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All Journal Jurnal Anestesi Perioperatif Indonesian Journal of Medicine Jurnal Anestesi Obstetri Indonesia Jurnal Kedokteran Mulawarman Solo Journal of Anesthesi, Pain and Critical Care Cermin Dunia Kedokteran Jurnal Neuroanestesi Indonesia
Ardana Tri Arianto
Bagian Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Sebelas Maret/RSUD Dr Moewardi Surakarta
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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POLA BAKTRI DARI JAM TANGAN DAN KACAMATA YANG DIBAWA KE INSTALASI BEDAH SENTRAL RUMAH SAKIT Dr. MOEWARDI SURAKARTA Siregar, Geovaldy; Arianto, Ardana Tri; Putro, Bambang; Wicaksono, Nefrizal
Jurnal Kedokteran Mulawarman Vol 10, No 3 (2023): Jurnal Kedokteran Mulawarman
Publisher : Fakultas Kedokteran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30872/jkm.v10i3.7662

Abstract

Ruang bedah berperan sebagai penyebab infeksi nosokomial terutama akibat luka bedah. Transmisi patogen oleh tangan petugas kesehatan berperan penting dalam rute infeksi silang. Beberapa jam tangan mengandung bakteri patogen, namun efeknya sebagaipembawa bakteri belum dapat dijelaskan. Penelitian ini bertujuan untuk mengetahui pola bakteri jam tangan dan kacamata yang dibawa ke kamar operasi di Rumah Sakit Dr. Moewardi Surakarta. Penelitian menggunakan metode kuantitatif dengan pendekatan deskriptif laboratorik di Instalasi Bedah Sentral RSUD Dr. Moewardi Surakarta pada Juni - Juli 2018. Sampel adalah seluruh hardware yang dibawa masuk ke ruang bedah umum dan memenuhi kriteria inklusi. Pengambilan sampel menggunakan metode swab dan dibawa ke Laboratorium Mikrobiologi Fakultas Kedokteran Universitas Sebelas Maret untuk diidentifikasi. Data dianalisis dengan Uji Fhiser Exact Test. Hasil penelitian terhadap 40 hardware yaitu 19 jam tangan dan 21 kacamata yang dipakai dan dibawa ke kamar operasi Instalasi Bedah Sentral RS Dr. Moewardi Surakarta. Hardware yang dibawa dan mengandung bakteri patogen sebanyak 33 hardware (82,5%). Hardware yang terkontaminasi patogen paling banyak adalah kacamata, (p= 0,040). Jenis bakteri yang paling banyak ditemukan adalah Staphylococcus              hominis sebanyak 16 hardware (40,0%). Staphylococcus haemolyticus ditemukan pada 7 hardware (17,5%). Staphylococcus epidermidis ditemukan pada 4 hardware (10,0%). Kesimpulan dari penelitian ini adalah hardware yang diteliti dan terdapat pathogen ada 33 hardware (82,5%).Jenis bakteri yang paling banyak ditemukan adalah Staphylococcus hominis pada 40,0% hardware.
Dexmedetomidine Adjuvant in Awake Intubation as Difficult Airway Management for Submandibular Abscess with Mediastinum Infiltration Arianto, Ardana Tri; Utama, Sigit Prastya; Faras, Asaduddien
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.67811

Abstract

Background: Maintaining a secure airway in difficult airway settings is important due to morbidity and mortality. Conventional intubation relies on benzodiazepines, opioids, and propofol which have a respiratory depression effect. Dexmedetomidine has a minimal to no central respiratory depression effect. A submandibular abscess can result in laryngeal edema which narrows or occludes the airway.Case Ilustration: A 65-year-old male complained of difficulty breathing and shortness of breath accompanied by neck and right jaw pain that radiated to the right cheek. The patient also complained of a salty taste every time the patient swallows. Obtained blood pressure 112/73 mmHg on norepinephrine support syringe pump 0.1 mcg/kg/minute (5.4 cc/hour), pulse rate 120 bpm, respiratory rate 32 times per minute with the help of respiratory muscles. The patient’s temperature was 36.7oC. The patient’s initial Glasgow Coma Scale was E3V5M6. Difficult airway was observed due to submandibular mass, 1-2 finger mouth opening, trismus, mallampati was difficult to evaluate, limited neck motion due to pain, and missing teeth. Imaging showed a soft tissue mass in the neck region. The patient underwent awake intubation using a video laryngoscope and Nasoendotracheal tube number 6.5 was installed with 70 mcg of dexmedetomidine syringe pump in 10 minutes (with pump rate of 105 ml per hour) and lidocaine mouth rinse. The intubation process went smoothly and the patient was admitted to the Intensive Care Unit for further monitoring.Conclusion: Management of difficult airway settings is important due to morbidity and mortality. The use of dexmedetomidine is considered safe and effective in securing the airway in patients with difficult airway.
Effect of Preoperating Maltodextrin 12.5% Carbohydrate Drink on High Sensitive C Reactive Protein Levels Post-Brachytherapy Purwoko, Purwoko; Arianto, Ardana Tri; Putra, Eka Satrio; Purnomo, Frederick Johan
Indonesian Journal of Medicine Vol. 10 No. 3 (2025)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2025.10.3.853

Abstract

Background: Brachytherapy is radiation therapy that will cause inflammation and tissue damage that leads to inflammation, characterized by the release of pro-inflammatory cytokines, including hs-CRP levels in the plasma. Preoperative administration of glucose solution is known to reduce the increase in cortisol, and is thought to reduce postoperative hs-CRP levels. So far there has been no research that specifically examines the effect of preoperative carbohydrate administration on hs-CRP values after brachytherapy. This study aims to determine the effect of preoperative carbohydrate administration on post-brachytherapy hs-CRP values. Subjects and Method: This study was designed a double-blind randomized controlled trial was conducted at the Radiotherapy Unit of Dr. Moewardi General Hospital, Surakarta, from April to September 2022. Sixty-four cervical cancer patients with ASA physical status I or II undergoing brachytherapy under general anesthesia were recruited using consecutive sampling. Participants were randomly assigned into two groups: an intervention group receiving 12.5% maltodextrin solution and a control group receiving mineral water. The independent variable was preoperative carbohydrate administration, and the dependent variable was hs-CRP level measured 2 hours before and 4 hours after brachytherapy. Data were analyzed using paired t-test Results: Post-brachytherapy hs-CRP levels were significantly lower in the treatment group (mean = 2.565 ± 2.0 mg/dL) compared to the control group (mean = 3.69 ± 2.58 mg/dL; p = 0.019). Both groups showed significant increases in hs-CRP from pre- to postoperative values (p < 0.001). The change in hs-CRP (Δhs-CRP) was also significantly lower in the treatment group (p = 0.025). Conclusion: The administration of maltodextrin was able to significantly reduce post-brachytherapy hs-CRP levels compared to placebo.
Pengelolaan Neuroanestesi pada Pasien dengan Pentalogy of Fallot Putra, Eka Satrio; Suryandari, Retno; Purwoko, Purwoko; Arianto, Ardana Tri
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2770.473 KB) | DOI: 10.24244/jni.v9i3.273

Abstract

Pentalogy of Fallot (POF) salah satu jenis cacat jantung bawaan sianotik langka yang berpotensi tinggi komplikasi abses cerebri. Abses cerebri sering dijumpai pada kelainan jantung sianotik karena terjadinya hipoksia kronis dan yang kedua adalah hiperviskositas karena berkurangnya aliran mikrosirkulasi ke otak. Kami melaporkan seorang anak laki-laki berusia 6 tahun, berat badan 14 kg dengan abses otak multiple yang disertai dengan Pentalogy of Fallot (POF) yang akan dilakukan kraniotomi evakuasi abses. Pemeriksaan fisik preoperatif didapatkan GCS E4V5M6, SpO2 preductal 88%, post ductal 84 % dalam posisi supine. Pada sistem kardiovaskular didapatkan bunyi jantung I-II regular, bising sistolik terkuat di parasternal kiri ICS 3 grade 3, clubbing finger. Nilai hemoglobin 14,4gr%, hematokrit 43%, leukositosis 13,200/mm Tujuan anestesi pada penyakit jantung sianotik POF adalah menjaga curah jantung dengan mempertahankan denyut jantung, kontraktilitas juga preload, mencegah peningkatan rasio PVR:SVR serta menghindari hipersianosis akibat peningkatan mendadak kebutuhan oksigen sistemik. Pilihan agen anestesi harus didasarkan pada fisiologi pasien dan tujuan menyeimbangkan aliran darah paru dan sistemik. Rehidrasi yang adekuat sebelum induksi dan penggunaan diuretik manitol dapat dipertimbangkan mengingat hiperviskositas menurunkan pengiriman oksigen ke otak. Peningkatan TIK dari ketamine dapat dikurangi dengan hiperventilasi, kombinasi dengan benzodiazepin dan dengan pencegahan hipercapnia. Maka dari itu monitoring end tidal CO2 (ETCO2) perlu diperhatikan. Pengelolaan perioperatif pasien POF pada kasus evakuasi abses cerebri pada anak laki- laki usia 6 tahun pada laporan berikut ini menuliskan pentingnya pemahaman akan patofisiologi POF dan teknik neuroanestesi untuk mendapatkan luaran yang baik.Neuroanesthesia on Patient with Pentalogy of FallotAbstractPentalogy of Fallot (POF) is a rare type of cyanotic congenital heart defect with high risk of having cerebral abscesses as one of its complications. Cerebral abscesses are often found in cyanotic heart disease due to chronic hypoxia and hyperviscosity reduced microcirculatory flow to the brain. We report a 6-year-old boy, 14 kg body weight with multiple brain abscesses accompanied by Pentalogy of Fallot (POF) who undergone a craniotomy to evacuate the abscess. Preoperative physical examination found GCS E4V5M6, other vital signs within normal limits, preductal oxygen saturation 88%, post ductal oxygen saturation in supine position 84%. The I-II heart sounds are regular with grade 3 systolic murmur in the left parasternal third intercostal space and clubbing finger was found. The laboratory shows a hemoglobin value of 14.4gr%, hematocrit of 43%, leukocytosis 13,200/mm. The goal of anesthesia in cyanotic heart disease is to maintain cardiac output by stabilize heart rate, contractility as well as preload, prevent the increase of PVR:SVR ratio and avoid hypercyanotic due to sudden increase in systemic oxygen demand. The choice of anesthetic agent must be based on the patient's physiology. Adequate rehydration before induction and use of mannitol diuretics can be considered to reduce hyperviscosity that decrease oxygen delivery to the brain. Increased intracranial pressure from ketamine can be reduced by hyperventilation, in conjunction to benzodiazepines and prevention of hypercapnia. Therefore, monitoring end tidal CO2 (ETCO2) needs to be done. This case report delineating the perioperative management of a 6 years old boy with POF underwent evacuation of cerebral abscesses, will highlight the importance of understanding the pathophysiology of POF and neuroanesthesia techniques in order to receive a good outcome.
Pengaruh Pemberian Propofol Intravena terhadap Ekspresi Kaspase 3 Hipokampus pada Mencit Balb/C dengan Cedera Kepala Yani, Yusri; Arianto, Ardana Tri; Sudjito, M.H
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (277.15 KB) | DOI: 10.24244/jni.vol2i2.160

Abstract

Latar Belakang dan Tujuan: Cedera kepala masih menjadi penyebab utama kecacatan dan kematian. Dalam cedera kepala terjadi proses biomolekuler dan biokimiawi patologik yang dapat menyebabkan nekrosis maupun apoptosis melalui aktivasi kaspase 3. Propofol obat anestesi intravena mempunyai mekanisme neuroproteksi dengan pengaturan pada kaspase 3. Tujuan penelitian ini adalah meneliti keefektifan pemberian propofol 10 mg/kgbb, 25 mg/kgbb dan 50 mg/kgbb terhadap ekspresi kaspase 3 pada mencit balb/c dengan cedera kepala.Subjek dan Metode: Penelitian eksperimental laboratorik dengan desain randomized controlled trial group pada 32 ekor mencit Balb/c yang disuntik propofol intravena. Mencit dibagi menjadi 4 kelompok secara random, yaitu kelompok K1 sebagai kontrol. Semua kelompok diberi perlakuan cedera kepala dengan metode weight drop dan kemudian diberi propofol 10 mg; 25 mg; 50 mg/kgBB intravena untuk kelompok K2, K3, K4. Pemeriksaan aktivasi kaspase 3 menggunakan pengecatan khusus immunohistokimia setelah 6 jam pemberian propofol. Hasil dinilai dengan SPSS 19 dengan derajat kemaknaan p0,05.Hasil: Rata-rata persentase ekspresi kaspase 3: K1=4,08, K2= 2,95, K3= 2,52, K4=1,77. Perhitungan statistik dari semua kelompok menunjukkan signifikan (P=0,000). Perbandingan antar kelompok menujukkan: K1-K2 (p=000), K1-K3 (p=0,000), K1-K4 (p=0,000), K2-K4 (p=0,000), K3-K4 (p=0,000), sedangkan antara K2-K3 tidak ada perbedaan signifikan (P=0,232).Simpulan: Pemberian propofol 10,25,50 mg/kgbb menunjukkan hasil yang signifikan menghambat ekspresi kaspase 3 aktif dibandingkan dengan kontrol pada mencit yang diberi cedera kepala. Dari penelitian ini dapat ditarik simpulan bahwa pemberian propofol dosis 50 mg/kgbb merupakan dosis yang efektif untuk menurunkan ekspresi kaspase 3 aktif pada mencit dengan cedera kepalaThe Effect of Propofol Intravena to Expression of Caspase 3 in Hipocampus Mice Balb/C with Brain Injury Background and Objective: Head injury is a leading cause of disability and death. In head injury occurs biomolecular and biochemical processes that can lead to pathologic necrosis or apoptosis through the expression of caspase 3. Propofol an intravenous anesthetic drug has neuroprotective mechanism by setting the caspase 3. The objective of the research is to identify effect of propofol 10 mg/kg,25 mg/kg, and 50 mg/kg dose toward activation caspase 3 in Balb/c mice hipocampus with brain injury.Subject and Methods: This is a laboratory setting experiment with randomized post test only controlled group design. Thirty two balb/c mice makes head injury by given of weight drop and intravenous propofol. The mice were given the same procedure weight drop and intravenous propofol 10,25,50 mg/kg 6 hours after injury for the K2, K3, K4 group respectively. Activation of caspase 3 was studied by immunohistochemistry method 6 hours after intravenous propofol administration. Data was analized using Kruskal Wallis Test, cross-tabulation chi square, one way ANOVA and processed by SPSS program. Result: Means expression of caspase 3: K1= 4.08; K2 = 2.95; K3 =2.52; K4 = 1.77. The statistic result test among all groups show significant differences (p=0.000). The comparation of groups that have significant 82 Jurnal Neuroanestesia Indonesia outcome are: K1-K2 (p=0.00), K1-K3 (p=0.000), K1-K4 (p=0.000), K2-K4 (p=0.000), K3-K4 (p=0.000).There is no significant difference between K2-K3 (p=0.232). Conclusion: Administration of propofol 10, 25, 50 mg/kg intravenous after traumatic head injury show significant difference in hipocampus caspase 3 activation compared to control, group. From this research, we can also conclude that administering propofol in 50 mg is the effective dose to lowering expression of caspase 3 to mice, with given brain injury.
Anestesi untuk Malformasi Arnold Chiari Arianto, Ardana Tri; Sudjito, M.H
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2509.54 KB) | DOI: 10.24244/jni.vol3i3.146

Abstract

Malformasi Arnold-Chiari, merupakan suatu bentuk malformasi pada otak. Pada malformasi ini terjadi pergeseran (displasi) tonsila serebelum ke arah bawah melalui foramen magnum (lubang di basis kranii), yang terkadang menyebabkan hidrosefalus non-komunikans sebagai akibat terjadinya obstruksi aliran keluar dari cairan serebrospinal. Seorang wanita 23 tahun datang dengan keluhan sering pusing, nyeri tengkuk, serta kelemahan pada lengan kanan. CT Scan dan MRI didapatkan gambaran cerebellar tonsil yang mendukung Arnold Chiari Malformation. Dilakukan operasi osteotomi suboccipital dengan posisi prone. Rumatan anestesi dengan sevoflurane 1 vol% dan O2: udara 1,5: 1,5, analgetik fentanyl 25 mcg tiap 30 menit, pelumpuh otot vecuronium 3 mg/jam. Operasi berlangsung selama 2 jam 45 menit. Hemodinamik selama operasi stabil. Dilakukan ekstubasi segera di kamar operasi. Pascaoperasi pasien dirawat di unit intensif selama sehari. Hemodinamik selama di ICU stabil. Tidak ada keluhan selama di ICUAnesthesia for Arnold Chiari MalformationArnold-Chiari's malformation, is a brain malformation caused by the displacement of the cerebellar tonsil caudally into the foramen magnum, which in some cases will cause obstruction of the cerebrospinal fluid flow, resulting in a communicating hydrocephalus condition. A 23 years old female patient with a chief complaint of having frequent dizzines, painful neck, and weakness of the right arm. CT scan and MRI reveal cerebellar tonsil imaging that support the diagnosis of Arnold-Chiari's malformation. Surgical procedure was performed using suboccipital osteotomy approach in a prone position. Maintenance anesthesia with sevoflurane 1 vol% and O2: air 1,5: 1,5, analgetic fentanyl 25 mcg every 30 minute, muscle relaxant vecuronium 3 mg/hour. The time of surgery was 2 hours and 45 minutes. Hemodynamics were stable during the procedure. Patient was extubated early after surgery at operating room, and admitted to the ICU for 24 hours. Hemodynamics parameter were stable, without any remarkable events.
Kerusakan Barier Pertahanan Alamiah: Sawar Darah Otak Arianto, Ardana Tri; Sudjito, M. H
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3160.98 KB) | DOI: 10.24244/jni.vol4i1.105

Abstract

Sawar Darah Otak (SDO) adalah struktur membran yang secara primer memisahkan serta memfiltrasi darah ataupun zat dari sirkulasi sistemik yang masuk ke dalam sirkulasi otak. Sawar Darah Otak merupakan penghalang fisik antara pembuluh darah lokal dan sebagian besar dari sistem saraf pusat itu sendiri, dan tempat berhentinya zat makromolekul. Konsep Sawar Darah Otak pertama kali diperkenalkan oleh Paul Ehrlich. Paul Ehrlich menemukan bahwa injeksi intravena perwarna ke dalam aliran darah meninggalkan noda pada seluruh jaringan di sebagian besar organ kecuali otak. Pada trauma kerusakan sawar darah otak banyak diakibatkan oleh rusaknya integritas membrane sawar darah otak dan pada tumor disebabkan oleh peningkatan permeabilitas sawar darah otak akibat invasi sel tumor. Pada keadaan trauma, disfungsi sawar darah otak dapat terjadi secara cepat ataupun lambat, gangguan dari kompleks tight junction dan integritas membran menghasilkan peningkatan permeabilitas seluler. Sedangkan tumor otak dapat menyebabkan peningkatan permeabilitas sawar darah otak, pembengkakan jaringan sekitar tumor, dan terjadi absorpsi serta pengeluaran cairan dan protein dengan cairan serebrospinal di ventrikel. Terapi kortikosteroid menurunkan ekspresi dari vascular endothelial growth factor (VEGF) yang diproduksi edema yang terikat dengan sel endotel. Pengelolaan perioperatif penting untuk mengetahui hal-hal yang berkaitan tentang sawar darah otak dikarenakan kompleksitas dari anatomi, fisiologi, fungsi transpor sampai hubungan antara sawar darah otak dengan gangguan neurologis seperti yang terdapat pada kasus cedera otak traumatik dan tumor otak.Disruption of Natural Defense Barrier: Blood-Brain BarriereThe blood brain Barrier (BBB) is a structural membrane that separates and filters blood and subtances that enters the cntral nervous system from systemic circulation. It is a physical barrier between the local blood vessels and most parts of the central nervous system itself, and the flow of macro substances. The concept of the blood brain barrier was first introduced by Paul Ehrlich. He found that intravenous injection of dyes into the bloodstream stained all the tissues in most organs except the brain. In traumatic brain injury, vascular disruption causes damage to integrity of the membrane BBB while in case of tumor, there's an increase of permeability due to tumor cell invasion. In traumatic brain injury , the onset of BBB dysfunction can be immediate or delayed, increased cellular permeability is the result of thr damage of the tight junction complex and membrane integrity. Brain tumor can increase the permeability of BBB edema in the surrounding area, and cause absorption and excretion of cerebrospinal fluid and protein in to the ventricel. Corticosteroid therapy can reduce the expression of vascular endothelial growth factor (VEGF) in the edematous endothelial cells. Perioperative mamagemrnt requires comprehensive knowledge of the complexity of blood brain barrier's anatomy, physiology, transport function, and the relation between BBB with neurologic dysfunctions which are commonly seen in traumatic brain injury and tumor.
Co-Authors Alfianto, Untung Anindita Anindita Arif Ramadhan, Alriztya Arif Wahyu Widayat Bambang Novianto Putro Budi Santosa, Sugeng Djoko Tjahyo Nugroho Faras, Asaduddien Fritzky Indradata Hadian, Ingga Heri Dwi Purnomo Heri Dwi Purnomo Indra Chuandy Kaligis, Stephanus Andy Prakasa Muh. Husni Thamrin Muhammad Husni Thamrin Muhammad Husni Thamrin, Muhammad Husni Purnomo, Frederick Johan Purwoko Purwoko Purwoko Purwoko Putra, Eka Satrio Putro, Bambang RTH Supraptomo Siregar, Geovaldy Stephanus Andy Prakasa Kaligis Sudjito, M. H Sudjito, M. H Sudjito, M.H Sudjito, M.H Sugeng Budi Santosa Sugeng Budi Santosa Sugeng Budi Santoso Suryandari, Retno Syarif Afif Utama, Sigit Prastya Wicaksono, Nefrizal Yani, Yusri Yani, Yusri