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Perbandingan Keberhasilan Insersi Kanul Intravena antara Penggunaan dan Tanpa Penggunaan Penampil Vena pada Pasien Pediatrik Perdana, Aries; Kapuangan, Christopher; Alantas, Anas; Manggala, Sidharta Kusuma; Wardhani, Yosi Dwi
Majalah Anestesia dan Critical Care Vol 34 No 1 (2017): Februari
Publisher : Perdatin Pusat

Show Abstract | Download Original | Original Source | Check in Google Scholar

Insersi kanul intravena pada bayi, balita atau anak-anak cukup sulit karena kecilnya ukuran pembuluh darah vena dan lokasinya yang dalam di jaringan subkutis. Kesalahan insersi kanul intravena cenderung terjadi pada kasus difficult venous access (DVA). Penelitian ini membandingkan keberhasilan insersi kanul intravena dengan atau tanpa penggunaan penampil vena pada pasien pediatrik. Setelah mendapat persetujuan dari Komite Etik FKUI/RSCM dan konsen dari pasien, dilakukan penelitian uji klinis acak tidak tersamar pada 88 sampel pasien pediatrik. Pasien dirandomisasi menjadi dua kelompok, pada kelompok 1 dilakukan insersi kanul intravena tanpa penampil vena, sedangkan kelompok 2 dilakukan insersi kanul intravena dengan penampil vena. Data yang terkumpul diuji dengan uji Chi-square. Insersi kanul intravena sekali tusuk dengan penampil vena keberhasilannya 3,095 kali lebih besar dibanding dengan tanpa penampil vena (p<0,05). Insersi kanul intravena sekali tusuk pada pasien dengan status gizi kurang-buruk memiliki angka keberhasilan 0,285 kali dibanding dengan status gizi normal lebih (p<0,05). Usia memiliki hubungan signifikan terhadap insersi kanul intravena (p<0,05). Keberhasilan insersi kanul intravena sekali tusuk dengan menggunakan penampil vena lebih baik dibanding dengan tanpa penampil vena. Keberhasilan insersi kanul intravena memiliki hubungan yang signifikan dengan status gizi dan usia. Kata kunci: Difficult venous access, kanul intravena, penampil vena, status gizi Comparison of Successful Vein Cannula Insertion between Using Vein Viewer and without Vein Viewer in Pediatric Patients Vein cannula insertion in infants, toddlers, or children is quite difficult because of the size and location of their veins. Wrong vein cannula insertion are prone to happen in Difficult Venous Access (DVA) cases. This research is comparing the successful vein cannula insertion between using vein viewer and without vein viewer in pediatric patients. After obtained the ethical approval from Ethical Committee of Cipto Mangunkusumo Hospital and informed consent from patients, 88 pediatric patients were enrolled to this randomized controlled trial. Patients were randomized into 2 groups: first group was inserted without vein viewer and second group was inserted using vein viewer. Data was analyzed with Chi-square test. Successful rate in first attempt vein cannula insertion using vein viewer is 3.095 times higher than without vein viewer (p<0.05). First attempt vein cannula insertion in malnutrition patients has successful rate 0.85 times higher than good nutrition-obese patients (p<0.05). Age has significant relationship with vein cannula insertion (p<0.05). Successful rate in first attempt vein cannula insertion using vein viewer is higher than without vein viewer. Successful first attempt in vein cannula insertion has significant relationship with nutrition status and age. Key words: Difficult venous access, nutrition status, vein cannula, vein viewer

Refleks Nasokardiak yang Disebabkan oleh Pemasangan Selang Nasogastrik: Laporan Kasus Sidharta Kusuma Manggala; Luther Napitupulu; Septianto Halim
Majalah Anestesia & Critical Care Vol 38 No 2 (2020): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Refleks nasokardiak merupakan bagian dari refleks trigeminokardiak. Refleks nasokardiak dapat menyebabkan bradikardia dan hipotensi karena adanya manipulasi terhadap cabang nervus trigeminus yang berada pada rongga hidung. Pemasangan selang nasogastrik adalah prosedur medis yang umum dilakukan dan dapat menyebabkan iritasi pada rongga hidung, Laporan kasus ini menggambarkan adanya kejadian bradikardia, hipotensi, dan penurunan kesadaran yang terjadi segera setelah pemasangan selang nasogastrik pada seorang pasien laki-laki berusia 46 tahun dengan diagnosis pneumonia, tuberkulosis paru, sepsis, hipoksemia, dan hiperkapnia. Refleks nasokardiak harus dicurigai sebagai etiologi terjadinya refleks vagal pada pasien setelah pemasangan selang nasogastrik dan kejadian ini harus diantisipasi dengan baik terutama pada pasien dengan kondisi kritis. Dengan adanya keterbatasan referensi pada topik ini, penelitian lanjutan untuk kejadian ini perlu dilakukan. Kata Kunci: refleks nasokardiak; refleks vagal; selang nasogastrik

Perbandingan Keberhasilan Insersi Kanul Intravena Antara Penggunaan dan Tanpa Penggunaan Pemindai Vena pada Pasien Pediatrik Aries Perdana; Sidharta Kusuma Manggala; Astari Karina
Majalah Anestesia & Critical Care Vol 38 No 3 (2020): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Latar Belakang: Pemasangan akses intravena pada pasien pediatrik memiliki kesulitan tersendiri. Pembuluh darah yang lebih kecil, lebih rapuh, dan jaringan subkutan yang lebih tebal pada pasien pediatrik mempersulit visualisasi vena. Pasien pediatrik yang tidak dalam pengaruh anestesi sering kali tidak kooperatif karena takut dan trauma akibat tindakan sebelumnya. Hal ini berdampak pada rendahnya angka keberhasilan upaya pertama insersi kanul intravena pada pediatrik. Alat pemindai vena dapat membantu visualisasi vena, namun efektivitasnya pada pasien pediatrik masih kontradiktif. Penelitian ini bertujuan untuk membandingkan angka keberhasilan insersi pertama kanul intravena pada pasien pediatrik menggunakan pemindai vena dan tanpa pemindai vena. Metode: Penelitian ini merupakan uji klinis, acak, tidak tersamar pada pasien pediatrik usia 0-5 tahun yang mendapat layanan anestesi di ruang diagnostik magnetic resonance imaging, computed tomography scan, dan radioterapi di Rumah Sakit Dr. Cipto Mangunkusumo. Sembilan puluh dua subjek dikelompokkan menjadi 2 kelompok yaitu kelompok insersi kanul intravena dengan bantuan alat pemindai vena (Accuvein AV400) dan kelompok kontrol, insersi tanpa alat bantu. Data keberhasilan insersi pertama, waktu pemasangan, total jumlah upaya, serta status demografi subjek dicatat dan dianalisa untuk melihat hubungan penggunaan pemindai vena dan faktor lain yang mempengaruhi dalam keberhasilan upaya pertama insersi kanul intravena. Hasil: Angka keberhasilan insersi pertama lebih tinggi pada kelompok pemindai vena (76,1%) dari pada kelompok tanpa pemindai vena (52,2%) dengan cOR 2,92 (p 0,017). Warna kulit gelap memiliki angka keberhasilan yang lebih tinggi dibandingkan warna kulit terang (74,5% dibandingkan 53,5%, dengan nilai p sebesar 0,035). Faktor lainnya tidak berhubungan dengan keberhasilan insersi kanul intravena. Kelompok pemindai vena memiliki rerata waktu insersi yang lebih singkat yaitu 133,5 detik (55-607) dibandingkan tanpa pemindai vena 304,5 detik (65-1200). Simpulan: Kelompok pemindai vena memiliki angka keberhasilan upaya insersi pertama yang lebih tinggi dibandingkan tanpa pemindai vena. Faktor yang mempengaruhi keberhasilan insersi hanya warna kulit.

The Role of Virtual Reality in Cancer Pain Management: A Systematic Literature Review Ignatia Novianti Tantri; Aida Rosita Tantri; Sidharta Kusuma Manggala; Riyadh Firdaus; Tasya Claudia Pardede
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 1 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i1.752

Background: Virtual reality (VR) is a 3D environment-based simulation using computer technology that creates a realistic multi-sensorial experience. VR allows users to simulate real-world scenarios in a safe, attractive virtual space. Immersive VR has been proposed as a non-pharmacologic approach to cancer pain management. This systematic review aimed to explore the role of virtual reality in cancer pain management. Methods: The current review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study used PICO consisting of population: adult patients with cancer pain, intervention: virtual reality, comparison: placebo, outcome: reducing cancer pain. Results: Four studies of moderate to the high quality that met the inclusion and exclusion criteria were reviewed in this study. Two studies show VR can reduce stress and anxiety and increase relaxation. Two RCTs demonstrated the effectiveness of VR in reducing cancer pain. Conclusion: Virtual reality technology can help to reduce cancer pain. In addition to pain severity, other parameters such as fatigue, depression, anxiety, and stress also were decreased. VR also could increase the level of relaxation. Virtual reality's role in reducing pain can have good implications for cancer pain management and increasing patient comfort.

Developing “do it yourself” Phantom for Teaching Seldinger Technique in Vascular Access Placement to General Practitioners Hafidz, Noor; Sedono, Rudyanto; Aditianingsih, Dita; Sugiarto, Adhrie; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 7 No. - (2023): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v7i-.201

Establishing a vascular access is a crucial aspect in managing critically ill patients in the Intensive Care Unit (ICU). The skill in placing vascular access varies among healthcare professionals. Clinical experience and level of training among nurses, general practitioners, and intensivists are the determinants of skill in placing vascular access. Training to establish vascular access using the Seldinger technique needs practice using a vascular phantom or a cadaver. Commercially sold phantoms are difficult to get, and an alternative training phantom is needed. We built a simple “do-it-yourself” model of a vascular phantom using “easy-to-find” material that can be used to practice the Seldinger technique. We used a synthetic polyurethane sponge 16x16 cm in size as a base and a polyvinyl alcohol sheet of the same size. We used 22 F urinary catheters trimmed to 12 to represent blood vessels. The final product is a piece of the urinary catheter embedded in the sponge and then covered by polyvinyl alcohol to simulate the epidermis. The phantom can be used in training programs to improve the skill of general practitioners in placing advanced vascular access. 13 general practitioners were involved in this training, and 100% said that this phantom could simulate the experience. “Do-it-yourself” phantom for vascular access training can be used ro practice the Seldinger technique and can simulate the real experience.

The Economic Burden on Private Hospitals in Treating ICU Vs Non-ICU Patients: Investigating The Financial Gap Between Indonesian Case Base Groups (INA-CBG) Rates and Hospital Billing Halim, Ida Juita; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.241

Objectives: Indonesia’s healthcare financing relies on a bundled payment system, the Indonesian Case Base Groups (INA-CBG) rates, whereas private hospitals calculate costs using Activity-Based Costing (ABC). This difference can lead to significant financial gaps, especially in ICU and non-ICU care. Methods: A random sample of 93 ICU and non-ICU patients from a private hospital in Bekasi, West Java, was analyzed. We compared the INA-CBG rates and hospital billing for ICU and non-ICU care by considering comorbidities, hospital length of stay (LOS), and mortality rates. Results: The average LOS was longer for ICU patients (6.78 days) than non-ICU (4.98 days). The ICU mortality rate was 20%, while non-ICU was 2.33%. Globally, ICU LOS averages 5-7 days, with a 30% mortality rate. INA-CBG covered only 41.89% of costs for non-ICU patients and 57.14% for ICU patients. Conclusion: This study demonstrates the significant financial strain created by the discrepancy between the INA-CBG claims and the actual costs particularly for private hospitals handling patients with high severity.

Plasmapheresis and Multidisciplinary Intensive Care Management for Guillain-Barré Syndrome with Prolonged Mechanical Ventilation: A Case Report Indrawan, Khadafi; Manggala, Sidharta Kusuma
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.249

Guillain-Barré syndrome (GBS) is a rare, acute autoimmune peripheral neuropathy often triggered by infections. It leads to rapid-onset muscle weakness and, in severe cases, respiratory failure requiring mechanical ventilation. Plasmapheresis is recommended to reduce circulating autoantibodies that damage peripheral nerves. Guidelines suggest that early initiation of plasmapheresis may improve clinical outcomes, especially in patients with significant motor weakness. A 41-year-old female was referred to the emergency room with progressive ascending bilateral limb weakness, sensory deficits, and urinary incontinence. Symptoms emerged 26 days prior and treatments from previous hospitals were ineffective. Physical examination revealed cranial nerve involvement, proprioceptive disturbance, and reduced deep tendon reflexes. Laboratory tests showed leukocytosis, thrombocytosis, hypoalbuminemia, electrolyte imbalance, and elevated D-dimer. Cerebrospinal fluid analysis was normal. The patient was diagnosed with GBS, intubated by day six post-admission due to respiratory failure and tracheotomized by day eight. The patient was admitted to the intensive care unit. Plasmapheresis, initiated on day 17, improved motor strength after three sessions spaced over 10 days. However, delayed intervals between sessions and limited access potentially impeded the recovery process. Despite improvements, the patient remained ventilator-dependent and require multidisciplinary interventions. Inhalation therapy, enteral feeding, physical rehabilitation, and psychiatric interventions were administered. The family was informed of potential long-term ventilator dependency and home care preparation. This case underscores the importance of timely plasmapheresis and coordinated, multidisciplinary ICU management in severe GBS, encompassing neurological treatment, respiratory care, nutrition management, physical rehabilitation, and psychological support for the patient and their caregivers.

The Role of Virtual Reality in Cancer Pain Management: A Systematic Literature Review Ignatia Novianti Tantri; Aida Rosita Tantri; Sidharta Kusuma Manggala; Riyadh Firdaus; Tasya Claudia Pardede
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 1 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i1.752

Background: Virtual reality (VR) is a 3D environment-based simulation using computer technology that creates a realistic multi-sensorial experience. VR allows users to simulate real-world scenarios in a safe, attractive virtual space. Immersive VR has been proposed as a non-pharmacologic approach to cancer pain management. This systematic review aimed to explore the role of virtual reality in cancer pain management. Methods: The current review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study used PICO consisting of population: adult patients with cancer pain, intervention: virtual reality, comparison: placebo, outcome: reducing cancer pain. Results: Four studies of moderate to the high quality that met the inclusion and exclusion criteria were reviewed in this study. Two studies show VR can reduce stress and anxiety and increase relaxation. Two RCTs demonstrated the effectiveness of VR in reducing cancer pain. Conclusion: Virtual reality technology can help to reduce cancer pain. In addition to pain severity, other parameters such as fatigue, depression, anxiety, and stress also were decreased. VR also could increase the level of relaxation. Virtual reality's role in reducing pain can have good implications for cancer pain management and increasing patient comfort.

Magnesium as Immediate Management for Suspected Intraoperative Malignant Hyperthermia Crisis: A Case Report from Indonesia Farida Soenarto, Ratna; Kusuma Manggala, Sidharta; Montolalu, Gabriela; Listyana, Tia; Kurniawan, Celine
Majalah Anestesia & Critical Care Vol 43 No 2 (2025): 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.v43i2.437

Background: Malignant hyperthermia (MH) is a life-threatening disorder triggered by certain anesthetics and characterized by a hypermetabolic state in skeletal muscles. Magnesium sulfate is gaining recognition as a crucial adjunct in the immediate management of MH, particularly when dantrolene is not readily available. This case report presents a successful use of magnesium during an MH crisis, emphasizing its potential as a life-saving intervention in resource-limited settings. The report adds to the growing evidence supporting magnesium's role in early MH management, especially when there is a delay in dantrolene administration.Case Illustration: A 2-year-old healthy boy underwent Achilles tendon lengthening under general anesthesia. Post-induction, the patient developed signs of increased sympathetic activity, muscle rigidity, and hypercarbia. Due to dantrolene unavailability, 400 mg of magnesium sulfate was administered, which successfully reduced muscle rigidity and stabilized hemodynamics. Dantrolene was later given, further improving the patient's condition. The patient was extubated 28 hours later and fully recovered, highlighting the critical role of magnesium in managing this crisis.Conclusion: Early detection and management of MH are crucial for patient survival. In the absence of dantrolene, MgSO4 serves as an effective alternative for immediate intervention. This experience underlines the importance of having alternative treatment strategies in resource-limited settings and stresses the need for continued education and preparedness for MH crises.

Association Between Shock Index and Post-Emergency Intubation Hypotension in Patients Who Called the Rapid Response Team at Dr. Cipto Mangunkusumo Hospital Rahmah, Herlina; Adisasmita, Asri; Manggala, Sidharta Kusuma; Sugiarto, Adhrie; Zahrina, Fadiah; Rosdiana, Prita
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.27-36

Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Methods: This research is a cohort retrospective study that analyzed 171 patients aged â‰¥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p <0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.

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