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Perbandingan Efektifitas Teknik Jugular Interna dan Supraklavikula pada Pemasangan Kateter Vena Sentral dengan Panduan USG di RSUP H. Adam Malik Medan Fauzi, Muhammad; Lubis, Bastian; Irina, Rr Sinta
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.v42i2.338

Latar Belakang: Kateter vena sentral (KVS) bermanfaat untuk pemantauan invasif resusitasi hemodinamik. Penggunaan ultrasonografi (USG) dapat mengurangi komplikasi saat pemasangan KVS. Penelitian ini dilakukan untuk mengetahui efektivitas pemasangan KVS antara teknik jugular interna dengan supraklavikula menggunakan ultrasonografi.Metode: Penelitian ini menggunakan metode ekperimen kuasi (eksperimen semu). Penelitian dilakukan di RSUP H. Adam Malik Medan dengan besar sampel sebanyak 56 orang. Dilakukan pencatatan karakteristik, kedalaman tip KVS, rasio sukses, jumlah percobaan, durasi insersi, dan komplikasi, dengan uji analisis Independent T-Test.Hasil: Terdapat 28 orang melalui prosedur supraklavikula dan 28 orang melalui prosedur jugularis interna. Frekuensi sampel dengan ujung tip yang tepat sebanyak 23 sampel (82,14%) dan 5 sampel (17,86%) tidak tepat. Dari uji Chi-Square diketahui bahwa tidak terdapat hubungan yang signifikan antara kelompok dengan tingkat ketepatan kedalaman tip KVS di atas atrium kanan (p = 1,000). Rerata waktu pemasangan KVS dengan pendekatan jugularis interna adalah 19,64 (2,18) menit dan pendekatan supraklavikula adalah 21,11 (2,28) menit, dan kecepatan secara keseluruhan adalah 20,28 (2,33) cm. Terdapat perbedaan yang signifikan antara pendekatan jugularis interna dengan supraklavikula (p < 0,05).Simpulan: Pemasangan KVS dengan pendekatan teknik jugular interna lebih efektif dibandingkan supraklavikula dinilai dari waktu pemasangan, tingkat ketepatan sebesar 82,14 % dan tidak memiliki komplikasi. Pemasangan KVS pada teknik jugular interna memiliki tingkat keberhasilan yang sama dengan teknik supraklavikula. Pemasangan KVS pada teknik jugular interna lebih cepat dibandingkan teknik supraklavikula yang bermakna secara statistik. Komplikasi tidak dijumpai pada pemasangan KVS pada jugular interna dan supraklavikula.

Relationship Blood Gas Analysis And Hemostasis Physics In Multiple Trauma Patients In Adam Malik Hospital Medan Karim, T. Abdul; Wijaya, Dadik Wahyu; Irina, Rr Sinta
Journal of Society Medicine Vol. 2 No. 1 (2023): January
Publisher : CoinReads Media Prima

Introduction: Trauma is currently the most common cause of death in the first four decades of life and is still a major public health problem in every country. Arterial blood gas analysis (AGDA) is known to be an important marker for poor patient outcomes and occult or compensatory hypoperfusion. This study also evaluated the relationship and influence of AGDA scores on the outcome and prognosis of patients with multiple trauma. The results of this study will be able to assist in the rapid triage of acute trauma patients, which will also help identify high-risk patients who develop severe complications. Method: This study assessed the relationship between initial arterial blood gas and initial hemostatic function in acute trauma patients who came to the emergency department at H. Adam Malik General Hospital Medan. This type of research is a retrospective analytic where data is taken from medical records to see the relationship between AGDA and coagulation profile in multiple trauma patients at H. Adam Malik General Hospital Medan. After recruiting research samples at Adam Malik Haji Center General Hospital Medan, it was found that 141 multiple trauma patients who underwent surgery at H. Adam Malik General Hospital Medan met the inclusion criteria and were not included in the exclusion criteria Results: In this study, there were significant results between the pH and the three hemostatic physiology, there were no significant results between pCO2 and the three hemostatic physiology, and there were significant results between the HCO3 value and the PT and INR values, but no significant results were obtained with the APTT. Some authors believe that arterial PCO2 at admission is a significant prognostic factor in patients with traumatic head injury, but several studies dispute the arterial blood gas (ABG) parameter as a reliable indicator of short-term outcome in these patients. The main goal of the management of critically ill patients is the maintenance and optimization of cellular (and organ) health. Conclusion: This goal can be achieved by maintaining oxygenation, perfusion, fluid, electrolyte, and acid-base balance. Acid-base and oxygenation disorders are also critical, especially when these disorders develop rapidly.

Comparison of Changes in Rso2 in Midazolam and Propofol Sedation Post Craniotomy in the Icu of H. Adam Malik Hospital Pratama, Dicko Kanugrahan; Irina, Rr Sinta; Winata, Ade
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.579

Introduction: Cerebral oxygen saturation reflects tissue perfusion in the cerebrum. Decreases in cerebral oxygen saturation are linked to longer hospital stays and cognitive impairment. Midazolam and propofol can decrease cerebral blood flow through decreasing the cerebral oxygen metabolic rate. The purpose of this research is to analyze the comparison of changes in cerebral oxygen saturation after midazolam and propofol administration in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan.Subject and Method: This is a randomized control trial study. Patients were divided into, Midazolam group, that given an initial dose of 0.05 mg/kg followed by a maintenance dose of 0.02-0.10 mg/kg/hour and Propofol group that given sedation with a dose of 0.3-3mg/kg/hour, with the target of the 2 groups being a Richmond Agitation-Sedation Scale (RASS) value of 0 to -2. Data analysis using unpaired T test.Results: The results for cerebral regional oxygen saturation and RASS between groups showed significant differences in right and left value (p 0.001), but there was no significant difference in RASS (p0.05) between each group at each measurement time. The results of the analysis of cerebral regional oxygen saturation and RASS between times, there was no significant difference in right and left value (p0.05), but there was a significant difference in RASS (p0.001) at each measurement time. Based on the results of the analysis carried out, it is known that there is no statistically significant difference in changes in cerebral regional oxygen saturation both right and left in changes in RASS because it is found that all data have p0.05.Conclusion: There is no change in right and left for cerebral regional oxygen saturation after administration of propofol and midazolam groups with RASS value 0 to -2 in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan

Korelasi antara Skor ICH C-Reactive Protein, D-Dimer terhadap Luaran Pasien Perdarahan Intraserebral Irina, Rr Sinta; Indharty, Rr Suzy
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.541

Latar Belakang dan Tujuan: Perdarahan intraserebral (Intracerebral hemorrhage/ICH) merupakan 10% hingga 15% dari semua stroke dan memiliki angka mortalitas dan morbiditas yang tinggi di dunia. Skor ICH valid untuk memprediksi derajat keparahan pasien perdarahan intraserebral yang dirawat di ICU. Kenaikan nilai C-reactive protein (CRP) menjadi prediktor terhadap hasil luaran pasien ICU. Tujuan penelitian adalah untuk mengetahui korelasi skor ICH, CRP dan D-dimer terhadap hasil luaran pada pasien perdarahan intraserebral.Subjek dan Metode: Subjek penelitian merupakan 27 orang pasien perdarahan intraserebral yang dirawat di ICU RSUP H. Adam Malik dan Rumah sakit Universitas Sumatera Utara. Pengambilan data secara consecutive sampling, kemudian diukur skor ICH, CRP, D-dimer dan dianalisa pemeriksaan tersebut dengan lama perawatan.Hasil: Dari total 27 pasien, 22 (81,5%) pasien pindah ruang rawat dan 5 (18,5%) pasien meninggal dunia. Rerata untuk skor ICH 2,70(0,67), CRP 1,41(0,72), dan D-dimer 2757,96(1230,73). Hasil korelasi antara skor ICH dengan lama rawatan dijumpai korelasi positif (r = 0,498; p = 0,008), didapatkan korelasi lemah antara CRP dengan lama rawatan (r = 0,315; p = 0,109) dan korelasi antara D-dimer dengan lama rawatan dan dijumpai korelasi positif (r = 0,546; p = 0,003).Simpulan: Didapati skor ICH, CRP dan D-dimer memiliki pengaruh terhadap lama rawatan pasien dengan perdarahan intraserebralCorrelation between ICH Score, C-Reactive Protein and D Dimer on the outcome of Intracerebral Hemorrhage PatientsAbstractBackground and Objective: Intracerebral hemorrhage (ICH) accounts for 10% to 15% of all strokes and has a high mortality and morbidity rate in the world. The ICH score is valid for predicting the severity of intracerebral hemorrhage patients treated in the ICU. The increase in C-reactive protein (CRP) value is a predictor in the outcome of ICU patients. The aim of this study was to find out how the ICH, CRP and D-dimer scores correlated with the outcome in intracerebral hemorrhage patients.Subjects and Methods: The subjects of this study were 27 patients with intracerebral hemorrhage who were treated in the ICU of H. Adam Malik Hospital and the University of North Sumatra Hospital. Data were collected using consecutive sampling, then ICH, CRP, D-dimer scores were measured and the examination was analyzed by length of stay.Results: Out of a total of 27 patients, 22 (81.5%) patients moved to the ward and 5 (18.5%) patients died. The mean for ICH score was 2.70(0.67), CRP was 1.41(0.72), and D-dimer was 2757.96(1230.73). The results of the correlation between ICH score and length of stay found a positive correlation (r = 0.498; p = 0.008), a correlation between CRP and length of stay had a weak correlation (r = 0.315; p = 0.109) and a correlation between D-dimer and length of stay and found a correlation positive (r = 0.546; p = 0.003).Conclusion: It was found that ICH, CRP and D-dimer scores had an effect on the length of stay of patients with intracerebral hemorrhage

Correlation between Mean Platelet Volume, Fibrinogen and D-dimer with NIHSS Score Nasution, Putra Fajar; Irina, Rr Sinta; Lubis, Bastian
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.581

Introduction: Stroke is a clinical syndrome that develops rapidly due to focal or global brain disorders with symptoms last for 24 hours and potentially cause death. Due to the consideration that this Mean Platelet Volume (MPV) marker is not invasive, easy to do and is in line with the pathogenesis of stroke, researchers are interested in carrying out this research. And hopefully this research can provide information for the world of education and health about changes in MPV, fibrinogen and D-dimer in ischemic stroke patients. So it can be taken as consideration in the early management of ischemic stroke patients. Subject and Methods: This research was an observational study with a cross-sectional design at Haji Adam Malik General Hospital from October to November 2023. The research subjects were stroke patients who were treated in emergency room and met inclusion criteria. This research was to study about correlation of MPV, fibrinogen, and D-dimer with NIHSS scores of ischemic stroke patients. The method used in this research is the Pearson correlation test where data was normally distributed. All statistical tests with a p value 0.05 were considered significant. Results: The mean MPV was 10.4 1.6, while the mean NIHSS value was 19.9 8.7, and there was a statistically significant correlation between the MPV value and the NIHSS score (p0.05). The mean fibrinogen was 421.9 109.3, while mean NIHSS value was 19.9 8.7, and there was a statistically significant correlation between fibrinogen values and NIHSS scores (p0.001). The mean D-Dimer was 8.0 11.3, while the mean NIHSS value was 19.9 8.7, and showed a statistically significant correlation between D-Dimer value and NIHSS score (p0.05). The r value of MPV, fibrinogen, and D-dimer on NIHSS score was 0.494; 0.495; and 0.504. The regression coefficient for MPV variable is 0.093, therefore MPV variable influence on NIHSS variable is positive.Conclusion: There is a strong correlation between D-dimer and the NIHSS score, and a moderate correlation between MPV and fibrinogen with NIHSS score.

Comparison of Changes in Cortisol Levels in the Blood of Patients Undergoing Craniotomy Using Continuous Infusion Lidocaine and Fentanyl Syaputra, Adhika; Irina, Rr Sinta; Lubis, Andriamuri Primaputra; Harahap, Juliandi
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.565

Background and Objectives: Craniotomy is a surgical procedure that involves part of the skull, temporarily removing it to expose the brain and carrying out intracranial procedures. The surgery can be considered as the standard model for assessing cortisol as a stress response. Cortisol in the blood can cause hemodynamic and physiological changes in the body such as increased heart rate, increased blood pressure, and also increased blood sugar levels. Some literature showed that continuous infusion of fentanyl and lidocaine - has an effect in maintaining the responses to stress, namely the level of cortisol in the blood. The aim aimed to determine the comparison of changes in cortisol levels in the bloodpatients undergoing craniotomy using continuous infusion lidocaine and continuous infusion fentanyl.Subject and Method: This research used a double-blind randomized controlled trial (RCT) with a pre-test and post-test with a control group design. This study divided the samples into 2 groups. Continuous infusion of lidocaine and continuous infusion of fentanyl were then checked for cortisol levels in the patient's blood before and after undergoing craniotomy.Results: The result of 28 samples that underwent craniotomy, 6 samples were excluded, so the total number of samples analyzed was 22 samples. Differences in mean cortisol levels before and after surgery in the lidocaine and fentanyl groups were 193.90 nmol/L and 153.90 nmol/L respectively with a P value of 0.021.Conclusion: In the study, it was found that cortisol levels increased in both fentanyl and lidocaine groups after a craniotomy. There is a significant difference between the two groups of fentanyl and lidocaine, where statistically the fentanyl group was better at maintaining blood cortisol levels after craniotomy than the lidocaine group.

Perbandingan Kadar Interleukin-6 antara Pemberian Kombinasi Fentanil dan Midazolam Kontinyu dengan Deksmedetomidin Kontinyu pada Pasien Pascaoperasi Kraniotomi di Ruang ICU Munawar, Riza; Irina, Rr Sinta; Hamdi, Tasrif
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.557

Latar Belakang dan Tujuan:Pembedahan kraniotomi dapat meningkatkan respon inflamasi tubuh akibat memprovokasi respon stres neuroendokrin. Interleukin-6 adalah salah satu parameter inflamasi memiliki hubungan yang erat pada inflamasi pasca operasi kraniotomi. Kombinasi fentanil dengan midazolam dan deksmedetomidin sebagai obat analgesia memiliki peran menghambat regulasi inflamasi sehingga bisa mengurangi pelepasan mediator inflamasi termasuk Interleukin-6. Tujuan penelitian untuk memperoleh hasil perbandingan pemberian kombinasi fentanil dengan midazolam dan deksmedetomidin terhadap kadar interleukin-6 pada pasien pasca kraniotomi di ruang ICUSubjek dan Metode:Penelitian menggunakan uji klinis double-blind randomized controlled trial (RCT) dengan 32 subjek penelitian yang setelah memenuhi kriteria inklusi dibagi secara acak menjadi 2 kelompok. Kelompok A mendapat kombinasi fentanil dan midazolam kontinyu dan kelompok B mendapat deksmedetomidin kontinyuHasil:Terdapat penurunan nilai rata-rata kadar interleukin-6 pada kelompok pemberian kombinasi fentanil dengan midazolam dan kelompok pemberian deksmedetomidin, namun secara statistik tidak memberikan nilai yang signifikan antara kedua kelompokSimpulan:Pemberian kombinasi fentanil dengan midazolam dan deksmedetomidin memberikan efek sebanding dalam menurunkan kadar Interleukin-6.Comparison of Interleukin-6 Levels between Continuous Combination of Fentanil and Midazolam with Dexmedetomidine Continuity in Postoperating Patients Craniotomy in ICUAbstractBackground and Objective: Craniotomy surgery can increase the body's inflammatory response by provoking a neuroendocrine stress response. Interleukin-6 as one of the inflammatory parameters has a close relationship with inflammation after craniotomy surgery. Combination fentanyl with midazolam and dexmedetomidine as anelgesia drugs have the role of inhibiting inflammatory regulation to reduce the release of inflammatory mediators including Interleukin-6. The aim of this study to compare the results of Combination fentanyl with midazolam and dexmedetomidine administration on interleukin-6 levels in post-craniotomy patients in the ICU room.Subjects and Methods: This study is an experimental study with The Pretest-Posttest Control Group Design, with a double blind randomized controlled trial (RCT) clinical trial where in this study two groups were divided. After obtaining approval from the Ethics Committee of the Faculty of Medicine, University of Sumatera Utara Medan, 32 research samples were collected, which after meeting the inclusion criteria were randomly divided into 2 groups. Group A received a combination of fentanyl and midazolam and group B received dexmedetomidine. The data obtained were tested using SPSS.Results: There was a decrease in the mean value of interleukin-6 levels in combination fentanyl with midazolam administration group and the dexmedetomidine administration group, but statistically did not provide a significant value between the two groups.Conclusion: Combination fentanyl with midazolam and dexmedetomidine administration have comparable effects in reducing Interleukin-6 levels.

Comparison of Changes in Cortisol Values Before and After Administration of a Combination of Continuous Fentanyl and Paracetamol Drip in Post-Craniotomy Patients in ICU of Haji Adam Malik General Hospital Medan Etania, Cassandra; Irina, Rr Sinta; Ihsan, Muhammad
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.593

Introduction: Post-craniotomy surgical pain can trigger an inflammatory response and release various stress response mediators. Prolonged stress response to pain can increase cortisol secretion which will eventually be resulted in cortisol dysfunction and widespread inflammation. Opioids have been shown to provide pain management after craniotomy. Fentanyl is a commonly used opioid analgesic to manage postoperative pain. The addition of paracetamol is often used as multimodal analgesia which aims to reduce postoperative pain and to minimize the stress response that occurs. The aim of the study was to obtain a comparison of changes in cortisol values before and after the administration of a combination of continuous fentanyl and paracetamol in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan. Subject and Methods: This research design used a cross sectional test with pretest and posttest design, with primary data sources obtained directly from examinations on patients in the ICU. This study involved 15 post-craniotomy patients in the ICU with mechanical ventilation. The cortisol levels in the patients blood were checked before and after administration continuous fentanyl and paracetamol drip. Results: There was a decrease in cortisol levels after being given a combination of continuous fentanyl and paracetamol drip in post-craniotomy patients by 18% with a p-value of 0.001 (p

Bronchial Toilets in Sepsis Patients Treated in The Intensive Care Unit (ICU): A review On Indications and Complications Lubis, Andriamuri Primaputra; Irina, Rr Sinta; Karim, T. Abdul
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.v0i0.56989

The respiratory system is very important for human life. Its performance determines the quality of life. Physical exercise helps patients suffering from various diseases to build physical fitness, improve respiratory mechanisms, and reduce secretions. It is important to choose the right technique for such patients, using fitness and strength training, breathing exercises, bronchial cleansing. Bronchial clearing aims to remove respiratory tract secretions that contribute to recurrent inflammation and respiratory distress. This is based on the position which facilitates the removal of dense secretions due to the influence of gravity. Pharmacological measures to reduce the secretions in the respiratory tract and facilitate coughing, should be administered prior to drainage. Tracheo-bronchial toilet is a method used to clear mucus and secretions from the airways. The benefits of a tracheo-bronchial toilet include preventing infections such as pneumonia and improving drainage of secretions. Methods used in tracheo-bronchial toilets include temporary naso-tracheal intubation with small tubes, percussion, positioning, and coughing. A tracheotomy can also be performed for lung clearance. Toilet bronchoscopy is a potentially therapeutic intervention to aspirate retained secretions in the endotracheal tube and airway and restore atelectasis.

Perbandingan Hemodinamik Pasca-Intubasi Operasi Bedah Saraf pada Penggunaan Lidokain 10% Spray dan Lidokain 2% Intravena di RSUP H. Adam Malik Medan Juliara, Faura Dwika; Irina, Rr Sinta; Lubis , Bastian
Majalah Anestesia & Critical Care Vol 42 No 3 (2024): 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.v42i3.337

Latar Belakang: Stabilitas hemodinamik pada saat tindakan intubasi sebelum tindakan operasi bedah saraf penting untuk mencegah terjadinya secondary brain injury. Penelitian ini bertujuan untuk menilai perbandingan hemodinamik pasca-intubasi pasien bedah saraf pada penggunaan lidokain 10% spray dan lidokain 2% intravena di RSUP H. Adam Malik Medan. Metode: Penelitian ini merupakan jenis penelitian uji klinis acak terkontrol secara random tersamar ganda pada pasien yang menjalani operasi bedah saraf di RSUP Haji Adam Malik Medan yang memenuhi kriteria inklusi dan eksklusi. Pengolahan dan analisis data dengan program pengolah statistik dengan nilai p < 0,05 dianggap bermakna. Hasil: Penelitian ini melibatkan 20 subjek yang dibagi menjadi kelompok A (lidokain 10% spray) dan kelompok B (lidokain 2% intravena). Rerata tekanan darah sistolik pada kelompok A adalah 94,70 ± 4,80 dan pada kelompok B 104 ± 6,81 (p=0,01). Rerata tekanan darah diastolik pada kelompok A adalah 61,90 ± 4,30 dan pada kelompok B 68,10 ± 3,24 (p=0,02). Rerata mean arterial pressure (MAP) pada kelompok A adalah 72,70 ± 4,11 dan pada kelompok B 80,30 ± 3,46 (p=0,001). Rerata HR pada kelompok A adalah 65,70 ± 3,94 dan pada kelompok B 75,50 ± 3,89 (p=0,001). Simpulan: Terdapat perbedaan yang signifikan pada perubahan tekanan darah, MAP, dan denyut jantung pada pemberian lidokain 10% dan lidokain 2% intravena pada pasien bedah saraf pasca-intubasi

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