Aris Darmoko, Aris
Bagian Yanmed (Pelayanan Medik) Rumah Sakit Al-Islam Bandung, Jl. Soekarno Hatta No. 644

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Perbandingan Penggunaan Jarum Sudut Tumpul dengan Jarum Tuohy untuk Transversus Abdominis Plane Block terhadap Penyebaran Anestetik Lokal pada Operasi Ginekologi Darmoko, Aris; Yadi, Dedi Fitri; Maskoen, Tinni Trihartini
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Transversus abdominis plane block (TAPB) merupakan salah satu teknik anestesia regional untuk memblokade nyeri saat dilakukan sayatan kulit di dinding abdomen. Penelitian ini bertujuan membandingkan penggunaan jarum sudut tumpul dengan jarum tuohy untuk TAPB terhadap penyebaran anestetik lokal pada operasi ginekologi. Jenis penelitian eksperimental dengan uji acak terkontrol buta tunggal dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli–Agustus 2014. Penelitian ini dilakukan terhadap 30 wanita berusia 18–60 tahun dengan status fisik American Society of Anesthesiologists (ASA) I–II yang menjalani operasi ginekologi dalam anestesi umum. Penelitian ini dibagi menjadi dua kelompok yaitu jarum sudut tumpul dan jarum tuohy. Teknik TAPB dilakukan di kedua sisi abdomen menggunakan 20 mL bupivakain 0,125%. Sebelum dan sesudah TAPB dilakukan pencitraan ultrasonografi untuk membandingkan penyebaran anestetik lokal. Analisis statistika menggunakan Uji Mann-Whitney dan uji Z. Hasil penelitian ini menunjukkan penyebaran anestetik lokal pada kelompok jarum sudut tumpul 50% dan pada kelompok jarum tuohy 26,7% secara statistika berbeda bermakna (p<0,05). Simpulan, pada operasi ginekologi dengan teknik TAPB penggunaan jarum sudut tumpul lebih baik dibanding dengan jarum tuohy terhadap penyebaran anestetik lokal.Kata kunci: Jarum tuohy, jarum sudut tumpul, penyebaran anestetik lokal, transversus abdominis plane blockComparison between Short Bevel Needle and Tuohy Needle Use in Transversus Abdominis Plane Block on Local Anesthetic Spread During  Gynecological SurgeriesTranversus abdominis plane block (TAPB) is one of the regional anesthesia techniques which enable multimodal analgesia involving skin incision in abdominal wall. This study aimed to compare the use of short bevel needle and tuohy needle for TAPB on the spread of local anesthetics in gynecological surgeries through a experimental randomized single blind trial. This study was conducted in Dr. Hasan Sadikin General Hospital Bandung on July–August 2014 to 30 woman between 18–60 years with the American Society of Anesthesiologists (ASA) physical status I–II underwent gynecological surgery under general anesthesia. The subjects were divided into 2 groups, short bevel needle and tuohy needle groups. The block was given on both sides of the abdomen using 20 mL of bupivacaine 0.125%. Before and after TAPB, an ultrasonography was performed to assess the spread of local anesthetics. Mann Whitney and Z test were used for statistical analysis. The results showed the spread of local anesthetic with short bevel needle was 50%, and with tuohy needle was 26.7%, the difference based on statistical analysis was significant (p<0.05). In conclusions, the use of dull angle needle is better than tuohy needle in the spread of local anesthetics in TAPB in patients undergo gynecological surgeries.Key words: Local anesthetic spreading, transversus abdominis plane block, short bevel needle,  tuohy needle DOI: 10.15851/jap.v3n2.575
Intensive Care Management of Non-Ischemic Dilated Cardiomyopathy with Morbid Obesity in a Parturient Undergoing Cesarean Section Darmoko, Aris; Kestriani , Nurita Dian
Journal of Society Medicine Vol. 4 No. 11 (2025): November
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.242

Abstract

Introduction: Dilated cardiomyopathy (DCM) in pregnancy is a rare but life-threatening condition, with reported incidence ranging from 1:4,950 deliveries in Europe to 2.38:1,000 deliveries in Asia. When complicated by morbid obesity, it significantly increases perioperative and critical care challenges, requiring a coordinated multidisciplinary approach to optimize maternal outcomes. Case Description: A 32-year-old primigravida with morbid obesity (BMI 49.5 kg/m²) and non-ischemic dilated cardiomyopathy presented with decompensated heart failure at 29 weeks of gestation. She underwent elective cesarean section under general anesthesia followed by 19 days of intensive care. Management included hemodynamic optimization with dobutamine infusion, restrictive fluid strategy targeting negative balance, stepwise ventilator weaning from mechanical ventilation to nasal cannula, and treatment of complications including electrolyte disturbances and postoperative delirium secondary to obesity hypoventilation syndrome (Pickwickian syndrome). Continuous hemodynamic monitoring using MostCare and invasive arterial pressure enabled precise titration of therapy. Conclusion: Successful maternal outcome in pregnant patients with dilated cardiomyopathy and morbid obesity can be achieved through comprehensive preoperative optimization, carefully selected anesthetic technique, and prolonged multidisciplinary intensive care. This case highlights the importance of integrated hemodynamic, respiratory, and metabolic management in this high-risk population.