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A False Route Case of Primary Excision Anastomosis (EPA) Procedure in The Treatment of Traumatic Bulbar Urethral Stricture I Gusti Ayu Putri Purwanthi; Gede Wirya Kusuma Duarsa; Tjokorda Gde Agung Senapathi
Neurologico Spinale Medico Chirurgico Vol 2 No 3 (2019)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (442.502 KB) | DOI: 10.36444/nsmc.v2i3.82

Abstract

The bulbar urethra stricture is the most common form of anterior urethral stricture. The treatment of urethral strictures are varies and remains a challenging field in urology. Excision Primary Anastomosis (EPA) described as the most effective intervention for traumatic urethral stricture cases with a long-term success rate. This case report described male, 42 years old with history of pelvic injury. He had underwent cystostomy and conservative management for his pelvic injury. After EPA and pubectomy procedure in September 2019, he was still unable to void from his urethra. Radiologic evaluation with BVUC was done on October 2019, showing total obstruction of urethral as high as superior aspects of pars bulbosa, unfavourable anastomosed and displaced urethra. Acquired urethral stricture or fistula is an unexpected result of urethral reconstruction and leads to much inconvenience as well as psychological problem for the patient. This condition is avoidable by operation that was performed by experienced urologist and using a flexible cystoscopy as a guidance.
Antifungals patterns in critical patients with candidiasis in the intensive care units at Sanglah General Hospital 2019 Komang Ady Widayana; I Wayan Aryabiantara; Tjokorda Gde Agung Senapathi; I Wayan Suranadi; I Gusti Ngurah Mahaalit Aribawa
Neurologico Spinale Medico Chirurgico Vol 2 No 3 (2019)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (378.685 KB) | DOI: 10.36444/nsmc.v2i3.83

Abstract

Abstract Introduction: The prompt initiation of appropriate antifungal therapy is essential in controlling invasive candidiasis and improving the prognosis in critical patients undergoing treatment in the Intensive Care Unit. Candida Score can assess patients at risk of candidiasis and is expected to assist clinicians in starting antifungal therapy in patients suspected Candidiasis. The purpose of this study was to determine the pattern of antifungal administration in critically ill patients with candidiasis in the Intensive Care Unit at Sanglah General Hospital. Patients and Methods: The design of this study is a cross-sectional descriptive study involving critically ill patients who were under treatment in Intensive Care Unit of Sanglah General Hospital from Januari to June 2019. The patients included in this study were patients who were ≥ 18 years old and under treatment in ICU for at least 7 days. Results: There are 64 patients undergoing treatment in the Intensive Care Unit. From 64 patients, 6 pasien had CS = 0, 29 patients had CS = 1, 13 patients had CS = 2, 11 patients had CS = 3, 5 patients had CS = 4, and no patients had CS = 5. Eleven patients received empirical antifungal therapy. All empirical antifungal therapies use the Triazole group. Conclusion: In this study was found that 11 of 16 patients with a CS value of ≥ 2.5 were given empirical antifungal therapy, while 48 patients with a CS value of <2.5 were not given empirical antifungal therapy. Keywords: Invasive Candidiasis, Candida Score, Empirical Antifungal Therapy.
The relation between sex, age, education level, and premedication towards lower-abdominal postoperative pain intensity at Sanglah General Hospital Komang Alit Artha Wiguna; I Gusti Ngurah Mahaalit Aribawa; I Wayan Aryabiantara; Tjokorda Gde Agung Senapathi
Neurologico Spinale Medico Chirurgico Vol 3 No 1 (2020)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v3i1.93

Abstract

Introduction: Pain reporting is very subjective. Several studies reveal sex, age, education level, and premedication have impacts on postoperative pain intensity. However, other studies report no relationship between these factors to pain intensity. There only a few researches on pain predictors in Bali, so this study conducts to determine relation between sex, age, education level, and premedication towards lower-abdominal postoperative pain intensity at Sanglah Hospital. Patients and Methods: This is an analytic cross-sectional study. The data were collected from medical records of patients after lower abdominal surgery at Sanglah Hospital from January to July 2018 and fit to inclusion criteria and did not suit to exclusion criteria. Data of patients characteristic were collected to indentify their relation toward pain intensity on the first day. Results: There were 99 patients post-lower abdominal surgery included in this study. The mean pain intensity based on sex was 2.83±0.87 for males and 2.98 ± 1.16 for females. Whereas based on ages were 3.04±1.11 for young, 2.90±0.95 for adults, and 2.40±0.96 for elderly. Based on the education level 2.40±1.26 in elementary educated patient, 2.72±1.27 in patients with junior high education, 2.96±1.04 in patients with high school education, and 3.15±0.74 in college patients. The average of pain in patients with premedication is 2.81±0.94 while the patient without premedication is 3.81±1.16. After performing correlation test, only the premedication factor showed a significant impact (p <0.05) to the pain intensity. Conclusion: Therefore, premedication has a greater impact than the other factor toward postoperative pain intensity at Sanglah Hospital.
The use of CONOX as a guide to the general anesthesia on laparotomy patients compared with standard clinical care – A pilot study Brillyan Jehosua Toar; I Putu Pramana Suarjaya; IGAG Utara Hartawan; Tjokorda Gde Agung Senapathi
Neurologico Spinale Medico Chirurgico Vol 4 No 2 (2021)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v4i2.158

Abstract

Background: Avoiding excessive doses of anesthesia was fundamental, mainly to reduce the adverse effect of anesthesia. Electroencephalography (EEG)-based monitors can be used to measure the depth level of anesthesia and guide intraoperative hypnosis drug and opioid administration. This study aims to evaluate the benefit of using CONOX monitor when administering anesthesia drugs in laparotomy procedures. Method: Twenty patients aged 18-65 years with physical status ASA I-III who underwent major laparotomy surgery with general anesthesia total intravenous anesthesia (TIVA) were divided into two groups. Group A received general anesthesia guided with the CONOX monitor, while group B using standard clinical care. We later evaluate the total use of propofol and fentanyl, intraoperative hemodynamic profile, postoperative cognitive disorder (POCD), intraoperative awareness, postoperative nausea and vomiting (PONV), and moderate to severe pain in the post-anesthesia care unit (PACU). Results: The mean total propofol used is lower in CONOX group (63.6 ± 11.7 mcg/kg/min vs. 74 ± 17.87 mcg/kg/min). A similar result was obtained with fentanyl. The CONOX group use a lower total of fentanyl (212.5 ± 32.3 mcg vs. 249 ± 54.6 mcg) than the control group. POCD was found to be more prevalent in the control group (5 vs 2 patients). While there is no report of intraoperative awareness. Conclusion: The incidence of PONV and moderate to severe pain in PACU was similar between the two groups. This pilot study is a preliminary study to evaluate the benefit of using EEG-based monitors to adjust anesthesia drugs.
Effectivity battle between C-MAC and McGrath® video laryngoscope in a patient with general anesthesia at Sanglah Hospital: A pilot study Jhoni Pardomuan Pasaribu; Tjokorda Gde Agung Senapathi; Pontisomaya Parami
Neurologico Spinale Medico Chirurgico Vol 4 No 2 (2021)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v4i2.161

Abstract

Background: Intubation is a common essential procedure to maintain the airway during general anesthesia. Various video laryngoscopes (VL) on the market today assist anesthesiologists in improving intubation success rates and also in complicated airway cases. There are two types of VL found in our institution, which are C-MAC and McGrath®. Each of them has its pros and cons, which withdrawn our curiosity to compare their effectiveness. Methods: A pilot study was conducted in our center; we included all patients undergoing general anesthesia with physical status ASA I-III and consent to the study and divide them into two groups, C-MAC and McGrath®. We compare C-MAC and McGrath® VL effectiveness in terms of time for intubation, ease of intubation, total attempt, failure to intubate, Cormack Lehane degree, POGO Score, and hemodynamic stability. Results: A total of 20 patients were intubated with two different VL, ten patients for each group. Both VLs accommodate ease of intubation, and overall first attempt successful intubation, though C-MAC showed better laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change. Conclusion: C-MAC gives better results in laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change.
Contact force exerted on the maxillary incisors by direct laryngoscopy with mcgrath video laryngoscope in predicted difficult intubation Doddy Setiawan; Tjokorda Gde Agung Senapathi; I Gede Budiarta; I Gusti Ngurah Mahaalit Aribawa
Neurologico Spinale Medico Chirurgico Vol 4 No 2 (2021)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v4i2.162

Abstract

Patients with difficult airways who are going to undergo surgery under general anesthesia require special consideration from an anesthesiologist. Knowing the most significant risk of morbidity and mortality is often due to difficult cases of airway management. One of the most common complications and often becomes lawsuits in the field of anesthesia is dental trauma that occurs during the intubation process due to contact from laryngoscope blade to the teeth. This descriptive study will show the measured force exerted on the maxillary incisors at the time of performing laryngoscopy using a McGrath video laryngoscope in patients with a potentially difficult intubation (LEMON criteria ≥ 3). The contact force exerted on the maxillary incisors is measured using a special instrument. The contact force exerted on the maxillary incisors in patients with a potentially problematic airway was discovered to vary.
Perbandingan nyeri akut, status hemodinamik, dan efek samping pada pasien low back pain pascalaminektomi antara pemberian terapi adjuvan oksikodon intravena dengan fentanil patch Sunanda Naibaho; Tjok GB Mahadewa; Tjok Gde Agung Senapathi
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (342.583 KB) | DOI: 10.15562/ism.v11i2.747

Abstract

Introduction: Good control of postalaminectomy pain is a determining factor for the success of laminectomy. Although intravenous opioids are widely used, lately fentanyl patches have begun to be considered with the same effectiveness and lower side effects. In this study, an acute comparison of hemodynamic status and side effects in low back pain patients postlaminectomy with intravenous oxycodone adjuvant therapy was compared with fentanyl patches.Methods: This research is a prospective cohort study by taking a subject of low back pain postlaminectomy at Sanglah General Hospital. The research subjects who approved informed consent, then observed visual analogue scale differences, hemodynamic status, and side effects between groups who received intravenous oxycodone and fentanyl patches. Data were recorded, tabulated, and analyzed with SPSS 16.Results: This study included 22 subjects who received intravenous oxycodone and fentanyl patch. From VAS 0, 30 and 60 minutes, only in the 60th minute after analgesic administration had significant differences were observed (p=0.005). In this case intravenous oxycodone was significantly better at reducing pain (0.5 vs 1.23) than fentanyl patches. From hemodynamic status, only respiration rates were found that were significantly higher in the intravenous oxycodone group (p=0.037) although not clinically significant (14.73 vs. 15.50). No side effects were found in either group.Conclusion: There is a difference in pain in low back pain patients with the use of intravenous oxycodone with fentanyl patch, where the effect appears only after 60 minutes. There were no side effects of tightness, nausea and vomiting between the two groups. Pendahuluan: Kontrol nyeri pascalaminektomi yang baik menjadi suatu faktor penentu keberhasilan laminektomi. Walaupun opioid intravena banyak digunakan,  belakangan ini fentanil patch mulai dipertimbangkan dengan efektivitas yang sama dan efek samping yang lebih rendah. Dalam penelitian ini, akan dilakukan perbandingan akut, status hemodinamik, dan efek samping pada pasien low back pain pascalaminektomi dengan pemberian terapi adjuvan oksikodon intravena dibandingkan dengan fentanil patch.Metode: Penelitian ini berupa studi kohort prospektif dengan mengambil subjek low back pain pascalaminektomi di  RSUP Sanglah. Subjek penelitian yang telah menyetujui informed consent, kemudian diobservasi perbedaan visual analogue scale, status hemodinamik, dan efek samping antara kelompok yang menerima oksikodon intravena dan fentanil patch. Data dicatat, ditabulasi, dan dianalisis dengan SPSS 16.Hasil: Penelitian ini mencakup masing-masing 22 subjek yang mendapatkan oksikodon intravena dan fentanil patch. Dari VAS 0,30, dan 60 menit, hanya ditunjukkan perbedaan signifikan pada menit ke-60 setelah pemberian analgesik (p=0,005). Dalam hal ini oksikodon intravena secara signifikan lebih baik dalam menurunkan nyeri (0,5 vs 1,23) dibandingkan fentanil patch. Dari status hemodinamik, hanya ditemukan laju respirasi yang secara signifikan lebih tinggi pada kelompok oksikodon intravena (p=0,037) walaupun tidak bermakna secara klinis (14,73 vs 15,50). Tidak ditemukan efek samping pada kedua kelompok.Simpulan: Ada perbedaan nyeri pada pasien low back pain dengan penggunaan oksikodon intravena dengan fentanil patch, dimana efeknya baru muncul setelah 60 menit. Tidak terdapat adanya efek samping sesak, mual, dan muntah antara kedua kelompok.
The Effectiveness of Ranitidine Compared to Omeprazole in Maintaining Gastric Acidity in Head Injury Patients Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 11 Issue 08 (2019) Aug. 2019
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (392.223 KB)

Abstract

Background: Gastric bleeding due to stress-related mucosal damage (SRMD) is a condition that is caused due to erosive gastritis that often occurs in critically ill patients in intensive care. One condition that is known as a risk factor for SRMD is traumatic brain injury. Two common agents used as gastric ulcer prophylaxis are proton pump inhibitor (PPI) and H2 antagonist receptor (H2AR). The goal of this study was to compare the effectiveness of PPI and H2AR administration as prophylaxis of SMRD in patients with TBIs who were treated in the ICU. Patients and Methods: This is a single-blind, randomized, controlled trial with pre and post-test measurements. All subjects were measured for baseline gastric pH before being given gastric ulcer prophylaxis. Gastric pH was measured using a pH-meter. The subjects were divided into two groups: omeprazole group (omeprazole 40 mg every 12 hours) and ranitidine group (received ranitidine 50 mg every 12 hours). The pH levels were measured regularly twice daily for five days.  Results: 56 subjects were involved in this study and divided equally into two groups. For each gastric pH measurement, the pH in both groups did not significantly differ. The optimal gastric pH was achieved in 24 hours after the first administration of gastric ulcer prophylaxis.  Conclusions: The administration of ranitidine or omeprazole is equally effective in maintaining the acidity of gastric acid in TBI patients in ICU. There was no significant difference in the incidence of gastric bleeding in ranitidine and omeprazole groups. Keywords: ICU, Gastric pH, PPI, H2-receptor antagonist.
Correlation between Central Vena Pressure Measurement with Collapsibility Index of Internal Jugular Veins in Critically ill Patients Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 11 Issue 08 (2019) Aug. 2019
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (373.261 KB)

Abstract

Background: Central venous pressure (CVP) is popular for assessing fluid estimation, especially critically ill patients. Another method in assessing the CVP today is by using ultrasonic cardiac output monitors (USCOM) using transaortic or transpulmonary Doppler’s ultrasound. The objective of this study was to determine the correlation between CVP and IJV collapsibility index to monitor the adequacy of the intravascular volume status in critically ill patients in ICU. Patients and Method: This analytic, cross-sectional study involved 70 patients of 19 to 64 years. The internal jugular vein (IJV) collapsibility index was examined with ultrasound cardiac output monitoring (USCOM) to assess the patient's intravascular volume status, then the data was compared to CVP. The Spearman rank correlation was used to test the hypothesis. Results: The subjects consisted of 38 males and 32 females, with an age range of 19-64 years. The Spearman’s rank correlation test showed a statistically negative correlation between the CVP value and the internal jugular venous pressure index collapsibility value (R=-0.844, p <0.001). Conclusion: There is a strong negative correlation between IJV collapsibility index and CVP in patients treated in the ICU.Keywords: Hemodynamics, Volume status, CVP, USCOM, Collapsibility index.
Cefazolin as a Prophylactic Antibiotic in Laparoscopic Cholecystectomy: A Systematic Review Tjokorda Gde Agung Senapathi
Journal of Global Pharma Technology Volume 12 Issue 12 (2020) Dec. 2020
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (449.66 KB)

Abstract

Background: Cefazolin is a first-generation cephalosporin prophylactic antibiotic which recommended for open cholecystectomy. Laparoscopic cholecystectomy is a clean contaminated surgery that does not require prophylactic antibiotics. Some surgeons still have the habit of giving prophylactic antibiotics for laparoscopic cholecystectomy. This systematic review aimed to examine evidence from randomized controlled trials comparing the incidence of surgical wound infection with cefazoline use. Methods: We collected randomized controlled trials (RCTs) throughout the years 2010-2020 from the Cochrane Library and PubMed in English language, which examined the incidence of surgical wound infection between the cefazolin prophylactic antibiotic groups versus placebo on laparoscopic cholecystectomy. Results: Six RCTs were included in the final analysis for a qualitative assessment using the Jadad scale, with four articles in the high category and the other two in the good category. The incidence of surgical wound infection in the cefazolin group was 1.09-4.8% (mean 2.63%) and did not differ significantly from the placebo group. Old age (> 60 years), obesity, timing of antibiotics, as well as tissue trauma and billiard spill during laparoscopic cholecystectomy were not significant factors. Conclusion: The prophylactic antibiotic cefazolin was not significant in reducing the incidence of surgical wound infection in lapaoscopic cholecystectomy. It is necessary to review the guidelines for prophylactic antibiotics in each health service place. Keywords: Cefazolin, Prophylactic antibiotics, Laparoscopic cholecystectomy, Surgical wound infection.
Co-Authors A A Gde Putra Semara Jaya Adinda Putra Pradhana Albert Albert Anak Agung Gde Agung Adistaya Andi Irawan Andi Kusuma Wijaya, Andi Anggreni, Anak Agung Ayu Aprilnita, Aida Aryasa EM, Tjahya Astawa N. M., Astawa N. Astawa P., Astawa Astuti, Mira Kusuma Astuti, Mira Kusuma Bayu Saputra, Ida Bagus Prema Satia Brillyan Jehosua Toar Budiadnyana, I Made Pasek Budiarta, Gede Cahyono, Ardy Wibowo Christopher Ryalino Christopher, Michael Cindryani Ra Ratumasa, Marilaeta Cung Flavyanto, Eugenius Silvester Cynthia Dewi Sinardja D.H., Asterina David Rendra Mahardika Dewa Ayu Mas Shintya Dewi Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Doddy Setiawan Ekaputra Ekaputra, Ekaputra Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Eric Makmur, Eric Ery Oktadiputra Estrada, Ronald Eugenia, Michelle Ferry, Ferdinand Gede Semarawima, Gede Gede Wirya Kusuma Duarsa Giovanni, Malvin Hadiwijono, Vanessa Juventia Hartanto, Wijaya Hartawan , I.G.A.G. Utara Hartawan, IGAG Utara Hengky Hengky, Hengky Humianto, Michael I Dewa Made Sukrama I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ayu Putri Purwanthi I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Wibawa Nada I Made Agus Kresna Sucandra I Made Bakta I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Prema Putra I Made Subagiartha I Made Wiryana, I Made I Putu Agus Surya Panji I Putu Fajar Narakusuma I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan IGNA Putra Arimbawa, IGNA Putra Jayantha Ananda, I Gusti Ngurah Bagus Jeanne, Bianca Jhoni Pardomuan Pasaribu Jimmy Wongkar Johanes, Kevin Paul Junaedi, I Made Darma Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Kamaswari, Ida Ayu Dwi Kenzi, Ignatio Armando Ketut Semara Jaya, Ketut Semara Ketut Wibawa Nada Ketut Yudi Arparitna, Ketut Yudi Komang Ady Widayana Komang Alit Artha Wiguna Komang Alit Artha Wiguna Kurnia, Prajnaariayi Prawira Kurniyanta, I P Kurniyanta, I Putu Kusuma, Oscar Indra Labobar, Otniel Adrians Leo, Joseph Nelson Lesmana, Pita Mora Leton, Yohanes PT Made Agus Kresna Sucandra Made Agus Kresna Sucandra, Made Agus Kresna Made Bagus Cahya Maha Putra Made Widnyana Made Wiryana Marilaeta Cindryani Marilaeta Cindryani Lolobali, Marilaeta Cindryani Marilaeta Cindryani, Marilaeta Marting, Millenia Mauritius Septa Murti, Dede Taruna Kreisnna Nada, I Ketut Wibawa Nandaswari, Ni Made Nilam Narakusuma, I Putu Fajar Ni Nyoman Sri Budayanti Ni Putu Novita Pradnyani, Ni Putu Novandi Kurniawan Pande Nyoman Kurniasari, Pande Panji, I PAS Patricia, Yoshie Pontisomaya Parami Pramana, Putu Bagus Gin Gin Pranoto, Theodorus Pascalis Yullie Pratana, Yolanda Jenny Putu Agus Surya Panji Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Raka-Sudewi A. A. Ratumasa, Marilaeta Cindryani Ra Reynaldi Reiky Hadiwijaya Riko Riko Santo, Budi Saputra, Darmawan Jaya Satoto D., Satoto Satria Pinanditas S Sidabutar, Beny Pratama Sidemen, I Gusti Ayu Eka Para Santi Sidemen, I.G.P.Sukrana Sidemen, IGP Sukrana Sonni Soetjipto, Sonni Sri Maliawan Stefanus Taofik stefanus taofik, stefanus Suarjaya, I PP Suastika, I Gede Juli Sucandra, I Made Agus Kresna Sucandra, I MK Sumanti, Alan F. A. Sunanda Naibaho Suranadi , I Wayan Suryadi N. T., Suryadi N. Suryana, I Ketut Syamsuddin, Johanis Bosco Troy Tanuwijaya, Tommy M Tirta, Ian Tjahya Aryasa Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Bagus Mahadewa Togi Stanislaus Patrick Virayanti, Luh Putu Diah W. A., W. Wardani, Dinar Kusuma Welly, Julian Widnyana, I MG Widyana, I Made Gede Wiryana M., Wiryana Yadikusumo, Andrian Yustisia, Putu Ngurah Krisna Denta