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All Journal International Journal of Public Health Science (IJPHS) Jurnal Anestesiologi Indonesia Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Majalah Anestesia & Critical Care (MACC)
Ramlan, Andi Ade Wijaya
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Public Health

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Blok Subarahnoid Dosis Rendah dan Epidural pada Pasien Hamil dengan Gagal Jantung dan Komorbid Lain yang Menjalani Seksio Sesarea: Sebuah Laporan Kasus Soenarto, Ratna Farida; Alexandra, Arky Kurniati; Ramlan, Andi Ade Wijaya; Alatas, Anas
Majalah Anestesia & Critical Care Vol 40 No 1 (2022): Februari
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 | Full PDF (634.716 KB) | DOI: 10.55497/majanestcricar.v40i1.238

Abstract

Latar Belakang: Penyakit kardiovaskuler merupakan penyebab signifikan pada mortalitas ibu di negara-negara berkembang. Komorbid yang mempengaruhi ini mencakupi obesitas, hipertensi dan kehamilan tua yang memperberat kinerja jantung sehingga dapat mengakibatkan gagal jantung. Ini menjadi tantangan untuk tatalaksana anestesi dengan tujuan utama mencegah luaran buruk kepada ibu dan neonatusnya. Ilustrasi Kasus: Pada kasus ini kami melaporkan wanita, 28 tahun, G4P3A1 hamil 28 minggu, ASA 3 dengan gagal jantung kongestif, superimposed pereklampsia, serta obesitas morbid. Pasien direncanakan untuk seksio sesarea dengan kombinasi anestesi menggunakan penggunaan blok subarahnoid dosis rendah dan epidural (Combined Spinal Epidural Anesthesia/CSE), serta pertimbangan tatalaksana anestesi pada ibu hamil dengan gagal jantung atau komorbid lainnya. Simpulan: Anestesi dengan blok subarakhnoid dosis rendah memiliki efek yang minimal terhadap hemodinamik, dan dapat digunakan pada selektif pasien yang mengalami gagal jantung dan komorbid lainnya.
Skor Kelelahan pada Peserta Didik Anestesiologi dan Terapi Intensif dan Faktor-Faktor yang Mempengaruhi Heriwardito, Aldy; Sugiarto, Adhrie; Setiadi, Bakti; Dwiputra, Anggara Gilang; Hafidz, Noor; Ramlan, Andi Ade Wijaya
Majalah Anestesia & Critical Care Vol 40 No 1 (2022): Februari
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 | Full PDF (618.993 KB) | DOI: 10.55497/majanestcricar.v40i1.252

Abstract

Latar Belakang: Prevalensi kelelahan secara global bervariasi antara 2,36-75,7%. Kelelahan merupakan konsekuensi yang dapat dialami oleh peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitasi Indonesia (FKUI) selama menjalami proses pendidikan. Penelitian ini dilakukan untuk mengetahui tingkat kelelahan pada PPDS Anestesiologi dan Terapi Intensif FKUI/RSCM setelah bertugas selama 24 jam di RSCM dengan menggunakan penilaian FAS, serta faktor-faktor yang memengaruhinya. Metode: Metode penelitian adalah studi potong lintang dan acak. Analisis dilakukan terhadap 36 subjek peserta PPDS Anestesiologi dan Terapi Intensif FKUI tahap paripurna, mandiri dan magang selama periode penelitian. Subjek diberikan kuesioner berisi pertanyaan mengenai faktor yang dapat memengaruhi tingkat kelelahan. Kelelahan secara subjektif diukur dengan Fatigue Assessment Scale (FAS) setelah peserta PPDS bekerja di Rumah Sakit dr.Cipto Mangunkussumo (RSCM) selama ≥ 24 jam. Hasil: Sebanyak 55,6% peserta PPDS Anestesiologi dan Terapi Intensif mengalami kelelahan seetelah bekerja di RSCM selama > 24 jam, dengan rerata skor kelelahan berdasarkan FAS adalah 23,6±4,2 yang berada diatas titik potong skor kelelahan dari FAS yaitu > 22. Kelelahan fisik memiliki rerata nilai yang lebih besar (15,19±2,7) dibandingkan dengan kelelahan mental (10,61±2,2) dengan perbedaaan yang bermakna (p<0.01). Kelelahan pada peserta PPDS Anestesiologi dan Terapi Intensif FKUI tidak dipengaruhi oleh karakteristik, gaya hidup dan karakteristik pekerjaan. Kesimpulan: PPDS Anestesiologi dan Terapi Intensif mengalami kelelahan fisik pasca bekerja selama >24 jam di RSCM. Kelelahan tersebut tidak dipengaruhi oleh faktor gaya hidup dan pola kerja.
Bleeding Following Pediatric Liver Transplantation: A Brief Overview Gunawan, Ferriansyah; Ramlan, Andi Ade Wijaya
Majalah Anestesia & Critical Care Vol 42 No 2 (2024): Juni
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.v42i2.382

Abstract

End-stage liver disease (ESLD) occasionally needs liver transplantation (LT) as a life-saving treatment. In pediatric population, LT procedure is more complicated than adults, since they are mainly caused by extrahepatic cholestasis, has a variety of age groups, and has various infection susceptibilities. Furthermore, there is a complication related to LT, such as bleeding, which cannot be disregarded because it may aggravate patients’ conditions and necessitate reoperation. Moreover, in the case of hepatic artery thrombosis and portal vein thrombosis, which is caused by severe bleeding, patients and grafts’ survival may be significantly reduced. In this review, we are discussing bleeding following LT phenomena from the basic introduction, pathophysiology, prevention, monitoring, and treatment
Colorado Pediatric Airway Score (COPUR) as a Predictor of Intubation Difficulty in Children Aged 1-8 Years Kapuangan, Christopher; Perdana, Aries; Fadhila, Fulki; Ramlan, Andi Ade Wijaya; Zahra, Raihanita; Ferdiana, Komang Ayu; Rahendra, Rahendra
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): 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.v0i0.70707

Abstract

Background: Airway management is critical in pediatric anesthesia, as failure can lead to severe complications, including cardiac arrest. Anticipating and preparing for difficult intubation is essential, particularly in children with unique anatomical and physiological characteristics. The Colorado Pediatric Airway Score (COPUR) is a predictive tool for assessing intubation difficulty in pediatric patients.Objective: This study evaluates the validity of COPUR in predicting difficult intubation in children.Methods: A cross-sectional diagnostic study was conducted on 121 pediatric patients (aged 1–8 years) undergoing general anesthesia at Cipto Mangunkusumo Hospital. COPUR assesses jaw structure, mouth opening, prior intubation history, uvula visibility, neck movement, and additional modifying factors (macroglossia, obesity, mucopolysaccharidosis, and protruding teeth). A COPUR score >7 was used to predict difficult intubation, while intubation difficulty was defined by an Intubation Difficulty Score (IDS) >5.Results: A COPUR score ≥8 predicted difficult intubation in 15.7% of patients, whereas actual difficult intubation occurred in 9.92%. A COPUR threshold of ≥7 provided optimal sensitivity (83.3%) and specificity (61.47%), outperforming the original cutoff of 8 (50% sensitivity, 87% specificity). The score demonstrated good discriminative ability (AUC-ROC: 0.770, 95% CI: 0.685–0.842) and suitable calibration (Hosmer-Lemeshow test, p = 0.584).Conclusion: The COPUR score is a valid tool for predicting difficult intubation in pediatric patients aged 1–8 years, demonstrating fairly good discrimination and calibration values.
Manajemen Anestesia pada Sindrom Hunter Nindya Auerkari, Aino; Ramlan, Andi Ade Wijaya
Majalah Kedokteran Indonesia Vol 69 No 10 (2019): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, V
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.69.10-2020-182

Abstract

Background: Hunter’s syndrome is characterized by congenital metabolic defect due to lysosomal enzyme deficiency. In this syndrome, glycosaminoglycans, a type of mucopolysaccharide cannot be metabolized, and therefore its deposit accumulates in tissue. This substrate deposits progressively over time and eventually interfere with organ function and causes symptoms. Multiple surgeries would be needed to counter its effect throughout patients’ life. Anesthesiologists are expected to prepare the patient for anesthesia, manage intraoperative, and provide postoperative care. The substrate accumulation on airway presents a special challenge for airway management. We describe a case of difficult airway management in a patient with Hunter’s Syndrome who was under enzyme therapy. The main airway challenge are short neck and limited neck extention. Glycosaminoglycans in joints, spine, and heart also require anesthetist’s attention. Drug metabolism in Hunter Syndrome may be different from normal. As this is a rare disease, patients with Hunter’s syndrome is recommended to undergo anesthesia with experienced anesthesiologist in health care facilities with experience in provide care for Hunter’s syndrome.
Influencing factors of patient safety in anesthesia services in a low- and middle-income country Heriwardito, Aldy; Ramlan, Andi Ade Wijaya; Zahra, Raihanita; Martira, Amelia; Pramodana, Bintang; Bintartho, Agung; Sukmono, Raden Besthadi; Lasanudin, Joshua Eldad Frederich
International Journal of Public Health Science (IJPHS) Vol 14, No 4: December 2025
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v14i4.26631

Abstract

Patient safety in anesthesia remains a concern in low- and middle-income countries due to workforce shortages, limited equipment, and inconsistent protocols. In Jakarta, where demand for anesthesia is rising, baseline data on these parameters are lacking. This study aimed to identify gaps in human resources, equipment availability, and safety protocol adherence. A cross-sectional survey of all actively practicing anesthesiologists in Jakarta was conducted in January 2024, yielding 115 responses. The questionnaire, developed and face-validated through a focus group with senior anesthesiologists, covered three domains: human resources, facilities and equipment, and protocols. Internal reliability was assessed using Cronbach’s alpha. Participation was voluntary, responses were anonymous, and data were analyzed using descriptive statistics. Prolonged work hours were reported by a minority of respondents (6.1-7%), with 22.7% agreeing that anesthesiologists' workload is too high. Most rated human resource parameters positively (median 4/5), but access to basic monitoring devices for oxygenation, ventilation, circulation, and temperature was limited. Protocol adherence was generally high (median 4-5/5), though a small minority of institutions lacked incident reporting pathways, patient risk assessment, and post-surgical recovery rooms. Improving patient safety in Jakarta requires ensuring essential monitoring equipment, optimizing staffing to manage workload, and mandating full perioperative safety protocols across facilities.
Rapid Response Systems as Secondary Responders to In-Hospital Clinical Deterioration: A Four-Year Observational Study Manggala, Sidharta Kusuma; Ramlan, Andi Ade Wijaya; Aditianingsih, Dita; Firdaus, Riyadh; Cahyadi, Arief; Auerkari, Aino Nindya; Hafidz, Noor; Parasian, Luther Holan; Sugiarto, Adhrie; Devina, Yoan; Mujono, Aivi; Cresma, Avisa Cetta
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.80762

Abstract

Background: In-hospital cardiac arrest (IHCA) is a major cause of preventable inpatient mortality, especially in low- and middle-income countries (LMICs) where rapid response systems (RRS) are still developing. Evidence regarding RRS performance in Indonesia is limited. This study evaluated the performance and operational challenges of an institutional RRS over four years at a large tertiary referral hospital in Jakarta.Objective: This study aimed to determine the proportion of immediate survival following RRS activation and to investigate secondary outcomes, including the association between activation indications and mortality, and system-level barriers.Methods: This retrospective observational cohort study included all inpatient RRS activations at Cipto Mangunkusumo National General Hospital (RSCM), Jakarta, Indonesia, from January 1, 2021, to December 31, 2024. Data from the hospital’s RRS registry were analyzed for activation triggers, interventions, immediate outcomes, and operational issues.Results: Among 246,367 inpatient admissions, there were 5,900 eligible inpatient RRS activations, yielding an activation rate of 23.9 per 1,000 admissions. Immediate survival occurred in 4,763 (80.7%) events, while 1,137 (19.3%) patients did not survive. Cardiac arrest (8.0%) and respiratory arrest (6.5%) were the strongest predictors of non-survival odds ratio (OR) 48.17 and 27.13 vs. red early warning score (EWS) reference, both p<0.001). Most activations occurred out of hours (63.0%), and mortality was significantly higher (71.3% vs. 61.1%; p < 0.001). The most frequent single-parameter triggers were oxygen saturation ≤90% (38.5%) and sudden deterioration of consciousness (15.8%). Mismatched activations, where the patient’s condition upon team arrival differed from the activation indicationwere strongly associated with higher mortality (OR 17.3, 95% confidence interval (CI) 14.3–20.2, p<0.001).Conclusion: The institutional RRS demonstrated a moderate activation rate and favorable immediate survival compared with similar LMIC settings. However, outcomes were influenced by delayed recognition, out-of-hours activation, and limited critical-care capacity. Strengthening early-escalation culture, monitoring afferent-limb failure (ALF), expanding nighttime coverage, and increasing intensive care unit (ICU) capacity are essential to enhance RRS effectiveness and reduce preventable in-hospital mortality in resource-limited settings.
Co-Authors Agung Bintartho Alatas, Anas Aldy Heriwardito Alexandra, Arky Kurniati Arief Cahyadi Auerkari, Aino Nindya Cresma, Avisa Cetta Devina, Yoan Dita Aditianingsih Dwiputra, Anggara Gilang Fadhila, Fulki Ferdiana, Komang Ayu Firdaus, Riyadh Gunawan, Ferriansyah Hafidz, Noor Kapuangan, Christopher Lasanudin, Joshua Eldad Frederich Manggala, Sidharta Kusuma Martira, Amelia Mujono, Aivi Nindya Auerkari, Aino Parasian, Luther Holan Perdana, Aries Pramodana, Bintang Rahendra, Rahendra Ratna Farida Soenarto Setiadi, Bakti Sugiarto, Adhrie Sukmono, Raden Besthadi Zahra, Raihanita