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All Journal Jurnal Anestesi Perioperatif Majalah Anestesia dan Critical Care Indonesian Journal of Anesthesiology and Reanimation (IJAR) Journal of Social Research Jurnal Neuroanestesi Indonesia
Doddy Tavianto
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Economics, Econometrics & Finance Education Health Professions Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Penatalaksanaan Anestesi pada Pasien dengan Sick Sinus Syndrome yang Menjalani Laparotomi Ec Perforasi Gaster Radian Ahmad Halimi; Doddy Tavianto
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Disfungsi dari Sinoarterial node (SA node, yang dikenal sebagai “Sick Sinus Syndrome”,  merupakan salah satu penyebab gangguan ritme jantung, dan dapat disebabkan  oleh gangguan baik faktor intrinsik atau faktor ekstrinsik dari SA node. Diagnosis Sick Sinus Syndrome ditegakkan dengan adanya gangguan ritme jantung dengan episode takikardia-bradikardia, dan disertai  gejala klinis seperti; sinkop, palpitasi, atau dapat saja  tanpa gejala klinis. Semua literatur mengatakan penatalaksanaan Sick Sinus Syndrom perioperatif adalah dengan  pemasangan  pacemaker jantung baik transkutaneus maupun secara transvenous pada preoperatif. Seorang pria berumur 75 tahun dengan diagnose peritonitis diffuse yang disebabkan oleh perforasi gaster. Pada pemeriksaan klinis preoperatif didapatkan pasien kompos mentis, anamnesis ada riwayat hipertensi yang tidak terkontrol. Pada pemeriksaan fisik didapatkan bradikardi dengan nadi 31x/menit, tekanan darah 190/100 mmHg. Ditempat tersebut tidak terdapat fasilitas untuk pemasangan pace maker baik trans kutaneous maupun secara transvenous. Dengan pertimbangan sirkulasi organ (mikrosirkulasi) cukup baik ( kompos mentis, SpO2 99% dan setelah optimalisasi diuresi mencapai 1cc/kgBB/jam). Pemeriksaan foto toraks didapatkan kardiomegali tanpa bendungan paru, pemeriksaan laboratorium menunjukkan angka – angka normal termasuk tes fungsi ginjal (kreatinin 0,97 mg/dl dengan ureum 82,6 mg/dl). Diputuskan untuk melakukan tindakan anestesi / pembedahan ditempat ybs dan rencana anestesi adalah dilakukan dengan anestesi umum. Saat pasien masih sadar, mulai diberikan fentanyl secara bertahap, 2 µgr/kgBB. Nadi berkisar antara 28 – 44x/menit, SpO2 98%.  Limabelas menit kemudian diberikan propofol secara titrasi dan setelah pasien tertidur fasilitas intubasi dengan atrakurium. Setelah intubasi  nadi mencapai 44 - 90x/menit dan saat nadi mencapai 90x/menit, didapatkan nadi yang iregular berupa ventricular extrasystole ( VES ) yang multifokal, diputuskan untuk mempertahankan nadi sekitar 35 – 40x/ menit dengan tekanan darah 160/70 mmHg. Selama pembedahan, nadi dan tekanan darah stabil pada kisaran diatas. Pasca bedah pasien dirawat di ruang perawatan intensif selama 2 hari setelah itu pindah ke ruang perawatan biasa dalam keadaan baik. Pasien pulang setelah hari ke 8.Kata kunci: Sick Sinus Syndrome, Bradikardia Anesthesia for Laparatoy e.c Gaster Perforation with Sick Sinus SyndromeSA node dysfunction, or known as  Sick Sinus Syndrome is the common cause of disrythmia and can be caused by intrinsic and extrinsic factors of the SA node. The diagnose performed by the occurrence of bradi- takhikardia episode and the clinical symptoms, could be syncope, palpitation, or maybe asymptomatic. Some of the literature defined that the perioperative management of  sick sinus syndrome is preoperative insertion of pacemaker (transcutaneal or transvenous pacing). A 75 years old man underwent laparotomy with diffuse peritonitis caused by gastric perforation. In preoperative clinical evaluation the patients revealed full awake ( compos mentis), with  history of uncontrolled hypertension. In physical exammination a severe bradicardia was found with pulse of 31x/minute, and the blood pressure was 190/100 mmHg. In this rural hospital there was no fascility to insert the pace-maker. The organ perfusion was considered to be optimal from clinical evaluation ( proved by the wakefullness, SpO2 99%, and diuresis 1cc/kgBW after optimalization ). The chest X’ray showed a cardiomegali without the sign of pulmonary congestion. The laboratory test were within normal limit including the renal function test ( creatinin; 0,97 mg/dl, and ureum 82,6 mg/dl). We decided to perform general anesthesia in this procedure. Before the  induction while patient still awake, fentanyl 2µg/kgBW was given intravenously. Fifteen menue after fentanyl administration induction of anesthesia performed and initiated with propofol intravenous injection slowly until patients felt asleep, than intubated after muscle relaxant intravenous reached  the onset After intubation the pulse / heart rate of patients rose to 44 – 90x/minute. While the pulse was 90/ minute the heart rythm of the patients became irregular, a multifocal ventricular extra systole occured, and it was reversible when the heart rate back to 44x/ minute. We decided to maintain the heart rate between 35 – 40dmitted to the iCU, and after 2 days in the ICU patients was transfered to the ward, and can be dischared home after 8 days.Keywords: Bradikardia, Sick Sinus Syndrome DOI: 10.15851/jap.v1n1.159
Implementasi Early Warning Score pada Kejadian Henti Jantung di Ruang Perawatan Rumah Sakit Dr. Hasan Sadikin Bandung yang Ditangani Tim Code Blue Selama Tahun 2017 Nurul Subhan; Gezy Weita Giwangkencana; M. Andy Prihartono; Doddy Tavianto
Jurnal Anestesi Perioperatif Vol 7, No 1 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (219.006 KB) | DOI: 10.15851/jap.v7n1.1583

Abstract

Angka kejadian henti jantung di rumah sakit sangat bervariasi. Sebagian besar kasus henti jantung didahului oleh penurunan kondisi pasien yang digambarkan dengan gangguan parameter tanda vital. Keberhasilan Early warning score (EWS) dalam menurunkan angka kejadian henti jantung dipengaruhi oleh implementasi yang baik dari instrumen EWS sesuai dengan pedoman yang ditetapkan. Penelitian ini bertujuan melihat implementasi EWS di RSUP Dr. Hasan Sadikin Bandung. Penelitian bersifat deskriptif dengan desain potong lintang menggunakan data rekam medis pasien henti jantung di ruang perawatan yang ditangani oleh tim Code Blue selama tahun 2017, dan dilakukan pada bulan November 2018. Data EWS 6 jam sebelum dan saat henti jantung, serta tindak lanjut yang dilakukan setelah penilaian EWS dicatat. Didapatkan 87 data rekam medis henti jantung yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Di antaranya, 72% memiliki catatan EWS lengkap, 9% memiliki catatan EWS tidak lengkap, dan 18% tidak memiliki data EWS. Dari 63 data rekam medis yang memiliki data EWS lengkap hanya 21% yang mendapat tindak lanjut yang sesuai dengan standar prosedur operasional EWS. Simpulan penelitian ini adalah implementasi EWS di ruang rawat inap RSUP Dr. Hasan Sadikin belum cukup memuaskan. Tindak lanjut yang dilakukan setelah penilaian EWS belum sesuai dengan standar prosedur operasional EWS yang berlaku.Implementation of Early Warning Score to Patients with In-Hospital Cardiac Arrest in Dr. Hasan Sadikin General Hospital Managed  by Code Blue Team Incidence of in-hospital cardiac arrest varies greatly around the world. Most in-hospital cardiac arrests are preceded with physiological deteriorations that manifest as alterations in vital signs. The success of early warning score (EWS) in reducing the incidence of cardiac arrest is influenced by the good implementation of EWS instruments by ward staff in accordance with the guidelines The aim of this study was to assess to what degree EWS was implemented at Dr. Hasan Sadikin General Hospital Bandung. This was a cross sectional descriptive study on patients with in-hospital cardiac arrest managed by the code blue team during 2017 that was conducted in November 2018. EWS 6 hour prior to cardiac arrest event, EWS at the event, and action taken upon finding an abnormal value were obtained from medical records.  Eighty seven medical records were included. Of these, 72% medical records had complete EWS data, 9 medical records had incomplete EWS data, and 18% medical records had no EWS recorded. From those 63 medical records with complete EWS recorded, only 21% had been managed correctly according to the EWS guideline. This study concludes that the implementation of EWS in the wards of Dr. Hasan Sadikin General Hospital Bandung has not been completely satisfactorily. Actions taken after EWS assessment are still not accordance with the EWS guideline.
Perubahan Fungsi Kognitif Peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran Setelah 24 Jam Kerja Nurchaeni, Ati Nurchaeni; Tavianto, Doddy; Oktaliansah, Ezra
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2850.464 KB) | DOI: 10.24244/jni.v8i3.3

Abstract

Latar Belakang dan Tujuan: Profesi dokter anestesi merupakan profesi dengan beban kerja tinggi yang dituntut untuk berpikir dan bertindak cepat dan tepat dalam situasi kritis. Kekurangan tidur, kelelahan, dan perubahan irama sirkadian mempengaruhi fungsi kognitif dokter anestesi. Tujuan penelitian ini untuk mengetahui perubahan fungsi kognitif peserta Peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran setelah 24 jam kerja yang diperiksa menggunakan Montreal Cognitive Assessment versi Indonesia (MoCA-INA). Subjek dan Metode: Penelitian ini merupakan penelitian deskriptif observasional prospektif dengan pendekatan cross sectional yang dilakukan pada 62 subjek dengan memeriksa MoCA-INA jam ke-0 dan jam ke-24. Hasil: Pada penelitian ini didapatkan penurunan nilai rata-rata MoCA-INA dengan nilai jam ke-0 yaitu 29,84 0,365 dan jam ke-24 yaitu 28,92 1,010. Berdasarkan aspek kognitif yang diperiksa, fungsi atensi merupakan aspek yang mengalami penurunan setelah jam ke-24. Penurunan nilai MoCA-INA paling banyak terdapat pada subjek yang bertugas di kamar operasi. Penurunan nilai rata-rata MoCA-INA setelah 24 jam kerja tersebut masih dalam batas normal karena masih di atas nilai acuan dan secara klinis tidak menunjukkan gangguan. Simpulan: Terdapat penurunan fungsi kognitif peserta PPDS Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran setelah 24 jam kerja.Cognitive Function Alterations on Residents Anesthesiology and Intensive Care of Medical Faculty Universitas Padjadjaran after 24 Hours ShiftAbstractBackground and Objective: Anesthesiologist is a profession with a heavy workload which is need fast thinking and rapid decision making in a critical and life-threatening situation. Sleep deprivation, extended workshifts, exhaustion and circardian cycle changes can affect anesthesiologists cognitive function. This aim of this study was to evaluate cognitive function changes in Residents of Anesthesiology and Intensive Therapy in Medical Faculty Universitas Padjadjaran after 24 hours shift using Montreal Cognitive Assesment-Indonesia Version (MoCA-INA).Subject and Method: This study was an observational-descriptive-prospective study using crosss sectional approach evaluating MoCA-INA score in 0th hour and 24th hour after shift in 62 subjects. Result: The result of this study shown an average MoCA-INA score at 0th hour was 29.84 0.365 while at 24th hours the average score was 28.92 1.010. According to MoCA-INA, attention is the deprived domain at 24th hour after shift. MoCA-INA score declines mostly in subjects working in the operating room. According to MoCA-INA cut off value, the score of 26 is considered normal after 24 hours shift and not showing any clinical disturbance. Conclusion: The conclusion of this study is decreasing cognitive function among Anesthesiology Medical Faculty Universitas Padjadjaran residents after 24 hours shift.
Blokade Peribulbar dengan Adjuvan Fentanil: Efek Hemodinamik dan Analgetik pada Vitrektomi Yadi, Dedi Fitri; Nadya, Siti Fairuz; Halimi, Radian Ahmad; Tavianto, Doddy; Pradian, Erwin; Fuadi, Iwan
Jurnal Anestesi Perioperatif Vol 13, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v13n2.4413

Abstract

Operasi vitrektomi membutuhkan analgesia adekuat dan stabilitas hemodinamik, terutama pada pasien usia lanjut dengan komorbiditas. Ropivakain adalah anestesi lokal yang umum digunakan untuk blokade peribulbar, namun kualitas bloknya dapat ditingkatkan dengan penambahan opioid seperti fentanil. Studi ini merupakan penelitian pertama yang membandingkan efektivitas ropivakain 0,75% dengan kombinasi ropivakain 0,75% dan fentanil 3 μg/mL pada tekanan darah dan kualitas analgesia pada operasi vitrektomi. Desain penelitian ini adalah single blind randomized controlled trial yang melibatkan 54 pasien yang menjalani vitrektomi. Penelitian dibagi menjadi dua kelompok yang masing-masing terdiri 27 pasien: kelompok R yang menerima ropivakain 0,75% dan kelompok RF yang menerima ropivakain 0,75% dan fentanil 3 μg/ml. Tekanan darah sistolik, diastolik, MAP, serta kualitas analgesia (NRS) diukur pada tiga waktu yaitu sebelum, selama dan setelah operasi. Analisis statistik menggunakan uji t tidak berpasangan, Mann Whitney dan Chi-Square. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan bermakna dalam perubahan tekanan darah sistolik, diastolik, dan MAP antara kedua kelompok (p>0,05). Kualitas analgesia yang dinilai menggunakan NRS juga tidak menunjukkan perbedaan signifikan (p>0,05). Kesimpulan penelitian ini adalah kombinasi ropivakain 0,75 % dan fentanil 3 mcg/ml memberikan hasil yang sebanding dengan ropivakain 0,75 % saja dalam hal stabilitas hemodinamik dan kualitas analgesia pada operasi vitrektomi.
Comparison of Intravenous Administration of Remifentanil with Fentanyl for Increased Blood Sugar Levels in Post Cardiac Surgery Patients Irvan; Tavianto, Doddy; Sudjud, Reza Widianto
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 1 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I12024.14-22

Abstract

Introduction: The incidence of hyperglycemia in patients with heart disease undergoing cardiac surgery reaches 50% in patients without a history of Diabetes Mellitus. This condition of hyperglycemia can increase morbidity and mortality. Objective: This study aims to assess the effect of using the agent remifentanil intravenously 0.5-1 µg/kgBW bolus followed by maintenance at a dose of 0.05-0.1 µg/kgBW/minute intravenously compared to the use of fentanyl 3-10 µg/kgBW followed by a maintenance dose of 0.03-0.1 µg/kgBW/minute for increased blood sugar levels in patients undergoing cardiac surgery with the Cardiopulmonary Bypass (CPB) procedure. Methods: This study is an experimental study with a single-blind randomized controlled design. Patients will be divided into 2 groups consisting of 12 patients each, namely group R (remifentanil) received remifentanil, and group F (fentanyl) received fentanyl. Blood sugar levels will be checked before and after surgery. Results: The research has been conducted at Dr. Hasan Sadikin Hospital Bandung from February 2023 to May 2023. The average increase in blood sugar levels in the remifentanil group was 74 mg/dl, while in the fentanyl group, it was 90 mg/dl. The p-value given is 0.214. Statistical test results showed that the value of p> 0.05. Conclusion: This study concludes that there is no significant difference in the increase in blood sugar levels between the two groups (remifentanil and fentanyl). This can be caused by the use of opioid doses in the lower range and more complex surgical procedures in our research.
Comparing 0.75% Ropivacaine and 0.5% Levobupivacaine For Peribulbar Blockade In Vitrectomy Surgery Towards Intraocular Pressure Tavianto, Doddy; Aditya, Ricky; Irawati, Dian; Annasya, Aria
Journal of Social Research Vol. 3 No. 5 (2024): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v3i5.2085

Abstract

Peribulbar blockade is a regional anesthetic technique that can be used for vitrectomy surgery. Ropivacaine and levobupivacaine are local anesthetics that have the advantage of a long duration of action and a lower complication rate than bupivacaine. This study aims to find the effect of intraocular pressure from ropivacaine and levobupivacaine. The study design was a double-blind randomized controlled trial on 60 patients underwent vitrectomy at Netra Ophthalmic Clinic Bandung with peribulbar blockade. Twenty-nine subjects received 0.75% ropivacaine and thirty-one subjects received 0.5% levobupivacaine for peribulbar blockade. Assessment of eye intraocular pressure was assessed before the block, 5 minutes, 10 minutes, and 15 minutes. The 0.75% ropivacaine group obtained an average of 4.42mmHg at 15 minutes, while the 0.5% levobupivacaine group averaged 2.33mmHg after 15 minutes after injection. Statistical results obtained p value <0.05 which means significant intraocular pressure of the two drugs. Intraocular pressure of ropivacaine 0.75% lower than levobupivacaine 0.5% in peribulbar blockade in vitrectomy surgery.
Co-Authors A. Himendra Wargahadibrata A. Himendra Wargahadibrata Andi Mursali Andi Mursali, Andi Annasya, Aria Arsy Felisita Dausawati Arsy Felisita Dausawati Chairil Gani C. Chairil Gani C. Dedi Fitri Yadi Dewi Yulianti Bisri Dian Irawati, Dian Dino Irawan Dino Irawan Eri Surahman Eri Surahman Erwin Pradian Ezra Oktaliansah Fadlyansyah Ramli Fadlyansyah Ramli Fikran, Zaki Fitri Sepviyanti Fitri Sepviyanti Gezy Weita Giwangkencana Handoyo Harsono Harsono, Handoyo Hilmy Manuapo Iervan Churniawan Tanjung Ike Sri Redjeki Ike Sri Redjeki Irvan Iwan Fuadi M. Andy Prihartono M. Fajar Sadli Mira Silviana Mira Silviana, Mira Nadya, Siti Fairuz Nurchaeni, Ati Nurchaeni, Ati Nurchaeni Nurul Subhan Radian Ahmad Halimi Raditya Fauzan Raditya Fauzan, Raditya Reza Widianto Sudjud Ricky Aditya, Ricky Rudi K. Kadarsah Rudi K. Kadarsah Rudi Kurniadi Kadarsah Ruli Herman Sitanggang Sadli, M. Fajar Suwarman Suwarman Suwarman Suwarman, Suwarman Tanjung, Iervan Churniawan Tinni T. Maskoen Tinni T. Maskoen Tinni T. Maskoen U. Kaswiyan U. Kaswiyan Yuanda Rizawan Putra Yustisa Sofirina Harahap Yustisa Sofirina Harahap, Yustisa Sofirina Zaki Fikran