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All Journal E-Jurnal Medika Udayana Jurnal Anestesi Perioperatif PREPOTIF : Jurnal Kesehatan Masyarakat Journal of Anaesthesia and Pain Majalah Anestesia & Critical Care (MACC)
Adi, Made Septyana Parama
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Education Health Professions Medicine & Pharmacology Public Health

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INDEKS KOLAPSIBILITAS (CI) SEBAGAI PREDIKTOR HIPOTENSI PADA PASIEN DENGAN ANESTESI UMUM Pranata, I Made Harry; Adi, Made Septyana Parama; Suarjaya, I Putu Pramana; Kurniyanta, Putu
E-Jurnal Medika Udayana Vol 12 No 10 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i10.P02

Abstract

Intraoperative hypotension (IOH) is important to identify early because it is associated with high morbidity and mortality in old age. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) can detect volume responsiveness in circulatory shock. The purpose of this study was to examine the collapsibility index (CI) as a predictor of hypotension in patients under general anesthesia. This study was an observational cross-sectional design in adult patients who underwent elective surgery under general anesthesia at Sanglah General Hospital from December 2021 to January 2022 using a consecutive sampling technique. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVC CI as a diagnostic tool for predicting hypotension (systolic pressure?<?90?mmHg or a???30% drop from the baseline) was evaluated by ROC curve analysis. At the point of collapsibility index (CI) ? 47, there were 29 patients (96.7%) with hypotension. At the point of collapsibility index (CI) < 47, there was 1 patient (3.3%) with hypotension and 24 patients (100%) without hypotension. The cut-off level of collapsibility index (CI) is obtained with the Receiver Operating Curve (ROC) curve, below 0.985. The cut-off CI level for hypotension was 47.0 with a sensitivity of 96.7% and specificity of 100%. There is a significant relationship between IVC CI with a decrease in MAP before and after induction at 4,8, and 10 minutes (p<0,05). The collapsibility index (CI) 50 can be used as a predictor of the incidence of hypotension in patients under general anesthesia. Keywords : hypotension, collapsibility index, general anesthesia.
TRENDS IN SPECIALIZATION CHOICES AMONG SECOND-SEMESTER STUDENTS AND SECOND-YEAR JUNIOR DOCTORS IN MEDICAL FACULTY AT UDAYANA UNIVERSITY Prastiti, Ni Ketut Devi Widhi; Parami, Pontisomaya; Adi, Made Septyana Parama
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 1 (2025): APRIL 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i1.39639

Abstract

Pendidikan kedokteran memiliki beragam pilihan karir yang menarik bagi mahasiswa. Wawasan tentang preferensi karir dan alasan pemilihannya di bidang kedokteran akan membantu mahasiswa menentukan karir medis yang tepat. Penelitian ini bertujuan mengetahui gambaran kecenderungan pemilihan spesialisasi pada mahasiswa semester dua dan dokter muda Sarjana Kedokteran Universitas Udayana serta kecenderungan alasan yang mendasarinya. Penelitian ini merupakan penelitian desain potong lintang kualitatif deskriptif. Pengambilan data dilakukan secara daring kepada mahasiswa semester dua dan dokter muda Sarjana Kedokteran Universitas Udayana dengan metode total sampling dan memakai kuesioner oleh Takeda (2013) yang telah diterjemahkan. Sebanyak 213 mahasiswa semester dua dan 228 dokter muda memenuhi kriteria inklusi. Spesialisasi yang paling diminati mahasiswa semester dua adalah spesialis penyakit dalam (21,6%). Bagi dokter muda, spesialisasi terbanyak dipilih adalah spesialis bedah (11%). Dua populasi menyatakan alasan pemilihan spesialisasi adalah minat pada pekerjaan klinis spesialisasinya (74,6% dan 70,9%), ketertarikan pada spesialisasi sebelum masuk sekolah kedokteran (48,7% dan 63,4%), dan nasihat orang tua (50% dan 72,8%). Pada mahasiswa semester dua, alasan lain meliputi ingin memiliki pendapatan tinggi (51,2%) dan pernah bertemu dokter yang dijadikan panutan (26,3%). Pada dokter muda, alasan lain adalah karena mendapat pengajaran yang baik (46,5%) dan ketersediaan lapangan pekerjaan (47,4%). Mahasiswa semester dua memilih spesialis penyakit dalam, sementara dokter muda mayoritas memilih spesialis bedah. Alasan pemilihan spesialisasi terbanyak adalah minat pada karakteristik pekerjaan klinisnya. 
Dexamethasone as Prophylaxis of Postoperative Nausea and Vomiting in Cardiothoracic Surgery: Systematic Review and Meta-Analysis Wibowo, Marcell Dion; Ratumasa, Marilaeta Cindryani Ra; Ningrat, I Ketut Jaya; Adi, Made Septyana Parama; Krisnayana, Anak Agung Gede
Majalah Anestesia & Critical Care Vol 43 No 3 (2025): Oktober
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.v43i3.450

Abstract

Introduction: Postoperative nausea and vomiting (PONV) remain common and distressing complications following surgery, particularly after high-risk procedures such as cardiothoracic surgeries. Dexamethasone, a corticosteroid with anti-inflammatory and antiemetic effects, has been widely investigated for its role in PONV prevention. This study aimed to evaluate the efficacy of dexamethasone in reducing the incidence of PONV among patients undergoing cardiothoracic surgery through a systematic review and meta-analysis. Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Randomized Controlled Trials (RCTs) comparing dexamethasone with placebo or no intervention in cardiothoracic surgery were included. The primary outcome was the incidence of PONV within 24 hours postoperatively; secondary outcomes included the need for rescue antiemetics and the occurrence of adverse effects such as hyperglycemia or infection. Statistical analysis was conducted using Review Manager 5.4, with heterogeneity assessed by the I² and Q/df tests. Results: Four RCTs published between 2018 and 2023 were included, showing low risk of bias and symmetrical funnel plots. The pooled analysis demonstrated a statistically significant reduction in PONV with dexamethasone (OR = 0.57, 95% CI = 0.41–0.80, p = 0.001, I² = 9%, Q/df = 0.98). Conclusion: Dexamethasone significantly reduces the incidence of PONV in patients undergoing cardiothoracic surgery with consistent findings across studies. Further large-scale RCTs are needed to confirm long-term safety and optimize clinical protocols.
Combined Lumbar Plexus and Sciatic Nerve Blocks Improve Postoperative Recovery in Lower Extremity Surgery: A Randomized Controlled Trial Wiranata, Jeremia Alvian; Aribawa, I Gusti Ngurah Mahaalit; Parami, Pontisomaya; Senapathi, Tjokorda Gde Agung; Hartawan, I Gusti Agung Gede Utara; Adi, Made Septyana Parama; Kurniajaya, I Gusti Agung Made Wibisana; Pradhana, Adinda Putra
Journal of Anaesthesia and Pain Vol. 7 No. 1 (2026): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Patients undergoing lower extremity orthopedic surgery often experience moderate to severe postoperative pain, commonly managed with opioids. Regional anesthesia techniques, such as peripheral nerve blocks, offer promising alternatives. This study evaluates the efficacy of combined lumbar plexus block (LPB) and sciatic nerve block (SNB) versus intravenous opioid analgesia in enhancing postoperative recovery and pain control. Methods: In a single-blind, randomized controlled trial, 42 patients scheduled for lower extremity orthopedic surgery under spinal anesthesia were allocated to two groups. Group P1 received postoperative LPB and SNB using 20 mL of 0.25% bupivacaine, while group P2 received intravenous opioids. Outcomes at 24 hours included quality of recovery (QoR-40) scores, total morphine consumption, duration of analgesia, and monitored adverse events. Result: Group P1 showed significantly better recovery scores [QoR-40: 183 (178–188) vs. 152 (136–161.5), p < 0.001], reduced morphine consumption [4 (4–6.5) mg vs. 18 (16–22) mg, p < 0.001], and longer analgesia duration [480 (340–600) min vs. 75 (60–110) min, p < 0.001]. No adverse events were observed. Conclusion: Combined LPB and SNB significantly improve postoperative recovery quality and analgesia in patients undergoing lower extremity orthopedic surgery, reducing opioid requirements and extending pain-free duration compared to intravenous opioids.
Peritonsillar Block as a Treatment for Post-Tonsillectomy Pain in Pediatric Patients with a History of OSA Merry, Merry; Adi, Made Septyana Parama
Jurnal Anestesi Perioperatif Vol 13, No 3 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v13n3.4159

Abstract

Background: Postoperative pain remains one of the most common and distressing complaints following tonsillectomy in children. Among the various strategies explored, regional anesthesia techniques have gained attention for their ability to provide targeted analgesia with minimal systemic side effects. Our objective is to evaluate the effectiveness of ropivacaine and dexamethasone in controlling postoperative pain in children undergoing tonsillectomy, with a focus on its potential to improve recovery outcomes and patient satisfaction.Case: This case involved an 8-year-old male patient who exhibited classic symptoms of OSA, who underwent tonsillectomy procedure. In the anesthetic management, the patient received premedication with midazolam, ondansetron, and intravenous paracetamol. Induction was achieved using propofol, fentanyl, and atracurium, while anesthesia maintenance was provided with Sevoflurane. Prior to extubation, bilateral injections of ropivacaine and dexamethasone were administered in the peritonsillar fossae. Postoperative pain assessments indicated mild pain, with no occurrence of nausea or vomiting. The patient was discharged one day after surgery with manageable pain.Discussion: This case highlights the potential benefit of pre-extubation peritonsillar infiltration with 0.2% ropivacaine (3 mL) and dexamethasone for postoperative pain control. This multimodal, opioid-sparing approach may reduce central sensitization, minimize opioid-related adverse effects, and improve postoperative recovery. Although recent evidence suggests ropivacaine provides superior analgesia at 24 hours compared with bupivacaine, variability in pain timing underscores the need for further research on optimal administration strategies.Conclusion: This case highlights the effectiveness of ropivacaine and dexamethasone in controlling postoperative pain in children.
Co-Authors Adinda Putra Pradhana I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit Aribawa Krisnayana, Anak Agung Gede Kurniajaya, I Gusti Agung Made Wibisana Merry Merry Ningrat, I Ketut Jaya Pontisomaya Parami Pranata, I Made Harry Prastiti, Ni Ketut Devi Widhi Putu Kurniyanta Putu Pramana Suarjaya Ratumasa, Marilaeta Cindryani Ra Tjokorda Gde Agung Senapathi Wibowo, Marcell Dion Wiranata, Jeremia Alvian