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All Journal Jurnal Anestesiologi Indonesia Jurnal Kedokteran Brawijaya Jurnal Anestesi Perioperatif Journal of Anaesthesia and Pain
Karmini Yupono
Departemen Anestesiologi Dan Terapi Intensif; Fakultas Kedokteran; Universitas Brawijaya/ RSUD Dr. Saiful Anwar; Malang
Education Health Professions Medicine & Pharmacology Public Health

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Laporan Kasus: Tatalaksana Anestesi Penyakit Hirschsprung dengan Sindrom Aspirasi Mekoneum dan Pneumomediastinum pada Neonatus Yupono, Karmini; Hartono, Ruddi
Jurnal Kedokteran Brawijaya Vol 25, No 3 (2009)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (466.581 KB) | DOI: 10.21776/ub.jkb.2009.025.03.9

Abstract

We report  one female  newborn baby suffered from  moderate asphyxia, meconium aspiration syndrome, and Hirschsprung  disease.  The  patient  admitted  in  Neonatal  Intensive  Care  Unit  (NICU)  and  ventilated  with Pressure Controlled Mandatory Ventilation (PCMV)  mode ventilator.  Patient suffered from  pneumodiastinum and therefore  mediastinotomy was performed. Sepsis and Necrotizing Enterocolitis (NEC)  made the  case more  complicated.  On  further  examination,  abdominal  was  distended  and  perforated  and  therefore  we decided  to  perform  exploration  laparatomy  and  sigmoidoctomy .  Anaesthesia  management  with  general anaesthesia  had  been  performed.  Premedication  was  not  given.  We  used  oxygen  and  Sevofluran  for induction;  Oxygen, Sevofluran, Atracurium, Fentanyl,  and  Morphin for  maintenance; and  Morphin for  post operative analgesic. On follow up examination, we found wound disruption and therefore relaparotomy was performed.  T ypes  and  doses  of  anesthesia  drugs  were  chosen  according  to  newborn  immature  organ  noticely . Providing adequate oxygenation, preventing hypotermi, and balancing electrolytes and acid base states still be the  most considerations in  management of this  patient.  Anesthetic management and intensive  care of this patient  gained  a  satisfying  outcome.  The  prognosis  was  good. Keywords:  Hirschsprung  disease,  meconium  aspiration  syndrome,  pneumomediastinum,  sepsis,  NEC.
Premedikasi Lidokain dengan Torniket Lebih Baik Dibanding dengan Kombinasi Lidokain dan Propofol untuk Mencegah Nyeri Injeksi Propofol Ristiawan Muji Laksono; Isngadi Isngadi; Yudi Hadinata; Karmini Yupono; Ruddi Hartono; Djudjuk Rahmad Basuki
Jurnal Anestesi Perioperatif Vol 9, No 3 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n3.2382

Abstract

Propofol merupakan jenis obat induksi intravena yang paling sering digunakan dalam pembiusan umum, namun dapat menimbulkan rasa nyeri pada lokasi injeksi. Tujuan penelitian ini adalah mengetahui perbandingan persentase nyeri pascainjeksi propofol setelah premedikasi lidokain dengan perlakuan torniket selama satu menit dan teknik campuran lidokain fropofol. Penelitian ini merupakan uji klinis tersamar tunggal bersifat eksperimental. Penelitian dilaksanakan di RSUD Dr. Saiful Anwar pada April–Mei 2013. Subjek penelitian adalah 50 pasien yang dibagi menjadi dua kelompok secara acak. Kelompok A (n=25) mendapat perlakuan campuran 40 mg lidokain dalam propofol intravena (i.v.). Kelompok B (n=25) mendapat perlakuan lidokain 40 mg (i.v.) dengan perlakuan torniket selama satu menit, diikuti injeksi propofol. Derajat nyeri diukur menggunakan Verbal Rating Score. Hasil pengukuran dianalisis statistik dengan uji normalitas, homogenitas, dan Mann Whitney menggunakan software SPSS (versi 18, IBM Statistic, USA). Pemberian lidokain dengan perlakuan torniket signifikan dapat merunkan detajat nyeri lebih baik (24/25 tidak nyeri, 1/25 nyeri) dibanding dengan kelompok campuran lodokain dan propofol (10/25 tidak nyeri, 11/25 nyeri ringan, 4/25 nyeri sedang) (p=0,000). Premedikasi lidokain dengan perlakuan torniket lebih baik dalam menurunkan derajat nyeri dibanding dengan pemberian campuran lidokain dan propofol.Premedication Using Lidocaine with Tourniquet Technique is Superior to Combining Lidocaine and Propofol to Prevent Propofol Injection PainPropofol is one of the most used intravenous induction drugs in general anesthesia, but it produces pain at the injection site. This study aimed to compare the post-propofol injection pain after premedication using lidocaine with the tourniquet technique and a mixture of lidocaine in propofol. This study was a single-blind, experimental clinical trial conducted from April to May 2013. The study's subject was 50 patients divided into two groups. Group A (n=25) received a mixture of 40 mg lidocaine in propofol intravenously (i.v.). Group B (n=25) received 40 mg lidocaine (i.v) with a tourniquet technique for one minute, followed by propofol injection. The degree of pain is measured using the Verbal Rating Score. The results were statistically analyzed using the normality, homogeneity, Mann-Whitney test using SPSS (version 18, IBM Statistic, USA) software. The administration of lidocaine with the tourniquet technique was significantly better in reducing the pain levels (24/25 painless, 1/25 mild pain) compared to the mixture of lidocaine in the propofol group (10/25painless, 11/25 mild pain, 4/25 moderate pain) (p= 0,000). The premedication of lidocaine with the tourniquet technique significantly produces lower pain levels than the mixture of lidocaine in propofol. Premedication of lidocaine with a tourniquet technique can prevent pain after injecting propofol.
Korelasi Kadar Prokalsitonin dan Jumlah Eosinofil pada Pasien Sepsis di Ruang Intensive Care Unit RSUD Dr. Saiful Anwar, Malang Ruddi Hartono; Karmini Yupono; Yana Agung Satriasa; Arie Zainul Fatoni
JAI (Jurnal Anestesiologi Indonesia) Vol 12, No 1 (2020): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (15.067 KB) | DOI: 10.14710/jai.v12i1.25713

Abstract

Latar Belakang: Sepsis merupakan suatu kondisi di mana terjadi ketidak seimbangan sistem pertahanan tubuh ketika terjadi infeksi. Prokalsitonin merupakan parameter baru yang  berperan penting dalam diagnosis klinis sepsis dan merupakan parameter yang paling akurat. Eosinopenia diketahui sebagai respons inflamasi tipe akut sehingga dapat digunakan sebagai salah satu penanda diagnosis sepsis.Tujuan: Tujuan penelitian ini adalah mengetahui hubungan antara kadar prokalsitonin dengan jumlah eosinofil pada pasien sepsis.Metode: Penelitian ini merupakan penelitian deskriptif observasional analitik untuk mengkaji hubungan antara prokalsitonin dengan jumlah eosinofil pada pasien sepsis yang dirawat di intensive care unit (ICU) RSUD Dr. Saiful Anwar Malang. Penelitian ini menggunakan data rekam medis 74 pasien sepsis yang diperiksa kadar prokalsitonin dan jumlah eosinofil. Data yang diperoleh dianalisis dengan uji korelasi Spearman (p<0.05) menggunakan software SPSS 16.Hasil: Hasil penelitian menunjukkan jika ada korelasi yang kuat antara kadar prokalsitonin dan jumlah eosinofil (p= 0.000) dengan koefisien korelasi -0.610. Penderita sepsis memiliki kadar prokalsitonin yang berbanding terbalik dengan jumlah eosinofil.Kesimpulan: Eosinofil dibuktikan memiliki korelasi yang kuat dengan prokalsitonin. Eosinofil berpotensi menjadi alternatif biomarker diagnosis sepsis pada fasilitas kesehatan yang tidak memiliki fasilitas pemeriksaan kadar prokalsitonin.
Manajemen Anestesi Torakotomi Ligasi Fistel Pasien Tracheoesophageal Fistle Tipe C dengan Atrial Septal Defect (ASD) Sinus Venosus Besar dan Patent Ductus Arteriosus (PDA) Muhamad Akbar Sidiq; Karmini Yupono
Journal of Anaesthesia and Pain Vol 2, No 1 (2021): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.002.01.03

Abstract

Latar Belakang: Insiden tracheoesophageal fistula (TEF) dan esophageal atresia (EA) berkisar antara 1:3000 dan 1:4500 kelahiran. Antara 20% sampai 50% bayi dengan TEF/EA memiliki defek kongenital lainnya yang biasa disebut VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb).Kasus: Bayi usia 30 hari berat badan 2600 gram dengan diagnosis TEF tipe C dengan komplikasi pneumonia neonatal dan penyakit jantung bawaan ASD sinus venosus besar dan PDA sedang direncanakan tindakan thorakotomi ligasi fistel. Pasien sudah dilakukan gastrostomi dan esofagostomi sebelum tindakan ligasi.  Pasien dilakukan manajemen anestesi dengan general anestesi intubasi dengan kontrol ventilasi. Selama operasi terjadi beberapa kali desaturasi akibat retraksi paru yang dimanajemen dengan ventilasi manual dengan pemberian PEEP dan pengurangan retraksi oleh operator. Dua hari post operasi pasien dilakukan ekstubasi dan diganti dengan CPAP.Kesimpulan: Manajemen anestesi dengan TEF/EA memerlukan evaluasi dan perencanaan mulai preoperatif, intraoperatif, dan postoperatif. Evaluasi preoperatif berupa investigasi VACTERL, masalah kardiak dan respirasi berkaitan perencanaan manajemen anestesi yang akan dilakukan. Manajemen intraoperatif termasuk teknik intubasi, pemilihan teknik awake atau apnea bergantung kondisi dan komorbid dari pasien. Manajemen postoperatif berupa perawatan ventilator, kontrol nyeri optimal serta pengawasan kardiorespirasi.
The Use of Dexmedetomidine on Pediatrics Undergoing Magnetic Resonance Imaging (MRI) Examination Gembong Pandhu Suprobo; Karmini Yupono; Rudy Vitraludyono
Journal of Anaesthesia and Pain Vol 2, No 2 (2021): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.002.02.05

Abstract

Dexmedetomidine, an α2 adrenergic agonist, has been commonly used as an off-label anesthetic adjuvant in various procedures and age groups. Lately, dexmedetomidine is increasingly preferred as sedation for pediatric patients undergoing MRI, which requires the patient to remain still in a deep sedation without disturbing airway patency. Dexmedetomidine administration via intranasal or buccal route is preferred for pediatric patients. Dexmedetomidine does not undergo significant pharmacokinetic changes when used in conjunction with other anesthetics, and has a good safety profile. It is 8-10 times more selective against α2 receptors than clonidine and produces sedation, analgesia, vasodilation, and bradycardia without significant airway and respiratory depression risk. Unlike other anesthetic agents, dexmedetomidine does not have any negative effect on brain development. Compared with propofol, dexmedetomidine has a longer onset and duration of action. Thus, dexmedetomidine can be used as the sole sedating agent in infants and children undergoing MRI procedures, with good sedation results and minimal side effects. However, correct dosing is very important given the side effects of bradycardia and hypotension that can occur with its use.
Dexmedetomidine as an Ambulatory Sedation Agent for Abdominal MRI in Patients with Suspected Pheochromocytoma Iradat, Prataganta; Vitraludyono, Rudy; Yupono, Karmini
Journal of Anaesthesia and Pain Vol 5, No 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.04

Abstract

Background: Pheochromocytoma is a vascular tumor of chromaffin tissue, most commonly at the adrenal medulla, that produces and secretes norepinephrine and epinephrine and is a tumor that secretes catecholamines. Magnetic resonance imaging (MRI) is often used to provide clinical data and remains challenging in pediatrics. We present anesthesia management for abdominal MRI in pediatric patients with suspected pheochromocytoma.Case: A 12-year-old child weighing 25 kg with a diagnosis of suspected pheochromocytoma will have an abdominal MRI for diagnosis with sedation. Intravenous sedation technique using dexmedetomidine loading dose 50 μg for 10 minutes and continued maintenance of dexmedetomidine dose 17.5 μg/hour. Durante's MRI showed stable hemodynamics. Post-MRI of the abdomen, monitoring, and evaluation were carried out in the conscious recovery room and found no complications.Conclusion: The use of dexmedetomidine as a sedation agent in patients with suspected pheochromocytoma generally shows stable hemodynamics in the absence of signs of catecholamine spikes.
Dexmedetomidine as an Ambulatory Sedation Agent for Abdominal MRI in Patients with Suspected Pheochromocytoma Iradat, Prataganta; Vitraludyono, Rudy; Yupono, Karmini
Journal of Anaesthesia and Pain Vol. 5 No. 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.04

Abstract

Background: Pheochromocytoma is a vascular tumor of chromaffin tissue, most commonly at the adrenal medulla, that produces and secretes norepinephrine and epinephrine and is a tumor that secretes catecholamines. Magnetic resonance imaging (MRI) is often used to provide clinical data and remains challenging in pediatrics. We present anesthesia management for abdominal MRI in pediatric patients with suspected pheochromocytoma.Case: A 12-year-old child weighing 25 kg with a diagnosis of suspected pheochromocytoma will have an abdominal MRI for diagnosis with sedation. Intravenous sedation technique using dexmedetomidine loading dose 50 μg for 10 minutes and continued maintenance of dexmedetomidine dose 17.5 μg/hour. Durante's MRI showed stable hemodynamics. Post-MRI of the abdomen, monitoring, and evaluation were carried out in the conscious recovery room and found no complications.Conclusion: The use of dexmedetomidine as a sedation agent in patients with suspected pheochromocytoma generally shows stable hemodynamics in the absence of signs of catecholamine spikes.
Co-Authors Arie Zainul Fatoni Djudjuk Rahmad Basuki Gembong Pandhu Suprobo Iradat, Prataganta Isngadi Isngadi Muhamad Akbar Sidiq Ristiawan Muji Laksono Ruddi Hartono Rudy Vitraludyono Vitraludyono, Rudy Yana Agung Satriasa Yudi Hadinata