular block, ultrasound-guided, with ropivacaine 0.5% can improve the accuracy and effectiveness of local anesthetic administration. This technique is helpful for patients with excess body mass because the brachial plexus is located superficially in the supraclavicular region
Characteristic Outline of Head Trauma Patients at Dr. Saiful Anwar General Hospital Laksono, Buyung Hartiyo; Pertiwi, Previasari Zahra; Siswagama, Taufiq Agus; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Traumatic brain injury is defined as a decline in brain function characterized by a decreased level of consciousness, seizures, and focal sensory and motor neurologic deficits caused by blunt force or penetration by a sharp object into the intracranial space. This reseracrh aims to determine the characteristics of head trauma patients at Dr. Saiful Anwar General Hospital, Malang.Methods: This descriptive observational study sampled all head trauma patients at Dr. Saiful Anwar General Hospital, Malang, from March to August 2023. The study variables included patient demographics, cause of trauma, clinical data, pre-and postoperative procedures, outcomes of trauma patients undergoing treatment, and length of stay. Data were analyzed using Microsoft Excel.Results: A total of 227 head trauma patients were identified, most of whom were men aged 20-39 (71). Students (72) were the most common victims of head trauma, most often due to accidents. There were 156 patients with mild head injuries. 208 patients had normal oxygen saturation. 157 patients had normal hemoglobin, 181 patients had normal sodium, and 196 patients had normal blood glucose levels. 102 patients experienced hypocarbia. A normal CT scan of 141 patients was performed. 206 patients underwent surgery, while 214 patients did not undergo tracheostomy. 149 patients underwent surgery with early emergence. The highest number of patients were patients with a hospital stay of more than 14 days (140 patients). The most common outcome was mild disability (84 patients).Conclusion: Most patients were male, aged 20-39. The most common cause was accidents involving students. Most patients with mild head injuries had normal oxygen saturation, hemoglobin,sodium, and blood glucose levels. Most patients with hypocarbia had no bleeding, and CT scans showed no bleeding. Most patients underwent surgery and early emergence, with a hospital stay of more than 14 days, and the most common outcome was mild disability.
Comparison of Intermittent Epidural Bolus and Continuous Epidural Infusion for Postoperative Pain Management in Abdominal Surgery Patients Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk; Subagyo, Houdini Pradanawan; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.02

Abstract

Background: Abdominal surgery often leads to high postoperative pain scores, which are commonly managed using epidural analgesia through either continuous infusion or intermittent bolus administration. This study aimed to compare the effectiveness of intermittent epidural bolus and continuous epidural infusion in managing postoperative pain among patients who underwent abdominal surgery.Methods: This cross-sectional study included 90 patients who underwent abdominal surgery and were randomly assigned to two groups. Group one received intermittent epidural bolus analgesia with ropivacaine 0.1875% and fentanyl 50 µg, administered as 10 cm³ every 8 hours (n=45). Group two received continuous epidural infusion analgesia with ropivacaine 0.1875% and fentanyl 100 µg, in a total volume of 50 cm³ at a rate of 3 cm³/hour (n=45). Pain levels were assessed using the numerical rating scale (NRS) at rest and during movement, measured every 12 hours for 84 hours. Statistical analysis was conducted using the independent t-test with a significance level of α=0.05 and a 95% confidence interval.Result: At 24 hours postoperatively, the NRS at rest was significantly lower in the continuous infusion epidural (0.15 ± 0.36) compared to the intermittent bolus (0.91 ± 0.35) (p=0.000), and this trend persisted at subsequent time points (36, 48, 60, 72, and 80 hours postoperatively). For movement, the NRS at 36 hours was also lower in the continuous infusion epidural (1.00 ± 0.00) compared to the intermittent bolus (1.29 ± 0.45) (p=0.000), with similar differences observed at other time points.Conclusion: Continuous epidural infusion provides superior analgesia to intermittent epidural bolus administration in abdominal surgery patients. This method is associated with faster and sustained reductions in pain intensity at rest and during movement.
Co-Authors Ahmad Feza Fadhlurrahman Arie Zainul Fatoni Aswoco Andyk Asmoro Dendy Dwi Ramadhani Hari Bagianto Imunu, Naim Ismail Isngadi Isngadi Laksono, Buyung Hartiyo Mirza Koeshardiandi Pertiwi, Previasari Zahra Ristiawan Muji Laksono Rudy Vitraludyono Subagyo, Houdini Pradanawan