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All Journal PREPOTIF : Jurnal Kesehatan Masyarakat Sehat Rakyat: Jurnal Kesehatan Masyarakat
I Ketut Wibawa Nada
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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THE EFFECTIVENESS OF POSTOPERATIVE PERICAPSULAR NERVE GROUP ANALGESIA BLOCK IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENT WITH REGIONAL ANESTHESIA SUBARACHNOID BLOCK I Gede Prima Julianto; I Made Gede Widnyana; Kadek Agus Heryana Putra; I Ketut Wibawa Nada; I Gusti Ngurah Mahaalit Aribawa; Ida Bagus Krisna Jaya Sutawan; Made Wiryana; Tjokorda Gde Agung Senapathi
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 1 (2024): APRIL 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i1.27258

Abstract

Penggunaan blok saraf kelompok perikapsular (PENG) dapat menjadi alternatif analgesia post-operatif yang efektif untuk Penggantian Sendi Panggul Total, dengan komplikasi rendah. Penelitian ini bertujuan untuk menentukan efektivitas analgesia blok PENG terhadap tingkat nyeri, jumlah konsumsi opioid dalam 24, 48, dan 72 jam serta analgesia post-operatif THR di Rumah Sakit Prof. Dr. I. G. N. G. Ngoerah Denpasar. Penelitian ini adalah studi eksperimental dengan desain uji acak terkontrol buta tunggal yang dilakukan di ruang operasi Instalasi Bedah Sentral Rumah Sakit Prof. Dr. I. G. N. G Ngoerah, Denpasar. Uji perbandingan rata-rata menggunakan uji Mann-Whitney jika distribusi data tidak normal. Seluruh proses analisis data di atas menggunakan perangkat lunak statistik SPSS 26. Ada 48 subjek yang menjalani THR dan dibagi menjadi 2 kelompok. Ada perbedaan yang signifikan secara statistik antara kelompok-kelompok tersebut. Berdasarkan hasil analisis non-parametrik, NRS saat istirahat dan bergerak di kelompok perlakuan lebih rendah daripada kontrol dengan nilai p <0,001. Jumlah opioid yang diperoleh memiliki nilai p <0,001 dalam 24 jam pertama, 48 jam, dan 72 jam. Durasi efek ditemukan lebih lama pada kelompok PENG dibandingkan dengan kontrol (p <0,001). Pemberian blok PENG selama prosedur THR menghasilkan NRS yang lebih rendah pada 24 jam, penggunaan opioid yang lebih rendah pada 24 jam, 48 jam, dan 72 jam pascaoperatif, dan durasi efek bebas nyeri yang lebih lama.
Epidural Anesthesia for Elective Cesarean Section in a Parturient with Noonan Syndrome and Severe Pulmonary Stenosis: A Case Report Kadek Agus Putra Udayana; I Gusti Ngurah Mahaalit Aribawa; I Ketut Wibawa Nada
Sehat Rakyat: Jurnal Kesehatan Masyarakat Vol. 5 No. 1 (2026): Februari 2026
Publisher : Yayasan Pendidikan Penelitian Pengabdian Algero

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54259/sehatrakyat.v5i1.5940

Abstract

Pregnancy complicated by congenital heart disease (CHD) presents significant anesthetic challenges, particularly in syndromic conditions such as Noonan syndrome characterized by pulmonary stenosis and multiple right-sided valvular abnormalities. We report a 27-year-old primigravida at 37+5 weeks of gestation with a clinical suspicion of Noonan syndrome, severe pulmonary stenosis, tricuspid and pulmonary valve regurgitation, and right heart failure classified as New York Heart Association (NYHA) class II, who underwent an elective cesarean section combined with intrauterine device (IUD) insertion. An incremental epidural block using 0.5% bupivacaine was selected to provide adequate anesthesia, prevent airway manipulation, and maintain optimal hemodynamic stability under continuous invasive monitoring, including arterial and central venous pressure assessment. The intraoperative and postoperative periods proceeded uneventfully, with stable maternal parameters and a vigorous neonate, both demonstrating favorable recovery and no postoperative complications. This case underscores the importance of an individualized anesthetic approach, meticulous titration of anesthetic agents, and comprehensive perioperative monitoring to ensure safety and positive outcomes in parturients presenting with complex congenital cardiac conditions such as Noonan syndrome.
Manajemen Anestesi Perioperatif pada Kraniotomi pada Pasien dengan Tetralogy of Fallot: Laporan Kasus Faridatun Hasanah; I Ketut Wibawa Nada; I Gusti Ngurah Mahaalit Aribawa
Sehat Rakyat: Jurnal Kesehatan Masyarakat Vol. 5 No. 1 (2026): Februari 2026
Publisher : Yayasan Pendidikan Penelitian Pengabdian Algero

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54259/sehatrakyat.v5i1.6098

Abstract

Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease characterized by a right-to-left shunt, predisposing patients to complications such as brain abscess due to paradoxical emboli and chronic hypoxemia. Perioperative anesthetic management in non-cardiac neurosurgery presents a dual challenge: maintaining stable TOF hemodynamics while ensuring neuroanesthetic safety. This report describes an 18-year-old female presenting with progressive headache and a single episode of generalized seizure. Baseline oxygen saturation was 71% on 4 L/min O₂, hemoglobin 16.1 g/dL, and hematocrit 52.6%. Computed tomography revealed a right frontotemporal brain abscess with subfalcine herniation, and echocardiography confirmed classic TOF with severe pulmonic stenosis. The patient, classified as ASA III, underwent abscess-evacuation craniotomy under invasive monitoring. Anesthetic strategy included premedication with midazolam and sufentanil, induction with titrated ketamine and rocuronium, and maintenance with ≤1 MAC sevoflurane without N₂O. Protective ventilation targeted normocapnia (ETCO₂ 35–40 mmHg) and oxygen saturation of 72–78%. Hemodynamic stability was achieved using titrated vasopressors and isotonic fluids. The four-hour surgery proceeded uneventfully, with no occurrence of tet spells or arrhythmias. Key perioperative principles emphasized preserving systemic over pulmonary vascular resistance, maintaining neuroprotection through normocapnia, normothermia, and adequate analgesia, and individualized hemodynamic management. The patient was successfully extubated on postoperative day two and discharged from the ICU on day four without complications. This case underscores the critical importance of a structured, multidisciplinary approach in managing perioperative anesthesia for TOF patients undergoing neurosurgery, balancing cardiac physiology and neuroanesthetic safety.
Co-Authors Faridatun Hasanah I Gede Prima Julianto I Gusti Ngurah Mahaalit Aribawa I Made Gede Widnyana Ida Bagus Krisna Jaya Sutawan Kadek Agus Heryana Putra Kadek Agus Putra Udayana Made Wiryana Tjokorda Gde Agung Senapathi