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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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Tatalaksana Komplikasi Prosedur Laparoskopi pada Pasien dengan Komorbid Obesitas Saputra, Dya; Pratomo, Bhirowo Yudo; Sudadi
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
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.v11i1.12663

Abstract

The main problems with laparoscopy are related to cardiopulmonary effects due to pneumoperitoneum, systemic absorption of carbon dioxide, extraperitoneal gas insufflation, venous gas embolism, injury to intra-abdominal structures and position of the patient, especially in laparoscopic cholecystectomy which is a procedure performed in the upper abdominal region.Therefore the author will discuss the complications of anesthesia in laparoscopic procedures and the management that can be done to prevent and treat these complications. Characteristics of the hemodynamic response begins with a decrease in cardiac index after intraperitoneal insufflation of CO2 gas and is followed by recovery. Compression of the abdominal organs as a result of increased intra-abdominal pressure and increased sympathetic may be one of the causes of increased cardiac filling pressure which can also be associated with increased intrathoracic pressure due to pneumoperitoneum. Insufflation of the intraperitoneal space with CO2 gas produces a pneumoperitoneum, a systemic effect of CO2 absorption and a reflex increase in vagal tone that can develop into arrhythmias
USG Guiding Spinal Anesthesia pada Sectio Caesarea Saputra, Dya; Sudadi, Sudadi; Wisudarti, Calcarina Fitri Retno
Jurnal Komplikasi Anestesi Vol 11 No 2 (2023)
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.v11i2.12664

Abstract

The practice of using central neuraxial block (CNB) techniques is now increasingly being done. In principle, this technique is highly dependent on the palpation of anatomical markings in bones, along with feedback from tactile sensations when inserting needles. Although anatomic landmarks are useful, they are often difficult to find or feel in patients pregnancy with obesity, changes in the patient's anatomical structure, edema in the back, and underlying spinal abnormalities or after spinal surgery. Recent years have seen increasing interest in the use of ultrasound for interventions in regional anesthesia. Ultrasound is non-invasive, safe, easy to use, can be done quickly, does not involve exposure to radiation, provides real-time images, is free of side effects, and may also be beneficial in pregnancy with obesity and abnormal spinal anatomy
Management of Diabetes Insipidus After Sublabial Transsphenoidal Hypophysectomy Surgery Prasamya, Erlangga; Wisudarti, Calcarina Fitriani Retno; Widodo, Untung; Jufan, Ahmad Yun
Jurnal Komplikasi Anestesi Vol 11 No 2 (2023)
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.v11i2.12773

Abstract

Summary A 36-year-old female patient was diagnosed with diabetes insipidus after sublabial transsphenoid hypophysectomy (SLTH) surgery. The patient had pituitary adenoma. The patient undergoes 14 days of care in the ICU with titrated intravenous vasopressin dose(0,01-0,3unit/hour) and later subcutaneous dose(6-13unit/8 hours). Subcutaneous vasopressin started on day 3 while intravenous was tapering down; at the early transition from the intravenous vasopressin route to the subcutaneous vasopressin route on day 7, there is a sharp surge of urine production as well at plasma sodium level. The intravenous vasopressin started again, along with the elevated dose of subcutaneous vasopressin. The patient shows a response to therapy after a watchfully titrated dose. Background Diabetes insipidus is a combination of signs and symptoms generating a plentiful volume of urine and causing elevated serum osmolality. There are two types of diabetes insipidus: central diabetes insipidus and nephrogenic diabetes insipidus. Central neurogenic diabetes insipidus occurs when the production of the hormone Arginine Vasopressin (AVP) is low. In contrast, nephrogenic diabetes insipidus occurs when the kidneys cannot respond to high levels of the hormone AVP. Postsurgical central insipidus can be categorized into transient, permanent, and triphasic. Transient courses of diabetes insipidus following surgery represent most of the cases. Temporary diabetes insipidus is thought to be caused by temporary dysfunction of AVP-producing neurons as a result of direct surgical trauma or indirect after-surgical edema. The incidence of diabetes insipidus in patients who underwent pituitary surgery is 5%, and 4.6% of these patients will have only transient diabetes insipidus, and only 0.4% became permanent. Transphenoidal surgery is considered a minimally invasive and effective procedure for pituitary adenomas. Diabetes Insipidus after this surgery is not an uncommon complication, even though the reported rate of postsurgical central diabetes insipidus varies widely from 1 to 67%. Postoperative temporary diabetes insipidus gradually resolves up to 6 months. Case Presentation A 36-year-old female patient presented chief complaints of headache and blurred vision, which gradually worsened one year ago. After undergoing several examinations, the patient was diagnosed with pituitary adenoma. The patient underwent a sublabial transsphenoidal hypophysectomy. The duration was three long hours and uneventful. On Day 0, the patient arrived at the intensive care unit (ICU) intubated, hemodynamically stable, and sedated. The patient is then monitored and weaned; a brain protection strategy and strict fluid balance urine collection and pain management are applied. On day 1, the patient was then extubated. The patient was examined for several parameters, such as electrolytes, kidney function, and blood glucose level. The patient began to significantly increase urine output (>5 milliliters/kilogram body weight/hour). Increased urine production is accompanied by a simultaneous decrease in urine-specific gravity (<1.005) and an increase in serum sodium level up to 151 mmol/liter. The patient was diagnosed with postsurgical diabetes insipidus. The patient started receiving intravenous vasopressin at a dose of 0.3 units/hour and titrated according to urine production until the target urine output was reached after the third day of care. After urine is reached, the dose of vasopressin slowly decreases, and the administration begins to transition to the subcutaneous route. On day 7 of treatment, when the intravenous vasopressin dose had been discontinued and the vasopressin dose at the 8u/h point, there was a significant urine production spike and an increase in the plasma sodium level to 156 mmol/liter. On the eighth day of treatment, the administration of vasopressin was again given intravenously and subcutaneously until a decrease in urine production towards the target was achieved. Finally, on days 11 to 14, vasopressin is administered only subcutaneously until the patient is discharged from the ICU. The patient was successfully discharged to the ward with a tapering-off subtotal dose. Discussion The patient developed polyuria within the initial hours of treatment. Polyuria is a hallmark sign of diabetes insipidus. The clinician should be aware of other polyuria causes, such as postoperative hypervolemia, hyperglycemia, and the use of diuresis drugs. This differential diagnosis must be excluded. In this case, the differential diagnosis was excluded through proper fluid balance calculations, monitoring serum electrolytes and glucose levels, and ensuring the absence of diuretic use. Confirmation of the postoperative central diabetes insipidus is made based on findings of high urine output (5 ml/kg BW/hour), urine specific gravity (<1.005), response to vasopressin, average blood glucose level, and absence of diuretic use. Diabetes Insipidus is the body's inability condition to concentrate urine due to defective production of the antidiuretic hormone (central diabetes insipidus) or nephrogenic diabetes insipidus (NDI), which corresponds to the insensitivity of the kidney to the antidiuretic effects of vasopressin. Diabetes insipidus (DI) is a syndrome characterized by polyuria (>30ml/kg/24H) of hypotonic urine, equivalent polydipsia, and hypernatremia. The patient shows elevated urine volume (108 cc/kg/24H) and blood sodium levels (144-151mmol/L). The primary therapy was the titrated vasopressin dose, in conjunction with electrolytes and fluid management. Vasopressin titration is based on patient clinical condition, urin output, fluid management, oral intake, and laboratory measures (natrium blood level and urin osmolarity). Transient Diabetes Insipidus must be closely monitored after neurosurgical operations, especially in regions adjacent to the pituitary DI. Transient Management with good monitoring is the key. The risk of morbidity comes from the risk of untreated dehydration, electrolyte imbalance Intravenous vasopressin provides a rapid effect with lower doses. At the same time, subcutaneous administration requires caution in critically ill patients because absorption is slow, resulting in a slow effect and the need for higher doses. The conversion of the administration route needs to consider the patient's pharmacology, route, and hemodynamics. References Leroy, C., Karrouz, W., Douillard, C., Do Cao, C., Cortet, C., Wémeau, J.-L., Vantyghem, M.-C., 2013. Diabetes insipidus. Ann. Endocrinol. 74, 496–507. https://doi.org/10.1016/j.ando.2013.10.002 Priya, G., Kalra, S., Dasgupta, A., Grewal, E., 2021. Diabetes Insipidus: A Pragmatic Approach to Management. Cureus. https://doi.org/10.7759/cureus.12498 Schreckinger, M., Szerlip, N., Mittal, S., 2013. Diabetes insipidus following resection of pituitary tumors. Clin. Neurol. Neurosurg. 115, 121–126. https://doi.org/10.1016/j.clineuro.2012.08.009 Sharman, A., Low, J., 2008. Vasopressin and its role in critical care. Contin. Educ. Anaesth. Crit. Care Pain 8, 134–137. https://doi.org/10.1093/bjaceaccp/mkn021
Penyakit Paru Obstruktif Kronis (PPOK) dengan Multipel Komorbid Maryani, Nova; Akhmad Yun Jufan; Bowo Adiyanto
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
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.v11i1.12862

Abstract

Background: COPD is a common disease, can prevent and cure, but sometimes its difficult to diagnose and misdiagnose. Hence, patient couldn’t have the correct treatment. Case: A man 76 years old transfer from district hospital with diagnose COPD with multiple comorbid such as CAP, AKI, and CHF cf III needs to hemodialysis. One month before hospitalization, patient complaint dyspnea and become worst in last 1 week. The quality of dyspnea increasing by activity and cough. Cough with white sputum. He has intubated and give treatment for COPD and other comorbids. Patient hospitalize in ICU for 12 days and after that transfer to HCU for further treatment. Discussion: Intubation and weaning process for COPD patient was very challenging. Patient has treatment 12 days in ICU have COPD medical support based on diagnosa and management ventilation with NIV and NRM after autoextubate on day 5. Clinical and imaging evaluation shows us the recovery of pneumonia and pulmo edema that’s help patient to breathing easily even COPD needs more times to resolve. Results: COPD with multiple comorbid disease make the intesivist more difficult to wean and manage the treatment. Keywords: COPD, Cor Pulmonale, ICU
Serial Kasus Tatalaksana Sulit Jalan Napas pada Tumor Tiroid Bayu, Timor Krisna; Widodo, Untung; Sudadi; Wisudarti, Calcarina Fitriani Retno; Farid, Anisa Fadhila
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
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.v11i1.12913

Abstract

This case report studies three patients with difficult airways managed according to the American Society of Anesthesiologists (ASA) algorithm. The first case is a 46-year-old woman with bilateral SNNT who underwent a subtotal thyroidectomy without prior hyperthyroid therapy. The patient, with an ASA physical status II, was intubated using a videolaryngoscope. Postoperatively, the patient was cared for in the ward. The second case is a 58-year-old woman with a retrosternal goiter and comorbid hyperthyroidism and hypertension, who underwent a total thyroidectomy. The patient, with an ASA physical status II, was intubated while conscious. Postoperatively, the patient was admitted to the ICU. The third case is a 60-year-old woman with bilateral SNNT planned for thyroidectomy and permanent tracheostomy. The patient, with an ASA physical status III and comorbid hyperthyroidism, had failed intubation attempts with a videolaryngoscope and fiber optics. The patient could not be intubated, and the family was educated about the condition. This study demonstrates the importance of individualized management in patients with difficult airways, following ASA guidelines for optimal results.
Faktor-Faktor yang Berhubungan dengan Mortalitas pada Pasien Pediatrik yang Menjalani Pembiusan di Masa Pandemi Covid-19 di RSUP DR Sardjito Getar M, Geza Getar M; Djajantisari; Widyastuti, Yunita
Jurnal Komplikasi Anestesi Vol 11 No 2 (2023)
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.v11i2.12975

Abstract

Background: Anesthesia has the potential to cause physiological changes that lead to morbidity and mortality. Perioperative mortality alone is higher in children than in adults. During this time, the COVID-19 pandemic has affected anesthesia care around the world. The practice of pediatric surgery shows a significant decrease in the frequency of elective surgeries during the pandemic compared to the last three months before the pandemic. Surgical delays that occur, especially in "time-sensitive" surgeries and urgent illnesses in children, can affect the child's growth, development, and quality of life. There are several risk factors associated with mortality and morbidity in pediatric patients, namely age, ASA III-V physical status, emergency surgery, use of ventilators, oxygen support, inotropic drug support, preoperative sepsis, and patients refusing resuscitation. Objective: Identifying factors that influence mortality in pediatric patients undergoing anesthesia during the COVID-19 pandemic. Method: This study is a retrospective cohort observational study. This study included all pediatric patients who underwent anesthesia at Dr. Sardjito General Hospital between April 1, 2020 - March 31, 2021. Variables suspected of having a relationship with mortality will be tested bivariately in this study, and if p<0.25 is considered significant, they will be included in the multivariate analysis. They will be excluded from the multivariate analysis if p<0.05 is considered significant. Result: Factors that influence the incidence of mortality in pediatric patients undergoing anesthesia at Dr. Sardjito General Hospital are ASA III-V physical status with a value of p = 0.004 (OR 3.47), and the use of mechanical ventilation postoperative with a value of p=<0.001 (OR 9.46), both factors that have a significant effect with a p<0.05. Conclusion: ASA III-V physical status and the use of mechanical ventilation postoperative are factors that significantly influence the mortality of pediatric patients undergoing anesthesia at Dr. Sardjito General Hospital.
Faktor Risiko Perioperatif Terhadap Kejadian Delirium Saat Pulih Sadar Setelah Anestesi Umum Pada Pasien Dewasa Yang Menjalani Operasi Elektif Di RSUP Dr Sardjito Dewi, Wahyu Jati Paramita; Widodo, Untung; Apsari, Ratih Kumala Fajar
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.v10i3.13021

Abstract

Background. Emergence delirium in anesthesia is a common problem after anesthesia especially in recovery room,but the incidence and risk were unclear. Emergence delirium makes serious complication and impact in morbidity and mortality were no treated properly. So this study built. Objective. To determine the perioperative risk factors of emergence delirium after general anesthesia of elective surgery at Dr Sardjito Hospital. Method. Ninety-nine patients who have surgery under general anesthesia were prospectively observed and variables were potentials perioperative risk factors for delirium at recovery room were dated. The data were statistically analyzed by bivariate and multivariate analysis based on the incidence of delirium after recovery. Results. Total sample of the study were 99 patients who had delirium 55 (55.6%). The results of multivariate analysis showed risk factor of emergence delirium were age 18-25 years old (p=0,045, OR 5,54, 95%CI 1,02-15,189), smoker (p=0,06, OR 6,83, 95%CI 1,769-21,069), alkoholism (p=0,018, OR 10,34, 95%CI 2,09-78,98), ophthalmology (p=0,005, OR 5,43, 95%CI 1,86-32,266), alprazolam premedication (p=0,045, OR 4.035, 95%CI = 1.029-15.819), general anesthesia/ET (p=0,024, OR 5,23, 95%CI 1,697-21,792), duration of surgical procedure > 2 jam (p=0,025, OR 10.320, 95% CI 1.331-79.987), duration 1-2 jam (p=0.023, OR 6.554, 95% CI 1.291-33.266), opioid analgetic (p=0,019, OR 4,15, 95%CI 1,028-17,819) epidural cath (p=0,021, OR 5,83, 95%CI 1,981-20,069), artery line/CVC (p=0,043, OR 9,79, 95% CI 1,08-89,32), DC (p=0.010, OR 0.074. 95%CI 0.010-0.529), blood transfusion and vasopressors (p=0.004, OR 10,38, 95% CI = 2.11-51,08), pain scale/NRS >7 (p=0.049, OR 10.598, 95%CI 0.933-120.386), and NRS 3-7 (p=0.039, OR 5.465, 95%CI 1.091-27.372), PONV dan shivering (p=0.006, OR 3,77, 95% CI = 1.47-9,67). Conclusions. Age 18-25 years old, smoking and alcoholism, ophthalmology surgery, alprazolam premedication, general anesthesia/ET, duration surgery > 1 hour, opioid and epidural catheter analgesia, artery line/CVC, DC, blood transfusion and vasopressor, post operative pain with NRS >3, PONV/shivering have increased risk for emergence delirium.
Peran Ultrasound Guided Vascular Access (UGVA) dalam Menurunkan Risiko Komplikasi Central Line-associated Bloodstream Site Infection (CLaBSI) Yun Jufan, Akhmad
Jurnal Komplikasi Anestesi Vol 11 No 2 (2023)
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.v11i2.13316

Abstract

Central Line-associated Bloodstream Infection (CLaBSI) is a complication of infection that occurs when bacteria enter the bloodstream through a central venous catheter. CLaBSI is diagnosed by doctors through blood culture results and from the tip of the central venous catheter. Infections related to central venous catheters such as CLaBSI can lead to serious complications including sepsis, septic shock, and death. To reduce the incidence of CLaBSI, several prevention can be taken during central venous catheter insertion, one of which is using Ultrasound-Guided Vascular Access (UGVA) technique. This article aims to compare the effectiveness and safety of using the Ultrasound-Guided Vascular Access (UGVA) method with the landmark method in preventing Central Line-associated Bloodstream Infection (CLaBSI). The writing method used is literature review with keywords CLaBSI, USG guided, and central line catheter. The results show that the use of UGVA can reduce the incidence of CLaBSI to be two times lower compared to the landmark technique.
Efikasi Profilaksis Granisetron 40 mcg/kgBB Dibandingkan Ondansetron 8 mg dan Meperidine 0,4 mg/kgBB dalam Mencegah Shivering Paska Anestesi Spinal di RSUP Dr. Sardjito Gentong, Metia Gledis Gilang; Kurniawaty, Juni; Sudadi, Sudadi
Jurnal Komplikasi Anestesi Vol 11 No 3 (2023)
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.v11i3.13178

Abstract

Background. Spinal anesthesia induced hypothermia resulting in shivering and inducing adverse complications for the patient. Meperidine effectively prevent the incidence of shivering but has many side effects. Granisetron and ondasetron are known to prevent shivering with minimal side effects when working in thermoregulation. Aim. Efficacy of granisetron compared to ondansetron and meperidine in preventing shivering after spinal anesthesia. Method. The study was a double-blind randomized clinical trial of 97 male/female subjects, aged 18-65 years, physical status ASA I and II with emergency or elective surgery in RSUP Dr. Sardjito Yogyakarta. Subjects divided into three groups: Granisetron 40 mcg/kgbw (group G), Ondansetron 8 mg (Group O) and Meperidine 0.4 mg/kgbw (group M). Results. We found shivering in Group G showed 10 subjects (31.3%), group O showed 15 subjects (45.5%) and group M showed 10 subjects (31.3%) (p=0.386). Group G decreased the severity of shivering because grade 3 and 4 did not occur at 60 minutes, better than group O, which showed 5 subjects (15.2%) experiencing grade 3 and 1 subject (5%) experiencing grade 4. (p=0.044). Conclusion. Prophylactic granisetron 40 mcg/kgbw before spinal anesthesia reduces the severity of shivering compared to ondansetron 8 mg. Prophylactic granisetron 40 mcg/kgbw and ondansetron 8 mg reduced the incidence of shivering same as meperidine 0.4 mg/kgbw. Keywords. Shivering, Spinal Anesthesia, Granisetron, Ondansetron, Meperidine.
Bronkoskopi pada Pasien Kritis dengan Atelektasis di ICU Nurfitriani; Salam, Syamsul H
Jurnal Komplikasi Anestesi Vol 11 No 3 (2023)
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.v11i3.14650

Abstract

Bronchoscopy in critical ill patients in ICU is a procedure may carry higher risk considering that patients are often in unstable hemodynamic and hypoxemia which may increase morbidity rates, so the decision for bronchoscopy must be deeply considered with risks and benefits. We report a female patient admitted to the ICU with loss consciousness and acute respiratory failure. Patients with previous history of myasthenia gravis that reduce her ability to cough. From the physical and radiologic examination, we found signs of lower airway obstruction. The patient underwent bronchoscopy. We found mucus plugs obstructing both the upper and lower lobe of the left bronchus. During the procedure the patient is sedated. Mucus plugs were aspirated and microbiological culture were performed. The patient's condition was stable and clinical improvement was obtained.

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