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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Anestesi Obstetri Indonesia Jurnal Komplikasi Anestesi
Hartono, Pinter
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Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Manajemen Anestesi Seksio Sesarea pada Ibu Hamil dengan Acute Fatty Liver of Pregnancy (AFLP) Hartono, Pinter; Rahardjo, Sri
Jurnal Anestesi Obstetri Indonesia Vol 6 No 3 (2023): November
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v6i3.134

Abstract

Acute fatty liver of pregnancy (AFLP) merupakan kegawatan obstetrik yang fatal akibat kegagalan hati yang ditandai dengan akumulasi lemak mikrovaskuler dalam hepatosit. Diagonis ditegakkan berdasarkan kriteria Swansea. Gejala umum yang terjadi pada AFLP berupa disfungsi hati yang berat dan cepat, disseminnated intravascular coagulopathy, hipoglikemia dan ensefalopati. Wanita 24 tahun, G1P0A0 31 minggu dengan AFLP dan hipoglikemia. Gejala muntah muntah empat hari, penurunan kesadaran tiga hari. Klinis apatis, sklera ikterik, dan anemia. Hasil laboratorium menunjukkan fungsi hati abnormal dan kadar glukosa darah rendah. Pemeriksaan ultrasonografi dan kardiotokografi menunjukkan stres janin. Pasien ASA III menjalani operasi seksio mendesak di bawah anestesi umum. Penatalaksanaan AFLP bersifat suportif. Pemilihan teknik anestesi perlu dipertimbangkan ada tidaknya koagulopati serta komplikasi lainya. Pada pasien ini dipilih menggunakan general anesthesia karena terdapat koagulopati dan penurunan kesadaran. Pascaoperasi pasien dirawat di ICU dilakukan terapi suportif berupa norepinefrin, dextrose, fresh frozen plasma/FFP, Continous Renal Replacement Therapy/CRRT, lactulosa, vitamin K, albumin untuk komplikasi yang terjadi. Pasien meninggal di hari perawatan ke-7. Kegagalan hati pada AFLP dan pengobatan yang didapat pasien dapat menyebabkan terjadinya komplikasi metabolik. Pada pasien ditemukan asidosis metabolik, peningkatan laktat dan hipoglikemia refracter. Terapi pengganti ginjal (renal replacement therapy /RRT) mungkin diperlukan, pada pasien ini telah dikerjakan CRRT, namun hasil yang didapat tidak begitu memuaskan.
Resusitasi pada Pasien Intoksikasi Methanol Jufan, Akhmad Yun; Adiyanto, Bowo; Hartono, Pinter
Jurnal Komplikasi Anestesi Vol 3 No 3 (2016): Volume 3 Number 3 (2016)
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.v3i3.7262

Abstract

Laki laki 24 tahun, pasien dengan rujukan keracunan alkohol. Pasien riwayat mengkonsumsi alcohol 1 hari yang lalu. 8 jam setelah konsumsi alkohol campuran pasien mengeluh kepala pusing dan pandangan menjadi kabur. Pasien mengalami muntah dan penurunan kesadaran, tekanan darah turun, sesak nafas, asidosis metabolik serta gagal ginjal. Pertolongan yang dilakukan intubasi, ventilasi mekanik, obat inotropik serta koreksi asidosis dengan bicarbonat, selanjutnya dilakukan hemodialisa di ICU. Pasien tidak mendapatkan penghambat metabolik untuk toksin methanol.
Perioperatif Morbid Obese dengan OHS yang Menjalani Laparoskopi Bariatrik Saputra, Dya Restu; Prasamya, Erlangga; Hartono, Pinter
Jurnal Komplikasi Anestesi Vol 11 No 3 (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.v11i3.15135

Abstract

Introduction: Laparoscopy, a minimally invasive surgical procedure that uses CO2 gas to create space between the abdominal wall and internal organs for endoscopic access. The main challenges include cardiopulmonary effects from pneumoperitoneum, systemic absorption of CO2, gas embolism, and injuries to intra-abdominal structures. General anesthesia is often the preferred choice, especially in high-risk cases like obesity, to avoid complications like reflux and aspiration. The author intends to discuss with the aim of understanding physiological changes, complications, and specific management strategies for laparoscopic bariatric surgery. Case Description: A 30-year-old woman with significant weight gain underwent treatment for obesity but made no progress. She was referred for surgery and underwent a specific procedure called sleeve gastrectomy on October 5, 2022. Medical history included controlled hypertension and diabetes, and emerging symptoms were uncontrolled appetite, fatigue, and shortness of breath. The operation was performed under general anesthesia, and her care included detailed monitoring and prevention of complications. This case highlights a comprehensive approach to treating morbid obesity. Discussion: Obesity is often associated with hypertension and changes in heart response. In the context of bariatric laparoscopy, physiological changes associated with pneumoperitoneum and patient positioning may cause cardiorespiratory compromise, especially in obese patients who already have pre-existing cardiopulmonary dysfunction. The balanced general anesthesia technique with mechanical ventilation is considered the best for minimally invasive surgery requiring CO2 insufflation. A multimodal approach in analgesia and antiemetic prophylaxis is needed to reduce postoperative side effects, and early diagnosis of complications. Conclusion: Minimally invasive surgery, such as bariatric laparoscopy, aids in pain reduction and faster recovery, especially important for patients with obesity. The balanced general anesthesia technique with mechanical ventilation is considered optimal for this procedure. Proper monitoring and maintenance after surgery are key to preventing postoperative complications and side effects.
Left Ventricular Ejection Fraction (LVEF) dan Klasifikasi New York Heart Association (NYHA) sebagai Prediktor Mortalitas Pascaanestesi untuk Persalinan dengan Penyakit Jantung Hartono, Pinter; Yusmein Uyun; Ratih Kumala Fajar Apsari; Rahma, Aulia Zuhria
Jurnal Anestesi Obstetri Indonesia Vol 8 No 1 (2025): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v8i1.201

Abstract

Latar Belakang: Klasifikasi New York Heart Association (NYHA) mengkategorikan pasien berdasarkan tingkat keparahan gejala jantung. Fraksi ejeksi ventrikel kiri Left Ventricular Ejection Fraction (LVEF) juga penting, sebagai prediktor luaran bagi wanita hamil dengan penyakit jantung. Hingga kini, penelitian mengenai hubungan antara LVEF, klasifikasi NYHA, dan luaran anestesi obstetri masih terbatas, terutama di negara berkembang. Tujuan: Menilai apakah LVEF dan klasifikasi NYHA dapat memprediksi mortalitas pasca analgesia dan anestesi pada ibu hamil dengan penyakit jantung.Subjek dan Metode: Studi kohort retrospektif dari data sekunder pasien hamil, penyakit jantung tahun 2019–2022 menggunakan analisis deskriptif dan bivariat untuk mengetahui hubungan variabel bebas dengan luaran mortalitas.Hasil: Pemeriksaan rekam medis antara tahun 2019–2022 terhadap 74 subjek menunjukkan rerata usia 29,3 tahun. Terdapat 6 subjek meninggal. Hubungan signifikan antara klasifikasi NYHA dan mortalitas pasca analgesia atau anestesi (p=0,045), terutama NYHA Kelas IV (p=0,031; OR 16,5; CI95% 1,82 – 149,591). LVEF abnormal (p=0,031; OR 9,167; CI 95% 1,012 – 83,051) juga menunjukkan hubungan positif dengan mortalitas pasca analgesia atau anestesi dibandingkan dengan LVEF normal (LVEF 50–70%). Simpulan: Klasifikasi NYHA dan LVEF dapat memprediksi bermakna mortalitas pasca analgesia atau pasca anestesi pada persalinan ibu hamil dengan penyakit jantung
Developing an Effective Team-Based Emergency Training Program for Medical Students Hartono, Pinter; Adiyanto, Bowo; Nur, Rifdhani Fakhrudin; Ancilla, Cornelia; Rahma, Aulia Zuhria
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 1 (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.V6I12024.1-13

Abstract

Introduction: Team-based patient management in critical care demands a knowledgeable, skillful, and responsive doctor who collaborates well on teams. Medical education is responsible for producing competent graduates who meet the above requirements. However, the current medical curriculum in Indonesia tends to focus only on individual knowledge and appraisal. There was no standardized university-based group emergency training and examination with comprehensive emergency topics beyond cardiac and trauma cases. Objective: This study aimed to develop and evaluate a team-based emergency training program that enhances medical students' preparedness and teamwork skills in dealing with future emergencies in the workplace. Methods: We developed Acute Life Threatening Events Management (ALTEM), a three-day emergency training program consisting of pre-test, lectures, guided skill practice, group (case-based) simulation exam, and post-test. Group simulation occurred in a virtual hospital with high-fidelity mannequins, actual medical equipment (i.e., beds, monitors, drugs, tools, pads), two-way mirror rooms, and simulated patient family to resemble real hospital situations. The program was then evaluated by a modified Kirkpatrick evaluation model, which measures individual perception, satisfaction, understanding, and performance related to the program. Results: A total of 114 participants were involved in this study. Most subjects (>80%) had a good experience with the program. ALTEM training program significantly increased communication and teamwork (p <0.001) and decision-making towards critical patients (p <0.001) in the univariate analysis. Communication and teamwork remained related considerably in the multivariate analysis (aOR 7.866; p = 0.005). Conclusion: The ALTEM simulation program obtained a good response from the subjects and was a prospective program to improve medical students' competence and teamwork skills in emergencies.
Co-Authors Akhmad Yun Jufan Ancilla, Cornelia Bowo Adiyanto Nur, Rifdhani Fakhrudin Prasamya, Erlangga Rahma, Aulia Zuhria Ratih Kumala Fajar Apsari Saputra, Dya Restu Sri Rahardjo Yusmein Uyun