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All Journal Jurnal Anestesi Perioperatif Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Khildan Miftahul Firdaus
Department Of Anesthesiology And Reanimation, Faculty Of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya
Education Health Professions Medicine & Pharmacology

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prediksi berat badan pasien pediatri : analisis akurasi mercy method di rsud dr soetomo surabaya Khildan Miftahul Firdaus; Arie Utariani
Jurnal Anestesi Perioperatif Vol 8, No 3 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v8n3.2098

Abstract

Resusitasi pediatri bergantung pada berat badan untuk menentukan ukuran alat resusitasi, dosis obat, jumlah cairan, hingga dosis defibrilasi yang dibutuhkan. Berat badan aktual pada kondisi kegawatan sering kali sulit diukur sehingga membutuhkan suatu metode prediksi. Mercy method merupakan salah satu modalitas prediksi berat badan berbasis panjang yang dapat digunakan. Tujuan, menganalisis akurasi Mercy method sebagai metode prediksi berat badan pasien pediatri. Metode, dalam penelitian analitik observasional ini dilakukan pengukuran berat badan, panjang lengan, dan lingkar lengan atas tengah pada pasien usia 2 bulan–16 tahun di IRNA Pediatri RSUD Dr. Soetomo periode Desember 2019 hingga Maret 2020. Panjang dan lingkar lengan atas tengah kemudian dikonversi menjadi berat badan prediksi menggunakan Mercy method, lalu dilakukan uji korelasi dengan berat badan aktual. Uji bias dan predictive performance dinilai menggunakan ME, MAPE, RMSE, dan toleransi berat badan hingga 10% dan 20%. Hasil, dari 375 pasien, didapatkan hasil bahwa Mercy method merupakan modalitas yang baik untuk memprediksi berat badan pediatri pada populasi ini (r2=.964; p,000). Hasil uji bias dan predictive performance juga menunjukkan hasil yang baik dengan ME yang rendah, MAPE <10%, RMSE mendekati nol, serta dapat memprediksi berat badan aktual dengan toleransi 20% hingga 97,4%. Simpulan, Mercy method merupakan metode yang akurat untuk memprediksi berat badan pasien pediatri di RSUD Dr. Soetomo Surabaya. Feasibility Analysis of the Mercy Method - Weight Estimation Pediatric PatientsMost pediatric resuscitations interventions are based on the patient's body weight to determine the resuscitation device’s size, drug dose, amount of fluid needed, and defibrillation joule. Measurement of actual body weight in the emergency setting is often impossible because it requires a weight estimation method. The Mercy method is one of the modalities of length-based weight estimation used in emergency departments. This study aimed to analyze Mercy method’s accuracy as a weight estimation method in pediatric patients at RSUD Dr. Soetomo Surabaya in December 2019–March 2020. This prospective,  observational analytic, single-center study, measured the actual body weight (ABW), humeral length (HL) and mid- arm circumference (MAC) of patients aged 2 months–16 years at the pediatric ward with consecutive sampling techniques. HL and MAC were converted to predictive body weight (PBW) based on Mercy method. Then, PBWs were regressed against ABWs. The predictive performance assessment used mean error (ME), mean absolute percentage error (MAPE), root mean square error (RMSE) and the predicted percentage was within 10% and 20% (Agreement 10% and 20%). Results from 375 pediatric patients showed that the Mercy method offered a good correlation between ABW and PBW (r2=.964, p.000); Mercy method also demonstrated good predictive performance results with low ME, MAPE <10% and RMSE close to zero. The Mercy method estimated weight within 20% of ABW for nearly all children (97.4%) in this study population. In conclusion, the Mercy method performed exceptionally well in this study population without modification, extending this weight estimation strategy.
Studi Komparatif Ukuran Pipa Nafas Tanpa Cuff Pada Pasien Pediatri Berdasar Diameter Subglotis Dengan Metode Konvensional Khildan Miftahul Firdaus; Elizeus Hanindito; Bambang Pujo Semedi
Jurnal Anestesi Perioperatif Vol 8, No 3 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v8n3.2126

Abstract

tersendiri. Pipa endotrakeal (ETT) yang terlalu kecil/besar meningkatkan risiko komplikasi. Prediksi ukuran ETT berdasar atas usia merupakan metode yang paling sering digunakan namun ternyata tidak selalu tepat pada aplikasinya. Parameter lain seperti diameter subglotis atau diameter kelingking tangan dapat menjadi alternatif untuk memprediksi ukuran ETT pediatri. Tujuan penelitian ini menganalisis dan membandingkan akurasi prediksi ukuran ETT tanpa cuff berdasar berbagai variabel pada pasien pediatri di RSUD Dr Soetomo Surabaya mulai Februari hingga April 2020. Subjek penelitian ini pasien usia 2–9 tahun, PS ASA 1–2 yang akan dilakukan operasi elektif. Saat preoperatif, usia, berat, dan panjang badan dicatat. Saat intraoperatif, diameter kelingking tangan dan diameter subglotis menggunakan USG diukur dan dicatat. ETT yang digunakan adalah ETT tanpa cuff berdasar atas diameter subglotis. ETT dianggap tepat apabila memberikan audible air leak pada tekanan 10–25 cmH2O. Bila ETT terlalu kecil/besar maka dilakukan reintubasi. Tiap-tiap parameter dilakukan uji korelasi, agreement test, serta predictive performance menggunakan MAPE, dan RMSE. Dari 48 pasien, didapatkan hasil bahwa prediksi ukuran ETT tanpa cuff berdasar atas diameter subglotis memiliki akurasi yang paling baik hingga 91,67% (r=0,973, koefisien kappa 0,892; p<0,001, MAPE 0,803%, dan RMSE 0,144). Simpulan, prediksi berdasar atas diameter subglotis merupakan metode yang akurat untuk memprediksi ukuran ETT tanpa cuff pediatri. Subglottic Diameter Ultrasonographic Assessment for Estimating Pediatric Uncuffed Endotracheal Tubes Compared to Conventional MethodsAnatomical differences in pediatric airways could be quite a challenge. Choosing endotracheal tube (ETT) optimum size is essential as a larger or smaller tube may cause undesirable complications. ETT size prediction based on age formula is most commonly used, but is not always successful. The little finger diameter and subglottic diameter are alternative parameters to predict pediatric uncuffed ETT optimum size. This study analyzed and compared the multiple variable-based formulas’ accuracy to predict the pediatric uncuffed ETT optimum size. The ETT prediction used subglottic diameter-based formulas. Clinically fit ETT has an audible air leak within the pressure of 10–25 cmH2O. If the ETT predicted was relatively too small/big than clinically fit ETT, it was changed to one size smaller/ bigger. Each variable was then analyzed by correlation test, regressed against clinically fit ETT to test the agreement rates, and predictive performance was assessed using mean absolute percentage error (MAPE), and root mean square error (RMSE). From 48 patients it found that subglottic diameter formulas offered the best result in predicting optimum size uncuffed ETT in pediatrics with an agreement rate up to 44 of 48 patients got the right clinically fit uncuffed ETT (91.67%, r=0.973, kappa 0.892, p-value<0.001, MAPE 0.803%, and RMSE 0.144). In conclusion, the prediction based on subglottic diameter using USG is the best method to predict the optimum size of uncuffed ETT in pediatrics.
Ultrasound-Guided Peripheral Nerve Block as Post-Operative Management of Lower Abdominal Surgery in Ksatria Airlangga Floating Hospital Vina Lidya Setjaputra; Steven Christian Susianto; Jessica Deborah Silitonga; Maya Hapsari Kusumaningtyas; I Putu Agni Rangga Githa; Robbi Tri Atmaja; Burhan Mahendra Kusuma Wardhana; I Ketut Mega Purnayasa Bandem; Khildan Miftahul Firdaus; Agus Harianto
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 2 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I22024.99-105

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) implementation in remote areas by operating hospital ships is immensely helpful due to high patient turnover, reducing costs, and minimizing the effects of surgical stress. Utilization of regional anesthetics, namely ultrasound-guided Transversus Abdominis Plane (TAP) block or Quadratus Lumborum (QL) block, is applicable and beneficial in this setting. Objective: Due to the limited time, facilities, and health personnel available in floating hospital services surgery, several adjustments in anesthetic methods are required to rapidly return patients to their preoperative physiologic state. Therefore, we wrote this case report. Case Series: We presented case series of lower abdominal surgery performed in Ksatria Airlangga Floating Hospital with the implementation of peripheral nerve blocks as one of the ERAS protocols in one of the remote islands in Indonesia, Gili Iyang Island. Two patients underwent TAP blocks, while the remaining two received QL Blocks. A peripheral nerve block was performed under ultrasound guidance and a 20-mL injection of 0.25% levobupivacaine to QL muscle or TAP. During the observation, we found Visual Analogue Score (VAS) of 1-2 after surgery, no post-operative sedation needed, only 1 patient experienced nausea without vomiting, and the length of health facility stay were less than 3 days. Nearly all of our patients who underwent lower abdomen surgery got benefits from the application of peripheral nerve block. Because there was no opioid consumption in our cases, the risk of unwanted effect of opioids like postoperative nausea and vomiting, were also decreased. Conclusion: Peripheral nerve block, as mentioned TAP Block and QL Block, has emerged as a promising alternative to prevent and manage post-operative pain in remote medicine settings, namely Ksatria Airlangga Floating Hospital, particularly in areas with few medical facilities.
Co-Authors AGUS HARIANTO Burhan Mahendra Kusuma Wardhana Elizeus Hanindito I Ketut Mega Purnayasa Bandem I Putu Agni Rangga Githa Jessica Deborah Silitonga Maya Hapsari Kusumaningtyas Robbi Tri Atmaja Semedi, Bambang Pujo Steven Christian Susianto Utariani, Arie Vina Lidya Setjaputra