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All Journal SAINS MEDIKA : JURNAL KEDOKTERAN DAN KESEHATAN Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Indonesian Journal of Anesthesiology and Reanimation (IJAR) Journal of Anaesthesia and Pain Jurnal Kesehatan Tambusai Solo Journal of Anesthesi, Pain and Critical Care Ahmad Dahlan Medical Journal The International Journal of Medical Science and Health Research Jurnal Komplikasi Anestesi
Akhmad Yun Jufan
Department Of Anesthesiology And Intensive Therapy, Faculty Of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Veterinary

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Perioperatif Operasi Mata pada Pediatrik Jufan, Akhmad Yun; Sari, Djayanti; Wibowo, Adi
Jurnal Komplikasi Anestesi Vol 4 No 3 (2017): Volume 4 Number 3 (2017)
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.v4i3.7307

Abstract

Pada mayoritas kasus anak - anak membutuhkan anestesi umum untuk prosedur mata dan operasi. Tehnik anestesi yaitu mencegah dan menjaga terjadinya peningkatan tekanan intra okuler bola mata, yaitu dengan smoth induction dan smoth intubation, alternatif lain adalah dengan menggunakan Laringeal Mask Airway (LMA) untuk prosedur yang sederhana. Oculocardiac refleks dapat terangsang selama operasi mata dan risiko menyebabkan efek berbahaya bradycardi, yang dapat dicegah dengan premedikasi dengan agen antikolinergik. Mual pasca operasi dan muntah sering terjadi setelah operasi mata pada anak-anak dan mungkin pemberian profilaksis antiemetik. Pada kasus operasi tertentu mungkin sangat nyeri seperti evisceration, enucleation dan operasi vitroretinal pertimbangan pemberian analgetik dengan opioid seperti fentanyl dapat dipertimbangkan.
Falls Protocol Wibowo, Catur Prasetyo; Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno
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.v5i2.7334

Abstract

Fluid therapy in the emergency case, especially shock is usefull for the patient, but it can be detrimental if we give it too much. There is so many type of shock, and fluid therapy is not the answer for all type of shock. FALLS-protocol (Fluid Administration Limited by Lung Sonography) was designed so that there is guidance for fluid therapy on shock patient. FALLS-protocol follows weil’s classification of shock. It uses simple equipment (ultrasonography) and microconvex probe that can be used to assess heart, lung, and vascular. Right now, the ultrasonography is so well known in the emergency setting.
Validasi European System for Cardiac Operative Risk Evaluation (Euroscore) II sebagai Prediktor Lama Perawatan Intensive Care Unit (ICU) pada Pasien Operasi Bedah Jantung (Kelainan Katup dan Kongenital) di RSUP Dr. Sardjito Febrianti, Skolastika Rani; Widyastuti, Yunita; Jufan, Akhmad Yun
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.v5i3.7336

Abstract

Background. Development quality of care, health care resources, and methods to assess the risk of cardiacsurgery are increasing in this era. Cardiac surgery is high risk procedure and require post-operative intensive care. Our objectives were to validating EuroSCORE II as ICU length of stay predictor for post cardiac surgery patient (valvular and congenital heart disease) in Dr. Sardjito General Hospital.Methods. A cohort retrospective study was conducted. Data were collected from the medical records of postoperative cardiac surgery patients in 2006-2016 at Dr. Sardjito General Hospital. EuroSCORE II values were obtained from all subjects. EuroSCORE II model was used to predict prolonged care in the ICU for >48 hours. Discriminative ability was analyzed using receiver operating characteristic (ROC) curve. Calibration were assessed with areas under the receiver operating characteristic curve (AUC) and the Hosmer– emeshow test.Results. In this study the data were obtained from 92 patients post-cardiac surgery in 2006-2016 at Dr. Sardjito General Hospital. Fifteen patients (16.3%) have prolonged ICU stay>48 hours. In this research, the predictive value is underestimate than actual value. EuroSCORE II showed good discrimination ability to predict prolonged ICU stay (AUC=0.711). However, EuroSCORE II showed poor calibration in predicting prolonged ICU stay (Hosmer-Lemeshow: p<0.05).Conclusion. EuroSCORE II showed good discrimination but poor calibration ability. EuroSCORE II can differentiate the outcome of ICU stay between ≤48 hours and >48 hours groups, but it cannot be used for patient risk stratification of prolonged ICU stay.
Manajemen Perioperatif Seksio Sesarea Pasien G2P1A0 Hamil 38 Minggu dengan Plasenta Akreta dan Plasenta Previa Totalis Fajar A, Ratih Kumala; Jufan, Akhmad Yun; Kuncoro, Kusuma Edhi
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.v6i3.7359

Abstract

Placenta accreta is becoming more common and is the most frequent indication for peripartum hysterectomy. Management of cesarean delivery in the setting of a morbidly adherent placenta has potential for massive hemorrhage, coagulopathies, and other morbidities. Anesthetic management of placenta accreta presents many challenges including optimizing surgical conditions, providing a safe maternal delivery, preparing for massive hemorrhage and transfusion, preventing coagulopathies, and optimizing postoperative pain control. Balancing these challenging goals requires meticulous preparation with a thorough preoperative evaluation of the parturient and a well-coordinated multidisciplinary approach in order to optimize outcomes for the mother and fetus.
Manajemen Diabetes Insipidus pada Pasien Meningioma Pascakraniotomi Pengangkatan Tumor di Ruang Rawat Intensif Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun; Yuliani, Irma
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.v6i3.7362

Abstract

Surgery in the hypothalamic area is often accompanied by disturbances of water, electrolytes, and osmoregulation due to manipulation and vascular changes of the neurohypophysis. Over the last few decades, surgical approaches to craniopharyngioma have been developed. Initially, tumor resection was the treatment of choice but now evolved to minimally invasive surgery such as transphenoidal surgery. We reported a 58 years old female patient with suprasellar meningioma underwent removal tumor craniotomy. Patient was ASA 2 physical status with controlled Diabetes Mellitus type 2 non-obese. The operation was smooth and hemodynamically stable during surgery. Patient underwent post-surgery treatment in the ICU.During monitoring in the ICU, urin output of the patient was more than >2 cc/kgBB/hour. From the resultsof investigations, patient was diagnosed with Diabetes Insipidus. During the 6 days of ICU care, periodicexamination of serum and urin electrolytes and periodic fluid balances for monitoring, as well as the use ofvasopressin as a management of Diabetes Insipidus were conducted periodically. The patient improved after treatment for 6 days in the ICU, with urin output and electrolytes returning to normal without vasopressin.
Penatalaksanaan Intensif Badai Thyroid pada Wanita Hamil Jufan, Akhmad Yun; Apsari, Ratih Kumala Fajar; Apriyanto
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (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.v7i1.7381

Abstract

Anesthesia management was conducted in a case of female 33 years old with G4P2A1, 35 weeks of pregnancy, type I respiratory failure, suggestive Thyroid Storm, CAP, anemia, and hypoalbuminemia. In emergency admission, patient was found dyspneic, agitated, measured BP is 117/60 mmHg, HR 153 x/min, RR 35 x/min, temperature 37,8oC, no wheezing or rales in physical examination. From ECG evaluation was STC 148 x/min, AF RVR. According to Burch and Wartofsky scoring, obtained score is 60, from temperature (score 5), tachycardia ≥140 (score 25), AF (score 10), agitated (score 10), and pregnancy as a precipitating factor (score10). Thyroid crisis can be diagnosed if scoring more than 45 points. The patient was intubated, and connected to mechanical ventilation, and admitted to HCU. In HCU, the patient was given supportive therapy, invasive monitoring such as CVC and parenteral nutrition. Causative therapy such as antibiotic administration, lugol, PTU, corticosteroid and propanolol were also given. During HCU admission, patient’s condition had not improved because of gravis anemia, after 3 days in HCU, patient was moved to ICU admission for 5 days, in 4th day of ICU admission, pregnancy was terminated, and in 5th day, patient was moved to maternal ward.
Hubungan Antara Mikroalbuminuria dan Skor SOFA pada Pasien Sepsis yang Dirawat di ICU RSUP Dr Sardjito Sulistiyantoro, Antonius Catur; Widodo, Untung; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (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.v7i1.7382

Abstract

Background: Sepsis causes release of inflammatory mediator to circulation. The inflammatory molecules and oxidative stress increase the capilar permeability include the glomerular renalis. An early event is the loss of barrier integrity leading to systemic capillary leakage. The glomerular manifestation of this increased permeability is increased excretion of albumin in the urine. Microalbuminuria, defined as 30–300 mg/day of albumin excretion in the urine, occurs rapidly after an acute inflammatory insult such as sepsis. SOFA scoreis one of parameter to asses the degree of organ dysfunction severity.Purpose: The purpose of this study was to determine the correlation between microalbuminuria and SOFA score in patient with sepsis in ICU Dr. Sardjito Government General Hospital.Methods: This observational study was conducted in ICU Dr. Sardjito Government General Hospital between January-July 2019. Inclusion criteria were all patients with sepsis admited to ICU (≥18 years old), exclusion criteria were patient with diabetic mellitus, anuria, chronic kidney disease, pregnant, urological trauma, nephrotic syndrome, urinary tract infection. urine samples were collected per 24 hour (Day-1st), 48 hour (Day-2nd) and 72 hour (Day-3st). The microalbuminuria was measured in hospital laboratory. The SOFA score evaluated every day. The correlation between SOFA score with microalbuminuria was analyzed with SPSS.Result: Total 35 subject included, 20 subject excluded, 1 subject dropout. The study included 57,1% male and 42,9% female, mean of SOFA score were 9,4 ± 3,4, mean of microalbuminuria were 132 ± 75,2 mg/l. Subject with septic shock were 42,9% and all of subject required mechanical ventilation. Mortality rate were 50%, the major infection sourced was respiratory tract (42,9%), and the major bacteria was Acinebacter baumanii. The mean of SOFA score in survivor subject were 6,43 ± 2,80 and not survivor were 10,34 ± 3,00, the microalbuminuria in survivor subject were 82,10 ± 70,73 mg/l and not survivor were 167,71 ± 46,81 mg/l. There was positive correlation between microalbuminuria and SOFA score with strength correlation r: 0,627, p: 0,016. SOFA score >7 had risk 16 times to die, and microalbuminuria >156,35 had prognostic risk 36 times to die.Conclusion: There was positive correlation between microalbuminuria level and SOFA score in septic patients in ICU Dr. Sardjito Government General Hospital.
Hubungan Antara Neutrophyl-Lymphocyte Ratio dan Kadar Prokalsitonin Plasma pada Pasien Sepsis yang Dirawat di Ruang Intensif RSUP Dr Sardjito Wibowo, Erry Alamsyah Asjhuri; Kurniawaty, Juni; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
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.v7i2.7446

Abstract

Background: The immune response of leukocytes to physiological stresses such as tissue damage, severe trauma, major surgery and sepsis is characterized by increased neutrophil levels and decreased lymphocyte levels. In pathological conditions due to severe infection or systemic inflammation, the NLR will increase, so that NLR can be used for clinical evaluation in patients with systemic inflammation. This study aims to determine whether there is a correlation between alteration of Neutrophyl-lymphocyte ratio and plasma procalcitonin as a parameter of infection severity in sepsis patients treated in intensive care RSUP Dr Sardjito. Methods: Prospective observational correlation study. The study was conducted in Intensive care RSUP Dr. Sardjito Yogyakarta for 5 months (starting June 2019). Subject: 29 patients of sepsis admitted to intensive care RSUP dr. Sardjito on June-October 2019. Results: Positive correlations between Neutrophil-lymphocyte ratio and plasma procalcitonin on day 0, day 1 and day 3 of observations, r=0,220 (very weak), r=0,389 (moderate), and 0,065 (very weak). Positive significant correlation was found on day 1 of observation. Meanwhile, on analysis between Neutrophillymphocyte ratio and plasma procalcitonin, Positive correlations were obtained on day 0-1, day 1-3 and day 0-3 of observations, r = 0.159 (very weak), r = 0,450 (moderate) and 0,235 (very weak). The significant positive correlation (p<0.05) was found in alterations between day 1-3. Conclusion: There were no strong correlations between Neutrophyl-lymphocyte ratio and plasma procalcitonin in sepsis patients treated at ICU RSUP Dr Sardjito on day 1 of observation.><0.05) was found in alterations between day 1-3. Conclusion: There were no strong correlations between Neutrophyl-lymphocyte ratio and plasma procalcitonin in sepsis patients treated at ICU RSUP Dr Sardjito on day 1 of observation.
Hubungan Nilai “Lung Ultrasound Score (LUS)” dengan P/F Ratio pada Pasien Pneumonia yang Dirawat di ICU RSUP Dr Sardjito Wibowo, Catur Prasetyo; Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
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.v7i2.7448

Abstract

Background: Respiratory tract disease (about 22.4%) is the frequent reason of admitting patients to the Intensive Care Unit (ICU), with 72.6% of it is caused by infection, such as pneumonia. On patient with pneumonia, there will be impairment in oxygen diffusion from alveoli to the blood flow that can affect the P/F ratio. Lung ultrasonography is directly proportional to the degree of pulmonary aeration or the ratio of air to liquid composition in the lung. Changes in pulmonary aeration can be detected accurately using pulmonary ultrasonography. Objectives: Knowing the relationship of “Lung Ultrasound Score (LUS)” with P/F ratio as a parameter to assess the degree of oxygenation in pneumonia patients treated at ICU Dr. Sardjito General Hospital. Methods: The design of this study was cross sectional study. In this study, every single sample will be examined only one time to obtain Lung Ultrasound Score (LUS) and arterial blood gas analysis (BGA) sampling to get the P/F ratio. LUS measurement was done by performing pulmonary ultrasonography at 12 predetermined examination points (6 in the left hemithorax and 6 in the right hemithorax) then scoring (0-3) per examination point, the total scoring from the 12 examination points is the result of the LUS sample. Inclusion criteria in the subjects of this study were >18 years of age, diagnosed pneumonia (score ≥6 from CPIS score), intubated with mechanical ventilation, and the candidate could be mobilized slightly right and left incline. While exclusion criteria were, patients with unstable hemodynamics (HR <60x / min or>130x / min and MAP <70mmHg or>120mmHg), pulmonary trauma, patients undergoing hemodialysis, there are contraindications to the oblique position (spinal cord injury), patients with wound dressing on the chest, and patients with morbid obese (BMI> 40). Results: There were 60 subjects in this study. Patient observation pointed that have high P/F ratio values tend to have lower Lung Ultrasound Score (LUS) values. Based on the correlation results, the value of p = 0.010 (p <0.05) with the correlation coefficient (r) = -0.332 had a negative sign which means there is a significant negative correlation between the value of Lung Ultrasound Score (LUS) with the P / F ratio with the closer relationship of the category weak (0.2 - 0.399). Conclusion: The higher the P/F ratio, the lower the LUS value in patients with pneumonia who were getting mechanical ventilation in ICU Dr. Sardjito.
Perbandingan Antara Nilai Indeks Variasi Gelombang Plethysmography dengan Nilai Variasi Tekanan Pulsasi Arteri pada Pasien dengan Ventilasi Tekanan Positif di ICU RSUP Dr. Sardjito Bhaktiyar, Agung; Widodo, Untung; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 3 (2020): Volume 7 Number 3 (2020)
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.v7i3.7470

Abstract

Background: Pulse pressure variations (PPV) provide a good assessment of fluid status but require the installation of arterial line with high cost, difficult installation, and the risk of complications in the form of tissue death as well as infection. Meanwhile, the plethysmography variation index which has similarities to the pulse pressure variation that arises due to arteriolar pulses and is influenced by the breathing cycle, but is non-invasive, easy to apply, cheaper material, and without the risk of tissue death or infection. Methods: This study uses a prospective observational study design. We measured pulse pressure variation and plethysmography variability index (PVi) in 22 patients mechanically ventilated with preexisting radial artery catheter in intensive care unit (ICU). PPV was obtained by installing radial arterial line connected to Mostcare®. PVi was obtained by installing an oximetry probe on fourth finger and connected to the Masimo® monitor. We compared PPV and PVi using Mann-whitney test and looked for correlations with the spearman coefficient. Result: Twenty-two patients (SAPS II = 1.74 (0.4-75) had PPV values of 11.7 (7.03) and PVi 13.29 (7.76) different but were not statistically significant p = 0.405 (p> 0.05). There was a moderate correlation between PPV and PVi (r = 0.55). Four of the 22 patients receiving noreepinephiren (dose = 0.125 mcg / kg / min (0.1- 0.15)) showed no correlation between PPV and PVi (r = 0.40 p = 0.60). Conclusion: There was no significant difference between the value of the pulse pressure variation and the plethysmography variability index (PVi). There was a moderate correlation between the pulse pressure variation with the plethysmography variability index. There was no correlation between PVi and PPV in patients receiving norepinephrine.
Co-Authors Adi Wibowo Adiyatma, Krisna Hario Adrin, Olga Elenska Al-Munawar, Nira Muniroh Anwar, Yusuf ‘Alim Musthofa Apriyanto Arifin, Achmad Reza Atmanagara, Dikho Bahrun, Nugraha Septian Bhaktiyar, Agung Bhirowo Yudo Pratomo Bowo Adiyanto Calcarina Fitriani Retno Wisudarti Dewi, Baiq Dessy Resmana Dian Ayu Listiarini Djayanti Sari Fauzi, Rizqi Ahmad Febrianti, Skolastika Rani Firman Ardiansyah FRW, Calcarina Hanafi, Irham Hanafia, Mochamad Fauzi Hartono, Pinter helen yudi irianto Indra Wijaya, Adi Irianto, Helen Yudi Juni Kurniawaty Muhdar Abubakar Djayanti Sari Kuncoro, Kusuma Edhi Kusuma, Danur Adi Kusumawardani, Dwi Indriati Mahardieni, Karlina Maryani, Nova Nova Maryani Pradana, Gilar Rizki Aji Prasamya, Erlangga Pratama, Andhika Marthsyal Ratih Kumala Fajar Apsari Rayhandika Sari, Dhanty Dwita Sarosa, Pandit Sudadi Sulistiyantoro, Antonius Catur Sunantara, I Gusti Ngurah Putu Mandela Teguh Setiadi Trijayanti, Christiana Untung Widodo Untung Widodo Untung Widodo, Untung Utami, Vengky Wibowo, Catur Prasetyo Wibowo, Erry Alamsyah Asjhuri Wijaya, Andryadi Yuliani, Irma Yunita Widyastuti Yusmein Uyun Zulfakhri, Zulfakhri