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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 Patent Ductus Arteriosus dengan Hipertensi Pulmonal Berat dan Regurgitasi Trikuspid Berat Sugiarto, Tomi; Rachman, Iwan Abdul
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.v11i3.14678

Abstract

Patent ductus arteriosus (PDA) merupakan penyakit jantung bawaan asianotik yang didefinisikan sebagai persistensi dari pintasan janin antara arteri pulmonalis dan aorta, menyebabkan terjadinya oversirkulasi pulmoner dan hipoperfusi sistemik. Pasien PDA yang menjalani operasi nonkardiak memiliki resiko morbiditas dan mortalitas yang tinggi. Kondisi diperberat dengan adanya hipertensi pulmonal yang diketahui memberi kontribusi kasus henti jantung perioperatif, dan regurgitasi tricuspid menimbulkan overload volume ventrikel kanan dan meningkatkan resiko gagal jantung kanan. Dilaporkan satu kasus multiple karies dengan PDA disertai hipertensi pulmonal berat dan regurgitasi tricuspid berat pada anak usia 6 tahun yang akan menjalani operasi mouth preparation. Pasien datang dengan keluhan gigi berlubang sejak 1 tahun, disertai dengan sesak nafas dan batuk. Pemeriksaan fisik menunjukkan adanya peningkatan denyut nadi dan laju nafas disertai dengan penurunan saturasi oksigen perifer, bunyi jantung tambahan dan clubbing finger disertai akral cyanosis. Foto rontgent thoraks menunjukkan kesan kardiomegali disertai bronkopneumonia bilateral dd/ edema paru perbaikan, efusi pleura kiri perbaikan. Hasil echokardiografi didapatkan PDA 7-8 mm bidirectional shunt, RV dan RA dilatasi dengan TR severe, dengan EF 52,6%. Pasien dikategorikan status ASA III. Pasien diberikan premedikasi intravena dengan midazolam 0,5 mg, dilakukan anestesi umum, preoksigenasi dengan oksigen 100%, diinduksi secara intravena dengan fentanyl 35 mcg dan midazolam 3 mg, dan diberikan pelumpuh otot atracurium 6 mg. Pasien diintubasi dengan menggunakan endotracheal tube no. 5,0. Saat operasi diberikan rumatan anestesi dengan sevoflurance 2-3vol% dalam O2:udara. Paska operasi pasien dipindahkan ke ruang semiintensif dengan oksigenasi nasal kanul dan diberikan analgetik berupa paracetamol 240mg/6 jam secara intravena dan ketoprofen supositoria 25mg. Operasi dengan kondisi PDA, hipertensi pulmonal berat dan perlu dipastikan agar tercapai keseimbangan aliran darah, sehingga tidak terjadi peningkatan aliran darah pulmonal yang dapat menyebabkan desaturasi dan penurunan perfusi oksigen ke jaringan. Ventilasi perlu diberikan secara cukup; tidak hipoventilasi yang memicu peningkatan PVR, dan tidak berlebihan agar menghindari overdistensi alveolar yang dapat berakibat meningkatkan tekanan arterial paru. Anestesi umum menjadi pilihan agar tercapai kontrol ketat oksigenasi dan ventilasi.
Management of Anesthesia in Patients with Adrenal Tumor Accompanied by Cushing's Syndrome Pratama, Roufisma Abdi; Herman , Ruli
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.v11i3.14685

Abstract

Tumor kelenjar adrenal dengan prevalensi sekitar 532/100.000 yang merupakan neoplasma jinak yang berasal dari korteks adrenal. Kondisi ini meningkatkan produksi kortikosteroid dan aldosteron yang mengakibatkan komplikasi seperti hipertensi, hiperglikemi, hingga cushing sindrom. Seorang perempuan 29 tahun dengan keluhan wajah bengkak, rambut rontok, perut membesar, dan mudah memar pada ekstremitas, dikonsultasikan untuk tindakan adrenalektomi. Pada pasien dilakukan tindakan anestesi umum. Intra-operatif pasien didapatkan hemodinamik stabil. Pasca operasi pasien dirawat di ruangan ICU. Kontrol perioperatif hipertensi, hiperglikemi, hipokalemi, dan kortisol sebagai akibat dari reseksi adrenal menjadi peran anestesiologis pada pasien dengan tumor kelenjar adrenal yang disertai dengan cushing sindrom.
Penggunaan Magnesium Sulfat pada Pasien dengan Asma Persisten Sedang Menjalani Operasi Elektif Tiroidektomi Total Tyastarini, Ni Putu Ade Tiwi; Perdana , Aries
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.v11i3.14981

Abstract

Case: Female, 45 years old, with a history of moderate persistent asthma, type 2 diabetes mellitus, and bilateral struma multiple nodusa nontoxic (SMNT), planned to undergo a total thyroidectomy procedure. During the pre-anesthesia visit, it was found that the patient's condition was in acute exacerbation, then the night before the surgical procedure, the patient was given 2.5 mg salbutamol and Budesonide 5 mg inhalation. Magnesium sulfate (MgSO4) 25 mg/kg/kg intraveously in normal saline solution 100ml drip in 10 minutes, and continued with the administration of MgSO4 5 mg/kg/hour drip intravenously intra-operative. Post-operative, deep extubation was performed on the patient and monitored in the ICU for <24 hours, and continued in ward until allowed outpatient discharge on the second postoperative day. Discussion: In elective surgery particularly in the airway area, the risk of bronchospasm increases and optimal perioperative management is required as well as in patients with comorbid asthma. The administration of magnesium sulfate has several advantages in this case, in terms of the bronchodilation effect produced, as an adjuvant analgesia and also hypomagnesemia therapy related to diabetes mellitus. In conclusion, MgSO4 can be used as an alternative in the anesthetic modality of patients with a history of moderate persistent asthma who will undergo surgery.
Penatalaksanaan Konservatif Pasien Cidera Kepala Traumatik dengan Perdarahan Intrakranial Di Rumah Sakit dengan Fasilitas Terbatas Pratama, Joshua Roberto; Baskoro, Ronggo
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.v11i3.14997

Abstract

Kasus : Pasien seorang pria usia 62 tahun dibawa ke IGD setelah terjatuh dari ketinggian 10 meter. Pada pemeriksaan fisik didapatkan tingkat kesadaran pasien dengan GCS adalah Eye (E) 1, Verbal (V) 1, Motoric (M) 2 dan tekanan darah 80/50 mmHg tanpa ditemukan lateralisasi pada pemeriksaan fisik. Pasien kemudian dilakukan intubasi dan dirawat di ICU. Pemeriksaan CT-Scan kepala ditemukan beberapa titik perdarahan intrakranial dengan volume perdarahan terbesar berada pada kornu anterior ventrikel lateral dekstra. Terapi : Pasien diberikan terapi drip Norepinefrin 0.01 meq dan drip Dopamine 5 meq dengan target MAP >65mmHg selain itu pasien juga diberikan terapi Asam Traneksamat 500 mg / 8 jam, Deksametason 10 mg / 8 jam, Mannitol 500 cc / 8 jam, Citicholine 500 mg / 12 jam dan dengan pengaturan ventilator SIMV TV 400 cc, RR 16, FIO2 50%, PEEP 5, Inspirasi : Ekspirasi 1:2. Hasil : Pasien mengalami perbaikan selama rawatan. Pasien di ekstubasi dan keluar rawatan ICU setelah 2 hari dengan peningkatan kesadaran GCS E4,V5,M6 dan hemiparese ekstrimitas kiri.
Manajemen Anestesi pada Pasien Anak yang Menjalani Operasi Coloboma dengan Penyakit Jantung Bawaan Asianotik Budiadnyana, I Made Pasek; Ratumasa, Marilaeta Cindryani Ra; Panji, Putu Agus Surya; Senapathi, Tjokorda Gde Agung
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.v11i3.15090

Abstract

Anesthesia for pediatric patients with acyanotic congenital heart disease demands a specialized approach due to complex cardiac anatomy and physiology interactions and the risk of perioperative hemodynamic instability. A two-month-old, five-kilogram child presented with a congenital heart disorder and a left eyelid anomaly since birth. Physical examination revealed superior palpebral coloboma with symblepharon and exposure keratitis. Scheduled for surgical repair, the preoperative assessment included anemia and thrombocytosis. Anesthesia management involved fasting, fluid calculation, and premedication with atropine sulfate 0.1 mg and intravenous analgesic fentanyl 15 mcg (2-3 mcg/kgBW). Intubation proceeded with atracurium, and maintenance included sevoflurane and fentanyl. Monitoring ensured proper EtCO2 and oxygen saturation levels. The one-hour surgery addressed the eyelid issue, followed by post-operative analgesia. The patient was monitored for three days post-op and discharged on the fourth day. Previous studies showed that children with congenital heart disease undergoing noncardiac surgery face increased perioperative risks, influenced by factors such as general condition and disease status, so clinical outcomes during surgery are greatly influenced by anesthesia management that adapts to these factors. Pediatric patients with congenital heart disease can safely undergo general anesthesia for noncardiac surgeries by requiring comprehensive preoperative preparation and careful intraoperative monitoring.
Perioperatif Morbid Obese dengan OHS yang Menjalani Laparoskopi Bariatrik Saputra, Dya Restu; Prasamya, Erlangga; Hartono, Pinter
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.v11i3.15135

Abstract

Introduction: Laparoscopy, a minimally invasive surgical procedure that uses CO2 gas to create space between the abdominal wall and internal organs for endoscopic access. The main challenges include cardiopulmonary effects from pneumoperitoneum, systemic absorption of CO2, gas embolism, and injuries to intra-abdominal structures. General anesthesia is often the preferred choice, especially in high-risk cases like obesity, to avoid complications like reflux and aspiration. The author intends to discuss with the aim of understanding physiological changes, complications, and specific management strategies for laparoscopic bariatric surgery. Case Description: A 30-year-old woman with significant weight gain underwent treatment for obesity but made no progress. She was referred for surgery and underwent a specific procedure called sleeve gastrectomy on October 5, 2022. Medical history included controlled hypertension and diabetes, and emerging symptoms were uncontrolled appetite, fatigue, and shortness of breath. The operation was performed under general anesthesia, and her care included detailed monitoring and prevention of complications. This case highlights a comprehensive approach to treating morbid obesity. Discussion: Obesity is often associated with hypertension and changes in heart response. In the context of bariatric laparoscopy, physiological changes associated with pneumoperitoneum and patient positioning may cause cardiorespiratory compromise, especially in obese patients who already have pre-existing cardiopulmonary dysfunction. The balanced general anesthesia technique with mechanical ventilation is considered the best for minimally invasive surgery requiring CO2 insufflation. A multimodal approach in analgesia and antiemetic prophylaxis is needed to reduce postoperative side effects, and early diagnosis of complications. Conclusion: Minimally invasive surgery, such as bariatric laparoscopy, aids in pain reduction and faster recovery, especially important for patients with obesity. The balanced general anesthesia technique with mechanical ventilation is considered optimal for this procedure. Proper monitoring and maintenance after surgery are key to preventing postoperative complications and side effects.
Continous Renal Replacement Therapy pada Pasien Sepsis, Respiratory Failure, Acute Kidney Injury, dan Asidosis Metabolik Septian, Dendi; Oktaliansah, Ezra
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.v11i3.15136

Abstract

Sepsis is a life-threatening organ dysfunction resulting from dysregulation of the body's response to infection. The hypermetabolic response results in an imbalance between oxygen supply to tissues while oxygen demand in peripheral organs increases. Acute Kidney Injury (AKI) is one of the most common and severe complications of sepsis, and is associated with high mortality and poor outcomes. If pharmacological therapy has been given but there is no clinical improvement, Continuous Renal Replacement Therapy (CRRT) with Continuous Venovenous Hemodiafiltration (CVVHDF) modality can be considered. A 31-year-old male patient came with complaints of shortness of breath, the patient was diagnosed with septic shock accompanied by acute kidney injury and chronic kidney disease. The patient's condition worsened with unstable hemodynamics. CRRT is performed as an option for AKI management in critically ill patients with unstable hemodynamics. There was improvement in renal function, acidosis, and hemodynamics in patients. Renal Replacement Therapy (RRT) is an option for treating AKI in critically ill patients with unstable hemodynamics. CRRT plays an important role in treating septic shock patients with AKI in the intensive care unit.
Epidural Anesthesia Management for Unilateral Salpingo-Oophorectomy in Patients with Ovarian Mass : A Case Report Ksatriaputra, Alesandro; Saputra, Taufik; Paramita, Dina
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.v11i3.15146

Abstract

with sedation and mainly used in elderly patients or those with medical problems, including those who had ovarian mass. Epidural administration of amide local anesthetics in combination with opioids is widely used for pain relief because of the dose minimizing and side effects reducing benefits. Case: Patient was diagnosed with ovarian mass. The patient also had pleural effusion, ascites, and hypoalbuminemia. Epidural anesthesia used in this patient as a resource for perioperative and postoperative pain management. Discussion: Patient underwent unilateral salpingo-oophorectomy for her ovarian mass. Anesthetic doses were given carefully due to patient conditions with pleural effusion and ascites. Opioid and Neuromuscular Blocking Agents (NMBAs) effects were absolutely decreased due to hypoalbuminemia, but were overcome with Naloxone and Sugammadex. Epidural anesthesia used to stabilize the drugs and pain management for this patient. Conclusion: Epidural anesthesia is an excellent choice for unilateral salpingo-oophorectomy in patients with ovarian mass. It has been proven to provide excellent pain control after major surgeries and may be associated with a lower incidence of postoperative complications.
Pertimbangan Khusus Pemberian Nutrisi Enteral pada Pasien ICU Non-ARDS dengan Posisi Prone Jangka Panjang Cahyo Purnomo, Ika; Jufan, Ahmad Yun
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
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.v12i1.14646

Abstract

Background: Early enteral nutrition (EN) is recommended in critical care to reduce the complications. However, hesitancy exists when administering EN in a prone position. We report a case of non-ARDS patient with extended periods of prone position receiving EN. Case: A 18 years, quadriplegic, male, underwent cervical internal fixation and gluteal flap. Postoperatively, he was to be prone positioned for 10 days. Analgesics was tramadol and NSAID. NGT placement and patency was confirmed. The bed was tilted 30ยบ upright and EN intermittently administered every 4 h, followed by GRV check in 2 h. Intake was gradually increased in each feeding. Patient was discharged after 48 h. Further management was also in the prone position. Discussions: Feeding tolerance reduction and tube displacement is associated with EN in prone patients. Pre-feeding tube patency and position check is imperative. Feeding tolerance, GRV, and vomiting should be monitored. No recommendation for ultrasound monitoring. Upright tilting was to aid nutrition passage by gravity. Prokinetics and pump feeding were not performed in this patient. Tolerance was excellent, no complications in nutritional management were found. Conclusions: EN during a prone position is challenging, yet the findings support that EN is feasible and can be well tolerated.
SERIAL KASUS EKSTUBASI FAST-TRACK PADA BEDAH JANTUNG TERBUKA Hapsari, Paramita Putri; Pratomo, Bhirowo Yudo; Putro, Bambang Novianto
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
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.v12i1.14651

Abstract

Fast-track extubation (FTE) has been shown to reduce the incidence of prolonged mechanical ventilation, resulting in shorter hospitalization, lower morbidity, mortality, and hospital costs. We present a case series of fast-track extubation involving two females aged 31 and 33 with Atrial Septal Defect (ASD) and a 33-year-old male with Ventricular Septal Defect (VSD) scheduled for defect closure. These patients were in good clinical condition with normal biventricular function and a low probability of pulmonary hypertension. The anesthesia and surgery procedures proceeded smoothly, with cardiopulmonary bypass time < 90 minutes, aortic cross-clamp time < 60 minutes, no residual shunt, acceptable lactate and blood gas analysis, stable hemodynamic with low doses of vasoactive agents, and adequate analgesia. Following the successful execution of the fast-track extubation protocol in the operating theatre, the patients were transferred to the intensive care unit (ICU) where they received postoperative management. The total ICU length of stay was < 24 hours, demonstrating the safety and efficacy of FTE for simple cardiac procedures and favourable outcomes. This approach is aimed at accelerating patient recovery, reducing complications, and enhancing overall surgical outcomes.

Page 31 of 32 | Total Record : 317

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