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CARDIOPULMONARY RESUSCITATION SUCCESS RATE IN PATIENTS WHO HAVE CARDIAC ARREST IN SANGLAH HOSPITAL Cristy, Nadia Assecia; Ryalino, Christopher; Suranadi, I Wayan; Hartawan, I Gusti Agung Gede Utara
E-Jurnal Medika Udayana Vol 11 No 6 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i06.P10

ABSTRAK Henti jantung adalah hilangnya fungsi jantung secara mendadak dan bisa terjadi pada seseorang yang memiliki penyakit jantung atau tidak. Penyebab kejadian henti jantung terbanyak adalah penyakit pada sistem kardiovaskular seperti bradikardia, takikardia, kardiomiopati. Resusitasi Jantung Paru merupakan tindakan pertolongan untuk mengembalikan fungsi pernapasan dan sirkulasi pada orang henti jantung. Peneliti tertarik memperluas informasi mengenai Angka Keberhasilan Resusitasi Jantung Paru Pada Pasien Yang Mengalami Henti Jantung di Rumah Sakit Umum Pusat Sanglah. Penelitian ini dilakukan dengan metode deskriptif potong lintang. Subjek penelitian dipilih menggunakan metode consecutive sampling berdasarkan kriteria inklusi terhitung sejak 1 Januari 2021 sampai 30 Juni 2021 di IGD dan ruang rawat inap RSUP Sanglah Denpasar. Variabel dalam penelitian ini meliputi: data demografi pasien berupa usia, jenis kelamin, luaran. Data dianalisis secara deskriptif. Sebanyak 294 pasien yang di RJP pada tahun 2019, dan 121 pasien yang di RJP pada tahun 2020. Subjek penelitian pada tahun 2019 terdiri dari 42,5% perempuan, dan 57,5% laki-laki. Pada tahun 2020 terdiri dari 41,3% perempuan dan 58,7% laki-laki. Usia subjek penelitian dibagi menjadi delapan kelompok, namun usia dengan persentase terbanyak pada tahun 2019 adalah >65 tahun sebanyak 29,9%. Pada tabel menunjukkan bahwa populasi laki-laki yaitu 57,8% dengan usia terbanyak >65 tahun sebanyak 29,4% mengalami henti jantung. Terdapat 68,0% yang meninggal selama dua tahun. Kejadian henti jantung diperoleh sebanyak 415 kasus di RSUP Sanglah. Diperoleh angka keberhasilan RJP pasien henti jantung sebesar 32%. Keberhasilan RJP ini dapat dipengaruhi oleh beberapa faktor seperti usia, jenis kelamin. Kata kunci : angka keberhasilan, henti jantung, resusitasi jantung paru.

Fluid Overload Management in HELLP Syndrome with Pulmonary Edema Underwent Caesarean Section Agustina, Mona; Christopher Ryalino
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.341

Introduction: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a multisystemic disorder. HELLP syndrome is a life-threatening condition with high maternal and infant mortality rates. This study aimed to present an unexpected case of HELLP syndrome complicated by pulmonary edema. Case presentation: A 40-year-old woman, 80 kg, who was 26-27 weeks into her pregnancy, came to the obstetric department due to fever and nausea in the past three days. She was then referred to the internal medicine department and diagnosed with dengue fever by the symptom of fever and thrombocytopenia. After two days of in-patient treatment, the obstetrician diagnosed her with HELLP syndrome, followed by elevated liver enzymes. She was then posted for an urgent caesarean section, and we managed this case under general anaesthesia. Postoperatively, we aimed for -500 to -1,000 mL cumulative fluid balance to avoid further hypovolemia. Conclusion: The patient showed improvement, as evidenced by chest X-ray and oxygen saturation. Management of fluid overload in this patient with HELLP syndrome was challenging. On the second day in ICU, the antibiotic was changed from meropenem combined with levofloxacin to meropenem combined with amikacin because the leucocyte level increased and procalcitonin level increased in 48-72 hours.

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

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.

Erector Spinae Plane Block pada Operasi Payudara Dewi, Christina Angelia Maharani; Ryalino, Christopher
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i1.56468

Operasi payudara sering kali dikaitkan dengan nyeri post operasi yang memiliki intensitas dan durasi bervariasi, sehingga memerlukan intervensi perioperatif yang tepat untuk mengurangi nyeri dan efek samping terkait penggunaan opioid. Anestesi regional, khususnya Erector Spinae Plane Block (ESPB), menjadi pilihan yang lebih disukai karena efek opioid-sparing yang dimilikinya, yang mampu secara signifikan mengurangi nyeri post operasi akut dan risiko efek samping. ESPB, sebagai teknik blok regional yang relatif baru, telah menunjukkan kemampuan untuk memberikan anestesi multidermatomal unilateral dari T1 hingga L3 bila dilakukan pada T5. Penelitian ini menggarisbawahi kebaruan penerapan ESPB, termasuk efek analgesik yang lebih lama dibandingkan dengan teknik anestesi lainnya, pengurangan penggunaan opioid yang signifikan, dan cakupan anestesi multidermatomal yang lebih luas, menjadikannya pendekatan inovatif untuk manajemen nyeri post operasi payudara. Meskipun hasil uji coba sebelumnya mendukung keunggulan ESPB, penelitian lebih lanjut mengenai efikasi dan keamanannya tetap diperlukan untuk memastikan potensinya sebagai standar baru dalam anestesi regional operasi payudara.

Tatalaksana Anestesi Pada Pasien Dengan Severe Aortic Stenosis Dengan Tindakan Hemicolectomy Dextra Putu Diah Virayanti, Luh; Labobar, Otniel Adrians; Ryalino, Christopher; Agung Senapathi, Tjokorda Gede
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i1.56469

Pada pasien dengan gangguan katup jantung yang akan dilakukan operasi non kardiak memiliki beberapa potensi masalah selama operasi, sehingga diperlukan pemeriksaan, persiapan dan tatalaksana yang baik. Pasien dengan severe aortic stenosismemiliki permasalahan fixed cardiac output yang berarti cardiac output sangat ditentukan oleh laju jantung. Pemilihan modalitas anestesi sangat penting dilakukan untuk menjaga respons simpatis sehingga tidak terjadi takikardia ataupun bradikardia pada pasien dengan severe aortic stenosis. Pemilihan teknik anestesi, termasuk penghindaran neuroaxial anesthesia, serta penggunaan epidural untuk analgesi dan pemantauan yang cermat terhadap tekanan intratorakal saat ekstubasi. Pada pasien ini dilakukan anestesi umum dengan Midazolam, remifentanyl TCI Mode Minto target effect 3 – 4 mcg/ml, Rocuronium 30 mg IV, dan pemeliharaan dengan udara: O2: sevoflurane. Pemasangan epidural setinggi L2-L3, target tip T10, kateter masuk 6 cm di dalam ruang epidural, target dermatom T6-T10, target viscerotom T6-L2. Dilanjutkan dengan pemberian regimen Bupivacaine 0,0625% plain 10 ml sebagai agen analgesia. Selain itu dilakukan pemasangan akses vena sentral untuk mengetahui volume vena sentral, akses obat dan nutrisi parenteral paska operasi. Durante pasien stabil, dan dilakukan ekstubasi paska operasi dengan agen reversal berupa neostigmine dan sulfas atropine. Pasien dirawat diruang intensif paska operasi selama 2 hari.

ANESTHESIA MANAGEMENT IN MODIFIED PARK BENCH POSITION IN NEUROSURGERY : A CASE REPORT Wanda, Aprilia; Suarjaya, I Putu Pramana; Widnyana, Made Gede; Sutawan, IB Krisna Jaya; Ryalino, Christopher
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 2 (2024): AGUSTUS 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i2.31222

The modified park bench position enhances surgical exposure while minimizing brainstem manipulation but poses significant anesthetic challenges. This case report aimed to describe the author’s anesthesia management in a modified park bench position for neurosurgery. A 39-year-old woman presented with intermittent headaches, nausea, and vomiting for three months, alongside vision deterioration. She denied loss of consciousness, seizures, weight loss, or trauma. Examination revealed typical vital signs, neurological function, and musculoskeletal integrity. Supporting tests showed elevated SGOT levels and a primary malignant brain tumor with suspected hemorrhage and surrounding vasogenic edema. She underwent craniotomy after fasting and standard anesthesia preparation. An arterial line, premedication, and intubation were administered, followed by five-hour surgery in the modified park bench position. Postoperatively, pain was managed with fentanyl, paracetamol, and ibuprofen. She was monitored in the ICU for seven days and discharged on the eighth postoperative day. In summary, managing primary malignant brain tumors like glioblastoma requires thorough preoperative assessment, precise anesthesia planning, and vigilant intraoperative monitoring for patient safety and successful outcomes. The collaborative effort of neurosurgery and anesthesia teams and postoperative care is vital for patient recovery and underscores the importance of comprehensive perioperative management.

Effectiveness of Dexmedetomidine Compared to Midazolam for Sedation in Mechanically Ventilated Patients: A Narrative Review Haithami, Guntur Mu Ammar; Putu Agus Surya Panji; Ida Bagus Krisna Jaya Sutawan; Christopher Ryalino
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/359b8m36

Delirium is a common and clinically significant neuropsychiatric complication in mechanically ventilated adult ICU patients, contributing to prolonged hospitalization, increased morbidity, and long-term cognitive impairment. The choice of sedative agent plays a pivotal role in preventing delirium, with dexmedetomidine and midazolam representing the most commonly used drugs with contrasting mechanisms. This narrative review evaluates the clinical efficacy, safety profile, neurocognitive outcomes, and cost-effectiveness of dexmedetomidine compared with midazolam in mechanically ventilated ICU patients. Literature was searched through PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar for studies published between 2020 and 2025 using the keywords dexmedetomidine, midazolam, sedation, mechanical ventilation, delirium, and intensive care units. Seventeen peer-reviewed publications were included and analyzed narratively. Dexmedetomidine consistently reduced the incidence and duration of delirium (RR 0.55–0.65; 95% CI 0.4–0.8), shortened mechanical ventilation by 0.7–1.5 days, and facilitated earlier extubation compared to midazolam. Its α₂-adrenergic agonism at the locus coeruleus produces a sleep-like, cooperative sedation, with mild, dose-dependent bradycardia as the most frequent adverse effect. Despite higher acquisition cost, economic analyses reported average savings of US$ 450–700 (≈ IDR 7–10 million) per patient through reduced ICU stay and delirium-related complications. Overall, dexmedetomidine demonstrates superior efficacy and safety compared with midazolam for ICU sedation, providing both clinical and economic advantages. Integration into light-sedation and delirium-prevention bundles may improve ICU outcomes, particularly in resource-limited settings.

Effectiveness of Dexmedetomidine Compared to Midazolam for Sedation in Mechanically Ventilated Patients: A Narrative Review Haithami, Guntur Mu Ammar; Putu Agus Surya Panji; Ida Bagus Krisna Jaya Sutawan; Christopher Ryalino
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/359b8m36

Delirium is a common and clinically significant neuropsychiatric complication in mechanically ventilated adult ICU patients, contributing to prolonged hospitalization, increased morbidity, and long-term cognitive impairment. The choice of sedative agent plays a pivotal role in preventing delirium, with dexmedetomidine and midazolam representing the most commonly used drugs with contrasting mechanisms. This narrative review evaluates the clinical efficacy, safety profile, neurocognitive outcomes, and cost-effectiveness of dexmedetomidine compared with midazolam in mechanically ventilated ICU patients. Literature was searched through PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar for studies published between 2020 and 2025 using the keywords dexmedetomidine, midazolam, sedation, mechanical ventilation, delirium, and intensive care units. Seventeen peer-reviewed publications were included and analyzed narratively. Dexmedetomidine consistently reduced the incidence and duration of delirium (RR 0.55–0.65; 95% CI 0.4–0.8), shortened mechanical ventilation by 0.7–1.5 days, and facilitated earlier extubation compared to midazolam. Its α₂-adrenergic agonism at the locus coeruleus produces a sleep-like, cooperative sedation, with mild, dose-dependent bradycardia as the most frequent adverse effect. Despite higher acquisition cost, economic analyses reported average savings of US$ 450–700 (≈ IDR 7–10 million) per patient through reduced ICU stay and delirium-related complications. Overall, dexmedetomidine demonstrates superior efficacy and safety compared with midazolam for ICU sedation, providing both clinical and economic advantages. Integration into light-sedation and delirium-prevention bundles may improve ICU outcomes, particularly in resource-limited settings.

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