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All Journal Medicina Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Bali Journal of Anesthesiology Syntax Literate: Jurnal Ilmiah Indonesia Journal of Social Research Jurnal Komplikasi Anestesi
I Made Subagiartha
Bagian Anestesi Dan Terapi Intensif Fakultas Kedokteran Universitas Udayana/Rumah Sakit Umum Pusat Sanglah
Humanities Computer Science & IT Economics, Econometrics & Finance Education Environmental Science Health Professions Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Public Health Social Sciences Other

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Pemberian Magnesium Sulfat Intravena Meningkatkan Efek Analgesia Pascaoperasi pada Bedah Mayor Menggunakan Anestesi Umum Irawan, Hengki; Subagiartha, I Made; Widnyana, I Made Gede
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1159.515 KB)

Abstract

Penatalaksanaan nyeri akut pascaoperasi merupakan tugas penting dokter anestesi. Morfin banyak digunakan untuk mengontrol nyeri pascaoperasi. Tujuan penelitian ini untuk mengetahui pengaruh pemberian MgSO4 intravena selama operasi terhadap efek analgesia dan kebutuhan morfin pascaoperasi. Penelitian ini adalah uji klinik blok tersamar ganda. Tiga puluh enam subjek usia 21–55 tahun dialokasikan ke dalam kelompok A yang diberikan MgSO4 30 mg/kgBB intravena 15 menit dilanjutkan 15 mg/kgBB/jam sampai akhir operasi dan kelompok B diberikan NaCl 0,9% dengan volume sama yang menjalani operasi bedah mayor di RSUP Sanglah Denpasar pada Juni–Agustus 2014. Data hasil penelitian dianalisis dengan Uji Mann-Whitney. Nilai visual analog scale (VAS) diam dan bergerak pada jam ke-4 dan ke-8 pada kelompok Mg berbeda bermakna (p<0,05). Perbedaan konsumsi morfin pascaoperasi pada jam ke-4, ke-8, dan ke-24 berbeda bermakna (p<0,05). Simpulan penelitian ini adalah pemberian MgSO4 intravena selama operasi meningkatkan efek analgesia dan menurunkan kebutuhan morfin pascaoperasi.Kata kunci: Analgesia pascaoperasi, anestesi umum, bedah mayor, magnesium sulfatIntravenous Magnesium Sulphate Administration to Improve Post-operative Analgesia Effect in Major Surgery with General AnesthesiaAbstractRelieving acute post-operative pain is an important role of anesthesiologist. Morphine is frequently used to control moderate to severe post operative pain. The objective of this study is to understand the effect of intravenous MgSO4 administration in improving post-operative analgesia effect. This study was a double-blind randomized block clinical trial. The subjects of this study were patients who underwent major surgeries in Sanglah Hospital during the period of June to August 2014. Thirty six subjects age 21–55 years allocated to group A received intravenous MgSO4 30 mg/kgBW intravenous bolus in 15 minutes followed by 15 mg/kgBW/hour until the surgery is finished and group B received NaCl 0.9% with the same volume. Data were then analyzed using  the Mann-Whitney Test. The stationary and mobile VAS scores in the  4th and 8th hour in Mg group were significantly different (p<0.05). Post-operative morphine consumptions in the 4th, 8th, and 24th hour were significantly different between the Mg and NaCl 0.9% groups (p<0.05). It is concluded that the administration of  intravenous MgSO4 during operation increases analgesia effect and reduces post-operative morphine needKey words: General anesthesia, magnesium sulfate, major surgery, post-operative analgesia DOI: 10.15851/jap.v2n3.335
Continuous caudal analgesia as a safe and effective method for pediatric post - chordectomy analgesia Senapathi, Tjokorda Gde Agung; Subagiartha, I Made; Widnyana, I Made Gede; Kurniyanta, Putu; Ryalino, Christopher; Estrada, Ronald
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (176.235 KB) | DOI: 10.15562/bjoa.v3i1.113

Abstract

ABSTRACTIt brings great satisfaction for medical officers to be able to see children smiling, laughing, and playing without pain after surgery, yet many children still experience inadequate postoperative pain management. This phenomenon could lead to serious immediate and long term effects in the pediatric patient. Disruption of the healing process caused by pain could become the source of morbidity and mortality in the early postoperative period. Opioid side effects and transformation from acute to chronic pain due to inadequate analgesia are other problems met when dealing with postoperative pain management. This is where regional analgesia takes advantage. Caudal analgesia is an old yet very popular method in pediatric anesthesia and has gained widespread use. It can be delivered as a single injection or continuous infusion. The continuous technique provides a longer duration of analgesia than single injection does. We report a satisfying result from using continuous caudal analgesia for post chordectomy pain management in a 5-year-old boy. 
PERBANDINGAN VALIDITAS SISTEM SKORING ACUTE PHYSIOLOGICAL CHRONIC HEALTH EVALUATION II, SEQUENTIAL ORGAN FAILURE ASSESSMENT, DAN CUSTOMIZED SEQUENTIAL ORGAN FAILURE ASSESSMENT UNTUK MEMPERKIRAKAN MORTALITAS PASIEN NON-BEDAH YANG DIRAWAT DI RUANG PERAWATA Taofik, Stefanus; Subagiartha, I Made; Senapathi, Tjokorda Gde Agung
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (188.79 KB)

Abstract

Penerapan sistem jaminan kesehatan nasional (SJKN) dalam pelayanan di ruang terapi intensif (RTI) mendorong pelayanan di RTI untuk lebih efektif dan efisien. Prediksi hasil perawatan penting baik secara administrasi ataupun klinis dalam manajemen RTI. Pasien non-bedah meskipun jumlahnya tidak banyak, namun memiliki angka mortalitas yang tinggi. Untuk mendapatkan sistem skoring yang baik dan mudah diterapkan dilakukan penilaian missing value, dan diskriminasi dari masing masing sistem skoring. Penelitian ini melibatkan 184 pasien non-bedah yang dirawat di RTI RSUP Sanglah Denpasar yang diambil secara retrospektif dari data tanggal 1 Januari 2014 sampai dengan 31 Desember 2014. Semua pasien dilakukan penilaian APACHE II, SOFA, dan CSOFA. Uji analisis regresi logistik dilakukan untuk menilai pengaruh masing masing sub-variabel terhadap mortalitas, dan selanjutnya mencari cut off point dari analisis kurva ROC untuk mendapatkan sensitivitas dan spesifisitas masing masing. Area under receiver operating characteristic (AuROC) pada acute physiological and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), dan customized sequential organ failure assessment (CSOFA) berturut turut didapatkan 0,892, 0,919, dan 0,9172. Missing value terbanyak didapatkan berturut turut pada SOFA, APACHE II, dan CSOFA sebesar 84,23%, 8,15%, dan 1,65%, dengan dominan sub-variabel hepar (bilirubin). Uji regresi logistik memperlihatkan sub-variabel neurologi, dan kardiovaskular memberikan hubungan bermakna terhadap mortalitas dengan RO 4,58, dan 2,24. Sub-variabel lain yang berpengaruh antara lain acute kidney injury (AKI), sepsis, dan penyakit kronis dengan RO 8,14, dan 3,89. Sistem skoring CSOFA lebih valid dalam memperkirakan mortalitas pasien di RTI RSUP Sanglah Denpasar, karena mempunyai nilai diskriminasi yang lebih baik dan missing value yang lebih sedikit dibandingkan dengan sistem skoring APACHE II dan SOFA. [MEDICINA 2015;46:145-51].Application of sistem jaminan kesehatan nasional (SJKN) in intensive care unit (ICU) service encourages ICU services for being more effective and efficient. Prediction of mortality is important either for administration or clinical in ICU management. Even non-surgical patient population is not large, but it has high mortality rate. To gain good and easy to used scoring system, we assessed missing value, and discrimination for all scoring system. This research enrolled 184 non-surgical patients in ICU of Sanglah Hospital restrospectively started from 1 st january to 31 december 2014. All patient assessed by acute physiological and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and customized sequential organ failure assessment (CSOFA). Analytic logistic regression test was used to determine each sub-variable correlation with mortality, and then to gain cut off point of ROC analytical curve to get sensitivity and specificity. Area under receiver operating characteristic (AuROC) for APACHE, SOFA, and CSOFA were 0.892, 0.919, and 0.9172 consecutively. The missing value for SOFA, APACHE II, and CSOFA is 84.23%, 8.15%, dan 1.65%, which was dominated by bilirubin parameter. Logistic regression analysis shows sub-variable neurology, and cardiovascular respiration gave significant correlation with mortality with OR 4.58 and 2.24. Other significant subvariable were AKI and sepsis with OR 8.14 and 3.89. Customized sequential organ failure assessment scoring system is more valid than APACHE II and SOFA to predict mortality, because it had better discrimination value and less missing value. [MEDICINA 2015;46:145-51].
Pemberian Magnesium Sulfat Intravena Meningkatkan Efek Analgesia Pascaoperasi pada Bedah Mayor Menggunakan Anestesi Umum Hengki Irawan; I Made Subagiartha; I Made Gede Widnyana
Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1159.515 KB)

Abstract

Penatalaksanaan nyeri akut pascaoperasi merupakan tugas penting dokter anestesi. Morfin banyak digunakan untuk mengontrol nyeri pascaoperasi. Tujuan penelitian ini untuk mengetahui pengaruh pemberian MgSO4 intravena selama operasi terhadap efek analgesia dan kebutuhan morfin pascaoperasi. Penelitian ini adalah uji klinik blok tersamar ganda. Tiga puluh enam subjek usia 21–55 tahun dialokasikan ke dalam kelompok A yang diberikan MgSO4 30 mg/kgBB intravena 15 menit dilanjutkan 15 mg/kgBB/jam sampai akhir operasi dan kelompok B diberikan NaCl 0,9% dengan volume sama yang menjalani operasi bedah mayor di RSUP Sanglah Denpasar pada Juni–Agustus 2014. Data hasil penelitian dianalisis dengan Uji Mann-Whitney. Nilai visual analog scale (VAS) diam dan bergerak pada jam ke-4 dan ke-8 pada kelompok Mg berbeda bermakna (p<0,05). Perbedaan konsumsi morfin pascaoperasi pada jam ke-4, ke-8, dan ke-24 berbeda bermakna (p<0,05). Simpulan penelitian ini adalah pemberian MgSO4 intravena selama operasi meningkatkan efek analgesia dan menurunkan kebutuhan morfin pascaoperasi.Kata kunci: Analgesia pascaoperasi, anestesi umum, bedah mayor, magnesium sulfatIntravenous Magnesium Sulphate Administration to Improve Post-operative Analgesia Effect in Major Surgery with General AnesthesiaAbstractRelieving acute post-operative pain is an important role of anesthesiologist. Morphine is frequently used to control moderate to severe post operative pain. The objective of this study is to understand the effect of intravenous MgSO4 administration in improving post-operative analgesia effect. This study was a double-blind randomized block clinical trial. The subjects of this study were patients who underwent major surgeries in Sanglah Hospital during the period of June to August 2014. Thirty six subjects age 21–55 years allocated to group A received intravenous MgSO4 30 mg/kgBW intravenous bolus in 15 minutes followed by 15 mg/kgBW/hour until the surgery is finished and group B received NaCl 0.9% with the same volume. Data were then analyzed using  the Mann-Whitney Test. The stationary and mobile VAS scores in the  4th and 8th hour in Mg group were significantly different (p<0.05). Post-operative morphine consumptions in the 4th, 8th, and 24th hour were significantly different between the Mg and NaCl 0.9% groups (p<0.05). It is concluded that the administration of  intravenous MgSO4 during operation increases analgesia effect and reduces post-operative morphine needKey words: General anesthesia, magnesium sulfate, major surgery, post-operative analgesia DOI: 10.15851/jap.v2n3.335
Perbandingan Dosis Induksi dan Pemeliharaan Propofol Pada Operasi Onkologi Mayor yang Mendapatkan Pemedikasi Gabapentin dan Tanpa Gabapentin Ida Bagus Okta; I Made Subagiartha; Made Wiryana
JAI (Jurnal Anestesiologi Indonesia) Vol 9, No 3 (2017): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (348.671 KB) | DOI: 10.14710/jai.v9i3.19837

Abstract

Latar Belakang : Anestesi umum merupakan teknik anestesi yang paling sering dikerjakan dibandingkan dengan teknik anestesi lain. Total Intravena Anestesi menggunakan propofol telah dikembangkan secara luas, karena menurunnya angka insiden PONV, biaya anestesi yang lebih murah, dan waktu pulih yang cepat. Berbagai teknik, alat dan obat-obatan diteliti untuk mengurangi dosis propofol yang diperlukan durasi operasi karena efek samping propofol yang berbahaya, yang dikenal PRIS (Propofol Related Infusion Syndrome), yang dapat menyebabkan morbiditas dan mortalitas yang tinggi.   Tujuan : Untuk membandingkan dosis induksi dan pemeliharaan propofol yang diperlukan intraoperatif antara kelompok gabapentin dan kelompok kontrol. Selanjutnya hasil penelitian dapat digunakan secara umum dalam penggunaan gabapentin sebagai obat akut pada periode perioperatif.Metode : Penelitian ini adalah double blind clinical trial. Teknik penelitian ini dapat mengkontrol ekspektasi dan  manipulasi subjek penelitian terhadap prosedur penelitian sehingga dapat menghasilkan hasil yang valid dan terpercaya. Penelitian dibagi menjadi dua kelompok, kelompok gabapentin dan kelompok kontrol. 32 sampel tiap kelompok telah menjalani operasi onkologi mayor dengan teknik anestesi yang sama total intravena propofol dengan TCI. Hasil : Dosis induksi kelompok gabapentin memiliki 1,15 mg/kgbb dibandingkan dengan kelompok kontrol yang memiliki median 1,48 mg/kgbb (p < 0,001). Dosis pemeliharaan kelompok gabapentin memiliki median 93,27 mcg/kgbb/menit dibandingkan kelompok kontrol yang memiliki median 123,80 mcg/kgbb/menit (p < 0,001).Simpulan : Premedikasi oral gabapentin 600 mg efektif menurunkan dosis induksi dan pemeliharaan propofol yang digunakan pada teknik TIVA untuk menjaga operasi mayor onkologi. Selanjutnya premedikasi gabapentin dapat digeneralisir penggunaannya pada operasi lain untuk menurunkan kebutuhan propofol intraoperatif.
Quadratus Lumborum Block as Intraoperative Analgesic Treatment in Pediatric with Hirschprung’s disease Lesmana, Pita Mora; Ratumasa, Marilaeta Cindryani Ra; Subagiartha, I Made; Senapathi, Tjokorda Gde Agung
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
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.v12i1.14973

Abstract

Overview: A 4-year-old boy diagnosed with Hirschsprung's disease since birth will undergo a planned Duhamel procedure. Internationally, the prevalence of Hirschsprung's disease is approximately 1 in 1,500 to 1 in 7,000 live births and usually requires immediate intervention through surgical procedures. The extended length of pediatric surgeries presents a unique challenge for anesthesiologists aiming to minimize the use of opioids, considering their less desirable effects in this patient population. In this case, we opted for the use of quadratus lumborum block (QLB) as intraoperative analgesia. This refers to a meta-analysis by Wen-li Zhao et al, all suggest that QL block offers more effective postoperative pain relief in children after lower abdominal surgeries. Management: After the patient was intubated, we performed a quadratus lumborum block using an anterior approach as an intraoperative analgesia technique. The local anesthetic used was 0.375% ropivacaine + 4 mg dexamethasone, volume 10 ml on both sides. Dermatom covered anterior QL block includes T4 to T12-L1, blocks the anterior and the lateral cutaneous branches of the nerves Result: No additional opioid dose administered during the surgical procedure. Conclusion: The QLB in pediatric patients is quite effective in managing pain during surgery for patients undergoing the Duhamel procedure.
Optimizing Anesthesia for a Pediatric Patient with Cyanotic Heart Disease: Pulmonary Atresia with MAPCAs Putra, Kadek Agus Heryana; Kurniyanta, I Putu; Subagiartha, I Made; Akbar, Lalu Reza Aldira
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i2.57739

Abstract

Pulmonary atresia with major aortopulmonary collateral arteries (MAPCAs) is a rare and complex congenital heart anomaly marked by the absence of a direct connection between the right ventricle and the pulmonary arteries. The pulmonary blood supply originates via collateral arteries that arise from the aorta. Pulmonary atresia with major aortopulmonary collateral arteries (MAPCAs) poses considerable difficulties in perioperative management, especially during general anesthesia for dental procedures in pediatric patients. This case report details the anesthetic management of a 5-year-old male with pulmonary atresia and MAPCAs undergoing dental extractions under general anesthesia. The anesthetic plan prioritized maintaining systemic blood pressure to ensure pulmonary perfusion, avoiding increases in pulmonary vascular resistance, and preventing myocardial depression. Anesthesia was induced with ketamine and fentanyl, while maintenance was achieved using sevoflurane and dexmedetomidine, with pressure-controlled ventilation to optimize hemodynamics. Postoperative recovery was uneventful, with the patient monitored in the pediatric intensive care unit. The management of patients with pulmonary atresia and MAPCAs requires careful planning and a multidisciplinary approach. A tailored anesthetic strategy emphasizing hemodynamic stability and oxygenation is critical. This report underscores the importance of understanding the pathophysiology of MAPCAs to optimize perioperative outcomes.
Spinal Anesthesia for Cesarean Section in a Patient with Total AV Block Choirunanda, Agiel Fahlevie; Subagiartha, I Made
Journal of Social Research Vol. 5 No. 1 (2025): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v5i1.2924

Abstract

Anesthetic management in obstetric patients with heart disease, especially Total Atrioventricular (AV) Block, is a major challenge due to the high risk of hemodynamic collapse and maternal mortality. This condition requires a very careful approach to anesthesia, especially in patients with comorbid preeclampsia. This case study aims to describe a safe spinal anesthesia management strategy in pregnant patients with Total AV Block without the installation of a prophylactic pacemaker. A 31-year-old female patient with G2P1001 at 37+6 weeks gestation, diagnosed with Superimposed Preeclampsia with Total AV Block, underwent emergency cesarean section. Preoperative evaluation showed a pulse rate of 38–55 bpm and evidence of total AV block on the ECG. The anesthesia procedure uses spinal with a low dose 0.5% Bupivacaine Heavy (10 mg) to limit the sensory block at the T5 level from hitting the heart accelerator fibers. Throughout surgery, the patient's hemodynamics are stable with tolerable fluctuations in blood pressure and pulse. Interestingly, the administration of 0.5 mg of atropine still produced an increased response in heart rate and blood pressure although it was generally ineffective in total AV blocks. The surgery took place safely, the baby was born with a good Apgar score, and the patient was admitted to the postoperative ICU for strict monitoring. In conclusion, low-dose spinal anesthesia can be a safe option in patients with Total AV Block with rigorous preparation, intensive monitoring, and emergency pacemaker readiness.
Co-Authors Akbar, Lalu Reza Aldira Choirunanda, Agiel Fahlevie Christopher Ryalino Estrada, Ronald Hengki Irawan Hengki Irawan I Made Gede Widnyana Ida Bagus Okta Kadek Agus Heryana Putra, Kadek Agus Kurniyanta, I Putu Lesmana, Pita Mora Made Wiryana Putu Kurniyanta Ratumasa, Marilaeta Cindryani Ra stefanus taofik, stefanus Tjokorda Gde Agung Senapathi