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All Journal PREPOTIF : Jurnal Kesehatan Masyarakat Majalah Anestesia & Critical Care (MACC) Jurnal Komplikasi Anestesi
Ratumasa, Marilaeta Cindryani Ra
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Medicine & Pharmacology Public Health

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Machine Learning as Our Weapon to Become Anesthesiologist 5.0 Ratumasa, Marilaeta Cindryani Ra; Sucandra, MA Kresna; Aryasa, Tjahya; Sutawan, IB Krisna Jaya
Majalah Anestesia & Critical Care Vol 41 No 3 (2023): 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.v41i3.319

Abstract

Machine learning is one of the most renowned things that have emerged in the last five years in medicine. The machine is made as if it has the cognitive ability to think independently, is able to distinguish incoming inputs and get the desired output. Along with the development of statistical and computer science, machine learning has evolved into a distinct subfield within the broader domain of data science, with far-reaching implications for various sectors, including healthcare. In medical science, technology and artificial intelligence are starting to take over anesthetic services. This paradigm shift necessitates a fundamental change in the role of future anesthesiologists A future anesthesiologist will need to continuously monitor and evaluate the performance of data science and artificial intelligence systems, and make adjustments when necessary to improve impact on patient care and outcomes. Anesthesiologists of the future will need to harness the power of data science and artificial intelligence to enhance patient care continually, emphasizing adaptability and collaboration as key elements in delivering improved healthcare outcomes.
Quadratus Lumborum Block (QLB) pada Percutaneous Nephrolithotomy (PCNL): Tinjauan Sistematik dan Meta-Analisis Hadiwijono, Vanessa Juventia; Ratumasa, Marilaeta Cindryani Ra
Majalah Anestesia & Critical Care Vol 41 No 3 (2023): 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.v41i3.320

Abstract

Percutaneous Nephrolithotomy (PCNL) merupakan metode endoskopik untuk manajamen nefrolitiasis yang lebih tidak invasif, namun tetap bisa menyebabkan nyeri pasca operatif yang mempengaruhi morbiditas. Quadratus lumborum block (QLB) adalah blok pada posterior dinding abdominal. Hingga kini, blok ini sudah dimodifikasi menjadi empat pendekatan serta dilakukan pada beragam pembedahan seperti pembedahan sesar, muskuloskeletal, hingga nefrolitotomi. Melalui tinjauan ini penulis hendak meringkas efikasi dari QLB pada PCNL dilihat dari penggunaan morfin dan nilai Visual Analog Scale (VAS) 24 jam pasca operatif dan ke depannya dapat diaplikasikan secara klinis. Tinjauan sistematis ini dibuat berdasarkan Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) dan dianalisis dengan Review Manager (versi 5.4). Lima Randomized Control Trial (RCT) dari tahun 2018-2023 dilibatkan. Risiko bias dianalisis dengan plot funnel dan tes I2 untuk heterogenitas. Perbedaan standar rata-rata dilaporkan bermakna apabila p<0,05 dengan interval kepercayaan 95%. Hasil analisis komparatif pada penggunaan opioid (SMD=2,44 IK95%=2,09-2,79 p<0,00001 I2=94%) dan VAS (SMD=2,10 95% IK95%=1,74-2,45 p<0,00001 I2=93%) 24 jam pasca operatif menunjukkan perbedaan yang signifikan secara statistik. Studi ini mendapatkan perbedaan rata-rata yang signifikan pada penggunaan opioid dan penilaian VAS 24 jam pasca operasi pada pasien yang menjalani PCNL dengan QLB. Namun, pertimbangan ulang diperlukan untuk implentasi klinis mengingat heterogenitasnya yang cukup tinggi. ditambah dengan parasetamol 1000 mg.
Manajemen Anestesi pada Pasien Anak yang Menjalani Operasi Coloboma dengan Penyakit Jantung Bawaan Asianotik Budiadnyana, I Made Pasek; Ratumasa, Marilaeta Cindryani Ra; Panji, Putu Agus Surya; Senapathi, Tjokorda Gde Agung
Jurnal Komplikasi Anestesi Vol 11 No 3 (2024): Volume 11 Number 3 (2024)
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.v11i3.15090

Abstract

Anesthesia for pediatric patients with acyanotic congenital heart disease demands a specialized approach due to complex cardiac anatomy and physiology interactions and the risk of perioperative hemodynamic instability. A two-month-old, five-kilogram child presented with a congenital heart disorder and a left eyelid anomaly since birth. Physical examination revealed superior palpebral coloboma with symblepharon and exposure keratitis. Scheduled for surgical repair, the preoperative assessment included anemia and thrombocytosis. Anesthesia management involved fasting, fluid calculation, and premedication with atropine sulfate 0.1 mg and intravenous analgesic fentanyl 15 mcg (2-3 mcg/kgBW). Intubation proceeded with atracurium, and maintenance included sevoflurane and fentanyl. Monitoring ensured proper EtCO2 and oxygen saturation levels. The one-hour surgery addressed the eyelid issue, followed by post-operative analgesia. The patient was monitored for three days post-op and discharged on the fourth day. Previous studies showed that children with congenital heart disease undergoing noncardiac surgery face increased perioperative risks, influenced by factors such as general condition and disease status, so clinical outcomes during surgery are greatly influenced by anesthesia management that adapts to these factors. Pediatric patients with congenital heart disease can safely undergo general anesthesia for noncardiac surgeries by requiring comprehensive preoperative preparation and careful intraoperative monitoring.
Quadratus Lumborum Block as Intraoperative Analgesic Treatment in Pediatric with Hirschprung’s disease Lesmana, Pita Mora; Ratumasa, Marilaeta Cindryani Ra; Subagiartha, I Made; Senapathi, Tjokorda Gde Agung
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024): Volume 12 Number 1 (2024)
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.v12i1.14973

Abstract

Overview: A 4-year-old boy diagnosed with Hirschsprung's disease since birth will undergo a planned Duhamel procedure. Internationally, the prevalence of Hirschsprung's disease is approximately 1 in 1,500 to 1 in 7,000 live births and usually requires immediate intervention through surgical procedures. The extended length of pediatric surgeries presents a unique challenge for anesthesiologists aiming to minimize the use of opioids, considering their less desirable effects in this patient population. In this case, we opted for the use of quadratus lumborum block (QLB) as intraoperative analgesia. This refers to a meta-analysis by Wen-li Zhao et al, all suggest that QL block offers more effective postoperative pain relief in children after lower abdominal surgeries. Management: After the patient was intubated, we performed a quadratus lumborum block using an anterior approach as an intraoperative analgesia technique. The local anesthetic used was 0.375% ropivacaine + 4 mg dexamethasone, volume 10 ml on both sides. Dermatom covered anterior QL block includes T4 to T12-L1, blocks the anterior and the lateral cutaneous branches of the nerves Result: No additional opioid dose administered during the surgical procedure. Conclusion: The QLB in pediatric patients is quite effective in managing pain during surgery for patients undergoing the Duhamel procedure.
EPIDURAL BUPIVACAINE 0,25% MENURUNKAN KONSUMSI OPIOID PADA PASIEN PEDIATRI DENGAN WILMS TUMOR YANG MENJALANI NEFREKTOMI RADIKAL PER LAPAROSKOPI : SEBUAH LAPORAN KASUS Dharmawan, IGB Adi; Putra, Kadek Agus Heryana; Ratumasa, Marilaeta Cindryani Ra
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 2 (2025): AGUSTUS 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i2.45654

Abstract

Wilms Tumor (WT) merupakan tumor ginjal ganas tersering pada anak, dengan prevalensi 2-6% dari kasus keganasan anak. Pendekatan minimal invasif dengan laparoskopi menjadi pilihan terapi. Penggunaan anestesi epidural dengan bupivacaine menjadi salah satu pilihan manajemen nyeri multimodal yang dapat meningkatkan kenyamanan, menstabilkan hemodinamik, serta menurunkan kebutuhan opioid. Kami melaporkan kasus anak perempuan 5 tahun dengan massa ginjal kiri sesuai WT yang telah mendapat 12 seri kemoterapi. Pasien menjalani nefrektomi radikal per laparoskopi dengan anestesi umum kombinasi analgesia epidural. Induksi menggunakan sevoflurane, fentanyl, atracurium, dan pemeliharaan dengan sevoflurane 2-2,5%. Kateter epidural dipasang dengan bupivacaine 0,25% untuk analgesia perioperatif. Operasi dikonversi menjadi laparotomi terbuka karena adhesi dan hematoma renal. Hemodinamik tetap stabil selama 8 jam operasi, dengan perdarahan 200 ml. Nyeri pascaoperasi dikelola dengan bupivacaine 0,1% + morfin epidural dan parasetamol. Penggunaan anestesi epidural bupivacaine 0,25% memberikan stabilitas hemodinamik selama operasi. Analgesia epidural multimodal dengan morfin memperpanjang efek analgesik pascaoperasi, mengurangi kebutuhan opioid sistemik, mempercepat ekstubasi dan pemulihan. Pemantauan ketat di PICU diperlukan untuk mendeteksi komplikasi. Penggunaan anestesi epidural sebagai modalitas tambahan pada nefrektomi Wilms Tumor efektif menstabilkan hemodinamik intraoperatif, mengoptimalkan kontrol nyeri pascaoperasi, serta mendukung pemulihan pasien yang lebih cepat dan nyaman.
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.
Co-Authors Adi, Made Septyana Parama Budiadnyana, I Made Pasek Dharmawan, IGB Adi Hadiwijono, Vanessa Juventia I Made Subagiartha I Putu Agus Surya Panji Ida Bagus Krisna Jaya Sutawan Kadek Agus Heryana Putra, Kadek Agus Krisnayana, Anak Agung Gede Lesmana, Pita Mora Ningrat, I Ketut Jaya Sucandra, MA Kresna Tjahya Aryasa Tjokorda Gde Agung Senapathi Wibowo, Marcell Dion