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All Journal E-Jurnal Medika Udayana Bali Journal of Anesthesiology ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Bioscientia Medicina : Journal of Biomedicine and Translational Research COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat Journal of Anesthesiology and Clinical Research Majalah Anestesia & Critical Care (MACC) Promotor: Jurnal Mahasiswa Kesehatan Masyarakat Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Cynthia Dewi Sinardja
SMF/Departemen Anestesiologi Dan Terapi Intensif RSUP Sanglah, Fakultas Kedokteran Universitas Udayana
Humanities Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Other

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Safety Timeout for Local Anesthetics and Regional Anesthesia Sinardja, Cynthia Dewi; Widnyana, I Made Gde; Lolobali, Marilaeta Cindryani
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.v1i3.38

Abstract

Our anesthesia practices are always based on patient safety in WHO surgical and anesthesia guidelines. Those guidelines are interpreted in checklists and protocols that could be applied in daily routine in every standard operating theaters. A surgical patient would be notified and identified during the surgery by all member of the operating room including the anesthesiologist through a specialized checklists which was called a safety surgical checklist usually done in the preparation room, signing in, 5 minutes for timeout before the incision, and the last sign out before closure stitching. Anesthesia conduct and monitoring is viewed as a part of the whole surgery practice.The safety timeout that has been elaborated in ASRA Regional Block Pre-Procedural Checklist is one important thing that needs to be encouraged and confirmed every time an anesthesiologist is getting ready to do a regional anesthesia.  The safety timeout is useful as a quick reminder for operating theater personnel especially anesthesiologist and the nurse anesthetists to do a double check and reassessment on patient condition, drug and adjuvant choice, labels, and other implicating factors. There are many contributing factors that could induced emergency and crisis situations in regional anesthesia conduct, and the safety timeout is an alternative way to eliminate and trace those factors in an appropriate way.
Anaesthesia Management of Patient at 16 Weeks Pregnancy with Primary Malignant Bone Tumour Underwent Hemipelvectomy Surgery Sinardja, Cynthia Dewi; Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Kusuma, Oscar Indra; D.H., Asterina
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.v2i2.39

Abstract

Chondrosarcoma is a type of sarcoma that affects the bones and joints. It is a rare cancer that accounts for about 20% of bone tumours and is diagnosed in approximately 600 patients each year in the United States. Chondrosarcoma typically affects adults between the age of 20 and 60 years old. The disease usually starts in the bones of the arms, legs or pelvis, but it can be found in any part of the body that contains cartilage. Sometimes chondrosarcoma grows on an otherwise healthy bone or it grows on a benign bone tumour (an enchondroma or osteochondroma). Non-obstetric surgery during pregnancy is not uncommon and can have excellent outcomes with proper planning. Between 0.75% and 2% of pregnant women require non-obstetric surgery. Surgery can be required during any stage of pregnancy depending on the urgency of the indication. When caring for pregnant women undergoing non-obstetric surgery, safe anaesthesia must be provided for both the mother and the child. Thorough understanding of the physiological and pharmacological adaptations to pregnancy is required to ensure maternal safety. Fetal safety requires avoidance of potentially dangerous drugs at critical times during fetal development, assurance of continuation of adequate uteroplacental perfusion, and avoidance and/or treatment of preterm labour and delivery.Pregnant patients beyond 18–20 weeks of gestation should be positioned with a 15° left lateral tilt, to reduce aortocaval compression and supine hypotension syndrome. Regional anaesthesia with combined spinal epidural is an option for this case. Regional anaesthesia does reduce the exposure of foetus to potential teratogens, avoids the potential risk of failed intubation and aspiration, and provides excellent post-operative analgesia. The major concern with neuraxial anaesthesia is maternal hypotension, which may reduce placental perfusion.  During anaesthesia and surgery, foetal well-being is best ensured by careful maintenance of stable maternal haemodynamic parameters and oxygenation. Close monitoring of foetal responses for signs of distress is strongly advocated.
PERIOPERATIVE EFFECTS OF CO-ADMINISTRATION OF TCI PROPOFOL COMBINED WITH CLONIDINE AND KETAMINE Aryabiantara, I Wayan; Sinardja, I Ketut; Sutawan, Ida Bagus Krisna Jaya; Sinardja, Cynthia Dewi; Parami, Pontisomaya; Ryalino, Christopher; Junaedi, Made Darma
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (371.815 KB) | DOI: 10.15562/bjoa.v2i3.69

Abstract

Background: Propofol is often used in Total Intravenous Anesthesia (TIVA). Studies found that adding clonidine and ketamine can increase the potential to achieve an adequate level of anesthesia while reducing inflammation and post-operative pain. The goal of this study is to see if the combination of Target Controlled Infusion (TCI) propofol plus clonidine and ketamine is more effective in reducing the IL-6 level, maintaining intraoperative stability, and reducing postoperative pain and morphine consumption.Methods: Forty patients planned for major oncology surgery were divided into two groups. The treatment group (Group T) received pre-medication with clonidine, induction with TCI propofol, and intraoperative ketamine. The control group (Group C) received normal saline solution.Results: The difference of IL-6 level increase between the two groups was not statistically significant (13.6 vs. 16.6 pg/mL, p>0.05). Mean systolic blood pressure (SBP) and mean arterial pressure (MAP) in group T were higher in 5 and 10 minutes after incision, but lower in minutes 30, 60, and 120 (p <0.05). Heart rate in group T was higher in minutes 5, 10, 15, 30, 60, and 120. Visual analog scale (VAS) in 4, 8, 12, and 24 hours post-surgery were lower in group T compared to group C. And post-operative morphine consumptions in group T were also lower. (3.6 ± 1.5 vs 9.9 ± 3.3, p <0.05).Conclusion: TIVA using TCI propofol combined with preoperative clonidine and intraoperative ketamine is effective in maintaining hemodynamic stability, reducing post-operative and reducing morphine consumption compared to TCI propofol alone.
Acinetobacter baumannii Is an opportunistic pathogen as an MDRO especially on intensive ward Suranadi, I Wayan; Dwi Fatmawati, Ni Nengah; Aryabiantara, I Wayan; Sinardja, Cynthia Dewi; Saputra, Darmawan Jaya
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (169.797 KB) | DOI: 10.15562/bjoa.v3i2.199

Abstract

Acinetobacter baumannii is an opportunistic bacterial pathogen that is associated with hospital acquired infections and is a major cause of nosocomial infections especially in intensive spaces; this is becoming increasingly a widespread concern in various hospitals around the world. Acinetobacter baumannii, which is resistant to many antibiotics, is now recognized as clinically very important. Reports suggest that the spread of A. baumannii in the hospital environment led to an increase in nosocomial outbreaks associated with high mortality rates. However, many other Acinetobacter spp. can also cause nosocomial infections. This review focuses on the role of Acinetobacter spp. as nosocomial pathogens, resistance patterns and epidemiology.
PENGARUH BERSEPEDA STATIS TERHADAP VO2 MAX PADA SISWA KELAS VIII BERBERAT BADAN LEBIH (OVERWEIGHT) DI SMP NEGERI 4 TEMBUKU BANGLI Gede Githa Widya Pranatha; I Made Agus Kresna Sucandra; Cynthia Dewi Sinardja
E-Jurnal Medika Udayana Vol 9 No 6 (2020): Vol 9 No 06(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (251.5 KB) | DOI: 10.24843/MU.2020.V09.i6.P05

Abstract

ABSTRAKKondisi berat badan berlebih (overweight) terjadi pada seseorang dengan jumlah sel lemak bertambah pada tubuh sehingga ukuran tubuh akan bertambah lebih besar dan seiring waktu sel lemak iniakan bertambah banyak. Bersepeda statis dapat menjadi cara yang efektif untuk menurunkan lemakapabila dilakukan secara rutin. Kebugaran seseorang dapat dilihat dari kadar VO2 Maxnya. Bagiseseorang berberat badan lebih (overweight) yang mengikuti latihan bersepeda statis dapat meningkatkankadar VO2 Max, jika dilakukan secara rutin diharapkan berat badan ideal dapat tercapai dan responkardiovaskular terhadap aktivitas fisik meningkat. Tujuan penelitian ini untuk mengetahui pengaruhbersepeda statis terhadap kadar VO2 max pada siswa berberat badan lebih (overweight) di SMP Negeri 4Tembuku Bangli dan mengetahui perbedaan rerata VO2 Max pada siswa laki-laki dan perempuanberberat badan lebih (overweight) di SMP Negeri 4 Tembuku Bangli. Jenis penelitian ini merupakanpenelitian eksperimen dengan penelitian pre dan post controlled group design. Pada penelitian inididapatkan perbedaan hasil rerata dari nilai VO2 Max pada perempuan dan laki-laki dengan nilaip=0,000. Pada perempuan didapatkan hasil VO2 max sebelum diberikan perlakuan adalah 31,82ml/kg/menit dan sesudah di berikan perlakuan adalah 36,10 ml/kg/menit, sedangkan hasil rerata nilaiVO2 Max laki-laki sebelum diberikan perlakuan adalah 41,79 ml/kg/menit dan sesudah diberikanperlakuan adalah 49,83 ml/kg/menit. Berdasarkan hasil penelitian di atas, disimpulkan bahwa terdapatperubahan secara signifikan pada kadar VO2 max pada siswa berberat badan lebih (overweight) di SMP Negeri 4 Tembuku Bangli. Kata kunci : berat badan lebih, sepeda statis, VO2 max
TINGKAT PENGETAHUAN PENDUDUK USIA LANJUT TENTANG HIPERTENSI DI BANJAR CELUK, DESA CELUK, KECAMATAN SUKAWATI Nindya Kusuma Mahadewi; I Made Agus Kresna Sucandra; Cynthia Dewi Sinardja
E-Jurnal Medika Udayana Vol 9 No 2 (2020): Vol 9 No 02(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (590.43 KB) | DOI: 10.24843/MU.2020.V09.i2.P05

Abstract

Angka kejadian hipertensi pada penduduk Indonesia umur ?18 tahun sebanyak 25,8%. Tingginya prevalensi kejadian hipertensi dapat dilihat dari kurangnya pengetahuan masyarakat tentang hipertensi. Berdasarkan data Pondok Bersalin Desa (Polindes) Celuk pada tahun 2017, terdapat 313 kasus hipertensi di Desa Celuk yang berasal dari penduduk usia lanjut dan kasus terbanyak terdapat di Banjar Celuk yaitu sebanyak 173 kasus. Banjar Celuk memiliki populasi penduduk usia lanjut tertinggi di Desa Celuk yaitu sebanyak 291 orang. Penelitian ini menggunakan desain penelitian deskriptif potong lintang. Sampel berjumlah 106 penduduk usia lanjut di Banjar Celuk. Tujuan dari penelitian untuk mengetahui tingkat pengetahuan penduduk usia lanjut tentang hipertensi di Banjar Celuk,Desa Celuk, Kecamatan Sukawati. Data didapatkan melalui wawancara dengan kuesioner kepada responden usia lanjut. Hasil penelitian ini menunjukkan 59,4% dari penduduk usia lanjut di Banjar Celuk memiliki tingkat pengetahuan sedang terhadap hipertensi. Saran yang dapat diberikan adalah pemberian penyuluhan rutin tentang hipertensi terutama pada aspek faktor risiko, komplikasi dan penatalaksanaan. Sasaran penyuluhan bisa dilakukan pada kelompok penduduk yang tidak bersekolah serta penduduk yang bekerja sebagai pedagang, petani, dan tidak bekerja. Sehingga pengetahuan penduduk usia lanjut di Banjar Celuk tentang hipertensi menjadi meningkat dari sebelumnya. Kata kunci: Hipertensi, Lansia, Tingkat Pengetahuan
Gambaran tingkat pengetahuan terkait anemia pada ibu hamil di Puskesmas Bangli, Kecamatan Bangli, Kabupaten Bangli Rifky Acga; Made Agus Kresna Sucandra; Cynthia Dewi Sinardja
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (256.501 KB) | DOI: 10.15562/ism.v11i3.659

Abstract

Background: Anemia is a disease or disorder that occurs in the blood and is an important fluid for the heart to pump throughout the body through arteries and veins. Abnormalities in the blood can affect one's health and quality of life. Based on WHO data in 2011 found the lowest average hemoglobin in Africa, Southeast Asia and the Mediterranean. Southeast Asia has the highest number of anemia in children and women. The prevalence of anemia in nonpregnant women is 37.7% to 41.5%, whereas in pregnant women it is 38.9% to 48.7%.Methods: The purpose of this study was to determine the description of pregnant women's knowledge about anemia. This research is descriptive with an observational research approach that is cross sectional. The sample in this study was G1 pregnant women in Bangli District, Bangli Regency. Sampling is done using a totally sampling method where the samples taken are all members of the affordable population. Data is processed univariately.Results: The results obtained from 31 respondents, showed that the level of knowledge of pregnant women associated with anemia has a higher rate in the age group 26-30 years (33.3%). Based on work, found a low level of compliance found in pregnant women who are not working or as housewives (IRT) which is 68.4%. Patients with junior high school education have a low adherence rate of 66.7%.Conclusions: The description of the level of knowledge of pregnant women related to anemia in Bangli District mostly had a low level of knowledge, as many as 16 people or 51.6%. It is recommended to explain about the definition of anemia, things that cause anemia, signs and symptoms of anemia. Latar Belakang: Anemia adalah suatu penyakit atau gangguan yang terjadi pada darah dan merupakan cairan penting bagi jantung untuk di pompa ke seluruh tubuh melalui pembuluh darah arteri maupun vena Kelainan pada darah dapat mempengaruhi kesehatan dan kualitas hidup seseorang. Berdasarkan data WHO tahun 2011 ditemukan rata-rata hemoglobin yang paling rendah di Negara Afrika, Asia Tenggara dan Mediterania. Asia Tenggara memiliki jumlah anemia pada anak-anak dan wanita tertinggi. Prevalensi anemia pada wanita tidak hamil adalah 37.7% hingga 41.5%, sedangkan pada wanita hamil adalah 38.9% hingga 48.7%.Metode: Tujuan penelitian ini adalah untuk mengetahui gambaran pengetahuan ibu hamil tentang anemia. Penelitian ini bersifat deskriptif dengan pendekatan penelitian observasional yaitu cross sectional. Sampel pada penelitian ini adalah adalah ibu hamil G1 di Kecamatan Bangli, Kabupaten Bangli. Pengambilan sampel dilakukan dengan menggunakan metode totally sampling dimana sampel yang diambil merupakan semua anggota populasi terjangkau. Data diolah secara univariat.Hasil: Hasil penelitian didapatkan dari 31 responden, menunjukkan bahwa tingkat pengetahuan ibu hamil terkait anemia yang tinggi memiliki angka yang lebih tinggi pada kelompok usia 26-30 tahun (33,3%). Berdasarkan pekerjaan, ditemukan tingkat kepatuhan yang rendah terdapat pada ibu hamil yang tidak bekerja atau sebagai ibu rumah tangga (IRT) yaitu 68,4%. Pasien dengan tingkat pendidikan SMP memiliki tingkat kepatuhan yang rendah yaitu 66,7%.Simpulan: gambaran tingkat pengetahuan ibu hamil terkait anemia di Kecamatan Bangli sebagian besar memiliki tingkat pengetahuan rendah yaitu sebanyak 16 orang atau 51,6%. Disarankan untuk menyuluh tentang pengertian anemia, hal-hal yang menyebabkan anemia, tanda dan gejala anemia.
Anesthesia Management in Morbidly Obese Patient Undergoing Neurosurgical Procedure: A Case Report Charles; Cynthia Dewi Sinardja
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.903

Abstract

Background: Anesthesia management in morbidly obese patients undergoing any neurosurgical procedure is particularly challenging. This case report aims to further discuss the importances and concerns regarding the anesthesia management of decompression craniectomy in morbidly obese patients. Case presentation: A 46-years-old male patient was diagnosed with intracerebral hemorrhage on regio left external capsule due to hypertensive emergency suspected from Middle Cerebral Artery (MCA) aneurysma rupture. Decompression craniectomy with clot evacuation was planned. This patient has morbid obesity. Prediction of difficult intubation and mask ventilation can be assessed using LEMONS, MOANS, Mallampati score and STOP-Bang Questionnaire. The dosage of anesthetic agents used in these patients had been adjusted according to current recommendations. Intraoperatively, patient’s hemodynamic was successfully maintained stable. Postoperatively, patient was closely monitored in the intensive care unit. Conclusion: It is imperative to acquire adequate knowledge on choosing the effective anesthetic management during the preoperative, intraoperative, and postoperative periods to achieve good outcome in morbidly obese patient undergoing neurosurgical procedures.
Pengendalian Urine Output pada Diabetes Insipidus Sentral dengan Hipernatremia Berat Pasca Traumatic Brain Injury Pratana, Yolanda Jenny; Suarjaya, I Putu Pramana; Senapathi, Tjokorda GA; Sinardja, Cynthia Dewi
Majalah Anestesia & Critical Care Vol 42 No 2 (2024): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v42i2.347

Abstract

Pendahuluan: Diabetes insipidus sentral (DIS) merupakan komplikasi cedera sekunder pada traumatic brain injury (TBI). Cedera neurohipofisis menyebabkan insufisiensi hipofisis posterior untuk mensekresi arginine vasopressin (AVP) dalam kondisi hiperosmolalitas. Prevalensi hipernatremia pada pasien dengan TBI lebih dari 35% dengan kemungkinan penyebab dehidrasi dan hipovolemia dengan tingkat mortalitas mencapai 86,8%.Ilustrasi Kasus: Kami melaporkan sebuah kasus dari pria berusia 20 tahun dengan DIS dan hipernatremia berat pasca TBI. Pasien menjalani operasi pemasanganan ventriculoperitoneal shunt dengan perawatan pasca operasi di ruang rawat intensif. Ditemukan poliuria dengan urine output 3,2 ml/kg/jam dengan kadar natrium 190 mmol/L. Koreksi hipernatremia dengan KA-EN 3B intravena dan intake cairan per oral diberikan sebagai pengganti free water deficit. Desmopressin oral diberikan sebagai kompensasi defisiensi AVP untuk mengurangi kehilangan cairan yang berlangsung. Respon baik tercapai pada hari kedua perawatan, ditunjukkan dengan penurunan urine output hingga 1,4 ml/kg/jam dan penurunan kadar natrium dengan target 10-12 meq/L/hari. Efek samping pemberian desmopressin tidak ditemukan pada pasien ini.Simpulan: Kasus ini menunjukkan bahwa pemantauan ketat dan terapi yang sesuai menghasilkan luaran yang baik pada pasien DIS dengan hipernatremia berat pasca TBI.
Epidural Anaesthesia Technique in Caesarean Section Operation in Pregnant Patients with Rheumatic Heart Disease and Severe Mitral Stenosis Wangsa, Aditya; FX Adinda Putra Pradhana; Tjahya Aryasa EM; Cynthia Dewi Sinardja
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.v4i2.324

Abstract

Introduction: Mitral stenosis (MS) is the most common form of rheumatic heart disease (RHD). Pregnant women with moderate/severe MS are more prone to heart failure and pulmonary edema than normal pregnant women. It is very important to prevent the potential for maternal heart failure before delivery. This study aimed to present a case report on the epidural anaesthesia technique in caesarean section in pregnant patients with rheumatic heart disease and severe mitral stenosis. Case presentation: A 31-year-old pregnant woman patient came to the hospital with complaints of shortness of breath and found rheumatic heart disease and severe mitral stenosis. The patient was premedicated with fentanyl 50 mcg and midazolam 1 mg intravenously, followed by oxygen supplementation with a 2 lpm nasal cannula. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, targeting the T10-L1 dermatome and T6-L1 target of the viscerotome. The local anaesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 25 ml. The onset of action of epidural anaesthesia is achieved within 15 minutes as long as the operation is reached a total blockade as high as T6. During surgery, the patient is monitored with standard monitors and an artery line. There were no complaints of shortness of breath felt by the patient during the operation. Conclusion: Epidural anaesthesia technique can be performed safely in pregnant women with comorbid mitral regurgitation and atrial fibrillation, with good intraoperative hemodynamic stability.
Co-Authors Adinda Putra Pradhana Arisadika, Putu Bagus Charles Christopher Ryalino D.H., Asterina Dharmawan, IGB Adi FX Adinda Putra Pradhana Gede Githa Widya Pranatha Hartawan, IGAG Utara I Ketut Sinardja I Made Agus Kresna Sucandra I Made Gede Widnyana I Made Subargiartha I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan Johanes, Kevin Paul Junaedi, Made Darma Kadek Agus Heryana Putra, Kadek Agus Kapitan, Titin Agustin Kusuma, Oscar Indra Made Agus Kresna Sucandra Made Wiryana Marilaeta Cindryani Lolobali, Marilaeta Cindryani Ni Nengah Dwi Fatmawati Nindya Kusuma Mahadewi Pamudji, Ivan Sebastian Pontisomaya Parami Pratana, Yolanda Jenny Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Rifky Acga Saputra, Darmawan Jaya Tirta, Ian Tjahya Aryasa Tjokorda Gde Agung Senapathi Togi Stanislaus Patrick Wangsa, Aditya Win Muliadi