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INDUKSI PADA PASIEN PEB DENGAN KARDIOMIOPATI DAN EDEMA PARU Suryani, Shila; Prihatno, MM Rudi
MANDALA of Health Vol 7, No 3 (2014): Mandala Of Health
Publisher : Jurusan Kedokteran FK Unsoed

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Preeclampsi is a desease that occur in pragnancy after 20 weeks gestaton with manifestation include multiorgans system such as pulmonary oedema and ventricel disfunction. Cardiomyopathy is a heart disorder that characterized by myocard disfunction and there is no relation with others heart desease before.Â Â Â Â Â Â Â Â Â Â Â This case report discuss about induction anesthesia management to a women, 22 years old diagnosed with GIP0A0, severe preeclampsi, pulmonary oedem, cardiomyopathy, and fetal distress underwent caesaria section. Its a challange for anesthesiologist, how anesthesia management to this patient. There are four thing that we should do when induction, that is : optimalitation of preoxygenation,Â give positive pressure ventilation with PEEP, minimal myocardial depressant effect of drugs, and keep normovolume. By doing these things we can keep adequate oxygenation so that can increase mother and baby outcome

Pengaruh Nebulisasi N-acetylcysteine Terhadap Pembentukan Biofilm Bakteri Pada Pipa Endotrakeal Pada Pasien yang Terpasang Ventilator di ICU Suryani, Shila; Widodo, Untung; Aman, Abu Tholib
Majalah Anestesia & Critical Care Vol 42 No 1 (2024): Februari
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v42i1.322

Latar belakang: Kemampuan bakteri membentuk biofilm merupakan salah satu penyebab resistensi antibiotik dan menurunkan angka keberhasilan terapi. N-acetylcysteine merupakan obat mukolitik yang juga memiliki efek menghambat produksi dari matriks polisakarida ekstraseluler, sehingga dapat mencegah pembentukan biofilm. Penelitian ini bertujuan untuk mengetahui pengaruh nebulisasi N-acetylcysteine terhadap pertumbuhan biofilm pada pipa endotrakeal pada pasien yang terpasang ventilator. Metodologi: Rancangan penelitian ini uji klinis acak terkontrol, ketersamaran ganda. Kriteria inklusi subyek penelitian adalah usia 18-70 tahun, menggunakan ventilator dengan pipa endotrakeal H-0, dan setuju menjadi subyek penelitian, kriteria eksklusi adalah pasien yang mempunyai penyakit paru sebelum intubasi dan pasien sulit intubasi, kriteria drop out adalah pipa endotrakeal (ET) ekspulsi atau autoextubasi, meninggal < 48 jam, dan ekstubasi > 96 jam. Pasien dibagi menjadi dua kelompok. kelompok A mendapatkan nebulisasi N-acetylcysteine dan kelompok B yang mendapatkan nebulisasi akuades setiap delapan jam hingga ekstubasi. Sampel diambil berupa apusan ujung ET pasien yang terpasang ventilator 48-96 jam. Hasil: Total subjek berjumlah 122 pasien, 12 drop out. Sampel yang didapatkan berjumlah 110, 55 sampel kelompok A dan 55 kelompok B. Terdapat perbedaan karakteristik sampel pada faktor komorbid sepsis dan jenis oprasi. Tidak didapatkan perbedaan bermakna secara statistik pada bakteri pembentuk biofilm ringan dan sedang, namun dijumpai perbedaan bermakna pada bakteri pembentuk biofilm kuat. Simpulan: pemberian nebulisasi N-acetylcysteine pada pasien yang menggunakan ventilator dengan pipa ET 48-96 jam tidak mencegah terbentuknya biofilm namun dapat menghambat pembentukan biofilm kuat.

Edema Paru Neurogenik Perioperatif Prihatno, MM Rudi; Suryani, Shila; Pramono, Wisnu Budi
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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.v12i2.464

Edema paru neurogenik (EPN) merupakan salah satu penyebab kematian di ruang perawatan intensif. Kejadian ini lebih sering tersamarkan sebagai penyakit atau gangguan yang murni berasal dari sistem pernafasan. Pemeriksaan untuk menegakkan diagnosis EPN perlu dilakukan, baik secara radiologis dan laboratoris. Ada beberapa hal yang sangat berguna pada penentuan perkiraan kejadian EPN ini, antara lain adalah penyebab kejadian neurologis yang terjadi, pemeriksaan penunjang, lama perawatan berjalan di RS, serta prakondisi penyakit penyerta yang dimiliki oleh pasien ataupun keluarganya. Pasein yang akan menjalani prosedur operasi dan memiliki gangguan respirasi sebelumnya atau riwayat gangguan neurologis sebelumnya atau bahkan keduanya, menjadi catatatan tersendiri akan resiko kejadian EPN perioperatif. EPN pada dasarnya bisa ditatalaksana dengan baik bilamana dalam pengelolaannya secara komprehensif dan selalu mempertimbangkan kemungkinan diagnosa banding kausatifnya, karena bila salah dalam penentuan diagnosanya, maka tentunya akan mengakibatkan kesalahan dalam terapinya.Pengelolaan EPN yang efektif dan efisien, didasarkan pada tegaknya diagnosis yang diperkuat dengan dukungan pemeriksaan laboratorium dan penunjang, untuk menyingkirkan kerancuan penyebab dari EPN, apakah murni kasus neurologis ataupun non neurologis. Pasien pasca pembedahan yang terindikasi mengalami EPN, selama perawatan di ruang perawatan intensif ataupun ruangan perawatan pasca anestesi (post anesthesia care unit/ PACU), perlu mendapatkan perhatian khusus untuk sementara waktu, dengan tujuan agar pasien tidak mengalami pemburukan.Perioperative Neurogenic Pulmonary EdemaAbstractNeurogenic pulmonary edema (NPE) is one of the leading causes of death in the intensive care unit. These events are often disguised as diseases or disorders that originate purely from the respiratory system. Diagnostic examination of NPE needs to be done, both radiologically and in the laboratory. Several things are useful in determining the estimated incidence of NPE, including the causes of neurological events, supporting examinations, length of stay, and preconditions for comorbidities owned by the patient or his family. Patients who are about to undergo a surgical procedure and have previous respiratory problems, a recent history of neurological disorders, or even both have a special note about the risk of perioperative NPE events. Management of NPE can be appropriate if it is managed comprehensively and always considers possible differential diagnoses of causes because if it is wrong to make a diagnosis, then of course it will result in an error in therapy. Effective and efficient management of NPE, based on diagnosis that is strengthened by the support of laboratory and supporting examinations, to rule out ambiguous causes of NPE, both purely neurological and non-neurological cases. Postoperative patients who are indicated to have NPE, during treatment in the intensive care unit or post anesthesia care unit (PACU), need to receive temporary special attention so that the patient does not experience aggravation.

Plasmaferesis pada Krisis Myasthenia : Kasus Serial Suryani, Shila; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 10 No 2 (2023): Volume 10 Number 2 (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.v10i2.8298

Adrenal gland surgery needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, and surgeon. The indications for adrenal gland surgery include hormonal secreting and non-hormonal secreting tumors. Adrenal hormonal secreting tumors present to the anesthesiologist unique challenges requiring good preoperative evaluation, perioperative hemodynamic control, corrections of all electrolytes and metabolic abnormalities, a detailed and careful anesthetic strategy, overall knowledge about the specific diseases, control and maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues.

Anesthetic Management in Cerebellopontine Angle Tumor Craniotomy with a History of Nasopharyngeal Tumor Fitryono, Eko Prasetyo; Prihatno, Muhammad Mukhlis Rudi; Suryani, Shila
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.62326

Background: Cerebellopontine angle (CPA) tumor is the most common type of neoplasm found in the posterior fossa. In this case report, we aim to describe the anesthetic management of craniotomy surgery in patient CPA tumor with a history of nasopharyngeal tumor.Case: A 49 years old female patient, weight 58 kg, was admitted with the main complaint of headache, dizziness, her lips drooped to the right and her left eye could not close completely. The left extremity is weak, walk unsteadily, the vision in both eyes is blurry, the left hearing is decreased. There is a history of nasopharyngeal carcinoma from biopsy results in 2019. The patient is diagnosed with a CPA tumor, a craniotomy will be performed under general anesthesia, the patient is fasted for 8 hours before surgery, which was administration of premedication ondansetron 4 mg iv, dexamethasone 5 mg iv. Preemptive analgesia sufentanyl 15 mcg iv, thiopental induction 250 mg iv, muscle relaxant rocuronium 30 mg iv, fresh gas flow (FGF) 3 L/min, maintenance with sevoflurane gas 2%, rocuronium 20 mg/hour syringe pump, dexmedetomidine 20 mcg/hour syringe pump. Analgetics after surgery patient was given morphin 1 mg/hour syringe pump, paracetamol 3x1 gr iv. After craniotomy the patient condition improved, complaints before surgery decreased.Discussion: In this cases report, patient with CPA tumor underwent craniotomy surgery under general anesthesia. During operation, in neuroanesthesia management is to maintained hemodynamic stability.Conclusion: Anesthetic management of CPA tumor starts from pre-surgical evaluation, premedication, induction, durante position, anesthetic management and supervision. Anesthesia has a very important role in the overall management of these patients to obtain good surgical results.

Role of Neuroprotective Agents in the Anesthetic Management of Brain Tumors for Patients with Recidive Cystic Tumor with Signs of Intracranial Hypertension Underwent Re-Craniotomy Decompression Tumor Resection: Case Report Utami, Yulia Kartika; Prihatno, Rudi; Suryani, Shila
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): Jurnal Anestesiologi Indonesia (Issue in Progress)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.66384

Background: The management of brain tumor surgeries, particularly recurrent cystic tumors with cerebral edema, poses significant challenges. Elevated intracranial pressure (ICP) and the associated risk of ischemia necessitate a comprehensive neuroprotective approach during anesthesia to ensure optimal surgical and postoperative outcomes.Case: A 54-year-old male presented with two weeks history of headaches and dizziness. He had previously undergone a craniotomy six months ago for the removal of a metastatic right parieto-occipital adenocarcinoma. Imaging revealed tumor recurrence, and the patient was scheduled for a re-craniotomy. The anesthetic plan included neuroprotective strategies: thiopental for metabolic suppression, sufentanil for hemodynamic stability, and sevoflurane for neuroprotection. The surgery lasted 3.5 hours, with minimal intraoperative blood loss and stable perioperative hemodynamics. Postoperatively, the patient recovered without complications and was discharged in stable condition.Discussion: The anesthetic management prioritized maintaining ICP, cerebral perfusion pressure (CPP), and minimizing neuroinflammatory responses. Thiopental effectively reduced cerebral metabolic demands, sufentanil stabilized hemodynamics, and sevoflurane provided neuroprotective and anti-inflammatory benefits. hypothesis and principles. These strategies ensured cerebral autoregulation, controlled cerebral edema, and optimized recovery. The Monro-Kellie hypothesis and principles of neuroprotection were key guiding frameworks in this case.Conclusion: This case highlights the critical role of neuroprotective agents in the anesthetic management of brain tumor surgeries. The combination of thiopental, sufentanil, and sevoflurane contributed to a stable intraoperative course and uneventful recovery. Integrating these strategies ensures improved surgical outcomes and patient safety in challenging neurosurgical cases.

PERBANDINGAN ONSET DAN DURASI BLOK SENSORIK MOTORIK MENGGUNAKAN METODE KOMBINASI BUPIVAKAIN DAN BUPIVAKAIN MURNI PADA PASIEN SEKSIO SESARIA Utami, Yulia Kartika; Suryani, Shila; Setiawati, Setiawati
Mandala Of Health Vol 17 No 2 (2024): Mandala of Health: a Scientific Journal
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.mandala.2024.17.2.13191

Anesthesia plays as an important role in the caesarean section procedure. The use of multimodal analgesia regimen has been considered as the gold standard of anesthesia for patients undergoing cesarean section. This study examines the comparison between the onset and duration of motoric and sensoric nerve blocks in patients undergoing cesarean section with spinal anesthesia using Bupivacaine Combination and Bupivacaine Only at Margono Soekarjo Hospital, Purwokerto. This research was a randomized controlled trial with double blind. Inclusion criteria in this study were patients aged 20-45 years, ASA physical status II and BMI between 18.5-35. Exclusion criteria in this study were patients with anatomical abnormalities or severe congenital abnormalities, contraindications to spinal anesthesia, history of allergy to the anesthetic agents used and unconsciousness patients. Subjects were divided into two groups, each group consists of 15 patients, Bupivacaine Combination (spinal anesthesia with Bupivacaine 7.5 mg + Fentanyl 25 mcg + Morphine 100 mcg) and Bupivacaine Only (spinal anesthesia with Bupivacaine 15 mg). Data were analyzed using Independent Sample T Test with a significance level of α=0.05. There were differences in onset of motoric block (p=0.00), duration of motoric block (p=0.00), onset of sensoric block (p=0.00) and duration of sensoric block (p=0.00) between Bupivacaine Combination and Bupivacaine Only groups. The Bupivacaine Combination group has a slower onset and shorter duration of anesthesia than the Bupivacaine Only group.

ENCEPHALITIS ANTI N-METHYL-D-ASPARTATE RECEPTORS Suryani, Shila; Wisudarti, Calcarina Retno Fitriani
Mandala Of Health Vol 16 No 2 (2023): Mandala of Health
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.mandala.2023.16.2.8584

Background : Anti-N-Methyl-D-Aspartate receptor encephalitis is an autoimmune disease where the incidence is still rare which is characterized by complex neuropsychiatric syndrome. In severe stages, it can cause morbidity and mortality so it requires adequate intensive therapeutic management. Cases: 1) Male, 23 years old diagnosed with NMDAR encephalitis at an advanced stage in 10 days of treatment. Patient was given plasma exchange therapy three times and steroids did not respond then given rituximab, did not respond as expected. 2) A 19-year-old male diagnosed with NMDAR encephalitis at an advanced stage on the 7th day of hospitalization. Patient was given plasma exchange therapy 7 times and steroids. The patient showed an improved response to the third plasma exchange therapy, the patient could weaned from the ventilator and then transferred from the ICU. Conclusion: NMDAR encephalitis at an advanced stage requires long intensive care. Immunotherapy is the first-line therapy for NMDAR encephalitis. Immunotherapy options in severe cases can be given plasma exchange in combination with steroids. Rapid diagnosis and early initiation of therapy can provide better outcomes, reduce complications of nosocomial infections and reduce length of stay in the ICU.

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