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INCIDENCE AND RISK FACTOR OF ACUTE KIDNEY INJURY POST OPEN HEART SURGERY IN PAEDIATRIC PATIENTS Heriwardito, Aldy; Alatas, Anas; Perdana, Aries; Sutedja, Anasthasia Devina
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.65

Introduction: Acute Kidney Injury (AKI) was a frequently complication after open heart surgery, especially in paediatric patients < 2 years old and had been related with increased mortality and adverse renal outcomes. This study aimed to know the incidence of AKI post open heart surgery in paediatric patients and its relation with duration of cardiopulmonary bypass (CPB) and patientâs age in Indonesia tertiary national hospital.Methods: This was a cohort retrospective study, using medical record and Cardiac ICU chart data, of 195 paediatric patients who underwent open heart surgery from June 2014 - June 2015 in Integrated Cardiovascular Center Cipto Mangunkusumo hospital. After ethical approval from Research Ethic Committee, data were collected and sorted by inclusion and exclusion criteria. AKI was diagnosed based on RIFLE criteria. Data were analyzed by chi-square and multivariate analysis (SPSS software 22.0 version).Results: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB > 60 min had a significant correlation with increased incidence of AKI (p 0.043; RR 1.248). Patientâs age â¤ 2 years old also had a significant correlation with increased incidence of AKI (p<0.001; RR 2.431). Multivariate analysis results showed that both duration of CPB > 60 min and patientâs age â¤ 2 years old were significant risk factors of AKI (OR 2.951, OR 5.371).Conclusion: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB duration > 60 min and patientâs age < 2 years old were significant risk factors of AKI.

Kefektifan Sedasi antara Campuran Ketamin Propofol (Ketofol), dan Propofol Fentanil pada Prosedur Endoscopic Retrograde Cholangiopancreatography (ERCP) Sugiarto, Adhrie; Perdana, Aries; Jefrey Tuhulele, Norman Rabker
Majalah Anestesia dan Critical Care Vol 34 No 1 (2016): Februari
Publisher : Perdatin Pusat

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Sedasi adekuat diperlukan untuk menjaga kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasienselama prosedur ERCP. Propofol merupakan sedasi yang tanpa efek analgesia namun memiliki efek depresikardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan menurunkankebutuhan dosis propofol dalam mempertahankan kedalaman sedasi, analgesia, kestabilan hemodinamik danrespirasi. Penelitian ini membandingkan keefektifan sedasi antara campuran ketamin-propofol (ketofol) danpropofol-fentanil pada prosedur ERCP. Penelitian ini adalah uji klinis acak tersamar ganda, 36 pasien dewasayang menjalani prosedur ERCP, dibagi menjadi dua kelompok yaitu kelompok KF (n=18) yang mendapatkanketofol 1:4 dalam semprit 50 mL, serta kelompok PF (n=18) yang mendapatkan fentanil 1 mcg/kgBB dan propofoldalam semprit 50 mL. Kedalaman sedasi diukur dengan Ramsay Sedation Scale. Hasil penelitian didapatkan reratakonsumsi propofol permenit, kelompok ketofol lebih rendah bermakna dibanding dengan kelompok propofolfentanil (p<0.05). Jumlah kebutuhan fentanil pada kelompok ketofol lebih rendah dibanding dengan kelompokpropofol-fentanil (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol-fentanil lebih cepat dibandingdengan kelompok ketofol (p<0.05). Kejadian hipotensi pada kedua kelompok tidak berbeda bermakna (p>0.05).Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Simpulan adalah ketofol lebihefektif daripada propofol-fentanil untuk kedalaman sedasi dan analgesia serta memiliki efek samping yangminimal. Kata kunci: ERCP, Propofol, ketamin, fentanil, sedasi, analgesia The effectiveness of sedation is the ability of the drugs to maintain sedation depth and analgesia, and to controlpatients movements during ERCP procedure. Propofol is a sedative agent that has no analgesia effect and hasa dose-dependent cardiovascular and respiratory depressant effects. The addition of small dose of ketamin isexpected to reduce the required dose to maintain hemodinamic and respiratory stability. This study comparedthe effectiveness of sedation between 1:4 ketamin propofol mixtures (ketofol) and propofol-fentanyl in ERCPprocedure. This research a double blind randomised clinical trial was done in 36 adult patients who underwentERCP procedure, which were divided into two groups: KF group (n = 18), which were treated with ketofol 1:4in a 50 mL syringe, and PF group (n = 18) which were treated with fentanil 1 mcg/kgBW and propofol in a 50mL syringe. The depth of sedation was measured by Ramsay Sedation Scale (RSS). The average consumption ofpropofol per minute of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The medianfentanyl consumption of ketofol group was significantly lower than fentanyl propofol group (p<0.05). The onsetand the recovery time in fentanyl propofol group were faster than ketofol group (p<0.05). There was no significantdifferent in the incidence of hypotension in both groups (p>0.05). There were no desaturation events or nausea/vomiting in both groups. Conclution ketofol was more effective than fentanyl-propofol mixture in maintaining thedepth of sedation and analgesia and has minimal side effects. Key words: Analgesia,ERCP, fentanyl, ketamine, propofol, sedation Reference Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62(1):1–8. Glomsaker TB. Endoscopic Retrograde Cholangiopancreatography (ERCP) in Norway, University of Bergen, 2013. Available at http://www.ivs.no/downloads/ thesis_Glomsaker.pdf, accessed on October 24, 2014 Chainaki IG, Manolarki MM, Paspatis GA. Deep sedation in gastrointestinal endoscopy, World J Gastroentero, 2011, 3 (2): 34–9. Sumaratih L. Perbandingan keluaran antara teknik pemberian propofol bolus berkala dengan Target Controlled Infusion pada pasien endoskopi saluran cerna di RSUPN Cipto Mangunkusumo, Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Indonesia, Jakarta, 2013. Wang Y, Jiang X, Pan L, Dong S, Feng Y, Prajapati SS, et al. Randomized double-blind controlled study of the efficacy of ketofol with propofolfentanyl and propofol alone in ttermination of pregnancy. Afr. J.Pharm. pharmacol.2012;6(34):2510–14. Coulter FLS, Hannam JA, Anderson BJ. Ketofol dosing simulations for procedural sedation, Pediatr Emerg Care, 2014;30(9): 621–30. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamin propofol (ketofol), Acad Emerg Med, 2010;17:194–201. Hassenein R, El-Sayed W. Ketamin/propofol versus fentanyl/propofol for sedating obese patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP), Egypt J Anesth, 2013;29:207–11. Thom G. The evolving role of ketofol and its use as sedation agent in PSA in children: systemic review, 2013. Available at http://sedationspecialists.co.za/wpcontent/uploads/2013/07/Ketofol-in-sedationnew-developments_Dr-George-Thom.pdf, accessed on October 11, 2014.

Perbandingan Keberhasilan Insersi Kanul Intravena antara Penggunaan dan Tanpa Penggunaan Penampil Vena pada Pasien Pediatrik Perdana, Aries; Kapuangan, Christopher; Alantas, Anas; Manggala, Sidharta Kusuma; Wardhani, Yosi Dwi
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
Publisher : Perdatin Pusat

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Insersi kanul intravena pada bayi, balita atau anak-anak cukup sulit karena kecilnya ukuran pembuluh darah vena dan lokasinya yang dalam di jaringan subkutis. Kesalahan insersi kanul intravena cenderung terjadi pada kasus difficult venous access (DVA). Penelitian ini membandingkan keberhasilan insersi kanul intravena dengan atau tanpa penggunaan penampil vena pada pasien pediatrik. Setelah mendapat persetujuan dari Komite Etik FKUI/RSCM dan konsen dari pasien, dilakukan penelitian uji klinis acak tidak tersamar pada 88 sampel pasien pediatrik. Pasien dirandomisasi menjadi dua kelompok, pada kelompok 1 dilakukan insersi kanul intravena tanpa penampil vena, sedangkan kelompok 2 dilakukan insersi kanul intravena dengan penampil vena. Data yang terkumpul diuji dengan uji Chi-square. Insersi kanul intravena sekali tusuk dengan penampil vena keberhasilannya 3,095 kali lebih besar dibanding dengan tanpa penampil vena (p<0,05). Insersi kanul intravena sekali tusuk pada pasien dengan status gizi kurang-buruk memiliki angka keberhasilan 0,285 kali dibanding dengan status gizi normal lebih (p<0,05). Usia memiliki hubungan signifikan terhadap insersi kanul intravena (p<0,05). Keberhasilan insersi kanul intravena sekali tusuk dengan menggunakan penampil vena lebih baik dibanding dengan tanpa penampil vena. Keberhasilan insersi kanul intravena memiliki hubungan yang signifikan dengan status gizi dan usia. Kata kunci: Difficult venous access, kanul intravena, penampil vena, status gizi Comparison of Successful Vein Cannula Insertion between Using Vein Viewer and without Vein Viewer in Pediatric Patients Vein cannula insertion in infants, toddlers, or children is quite difficult because of the size and location of their veins. Wrong vein cannula insertion are prone to happen in Difficult Venous Access (DVA) cases. This research is comparing the successful vein cannula insertion between using vein viewer and without vein viewer in pediatric patients. After obtained the ethical approval from Ethical Committee of Cipto Mangunkusumo Hospital and informed consent from patients, 88 pediatric patients were enrolled to this randomized controlled trial. Patients were randomized into 2 groups: first group was inserted without vein viewer and second group was inserted using vein viewer. Data was analyzed with Chi-square test. Successful rate in first attempt vein cannula insertion using vein viewer is 3.095 times higher than without vein viewer (p<0.05). First attempt vein cannula insertion in malnutrition patients has successful rate 0.85 times higher than good nutrition-obese patients (p<0.05). Age has significant relationship with vein cannula insertion (p<0.05). Successful rate in first attempt vein cannula insertion using vein viewer is higher than without vein viewer. Successful first attempt in vein cannula insertion has significant relationship with nutrition status and age. Key words: Difficult venous access, nutrition status, vein cannula, vein viewer

Ketepatan Rumus Peres dan Topografi Anatomi dalam Menentukan Prediksi Kedalaman CVC pada Pemasangan Subklavia Kanan Perdana, Aries; Pryambodho, Pryambodho; Kambey, Barry Immanuel
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Pemasangan kateter vena sentral (CVC) merupakan suatu tindakan yang cukup rutin dilakukan pada perawatan intensif maupun perioperatif. Diperlukan suatu metode atau rumus sederhana dan akurat untuk memperkirakan kedalaman kateter CVC yang tepat. Studi ini mengevaluasi posisi dan kedalaman kateter vena sentral dengan menggunakan rumus Peres ([tinggi badan/10]-2) dan pengukuran topografi anatomi, serta menilai insiden malposisi pada pemasangan CVC. Penelitian ini merupakan studi observasional analitik. Lima puluh pasien yang menjalani pemasangan kateter vena sentral (CVC) dengan pendekatan vena subklavia kanan dibagi ke dalam 2 kelompok yaitu kelompok Rumus Peres ([tinggi badan/10]-2) dan kelompok Pengukuran Topografi Anatomi.Hasil perhitungan prediksi dipakai untuk menentukan batas fiksasi kulit. Kedalaman CVC dievaluasi dengan mengukur jarak antara ujung distal kateter CVC dengan karina pada radiografi dada. Hasil pengukuran tersebut dianalisis dengan uji statistik Bland Altman. Pada kelompok Rumus Peres, rerata jarak antara karina dengan ujung distal kateter CVC adalah sebesar 1,5 cm dibawah karina (IC 95% 1,2 sampai 1,9 cm), limit agreement 0,0 sampai 3,0 cm. Rerata jarak pada kelompok pengukuran topografi anatomi sebesar 0,85 cm (IC 95% 0,5 sampai 1,1 cm) limit of agreement -0,5 sampai 2,2 cm. Pada penelitian ini insiden malposisi ditemukan sama pada kedua kelompok(masing-masing 3 insiden). Rumus Peres dan Pengukuran Topografi Anatomi tidak tepat dalam memprediksi kedalaman kateter CVC pada orang Indonesia. Kata kunci: Kateter vena sentral (CVC), subklavia kanan, metode prediksi, rumus Peres, topografi anatomi The AmLuracy of Peres formula and Landmark Technique to Predict the Depth of Central Venous Catheter with Right Subclavian Vein ApproachCentral venous catheter (CVC) insertion is a routine procedure in intensive care and perioperative care. Simple and amLurate method is needed to predict the optimal depth of CVC. This study evaluated the position and depth of central venous catheters by Peres formula ([height/10] -2) and Landmark measurement, and also assessed the incidence CVC insertion malposition. This was an analytic observational study. Fifty patients undergoing central venous catheter (CVC) with the right subclavian vein approach was divided into two groups: Formula Peres ([height / 10] -2) and Anatomy Topography Measurement group. The calculation result was used to determine the boundary prediction of skin fixation. CVC depth was evaluated by measuring the distance between the distal end of the CVC catheter with karina on chest radiographs. The measurement results were analyzed by statistical tests Bland Altman. In Peres Group, the mean of the distal CVC was 1,5 (0,82) cm under carina (IC 95% 1,2 to 1,9 cm), with the limit of agreement 0,0 cm to 3,0 cm. The mean of landmark groups was 0,85 (0,73) cm (IC 95% 0,5 to 1,1 cm) with limit of agreement -0.5 cm to 2,2 cm. The incidence of malposition was found similar in both groups. Both prediction methods were not amLurate to predict the depth of CVC insertion in Indonesian people. Key words: Central venous catheter (CVC), right subclavian, prediction methods, Peres formula, landmarks

The effectivity of ear plug utilization on emergence delirium incidence in pediatric patient undergoing general inhalated anesthesia Perdana, Aries; Kapuangan, Christopher; Zahra, Raihanita
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Background. Emergence Delirium (ED) also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors such as agitation, irritable, uncompromising, uncooperative, inconsolably crying following general anesthesia. The incidence of ED in pediatric patients in Dr. Cipto Mangunkusumo hospital was 39,7%. During emergence state, auditory stimulation induces thalamic synapse in lateral amygdala which leads to over response of fear (one of the risk factor of ED). A high noise level in operating room can be reduced with ear plug application to the patient. Design and Method. A double blind randomized clinical trial towards 1-5 years old pediatrics who underwent inhalation general anesthesia in Dr. Cipto Mangunkusumo hospital from September-December 2018. One hundred and seven subjects were randomized after a consecutive sampling into two groups. Earplug group (n=53) with application of ear plug at the end of surgery, while in control group (n=54) without application of ear plug. The incidence of ED and time to extubation were recorded. ED was measured using Pediatric Anesthesia Emergence Delirium (PAED) scale. All the data was analyzed using multivariate logistic regression and ANCOVA. Result. Incidence of ED in ear plug group was 16.7% while in control group was 32.1% (OR = 0.402; CI 95% 0.152-1.062; p=0.066). Mean value of time to extubation in ear plug vs control group (5.76+3.23 minutes) vs (6.54+ 3.67 minutes) with mean difference of 0.825(0.530-2.180); p=0.230. Conclusion. Ear plug application at the end of anesthesia was not statistically effective. However, it was clinically effective in reducing the incidence of ED in pediatric patient underwent inhalation anesthesia.

Construct Validity and Reliability of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) Indonesian Version Perdana, Aries; Firdaus, Muhammad Fikry; Kapuangan, Christopher; , Khamelia
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Preoperative anxiety has a significant effect on anesthesia and surgery. Currently there is no specific instrument for measuring preoperative anxiety in Indonesian population. APAIS have been used worldwidely to measure preoperative anxiety. APAIS instrument has been used widely to measure preoperative anxiety. The purpose of this study was to obtain the validity and reliability of APAIS instrument in Indonesia. This cross-sectional study enrolled 102 patients in Cipto Mangunkusumo Hospital who underwent elective surgery to answer the Indonesian APAIS one day before operation. The translation utilized backward and upward approach. Following ethic approval, the subjects filled the APAIS instrument one day before the surgery. Construction validity was measured by factor analytic method. The internal consistency was evaluated by Cronbach?s alpha. A total 102 patient (42 men and 60 women) enrolled in this study. Factor analysis showed anxiety scale and similar information in comparison to the original instrument. High reliability Cronbach?s alpha anxiety and need for information scale Indonesian APAIS respectively 0,825 and 0,863. The APAIS scales were independent of sex, previous surgery, type of operation or type of anesthesia. Indonesian APAIS proved to be reliable and valid instrument to measure preoperative anxiety in Indonesian population.

Blok Fascial Pecto-intercostal Bilateral sebagai Analgesia untuk Median Sternotomi pada Anak A A Gde Putra Semara Jaya; Raden Besthadi Sukmono; Aries Perdana
Majalah Anestesia & Critical Care Vol 38 No 2 (2020): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Median sternotomi pada anak mengakibatkan nyeri akut pascabedah dengan derajat sedang hingga berat, yang berhubungan dengan berbagai efek samping pascabedah. Blok fascia pecto-intercostal yang dipandu ultrasonografi memiliki potensi analgesia untuk median sternotomi sehingga dapat bermanfaat pada populasi anak. Kami melaporkan satu kasus anak laki-laki berusia tiga setengah tahun dengan tumor mediastinum anterior, yang akan menjalani median sternotomi dan eksisi tumor. Pasien dengan status fisik American Society of Anesthesiologists (ASA) 2, fibrosis segmen 2 dan 3 paru kanan dengan riwayat tuberkulosis paru. Eksisi tumor mediastinum anterior melalui median sternotomi berhasil dilakukan dengan fasilitasi kombinasi anestesi umum dan blok fascia pecto-intercostal bilateral. Pemulihan pascabedah juga berjalan dengan lancar. Penggunaan blok fascia pecto-intercostal bersama modalitas lainnya dapat memberikan analgesia yang memadai untuk median sternotomi. Kata Kunci: blok fascia pecto-intercostal; sternotomi; manajemen nyeri

Perbandingan Tanggapan Kardiovaskular dan Kemudahan Intubasi dengan Menggunakan Laringoskop McCoy dan Macintosh pada Ras Melayu di Indonesia Riyadh Firdaus; Nur’aini Alamanda; Aries Perdana
Majalah Anestesia & Critical Care Vol 39 No 3 (2021): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Latar Belakang : Intubasi endotrakeal dan laringoskopi direk merupakan standar baku emas dalam tatalaksana jalan nafas baik pada keadaan gawat darurat ataupun tidak. Peningkatan tanggapan kardiovaskular karena rangsangan simpatis merupakan komplikasi tersering saat intubasi. Tanggapan kardiovaskular ini dapat berbahaya bagi pasien-pasien yang berisiko, terutama yang memiliki masalah gangguan jantung. Metode pemilihan bilah merupakan salah satu teknik non farmakologi yang digunakan untuk mengurangi tanggapan kardiovaskular yang timbul akibat intubasi. Penelitian ini bertujuan untuk membandingkan tanggapan kardiovaskular dan kemudahan intubasi antara laringoskop McCoy dan Macintosh. Metode : Uji klinis acak tersamar tunggal, dengan 78 pasien yang akan menjalani anestesia umum dengan intubasi endotrakeal dan dibagi ke dalam 2 kelompok, yaitu McCoy dan Macintosh. Kriteria inklusi adalah 18-65 tahun dengan status fisik ASA 1 dan ASA 2 tanpa penyulit jalan nafas. Midazolam 0,05mg/kgBB dan fentanyl 2mcg/kgBB diberikan 2 sebagai agen koinduksi. Induksi anestesia menggunakan propofol 2mg/kgBB, dilanjutkan dengan pemberian rocuronium 0,6mg/kgBB setelah dipastikan hilangnya refleks bulu mata. Tanggapan kardiovaskular yang diukur (tekanan sistolik, diastolik, tekanan arteri rerata, dan laju denyut nadi). Intubasi dikatakan mudah bila dilakukan dalam waktu kuang dari 10 menit dan tidak lebih dari 3 kali percobaan. Hasil : Pada menit pertama pasca intubasi, tekanan darah sistolik, diastolik, dan lau denyut nadi kelompok McCoy lebih tinggi dibandingkan Macintosh, dengan perbedaan tekanan sistolik -2,38 (-9,93-5,16), tekanan diastolik -1,07(-7,313-5,15 95%IK), laju denyut nadi 2,79(-2,69 – 8,28). Pada menit ke-3 pasca intubasi, tekanan sistolik, diastolik, tekanan arteri rerata, dan laju denyut nadi kelompok McCoy tetap lebih tinggi dibandingkan dengan Macintosh, dengan perbedaan tekanan sistolik -1,23 (-8,51-6,05), tekanan diastolik -0,97(-6,69-4,75), tekanan arteri rerata -0,65(-6,27-4,97), dan laju denyut nadi 0,89(-3,99-5,78). Kesimpulan : Intubasi dengan laringoskop McCoy tidak mampu menekan tanggapan kardiovaskular yang timbul akibat rangsang nyeri dan stimulasi simpatis.

Perbedaan Laju Induksi Inhalasi pada Anak: Perbandingan Antara Sevofluran Ditambah Oksigen dengan Sevofluran Ditambah Oksigen dan N2O Dimas Rahmatisa; Aries Perdana; Andi Ade Wijaya; Alfan Mahdi N
Jurnal Komplikasi Anestesi Vol 1 No 3 (2014): Volume 1 Number 3 (2014)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v1i3.5545

Latar Belakang. N2Omerupakan gas anestesia inhalasi yang sering ditambahkan pada saat induksi anestesia inhalasi pada anak. Kontroversi penggunaan N2O sendiri masih ada hingga saat ini. Tujuan penelitian ini adalah untuk mengetahui perbedaan laju induksi anestesia, respons hemodinamik, dan komplikasi yang timbul selama menggunakan N2O saat induksi inhalasi anestesia pada pasien anak. Metode. Delapan puluh orang anak usia 1-5 tahun ASA 1 dan 2 yang menjalani anestesia umum, dibagi menjadi 2 kelompok perlakuan secara acak. Kelompok A sevofluran 8 vol% ditambah oksigen, dan kelompok B sevofluran ditambah oksigen dan N2O 50%. Hasil utama yang diukur adalah laju induksi, lainnya adalah respons laju nadi, tekanan darah sistolik, diastolik, serta insidens komplikasi desaturasi, eksitasi, laringospasme, dan breath holding.. Hasil. Laju induksi kelompok A dan B secara berurutan yaitu 54.12+5.89 detik dan 35+8.13 detik. Respons laju nadi, tekanan darah sistolik, tekanan darah diastolik tidak berbeda bermakna di antara kedua kelompok. Insidens komplikasi desaturasi dan laringospasme tidak terjadi pada penelitian ini. Eksitasi terjadi pada kelompok A dan B secara berurutan yaitu 26.8% dan 10.3%. Breath holding terjadi pada 2 orang (4.9%) di kelompok A, dan tidak terjadi di kelompok B. insidens eksitasi dan breath holding tidak berbeda bermakna antara kedua kelompok. Kesimpulan. Laju induksi inhalasi pada anak menggunakan sevofluran ditambah oksigen dan N2O lebih cepat dibandingkan tanpa N2O Respons hemodinamik dan insidens komplikasi tidak berbeda bermakna antara kedua kelompok.

Penggunaan Magnesium Sulfat pada Pasien dengan Asma Persisten Sedang Menjalani Operasi Elektif Tiroidektomi Total Tyastarini, Ni Putu Ade Tiwi; Perdana , Aries
Jurnal Komplikasi Anestesi Vol 11 No 3 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i3.14981

Case: Female, 45 years old, with a history of moderate persistent asthma, type 2 diabetes mellitus, and bilateral struma multiple nodusa nontoxic (SMNT), planned to undergo a total thyroidectomy procedure. During the pre-anesthesia visit, it was found that the patient's condition was in acute exacerbation, then the night before the surgical procedure, the patient was given 2.5 mg salbutamol and Budesonide 5 mg inhalation. Magnesium sulfate (MgSO4) 25 mg/kg/kg intraveously in normal saline solution 100ml drip in 10 minutes, and continued with the administration of MgSO4 5 mg/kg/hour drip intravenously intra-operative. Post-operative, deep extubation was performed on the patient and monitored in the ICU for <24 hours, and continued in ward until allowed outpatient discharge on the second postoperative day. Discussion: In elective surgery particularly in the airway area, the risk of bronchospasm increases and optimal perioperative management is required as well as in patients with comorbid asthma. The administration of magnesium sulfate has several advantages in this case, in terms of the bronchodilation effect produced, as an adjuvant analgesia and also hypomagnesemia therapy related to diabetes mellitus. In conclusion, MgSO4 can be used as an alternative in the anesthetic modality of patients with a history of moderate persistent asthma who will undergo surgery.

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