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Kuntoadi, Danang
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Anestesi Epidural pada Pasien dengan Sindrom Eisenmenger yang Menjalani Seksio Sesarea Ramadhani, Tito Ramadhani; Purwoko, Purwoko; Kuntoadi, Danang
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.v6i3.144

Abstract

Perubahan pada sistem kardiovaskuler yang terjadi selama kehamilan yaitu peningkatan volume intravaskuler dan perubahan hematologi, peningkatan cardiac output, penurunan resistensi vaskuler, dan adanya supine hypotension syndrome (SHS) akibat aortocaval syndrome. Sindrom Eisenmenger merupakan kondisi patofisiologik kompleks yang meliputi: sianosis klinis, shunting pada ruang jantung (atrial septal defect/ASD, ventricular septal defect/VSD atau aorticopulmonalanomaly) dan hipertensi pulmonal akibat elevasi irreversibel dari PVR. Peningkatan progresif dalam volume plasma menambah beban ventrikel kanan sehingga mempresipitasi terjadinya gagal jantung kanan, asidosis dan hiperkarbia yang dapat meningkatkan PVR. Peningkatan cardiac output dan aliran darah pulmonal akibat kehamilan menyebabkan hipertensi pulmonal memberat. Kebutuhan oksigen pada kehamilan meningkat, hal ini dapat mengancam terjadinya hipoksemia yang berefek pada maternal dan fetal. Manajemen anestesi pada Sindrom Eisenmenger seringkali menemui kesulitan. Salah satu aspek penting adalah menjaga keseimbangan antara tekanan systemic vascular resistance (SVR) dan PVR dan menghindari perubahan hemodinamik yang dapat memperburuk hipoksemia melalui peningkatan shunt kanan ke kiri. Anestesia umum dapat mengeksaserbasi shunt kanan ke kiri dan memperburuk sianosis melalui beberapa mekanisme. Anestesia regional dan epidural direkomendasikan penggunaannya pada Sindrom Eisenmenger. Perubahan hemodinamik dan respirasi biasanya minimal dengan anestesia epidural yang dimanajemen dengan baik. Tujuan monitoring perioperatif, intraoperatif dan postoperatif adalah untuk mendeteksi secara dini perubahan mendadak pada hemodinamik sehingga dapat diberikan penanganan segera untuk mencegah komplikasi pada Sindrom Eisenmenger
Adductor Canal Block (ACB) as an Adequate Analgesia Post Anterior Cruciate Ligament Repair Utama, Sigit Prasetya; Kuntoadi, Danang; Yuliana, Friskha
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.61865

Abstract

Background: Anterior cruriate ligament (ACL) injury is one of the most common cases in knee injury. Inadequate pain management will cause a decrease in quality of life, daily living abilities, increase hospitalization costs, and progressively causing chronic pain. Selection of inappropriate peripheral nerve block (PNB) can reduce range of movement ROM. Abductor canal block (ACB) is expected to facilitate adequate analgetic, improve early mobilization and ambulation, reduce the risk of post operative nausea vomiting (PONV), and needs for other analgeticsCase: A 21-year-old male patient with a diagnosis of ACL rupture knee (S) who will be performed anterior cruriate ligament recontruction (ACLR) procedure with physical status ASA II, premedication ondancentron 4 mg and dexamethasone 5 mg intravenously. Regional anesthesia subarachnoid block, at L3-L4 interspatium with bupivacaine hyperbaric 0.5% 15 mg and fentanyl 25 mcg as the adjuvant for subarachnoid block. Adductor canal block using ultrasound guide using 20 ml levo bupivacaine 0.25%. The outcome assessed using nurmmeric rating score (NRS), PONV, rescue analgetics, and ambulation score which includes: time up to go (TUG) with partial weight bearing, s-CST, 5xSST, 6 WMT straight leg raising (SLR) assessed at more than 48 hours.Discussion: PNB is proven to be reliable and effective for postoperative pain control, ambulation, rehabilitation and mobilization are also faster, adequate pain control will facilitate early mobilization and prevent side effects related to prolonged immobilization. Adductor canal block is a good modality as an adequate analgetic, the use of ACB can reduce use of rescue analgetic, reduce the incidence of PONV and support early mobilization.Conclusion: ACB in ACLR can facilitate adequate analgesia, does not require other rescue analgetics, reduce the incidence of PONV, and improve the ambulation as well as avoid other complications.
Fascia Iliaca Compartment Block as Pain Management for Postoperative Femur Fracture in the Elderly: A Case Report Utama, Sigit Prasetya; Yuliana, Friskha; Kuntoadi, Danang
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.66116

Abstract

Background: Femur fractures are most common in geriatric patients, necessitating careful consideration of perioperative medications. Effective pain management is crucial to minimize neurohormonal stress responses. Reducing opioid use in older patients can prevent side effects and complications. The fascia iliaca compartment block (FICB) is a safe and efficient nerve block method, known to decrease opioid needs in hip surgery. It is anticipated to enhance mobilization speed and ambulation and reduce postoperative nausea, vomiting, deep vein thrombosis, and pneumonia, thereby improving overall outcomes for geriatric patients undergoing hip surgery.Case: A 71-year-old female with a closed right intertrochanteric femur fracture underwent open reduction and internal fixation with a proximal femoral nail antirotation. Classified as ASA II, geriatric, with stage I hypertension, her preoperative vital signs included a blood pressure of 170/95 mmHg, heart rate of 65 beats per minute, respiration rate of 20 times per minute, and SpO2 of 98% with nasal cannula oxygen at 3 lpm. Spinal anesthesia was administered at L3-L4, and an FICB was performed postoperatively. Pain assessment, rescue analgesic use, and postoperative nausea were evaluated post-surgery, with monitoring at 6, 24, and 48 hours.Discussion: Pain management with regional FICB anesthesia can simultaneously block the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. Thus, minimizing systemic symptoms compared to analgesics administered intravenously. In this case, the administration of 30 cc of levobupivacaine via a FICB provided effective analgesia for up to 72 hours post-blockade in a geriatric patient without causing side effects, such as postoperative nausea.Conclusion: Postoperative FICB for hip surgery in geriatric patients provides effective analgesia with minimal side effects.
Co-Authors Purwoko Purwoko Ramadhani, Tito Ramadhani Utama, Sigit Prasetya Yuliana, Friskha