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All Journal Jurnal Anestesi Perioperatif
A. Himendra Wargahadibrata
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
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Ketamin Kumur Efektif untuk Mengurangi Sore Throat Pascaintubasi Satriyanto, M. Dwi; Husaeni, Husi; Wargahadibrata, A. Himendra
Jurnal Anestesi Perioperatif Vol 2, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tindakan intubasi merupakan salah satu penyebab trauma mukosa jalan napas tersering yang mengakibatkan nyeri tenggorok pascaintubasi atau post operative sore throat (POST), telah dilaporkan insidensi ini sekitar 6–50% setelah tindakan anestesi umum endotrakeal. Salah satu cara pencegahan POST adalah dengan menggunakan ketamin kumur sebelum induksi, karena ketamin mempunyai kemampuan sebagai antinosisepsi dan antiinflamasi. Limapuluh pasien dengan ASA I-II, yang telah dilakukan tindakan operasi elektif kasus ginekologi dengan anestesi umum endotrakeal, yang dilakukan penelitian secara prospektif dengan melakukan uji klinis rancangan acak lengkap terkontrol buta ganda (double blind randomized controlled trial) di Central Operating Theatre (COT) Rumah Sakit Dr. Hasan Sadikin Bandung pada April–Juli 2009. Pasien secara ancak dibagi menjadi dua kelompok dengan 25 subjek tiap kelompok, kelompok I, diberikan ketamin 0,5 mg/kgBB dalam NaCl 0,9% 30 mL; kelompok II, NaCl 0,9% sebanyak >30 mL. Pasien diminta untuk berkumur dengan cairan ini selama 30 detik, 5 menit sebelum induksi. POST dinilai pada jam T0, T2, T4, dan T24 setelah operasi dengan 4 skala (0–3). Kejadian POST lebih sering terjadi pada kelompok II dibandingkan dengan kelompok I pada T0, T2 dan T4 dan kelompok II secara signifikan lebih berat menderita POST dibandingkan dengan kelompok I (p<0,05). Simpulan penelitian ini adalah ketamin kumur mengurangi kejadian dan derajat POST.Kata kunci: Intubasi, ketamin kumur, post operative sore throat (POST)The Effectivity of Ketamine Gargle in Reducing Post Operative Sore Throat (POST) Following IntubationTracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in post operative sore throat (POST) with reported incidences of 6–50%. We compared the effectiveness of ketamine gargles compared to placebo in preventing POST after endotracheal general anesthesia. One of the POST preventions by usingketamine gargle before induction, because ketamine has anti-nociceptive and anti-inflamatory properties Fifty, ASA I–II, patients undergoing elective surgery for gynecologic under general anaesthesia endotracheal were enrolled in a double blind randomized controlled trial study at Central Operating Theatre (COT) Dr. Hasan Sadikin Hospital Bandung during April–June 2009. Patients were randomly allocated into two groups< of 25 subjects each: Group I, receiving ketamine 0,5 mg/kgBW in saline 30 mL; Group II, receiving saline 30 mL. Patients were asked to gargle this mixture for 30 second, 5 minutes before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0–3). POST occurred more frequently in Group II, when compared with Group I, at 0, 2, and 4 h and significantly more patients suffered POST in Group II compared with Group I (p<0.05). The conclusions of this study revealed that ketamine< gargles reduces the incidence and degree of POST.Key words: Intubation, ketamine gargle, post operative sore throat (POST) DOI: 10.15851/jap.v2n1.237
Perbandingan Efektivitas Anestesi Spinal Menggunakan Bupivakain Isobarik dengan Bupivakain Hiperbarik pada Pasien yang Menjalani Operasi Abdomen Bagian Bawah Longdong, Jeffry F.; Redjeki, Ike Sri; Wargahadibrata, A. Himendra
Jurnal Anestesi Perioperatif Vol 1, No 2 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penyebaran obat anestesi lokal pada anestesi spinal sangat ditentukan oleh barisitas obat anestesi lokal dan posisi pasien. Penelitian ini dilakukan untuk mengetahui perbandingan anestesi spinal menggunakan bupivakain 0,5% isobarik hiperbarik terhadap lama kerja blokade sensoris dan tinggi blokade sensoris pada operasi abdomen bagian bawah. Penelitian eksperimental secara randomized control trial (RCT) pada 40 pasien dengan status fisik ASA I–II, usia 17–60 tahun yang menjalani operasi abdomen bagian bawah di ruang operasi bedah sentral Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Januari sampai April 2011. Pasien dibagi dalam kelompok isobarik dan kelompok hiperbarik. Tinggi blokade sensoris, lama kerja blokade sensoris dicatat dan dilakukan uji statistik dengan student t-test, chi-kuadrat. Dari hasil penelitian didapatkan lama kerja blokade sensoris pada kelompok isobarik lebih panjang dibandingkan dengan kelompok hiperbarik (242,4 menit SB 28,04 vs 132,95 menit SB 11,33) dengan perbedaan yang bermakna (p<0,001). Tinggi blokade sensoris pada kelompok isobarik lebih rendah dibandingkan dengan bupivakain kelompok hiperbarik. Simpulan dari penelitian ini menunjukkan bupivakain isobarik mempunyai penyebaran lebih rendah dan lama kerja lebih panjang. Kata kunci: Abdomen bagian bawah, analgesia spinal, barisitas ,bupivakain, obat anestesi lokal, teknik anestesiEffectivity of Spinal Anaesthesia Using Isobaric Bupivacaine and Hyperbaric Bupivacaine on Patients Undergoing Lower Abdominal SurgeryDistribution of local anesthetics in spinal anesthesia is most determined by baricity and position. The study was conducted to explore the comparison of effect between spinal anesthesia technique using 0.5% isobaric bupivacaine with 0.5% hyperbaric bupivacaine on duration and level of sensory blocking action in lower abdominal surgery. This experimental study was conducted using randomized control trial (RCT)in 40 patients with physical ASA I–II status, aged 17–60 years, who underwent lower abdominal surgery in central operating theatre Dr. Hasan Sadikin Hospital-Bandung within January to April 2011. The patients were divided into two groups, the hyperbaric group and the isobaric group. The recording included sensory blocking level, sensory blocking duration, and statistical analysis using Student t-test and chi-square test. . Sensory blocking levels in isobaric group were lower than those in hyperbaric group. The conlusion of the study indicates that isobaric bupivacaine has lesser distribution and longer duration of action.Key words: Anesthesia technique, baricity, bupivacaine, local anesthetics, lower abdomen, spinal analgesia  DOI: 10.15851/jap.v1n2.117
Patofisiologi Pintasan Jantung Paru Tavianto, Doddy; Wargahadibrata, A. Himendra; Gani C., Chairil
Jurnal Anestesi Perioperatif Vol 1, No 2 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Perubahan fisiologi yang disebabkan oleh pintasan jantung paru (PJP) adalah perubahan pulsatilitas, pola aliran darah, pengaruh paparan darah terhadap permukaan nonfisiologis, kerusakan darah akibat tekanan (shear stress), hemodilusi, dan respons stres yang berlebihan. Peningkatan keamanan penggunaan PJP bergatung pada pengetahuan dan pemahaman yang baik terhadap perubahan homeostatis sirkulasi normal. Kontrol sirkulasi selama PJP dilakukan dengan memerhatikan aliran darah sistemik, tekanan arteri, tekanan vena, dan distribusi aliran darah. Perubahan sirkulasi selama PJP dapat terjadi saat PJP dimulai, pada periode hipotemia, pada fase pemulihan temperatur (rewarming), saat PJP dengan temperatur hangat (warm CPB) dan PJP juga akan mengakibatkan perubahan pada mikrosirkulasi, serta keadekuatan perfusi jaringan.Kata kunci: Efek pintasan jantung paru, patofisiologi, pintasan jantung paru Patophysiology of Cardiopulmonary Bypassphysiologic changes introduced by cardiopulmonary bypass include an alteration in pulsatile, blood flow >pattern, exposure of blood to nonphysiologic surface, blood damage due to shear stress, hemodilution, and overload stress response. The increase of cardiopulmonary bypass safety depends on good knowledge and understanding on normal circulatory hemostatis changes. Circulation control during cardiopulmonary bypass was done by observing systemic blood flow, arterial pressure, venous pressure, and blood< flow distribution. Circulatory changes during cardiopulmonary bypass can happen on set of action, hipotermia periode, rewarming phase, during cardiopulmonary bypass with warm temperature, and also cardiopulmonary bypass can cause changes in microsirculation and adequacy of tissue perfusion.Key words: Effect of cardiopulmonary bypass, pathophysiology, cardiopulmonary bypass DOI: 10.15851/jap.v1n2.125
Perbandingan Insidensi Post Dural Puncture Headache (PDPH) Pascaseksio Sesarea Dengan Anestesi Spinal Antara Tirah Baring 24 Jam Dengan Mobilisasi Dini Prihartono, Mohamad Andy; Oktaliansah, Ezra; Wargahadibrata, A. Himendra
Jurnal Anestesi Perioperatif Vol 1, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Post Dural Puncture Headache (PDPH) merupakan salahsatu komplikasi iatrogenik dari anestesi spinal. Patofisiologi PDPH sampai saat ini belum jelas, namun teori yang selama ini dianut akibat penurunan volume dan tekanan CSS (Cairan SerebroSpinal). Penelitian terdahulu menyatakan PDPH dapat dicegah dengan tirah baring selama 24 jam. Beberapa penelitian terbaru membuktikan mobilisasi dini tidak meningkatkan resiko PDPH. Tujuan penelitian ini untuk membuktikan bahwa tidak ada perbedaan insidensi PDPH pada pasien yang dilakukan tirah baring selama 24 jam dengan mobilisasi dini segera setelah fungsi motorik pulih.Penelitian dilakukan dengan tipe quasi experimental dan rancangan rangkaian waktu dengan pembanding. Penelitian melibatkan 200 wanita hamil berumur 18-30 tahun, yang akan dilakukan seksio sesarea dengan anestesi spinal, kemudian dibedakan dalam dua kelompok masing-masing 100 orang. Kelompok pertama dilakukan mobilisasi dini segera setelah fungsi motorik pulih (skala Bromage 1) dan kelompok kedua mobilisasi setelah tirah baring selama 24 jam pascaseksio sesarea. Kemudian, setiap kelompok dilakukan pengamatan terhadap ada atau tidaknya PDPH sampai 2 hari pascaoperasi. Dari hasil penelitian dianalisis dengan uji statistik yaitu uji chi kuadrat dan uji Mann Whitney, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa perbandingan insidensi PDPH pada kelompok yang dilakukan mobilisasi dini (setelah fungsi motorik pulih) dan tirah baring selama 24 jam tidak bermakna (p>0,05). Pada kelompok pertama (mobilisasi dini) 100% tanpa PDPH dan kelompok kedua (tirah baring 24 jam) 99% tanpa PDPH. Simpulan dari penelitian ini adalah tidak didapatkan perbedaan insidensi PDPH pada pasien pascaseksio sesarea dengan anestesi spinal yang dilakukan tirah baring selama 24 jam dengan mobilisasi dini segera setelah fungsi motorik pulih.Kata kunci : mobilisasi dini, Post Dural Puncture Headache, seksio sesarea dengan anestesi spinal, tirah baring 24 jamComparison Of Post Dural Puncture Headache (PDPH) Incidence In Post Caesarean Section Using Spinal Anesthesia Underwent Bed Rest Position For 24 Hours Compared With Early MobilizationPost Dural Puncture Headache (PDPH) is defined as an iatrogenic complication of spinal anesthesia. The pathophysiology of PDPH remains unknown until today, but the referenced theory is due to the decrease of the LCS (Liquor Cerebrospinal) volume and pressure. The early studies confirmed that PDPH was preventable with bed rest position for 24 hour. Numerous current studies have proven that early mobilization does not increase PDPH risks. The objective of this study was to prove that there is no significant difference in PDPH incidence in bed rest patients for 24 hours compared with early mobilization patients as soon as the motoric function has been recovered. The study was conducted using quasi experimental type and control time series design. This study involved 200 pregnant women at the age of 18-30 years that were on Caesarean Section using spinal anesthesia then they were classified into 2 groups with 100 subjects, respectively. The first group was conducted early mobilization as soon as the motoric function has been recovered (using Bromage 1 scale) and the second group was conducted mobilization after bed rest 24 hours post sectio Caesarean. And then, each group was observed for the occurrence of PDPH until 2 days post surgery. The study analysis was assessed using chi square test and Mann Whitney test, which the score of p<0,05 was considered statistically significant value. Statistical analysis showed that the comparison of PDPH incidence in the early mobilization group (after motoric function had been recovered) and the bed rest for 24 hour group was not statistically significant (p>0,05). The first group (early mobilization) showed 100% of the patients without PDPH incidence and the second group (bed rest for 24 hour) showed 99% of the patients without PDPH incidence. The summary of this study revealed that there was no significant difference on PDPH incidence in post Caesarean section patients underwent spinal anesthesia with bed rest for 24 hours compared with early mobilization as soon as the motoric function had been recovered. Key words: Cesarean section with spinal anesthesia, early mobilization, Post Dural Puncture Headache, 24 hours bedrestDOI: 10.15851/jap.v1n1.155
Perbandingan Efek Anestesi Spinal dengan Anestesi Umum terhadap Kejadian Hipotensi dan Nilai APGAR Bayi pada Seksio Sesarea Flora, Lasmaria; Redjeki, Ike Sri; Wargahadibrata, A. Himendra
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Teknik anestesi spinal atau anestesi umum pada seksio sesarea menyebabkan penurunan tekanan darah berbeda, demikian pula nilai APGAR bayi.  Tujuan penelitian ini untuk mengetahui kejadian hipotensi, nilai APGAR 1 menit dan 5 menit antara tindakan anestesi spinal dan anestesi umum. Penelitian dilakukan dengan cara randomized cross sectional pada 70 pasien di Rumah Sakit Dr. Hasan Sadikin Bandung pada Februari–Maret 2011. Setelah dilakukan randomisasi, pasien dibagi dalam dua kelompok, yaitu kelompok I (anestesi spinal) dan kelompok II (anestesi umum).  Data kejadian hipotensi dianalisis dengan uji chi-kuadrat, untuk nilai APGAR menggunakan Uji Mann-Whitney. Hasil penelitian menunjukkan kejadian hipotensi 57,1% pada kelompok anestesi spinal, sedangkan kelompok anestesi umum hanya 5,7% (p<0,001). Nilai APGAR rata-rata 1 menit pada kelompok anestesi spinal 8, sedangkan pada kelompok anestesi umum 7,06.  Berdasarkan Uji Mann Whitney didapatkan p<0,001. Nilai APGAR rata-rata 5 menit pada kelompok anestesi spinal 9,71,  sedangkan pada  kelompok   anestesi   umum  9,31 (p=0,015). Simpulan penelitian ini adalah angka kejadian hipotensi lebih tinggi pada anestesi spinal daripada anestesi umum.  Nilai APGAR bayi 1 menit dan 5 menit lebih tinggi pada anestesi spinal dibandingkan dengan anestesi umum.Kata kunci: Anestesi spinal, anestesi umum, hipotensi, nilai APGAR, seksio sesarea                      Comparison of  Effects  between  Spinal Anesthesia and General Anesthesia  on Hypotension and APGAR Scoring Values  of Caesarean Section BabiesTechnique of spinal anesthesia or general anesthesia on cesarean section causes decreasing in different blood pressure and APGAR score.  The purpose of this study was to identify the difference of hypotension, APGAR score 1 minute and 5 minutes on the action of spinal anesthesia and general anesthesia. A randomized cross sectional was conducted on 70 patients at Dr. Hasan Sadikin Hospital Bandung during February–March 2011. Patients were divided into two groups: group I (spinal anesthesia) and group II (general anesthesia).   The data of hypotension was analyzed with chi square test, for the APGAR score with Mann Whitney test. Result of the study showed that the case of hypotension was got 57.1% for the group of spinal anesthesia whereas the group of general anesthesia only 5.7% (p<0.001).  The mean of APGAR score 1 minute for the group spinal anesthesia was 8 whereas the group of general anesthesia was 7.06.  According to Mann Whitney test  got p<0.001.  The mean of APGAR score 5 minutes for the group spinal anesthesia was 9.71, whereas the mean for the group of general anesthesia was 9.31.  According to Mann Whitney test got p=0.015. The conclusion of the this study is the case of hypotension value is higher for the spinal anesthesia compared to general anesthesia.  APGAR score 1 minute and 5 minutes are higher for spinal anesthesia compared to general anesthesia.Key words: APGAR score, caesarean section, general anesthesia, hypotension,  spinal anesthesia   DOI: 10.15851/jap.v2n2.304
Perbandingan Lama Analgesia antara Kombinasi Bupivakain 0,125% dan Tramadol 1 mg/kgBB dengan Bupivakain 0,125% Melalui Blokade Kaudal pada Pasien Anak Pascaoperasi Hipospadia Wijayanti, Viana; Sitanggang, Ruli Herman; Wargahadibrata, A. Himendra
Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Blokade kaudal merupakan teknik anestesi regional yang paling banyak dilakukan pada operasi anak. Penelitian ini bertujuan mengetahui perbandingan lama analgesia kombinasi bupivakain dan tramadol dengan bupivakain melalui blokade kaudal pada pasien anak balita pascaoperasi hipospadia. Penelitian dilakukan terhadap 30 pasien, usia 1–5 tahun, status fisik American Society of Anesthesia (ASA) I di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Maret hingga Mei 2010. Tipe penelitian ini adalah eksperimental, rancangan acak lengkap terkontrol, tersamar tunggal. Kelompok BT menggunakan kombinasi bupivakain 0,125% dan tramadol 1 mg/kgBB  dan kelompok B menggunakan bupivakain 0,125%.  Data hasil penelitian diuji dengan uji-t. Lama analgesia pascaoperasi pada kelompok BT lebih panjang dibandingkan dengan kelompok B dengan hasil yang sangat bermakna (p<0,01). Kelompok BT dengan lama analgesia 531,33 (SD 42,86) menit dan kelompok B, 370,00 (SD 37,37) menit.  Simpulan penelitian ini adalah penggunaan kombinasi bupivakain 0,125% dan tramadol 1 mg/kgBB (0,5 mL/kgBB) untuk blokade kaudal  sebagai analgetik pascaoperasi hipospadia, menghasilkan lama analgesia yang lebih panjang bila dibandingkan dengan bupivakain 0,125%.  Kata kunci: Blokade kaudal, bupivakain, operasi hipospadia, tramadolComparison of the Duration of Analgesia between Combination of 0.125% Bupivacaine Mixed with Tramadol 1 mg/kgBW and 0.125% Bupivacaine Through Caudal Blockade in Toddlers after Hypospadia Surgery Caudal block is the most common regional anesthetic technique performed in pediatric surgery. This study was designed to compare the duration of analgesia of caudal block between combination of bupivacaine with tramadol and bupivacaine in toddler with hypospadia repair. Thirty American Society of Anesthesia (ASA) I toddlers, aged 1–5 years old at Dr. Hasan Sadikin General Hospital Bandung, runs from March to May, 2010. Patients in group BT, received 0.125% bupivacaine mixed with tramadol 1 mg/kgBW  0.5 mL/kgBW and group B, received plain 0.125% bupivacaine in the same total volume. This type of research is experimental. It was  a single blind randomized controlled trial. Duration of postoperative analgesia were noted. The t-test was used for analysing the data of this study. The duration of analgesia in group BT 531.33 (SD 42.86) was significantly longer than in group B 370.00 (SD 37.37) minutes with p value<0.001. Caudal administration of 0.125% bupivacaine mixed with tramadol 1 mg/kgBW resulted in longer duration of analgesia compared with 0.125% of bupivacaine.  Key words: Bupivacaine, caudal block, hypospadia repair, tramadol DOI: 10.15851/jap.v2n2.307
Co-Authors Chairil Gani C. Doddy Tavianto Ezra Oktaliansah Husi Husaeni Ike Sri Redjeki Jeffry F. Longdong Lasmaria Flora M. Dwi Satriyanto Mangastuti, Rebecca Sidhapramudita Mohamad Andy Prihartono Putu Pramana Suarjaya Ruli Herman Sitanggang Suyasa, Agus Baratha Tatang Bisri Umar, Nazaruddin Viana Wijayanti