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All Journal Jurnal Anestesi Perioperatif Jurnal Neuroanestesi Indonesia Medicosphere
Fitri Sepviyanti Sumardi
Bagian Anestesiologi dan Terapi Intensif Rumah Sakit Bayukarta Karawang, Jl. Lesmana No. 10 Bandung
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Mechanical Engineering Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Perbandingan Efek Pemberian Norepinefrin Bolus Intravena dengan Norepinefrin Infus Kontinu dalam Tatalaksana Hipotensi, Laju Nadi, dan Nilai APGAR pada Seksio Sesarea dengan Anestesi Spinal Sumardi, Fitri Sepviyanti; Nawawi, Abdul Muthalib; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 3, No 1 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1462.282 KB)

Abstract

Vasopresor sering digunakan dalam tatalaksana hipotensi anestesi spinal pada seksio sesarea. Penelitian bertujuan membandingkan efek pemberian norepinefrin bolus intravena dengan norepinefrin infus kontinu dalam tatalaksana hipotensi pada anestesi spinal pasien seksio sesarea dan pengaruh pada laju nadi serta nilai APGAR. Penelitian bersifat eksperimental acak tersamar ganda pada 44 ibu hamil status fisik American Society of Anesthesiologist (ASA) II yang menjalani seksio sesarea dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung pada September–November 2013. Subjek penelitian dibagi menjadi 2 kelompok yaitu kelompok  norepinefrin bolus intravena 4 µg (NB) dan kelompok norepinefrin infus kontinu 8 µg/menit (NK). Data dianalisis dengan uji-t, Uji Mann-Whitney, chi-kuadrat dan uji-t analysis of variance (ANOVA), nilai p<0,05 dianggap bermakna. Hasil penelitian menunjukkan bahwa peningkatan tekanan darah sistol, diastol, dan rata-rata lebih tinggi pada kelompok NB (p=0,000). Perubahan laju nadi secara umum pada kedua kelompok relatif stabil dan nilai APGAR menunjukkan perbedaan yang tidak bermakna (p>0,05). Simpulan penelitian ini adalah kedua cara pemberian norepinefrin ini dapat digunakan dalam tatalaksana hipotensi anestesi spinal tanpa memengaruhi laju nadi dan nilai APGAR.   Kata kunci: Anestesi spinal, hipotensi, nilai APGAR, norepinefrin, seksio sesareaEffect of Intravenous Norepinephrine Bolus and Norepinephrine Continuous Infusion on Hypotension Management, Heart Rate, and APGAR Score in Caesarean Section Patient under Spinal AnesthesiaAbstractVasopresors are commonly used for the treatment of hypotension in spinal anesthesia for cesarean section. This research aimed to compare intravenous bolus of norepinephrine to continuous infusion of norepinephrine effectiveness in hypotension management in caesarean section patient under spinal anesthesia and their effect on heart rate and APGAR Score, The experimental study was conducted in a double-blind randomized manner to 44 American Society of Anesthesiologist (ASA) physical status II pregnant women undergoing cesarean section with spinal anesthesia in Dr. Hasan Sadikin General Hospital Bandung within the period of September to -November 2013. The Study  subjects were grouped into two groups, the first group received 4 µg intravenous bolus of norepinephrine group (NB) and and the second received 8 µg/minute continuous infusion of norepinephrine group (NK).  Data were analyzed by t-test, Mann-Whitney test, chi-square and analysis of variance (ANOVA) t-test with p<0.05 was considered significant. The results showed that the increase in systolic, diastolic and mean arterial blood pressures were higher in the NB group (p=0.000). Changes in heart rate were generally relatively stable in both groups and APGAR score showed a non-significant difference (p>0.05). Conclusion from this study is the administration of norepinephrine in both ways can be used for the treatment of hypotension of spinal anesthesia without affecting the heart rate and APGAR scoreKey words: APGAR score, caesarean section, hypotension, norepinephrine, spinal anaesthesia DOI: 10.15851/jap.v3n1.375  
Kehilangan Penglihatan Pascabedah Laminektomi dalam Posisi Prone Sumardi, Fitri Sepviyanti; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (238.038 KB) | DOI: 10.24244/jni.vol1i4.193

Abstract

Kehilangan penglihatan pascabedah nonocular sangatlah jarang, akan tetapi, harus dipertimbangkan sebagai komplikasi pascabedah yang tidak diinginkan. Kehilangan penglihatan unilateral atau bilateral secara tiba-tiba yang terjadi pascaanestesia umum telah dilaporkan dan dihubungkan dengan berbagai sebab diantaranya syok haemorhagik, hipotensi, hipotermia, kelainan koagulopathi, trauma langsung, emboli, dan penekanan pada bola mata yang berlangsung lama. Kasus: seorang laki-laki berusia 60 tahun dengan diagnosis radiculopathi setinggi L4 e.c protunded disc L4-5 dan L5-S1 yang menjalani laminektomi dalam anestesi umum. Terjadi komplikasi pascabedah berupa kehilangan penglihatan yang disertai opthalmoplegi total akibat oklusi arteri retina sentralis, sindroma kompartemen orbita akut, dan pseudotumor tipe miositis.Visual Loss after Prone Lumbar Spine SurgeryVisual loss after nonocular surgery is a rare but devastating postoperative complication. Sudden unilateral or bilateral visual loss occurring after general anesthesia has been reported and attributed to various causes including haemorrhagic shock, hypotension, hypothermia, coagulopathic disorders, direct trauma, embolism, and prolonged compression of the eyes. Case: a man, 60 years-old with diagnosis radiculopathy in level L4 e.c. protunded disc L4-5 and L5-S1 who required laminectomy in general anesthesia. An unusual complication of visual loss with total opthalmoplegy was caused by central retina artery occlusion, acute ischemic orbital compartement syndrome, and pseudotumor type myositis.
The High-Stakes Balance: Patient Safety and Neurosurgical Practice in a COVID-19 Pandemic Sumardi, Fitri Sepviyanti
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.616

Abstract

Introduction: The COVID-19 pandemic profoundly affected neurosurgical practices globally, prompting the introduction of emergency health protocols to safeguard patients and healthcare personnel. While these measures were essential for controlling virus spread, they were resulted in challenges like surgical delays, resource shortages, and heightened stress for medical staff. This study aims to evaluate the impact of these protocols on neurosurgical care, identify the challenges posed, and suggest strategies to enhance patient safety and healthcare resilience in future outbreaksSubject and Methods: This qualitative study involved a systematic literature review on PubMed, Google Scholar, and ScienceDirect, along with interviews with neurosurgeons, anesthesiologists, and intensive care specialists. Through thematic analysis, it explored the disruptions in neurosurgical care during the pandemic, the adaptive strategies employed, and their impact on patient outcomes and medical staff well-being.Results: The study found that while emergency health protocols helped minimize COVID-19 transmission, they caused significant disruptions in neurosurgical care, with 30% of patients experiencing delays that adversely affected their outcomes. PPE shortages, inconsistent preoperative screening, and changing health protocols complicated surgical workflows. Hospitals with structured triage systems, expanded telemedicine, and enhanced preoperative screening managed the crisis better. Additionally, healthcare workers' psychological distress was reduced through improved mental health support and resource availability.Conclusion: The COVID-19 pandemic has transformed neurosurgical practice, highlighting the need for adaptation and resilience in healthcare. Strengthening collaboration, optimizing resources, and integrating technology will better prepare neurosurgical teams for future public health emergencies while maintaining high-quality patient care.
The Role of Artificial Intelligence in the Diagnosis and Management of Ischemic Stroke in Indonesia: A Systematic Review Sumardi, Fitri Sepviyanti
Journal of Diverse Medical Research: Medicosphere Vol. 2 No. 5 (2025): J Divers Med Res 2025
Publisher : Faculty of Medical - UPN Veteran Jawa Timur

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33005/jdiversemedres.v2i5.173

Abstract

Background: Ischemic stroke is a leading cause of death and disability in Indonesia. However, with the emergence of artificial intelligence (AI), there is a promising future for improving stroke diagnosis and management. This article aims to explore the potential of AI in this context, as well as the challenges and opportunities for its implementation in Indonesia, offering a hopeful outlook for the future of stroke care. Article Selection Methodology: This is a narrative study on the utilization of AI in diagnosing and managing ischemic stroke. Using the keywords' role of AI in diagnosing and managing ischemic stroke,' we retrieved and critically reviewed approximately 16 relevant articles from PubMed, Scopus, and Google Scholar. Results: Artificial intelligence (AI) presents a promising avenue for enhancing stroke diagnosis. Its ability to analyze data faster and more accurately and to assist medical personnel in making better clinical decisions is a significant advancement. However, it's crucial to recognize and address challenges, such as the need for high-quality data and adequate user training. Overcoming these hurdles is critical and requires our utmost determination and commitment to fully realizing the potential of AI in daily clinical practice. Conclusion: Artificial intelligence has significant potential in diagnosing and managing ischemic stroke in Indonesia. Its ability to enhance diagnostic accuracy, streamline clinical decision-making, and improve access to care is undeniable. However, to fully realize these benefits, we must urgently invest in further research and foster collaboration among various stakeholders. We can ensure the safe, effective, and ethical implementation of this transformative technology through these concerted efforts.
Kajian Konsep Lund dan Konsep Rosner untuk Tatalaksana Cedera Otak Traumatik Berat Sumardi, Fitri Sepviyanti; Rachman, Iwan Abdul; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2554.002 KB) | DOI: 10.24244/jni.v9i2.248

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Tatalaksana pasien dengan cedera otak traumatik (COT) berat mengalami perubahan berkesinambungan selama 30 tahun terakhir. Tatalaksana yang diarahkan di unit perawatan intensif (intensive care unit/ICU) mengacu pada tatalaksana klinis sebagai titik akhir terapi utama, bertujuan untuk mempertahankan variabel fisiologis tertentu secara ketat dalam rentang target yang telah ditentukan. Satu alternatif terhadap terapi konvensional ini adalah konsep Lund yang mengutamakan penurunan tekanan mikrovaskular. Konsep Lund termasuk suatu strategi target volume untuk mengendalikan tekanan intrakranial, berasal dari Universitas Lund Swedia, lebih dari 27 tahun yang lalu dan tetap masih kontroversi sampai saat ini. Sejak tahun 1996, American Brain Trauma Foundation dan European Brain Injury Consortium, yang mengacu pada konsep Rosner, telah menerbitkan dan memperbarui panduan untuk tatalaksana cedera otak traumatik. Para ahli sangat menyadari adanya patologi intrakranial multifaktorial yang terlihat pada pasien COT berat dan kompleksitas mekanisme cedera otak sekunder setelah trauma primer, akan menemukan bahwa revisi ini sulit untuk dipahami. Hubungan antara peningkatan tekanan intrakranial (TIK) dan hasil luaran klinis yang lebih buruk sudah terbukti. Menyederhanakan fisiologi otak setelah COT berat ke strategi tatalaksana pasien bedasarkan ambang batas adalah berkaitan erat dengan hubungan interaksi komplek antara: peningkatan TIK, aliran darah otak, dan metabolisme otak.Review of Lund Concept and Rosner Concept for Therapy of Severe Traumatic Brain InjuryAbstractThe management of patients with severe traumatic brain injury (TBI) has undergone continuous changes over the past 30 years. Management directed at the intensive care unit (ICU) refers to clinical management as the main end point of therapy, aiming to maintain certain physiological variables strictly within a predetermined target range. One alternative to this conventional therapy is the Lund concept which prioritizes the reduction of microvascular pressure. The concept of Lund includes a volume target strategy for controlling intracranial pressure, from Lund University in Sweden, more than 27 years ago and remains controversial to date. Since 1996, the American Brain Trauma Foundation and the European Brain Injury Consortium, which refers to the Rosner concept, have published and updated guidelines for the management of traumatic brain injury. Experts are well aware of the multifactorial intracranial pathology seen in severe TBI patients and the complexity of the mechanism of secondary brain injury after primary trauma will find that this revision is difficult to understand. The relationship between increased intracranial pressure (ICP) and worse clinical outcome has been proven. Simplifying the physiology of the brain after severe TBI to the patient's management strategy based on the threshold is closely related to the relationship between complex interactions: increased ICP, cerebral blood flow (CBF), and brain metabolism.
Pengelolaan Anestesi untuk Evakuasi Hematoma Epidural pada Wanita dengan Kehamilan 2224 Minggu Sumardi, Fitri Sepviyanti; Umar, Nazaruddin; Rehatta, Nancy Margareta; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2434.859 KB) | DOI: 10.24244/jni.vol5i2.67

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Tujuh sampai 8% dari seluruh wanita hamil pernah mengalami trauma yang dapat menyebabkan kematian ibu akibat traumanya, bukan akibat kehamilannya. Pengelolaan anestesi pada wanita hamil yang akan menjalani operasi dengan anestesi umum di luar seksio sesarea, terutama operasi bedah kepala, memberikan tantangan tersendiri kepada para ahli anestesi, karena terdapat 2 orang pasien yang harus dikelola agar menghasilkan nilai luaran klinis yang baik untuk keduanya. Kami akan melaporkan seorang wanita 22 tahun G1P0A0 dengan kehamilan 2224 minggu, yang akan menjalani operasi evakuasi hematoma epidural akibat kecelakaan motor yang terjadi sebelumnya, tanpa dilakukan seksio sesarea, mengingatkan usia kehamilan masih dalam trimester kedua. Pertimbangan perubahan anatomi dan fisologis pada kehamilan, upaya agar aliran darah uteroplasenta adekuat serta efek teknik dan obat anestesi terhadap otak dan aliran darah uteroplasenta harus dipikirkan secara matang, karena faktor-faktor kritis akan menunjukkan derajat cedera kepala yang lebih berat, sehingga hasil nilai luaran klinis ibu dan janin buruk. Pada kasus ini ini ibu dapat pulang dengan kehamilan yang baik.Management of Anesthesia in Epidural Hematoma Evacuation with Pregnancy 22-24 WeeksSeven to 8% of pregnant women had experienced trauma that can lead to maternal deaths due to trauma not as result of her pregnancy. Management of anesthesia in pregnant women who will undergo surgery with general anesthesia outside caesarean section, especially neurosurgery, providing a challenge to the anesthesiologist, because there are two patients who must be managed in order to have good clinical score outcomes for both patients. We will report a 22-year-old woman who will undergo surgery epidural hematoma evacuation due to a motorcycle accident that occurred previously, without performed caesarean section, reminiscent of gestation is still in the second trimester. Consideration of anatomical and physiological changes in pregnancy and effort that uteroplacental blood flow should be considered carefully, because critical factors will indicate the degree of head injury more severe, so that the results of the clinical outcomes of mother and fetus is bad. In this case mother and her pregnancy can discharge from hospital with good condition.
Peranan Index of Consciousness (IoC) dalam Tatalaksana Total Intravenous Anesthesia pada Operasi Mikrovaskular Dekompresi Sumardi, Fitri Sepviyanti; Fuadi, Iwan; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (436.902 KB) | DOI: 10.24244/jni.vol6i2.43

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Perkembangan ilmu pengetahuan dan tehnik operasi bedah saraf ini berbanding lurus dengan kemajuan keilmuan anestesi. Tatalaksana anestesi sangat mempengaruhi kualitas hidup dan kesehatan pasien pascabedah. Seorang laki-laki 58 tahun dengan diagnosis trigeminal neuralgia sinistra, berat badan 60 kg dan tinggi badan 165 cm. Pasien mengeluh nyeri wajah sebelah kiri yang terkadang disertai nyeri kepala. Riwayat hipertensi dan penyakit penyerta lain disangkal. Riwayat konsumsi obat-obatan seperti carbamazepine disangkal. Dilakukan induksi anestesi umum dengan tehnik total intravenous anesthesia (TIVA) menggunakan teknik target controlled infuse (TCI): propofol, dexmetomidine, fentanyl dan rocuronium, sebagai alat pantau/monitoring digunakan index of consciousness (IoC), lama operasi 2 jam dan lama pasien teranestesi 2 jam 30 menit. Pascabedah pasien dirawat di ICU selama 1 hari, lalu dipindahkan ke ruang rawat inap dan pulang ke rumah pada hari ke-6 perawatan. Mikrovaskular dekompresi merupakan operasi bedah otak yang minimal invasif menuntut para ahli anestesi untuk bertanggung jawab menyokong pascabedah yang lebih optimal, sehingga pasien cepat bangun dan penilaian neurokognitif dilakukan sedini mungkin. Penggunaan IoC sebagai alat pantau pasien/monitoring selama diberikan anestesi TIVA sangatlah berguna. Hal ini bertujuan untuk mencegah timbulnya pasien tetap sadar selama operasi berlangsung, dengan melihat kedalaman anestesi yang diberikan, agar tidak terjadi kekurangan atau kelebihan dosis obat-obatan anestesi yang diberikan.The role of index of consciousness (IoC) Total Intravenous Anesthesia Management for Microvascular Decompression SurgeryThe development of science and engineering neurosurgical operation is directly proportional to the scientific advancement of anesthesia. Management of anesthesia greatly affect quality of life and health of patients postoperatively. A man 58 years old with a diagnosis of the left trigeminal neuralgia, weighing 60 kg and height 165 cm. Patients complain of pain left face is sometimes accompanied by headache. A history of hypertension and other comorbidities denied. A history of consumption of drugs such as carbamazepine denied. Induction of general anesthesia with TIVA technique using TCI: propofol, dexmetomidine, fentanyl and rocuronium, as a means of monitoring / monitoring use IoC (index of consciousness), long operating time of 2 hours and anesthetized patients 2 hours 30 minutes. Postoperative patients admitted to the ICU for 1 day, and then transferred to the wards and go home on the 6th day of treatment. Microvascular decompression is a brain surgery less invasive and requires minimal bleeding anesthesiologists responsible for more optimal postoperative support, so patients quickly get up and neurocognitive assessment done as early as possible. The use IoC as a tool to monitor patients during anesthesia TIVA, its very useful. It aims to prevent the patient awareness during surgery, to see the depth of anesthesia is given, in order to avoid under- or overdosing anesthesia agents.
Co-Authors Abdul Muthalib Nawawi Dewi Yulianti Bisri Hamzah, Hanzah Iwan Abdul Rachman Iwan Fuadi Rahordjo, Sri Rehatta, Nancy Margareta Rehatta, Nancy Margareta Rose Mafiana Saleh, Siti Chasnak Saleh, Siti Chasnak Sri Rahardjo Surachman, Eri Tatang Bisri Tinni T. Maskoen Umar, Nazaruddin Umar, Nazaruddin