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NUTRISI PADA PENDERITA SAKIT KRITIS Wiryana, Made
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Malnutrition is always been being associated with the increase of morbidity and mortality rate due to lack of immunesystem, depending on ventilator, high rate of infection, and delayed healing process, so it will increase the cost and length of stayof the patients. Clinician need to have right information about how to manage nutrition for critical ill patient because it willinfluence the outcome of ICU patient.Objective measurement nutritional status of the patient is difficult because process of illnesses itself will disturb themethod that will be used in the population. Nutritional status is multidimension phenomenon that need several methods formeasurement, including associated factors of nutrition, nutrition intake, and energy expenditure.Nitrogen balance can be used to determine effectiveness of nutritional therapy. Nitrogen balance can be counted by formulathat count nitrogen in 24 hours from patch urine, especially urine urea nitrogen (UUN), minus nitrogen intake from the food.Resting Energy Expenditure (REE) must be determined for nutritional therapy in critical ill patients. Acuracy estimation REE willhelp to reduce complications due to overfeeding, such as infiltration fat to liver and pulmonyary compromise. Several methods areavailable to predict REE such as Calorimetry, and Harris-Benedict equation.The goal in nutritional therapy in critical ill patient is to support metabolic, not to complete their need in that time. Becausein critical ill patient there is no metabolic condition is able to metabolize total amount of calories to fulfill lack of energy expenses.Ideally the route of nutritional therapy is able to supply nutrition with minimal morbidity. Each routes (parenteral andenteral) have advantages and disadvantages, and the choice is depend on patient condition. In critical ill patient care, enteralnutrition is always being the first choice and parenteral nutrition become the next alternative.

VENTILATOR ASSOCIATED PNEUMONIA Wiryana, Made
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia that occurred 48 hours afterthe patient had a mechanical ventilation support either from endotracheal tube or tracheostomy tube. VAPussually charactherized by 3 component sign of systemic infection: fever, tachycardia and leukocytosisfollowed by new infiltrate sign or a worsening scheme on the chest x ray and bacteriologic findings of thecausal of lung infection, but acctually we can diagnosed a VAP based on the findings of a number ofcriteria: histopathologic examination of the lung tissue from an open biopsy, a fast cavity formation of alung infiltrate without any sign of tuberculosis or malignancy and a positive pleural fluid culture, in whichthe species that found on the blood culture and airway were the same.The insidens of VAP are high, according to the foreign literature approximately between 9 – 27 % from allIntensive Care Unit population. This condition made VAP as the first causal of a nosocomial infection inthe Intensive Care Unit. The mortality rate of VAP is also high, Chastre and Fagon stated that the crudemortality rate can reach of 76%. Early onset VAP which occurred on the first 4th day after admission in theIntensive Care Unit ussually had a better prognosis because of caused by a still antibiotic sensitivepathogens. The Late onset VAP which occurred after 5 days or more after hospitalization, has worseprognosis because of caused by a multidrug resistance (MDR) pathogens. In order to define the pathogensthat caused VAP, some scientist made a classification of VAP patient based on the degree of disease, riskfactor and the onset, which is the group I with mild-moderate degree, common risk factor and the onset isanytime during hospitalization or a severe degree with an early onset, ussually caused by a gram negativebacteria. The group II, patient with a mild-moderate degree, specific risk factor that happened anytimeduring hospitalization, ussually caused by all bacteria in the group I added with an anaerob bacteria. Thegroup III, patient with a severe degree, early onset with specific risk factor or a late onset, ussually caused by Pseudomonas aeruginosa, Acinetobacter sp and MRSA. Other approach is by classifying the bacteriacausing VAP in a primary endogen, secondary and eksogen type.Prevention of VAP can be done by 2 different ways, first by a non pharmachologic way, routine andstandard things that ussually done in the ICU, but this action still could not enough in lowering the insidensof VAP. Second, by a pharmachologic way, Selective Decontamination of the Digestive Tract (SSD) andOropharyngeal Decontamitation (OD). SSD is proven effective empirically in preventing VAP but the usedof antimicrobial can caused a higher risk on resistention. SDD is not recommended as a routine action inpreventing VAP so that OD with the used of antiseptic is preferred as another alternative.

THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 1 Januari 2010
Publisher : Udayana University

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Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients’prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 – 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.

THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

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Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients’prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 – 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.

Efektivitas Magnesium Sulfat 30 mg/kgBB Intravena Dibanding dengan Fentanil 2 mcg/kgBB Intravena dalam Menekan Respons Kardiovaskular pada Tindakan Laringoskopi dan Intubasi - Yehezkiel; Made Wiryana; Ida Bagus Gde Sujana; I Gusti Putu Sukrana Sidemen
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Laringoskopi dan intubasi merupakan tindakan rutin yang berisiko menyebabkan respons kardiovaskular berupa peningkatan tekanan darah dan laju denyut jantung terutama pada pasien risiko tinggi seperti kelainan jantung. Penelitian ini bertujuan mengetahui efektivitas MgSO4 30 mg/kgBB intravena dibanding dengan fentanil 2 mcg/kgBB intravena dalam menekan respons kardiovaskular pada tindakan laringoskopi dan intubasi sehingga dapat menjadi obat altenatif. Penelitian ini dilakukan secara uji klinis acak terkontrol tersamar ganda terhadap 42 pasien dengan status fisik American Society of Anesthesiologist (ASA) I–II yang dilakukan operasi dengan anestesi umum intubasi trakea di RSUP Sanglah Denpasar Bali pada Agustus–September 2014. Subjek dibagi menjadi dua kelompok, MgSO4 30 mg/kgBB (n=21) dan fentanil 2 mcg/kgBB (n=21) secara acak. Perubahan tekanan darah dan laju denyut jantung yang terjadi sebelum dan setelah tindakan dicatat sebagai data penelitian. Data penelitian dianalisis dengan uji repeated ANOVA, dengan p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak terdapat perbedaan bermakna antara kedua kelompok perlakuan. Simpulan, pemberian MgSO4 30 mg/kgBB sama efektif dengan fentanil 2 mcg/kgBB dalam menekan respons kardiovaskular pada tindakan laringoskopi dan intubasi.Kata kunci: Fentanil, intubasi, laringoskopi, magnesium sulfat, respons kardiovaskularComparison of Intravena Magnesium Sulfate 30 mg/kgBW and Intravena Fentanil 2 mcg/kgBW Effectiveness for Attenuating Cardiovascular Response in Laryngoscopy and Tracheal IntubationLaryngoscopy and intubation are routine actions which cause the risk of cardiovascular responses, including increased blood pressure and heart rate, especially in high-risk patients such as patients with heart disorders. The aim of this study was to determine the effectiveness of intravenous MgSO4 30 mg/kgBW compared to that of intravenous fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation to assess its possibility as an alternative drug. This study was a clinical trial with randomized double-blind controlled to 42 patients with physical status of the American Society of Anesthesiologists (ASA) I–II who underwent tracheal intubation under general anesthesia in Sanglah Denpasar Hospital Bali in the period of August–September 2014. Subjects were divided into two groups, MgSO4 30 mg/kgBW (n=21) and fentanyl 2 mcg/kgBW (n=21) groups. Changes in blood pressure and heart rate that occured before and after the action were recorded as research data. Data were analyzed with repeated ANOVA test, with p<0.05 considered significant. Statistical analysis showed that there was no significant difference between the two treatment groups. it is concluded that the administration of MgSO4 30 mg/kgBW is as effective as fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation.Key words: Cardiovascular response, fentanyl, intubation, laryngoscopy, magnesium sulfate DOI: 10.15851/jap.v3n2.574

PROFIL PENGGUNAAN ANALGETIKA PADA PASIEN NYERI AKUT PASCA BEDAH DI RSUP SANGLAH BULAN SEPTEMBER TAHUN 2013 Ida Bagus Alit Saputra; I Putu Pramana Suarjaya; I Made Wiryana
E-Jurnal Medika Udayana vol 5 no 2(2016):e-jurnal medika udayana
Publisher : Universitas Udayana

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ANALGESICS USING PROFILE TO THE PATIENTS WITH POST-SURGERY ACUTE PAIN IN SANGLAH GENERAL HOSPITAL, SEPTEMBER 2013Surgery is a common action taken to overcome the problem of patients who got tissue-damagewhich caused the pain. Acute pain of patients which is happened after the surgery generally accompanied by emotional and autonomic response that inflicted physiological response and finally would disturb the patient’s recovery process. The pain management usually uses multimodality analgesics such as opioid group, NSAID (Non Steroid Anti-Inflammatory Drugs), and adjuvant. Many patients still complaining because of the pain management therapy has not run well yet. This complained caused by the less knowledge or understanding of the medical practitioner about analgesics regiments, which made they are still afraid of the side effect that may affect patients. This research is aim to acknowledge the pain overcoming profile and analgesics therapy method in Sanglah General Hospital to the post-surgery patients during September 2013 and characteristic of the post-surgery patients. The design of this research is non-experimental cross-sectional which gathering data retrospectively using the secondary data of APS (Acute Pain Service) that belongs to Anesthetic, Re-animation, and Intensive Care Department of Sanglah General Hospital during September 2013, which amount 396 samples.Result and conclusion of this research is from 396 after surgery patients during September 2013 in Sanglah General Hospital receive multimodality analgesics regiments with 5 therapy method and monitoring by VAS (Visual Analogue Scale). Characteristics of patients with male sex amounts to 206 (52.0%) with the status ASA (American Society of Anesthesiology) dominated ASA 1 shows a patient undergoing surgery in good condition without significant systemic disorders. There are 13 types of surgeries which the largest number is 72 cases (18.2%). There are 154 persons of the sample (38.9%) receive the therapy method using syringe pump which become the most frequently method used to overcome the acute pain happened post-surgery. The pain measurement 24–48 hours reduced in amount 2.7 point which is calculated using VAS (Visual Analogue Scale).

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

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.

Perbandingan Validitas Sistem Skoring Apache II, SOFA, Dan Customized Sequential Organ Failure Assessment (Csofa) Untuk Memperkirakan Mortalitas Pasien Non-Bedah Yang Dirawat Di Ruang Perawatan Intensif Stefanus Taofik; Tjokorda Agung Senapathi; I Made Wiryana
JAI (Jurnal Anestesiologi Indonesia) Vol 7, No 2 (2015): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Latar Belakang : Penerapan Sistem Jaminan Kesehatan Nasional (SJKN) dalam pelayanan ICU mendorong pelayanan ICU untuk lebih efektif dan efisien. Prediksi hasil perawatan penting baik secara administrasi ataupun klinis dalam manajemen ICU. Pasien non-bedah meskipun jumlahnya tidak banyak, namun memiliki angka mortalitas yang tinggi.Tujuan : Untuk mendapatkan sistem skoring yang baik dan mudah diterapkan dilakukan penilaian missing value, dan diskriminasi dari masing masing sistem skoring.Metode : Penelitian ini melibatkan 184 pasien non-bedah yang dirawat di ICU 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 sensitifitas dan spesifisitas masing masing.Hasil : Area under Receiver Operating Characteristic (AuROC) pada APACHE II, SOFA, dan 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, kardiovaskular, dan respirasi memberikan hubungan bermakna terhadap mortalitas dengan RO 4,58, 2,24, dan 1,47. Sub variabel lain yang berpengaruh antara lain AKI, sepsis, dan penyakit kronis dengan RO 8,14, 3,89 dan 2,42.Simpulan : CSOFA lebih valid dalam memperkirakan mortalitas pasien di ICU RSUP Sanglah Denpasar, karena mempunyai nilai diskriminasi yang lebih baik dan missing value yang lebih sedikit dibandingkan dengan sistem skoring APACHE II dan SOFA

Manajemen Anestesi Perioperatif pada Kehamilan dengan Trombositopenia Kristian Felix Wundiawan; Tjahya Aryasa EM; Made Wiryana
Jurnal Anestesi Obstetri Indonesia Vol 6 No 1 (2023): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v6i1.109

Trombositopenia dalam kehamilan adalah suatu kondisi dimana jumlah hitung trombosit kurang dari 150.000 /µL dan bisa terjadi secara fisiologis. Pada kasus kehamilan dengan trombositopenia, ada kalanya diperlukan terminasi kehamilan melalui operasi seksio sesarea. Manajemen anestesi dengan pembiusan umum dikhawatirkan berdampak buruk pada janin akibat obat atau agen anestesi yang digunakan, sedangkan manjemen anestesi dengan pembiusan regional dikhawatirkan berdampak buruk pada ibu yaitu risiko terjadinya neuraksial hematom dengan komorbid trombositopenia. Pemilihan teknik manajemen anestesi perioperatif didasarkan pada penilaian klinis pasien dan jumlah hitung trombosit dengan rentang batasan minimal yang aman untuk dilakukan tindakan regional anestesi (neuraksial) adalah 75.000 /µL–80.000 /µL. Pada kasus yang dilakukan manajemen anestesi dengan pembiusan umum, dapat dipertimbangkan dilakukan induksi dengan pemberian opioid untuk menekan dan menumpulkan rangsang simpatis saat dilakukan laringoskopi intubasi yang bertujuan mencegah komplikasi seperti perdarahan intra-serebral. Trombositopenia pada kehamilan dapat memperberat kehamilan itu sendiri namun pada umumnya persalinan berjalan lancar dan memberikan hasil akhir yang baik. Kolaborasi antara interdisiplin secara komprehensif dan holistik diperlukan untuk menangani kasus ini mulai dari perencanaan tindakan, tatalaksana dan pencegahan komplikasi pada ibu dan janin. Tidak diragukan lagi, kasus gravida dengan trombositopenia merupakan tantangan unik bagi tim anestesi. Dengan terus berkembangnya ilmu dan penelitian dibidang ini, masih perlu dibuat panduan dan batasan yang jelas terkait manajemen perioperatif pada pasien gravida dengan trombositopenia.

Penggunaan Opioid Free Anesthesia pada Pasien Kehamilan Ektopik Terganggu dengan Hemodinamik Stabil yang Menjalani Operasi Laparotomi Devina Martina Bumi; Tjahya Aryasa EM; Made Wiryana
Jurnal Anestesi Obstetri Indonesia Vol 6 No 2 (2023): Juli
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v6i2.115

Opioid adalah analgesia yang paling sering digunakan pada periode perioperatif. Saat ini di Amerika Serikat, adiksi opioid menjadi epidemi dan kematian akibat overdosis opioid sintetis meningkat pesat selama dekade terakhir. Sekitar 6% dari populasi di Amerika berusia 15–64 tahun dilaporkan melakukan penyalahgunaan opioid, dan perkiraan kematian akibat overdosis opioid adalah 115 per hari pada tahun 2015. Hal ini juga dikaitkan dengan efek samping yang tidak diinginkan seperti depresi napas, ileus, retensi urine, mual dan muntah pascaoperasi (PONV), imunosupresi, dan opioid induced hyperalgesia. Wanita 20 tahun dengan berat 51 kg direncanakan untuk laparotomi eksplorasi emergensi. Pasien didiagnosis dengan akut abdomen e.c kehamilan ektopik terganggu. Teknik anestesi yang digunakan adalah anestesi umum dengan metode opioid free anesthesia (OFA). Selama operasi didapatkan hemodinamik yang stabil mulai induksi, intubasi, sampai pasca operasi. Keluhan nyeri pasca operasi dan efek samping lainnya tidak ditemukan pada pasien ini. OFA didefinisikan sebagai teknik anestesi di mana opioid tidak digunakan pada periode perioperatif (baik sistemik, neuroaksial maupun intrakaviter). Manajemen nyeri multimodal adalah cara terbaik untuk mengurangi konsumsi opioid. Penggunaan analgesik non-opioid multimodal intraoperatif memungkinkan penghambatan reseptor pre-emptive di jalur nyeri yang kompleks, baik secara sentral maupun perifer. Anestesi yang stabil dapat dicapai dengan menggunakan pendekatan multimodal dari obat-obatan simpatolitik dan analgesik non-opioid. Pada kasus ini, OFA memberikan kestabilan hemodinamik mulai induksi, intubasi, sampai pasca operasi, tidak didapatkan keluhan nyeri pasca operasi, tidak ada penggunaan rescue analgesik, dan tidak ada keluhan mual dan muntah pasca operasi.

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