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All Journal Jurnal Anestesiologi Indonesia Jurnal Kesehatan Masyarakat Jurnal Anestesi Perioperatif Jurnal Kesehatan Andalas Jurnal Berita Ilmu Keperawatan Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Anestesi Obstetri Indonesia Solo Journal of Anesthesi, Pain and Critical Care Journal of Anesthesiology and Clinical Research Jurnal Berita Ilmu Keperawatan Academic Hospital Journal Jurnal Manajemen dan Pendidikan Agama Islam Jurnal Komplikasi Anestesi
Yunita Widyastuti
Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Religion Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Decision Sciences, Operations Research & Management Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Identifikasi Faktor Risiko Prediktif Prolonged Length of Stay (PLOS) di ICU RSUP Dr. Sardjito Yogyakarta Fauzi, Rizqi Ahmad; Jufan, Akhmad Yun; Widyastuti, Yunita
Jurnal Komplikasi Anestesi Vol 9 No 1 (2021): Volume 9 Number 1 (2021)
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.v9i1.8517

Abstract

Background: One method to improve the service quality in the Intensive Care Unit (ICU) is to develop a risk prediction system to assess and analyze associated risk factors that cause the prolonged length of stay (PLOS) at the ICU. In Indonesia, there is no risk prediction system developed from the population of Indonesians themselves who have different disease characteristics and patterns from European countries that have developed risk prediction such as APACHE IV and SAPS II. Objective: This study aims to identify the predictive factors of PLOS in ICU RSUP Dr. Sardjito. The long-term goal of this research is to develop a PLOS risk prediction model in the ICU based on the patient population treated at RSUP Dr. Sardjito. Methods: A retrospective cohort study was conducted on 451 patients in the ICU RSUP Dr. Sardjito. Variables that are thought to have a relationship with PLOS were tested using bivariate and multivariable logistic regression tests. After that, an assessment of the power of discrimination and calibration of the new PLOS predictive risk scoring system was carried out using the Area Under the Curve (AUC) method. A calibration test with Hosmer-Lameshow was done to get a comparison value between the observed and expected PLOS. Results: Factors identified as risk factors for PLOS in the ICU RSUP Dr.Sardjito were the medical cases, GCS value <8, use of vasoactive or inotropic drugs, sepsis, respiratory failure, and renal failure in both univariate and multivariate tests. Factors that have passed the multivariable test were used as predictors of PLOS in the ICU and a discrimination test was performed with the AUC. The discriminatory ability of the PLOS predictive model was 0,878 (95% CI). This value is classified as strong as a predictor model. The calibration test with Hosmer-Lameshow obtained a p-value of 0.547 (p>0.05) which means that this model was good. Conclusion: The medical cases, GCS value <8, use of vasoactive or inotropic drugs, sepsis, respiratory failure, and renal failure are predictive factors for PLOS in the ICU RSUP Dr. Sardjito. The discriminatory ability of these factors is strong and is able to predict the incidence of PLOS in the ICU RSUP Dr.Sardjito.
Faktor Risiko yang Mempengaruhi Terjadinya Komplikasi Kardiovaskular Pasca Pembiusan/Sedasi Prosedural pada Pasien Pediatri hendra, hendra hermawan; Widyastuti, Yunita; Djajantisari
Jurnal Komplikasi Anestesi Vol 11 No 2 (2024): Volume 11 Number 2 (2024)
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.v11i2.12446

Abstract

Background: The morphology and physiology of neonates and children differ from those of adults. The most common complications encountered involve respiratory issues followed by cardiovascular problems. The predominant cardiovascular complications in the field of pediatric anesthesia are hemodynamic instability followed by cardiac arrest. Perioperative cardiovascular complications are closely related to a history of prematurity under the age of 1 year, ASA physical status ≥3, concomitant cardiovascular or metabolic diseases, emergency surgeries, and surgical procedures. To date, few risk factors related to the cardiovascular system have been identified in pediatric anesthesia. Objective: To identify risk factors influencing the occurrence of post-anesthesia/sedation cardiovascular complications in pediatric patients at Dr. Sardjito Hospital, Yogyakarta. Method: The research design employed in this study was a prospective cohort observation of pediatric patients undergoing anesthesia or procedural sedation at Dr. Sardjito Hospital. Research subject data included demographic characteristics, ASA status, history of concomitant diseases, type of surgery, urgency level, and post-anesthesia complication occurrences. Data normality was tested using the Kolmogorov-Smirnov test, bivariate analysis was conducted using the Fisher test, variables with p-value <0.25 underwent multivariate analysis using logistic regression for categorical data. The results were processed using SPSS version 23.00. Results: A total of 181 subjects were predominantly male patients aged >5 years. Factors influencing post-anesthetic cardiovascular complications included ASA physical status ≥3 (p=0.033) OR 8.96 (95% CI 2.07 – 38.89), emergency procedures (p=0.043) OR 12.63 (95% CI 1.08 – 147.15), age >5 years (p=0.033) OR 5.67 (95% CI 1.15 – 28.1), female gender (p=0.001) OR 7.85 (95% CI 2.23 – 27.71), and type of surgical procedure (p=0.017) OR 16.64 (95% CI 1.63 – 169.05). Conclusion: Age >5 years, female gender, ASA physical status ≥3, emergency procedures, and surgical procedures are risk factors associated with the occurrence of post-anesthetic/sedation cardiovascular complications in pediatric patients.
Hubungan Rasio Bun-Albumin Plasma Terhadap Mortalitas dan Lama Rawat Pasien Covid-19 Di RSUP Dr. Sardjito Primastuti, Githa Rizki; Wisudarti, Calcarina Fitri Retno; Widyastuti, Yunita
Jurnal Komplikasi Anestesi Vol 11 No 2 (2024): Volume 11 Number 2 (2024)
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.v11i2.12450

Abstract

Background: The increasing incidence of the COVID-19 pandemic has caused quite high mortality rates and length of stay in developing countries. Early detection is needed to reduce mortality rates. Early detection methods are reported, such as RT-PCR, immunoassay, and CT-scan, but they are expensive. Elevated BUN with decreased albumin is a laboratory condition produced by highly inflammatory states, such as COVID-19. The relationship between the plasma BUN-Albumin ratio in pneumonia sufferers has been proven to predict mortality and length of stay more strongly than the single parameter BUN or albumin. If proven to be relevant, these markers are advantageous because they are widely accessible, simple, and economical. Objective: To determine the relationship between plasma BUN-Albumin ratio on mortality and length of stay for COVID-19 patients at Dr. Sardjito. Methods: The research design used a retrospective cohort observational study method of patients with confirmed COVID-19 at RSUP Dr. Sardjito. Data on BUN and plasma albumin levels at admission were collected to calculate the optimal cut-off using the ROC curve. The relationship between BUN-Albumin ratio levels and mortality was analyzed using the chi-square test method followed by logistic regression in multivariate analysis. Analysis of length of stay using cox-regression survival analysis and is declared significant if it produces p < 0.05. Results: The total research subjects were 1650 patients, with a median age of 56 years. The cut-off value for the BUN-Albumin ratio in predicting mortality was found to be 5.634, with a sensitivity of 65.0% and a specificity of 63.7%. (AUC = 0.689; 95% CI 0.663-0.715; p=0.001). Multivariate analysis showed that an increase in the BUN-Albumin ratio was an independent and significant factor as a predictor of mortality (OR 2.378; 95% CI 1.809 - 3.127) and patient length of stay (HR 0.655; 95% CI 0.574 - 0.748; p<0.001). Age, gender, use of positive pressure oxygenation, hypertension, obesity, COPD, and asthma were not independently associated with mortality. Conclusion: An increase in the BUN-Albumin ratio is independently and significantly associated with an increased risk of mortality and length of stay in COVID-19 patients.
A Case report Myasthenia Gravis Adhinugroho, Sudjati; Sudadi, Sudadi; Widyastuti, Yunita
Jurnal Komplikasi Anestesi Vol 11 No 2 (2024): Volume 11 Number 2 (2024)
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.v11i2.12565

Abstract

Myasthenic crisis, defined as respiratory failure requiring mechanical ventilation, occurs in 15 to 20% of patients with myasthenia gravis (MG). Infection (usually pneumonia or viral upper respiratory infection) is the most common precipitant (40%), followed by no obvious cause (30%) and aspiration (10%). As a general rule, 25% of patients are successfully extubated after 1 week, 50% after 2 weeks, and 75% after 1 month. Risk factors for intubation beyond 2 weeks, the point at which tracheostomy is usually performed, include age greater than 50 years, preintubation serum bicarbonate 30 mg/dL or greater, and vital capacity within 6 days of intubation less than 25 mL/kg. Intensive care management of the myasthenic patient should focus on timely intubation, prevention of aspiration with tube feedings, and avoidance of complications, such as atelectasis, that can prolong the duration of crisis. Plasmapheresis leads to short-term improvement of weakness in 75% of patients, and should be performed in all patients unless otherwise contraindicated. Residual weakness leads to functional dependence in 50% of patients at the time of discharge, and one-third will experience two or more episodes of crisis
Faktor-Faktor yang Berhubungan dengan Mortalitas pada Pasien Pediatrik yang Menjalani Pembiusan di Masa Pandemi Covid-19 di RSUP DR Sardjito Getar M, Geza Getar M; Djajantisari; Widyastuti, Yunita
Jurnal Komplikasi Anestesi Vol 11 No 2 (2024): Volume 11 Number 2 (2024)
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.v11i2.12975

Abstract

Background: Anesthesia has the potential to cause physiological changes that lead to morbidity and mortality. Perioperative mortality alone is higher in children than in adults. During this time, the COVID-19 pandemic has affected anesthesia care around the world. The practice of pediatric surgery shows a significant decrease in the frequency of elective surgeries during the pandemic compared to the last three months before the pandemic. Surgical delays that occur, especially in "time-sensitive" surgeries and urgent illnesses in children, can affect the child's growth, development, and quality of life. There are several risk factors associated with mortality and morbidity in pediatric patients, namely age, ASA III-V physical status, emergency surgery, use of ventilators, oxygen support, inotropic drug support, preoperative sepsis, and patients refusing resuscitation. Objective: Identifying factors that influence mortality in pediatric patients undergoing anesthesia during the COVID-19 pandemic. Method: This study is a retrospective cohort observational study. This study included all pediatric patients who underwent anesthesia at Dr. Sardjito General Hospital between April 1, 2020 - March 31, 2021. Variables suspected of having a relationship with mortality will be tested bivariately in this study, and if p<0.25 is considered significant, they will be included in the multivariate analysis. They will be excluded from the multivariate analysis if p<0.05 is considered significant. Result: Factors that influence the incidence of mortality in pediatric patients undergoing anesthesia at Dr. Sardjito General Hospital are ASA III-V physical status with a value of p = 0.004 (OR 3.47), and the use of mechanical ventilation postoperative with a value of p=<0.001 (OR 9.46), both factors that have a significant effect with a p<0.05. Conclusion: ASA III-V physical status and the use of mechanical ventilation postoperative are factors that significantly influence the mortality of pediatric patients undergoing anesthesia at Dr. Sardjito General Hospital.
Klasifikasi Modified World Health Organization sebagai Prediktor Mortalitas Ibu Hamil dengan Penyakit Jantung Pasca Persalinan dengan Analgesia/Anestesi Ekuarianto, Donny; Widyastuti, Yunita; Uyun, Yusmein
Jurnal Anestesi Obstetri Indonesia Vol 7 No 3 (2024): November
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v7i3.196

Abstract

Latar Belakang: Kelainan jantung merupakan penyebab utama tingginya angka kematian ibu hamil secara tidak langsung serta potensi luaran merugikan pada janin. Klasifikasi Modified World Health Organization (mWHO) digunakan sebagai sistem penilaian untuk mengidentifikasi komplikasi jantung selama kehamilan. Tujuan: Menilai performa klasifikasi mWHO sebagai prediktor mortalitas ibu hamil dengan penyakit jantung pasca analgesia atau anestesi.Subjek dan Metode: Study kohort retrospektif, data tahun 2019–2023. Performa diskriminasi dengan menilai AUC serta cut off ROC, kalibrasi dengan Hosmer-Lemeshow. Analisis Bivariat memprediksi hubungan mWHO dan variabel perancu terhadap mortalitas dilanjutkan analisis multivariat dengan uji regresi logistik. Signifikan jika p<0,05.Hasil: Didapatkan 123 subjek rerata usia 29,54 tahun, angka kematian 8,1%. AUC 0,756 (95% IK = 0,645 – 0,866) p = 0,007, dengan Cut-off point terbaik pada klasifikasi mWHO kelas III dengan sensitivitas 70%, spesifisitas 70,8%. Uji kalibrasi (HL p= 0,262) dan hasil uji regresi logistik analisis multivariat (p = 0,04; OR = 5,802).Simpulan: Klasifikasi mWHO memiliki performa diskriminasi dan kalibrasi yang valid sebagai prediktor mortalitas maternal yang signifikan pada pasien ibu hamil dengan penyakit jantung pasca persalinan dengan analgesia/anestesia
PENGARUH SEVERE CRITICAL EVENT PERIANESTESI TERHADAP MORTALITAS PASIEN PEDIATRI YANG MENJALANI PEMBIUSAN DI RSUP DR. SARDJITO Napitu, Annika; Widyastuti, Yunita; Sari, Djayanti
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024): Volume 12 Number 1 (2024)
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.v12i1.15625

Abstract

Background: severe critical events or unwanted and preventable incidents associated with anesthesia in pediatrics have a higher incidence rate compared with adults. It could be due to the immature anatomy, physiology, pharmacology, emotional, and social aspects of pediatric patients. In addition to the higher incidence, the mortality rate of severe critical events in pediatric patients is also higher than in adults. In general, severe critical events in pediatric patients include difficult airway, cardiovascular events, and medical negligence. Based on the time of occurrence, those events can happen pre-anesthesia, during anesthesia, or post-anesthesia with different incidence numbers. Purpose: To assess the impact of critical events during peri-anesthesia on the mortality rate of pediatric patients. Such events include bronchospasm, laryngospasm, pulmonary aspiration, stridor, croup, desaturation, hypotension, arrhythmia, hemorrhage, cardiac arrest, anaphylaxis, neuro injury, delayed emergence, and medication errors. Method: This is a prospective cohort study. All pediatric patients who underwent anesthesia for surgical and non-surgical procedures at RSUP Dr. Sardjito hospital are consecutively included in this study. The inclusion criteria for this study are pediatric patients less than 18 years of age who underwent anesthesia procedures at RSUP Dr. Sardjito hospital. The exclusion criteria are patients who have no complete medical records. The severe critical events included in this study are bronchospasm, laryngospasm, pulmonary aspiration, stridor, croup, desaturation, hypotension, arrhythmia, hemorrhage, cardiac arrest, anaphylaxis, neuro injury, delayed emergence, and medication errors. To statistically assess the relationship between severe critical events and mortality outcomes, bivariate analysis using chi-square was used. Multivariate analysis was then conducted using logistic regression on the variables that had a p-value of less than 0.25 on the bivariate analysis. A p-value of less than 0.05 indicates statistical significance. Result: From the 425 research participants, 70 severe critical events happened in 39 patients, in which 14 cases resulted in mortality were recorded. The multivariate analysis showed that severe critical events of cardiac arrest (p=0,004; OR= 52,259; 95%CI= 3,505 – 779,081) and laryngospasm (p=<0,001; OR= 46,394; 95%CI= 6,001 – 358,640) significantly associated with patient mortality. Patient's demographic of ASA status (p=0,016; OR= 6,056; 95%CI= 1,403-26,139) and prematurity history (p=0,011; OR= 7,730; 95%CI= 1,607-37,193) are shown to be significantly associated with patient mortality. Conclusion: There is a statistically significant relationship between severe critical events of cardiac arrest and laryngospasm with the mortality of pediatric patients who undergo anesthesia in RSUP Dr. Sardjito hospital.
The Voice of the Qur'an's Potential in Pain Management : Review Study Purnawan, Iwan; Widyastuti, Yunita; Setiyarini, Sri; Probosuseno, P
Jurnal Berita Ilmu Keperawatan Vol. 15 No. 2 (2022): July
Publisher : Universitas Muhammadiyah Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23917/bik.v15i2.16990

Abstract

Pain is multidimensional. Pharmacological therapy is still not optimal and has unwanted side effects. Therefore, a safe, effective, and comprehensive non-pharmacological therapy is needed to compensate for the lack of pharmacological therapy. Listening to the recitation of the Quran in several studies has been shown to have a relaxing effect in various situations. The study aims to see whether listening to the Quran as a type of non-pharmacological therapy will help people overcome pain. Method used is comprehensive search on multiple databases (Clinical Key, Cochrane Lab, Medline, Host EBSCO, ProQuest, Science Direct, and Springer Link) using the term "Quran, Holy Quran, Koran, Quran, Pain, Pain Management, and endorphins.". There were 209 articles found, and after several screening stages, 9 articles met the inclusion and exclusion criteria. The level of evidence and the Cochrane Collaboration's tool for assessing the risk of bias was used to assess the article's quality. The result is listening to The Qur'an has been shown to reduce pain in post-surgery, blood sampling, wound care, dysmenorrhea, and childbirth. Some studies are still lacking evidence and are biased. Listening to the Quran is highly recommended for use as a health service.
Tunneled Epidural Analgesia for Refractory Scrotal Cancer Pain: A Case-Based Evaluation of Therapeutic Efficacy Nur Azza, Kamala Kan; Tomo, Wahyu Kartiko; Darwito, Darwito; Puspitasari, Ika; Mahmud, Mahmud; Widyastuti, Yunita
Academic Hospital Journal Vol 7, No 2 (2025)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v7i2.109434

Abstract

Background: Scrotal Squamous Cell Carcinoma (SCC) is a rare malignancy. Although SCC typically demonstrates slow progression, in advanced stages with significant size, it can cause considerable pain due to mass effect and local tissue invasion. The management of cancer-related pain encompasses a wide spectrum of approaches, ranging from pharmacologic to surgical interventions. In cases where patients become intolerant to the side effects of pharmacologic therapies and adequate pain relief cannot be achieved, while surgical options are either not feasible, interventional pain management may offer an effective alternative. Tunneled Epidural Analgesia represents one such interventional technique that can be considered for refractory pain. This case report aims to evaluate the efficacy of tunneled epidural analgesia administration in managing intractable pain associated with advanced scrotal SCC.Materials and methods: This case report is structured according to the CARE (Case Report) guideline. The study was conducted at UGM Academic Hospital, where the patient received evaluation and treatment.Case: A 65-year-old male diagnosed with SCC presented experiencing refractory cancer pain. Despite receiving conventional analgesic therapy, he experienced no significant pain relief and developed adverse effects. Pain management was subsequently escalated to an interventional approach using a bupivacaine 0.125% and fentanyl 25 mcg administered via a tunneled epidural drug delivery system. This intervention resulted in effective pain control, enabling him to do daily activities. With this modality, the pain remained well managed, although occasional breakthrough pain occurred, which was successfully managed with 1% lidocaine as a rescue analgesic.Conclusion: Tunneled epidural analgesia using a combination of opioid and bupivacaine has demonstrated effectiveness in the management of refractory scrotal cancer pain.
Co-Authors . Supomo Adhinugroho, Sudjati Adi, Danis Woro Kuncoro Akhmad Yun Jufan Alqustar, Adam Amelia Ananda Putri Lestari Anggraini, Diana Arifin, Achmad Reza Atmanagara, Dikho Atmojo, Danang Dwi Beni Indra, Beni Bhirowo Yudo Pratomo Budi Yuli Setianto Calcarina Fitriani Retno Wisudarti Cindy Elfira Boom Cornelia Ancilla Darwito, Darwito Denaldi Rananda Saputra Djajantisari Djayanti Sari Ekuarianto, Donny Erwin Kusumastuti Fadhilah Zulfa Fadinie, Wulan Fauzan Imani Ardanto Fauzi, Rizqi Ahmad Febrianti, Skolastika Rani Firman Ardiansyah Getar M, Geza Getar M Givano, Muhamad Randy Gunawan, Fanny Handayani, Donna Hartono, Dedy hendra, hendra hermawan Hernandes, Crodia Hernawan, Agung Diky Hidayat, Fachsyar Ika Puspitasari Ilman, Pesiar Iwan Purnawan Iwan Purnawan Juni Kurniawaty Muhdar Abubakar Djayanti Sari Khoeri, Fatkhur Roofi Krisdiyantoro, Nova Kurniawan, Novianto Mahmud Mahmud Muhammad Brian Ristianto Muhammad Mufti Sofyanoor Napitu, Annika Ngahu, Robby Mesakh Novianto Kurniawan Nugraha, Achmad Fauzani Nur Azza, Kamala Kan Prakosa, Nur Hamam Primastuti, Githa Rizki Priyadi Nugraha P Probosuseno Probosuseno Probosuseno, P Ramsi, Irhash Faisal Ratih Kumala Fajar Apsari Rayhandika Ridha, Ihsanur Rizki, Gilar Romeo Putra Dirama Rumpoko, Triaji Mudo Ruth Sally Sarosa, Pandit SATRIYAS ILYAS Siti Helmyati Sri Rahardjo Sri Setiyarini SRI SETIYARINI, SRI Sudadi Suhanda, Rellig Maret Susi Handayani Taneo, Desy Chery Marlyn Tjokronolo, Yudistira Tomo, Wahyu Kartiko Untung Widodo Untung Widodo, Untung Wardhana, Ardyan Prima Wikantama, Aswin Wisudarti, Calcarina Fitri Retno YP, Bhirowo Yusmein Uyun Zahroh Shaluhiyah