Yusmein Uyun
Departemen Anestesiologi Dan Terapi Intensif; Fakultas Kedokteran; Universitas Gadjah Mada; Yogyakarta

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Journal : Jurnal Komplikasi Anestesi

Uji Banding Respon Tekanan Darah dan Laju Jantung pada Intubasi Endotrakealantara Premedikasi MgSO4 30 mg/kgBB Intravena dengan Fentanil 1 mg/kgBB Intravena Liza, Helda; Uyun, Yusmein; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 4 No 1 (2016): Volume 4 Number 1 (2016)
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.v4i1.7275

Abstract

Pendahuluan: Tindakan intubasi endotrakea sering menimbulkan respon kardiovaskuler yang berlebihan berupa peningkatan tekanan darah, peningkatan laju jantung dan aritmia Hal ini terjadi karena timbulnya refleks simpatis dan simpatoadrenal yang berlebihan akibat rangsangan nyeri maupun stimulus mekanikpada daerah supraglotis. Penelitian ini dimaksudkan untuk membandingkan premedikasi MgSO4 30 mg/kgBB intravena dengan fentanyl 1 mg/kgbb intravena terhadap respon tekanan darah dan laju jantung pada tindakan intubasi endotrakea.Metode: Sebuah penelitian prospektif, uji klinis acak tersamar ganda, telah dilakukan pada 56 pasien ASA I-II yang menjalani operasi elektif dengan anestesi umum intubasi endotrakea di RSUP. Dr. Sardjito Yogyakarta. Subjek penelitian dibagi menjadi dua kelompok masing–masing 28 pasien. Kelompok A menerima MgSO4 30mg/kgBB intravena 15 menit sebelum intubasi dan kelompok B menerima Fentanyl 1 µg/KgBB intravena 3 menit sebelum intubasi. Semua pasien diinduksi dengan propofol 2 mg/kgbb intravena dan fasilitas intubasi dengan Rocuronium 0.6 mg/kgBB intravena, pemeliharaan dengan O2 : N2 O = 50: 50 dan isoflurane 1 vol %. Respon perubahan TDS, TDD dan LJ setelah induksi, menit ke-1, ke-3, ke-5 dan ke-10 setelah intubasi dibandingkan antara kedua kelompok.Hasil: Pada kelompok MgSO4 terjadi peningkatan bermakna (p<0,05) TDS 9,68 mmHg (+8%), TDD 6,64 mmHg (+9%), TAR 7,50 mmHg (8,5%) dan LJ 9,96 x/mnt ( + 11%) pada menit ke-1 setelah intubasi dan kelompok fentanil terjadi peningkatan bermakna (p<0,05) TDS 23,11 mmHg (+18%), TDD 18,04 mmHg (+25%), TAR 19,75 mmHg (21,6%) dan LJ 23,89 x/mnt (+29%) pada menit ke-1 setelah intubasi. Berdasarkan statistik, terdapat perbedaan bermakna (p<0,05) pada nilai rerata TDS menit ke-1 dan ke-3 setelah intubasi antara kelompok magnesium dibandingkan fentanil. Sedangkan perbedaan bermakna nilai rerata TDD danTAR terjadi pada menit ke-1, ke-3 dan ke-10 setelah intubasi. untuk nilai rerata LJ perbedaan bermakna terjadi pada pengukuran setelah induksi dan pada menit ke-1 setelah intubasi.Kesimpulan: Premedikasi MgSO4 30 mg/kgbb intravena menghasilkana respon tekanan darah (TD) dan laju jantung (LJ) lebih minimal dibandingkan dengan premedikasi fentanil 1 mg/kgbb intravena pada tindakan intubasi endotrakea.
Epidural Labour Anagesia (ELA) Mahisa, Orizanov; Uyun, Yusmein; Suryono, Bambang
Jurnal Komplikasi Anestesi Vol 4 No 1 (2016): Volume 4 Number 1 (2016)
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.v4i1.7278

Abstract

Sebagian besar wanita yang melahirkan akan merasakan nyeri yang sangat hebat, hampir sama dengan derajat nyeri regional yang kompleks. Meskipun nyeri hebat tidak mengancam nyawa wanita-sehat yang melahirkan, nyeri dapat memberikan dampak neurofisiologis. Meningkatnya penggunaan neuraxial analgesia untuk mengurangi rasa nyeri selama persalinan diikuti oleh perkembangan teknik aman dalam neuraxial analgesia. Epidural Labour Analgesia merupakan teknik analgesia yang didasarkan pada epidural anestesi. Analgesi yang optimal untuk persalinan dibutuhkan blok neural setinggi T10-L1 untuk kala I dan T10-S4 untuk kala II. Kala I persalinan tidak diperpanjang oleh epidural analgesia yang dapat menghindarkan kompresi aortocaval.
Neuroleptik Analgesia pada Operasi Direct Laringoscopy Purnomo, Dedi Pujo; Mahmud; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 4 No 2 (2017): Volume 4 Number 2 (2017)
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.v4i2.7297

Abstract

Teknik anestesi neuroleptik merupakan modifikasi dari anestesi umum konvensional untuk mengeliminasi persepsi stimuli nosiseptif pada korteks serebral tanpa mempengaruhi fungsi kognitif. Karakteristik spesifik dari teknik ini termasuk modulasi respon endokrin, metabolik, dan otonom terhadap stimulasi nosiseptif. Beberapa prosedur yang minimal invasif juga membutuhkan neuroleptanalgesia, sehingga teknik ini ideal digunakan pada pasien beresiko tinggi apabila dilakukan anestesi umum. Pasien yang sadar dan mampu memberi respon merupakan monitor terbaik selama prosedur diagnostik berlangsung. Meskipun teknik ini tetap memiliki kekurangan yaitu bila terjadi unconsciousness sampai pada tingkat unrousable, gannguanventilasi akibat rigiditas otot dan eksitasi ekstrapiramidal paska operasi.
Perbandingan Efektivitas Penambahan Tramadol 0,125 Mg/Kgbb/Jam dengan Tramadol Bolus Intermitten 50mg Per 6 Jam pada Pasien yang Mendapatkan Fentanil 1 Μg/Kgbb/ Jam untuk Penanganan Nyeri Pasca Operasi Noegroho, Wahyu; Uyun, Yusmein; Widodo, Untung
Jurnal Komplikasi Anestesi Vol 5 No 1 (2017): Volume 5 Number 1 (2018)
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.v5i1.7315

Abstract

Background : The effectiveness of tramadol and fentanyl as multimodal pain theraphy after surgery. Objective : The aim of this study is to compare the effectiveness of the addition of a continuous drip of tramadol is 0,125mg/kgbw /hour on a continuous fentanyl 1 ug/kg/h after the addition of bolus tramadol 50mg given every 6 hours in patients with fentanyl 1 ug/kgbw/hour as analgesia post operation. Methods : Thirty two patients who underwent surgery (oncology, gynecology and laminectomy) under general anesthesia were enrolled.. Samples were randomly divided into 2 groups TB and TK, each group contained 16 patients. In TK group got tramadol 0,125mg/kgbw/hour on a continuous fentanyl 1μg/kgbw/hour. TB group got Bolus tramadol 50 mg per 6 hours on a continuous fentanyl 1μg/kgbw/hour. Results : No significant clinical difference between VAS score TK Group and TB Group on minute 0, hour 6th and hour 12th (p > 0.05, p<0.05). Frequencies of additional fentanyl rescue at first 6 hour in TB group was 6 patients (37.5%), (VAS 4, 3 patients),(VAS 5, 2 patients), in TK group was 3 patients (18.8%), (VAS 4, 1 Patient), (VAS 5, 1 patient), (VAS 6, 1 patient). Additional of fentanyl rescue at second 6 hours in TB Group were 2 patients (12.5%), (VAS 4, 2 patients), in TK Group was 3 patients (18,8%), (VAS 4 , 2 patients) , (VAS 5, 1 patient). Conclusion : The addition of tramadol 0.125 mg/kgbw/h give the same effectiveness in clinical analgesia than tramadol intermittent bolus of 50 mg/6 hours in patients who received fentanyl 1 ug/kgbw/h for the treatment of postoperative pain
Manajemen Preoperatif Kehamilan Ektopik Terganggu dengan Syok Hipovolemia Budianti, Nugrahaeni; Rahardjo, Sri; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 5 No 1 (2017): Volume 5 Number 1 (2018)
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.v5i1.7320

Abstract

Had been reported a case of preoperative management for a woman 36 years old, G1P0A0, pregnant 11 weeks with ruptured ectopic pregnancy and run into hypovolemia shock. We assessed physic status patient as ASA (American Society of Anesthesia) 4E (emergency) with hypovolemia shock et causa internal bleeding and patient had been done relaparotomy. Patient had been refered from RSUD Wonosari and when she came to RSUP Sardjito, she feel pain and pale suspicious hypovolemia shock with internal bleeding then had been done laparatomy emergency surgery, dextra salphingectomy et causa ruptured ectopic pregnancy in IGD operation room for 2 hours and then she was observated in resusitation room for 6 hours and then she was transported to PACU. When in PACU, her condition compos mentis, she feel pain and the hemodynamic is blood pressure 90/ 60 mmHg, pulse 165 times/ minutes, respiration rate 32 times/ minutes on NRM 8 liters/ minutes, spO2 99 – 100 %, temperature 36,8 °C and VAS 3 – 4. In abdominal assessment, we found decreased of peristaltic, distended (+), tenderness (+), wound dressing blood seeped (-) and capilarry refill over 2 second and also radialis artery was not detected. We did evaluation to know internal bleeding, we did positive challange test with kristaloid 20 cc/ kg BB in 15 minutes and then in USG, we found free liquid intraabdomen and we planned emergency laparatomy in IGD operation room. Anesthetic technique that we used was general anesthesia. After surgery, patient was transported to ICU in sedation condition and was intubated.
Perbandingan Insidensi Kultur Apusan Kulit Positif setelah Pemberian Krim Emla® 5% Diikuti Disinfeksi Povidon IODIN 10% Dibandingkan dengan Disinfeksi Povidon IODIN 10% sebelum Anestesia Regional Prihatna, Hendi; Artika, I Gusti Ngurah Rai; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7338

Abstract

Background. Strategies for reducing pain during needle injection include the provision of eutectic mixture of local anesthesia (EMLA) cream, EMLA contains lidocaine that as in vitro experiment believed to have bacteriostatic and bacteriocid effects, EMLA cream can penetrate into deeper layers of skin, EMLA analgesia can penetrate the skin layer with a thickness of 2 mm after 60 minutes and 3 mm after 120 minutes, in which case it can explain the antibacterial effect of EMLA in the long term. Infection that related to spinal anesthesia is a serious complication which may cause meningitis, paralysis and even death. Many studies showed that the skin puncture site was a potential pathogen source during spinal anesthesia procedure. Therefore, effective skin disinfection before the procedure must be performed. Povidone iodine is the most common antiseptic for skin disinfection before spinal anesthesia procedure and has been already stated in Guidelines of Anesthesiology Practice in Sardjito Hospital, Yogyakarta. The aim of this study is to compare positive skin swab culture incidence among patients who are performed with 5% EMLA and 10 % povidone iodine compared with single 10% povidone iodine for skin disinfection in regional anesthesia procedure.Methods. The design of this study were using single blind randomized controlled clinical trial. Thirty-six patients undergoing regional anesthesia (spinal, epidural, combine spinal epidural) and divided into 2 groups, 5% EMLA + 10% povidone iodine (E) group and single 10% povidone iodine (P) group. Pretreatment was done by examination of skin culture and after disinfection was done re-skincare culture examination. The incidence of positive skin swab cultures were recorded then.Result. The incidence of positive skin swab cultures after administration with EMLA followed by 10% povidone iodine is (11.8%) was less than povidone iodine 10% (22.2%) in skin preparation prior to regional anesthesia procedures. However, there was no significant difference in incidence of positive skin swab cultures between administration 5 % EMLA followed by 10% povidone iodine with single 10% povidone iodine (p> 0,05). There was no side effects of 5% EMLA and 10% povidone iodine usage were found in this study.Conclusion. The positive skin swab cultures incidence after administration of 5% EMLA and povidon iodine 10% were less than a single 10% povidon iodine disinfection (11.8% versus 22.2%, p> 0.05).
Penggunaan Ultrasound di Anestesi Obstetri Apsari, Ratih Kumala Fajar; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7342

Abstract

The incidence of complex medical problems in obstetric populations is is rising, and anesthesia for parturient patients add another problem in this complexity. Ultrasound provides an accurate visualization of the internal anatomical structures that may help assess clinical conditions and improve the safety of therapeutic interventions. Ultrasound procedures in obstetric anesthesia have been used in guiding the neuraxial block, transversus abdominis plane block for post-caesarean section pain control, and vascular access. Ultrasound may also be performed to assess gastric volume, airway evaluation in critical obstetric patients, lung evaluation, transesophageal echocardiography, and intracranial pressure assessment as a surrogate marker of preeclampsia. To succeed in ultrasound guidance techniques, it requires familiarity with relevant cross sectional anatomy. Knowledge of anatomy, without any understanding of its structural formation on ultrasound will hamper the understanding of ‘sonoanatomy’.
Anestesi Spinal pada Seksio Sesaria Wanita dengan Karsinoma Nasofaring Supraptomo; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7344

Abstract

Introduction. Regional anesthesia and general anesthesia can be performed in patients with nasopharyngeal cancer, although spinal anesthesia is more aggressive lowering the patient’s hemodynamic state, but the likelihood of difficult intubation in these patients becomes a consideration for regional anesthesia. Case. 35-year-old woman, G3P1A1, 37 weeks pregnant in hospital wanted to give birth. Pasr medical history was difficult to swallow with pain and diagnosed with nasopharyngeal carcinoma. Spinal anesthesias was performed with lidocaine 5% dose 75 mg with adjuvant fentanyl 25 ug. Block achieved until dermatome thorakal. The duration of surgery is 60 minutes with systolic between 90-120 mmHg, diastolic between 55-80 mmHg and pulse between 100-112 times / min. Baby born with APGAR score 8-9, weight 3300 gram. Post surgery patients are treated at the Intensive Care Unit, and during treatment the hemodynamic condition is stable. Summary. The technique of spinal block anesthesia with lidocaine 5% 75 mg with adjuvant fentanyl 25 mcg was considered quite satisfactory as anesthesia management in this case. Synergistic effects of local anesthesia and opiod provide great benefits for obtaining adequate anesthesia, thereby reducing the risk of difficult intubation if general anesthesia is performed
Perbandingan Daya Guna Analgetik antara Tramadol 100 mg dan Natrium Diklofenak 100 mg Suppositoria Rektal untuk Penanganan Nyeri Pascaoperasi Sesar dengan Teknik Pembiusan Blok Subarachnoid Santoso, Arief Hariyadi; Uyun, Yusmein; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 6 No 2 (2019): Volume 6 Number 2 (2019)
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.v6i2.7350

Abstract

Latar Belakang: Operasi sesar menghasilkan nyeri pasca operasi yang signifikan. Tidak ada teknik standar pengelolaan nyeri pasca operasi sesar. Obat antiinflamasi nonsteroid seperti natrium diklofenak berkerja meng-inhibisi sintesis prostaglandin (PG) dengan menghambat enzim cyclooxygenase. Tramadol dengan aktivitas mu-agonis, tidak hanya bekerja pada reseptor opioid, tetapi juga menghambat serotonin (5-HT) dan reuptake noradrenalin.Tujuan: Mengetahui daya guna analgesi 24 jam pasca operasi sesar antara penggunaan suppositoria rektal tramadol dengan natrium diklofenak.Metode: Prospektif, uji klinis acak terkontrol pada 70 pasien status fisik ASA I-II, berusia 19-40 tahun, hamil aterm 37-42 minggu,, Indeks Massa Tubuh < 35 kg/m2. Pasien dikelompokkan acak ke dalam 2 kelompok : kelompok suppositoria rektal natrium diklofenak (D) dan tramadol (T) dengan teknik single blind. Dilakukan penilaian VAS pada kedua kelompok, jumlah penambahan rescue jika VAS ≥3, dan efek samping pada masing-masing kelompok.Hasil: Selama 24 jam pascaoperasi, rata-rata frekuensi pemberian tambahan fentanyl kelompok T sebanyak 3.13 kali dan kelompok D 1,7 kali, rata-rata dosis tambahan fentanyl kelompok T sebanyak 155,71 mcg dan kelompok D 67,65 mcg (p=0,000). Rata-rata VAS 24 jam pasca operasi pada kelompok T 2,14 dan pada kelompok D 1,74 (p<0,05). Untuk efek samping, kelompok T terdapat 4 kejadian (11,4%) mual muntah, sedangkan pada kelompok D tidak ada. Perbedaan ini bermakna yang ditunjukkan dengan nilai p=0,042 (p<0,05).Kesimpulan: Daya guna analgesi natrium diklofenak 100 mg suppositoria rektal lebih baik dibanding tramadol 100 mg suppositoria rektal, dengan efek samping yang lebih kecil pada 24 jam pasca operasi sesar.
Manajemen Anestesi pada Seksio Sesar Pasien G5P4A0 dengan Severe Pulmonal Stenosis Uyun, Yusmein; Kurniawaty, Juni; Daniswara
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (2019)
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.v7i1.7378

Abstract

Pada pasien ini terdapat PS severe dan TR moderate yang menunjukan bahwa PS severe sudah cukup lama, tetapi tidak ada manifestasi klinisdari pasien, hanya ditemukan bising jantung saat dilakukan auskultasi dan tidak ada limitasi aktifitas pasien. Target hemodinamik pada pembiusan pasien dengan PS dan TR hampir sama, sehingga target tersebut digunakan untuk membius pasien seperti pada kasus ini yaitu dengan menjaga preload tinggi, heart rate tinggi, kontraktilitas normal, SVR normal, dan PVR normal rendah. Pemilihan pembiusan dari beberapa literatur menyebutkan bahwa dapat dilakukan dengan anestesi umum maupun regional dengan targettarget hemodinamik seperti diatas. Persiapan obatobatan untuk menjaga target hemodinamik juga harus ada sebelum operasi, bisa juga diberikan profilaksis seperti pada suatu case report yang sudah disebutkan diatas untuk menjaga SVR tetap normal.
Co-Authors . Mujahidin Adi Hidayat Adi, Danis Woro Kuncoro Adrin, Olga Elenska Akhmad Yun Jufan Annemarie Chrysantia Melati Ardi Pramono Arief Hariyadi Santoso Arif Ikhwandi Arif Supriyono Artika, I Gusti Ngurah Rai Ayu Rosema Sari Bambang Suryono Bambang Suryono Bambang Suryono Bambang Suryono, Bambang Bhirowo Yudo Pratomo Budianti, Nugrahaeni Calcarina Fitriani Retno Wisudarti Dadik Wahyu Wijaya Daniswara Dewi Yulianti Bisri Djoko Wahyono Djoko Wahyono Djoko Wahyono Dwiana Sulistyanti Ekuarianto, Donny Erna Fitriana A Fadinie, Wulan Fitri Hapsari Dewi Fitri, Lillah Fitriana A, Erna Gutama, Bayu Satria Hartono, Pinter Hayati, Farida Helmina Wati Hendra, Maijoni Hernawan, Agung Diky Hidayat, Nopian Isngadi Isngadi Isngadi Juni Kurniawaty Muhdar Abubakar Djayanti Sari Liza, Helda Mahisa, Orizanov Mahmud Mahmud Muhammad Iqbal Noegroho, Wahyu Nopian Hidayat Nova Maryani Nugroho, Alfan Mahdi Nurul Ulfah Hayatunnisa Perbatasari, Inggita Dyah Perwira, Rendra Prakosa, Nur Hamam Prihatna, Hendi Purnomo, Dedi Pujo Rahma, Aulia Zuhria Ratih Kumala Fajar Apsari Redhy Sindharta Rizqi Adhelia Rose Mafiana RTH Supraptomo Ruddi Hartono Sandi, Dita Ayulia Dwi Sandi, Dita Ayulia Dwi Santoso, Arief Hariyadi Satrio Adi Wicaksono SATRIYAS ILYAS Septica, Rafidya Indah Septica, Rafidya Indah Septika, Rafidya Indah Siti Helmyati Sri Rahardjo Sri Rahardjo Sri Rahardjo Sudadi Suharso, Pamungkas Hary Sunartejo, Bayu Supraptomo Suryasaputra, Wahyu Untung Widodo Untung Widodo, Untung Utomo, F uad Cipto Wicaksono, Galih Sahid Wirawan, Angga Aditya Yunita Widyastuti Yusmalinda Yusmalinda