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Perbandingan Ukuran Droplet Emulsi Propofol 200 mg yang Dicampur dengan Lidokain 10 mg pada Suhu yang Berbeda 6 Jam Setelah Pencampuran Dona Eriyadi; Calcarina FRW; Sudadi
Jurnal Komplikasi Anestesi Vol 1 No 3 (2014): Volume 1 Number 3 (2014)
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.v1i3.5546

Abstract

Latar belakang. Propofol (2,6-diisopropylphenol) telah mendapatkan popularitas sebagai obat anestesi baik untuk induksi maupun pemeliharaan anestesi.Propofol diformulasikan sebagai makroemulsi dengan minyak kedelai (100 mg/ml), lesitin (12 mg/ml), dan gliserol (22,5 mg/ml). Penyuntikan emulsi propofol sering menimbulkan nyeri. Untuk menguranginya biasanya dicampur dengan lidokain berbagai konsentrasi. Makroemulsi propofol ini secara termodinamik tidak stabil dan mengalami degradasi seiring dengan waktu. Pencampuran dengan lidokain akan menurunkan pH emulsi propofol sehingga mempercepat terjadinya degradasi emulsi propofol yang secara fisik ditandai dengan pembesaran ukuran droplet emulsi propofol. Pembesaran ukuran droplet propofol berakibat terhadap penurunan kecepatan pelepasan propofol, penurunan konsentrasi propofol dan risiko terjadinya emboli lemak. Risiko emboli lemak meningkat bila ukuran droplet lebih besar daripada populasi percentage of FAT globule>5????m (PFAT5) yang lebih dari 0,05%. Pada praktek sehari-hari sering dijumpai adanya pencampuran emulsi propofol dengan lidokain guna mengurangi nyeri penyuntikan, yang kemudian disimpan dalam lemari pendingin atau suhu ruanganuntuk penggunaan berikutnya.Tujuan dari penelitian ini adalah untuk mengetahui apakah terjadi perbedaan ukuran rerata droplet emulsi propofol yang dicampur dengan lidokainsetelah prosedur penyimpanan selama 3 dan 6 jam pada suhu yang berbeda. Metode. Jenis penelitian yang digunakan adalah penelitian eksperimental terencana (control trial) dengan tujuan menilai perbandinganMean Droplet Size (MDS) sesudah prosedur penyimpanan pada suhu lemari pendingin (2-4)0 C dan suhu ruangan (19-24)0 C selama 3 dan 6 jam. Terdapat12 sampel pada masing-masing perlakuan. Ukuran droplet diamati di bawah mikroskop monitor secara manual sebanyak 500 droplet tiap sampel.Analisa dataperbedaan MDS antara penyimpanan dalam suhu yang berbeda, digunakan uji t tidak berpasanganpada data yang berdistribusi normal dan uji Man Whitneyuntuk data yang berdistribusi tidak normal. Nilai p<0,05 secara statistik dianggap bermakna. Hasil. Tampak adanya perbedaanMDS pada jam ke-3 antara penyimpanan lemari pendingin (1,99±0,45) dengan suhu ruangan (2,18±0,67) yang bermakna secara statistik (p<0.05), dan pada jam ke-6 penyimpanan lemari pendingin (2,84±0,93) dengan suhu ruangan (3,16±1,24) yang bermakana secara statistik (p< 0,05). Nilai PFAT5jam ke-6 penyimpanan lemari pendingin 1,56 % dan suhu ruangan 5 %. Secara makroskopis penampakan fisik warna dan homogenitas propofol dari waktu dan penyimpanan tidak berubah (warna sesuai standar dan homogen) (masing-masing n=12/100%). Kesimpulan. Rerata ukuran droplet campuran propofol 200 mg dengan lidokain 10 mg setelah prosedur penyimpanan dalam lemari pendingin, lebih kecil dibandingkan dengan penyimpanan suhu ruangan, pada jam ke-3 dan jam ke-6
Hubungan antara Kesesuaian Terapi Antibiotik Empiris dengan Mortalitas Rumah Sakit pada Pasien Hospital Acquired Pneumonia yang Dirawat Di ICU RSUP Dr. Sardjito Yogyakarta Nasution, Rusdi Anwar; Wisudarti, Calcarina Fitriani Retno; Sudadi
Jurnal Komplikasi Anestesi Vol 5 No 1 (2017): Volume 5 Number 1 (2018)
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.v5i1.7319

Abstract

Objective: To determine the association between appropriateness of empirical antibiotic therapy and hospital mortality in patients with hospital acquired pneumonia (HAP) admitted to ICU. Design: Retrospective cohort observational study Methods: Data were collected from patient’s medical record. The inclusion criteria were ICU’s patients aged 18 years old or older who diagnosed HAP within period of June 1, 2015 to December 31, 2016. Patients with HIV-positive were excluded and those without culture result were dropped out. The empiric antibiotic therapy was considered appropriate when all significant bacteria were susceptible or intermediate to at least one of the antibiotics. Variables determined were association between mortality and appropriateness of empirical antibiotic therapy, age, gender, ICU length of stay, duration of mechanical ventilation (MV), type of case (surgical or medical), and APACHE II scores (within the first 24 hours after ICU admission). Results: Eighty one patients were enrolled. Three patients were excluded and 9 patients were dropped because no bacterial cultures were reported. Sputum cultures were obtained from 59 patients while blood cultures were drawn from 10 patients. The sputum cultures were positive in 44 patients and negative in 15 patients, while all blood culture were negative. No differences in hospital mortality were related to age (p=0,345), gender (p=1,000), length of stay in ICU (p=0,059), duration on MV (p=0,09), type of case (p=0,199), and APACHE II score (p=0,331). No significant association was found between appropriateness of empirical antibiotic therapy and hospital mortality (p=1,000). The most common prescribed empiric antibiotics were ceftazidime (n=30), ciprofloxacin (n=21, and levofloxacin (n=19). The most common bacteria were Acinetobacter baumannii (n=13), Klebsiella pneumoniae (n=9), Pseudomonas aeruginosa (n=7), and Streptococcus viridans (n=7), which most of them were multi drug resistant (MDR). Conclusion: No association was found between appropriateness of empirical antibiotic therapy with hospital mortality in patients with hospital acquired pneumonia (HAP) admitted to ICU.
Gagal Spinal pada Pasien Operasi Amputasi Transfemoral dengan Debridemen dan Penatalaksanaannya Maryani, Nova; Artika, I Gusti Ngurah Rai; Sudadi
Jurnal Komplikasi Anestesi Vol 5 No 1 (2017): Volume 5 Number 1 (2018)
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.v5i1.7321

Abstract

A man 64 years old had a traffic accident 12 hours ago, resulting in crush injury on regio left femur and cruris. This man has fasted and for 8 hours and was planned to undergo debridement and transfemoral amputation surgery by orthopedics. The hemodynamic profile of this patient preoperative: stable with HB 8.4, had two colfs of PRC blood transfusion. Vital sign BP 110/55, HR 110x/minute, RR 22x/minute, SpO2 97%. The anesthesia technique planned for the surgery is spinal block anasthesia. Fluid preloading RL 500 ml, intravenous analgesics fentanyl 25 mcq, sitting position, spinal anesthesia L4-L5, CSF (+), blood (-), agent: bupivacaine 0,5 % hyperbaric 15 mg + fentanyl 25 mcq, aspiration (+) barbotage until 4cc. Thus, supine position after spinal anesthesia. Pin Prick result, Sensoric test (-), Motoric Bromage 0, evaluated until 10 minutes, just parasthesia. Pin prick, result sensoric test no sensoric. Block declared failed, conversion to General Anesthesia LMA. Operation held for 2 hours, post-operative patient transfers to High Unit Care.
Brain Protection pada Traumatik Brain Injury Sudadi
Jurnal Komplikasi Anestesi Vol 5 No 1 (2017): Volume 5 Number 1 (2018)
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.v5i1.7323

Abstract

Trauma is the leading cause of death in children and people under 45 years old, and brain trauma is theleading cause of death in 25% of cases. Brain trauma can be classified as both primary and secondary injury.Primary brain injury is a direct result on the head causing both anatomical and physiological damage.Secondary brain injury is the result of hypotension, hypoxia, acidosis, edema, or other advanced factors thatcause damage to brain tissue. Brain protection as prevention and improvement of neuronal damage causedby abnormalities of cerebral metabolism, histopathological or neurological functioning that occurs afterhypoxia or ischemic conditions. The key elements in brain protection that must be achieved are loweringoxygen demand, increasing oxygen supply and halting intracellular pathological processes.
Manajemen Preoperatif pada Protokol Enhanced Recovery After Surgery (Eras) Anindita, Mohammad Pradhana; Kurniawaty, Juni; Sudadi
Jurnal Komplikasi Anestesi Vol 5 No 2 (2018): Volume 5 Number 2 (2018)
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.v5i2.7327

Abstract

Surgery and trauma stimulate metabolic, hormonal, haematological, immunological complex response and activate sympathetic nerve systems. Generally, stress response induced by surgery may causes dangerous impacts. Enhanced Recovery After Surgery (ERAS) is multimodal and multidisciplinary perioperative management approach designed for minimizing stress response, patient complication, length of hospital stay, and enhancing patient recovery. ERAS protocol or pathway includes preoperative, intraoperative, and postoperative management. ERAS preoperative management is started at preadmission phase. Preadmission management includes patient and family education and counseling, alcohol and smoking cessation, nutritional screening, patient’s health condition optimizing and coexist disease medication optimizing. Preoperative management includes carbohydrate treatment, fasting protocol, preoperative antibiotic prophylaxis, preoperative thromboembolic prophylaxis, and prophylaxis against nausea and vomit.
Manajemen Anestesi Cedera Vertebra Cervical 4,5 dengan Tindakan Laminektomi Dekompresi Stabilisasi Zaki, Wildan Arsyad; Sudadi; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 5 No 3 (2018): Volume 5 Number 3 (2018)
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.v5i3.7341

Abstract

Preoperative management of cervical fractures of particular concern include the level of injury, onset of occurrence and cardiorespiratory complications. Then continued the definitive management of laminectomy requiring inline position intubation positions, invasive arterial line monitors and CVC, durante vasoactive drug support in case of hemodynamic decline. Equally important is postoperative intensive care, and treatment of complications of pneumonia, DVT, sepsis due to long immobilization. Treatment of a 54-year-old male patient with a diagnosis of VC IV-V compression fracture, tetraplegi and increased transaminase enzyme. Patients were initially treated in HCU LOC 2 for 10 days with drug support and hemodynamic monitoring, then definitive elective laminectomy, decompression, stabilization. The operation lasted for approximately five hours with bleeding approximately 1200cc, urine output 2.5 cc / kgBW / hour. Post surgery patients treated in ICU with attached tracheostomy, connected with ventilator and vasoactive drug support. During treatment in ICU, hemodynamic monitoring with arterial line, ECG, pulse oximetry, temperature monitor and CVC were performed. Patients are positioned in line mobilization, ureter catheter installed and NGT. Hemodynamic, blood pressure during ICU ranged from syst 100-110 mmHg, diastole blood pressure 50-80 mmHg, pulse 90-110 x / minute and saturation 93-100%. With supportive therapy of ceftriaxone injection, methylprednisolone, fentanyl, mecobalamin, omeprazole, and dobutamine and norepinephrine continue. The patient was treated for 5 days and after stabilizing the patient was returned to the ward.
Layanan Nyeri Akut Pascaoperasi: Organisasi dan Implementasi Sudadi; Mahmud; Bahrun, Nugraha Septian
Jurnal Komplikasi Anestesi Vol 6 No 2 (2019): Volume 6 Number 2 (2019)
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.v6i2.7356

Abstract

Acute pain is pain of recent onset, limited duration and usually related to a pathological process, disease,or injury. The experience of acute pain is universal, but hospital inpatients frequently suffer severe pain asa result of surgery, trauma or medical illness. In the hospital, two thirds of patients experience pain duringtheir admission. Within the surgical population, where the noxious stimulus is well defined and systems are in place to manage acute pain, almost 60% of patients experience severe pain in the postoperative period with a marked negative impact on health-related quality of life.The presence of Acute Pain Service (APS) including regional anesthesia services, has increased the awareness of patients and medical professionals that proper pain management in perioperative period is important to enhance patient’s well-being. A dedicated team, which aspires for excellence and good clinical governance, and appropriate organizational structure, will definitely help in achieving a pain-free hospital stay, especially for the surgical patients.
Manajemen Nyeri pada Pasien dengan Toleransi Opioid Mahmud; Sudadi; Rezkiawan, Dika Rezkiawan
Jurnal Komplikasi Anestesi Vol 6 No 3 (2019): Volume 6 Number 3 (2019)
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.v6i3.7357

Abstract

The number of patients prescribed opioids has grown rapidly over the last decade. The burden of chronic pain is more widely recognized and there has been an increase in the use of opioid for both cancer and non-cancer pain. As a result, the proportion of opioid-tolerant requiring acute pain management has increased, often presenting clinicians with greater challenges than those faced when treating the opioid naïve. The aims of opioid treatment include effective relief of acute pain, prevention of drug withdrawal, assistance with any related social, psychiatric and behavioural issues and ensuring continuity of long-term care. Pharmacological approaches incorporate the continuation of usual medication, short term use of sometimes much higher than average dose of additional opioid, and prescription of non-opioid and adjuvant drugs, aiming to improve pain relief and attenuate opioid tolerance and opioid induced hyperalgesia.
Cost Effectiveness General Anesthesia Combined with Scalp Block Compared to General Anesthesia in Patients Undergoing Removal Tumor Craniotomyin Dr. Sardjito Hospital Wicaksono, Galih Sahid; Sudadi; Uyun, Yusmein
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023): Volume 11 Number 1 (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.v11i1.10199

Abstract

Background. Providers of anesthesia services have many opportunities to reduce these costs, of course with the aim of maintaining balance between profit, security and costs. Craniotomy surgery removal of the scalp block tumor is an alternative option that can be combined with general anesthesia. The scalp block itself can blunt stress response in craniotomy and can maintain unwanted hemodynamic instability. Purpose. Find out the cost effectiveness of the scalp block in craniotomy patients removing tumors at Dr. SARDJITO Hospital. Method. Method. Twenty patients ranging in age from 18 - 65 years with intracranial tumors who underwent tumor binding craniotomy at RSUP Dr. SARDJITO is grouped into two treatment groups with general anesthesia and general anesthesia with a combination of scalp blocks, both techniques are calculated using drugs and consumables during the operation. Results. Total cost on the general anesthesia combined scalp block was Rp. 1,347,276 lower Rp. 377,833 compared to general anesthesia Rp. 1,725,109 with a significant difference (p = 0.005). Similarly, the hourly cost of the group in the combined general anesthesia scalp block was Rp. 286,351 Rp. 97,107 lower than general anesthesia Rp. 383,457 with a significant difference (p = 0.038). Conclusion. Combination of general anesthesia and scalp block using 0.5% levobupivacaine more cost effective than general anesthesia and scalp block with placebo in supratentorial tumor patients undergoing tumor removal craniotomy.
Pengaruh Teknik Anestesi Kombinasi Blok Skalp dengan Levobupivacaine 0,5% Terhadap Penggunaan Fentanyl Intravena untuk Mengatasi Nyeri Paska Operasi Kraniotomi Pengangkatan Tumor Di RSUP Dr. Sardjito Akbar, Shonnif; Sudadi; Widodo, Untung
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023): Volume 11 Number 1 (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.v11i1.10207

Abstract

Latar Belakang. Pengunaan opioid dosis besar terbukti efektif untuk memblokade stimulasi pada insisi kepala namun memiliki efek yang tidak diinginkan. Blok skalp adalah salah satu pilihan alternatif yang dapat dikombinasikan dengan pembiusan umum. Blok skalp sendiri dapat menumpulkan respon stres pada kraniotomi dan dapat menjaga gejolak hemodinamik yang tidak diinginkan. Blok skalp menurunkan insiden dan skala nyeri paska operasi kraniotomi pengangkatan tumor. Tujuan. Membandingkan jumlah konsumsi fentanyl paska operasi pada pasien yang menjalani operasi kraniotomi pengangkatan tumor dengan teknik pembiusan umum dan teknik pembiusan umum dengan kombinasi blok skalp menggunakan levobupivacaine 0,5%. Metode. Dua puluh orang pasien dengan rentang usia 18-65 tahun dengan tumor intrakranial yang menjalani tindakan operasi kraniotomi pengangkatan tumor di RSUP Dr. Sardjito dikelompokkan menjadi 2 kelompok perlakuan dengan teknik pembiusan umum dengan kombinasi blok skalp menggunakan levobupivacaine 0,5% dan pembiusan umum dengan kombinasi blok skalp menggunakan normal saline. Pasien dievaluasi kebutuhan fentanyl dan skala nyeri 12 jam paska operasi di ICU. Pasien dengan riwayat alergi anestesi lokal, riwayat alergi fentanyl, BMI <18 kg/m2 dan BMI >35 kg/m2 dan durasi operasi >6 jam akan dieksklusi dari pengambilan data. Hasil. Rerata penggunaan fentanyl 12 jam paska operasi pada pasien yang menjalani operasi kraniotomi pengangkatan tumor dengan teknik pembiusan umum dengan kombinasi blok skalp menggunakan levobupivacaine 0,5% sebesar 300,50 mcg dengan standar deviasi 68,65 mcg. Sedangkan pada pasien dengan teknik pembiusan umum dengan kombinasi blok skalp menggunakan normal salin sebesar 408,75 mcg dengan standar deviasi 84,02 mcg. Selisih rerata penggunaan fentanyl paska operasi pengangkatan tumor antara kedua kelompok sebesar 108,25 mcg menunjukkan perbedaan yang bermakna p=0,006 (p<0,05). Kesimpulan. Pembiusan umum dengan kombinasi blok skalp menggunakan levobupivacaine 0,5% terbukti mengurangi kebutuhan fentanyl 12 jam paska operasi kraniotomi pengangkatan tumor dibandingkan pembiusan umum dengan kombinasi blok skalp menggunakan normal salin.
Co-Authors AA Sudharmawan, AA Abdul Tahir Adi Hidayat Adityo, Galang Martin Adiyatma, Krisna Hario Adrin, Olga Elenska Akbar, Shonnif Akhmad Yun Jufan Ali Wahyudi, Ali Anindita, Mohammad Pradhana Anindita, Triatma Anisa Fadhila Farid Antoni Arifin, Achmad Reza Artika, I Gusti Ngurah Rai Bahrun, Nugraha Septian Bayu, Timor Krisna Benny Kurniawan, Benny Bhirowo Yudo Pratomo Bowo Adiyanto Calcarina Fitriani Retno Wisudarti Calcarina Fitriani Retno Wisudarti Calcarina FRW Djayanti Sari Dona Eriyadi Esti Susiloningsih Fakhrudin N, Rifdhani Fansori, Rosihan Farihatun Fitri, Lillah Frisianto, Rinaldi Tri FRW, Calcarina Gentong, Metia Gledis G. Gunawan, Fanny Hamdany, Ferry Hanafi, Irham Hariyadi S, Arief Herlambang, Panji Hermawan, Hendra Hernandes, Crodia Hifni Hisam, Muhammad Yusuf Husen IG Ngurah Rai Artika Ikhsan, Isroful Indah Munastari Ningsih Iqbal Alfiandy Irawati, Junita Izzatul Faizah Juni Kurniawaty Muhdar Abubakar Djayanti Sari Krisna Bayu, Timor Kuncoro, Kusuma Edhi Kurniawan, Novianto Loho, Irvan Revaldi Maryani, Nova Miftaku Ni'amah Mochammad Imron Awalludin Mufaizin Mugirah Muhammad Fikri Putra Perdana Muna Fauziah Musda, Diva Nasution, Rusdi Anwar Ngurah, I Gusti Ngurah, I Gusti Ngurah Novianto Kurniawan Nur, Rifdhani Fakhrudin Nurkolis Nurlatifah, Mahanani P, Inggita Dyah Parjiman Prasetya, Sandie Pratomo, Bhirowo Y. Rahmatiana Azizatun Nisa ramdhan, tri wahyudi Rani, Hajar Rafika Rasiman Rezkiawan, Dika Rezkiawan Rini, Isworo Ristianto, Muhammad Brian Rose Kusumaningratri RW, Calcarina Fitriani Sadiyanto, Dewang Saputra, Dya Saputra, Rory Denny Sarosa, Pandit Setiono, Agus Siti Helmyati Siti Munawaroh Soedjono Sri Rahardjo Sri Rahardjo Suharso, Pamungkas Hary Sunantara, I Gusti Ngurah Putu Mandela Sutarman Syahputra , Anggi Taneo, Desy Chery Marlyn Teguh Setiawan Wibowo Tjokronolo, Yudistira Tony Irawan Umi Umi Zulfa Untung Widodo, Untung Urmila Utomo, F uad Cipto Utomo, Wandito Gayuh Wahyu Nugroho Wicaksono, Galih Sahid Wijaya, Indriyani Wikantama, Aswin Yasinta Qur’aini Nurdiniyya Yoiceta Vanda, Yoiceta Yunita Widyastuti Yusmein Uyun Yusron, Ali Yusuf Hisam Zaki, Wildan Arsyad