Ratna Farida Soenarto
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto Mangunkusumo

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Hubungan Lima Parameter Kraniofasial dengan Skor Cormack-Lehane pada Anak Indonesia Usia 4–12 Tahun Kapuangan, Christoper; Tanod, Jemmy Wilson; Wijaya R., Andi Ade; Soenarto, Ratna Farida
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penilaian jalan napas sangat penting dilakukan, terutama pada pasien anak. Pedoman yang ada pada dewasa tidak dapat dipakai pada populasi pediatri. Tujuan penelitian ini untuk mengetahui hubungan antara lima ukuran parameter kraniofasial dan skor Cormack-Lehane pada populasi anak usia 4–12 tahun di Indonesia. Penelitian ini bersifat observasional analitik yang dilakukan di Rumah Sakit Dr. Cipto Mangunkusumo Jakarta dari Maret sampai September 2013. Pengumpulan data dilakukan secara berurutan pada 134 pasien yang menjalani anestesia umum. Pengukuran dilakukan dari jarak tepi bawah bibir ke ujung mentum, jarak angulus mandibula ke ujung mentum, jarak tragus telinga ke sudut bibir, jarak mentohioid dan jarak antara angulus mandibula kanan dan kiri. Tingkat kesulitan laringoskopi dinilai menggunakan skor Cormack-Lehane, kemudian dibagi menjadi mudah dan sulit. Analisis data dilakukan menggunakan Uji Mann-Whitney dan uji-t tidak berpasangan untuk mencari hubungan antara lima parameter tersebut dan skor Cormack-Lehane. Penelitian ini tidak mendapatkan hubungan yang bermakna antara semua parameter kraniofasial di atas dan skor Cormack Lehane (nilai p berturut adalah 0,349; 0,638; 0,499; 0,765; dan 0,301). Simpulan, pada populasi anak Indonesia usia 4–12 tahun, lima parameter kraniofasial tidak dapat digunakan untuk prediksi kesulitan visualisasi laring.Kata kunci: Jalan napas, parameter kraniofasial, pediatri, skor Cormack-LehaneAssociation between Five Craniofacial Parameters and Cormack-Lehane Score in 4 to 12 Years-old Indonesian Paediatric Patients AbstractAirway assessment is very important, especially in pediatric patients. Adult airway guidelines can not be applied to pediatric population. The aim of this study was to determine the association between five craniofacial parameters and the Cormack-Lehane scores in 4 to 12 year-old Indonesian pediatric patients. This was an observational analytic study conducted in RSUPN Cipto Mangunkusumo from March to September 2013. Data were collected consecutively on 134 patients who underwent general anesthesia. The distance of the lower lip to mentum, mandibular angle to mentum, ear tragus to mouth, mentohyoid distance and distance of left and right mandibles were measured. Laryngoscopic difficulty levels were assessed using Cormack-Lehane score and divided into two groups: easy and difficult. Data analysis was performed using the Mann-Whitney Test and unpaired t-test to find the association between those five parameters and the Cormack-Lehane score. This study did not find any significant relationshis between all craniofacial parameters above and Cormack Lehane scores (p values: 0.349, 0.638, 0.499, 0.765, and 0.301 respectively). We concluded that in Indonesian pediatric population aged 4 to 12 years, the five craniofacial parameters cannot be used to predict laryngeal visualization.Key words: Airway, pediatric, Cormack-Lehane score DOI: 10.15851/jap.v2n3.328
CASE SERIES: DEEP SEDATION FOR PAEDATRIC PATIENTS WITH PERICARDIAL EFFUSION Soenarto, Ratna Farida; Hidayat, Jefferson; Zaintama, Hendy Armanda
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.33

Abstract

Background: Pericardial effusion is an abnormal fluid accumulation in the pericardial space that potentially compromises cardiovascular function, thus it needs a prompt treatment. Pericardial effusion evacuation in paediatrics can be done by subxyphoid pericardiotomy, which requires patient’s cooperation. General anaesthesia for paediatrics with pericardial effusion has been reported unfavourable. This case series reports safe anaesthesia procedures done for pericardiocentesis through both sedation and general anaesthesia. Case Presentations: Cases were taken from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 6 patients underwent sedation and 3 patients underwent general anaesthesia. Both groups used ketamine, midazolam and fentanyl. Sevoflurane was used as inhalation agent for maintenance. Blood pressure, heart rate, and SpO2 were recorded before and after pericardiocentesis. In both groups, there were no significant different between systolic and diastolic blood pressure, heart rate, and SpO2 before and after the procedure (p>0.05). Immobilization through sedation or general anaesthesia is required to perform an optimal pericardiotomy. Anaesthetic agents were chosen based on their minimal effects toward myocardial depression. Fluids balance before and after the procedure was crucial to prevent hemodynamic instability during effusion evacuation. Conclusion: Both sedation and general anaesthesia were safe for pericardiocentesis, with concern toward anaesthetic agents that were minimally depressive to myocardium, combined with opioid analgesics and other sedative agents, with balanced anaesthesia principle. Optimal intravenous fluid therapy with echocardiography monitoring is crucial. Sedation is more advantageous for patients requiring pericardiocentesis without preoperative preparation for general anaesthesia.
Comparison of the Accuracy of Intraoperative Hemoglobin Measurement between Estimated Blood Loss and Point-of-Care Testing with Hematology Analyzer Soenarto, Ratna Farida; Nugroho, Alfan Mahdi; Fahmy, Ahmad Faishal
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Abstract

Measurement of Estimated Blood Loss (EBL) based on the Allowable Blood Loss (ABL) formula with certain hemoglobin target is often used to guide intraoperative transfusion. Point of Care Testing (POCT) offers easier way to measure haemoglobin. This study aimed to compare the accuracy of the intraoperative hemoglobin measurement between EBL and POCT with Hematology Analyzer in the laboratory as the golden standard. This study used a Bland-Altman test on intraoperative hemoglobin measurement in 43 patients undergoing elective surgery, which were expected require blood transfusion in the Operating Theater of Cipto Mangunkusumo Hospital from December 2014 until March 2015. When EBL had reached ABL with Hb level target 7 g/dL before transfusion was given, blood was drawn for Hb measurement with Sysmex XE-2100® as Hematology Analyzer and HemoCue® Hb 201+ as POCT. Bland-Altman analysis of Hb EBL (7 g/dL) to Hb Hematology Analyzer with interval considered as accurate for Hb 7 g/dL was -1 to 1, revealed wide limits of agreement (-2.267 to 2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealed narrow limits of agreement (-0418 to 0372). There was a significant difference in the accuracy of intraoperative hemoglobin measurement by EBL compared to Hematology Analyzer. Additionally, the measurement by POCT device had good accuracy.
Comparison between lidocaine and nacl 0.9% inhalation in heart rate and blood pressure changes during laryngoscopy and intubation Soenarto, Ratna Farida; Pryambodho, Pryambodho; Adji, Muhammad Prakoso
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (736.403 KB) | DOI: 10.15562/bjoa.v3i1.137

Abstract

Introduction: Laryngoscopy and intubation is an invasive procedure routinely done during general anesthesia. The cardiovascular response to these procedures can be harmful in patients who are vulnerable, especially those who have cardiac or cerebrovascular problems. One method to attenuates the cardiovascular response was the use of anesthetics, including lidocaine. This study aimed to assess the effect of inhaled lidocaine on cardiovascular responses after laryngoscopy and intubation.Patients and Methods: This study was a randomized double-blind clinical trial on 50 subjects who underwent elective surgery, 24 subjects were given inhaled lidocaine 1.5 mg/kg and 25 subjects were given 0.9 % NaCl inhalation before laryngoscopy and intubation. Cardiovascular parameters being investigated were changes in systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate in a serial manner.Results: In the first minute after intubation, MAP and heart rate were higher in the NaCl group. The difference in MAP was 15.5 mmHg (p <0.001) while heart rate was 9.5 beats/min (p <0.001). In the 3rd minute after intubation, MAP and heart rate kept different in both groups: 16.6 mmHg (p <0.001) and 11.2 beats/minute (p <0.001), respectively. In the 5th minute after intubation, MAP and heart rate remained different between two groups: 16.7 mmHg (p <0.001) and 10.0 beats/min (p=0.03), respectively.Conclusion: Lidocaine inhalation was able to attenuate cardiovascular response due to pain stimuli and sympathetic stimulation after laryngoscopy and intubation.
Rotasi Kepala dan Posisi Tubuh Mengubah Tekanan Balon Pipa Endotrakeal Soenarto, Ratna Farida; Harijanto, Eddy; Pramodana, Bintang; Prima, Kustenti
Majalah Anestesia & Critical Care Vol 40 No 1 (2022): Februari
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 | Full PDF (314.904 KB) | DOI: 10.55497/majanestcricar.v40i1.236

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Latar Belakang : Intubasi endotrakeal merupakan salah satu upaya dalam menjaga patensi jalan napas disertai dengan pengendalian oksigenasi dan ventilasi. Intubasi endotrakeal menggunakan sebuah pipa endotrakeal yang dilengkapi dengan balon yang berfungsi sebagai alat fiksasi dan mencegah terjadinya aspirasi jalan napas. Balon pipa endotrakeal dikembangkan umumnya berkisar 20-30 cmH2O sesuai rekomendasi. Tekanan ini dapat dipengaruhi beberapa faktor seperti diameter balon, daya regang, edema pada mukosa trakea, serta perubahan posisi kepala pasien. Perubahan tekanan endotrakeal ini dapat menyebabkan komplikasi mulai dari ringan hingga berat. Penelitian ini bertujuan untuk mengetahui gambaran perbedaan perubahan tekanan bola pipa endotrakeal pada beberapa posisi sehingga dapat meminimalisasi komplikasi. Metode: Penelitian ini merupakan uji klinis dilakukan di RSCM dari bulan Agustus sampai dengan Oktober 2018 pada total 36 subjek yang menjalani anestesia umum dan diintubasi. Tekanan balon pipa endotrakeal ditentukan sebesar 25 cmH2O, pada posisi supinasi dan kepala lurus. Dilakukan perubahan posisi dari supinasi ke lateral dekubitus serta rotasi kepala 15°, 45° dan 60° dari garis tengah. Kemudian dilakukan pengukuran kembali tekanan balon pipa endotrakeal setelah perubahan posisi kepala dan tubuh pasien. Analisis dilakukan dengan melakukan uji komparatif Friedman dan hasil dianggap bermakna jika nilai p 0,05. Hasil : Terdapat perbedaan bermakna tekanan bola pipa endotrakeal antara posisi supinasi dengan rotasi kepala 15°, 45°, 60° dan lateral dekubitus kanan secara statistik. (p<0,001) Namun secara klinis, didapatkan bahwa hanya posisi lateral dekubitus kanan yang memiliki perbedaan yang bermakna dengan nilai perbedaan tekanan 7 (2 - 25) mmH2O. Simpulan: Perubahan posisi supinasi dengan rotasi kepala 15°, 45°, 60° dan posisi lateral dekubitus kanan menyebabkan perubahan tekanan bola pipa endotrakeal. Posisi lateral dekubitus kanan memiliki perbedaan tekanan bola pipa endotrakeal yang bermakna secara klinis.
Blok Subarahnoid Dosis Rendah dan Epidural pada Pasien Hamil dengan Gagal Jantung dan Komorbid Lain yang Menjalani Seksio Sesarea: Sebuah Laporan Kasus Soenarto, Ratna Farida; Alexandra, Arky Kurniati; Ramlan, Andi Ade Wijaya; Alatas, Anas
Majalah Anestesia & Critical Care Vol 40 No 1 (2022): Februari
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 | Full PDF (634.716 KB) | DOI: 10.55497/majanestcricar.v40i1.238

Abstract

Latar Belakang: Penyakit kardiovaskuler merupakan penyebab signifikan pada mortalitas ibu di negara-negara berkembang. Komorbid yang mempengaruhi ini mencakupi obesitas, hipertensi dan kehamilan tua yang memperberat kinerja jantung sehingga dapat mengakibatkan gagal jantung. Ini menjadi tantangan untuk tatalaksana anestesi dengan tujuan utama mencegah luaran buruk kepada ibu dan neonatusnya. Ilustrasi Kasus: Pada kasus ini kami melaporkan wanita, 28 tahun, G4P3A1 hamil 28 minggu, ASA 3 dengan gagal jantung kongestif, superimposed pereklampsia, serta obesitas morbid. Pasien direncanakan untuk seksio sesarea dengan kombinasi anestesi menggunakan penggunaan blok subarahnoid dosis rendah dan epidural (Combined Spinal Epidural Anesthesia/CSE), serta pertimbangan tatalaksana anestesi pada ibu hamil dengan gagal jantung atau komorbid lainnya. Simpulan: Anestesi dengan blok subarakhnoid dosis rendah memiliki efek yang minimal terhadap hemodinamik, dan dapat digunakan pada selektif pasien yang mengalami gagal jantung dan komorbid lainnya.
The Accuracy of Yoon’s Formula for Predicting Central Venous Catheter Depth in Indonesian Pediatric CHD Patients: A Cross Sectional Study Meidisa Akhmad, Adinda; Soenarto, Ratna Farida; Heriwardito, Aldy; Nathania, Eloisa
Majalah Anestesia & Critical Care Vol 43 No 1 (2025): Februari
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.v43i1.419

Abstract

Introduction: A central venous catheter is a routinely inserted tool by anesthesiologists in open-heart surgery. However, incorrect central venous catheter placement depth may lead to complications or suboptimal usage. Yoon’s research in 2006 was done in paediatrics with congenital heart disease in Asia and developed a prediction formula for the depth of central venous catheter. This study aims to prove if Yoon’s formula can be applied to pediatric patients with congenital heart disease in Indonesia. Methods: This analytic observational study, with a cross-sectional design, involved 38 patients undergoing open-heart surgery in RSCM. Yoon’s formula determines the depth of central venous catheter placement. Transesophageal echocardiography assessed the position of the tip of the central venous catheter from the cavoatrial junction to confirm the depth’s accuracy. Results: Yoon’s formula can predict the optimal depth of the central vein catheter 63.16% of the time. There was no complication before central venous catheter placement. This study is limited to right internal jugular vein placements, reducing its generalizability to other insertion sites. Further research with a larger sample and varied approaches is needed to enhance accuracy and develop a more suitable formula. Conclusion: Yoon’s formula is inappropriate for predicting the depth of central vein catheters in pediatric patients with congenital heart disease in Indonesia, but it can still be applied clinically.