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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Molecular and Cellular Biomedical Sciences (MCBS) Bali Journal of Anesthesiology PREPOTIF : Jurnal Kesehatan Masyarakat Jurnal Ilmiah Vastuwidya Jurnal Anestesi Obstetri Indonesia Journal of Medicine and Health Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif

Made Wiryana

Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Udayana University, Indonesia

Author-ID : 419156

Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Control & Systems Engineering Dentistry Education Engineering Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Mechanical Engineering Medicine & Pharmacology Neuroscience Nursing Physics Public Health Other

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The interaction of neuroimmunology, neuromodulator, and neurotransmitter with nociceptor and MAPK signaling Dewi, Dewa Ayu Mas Shintya; Wiryana, Made
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTPhysiological pain is a protection mechanism against tissue damage or potential tissue damage. Inflammation pain is followed by tissue damage due to temperature, mechanical and chemical stimuli which increase crosstalk between neuron nociceptor, immune system, neuromodulator and neurotransmitter, and MAPK (Mitogen Activating Protein Kinase) signal. Initially, immune cell is produced at the primary afferent nerve endings and spinal cord, modulate thermal sensitivity and mechanic through MAPK signaling, then neuromodulator and neurotransmitter at the afferent nerve endings will regulate the innate immune response, adaptive and vascular

Udayana One Health Collaborating Center (OHCC) initiated Bali’s first mass, integrated basic life support training Sudewi, Anak Agung Raka; Budayanti, Nyoman Sri; Wiryana, Made; Senapathi, Tjokorda Gde Agung; Ryalino, Christopher; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTBasic Life Support (BLS) is a first-aid training that can be utilized in case of emergency until the victims are retained by medical professionals. Mastering BLS skills can be the difference between life and death. A cardiopulmonary resuscitation (CPR) performed by a passer-by is important to ensure a successful resuscitation in out-of-hospital cardiac arrest. Yet, improving the survival rate for out-of-hospital cardiac arrest is still a major problem. Starting in 2019, Udayana One Health Collaborating Center (Udayana OHCC) will implement the first mass and integrated BLS training in Bali. The goals are to introduce BLS to more people and to produce BLS-friendly environment in Bali.

The role of endothelial glycocalyx in sepsis Hartawan, I Nyoman Budi; Wiryana, Made
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTThe surface of endothelial cells is filled with various membrane-bound molecules that form the glycocalyx. The endothelial glycocalyx is a surface layer mainly consisted of glycosaminoglycans that include heparan sulfate, chondroitin sulfate, and hyaluronic acid and its core proteins. Previous studies suggest that endothelial surface glycocalyx shedding could play a role in endothelial dysfunction and inflammation. This article will review the endothelial glycocalyx and its role in sepsis.

Role of flow velocity and transient hyperemic response evaluated by transcranial doppler for assesing brain autoregulation in mild traumatic brain injury: a case report Demoina, I Gede Patria; Wiryana, Made; Suarjaya, Putu Pramana; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Head injuries are a common case throughout the world, based on data from the Centers for Disease Control, emergency cases, hospitalization cases, and also deaths due to head injuries have increased in the decade 2001-2010. Cerebral autoregulation (CA) is a mechanism for cerebral blood flow (CBF) regulation if there is a change from cerebral perfusion pressure (CPP). The mechanism of brain autoregulation is negative feedback that holds back the increase in mean arterial pressure (MAP) by reducing the diameter of blood vessels so that CBF returns to normal, whereas if MAP falls, brain autoregulation tends to widen blood vessel diameter so that CBF is normal. Transcranial doppler examination can be one of the modalities of investigation that is very useful in patients with head injuries. Transcranial doppler in patients with a head injury can be used to measure mean flow velocity of cerebral artery media and transient hyperemic response test, both of which can assess the prognosis of a course of head injury.

Correlation Between Protein Intake and Nitrogen Balance of Surgical Patients in Anesthesiology and Intensive Care Installation, Sanglah General Hospital, Denpasar, Bali, Indonesia Wiryana, Made; Sinardja, I Ketut; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Panji, Putu Agus Surya; Aryabiantara, I Wayan; Cindryani, Marilaeta
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

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Background: A cell injury from surgical stress in a trauma or a non-trauma case will induce a hyper metabolic response in which the protein degradation increases, the somatic protein synthesis decreases and the amino acid catabolism increases. Thus, the pyper metabolic response contributes to nitrogen loss in urine. This response, without an adequate nutrition, will lead an iatrogenic malnutrition and deterioration. A balance nitrogen formula through urinary urea nitrogen is one of many nutrition evaluation methods. This method aids in evaluating the daily nutrition status and it can be the baseline data for daily intake. Objective: To find a correlation between the protein intake and the nitrogen balance of the surgical patients in anesthesiology and intensive care installation, Sanglah General Hospital, Denpasar, Bali. Methods: Fifty-one surgical patients with trauma and non-trauma cases were observed for their protein intake for 2-3 days continuously. Moreover, they were evaluated for their nitrogen balance based on the urinary urea nitrogen per 24 hours for 2-3 days. For statistical analysis, we utilized Shapiro-Francia, Shapiro-Wilk, Spearman Frank correlation, two-sample t test, and multivariate regression analysis in Strata SE 12.1. Results: The correlation between the protein intake and the nitrogen balance on the first day was ra=0.50 (p<0.05), on the second day ra=0.70 (p<0,05), and on the third day ra=0.740 (p<0,05) Conclusions: There is a correlation between the protein intake and the nitrogen balance of surgical patients in Anesthesiology and Intensive Care Installation Sanglah General Hospital Denpasar.

Cost Minimization Analysis of Hypnotic Drug: Target Controlled Inhalation Anesthesia (TCIA) Sevoflurane and Target Controlled Infusion (TCI) Propofol Wiryana, Made; Aribawa, I Gusti Ngurah Mahaalit; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Hartawan, I Gusti Agung Gede Utara; Sucandra, Made Agus Kresna; Parami, Pontisomaya; Putra, Kadek Agus Heryana; Sutawan, IB Krisna Jaya; Arimbawa, IGNA Putra; Jaya, Ketut Semara; Semarawima, Gede
BALI MEDICAL JOURNAL Vol 5 No 3 (2016)
Publisher : BALI MEDICAL JOURNAL

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Background: Cost minimization analysis is a pharmaco-economic study used to compare two or more health interventions that have been shown to have the same effect, similar or equivalent. With limited health insurance budget from the Indonesian National Social Security System implementation in 2015, the quality control and the drug cost are two important things that need to be focused. The application of pharmaco-economic study results in the selection and use of drugs more effectively and efficiently. Objective: To determine cost minimization analysis of hypnotic drug between a target controlled inhalation anesthesia (TCIA) sevoflurane and a target controlled infusion (TCI) propofol in patients underwent a major oncologic surgery in Sanglah General Hospital. Methods: Sixty ASA physical status I-II patients underwent major oncologic surgery were divided into two groups. Group A was using TCIA sevoflurane and group B using TCI propofol. Bispectral index monitor (BIS index) was used to evaluate the depth of anesthesia. The statistical tests used are the Shapiro-Wilk test, Lavene test, Mann- Whitney U test and unpaired t-test (? = 0.05). The data analysis used the Statistical Package for Social Sciences (SPSS) for Windows. Results: In this study, the rate of drug used per unit time in group A was 0.12 ml sevoflurane per minute (± 0.03) and the group B was 7.25 mg propofol per minute (±0.98). Total cost of hypnotic drug in group A was IDR598.43 (IQR 112.47) per minute, in group B was IDR703.27 (IQR 156.73) per minute (p>0.05). Conclusions: There was no statistically significant difference from the analysis of the drug cost minimization hypnotic drug in a major oncologic surgery using TCIA sevoflurane and TCI propofol.

PERBANDINGAN EFEK OKSITOSIN BOLUS 3 IU, 5 IU, DAN 10 IU TERHADAP KONTRAKSI UTERUS DAN RESPON KARDIOVASKULAR PADA SEKSIO SESAREA DENGAN ANESTESI BLOK SUBARAKNOID Kusuma, Made Adi; Wiryana, Made; Hariyasa Sanjaya, I Nyoman; Gede Widnyana, I Made
Medicina Vol 44 No 3 (2013): September 2013
Publisher : Medicina

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Oksitosin merupakan obat yang rutin diberikan setelah kelahiran bayi pada seksio sesarea untukmemulai dan mempertahankan kontraksi uterus adekuat tetapi efek samping kardiovaskulardiketahui muncul setelah pemberian intravena seperti takikardi, hipotensi dan disritmia. Hal iniakibat efek relaksasi otot polos vaskular yang menyebabkan penurunan resistensi vaskular sistemik,hipotensi, dan takikardia. Besarnya efek ini tergantung dosis dan cara pemberiannya. Tujuan penelitianini adalah membandingkan kontraksi uterus, tekanan arteri rerata (TAR), dan laju nadi setelahoksitosin bolus 3, 5, dan 10 IU pada seksio sesarea dengan anestesi blok subaraknoid. Penelitian iniadalah uji klinik acak terkontrol tersamar ganda. Enam puluh enam pasien yang memenuhi kriteriapenelitian dibagi 3 yaitu kelompok 3IU, 5IU, dan 10IU. Oksitosin bolus diberikan setelah kelahiranbayi dalam 30 detik dan dilanjutkan kontinyu 0,04 IU/menit. Kontraksi uterus dinilai oleh operatordan perubahan TAR serta laju nadi dicatat pada lembar penelitian. Tidak ditemukan perbedaanprevalensi kontraksi uterus adekuat antar kelompok penelitian. Penurunan rerata TAR danpeningkatan rerata laju nadi kelompok 3IU secara bermakna lebih kecil dibandingkan kelompok 5dan 10IU, dan kelompok 5IU secara bermakna lebih kecil dibandingkan kelompok 10IU. Simpulanpenelitian ini bahwa oksitosin bolus 3 IU menghasilkan keadekuatan kontraksi uterus yang sama,penurunan TAR dan peningkatan laju nadi lebih kecil dibandingkan oksitosin bolus 5 dan 10 IU padaseksio sesarea dengan anestesi blok subaraknoid.

Osmolalitas plasma sebagai alternatif acute physiologic and chronic health evaluation II untuk memprediksi mortalitas pada pasien kritis yang dirawat di Intensive Care Unit RSUP Sanglah Wardani, Ni Putu; Wiryana, Made; Suarjaya, Putu Pramana
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

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Prediksi mortalitas bersifat esensial pada manajemen perawatan intensif. Acute Physiologic and Chronic Health Evaluation II merupakan sistem skor kompleks yang umum digunakan di Intensive Care Unit (ICU), sedangkan osmolalitas plasma merupakan salah satu sistem skor parameter tunggal yang diketahui dapat menjadi alternatif prediktor mortalitas di ICU. Tujuan penelitian untuk mengetahui besar nilai area undercurve (AUC), sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif dari kedua prediktor dan mengetahui adanya perbedaan bermakna dari nilai AUC kedua prediktor tersebut. Penelitian merupakan uji diagnostik metode cross sectional yang melibatkan 134 subjek. Uji diagnostik menggunakan kurva ROC dan tabel 2x2. Perhitungan data didapatkan nilai AUC osmolalitas plasma sebesar 75,9% (IK95% 67,7 sampai 84,3%), dengan cut off point 297 mOsm/kg, sensitifitas 70,0%, spesifisitas 79,7%. Tabel 2x2 menghasilkan NDP sebesar 79,0% (IK95% 66,8 sampai 88,3%), NDN 70,8% (IK95% 58,9 sampai 81%). Nilai AUC APACHE II sebesar 83,4% (IK95% 76,5 sampai 90,3%) dengan cut off point sebesar 24, sensitifitas 72,9%, spesifisitas 81,3%. Tabel 2x2 menghasilkan NDP 81,0% (IK95% 69,1 sampai 89,8%), NDN 73,2% (IK95% 61,4 sampai 83,1%). Analisis ROC didapatkan nilai P=0,19. Nilai AUC osmolalitas plasma tergolong level sedang (>70-80%), APACHE II tergolong level baik (>80-90%). Analisis ROC dengan P>0,05 menyatakan tidak terdapat perbedaan bermakna antara kurva ROC kedua prediktor. Sekalipun osmolalitas plasma memiliki nilai diagnostik sedang, dibandingkan APACHE II dengan nilai diagnostik baik tetapi perbedaan nilai tersebut tidak bermakna sehingga osmolalitas plasma dapat digunakan sebagai alternatif APACHE II untuk prediktor mortalitas di ICU. Prediction of in-hospital mortality is essential for management of intensive care. Complex scoring system commonly used is APACHE II, meanwhile plasma osmolality is a single parameter scoring system that has known to be an alternative for mortality predictors in the Intensive Care Unit (ICU). The objective of this study was to determine the area undercurve (AUC) value, sensitivity, specificity, positive predictive value, negative predictive value for both predictors and to determine significant differences in AUC values in both scoring system. This was a diagnostic test with cross-sectional method that included 134 subjects. Diagnostic test using ROC curves and 2x2 tables. Result of plasma osmolality with AUC 75.9% (95%CI 67.7 to 84.3%). Cut off point was 297 mOsm/kg, sensitivity was 70.0%, and specificity was 79.7%. Two point two table with PPV 79.0% (95%CI 66.8 to 88.3%) and NPV 70.8% (95%CI 58.9 to 81%). The AUC for APACHE II was 83.4% (95%CI: 76.5 to 90.3%). Cut off point was 24, sensitivity was 72.9%, and specificity was 81.3%. Two point two table with PPV 81.0% (95%CI 69.1 to 89.8%) and NPV 73.2% (95%CI 61.4 to 83.1%). ROC analysis with P value=0.19. AUC values of plasma osmolality was at moderate level (>70 to 80%), APACHE II at good level (>80 to 90%). ROC analysis with P>0.05 states there was no significant difference between the ROC curves in both predictors. Although plasma osmolality has moderate diagnostic value, compared with APACHE II, with a good diagnostic value but the value differences was unsignificant thus plasma osmolality can be used as an alternative of APACHE II for mortality predictors in critically ill patients in the ICU.

MANAJEMEN PERIOPERATIF PADA HIPERTENSI Wiryana, Made
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Hypertension is a leading cause of death and the most frequent preoperative abnormality in surgical patients, and becomemajor risk factor for cardiac, cerebral, renal and vascular disease during intraoperative or post-operative periode. Agressivecontrolled hypertension will decrease complications due to the damage of end organs. Consequences by taking anti-hypertensiveagents is the interaction with other medications that being used during surgery. Consideration must be taken especially due to thehalf life and adjustment dose of this medications. The National Committee 7 (JNC 7) on prevention, detection, evaluation andtreatment of high blood pressure 2003, degree of hypertension can be classified into pre-hypertension (120-139/80-89), hypertensionstage 1 (140-159/90-99 mmHg) and hypertension stage 2 (systolic pressure 160 mmHg or diastolic pressure 100 mmHg).According to the etiology, hypertension can be classified into primary hypertension (80-95%) and secondary hypertension (10-15%) due to the causes. Usually hypertension always has association with abnormality of sympathetic activity, increasing thepheripheral vascular resistance (SVR) or increasing both of them. But the most common cause of hypertension is increasing thepheripheral vascular resistance. Management perioperative of hypertension includes evaluation and optimalised patients conditionpreoperative, management patients who under influenced of anesthetic agents and treatment post operative. Patient withhypertension incline to have instability haemodinamic and more sensitive to anesthesia and surgery procedures, so carefull mustbe taken at the beginning of anesthesia and surgery until post operatively, especially to control hemodynamic. The best monitoringfor patient with hypertension is by using suitable anesthetic techniques, anesthetic agents and antihypertensive agents. Postoperative hypertension can be happened due to several factors such as, inadequate antihypertensive agents, respiratory disturbance,pain, fluid overload, or distended of the bladder. Excellent perioperative management of hypertension patients beforesurgery will decrease morbidity and mortality rate

PERANAN TERAPI INSULIN INTENSIF TERHADAP INTERLEUKIN-6 (IL-6) DAN LUARAN KLINIK PADA PENDERITA KRITIS DENGAN HIPERGLIKEMIA Wiryana, Made
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (288.956 KB)

Hiperglycemia and insulin resistance are common in critically ill patients, even that have not previously had diabetes.Though it has been reported that pronounced hyperglycemia may lead to complications in such patients and cause of reactiveoxygen species (ROS) production, although data from controlled trial are still lacking. The debatable issue focused on whetherintensive insulin therapy to normalized blood glucose improves prognosis. The debate is mainly about the time to start therapy,and target of blood glucose level. The main purpose of this research is to know the different between intensive insulin therapy andconventional insulin therapy on decreases of cytokine production (IL-6), increase of albumin level and event of systemic inflammatoryrespons syndrome (SIRS). The design of this study is randomized pre and post control group design involving 40 adultpatients that admitted to the ICU Sanglah hospital Denpasar. They were randomly assigned to receive intensive insulin therapy inwhich blood glucose at the level between 80 ? 110 mg/dL or conventionl insulin therapy in which insulin therapy start if the bloodglucose level exceed 215 mg/dL and blood glucose maintained at the level between 180 ? 200 mg/dL. The results of this studyshowed that: (1) Significant decrease of IL-6 level (10.25 vs 2.02; p=0.023); (2) Significant increase of albumin level (0.62 vs0.22); (3) Significant decrease of SIRS (10 % vs 45%, p=0.000) on intensive insulin therapy group compare to the conventionalinsulin therapy group. Conclusions of this study is that the increase insulin dose as well as intensive insulin therapy can maintainblood glucose level at the level normoglycaemia between 80-110 mg/dL faster compare to the conventional insulin therapy. Onthe otherhand, interleukin-6 decreases cause of decreases ROS production and anti inflammatory effect of insulin. Intensiveinsulin therapy can increase albumin level and decrease of SIRS event on hyperglycemia in critically ill ICU patients compare tothe conventional insulin therapy.

Co-Authors - Yehezkiel - Yehezkiel, - Adinda Putra Pradhana Anak Agung Gde Agung Adistaya Andi Irawan Andi Kusuma Wijaya, Andi Christopher Ryalino Cynthia Dewi Sinardja Demoina, I Gede Patria Devina Martina Bumi Dewa Ayu Mas Shintya Dewi Dyah Kanya Wati Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Gede Semarawima, Gede Giovanni, Malvin Hari Bagianto Hartawan , I.G.A.G. Utara I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit Aribawa I Gusti Putu Sukrana Sidemen I Ketut Sinardja I Ketut Suastika I Ketut Wibawa Nada I Made Agus Kresna Sucandra I Made Bakta I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Jawi I Made Prema Putra I Made Subagiartha I Nyoman Budi Hartawan I Nyoman Hariyasa Sanjaya I NYOMAN MANTIK ASTAWA I Putu Agus Surya Panji I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Alit Saputra Ida Bagus Gde Sujana Ida Bagus Gde Sujana, Ida Bagus Gde Ida Bagus Gede Suparyatha Ida Bagus Krisna Jaya Sutawan Ida Bagus Okta Ida Bagus Subanada IGNA Putra Arimbawa, IGNA Putra Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Ketut Semara Jaya, Ketut Semara Kristian Felix Wundiawan Kurnia, Prajnaariayi Prawira Kurniyanta, I P Kurniyanta, I Putu Made Adi Kusuma Made Agus Kresna Sucandra, Made Agus Kresna Made Widnyana Marilaeta Cindryani, Marilaeta Narakusuma, I Putu Fajar Ni Nyoman Sri Budayanti Ni Putu Novita Pradnyani, Ni Putu Ni Putu Wardani Pande Nyoman Kurniasari, Pande Panji, I PAS Pontisomaya Parami Putu Agus Surya Panji Putu Kurniyanta Putu Pramana Suarjaya Raka-Sudewi A. A. Satria Pinanditas S Sidemen, I.G.P.Sukrana Sonni Soetjipto, Sonni Stefanus Taofik Suarjaya, I PP Sucandra, I MK Suputra Widharma, I Gede Suranadi , I Wayan Sutawinaya, I Putu Tanuwijaya, Tommy M Tirta, Ian Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Agung Senapathi Wahyu Antara K., I Gede Wardani, Dinar Kusuma Widnyana, I MG Widyana, I Made Gede

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