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INDONESIA
Jurnal Komplikasi Anestesi
Published by Universitas Gadjah Mada
ISSN : 23546514     EISSN : 26155818     DOI : https://doi.org/10.22146/jka.v11i2.12773
Core Subject : Health,
Medicine & Pharmacology
JURNAL KOMPLIKASI ANESTESI (e-ISSN 2354-6514) is a scientific and original journal which published as a forum for various scientific articles including research, literature reviews, case reports and recent book reviews. The presence of this journal, it is hoped that it can provide input of knowledge and knowledge in the field of Anesthesiology and Intensive Therapy for medical personnel.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 317 Documents
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Manajemen Anestesi pada Pasien Sectio Caesarea dengan Preeklamsia Berat dan Edema Pulmo Rahardjo, Sri; Suryono, Bambang; Rudita, Muhammad
Jurnal Komplikasi Anestesi Vol 10 No 3 (2022)
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.v10i3.7379

Abstract

Perawatan multi modal yang memastikan oksigenasi optimal dan hemodinamik stabil denganjumlah cairan minimal tampaknya bisa dibenarkan. Dengan tidak adanya pemahaman lengkap tentang patogenesis edema pulmo, untuk mengurangi komplikasi ibu dan janin, manajemen terutama didasarkan pada pengobatan gejala dan tanda-tanda efek sekunder preeklamsia. Manajemen pasien ini idealnya harus multidisiplin dan ahli anestesi harusterlibat dalam perawatan pasien sejak tahap awal. Asesmen awal yang cermat oleh ahlianestesi direkomendasikan untuk semua pasien dengan preeklamsia, terutama dalam kasus yang berat. Kecuali ada kontraindikasi yang diketahui sebelumnya, seperti koagulopati, anestesi regional direkomendasikan untuk pasien preeklamsia. Mengingat risiko anestesi umum pada pasien dengan preeklamsia, anestesi spinal harus dipertimbangkan dalam kasus-kasus urgensi tanpa mengesampingkan anestesi epidural. ketika diperlukan anestesi umum, sangat penting untuk mengantisipasi dan mengobati tekanan darah yang tidak stabil. Jugapenting untuk dipersiapkan untuk manajemen jalan nafas ibu yang sulit, mengingat peningkatan risiko edema faringolaringeal.
Manajemen Anestesi Pasien Obstetri yang Menjalani Sectio Caesarea Emergency Indikasi Gagal dengan Preeklampisa Berat dan Asma Intermittent Sedang Suryono, Bambang; Apsari, Ratih Kumala Fajar; Nurdiansyah, Elba
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (2019)
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.v7i1.7380

Abstract

Penanganan perioperatif asma pada ibu hamil, perlu mendapat perhatian lebih, dikarenakan selain menyangkut keselamatan ibu juga keselamatan janin. Sebisa mungkin pasien dioptimalkan kondisipreoperatifnya, namun bila tidak memungkinkan, diperlukan pemilihan tehnik anaestesi yang dapat meringankan kondisi asma ibu dengan memilih obat-obat yang memiliki efek bronkodilatasi, non histamine release dan meringankan edema jalan nafas. Pasien ini dipilih teknik epidural dikarenakan tidak menimbulkan gejolak hemodinamik yang berarti, memberikan fasilitas analgesia anestesia selama tindakan operasi, resiko sulit intubasi dapat dihindarkan serta dapat digunakan sebagai modal analgesi paska operasi yang adekuat. Dengan mengoptimalkan kondisi preoperatif pasien, morbiditas terhadap pasien dapat diminimalkan dan memberikan outcome yang baik terhadap ibu maupun bayinya.
Penatalaksanaan Intensif Badai Thyroid pada Wanita Hamil Jufan, Akhmad Yun; Apsari, Ratih Kumala Fajar; Apriyanto
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (2019)
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.v7i1.7381

Abstract

Anesthesia management was conducted in a case of female 33 years old with G4P2A1, 35 weeks of pregnancy, type I respiratory failure, suggestive Thyroid Storm, CAP, anemia, and hypoalbuminemia. In emergency admission, patient was found dyspneic, agitated, measured BP is 117/60 mmHg, HR 153 x/min, RR 35 x/min, temperature 37,8oC, no wheezing or rales in physical examination. From ECG evaluation was STC 148 x/min, AF RVR. According to Burch and Wartofsky scoring, obtained score is 60, from temperature (score 5), tachycardia ≥140 (score 25), AF (score 10), agitated (score 10), and pregnancy as a precipitating factor (score10). Thyroid crisis can be diagnosed if scoring more than 45 points. The patient was intubated, and connected to mechanical ventilation, and admitted to HCU. In HCU, the patient was given supportive therapy, invasive monitoring such as CVC and parenteral nutrition. Causative therapy such as antibiotic administration, lugol, PTU, corticosteroid and propanolol were also given. During HCU admission, patient’s condition had not improved because of gravis anemia, after 3 days in HCU, patient was moved to ICU admission for 5 days, in 4th day of ICU admission, pregnancy was terminated, and in 5th day, patient was moved to maternal ward.
Hubungan Antara Mikroalbuminuria dan Skor SOFA pada Pasien Sepsis yang Dirawat di ICU RSUP Dr Sardjito Sulistiyantoro, Antonius Catur; Widodo, Untung; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (2019)
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.v7i1.7382

Abstract

Background: Sepsis causes release of inflammatory mediator to circulation. The inflammatory molecules and oxidative stress increase the capilar permeability include the glomerular renalis. An early event is the loss of barrier integrity leading to systemic capillary leakage. The glomerular manifestation of this increased permeability is increased excretion of albumin in the urine. Microalbuminuria, defined as 30–300 mg/day of albumin excretion in the urine, occurs rapidly after an acute inflammatory insult such as sepsis. SOFA scoreis one of parameter to asses the degree of organ dysfunction severity.Purpose: The purpose of this study was to determine the correlation between microalbuminuria and SOFA score in patient with sepsis in ICU Dr. Sardjito Government General Hospital.Methods: This observational study was conducted in ICU Dr. Sardjito Government General Hospital between January-July 2019. Inclusion criteria were all patients with sepsis admited to ICU (≥18 years old), exclusion criteria were patient with diabetic mellitus, anuria, chronic kidney disease, pregnant, urological trauma, nephrotic syndrome, urinary tract infection. urine samples were collected per 24 hour (Day-1st), 48 hour (Day-2nd) and 72 hour (Day-3st). The microalbuminuria was measured in hospital laboratory. The SOFA score evaluated every day. The correlation between SOFA score with microalbuminuria was analyzed with SPSS.Result: Total 35 subject included, 20 subject excluded, 1 subject dropout. The study included 57,1% male and 42,9% female, mean of SOFA score were 9,4 ± 3,4, mean of microalbuminuria were 132 ± 75,2 mg/l. Subject with septic shock were 42,9% and all of subject required mechanical ventilation. Mortality rate were 50%, the major infection sourced was respiratory tract (42,9%), and the major bacteria was Acinebacter baumanii. The mean of SOFA score in survivor subject were 6,43 ± 2,80 and not survivor were 10,34 ± 3,00, the microalbuminuria in survivor subject were 82,10 ± 70,73 mg/l and not survivor were 167,71 ± 46,81 mg/l. There was positive correlation between microalbuminuria and SOFA score with strength correlation r: 0,627, p: 0,016. SOFA score >7 had risk 16 times to die, and microalbuminuria >156,35 had prognostic risk 36 times to die.Conclusion: There was positive correlation between microalbuminuria level and SOFA score in septic patients in ICU Dr. Sardjito Government General Hospital.
Pengaruh Midazolam Dosis 10 mg/kgbb dan 40 mg/kgbb pada Ekspresi m-RNA Gen BAX di Otak Tikus Wistar Irawan, Tony; Sudadi; Sari, Djayanti
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (2019)
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.v7i1.7391

Abstract

Latar Belakang: Neurotransmiter GABA dan NMDA berperan penting pada sel otak yang masih mengalami perkembangan saraf. Secara umum, agen anestesi bekerja pada kedua neurotransmiter tersebut. Midazolam menghambat neurotransmisi dengan cara potensiasi reseptor GABA. Paparan pada reseptor GABA mengganggu perkembangan sel saraf dan memicu terjadinya proses apoptosis yang ditandai dengan peningkatan gen pro apotosis seperti Bax, Bak dan Bim.Metode: Penelitian ini merupakan penelitian experimental control trial, sampel dibagi menjadi 3 kelompok. 27 tikus dibagi menjadi kontrol NaCl 0,9% (n= 9), midazolam 10 mg/kgbb (n= 9), midazolam 40 mg/kgbb (n= 9) disuntikkan secara intraperitoneal. Kemudian otak tikus di setiap kelompok diambil dengan potong beku. Ekspresi gen proapoptosis mRNA Bax kemudian diukur dengan PCR.Hasil: Pemberian midazolam dengan dosis 10 mg/kgbb dan midazolam dosis 40 mg/kgbb terjadi peningkatan ekspresi gen-Bax dan bernilai signifikan < 0,05 jika dibandingkan kelompok kontrol.Kesimpulan : Terdapat peningkatan signifikan ekspresi gen bax pada pemberian midazolam dosis 10 mg/kgbb dan 40 mg/kgbb pada otak tikus wistar yang masih mengalami perkembangan saraf.
Anestesi pada Pembedahan Non-Obstetri dalam Kehamilan Apsari, Ratih Kumala Fajar; Uyun, Yusmein; Suryasaputra, Wahyu
Jurnal Komplikasi Anestesi Vol 7 No 1 (2019): Volume 7 Number 1 (2019)
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.v7i1.7392

Abstract

Non-obstetric surgery during pregnancy posts additional concerns to anesthesiologists. The chief goals are to preserve maternal safety, maintain the pregnant state and achieve the best possible fetal outcome. The choice of anesthetic technique and the election of appropriate anesthetic drugs should be guided by indication for surgery, type, and site of the surgical procedure. Anesthesiologist must consider the effects of the disease process itself and inhibit uterine contractions and avoid preterm labour and delivery. Fetal safety requires avoidance ofpotentially dangerous drugs and assurance of continuation of adequate uteroplacental perfusion. Until date, no anesthetic drug has been shown to be clearly dangerous to the human fetus. The decision on proceeding with surgery should be made by multidisciplinary team involving anesthesiologists, obstetricians, surgeons and perinatologists. This referral aims to discuss the physiological changes of pregnant patients who will undergo non-bstetric surgery and anesthesia management for non-obstetric operations of pregnant patients.
Hubungan Antara Neutrophyl-Lymphocyte Ratio dan Kadar Prokalsitonin Plasma pada Pasien Sepsis yang Dirawat di Ruang Intensif RSUP Dr Sardjito Wibowo, Erry Alamsyah Asjhuri; Kurniawaty, Juni; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
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.v7i2.7446

Abstract

Background: The immune response of leukocytes to physiological stresses such as tissue damage, severe trauma, major surgery and sepsis is characterized by increased neutrophil levels and decreased lymphocyte levels. In pathological conditions due to severe infection or systemic inflammation, the NLR will increase, so that NLR can be used for clinical evaluation in patients with systemic inflammation. This study aims to determine whether there is a correlation between alteration of Neutrophyl-lymphocyte ratio and plasma procalcitonin as a parameter of infection severity in sepsis patients treated in intensive care RSUP Dr Sardjito. Methods: Prospective observational correlation study. The study was conducted in Intensive care RSUP Dr. Sardjito Yogyakarta for 5 months (starting June 2019). Subject: 29 patients of sepsis admitted to intensive care RSUP dr. Sardjito on June-October 2019. Results: Positive correlations between Neutrophil-lymphocyte ratio and plasma procalcitonin on day 0, day 1 and day 3 of observations, r=0,220 (very weak), r=0,389 (moderate), and 0,065 (very weak). Positive significant correlation was found on day 1 of observation. Meanwhile, on analysis between Neutrophillymphocyte ratio and plasma procalcitonin, Positive correlations were obtained on day 0-1, day 1-3 and day 0-3 of observations, r = 0.159 (very weak), r = 0,450 (moderate) and 0,235 (very weak). The significant positive correlation (p<0.05) was found in alterations between day 1-3. Conclusion: There were no strong correlations between Neutrophyl-lymphocyte ratio and plasma procalcitonin in sepsis patients treated at ICU RSUP Dr Sardjito on day 1 of observation.><0.05) was found in alterations between day 1-3. Conclusion: There were no strong correlations between Neutrophyl-lymphocyte ratio and plasma procalcitonin in sepsis patients treated at ICU RSUP Dr Sardjito on day 1 of observation.
Efek Pemberian Premedikasi Deksametason Terhadap Durasi Rokuronium Dibanding Placebo pada Anestesi Umum Intubasi Adi, Danis Woro Kuncoro; Uyun, Yusmein; Apsari, Ratih Kumala Fajar
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
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.v7i2.7447

Abstract

Background: Dexamethasone is often used as prevention and treatment for postoperative nausea and vomiting, reducing the severity of postoperative pain and analgesic requirements. The study of dexamethasone effects on the rocuronium duration might be beneficial in patients who have contraindications to neostigmine or atropine reversal. Purpose: To evaluate the relation between rocuronium duration with dexamethasone premedication compare with placebo in patient with general anesthesia intubation procedure with rocuronium neuromuscular blocking agent in GBST RSUP Dr. Sardjito. Methods: An experimental research design, randomized clinical trial with double blind. The sample was chosen using the non-probability sampling method in a consecutive manner in 3 months. Sample was divided into two groups: group receiving dexamethasone premedication and group receiving placebo NaCl 0.9%. Time monitoring starts after the TOF shows the number 0 until it reaches TOF 0.9. Results: The study was conducted on 58 research subjects. Numeric data was analysed using independent T test and categorical data was analysed using chi square. Dexamethasone premedication was found to reduce the duration of rocuronium with the time needed to reach TOF 0.9 was 111±14.33 minutes compared with 123±14.57 minutes in the placebo group (P = 0.003). Conclusion: Dexamethasone premedication shortens the duration of rocuronium compared to the administration of placebo under intubation general anesthesia.
Hubungan Nilai “Lung Ultrasound Score (LUS)” dengan P/F Ratio pada Pasien Pneumonia yang Dirawat di ICU RSUP Dr Sardjito Wibowo, Catur Prasetyo; Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
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.v7i2.7448

Abstract

Background: Respiratory tract disease (about 22.4%) is the frequent reason of admitting patients to the Intensive Care Unit (ICU), with 72.6% of it is caused by infection, such as pneumonia. On patient with pneumonia, there will be impairment in oxygen diffusion from alveoli to the blood flow that can affect the P/F ratio. Lung ultrasonography is directly proportional to the degree of pulmonary aeration or the ratio of air to liquid composition in the lung. Changes in pulmonary aeration can be detected accurately using pulmonary ultrasonography. Objectives: Knowing the relationship of “Lung Ultrasound Score (LUS)” with P/F ratio as a parameter to assess the degree of oxygenation in pneumonia patients treated at ICU Dr. Sardjito General Hospital. Methods: The design of this study was cross sectional study. In this study, every single sample will be examined only one time to obtain Lung Ultrasound Score (LUS) and arterial blood gas analysis (BGA) sampling to get the P/F ratio. LUS measurement was done by performing pulmonary ultrasonography at 12 predetermined examination points (6 in the left hemithorax and 6 in the right hemithorax) then scoring (0-3) per examination point, the total scoring from the 12 examination points is the result of the LUS sample. Inclusion criteria in the subjects of this study were >18 years of age, diagnosed pneumonia (score ≥6 from CPIS score), intubated with mechanical ventilation, and the candidate could be mobilized slightly right and left incline. While exclusion criteria were, patients with unstable hemodynamics (HR <60x / min or>130x / min and MAP <70mmHg or>120mmHg), pulmonary trauma, patients undergoing hemodialysis, there are contraindications to the oblique position (spinal cord injury), patients with wound dressing on the chest, and patients with morbid obese (BMI> 40). Results: There were 60 subjects in this study. Patient observation pointed that have high P/F ratio values tend to have lower Lung Ultrasound Score (LUS) values. Based on the correlation results, the value of p = 0.010 (p <0.05) with the correlation coefficient (r) = -0.332 had a negative sign which means there is a significant negative correlation between the value of Lung Ultrasound Score (LUS) with the P / F ratio with the closer relationship of the category weak (0.2 - 0.399). Conclusion: The higher the P/F ratio, the lower the LUS value in patients with pneumonia who were getting mechanical ventilation in ICU Dr. Sardjito.
Hubungan Rasio Netrofil Limfosit dengan Ketebalan Dinding Diafragma pada Pasien Kritis Haloho, Agustina Br; Sedono, Rudyanto; Sugiarto, Adhrie; Zulkifli
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
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.v7i2.7449

Abstract

Background: The cause of weaning failure is multifactorial. One of the causes was Ventilator Induced Diaphragm Dysfunction (VIDD) due to thinning process of the diaphragm thickness. Decreased diaphragm muscle mass might occur due to inflammatory process. This study was aimed to find the relationship between neutrophil to lymphocyte ratio (NLR) with diaphragm thickness of critical patients in ICU. Methods: This was an observational analytic study from September 2018 to January 2019 in Mohammad Hoesin Hospital, Palembang – Indonesia. Ethical appoval for the study was obtained from Ethics Committee and subjects were recruited after signing the informed consents. Only 30 subjects were involved in the end of the study. About 6 mL of blood sample from cubital vein was withdrawn from each subject to measure neutrophils and lymphocytes. Patients’ diaphragm thickness was measured by using ultrasonography on 0th, 3rd, 5th day. Collected data were then analyzed with Stata 15. Results: The chi-square test showed that the relationship of NLR (neutophil to lymphocyte ratio) of the 0th day to the decrease in diaphragm thickness on the 3rd day was not significant (p = 0.254), while the decrease in diaphragm thickness on the 5th day was significant (p = 0.015). Subjects with initial NLR values >7 had a significant higher risk of having decreased diaphragm thickness compared to subjects with initial NLR values ≤7 (RR = 1.62 (0.99-2.64); p-value = 0.003). Conclusion: Neutrophil to lymphocyte ratio affected the decrease of diaphragm thickness in patients using mechanical ventilation.

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