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All Journal Jurnal Komplikasi Anestesi Klinik: Jurnal Ilmiah Kedokteran dan Kesehatan
Calcarina Fitriani Retno Wisudarti
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Medicine & Pharmacology Nursing Public Health

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Sebuah COST EFFECTIVENESS ANALYSIS Adiyatma, Krisna Hario; Mahmud; SUDADI; Calcarina Fitriani Retno Wisudarti; Djayanti Sari; Diah Ayu Puspandari
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
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.v12i1.15618

Abstract

Background : One of the frequent post-operative complications is pain, which is experienced by more than 80% of patients and 75% of them experience post-operative pain of moderate to severe intensity. Major abdominal surgery is a surgical procedure with moderate to severe postoperative pain intensity. Analgesic approach strategies that are often used are intravenous opioids and epidural analgesia. Epidural analgesia is considered the analgesic therapy of choice for post-major abdominal surgery, but at a higher cost when compared with intravenous opioids. The differences in route of administration, efficacy and side effect profiles make it important to assess the cost effectiveness between the two approaches as part of hospital quality control and cost management.Objective : To determine the cost effectiveness of epidural analgesia compared with intravenous opioids as analgetic after major abdominal surgery.Method : This study used a descriptive analytical design with decision tree analysis to assess clinical outcomes and estimated costs for two alternative therapies. Research samples were taken retrospectively from September – December 2022 at RSUP Dr. Sardjito Yogyakarta, using simple random sampling. The Incremental Cost Effectiveness Ratio (ICER) value was assessed and Probabilistic Sensitivity Analysis (PSA) was carried out with Monte Carlo simulation using Microsoft Excel®.Results : Epidural analgesia as anti-pain after major abdominal surgery has an Incremental Cost Effectiveness Ratio (ICER) value of IDR 20,857,416/pain free days. Probabilistic Sensitivity Analysis (PSA) produces data distribution with dominance in quadrant 3 of the CEA Plane. Conclusion : The epidural analgesia strategy for pain relief after major abdominal surgery is a cheaper strategy but with slightly lower effectiveness than intravenous opioids at RSUP Dr. Sardjito. Epidural analgesia has an ICER value of IDR 20,857,416/pain free days, has the opportunity to be an alternative choice for post-major abdominal analgetic management that is cost effective.
Bronchoscopy pada Pasien Atelektasis dengan Traumatic Brain Injury di ICU Niko Pamillian Ariesti; Calcarina Fitriani Retno Wisudarti
Jurnal Ilmiah Kedokteran dan Kesehatan Vol. 5 No. 3 (2026): September: Jurnal Ilmiah Kedokteran dan Kesehatan
Publisher : Lembaga Pengembangan Kinerja Dosen

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/klinik.v5i3.7583

Abstract

Pathological brain-lung crosstalk severely complicates the intensive management of traumatic brain injury (TBI). Pulmonary complications such as atelectasis and ventilator-associated pneumonia (VAP) frequently worsen patient outcomes by prolonging mechanical ventilation and increasing morbidity. This report analyzes the clinical dynamics of a patient with severe TBI who developed refractory atelectasis and early-onset VAP during intensive care management. A male patient presenting after blunt trauma with massive, multifocal intracranial hemorrhages required urgent decompressive craniectomy and invasive mechanical ventilation. During intensive care, the patient developed persistent right upper lobe atelectasis, which subsequently precipitated VAP caused by an extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. Performing flexible bronchoscopy in neurocritical patients carries a significant risk of intracranial pressure (ICP) elevation secondary to auto-positive end-expiratory pressure (auto-PEEP) generation and transient hypercapnia. Therefore, strict periprocedural mitigation strategies, including complete pharmacological paralysis, optimization of pressure-regulated volume control ventilation, intermittent bronchoscope insertion, and continuous hemodynamic and neurological monitoring, were implemented throughout the procedure. Therapeutic bronchoscopy remains an effective and safe intervention for resolving post-TBI atelectasis when carefully integrated with neuroprotective ventilation strategies designed to minimize intracranial pressure elevation and optimize respiratory function, thereby supporting favorable clinical outcomes in neurocritical care patients.
Co-Authors AA Sudharmawan, AA Adiyatma, Krisna Hario Djayanti Sari Niko Pamillian Ariesti Sudadi