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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina Jurnal Anestesi Perioperatif Bali Journal of Anesthesiology Jurnal Neuroanestesi Indonesia Jurnal Komplikasi Anestesi
I Putu Agus Surya Panji
Departemen Anestesiologi Dan Terapi Intensif Rumah Sakit Umum Puri Raharja Denpasar
Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health Other

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SPONTANEOUS RUPTURE OF ARTERIOVENOUS MALFORMATION: ICU BASED BRAIN RESUSCITATION Panji, Putu Agus Surya; Aryabiantara, I Wayan; Suranadi, I Wayan; Parami, Pontisomaya; Wibisana Kurniajaya, I Gusti Agung Made
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.25

Abstract

Arteriovenous malformations (AVM) is a relatively rare intracranial abnormality. Generally, it caused by congenital abnormalities that recognized after the bleeding started. Spontaneous intracranial bleeding after AVM rupture is an emergency condition and require immediate treatment to reduce mortality rate. After stabilization of intracranial bleeding due to AVM rupture, secondary injury may occur hours or even days after the inciting traumatic event. The injury may result from impairment or local declines in cerebral blood flow (CBF) after brain injury. The decrease in CBF is the result of local edema, hemorrhage, or increased intracranial pressure (ICP). An adequate brain resuscitation is needed to decrease brain edema and intracranial pressure by achieving several targets and avoid things that can interfere with CBF. A recovery phase should be given to the patient with rupture of AVM before going to definitive therapy.
Programmed intermittent epidural bolus improves efficacy of patient controlled epidural analgesia in postoperative pain management Agung Senapathi, Tjokorda Gde; Gede Widnyana, I Made; Wiryana, Made; Mahaalit Aribawa, I Gusti Ngurah; Surya Panji, Putu Agus; Soetjipto, Sonni; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.14

Abstract

Background: Postoperative acute pain will have negative impacts if not handled properly so it must be treated effectively. Patient Controlled Epidural Analgesia (PCEA) allows the patient to have an active role in determining the need of analgesia personally. Programmed Intermittent Epidural Bolus (PIEB) is a new method which proven better than Continuous Epidural Infusion. Ropivacaine has similar characteristic to Bupivacaine but with minimal cardiotoxic effect. Fentanyl as an adjuvant can accelerate the onset of action of local anesthetics in epidural analgesia. The purpose of this study was to compare the efficacy of PCEA+PIEB with PCEA as a modality of postoperative analgesia. Methods: Total 54 patients undergoing major surgery of the abdomen and lower extremities were divided into 2 groups randomly: PIEB+PCEA and PCEA. Then we did an evaluation of VAS, PCA demand, and total consumption of solution Ropivacaine 0.1% + Fentanyl 2  mcg/mL at 4 hours, 8 hours, and 24 hours postoperative. Results: VAS at resting and at moving in both groups were found clinically comparable, although statistically, VAS at moving at 4 hours and 24 hours postoperative were lower in PCEA+PIEB group (p < 0.01). PCA attempted and PCA given were lower in PCEA+PIEB group (p ≤ 0.05). Total consumption of solution until 8 hours postoperative was comparable in both groups but at 24 hours postoperative it was much greater in PCEA+PIEB group (p < 0.01). Conclusions: PCEA+PIEB have greater efficacy than PCEA. VAS (at resting and at moving), PCA attempted, and PCA given were lower in PCEA+PIEB group. Total consumption of solution RopivacaineFentanyl until 8 hours postoperative was comparable, but at 24 hours postoperative it was much greater in PCEA+PIEB group. In orthopedic surgery, VAS at resting was obtained below 30 mm in PCEA+PIEB group but VAS at moving was obtained in the category of moderate pain in both groups.
COMBINE MIDAZOLAM-FENTANYL-KETAMIN FOR EVISERATION SURGERY IN PATIENT WITH MULTIDRUG ALERGY IN ACUTE ON CHRONIC EXCACERBATION OF HIPERSENSITIVITY REACTION Panji, Putu Agus Surya; Sudjana, Ida Bagus Gde; Suranadi, I Wayan; Tanggono, Aninda
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.35

Abstract

ABSTRACTMultidrug Alergy is a relatively rare imunology abnormality. Generally, it caused by congenital genotype and influence with environment. After treated the acute on chronic exacerbation of hypersensivity tipe 1, and the inflamation can alleviate, the patient schedule of eviseration oculi dextra with general anesthesia. And the opthamologist curious about the proceddure because eviseration need antibiotic to wash the oculi, but there are no antibiotic saved for the patient. For general anesthesia, the patient has no history so we can’t predicted about the anesthetic drug’s allergy. We choose combine ketamine-midazolamadn fentanyl to facilitate the anesthesia. Ketamine significantly reduces the production of inflammatory cytokines without affecting the production of anti-inflammatory cytokines. Fentanyl is the opioid which is the most rarely caused allergy and have strong potential. Midazolam can help the sedation
THE SIGNIFICANCE OF MODIFIED PIRO SCORING WITH NLR BIOMARKER ON ENHANCING MORTALITY PREDICTION OF PATIENTS WITH VENTILATORS‑ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT Senapathi, Tjokorda Gde Agung; Budiarta, I Gede; Panji, Putu Agus Surya; Aprilnita, Aida
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (226.799 KB) | DOI: 10.15562/bjoa.v2i3.94

Abstract

Ventilator-associated pneumonia (VAP) is a pulmonary infection that occurs as a mechanical ventilator-related disease which accounts for almost 80% of hospital-acquired pneumonia with of high mortality rate, lengthens the hospital-stay rate and increases health costs. To provide a description of the likelihood of the patients life expectancy, mortality, and prognosis of patients in ICU, a scoring system should be utilized in order to assess the severity of the disease and estimate mortality during hospital treatment. The PIRO scoring system is a comprehensive concept that provides good validity and derivation in predicting mortality risk in a wide range severity of the disease so that it is very useful in the selection or categorization of patients, especially those admitted to the ICU with VAP. A conjunction or integration with a simple biomarker such as Neutrophil-to-lymphocyte ratio (NLR) provides a better performance of the tool in regards to the predictive value in VAP mortality risk estimation. Since the NLR has a strong predictive value, is simple, low-cost, and easily available compared to other biomarkers, therefore it is practical and useful for prognostic indications for VAP with conjunction with the PIRO score where medical facilities are lacking.
Correlation Between Protein Intake and Nitrogen Balance of Surgical Patients in Anesthesiology and Intensive Care Installation, Sanglah General Hospital, Denpasar, Bali, Indonesia Wiryana, Made; Sinardja, I Ketut; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Panji, Putu Agus Surya; Aryabiantara, I Wayan; Cindryani, Marilaeta
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (361.832 KB)

Abstract

Background: A cell injury from surgical stress in a trauma or a non-trauma case will induce a hyper metabolic response in which the protein degradation increases, the somatic protein synthesis decreases and the amino acid catabolism increases. Thus, the pyper metabolic response contributes to nitrogen loss in urine. This response, without an adequate nutrition, will lead an iatrogenic malnutrition and deterioration. A balance nitrogen formula through urinary urea nitrogen is one of many nutrition evaluation methods. This method aids in evaluating the daily nutrition status and it can be the baseline data for daily intake. Objective: To find a correlation between the protein intake and the nitrogen balance of the surgical patients in anesthesiology and intensive care installation, Sanglah General Hospital, Denpasar, Bali. Methods: Fifty-one surgical patients with trauma and non-trauma cases were observed for their protein intake for 2-3 days continuously. Moreover, they were evaluated for their nitrogen balance based on the urinary urea nitrogen per 24 hours for 2-3 days. For statistical analysis, we utilized Shapiro-Francia, Shapiro-Wilk, Spearman Frank correlation, two-sample t test, and multivariate regression analysis in Strata SE 12.1. Results: The correlation between the protein intake and the nitrogen balance on the first day was ra=0.50 (p<0.05), on the second day ra=0.70 (p<0,05), and on the third day ra=0.740 (p<0,05) Conclusions: There is a correlation between the protein intake and the nitrogen balance of surgical patients in Anesthesiology and Intensive Care Installation Sanglah General Hospital Denpasar.
Tata laksana gigitan ular yang disertai sindrom kompartemen di ruang terapi intensif Jaya, AA Gde Putra Semara; Panji, I Putu Agus Surya
Medicina Vol 47 No 2 (2016): Mei 2016
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (381.21 KB)

Abstract

Gigitan ular merupakan kegawatdaruratan yang telah diketahui secara global, terutama terjadi pada petani, nelayan, pemburu, dan pawang ular. Asia Tenggara merupakan area dengan insiden tinggi. Pada awal tahun 2009, kasus gigitan ular masuk ke dalam daftar penyakit tropis yang diterlantarkan menurut WHO, padahal gigitan ular menyebabkan puluhan ribu kematian setiap tahun dan berbagai kasus kecacatan fisis kronis pada korbannya. Kasus mengenai seorang petani, pria usia 53 tahun, dikonsulkan dengan gigitan ular dan sindrom kompartemen. Pasien dirawat di ruang terapi intensif dengan terapi antibisa ular, tata laksana suportif dan simtomatik sesuai dengan perkembangan penyakitnya, serta monitoring sindrom kompartemen dan komplikasi yang menyertai. Evaluasi terhadap sindrom kompartemen dan komplikasi lainnya menunjukkan hasil yang baik. Snake bite is a medical emergency which has been known globally, mainly in farmers, fishermen, hunters, and snake charmers. Southeast Asia is an area with a high incidence of snake bites. However, snake bites included into WHO’s list of neglected tropical diseases, early in 2009; whereas snake bites cause tens of thousands of deaths each year and many cases of chronic physical disability on its victims. This case about a farmer, a man aged 53 years, referred to our hospital with snake bites and compartment syndrome. Patients managed in the intensive care unit with antivenom serum, supportive and symptomatic therapy in accordance with the development of the disease, monitoring of compartment syndrome and complications. Evaluation of compartment syndrome and other complications showed good result.
Tinjauan Literatur: Alkalosis Respiratorik pada COVID-19: Sleeping with the “Silent Devil” Made Yudha Asrithari Dewi; Putu Agus Surya Panji
Jurnal Anestesi Perioperatif Vol 10, No 2 (2022)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v10n2.2620

Abstract

Dewasa ini krisis pertumbuhan penyakit coronavirus disease (COVID-19) telah menekan sistem kesehatan secara global bahkan lebih dari sebelumnya, menyebabkan kebutuhan peningkatan kapasitas unit perawatan intensif dalam menangani jumlah pasien kritis yang meningkat secara tajam. Gagal napas pada COVID-19 diperburuk oleh keadaan hipoksemia dan dapat memburuk menjadi acute respiratory distress syndrome (ARDS) yang segera membutuhkan terapi suplementasi oksigen. Menilai kebutuhan memulai terapi oksigen dapat dilakukan salah satunya dengan analisis gas darah untuk mengevaluasi gangguan asam basa terutama pada perjalanan awal COVID-19 simtomatis berat. Silent hypoxemia sebagai gejala COVID-19 yang mematikan merupakan sebuah tantangan dalam kegawatdaruratan COVID-19. Hipoksemia berat akibat hiperventilasi tanpa gangguan pernapasan akan menunjukkan gambaran hasil analisis gas darah berupa alkalosis respiratorik sebagai upaya kompensasi penurunan kadar PaCO2 untuk meningkatkan saturasi. Pergeseran kurva disosiasi ke kiri menyebabkan peningkatan afinitas Hb-O2 untuk memfasilitasi kebutuhan oksigen. Maka dari itu, tenaga kesehatan harus memperhatikan bukan hanya keadaan umum pasien melainkan juga laju pernapasan dan melihat tanda hiperventilasi untuk mengetahui gangguan asam basa melalui analisis gas darah agar dapat mencegah komplikasi alkalosis respiratorik. Literature Review: Respiratory Alkalosis in COVID-19: Sleeping with the Silent DemonToday the growing crisis of coronavirus disease (COVID-19) has urged the health system globally even more than ever before, leading to the need to increase the capacity of intensive care units in dealing with the sharply increasing number of critically ill patients. Respiratory failure in COVID-19, exacerbated by hypoxemia, can worsen into acute respiratory distress syndrome (ARDS), requiring immediate oxygen supplementation therapy. The need to start oxygen therapy can be assessed by examining blood gas analysis to evaluate the presence of acid-base disorders, especially in the early progress of severe symptoms of COVID-19. Silent hypoxemia, a deadly symptom of COVID-19, is a challenge in the emergency of COVID-19. Severe hypoxemia due to hyperventilation in the absence of respiratory disorders will show a picture of the results of blood gas analysis in the form of respiratory alkalosis to compensate for decreased PaCO2 levels to increase saturation. The left shift of the dissociation curve leads to an increase in Hb-O2 affinity to facilitate oxygen needs. Hence, healthcare workers should pay attention to the patient's general condition and breathing rate. Besides, looking for the signs of hyperventilation to find the presence of acid-base disorders through analysis of blood gases to prevent respiratory alkalosis complications.
Manajemen Anestesi Reseksi Tumor Cerebello-pontine Angle Vestibular Schwannoma dengan Posisi Lateral Suarjaya, I Putu Pramana; Paramartha, Bagus; J Sutawan, Ida Bagus Krisna; Panji, I Putu Agus Surya
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (492.324 KB) | DOI: 10.24244/jni.v11i2.477

Abstract

Tumor Cerebello-pontine angle (CPA) adalah tumor yang paling sering terjadi di daerah fossa posterior, dan berkisar 5-10 % dari seluruh kasus tumor intrakranial. Sebagian besar tumor CPA adalah tumor jinak, 85% diantaranya merupakan vestibular schwannoma (neuroma akustik). Terapi pilihan untuk tumor CPA vestibular schwannoma dengan gejala adalah tindakan pembedahan. Kraniotomi dengan posisi lateral penuh pada reseksi vestibular schwannoma yang berlangsung lama memberikan tantangan karena potensi terjadinya ketidaksesuaian ventilasi-perfusi dan atelektasis paru sisi bawah. Seorang pasien perempuan, usia 25 tahun, dengan gangguan pendengaran, gangguan keseimbangan, kelemahan separuh badan kiri, mengalami kesulitan menelan dan pada pemeriksaan magnetic resonance imaging (MRI) didapatkan lesi padat di cerebelo-pontine angle dengan ukuran 5,6 x 5 x 4.5 cm yang meluas hingga internal auditory canal dan didiagnosa sebagai tumor cerebro-pontine angle vestibular schwannoma sinistra. Pasien menjalani pembedahan dengan anestesi umum intubasi endotrakeal, posisi lateral kanan penuh, yang berlangsung selama 6 jam 40 menit. Target dari pengelolaan anestesi pada tindakan pembedahan tumor vestibular schwannoma adalah memfasilitasi lapangan pembedahan yang ideal dan melakukan proteksi serebral untuk mencegah cedera sekunder dengan mempertahankan tekanan perfusi serebral, menghindari instabilitas hemodinamik, memungkinkan dilakukannya pemantauan neurologi intraoperatif, deteksi dini dan pengelolaan segera bila terjadi komplikasi pembedahan.Anesthesia Management of Cerebello-pontine Angle Tumor Vestibular Schwannoma Resection in Lateral PositionAbstractCerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannoma (acoustic neuromas). The preferred treatment for symptomatic vestibular schwannoma has been surgical excision. Craniotomy for vestibular schwannoma resections in lateral position gave better surgical field exposure, but also posed increased risk of ventilation-perfusion mismatch and atelectasis of the dependent lung in lengthy surgery. A 25 years old woman, with loss of hearing function, disturbed sense of balance, left hemiplegia, difficulties to swallow, on magnetic resonance imaging (MRI) examination had solid lesion in the cerebello-pontine angle size 5,6 cm x 5 cm x 4.5 cm which is diagnosed as Cerebello-pontine angle vestibular schwannoma sinistra. Patient underwent surgical resection in right lateral position under general anesthesia and the surgical resection performed in 6 hour 40 minutes. The goals of anesthetic management in vestibular schwannoma tumor resection are to facilitate ideal surgical condition and provide brain protection by maintaining cerebral perfusion pressure, avoid hemodynamic instability, enable intraoperative neuro-monitoring and ensure the early detection and prompt management of potential complications.
Manajemen Anestesi pada Pasien Anak yang Menjalani Operasi Coloboma dengan Penyakit Jantung Bawaan Asianotik Budiadnyana, I Made Pasek; Ratumasa, Marilaeta Cindryani Ra; Panji, Putu Agus Surya; Senapathi, Tjokorda Gde Agung
Jurnal Komplikasi Anestesi Vol 11 No 3 (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.v11i3.15090

Abstract

Anesthesia for pediatric patients with acyanotic congenital heart disease demands a specialized approach due to complex cardiac anatomy and physiology interactions and the risk of perioperative hemodynamic instability. A two-month-old, five-kilogram child presented with a congenital heart disorder and a left eyelid anomaly since birth. Physical examination revealed superior palpebral coloboma with symblepharon and exposure keratitis. Scheduled for surgical repair, the preoperative assessment included anemia and thrombocytosis. Anesthesia management involved fasting, fluid calculation, and premedication with atropine sulfate 0.1 mg and intravenous analgesic fentanyl 15 mcg (2-3 mcg/kgBW). Intubation proceeded with atracurium, and maintenance included sevoflurane and fentanyl. Monitoring ensured proper EtCO2 and oxygen saturation levels. The one-hour surgery addressed the eyelid issue, followed by post-operative analgesia. The patient was monitored for three days post-op and discharged on the fourth day. Previous studies showed that children with congenital heart disease undergoing noncardiac surgery face increased perioperative risks, influenced by factors such as general condition and disease status, so clinical outcomes during surgery are greatly influenced by anesthesia management that adapts to these factors. Pediatric patients with congenital heart disease can safely undergo general anesthesia for noncardiac surgeries by requiring comprehensive preoperative preparation and careful intraoperative monitoring.
Anesthesia Management in Patients with Moyamoya Disease with Superficial Temporal ArteryMiddle Cerebral Artery Bypass: Case Report Virayanti, Luh Putu Diah; Suarjaya, I Putu Pramana; Ryalino, Christopher; Surya Panji, Putu Agus; Senapathi, Tjokorda Gde Agung
Jurnal Neuroanestesi Indonesia Vol 14, No 1 (2025)
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.v14i1.637

Abstract

Moyamoya Disease (MMD) is a rare unknown disease that causes occlusion of the blood vessels of the brain in adults and children. There are several methods of operation that can be used for therapy, such as direct bypass and indirect bypass. Direct bypass is a method to connect the branches of the external carotid artery, usually the superficial temporal artery (STA), to the branching of the internal carotid artery, generally the Middle Cerebral Artery. Its potentially created several problems such as secondary brain injury and changes in hemodynamic. We use general anesthesia based on neuroanesthesia concepts to protect brain perfusion and maintain the patient's hemodynamic stability. In this patient, induction was carried out using remifentanil TCI Minto mode 4-6 ng/ml, Propofol TCI Schneider target effect 46 mcg/ml and Rocuronium 40 mg IV. We also add SCALP Block with Bupivacaine 0.25% volume of 23 ml. Before induction, an arterial line was installed on the right radial artery to determine hemodynamic changes, to protect cerebral perfusion pressure. The patient was stable during the operation and extubated immediately after the surgery. The patient returned to his initial state of consciousness and was admitted to the ICU for 48 hours.
Co-Authors A A Gde Putra Semara Jaya Adinda Putra Pradhana Aprilnita, Aida Budiadnyana, I Made Pasek Christopher Ryalino I Gede Budiarta I Gusti Agung Made Wibisana Kurniajaya, I Gusti Agung Made I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Made Gede Widnyana I Wayan Aryabiantara, I Wayan I Wayan Suranadi J Sutawan, Ida Bagus Krisna Made Wiryana Made Yudha Asrithari Dewi Marilaeta Cindryani, Marilaeta Paramartha, Bagus Pontisomaya Parami Putu Pramana Suarjaya Ratumasa, Marilaeta Cindryani Ra Sonni Soetjipto, Sonni Sudjana, Ida Bagus Gde Tanggono, Aninda Tjokorda Gde Agung Senapathi Virayanti, Luh Putu Diah