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Jurnal Anestesi Perioperatif
Published by Universitas Padjadjaran
ISSN : 23377909     EISSN : 23388463     DOI : 10.15851/jap
Core Subject : Health, Education,
Education Health Professions
Jurnal Anestesi Perioperatif (JAP)/Perioperative Anesthesia Journal is to publish peer-reviewed original articles in clinical research relevant to anesthesia, critical care, case report, and others. This journal is published every 4 months with 9 articles (April, August, and December) by Department of Anesthesiology and Intensive Care Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung.
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Pola Pneumonia Nosokomial di Unit Perawatan Intensif Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung Periode Januari–Desember 2017 Salukanan, Ronald Tikuali; Zulfariansyah, Ardi; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (249.88 KB) | DOI: 10.15851/jap.v6n2.1337

Abstract

Pneumonia merupakan salah satu jenis infeksi nosokomial dengan jumlah kasus tertinggi dibanding dengan infeksi nosokomial lain di unit perawatan intensif (ICU) disertai jumlah morbiditas dan mortalitas yang tinggi. Pola pneumonia nosokomial merupakan suatu karakteristik pneumonia nosokomial yang digunakan untuk mengidentifikasi masalah dan dapat menjadi indikator untuk perbaikan terapi. Penelitian bertujuan menggambarkan pola pneumonia nosokomial di unit perawatan intensif RSUP Dr. Hasan Sadikin Bandung periode Januari–Desember 2017. Metode penelitian menggunakan deskriptif observasional yang dilakukan secara retrospektif terhadap 70 objek penelitian yang diambil dari rekam medis dan dilakukan dalam waktu 3 bulan, yaitu Oktober–Desember 2017. Hasil penelitian jumlah kematian akibat pneumonia nosokomial masih tinggi, yaitu 60% terutama pada pasien laki-laki usia ≥ 65 tahun. Komorbid terbanyak pada pneumonia nosokomial, yaitu hipertensi (31,4%) diikuti penyakit neuromuskular (15,7%). Mikrob terbanyak penyebab HAP adalah A. baumannii (38,1%), P. aeroginosa (30,4%), dan K. pneumoniae (15,2%), sedangkan mikrob penyebab terbanyak ventilator associated pneumonia (VAP) adalah A. baumannii (32%), P. aeroginosa (30,5%), dan K. pneumoniae (22%). Mikrob A. baumannii juga menjadi penyebab mortalitas tertinggi dengan persentase 45,4% dan terapi empirik yang sering digunakan adalah kombinasi meropenem–levofloxacin (40%), terapi tunggal meropenem (34,3%), dan kombinasi ceftazidime-levofloxacin (20%). Simpulan, pola pneumonia nosokomial di ICU RSUP Dr. Hasan Sadikin Bandung periode Januari–Desember 2017 masih diperlukan perbaikan program penanganan terhadap infeksi ini untuk mencapai pelayanan yang baik.Kata kunci: Mikrob, mortalitas, pneumonia nosokomial, unit perawatan intensif Nosocomial Pneumonia Pattern in Intensive Care Unit (ICU) of Dr. Hasan Sadikin General Hospital Bandung from January to December 2017Pneumonia is the most common nosocomial infection in intensive care unit with high morbidity and mortality rates. Pattern of nosocomial pneumonia is an infection characteristic that helps the identification of a phenomenon or problem and serves as an indicator or model for predicting future behaviors. These patterns can be used for making a standardized therapy management for the disease. The aim of this study was to describe nosocomial pneumonia pattern in Intensive Care Unit (ICU) in Dr.  Hasan Sadikin Bandung from January to December 2017. A retrospective observational descriptive method on 70 samples from medical records with an observation period of three months starting from October to December 2017. It was shown that the mortality rate of nosocomial pneumonia was 60% with male patients aged ≥ 65 years old as the most affected group. The most common comorbid was hypertension (31.4%) followed by neuromuscular diseases (15.7%). The most common HAP-causing microbes were A. baumannii (38.1%), P. aeroginosa (30.4%), and K. pneumoniae (15.2%) and the most common microbes for VAP were A. baumannii (32%), P. aeroginosa (30.5%), and K. pneumoniae (22%). Acinetobacter baumannii caused most deaths (45.4%). The most common empirical therapy was meropenem–levofloxacin combination (40%), meropenem (34.3%), and ceftazidime–levoflocacin combination (20%). In conclusion, pattern of nosocomial pneumonia in ICU of Dr. Hasan Sadikin General Hospital Bandung reflects a situation that therapy management for this infection needs to be improved for a proper service.Key words: Intensive care unit, microbes, mortality, nosocomial pneumonia 
Perbandingan Laringoskopi Indirek Kaca Laring dengan Laringoskopi Indirek Video Smartphone dalam Menilai Visualisasi Laring dan Kenyamanan Pasien Sulistiono, Paulus; Prihartono, M. Andy; Yadi, Dedi Fitri
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (873.967 KB) | DOI: 10.15851/jap.v6n2.1254

Abstract

Salah satu pemeriksaan preoperatif yang dapat digunakan sebagai prediktor kesulitan intubasi adalah laringoskopi indirek.  Penelitian ini bertujuan menilai visualisasi laring dan kenyamanan pasien antara laringoskopi indirek kaca laring dan laringoskopi indirek video smartphone. Penelitian menggunakan  metode prospective randomized parallel trial, dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan November–Desember 2017. Pasien dibagi menjadi kelompok laringoskopi indirek kaca laring (kelompok LIKL, n=22) dan kelompok laringoskopi indirek video smartphone (kelompok LIVS, n=22). Uji statistik menggunakan Uji Mann-Whitney. Hasil penelitian mengungkapkan visualisasi laring lebih jelas pada kelompok LIVS (1,73 SD±0,77) dibanding dengan kelompok LIKL (2,50 SD±0,86) dengan perbedaan signifikan (p<0,05). Kenyamanan yang lebih baik pada kelompok LIVS (skala di atas 5) dibanding dengan kelompok LIKL (skala di atas 5) dengan perbedaan signifikan (p<0,05). Simpulan penelitian ini adalah visualisasi laring dan kenyamanan pasien pada laringoskopi indirek dengan video smartphone lebih baik bila dibanding dengan laringoskopi indirek kaca laring.Kata kunci: Kaca laring, kesulitan intubasi, laringoskopi indirek, video smartphone  Comparison between Indirect Laryngoscopy Laryngeal Mirror and Indirect Laryngoscopy Smartphone Video in Evaluating Laryngeal Visualization and Patient ComfortIndirect laryngoscopy is an examination modality which can be performed during pre-operative phase as a predictor of difficult intubation. The purpose of this study was to compare indirect laryngoscopy using laryngeal mirror and indirect laryngoscopy using smartphone video in evaluating laryngeal visualization and providing convenience to patients during the examination procedure. This prospective randomized parallel trial was conducted at Dr. Hasan Sadikin General Hospital Bandung from November to December 2017. Patients were assigned to two study groups: those who underwent indirect laryngoscopy using laryngeal mirror (LIKL group, n=22) and those who underwent indirect laryngoscopy using smartphone video (LIVS group, n=22). Mann-Whitney test was utilized as the statistical test method. Result of this study showed that laryngeal visualization was significantly superior in LIVS group compared to LIKL group (1.73 SD±0.77 vs 2.50 SD±0.86, respectively, p value<0.05). Patient comfort was significantly superior in LIVS group compared to LIKL group (comfort score above 5 vs comfort score above 5, respectively, p value <0.05). Therefore, it is concluded that laryngeal visualization using indirect langryngoscopy with smartphone video is more comfortable than the one that uses direct laryngoscopy with laryngeal mirror.Key words: Difficult intubation, indirect laryngoscopy, laryngeal mirror, smartphone video
Perbedaan Skala Nyeri antara Blok Pleksus Servikalis Superfisialis Levobupivakain dan Fentanil Intravena Pascaoperasi Mastoidektomi Kaligis, Stephanus Andy Prakasa; Arianto, Ardana Tri; Thamrin, Muhammad Husni
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (497.814 KB) | DOI: 10.15851/jap.v6n2.1224

Abstract

Penelitian tentang penggunaan blok pleksus servikalis superfisialis sebagai analgetik pascaoperasi mastoidektomi masih sangat terbatas baik di Indonesia maupun luar negeri. Tujuan penelitian mengetahui efektivitas blok pleksus servikalis superfisialis sebagai analgetik pascaoperasi mastoidektomi. Penelitian ini berdisain uji klinik acak tersamar tunggal pada 30 pasien yang dilakukan operasi mastoidektomi dan memenuhi kriteria inklusi di Rumah Sakit Dr. Moewardi Surakarta periode Oktober 2017–Februari 2018. Sampel dibagi menjadi 3 kelompok, yaitu kelompok fentanil intravena, blok pleksus cervicalis superfisialis dengan levobupivakain, dan blok pleksus cervicalis superfisialis dengan salin. Semua pasien mendapatkan perlakuan anestesi umum sesuai standar dan dinilai skala nyeri berkala pascaoperasi. Selain itu, juga dinilai efek mual-muntah pascaoperasi, kebutuhan opioid selama operasi, dan efek samping tindakan blok. Skala nyeri pascaoperasi mulai jam ke-2 sampai ke-24 pada kelompok fentanil intravena (nyeri ringan 80–90%) dan levobupivakain (nyeri ringan 90–100%) lebih rendah dibanding dengan kelompok salin (nyeri ringan 10–50%; nyeri sedang 50–70%) (p<0,05). Pada kelompok salin bahkan terjadi nyeri berat sebanyak 40% pada jam ke-2. Skor PONV pada kelompok fentanil, levobupivakain, dan salin mayoritas mual ringan (60%; 40%; dan 50%). Tidak ada komplikasi yan g terjadi terkait blok pleksus servikalis superfisialis. Simpulan, tidak ada perbedaan skala nyeri yang bermakna antara blok pleksus servikalis superfisialis levobupivakain dan fentanil intravena pascaoperasi mastoidektomi. Kata kunci: Blok pleksus servikalis superfisialis, fentanil, levobupivakain, mastoidektomi Difference in Pain Scale between Levobupivacaine Superficial Cervical Plexus Block and Intravenous Fentanyl for Post-Post-Mastoidectomy PainResearch on the use of superficial cervical plexus block as an analgesic after mastoidectomy is still very limited both in Indonesia and abroad. The purpose of this study was to determine the efficacy of superficial cervical plexus block as an analgesics for post-post-mastoidectomy pain. This was a single blinded randomized clinical trial study performed on 30 patients underwent mastoidectomy who met the inclusion criteria in Dr. Moewardi General Hospital Surakarta October 2017–February 2018. Subjects were divided into 3 groups: levobupivacaine block, saline block, and intravenous fentanyl groups. All patients received standard general anesthesia treatment and  were evaluated periodically for the post-operative pain scale. The post-operative effects post-including  nausea-vomiting, opioid need during surgery, and side effects of  the block were also assessed. The pos-toperative pain scales 2 to 24 hours after surgery in the intravenous fentanyl (mild pain 80–90%) and levobupivacaine group (mild pain 90–100%) were lower than those in the saline group (mild pain 10–50%, moderate pain 50–70%) (p<0.05). In the saline group, severe pain was even identified 2 hours after the surgery in  as high as 40% of the subjects. Comparison of the pain scale between fentanyl and levobupivacaine groups from 2 to 24 hours after surgery did not show any significant difference. PONV scores in the fentanyl, levobupivacaine, and saline groups reflected mild nausea (60%, 40%, and 50% respectively). No complication occurred in superficial cervical plexus block application. In conclusion, there is no significant difference in pain scale between the superficial cervical plexus block using levobupivacaine and intravenous fentanyl in terms of  post-post-mastoidectomy pain. Key words: Fentanyl, levobupivacaine, mastoidectomy, superficial cervical plexus block 
Perbandingan Blokade Kaudal Bupivakain 0,25% dengan Kombinasi Bupivakain 0,25% dan Klonidin 1 µg/kgBB terhadap Waktu Kebutuhan Analgesik Pascaoperasi Hipospadia Atmoko, Agus Fitri; Yadi, Dedi Fitri; Oktaliansah, Ezra
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (779.028 KB) | DOI: 10.15851/jap.v6n2.1271

Abstract

Blokade  kaudal merupakan salah satu blokade regional yang digunakan pada pediatrik. Teknik ini digunakan sebagai tata laksana nyeri pascaoperasi urogenital, rektal, inguinal, dan operasi ekstremitas bawah. Penelitian ini bertujuan mengetahui perbandingan waktu kebutuhan analgesik pascaoperasi hipospadia pada blokade kaudal bupivakain 0,25% dengan kombinasi bupivakain 0,25% dan klonidin 1 µg/kgBB. Penelitian menggunakan uji klinis acak terkontrol buta tunggal dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung bulan November 2017 sampai Januari 2018. Pasien dibagi menjadi grup bupivakain 0,25% (grup B, n=15) dan grup kombinasi bupivakain 0,25% klonidin 1 µg/kgBB (grup BK, n=15). Uji statistik menggunakan uji-t tidak berpasangan dan Uji Mann-Whitney. Hasil penelitian mengungkapkan waktu kebutuhan analgesik pertama lebih lama pada grup BK (766,46±75,34 menit) dibanding dengan grup B (344,4±59,46 menit) dengan perbedaan signifikan (p<0,05). Simpulan, kombinasi bupivakain 0,25% dan klonidin 1 µg/kgBB pada blokade kaudal menghasilkan waktu kebutuhan analgesik pertama lebih lama dibanding dengan bupivakain 0,25% pascaoperasi hipospadia. Kata kunci: Blokade kaudal, bupivakain, hipospadia, klonidin, waktu kebutuhan analgesik  Comparison of Bupivacaine Caudal Blockade with Bupivacaine Clonidine Caudal Blockade to Timing of Post-operative Hypospadias Analgesic Requirement Caudal blockade was one of the regional blocks used in pediatrics. This technique was used as a post-operative pain management measure in urogenital, rectal, inguinal and lower extremity surgeries. The purpose of this study was to compare the first analgesic requirement between 0.25% bupivacaine caudal blockade and 0.25% bupivacaine and 1 µg/kgBW clonidine caudal blockade combination for post-operative hypospadia. The study used a single blind randomized control trial conducted at Dr. Hasan Sadikin General Hospital (RSHS) Bandung in the period of November 2017 to January 2018. Patients were divided into 0.25% bupivacaine group (B group, n=15) and 0.25% bupivacaine and 1 µg/kgBW clonidine combination group (BK group, n=15). Statistical test using unpaired t test and Mann Whitney test. Results revealed that the time of first analgesic requirement was longer in BK group (766.46±75.34 min) than in B group (344.4±59.46 min) with a significant difference (p<0.05). In conclusion, 0.25% bupivacaine and 1 µg/kgBW clonidine combination in caudal blockade resulting in a time analgesic requirement that is longer than 0.25% bupivacaine for post-operative hypospadias.                Key words: Analgesic requirement time, bupivacaine, caudal blockade, clonidine, hypospadias
Perbandingan antara Pemberian Diet Oral Dini dan Tunda terhadap Bising Usus Pascabedah Sesar dengan Anestesi Spinal Pasha, Mohammer; Hanafie, Achsanuddin; Ihsan, Muhammad
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (793.064 KB) | DOI: 10.15851/jap.v6n2.1422

Abstract

Inisiasi diet pascabedah masih merupakan kontroversi pada pasien pascabedah termasuk pada pasien pascabedah sesar. Penelitian ini bertujuan membandingkan waktu kembalinya fungsi gastrointestinal yang dilihat dari munculnya bising usus antara kelompok yang menerima diet oral dini dan diet oral tunda. Uji klinis acak terkontrol tersamar ganda dilakukan pada periode bulan April–Mei 2017 di RSUP Haji Adam Malik Medan, RS Universitas Sumatera Utara Medan, dan RSU Sundari Medan. Sebanyak 40 pasien yang memenuhi kriteria inklusi dan tidak termasuk eksklusi diamati waktu munculnya bising usus pascabedah sesar dan keluhan gastrointestinal yang muncul berupa mual, muntah, dan kembung. Dari 40 pasien tersebut, 20 subjek merupakan kelompok diet oral dini dan 20 subjek lagi merupakan kelompok diet oral tunda. Data dianalisis dengan menggunakan uji chi-square dan Mann-Whitney. Munculnya bising usus tidak berbeda signifikan (p>0,05) antara kedua kelompok dan tidak ada perbedaan yang signifikan dalam hal keluhan mual, muntah, dan kembung pascaoperasi antara kedua kelompok (p>0,05). Pemberian diet oral dini dapat diberikan 2 jam pascaoperasi bedah sesar tanpa penyulit dengan anestesi spinal tanpa keluhan gastrointestinal yang bermakna.  Kata kunci: Anestesi spinal, bedah sesar, diet oral dini, diet oral tunda, keluhan gastrointestinal Comparison of Peristaltic Sound between Early and Late Oral Diet Administration  in  Post-Caesarean Section Post-with Spinal Anesthesia A controversy still exists for post-operative diet administration, including for post-post-post-caesarean section patients. The aim of this study was to compare the return of gastrointestinal function reflected by the peristaltic sound between groups receiving early oral diets and late oral diets. This was a double blind randomized controlled trial performed from April to May 2017 in Haji Adam Malik General Hospital Medan, North Sumatera University Hospital, Medan, and Sundari General Hospital, Medang on 40 patients who met the inclusion and exclusion criteria. Subjects were observed to determine the time when bowel movement started as well as for gastrointestinal complaints. Of all 40sujects enrolled in this study, 20 were provided with early oral diet nd the remaining 20 subjects received late oral diet group. Data were then analyzed using chi-square and Mann-Whitney tesst The return of peristaltic sound was not significantly different between both groups (p>0.05). No significant difference found in the occurence of post-operative nausea, vomiting, and post-bloating between the two groups (p>0.05). Oral diet may be administered safely 2 hours after uncomplicated cesarean section under spinal anesthesia without any significant gastrointestinal complaint.Key words: Cesarean section, delayed oral diet, early oral diet, gastrointestinal complication, spinal anesthesia
Perbandingan Kedalaman Sedasi antara Deksmedetomidin dan Kombinasi Fentanil-Propofol Menggunakan Bispectral Index Score pada Pasien yang Dilakukan Kuretase Singarimbun, Daniel Asa; Indriasari, Indriasari; Maskoen, Tinni T.
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (929.029 KB) | DOI: 10.15851/jap.v6n2.1424

Abstract

Kuretase tergolong bedah minor yang menyebabkan nyeri dan ketidaknyamanan pasien sehingga memerlukan tindakan sedasi-analgesi. Tujuan penelitian adalah membandingkan kedalaman sedasi antara deksmedetomidin dan kombinasi fentanil-propofol menggunakan bispectral index score (BIS) pada pasien yang dilakukan kuretase. Penelitian ini merupakan penelitian randomized controlled trial dengan teknik double blind pada 36 pasien dengan status fisik American Society of Anesthesiologists (ASA) I−II yang menjalani kuretase di ruangan Obstetri dan Ginekologi RSUP Dr. Hasan Sadikin Bandung periode Juli sampai Oktober 2017. Kelompok deksmedetomidin mendapatkan loading dose deksmedetomidin 1 mcg/kgBB dalam waktu 10 menit dilanjutkan dosis pemeliharaan 0,5 mcg/kgBB/jam. Kelompol fentanil-propofol mendapatkan loading dose propofol 1 mg/kgBB dalam 10 menit diikuti dosis pemeliharaan 50 mcg/kgBB/jam ditambah fentanil 1 mcg/kgBB dalam 5 menit, lalu dicatat nilai BIS. Data dianalisis dengan uji-t dan Uji Mann-Whitney dengan p<0,05 dianggap bermakna. Analisis data statistik nilai BIS kelompok deksmedetomidin 79,50±2,121 dan fentanil-propofol 85,22±0,732 dengan perbedaan bermakna (p<0,05). Simpulan, penelitian ini menunjukkan kedalaman sedasi pada kelompok deksmedetomidin menghasilkan nilai BIS lebih rendah dibanding dengan fentanil-propofol pada pasien yang dilakukan kuretase. Kata kunci: Bispectral index score(BIS), dexmedetomidine, fentanil, kuretase, propofol Comparison of Sedation Depth between Dexmedetomidine and Fentanyl-Propofol using Bispectal Index Score in Patients Undergoing Curettage Curettage is a minor surgical procedure that can cause pain and anxiety. Therefore, analgesia and sedation are needed. The purpose of this research was to compare the depth of sedation using bispectral index score (BIS) scale between dexmedetomidine and fentanyl-propofol combination in patients undergoing curettage. This was a double blind randomized controlled trial on 36 patients with American Society of Anesthesiologists (ASA) physical status I−II at the delivery room of Dr. Hasan Sadikin General Hospital  from July to October 2017. Subjects were randomized into two groups: dexmedetomidine group receiving a loading dose of 1 mcg/kgBW dexmedetomidine in 10 minutes followed by 50 mcg/kgBW/hour for maintenance and fentanyl-propofol group receiving a loading dose of 1 mg/kgBW propofol in 10 minutes and fentanyl 1 mcg/kg within 5 minutes followed by a maintenance dose of propofol 50 mcg/kgBW/hour. The BIS score in dexmedetomidine group (79.0±2.121) was significantly lower than in fentanyl-propofol group (85.22±0.732) with p<0.05. Hence, the sedation depth observed through BIS score evaluation shows that the score in dexmedetomidine group is lower than in fentanyl-propofol group in patients undergoing curettage. Key words: Bispectral index score (BIS), curettage, dexmedetomidine, fentanyl, propofol 
Efektivitas Analgesik 24 Jam Pascaoperasi Elektif di RSUP Dr. Hasan Sadikin Bandung Tahun 2017 Prabandari, Dita Aryanti; Indriasari, Indriasari; Maskoen, Tinni Trihartini
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (798.105 KB) | DOI: 10.15851/jap.v6n2.1221

Abstract

Nyeri akut pascaoperasi masih merupakan permasalahan dalam pelayanan kesehatan di seluruh dunia. Hampir 50% pasien pascaoperasi elektif mengalami nyeri yang berujung terhadap peningkatan kejadian nyeri kronik dan penurunan kepuasan pasien terhadap pelayanan kesehatan. Penelitian ini bertujuan memberikan gambaran mengenai analgesik yang digunakan di RSUP Dr. Hasan Sadikin Bandung dan efektivitasnya terhadap nyeri pascaoperasi. Penelitian ini menggunakan metode deskriptif observasional prospektif cross-sectional yang dilakukan pada pasien usia 18–65 tahun dengan status fisik American Society of Anaesthesiologist (ASA) kelas I–III di ruang perawatan pada jam ke-24 pascaoperasi selama tahun 2017 sebanyak 476 pasien. Subjek penelitian dikelompokkan berdasar atas jenis operasi yang menyebabkan nyeri ringan, sedang dan berat. Jenis analgesik pascaoperasi yang digunakan dan skala nyeri menggunakan numeric rating scale (NRS) dicatat. Efektif bila skala nyeri menggunakan NRS pada jam ke-24 pascaoperasi <4 dan tidak efektif bila NRS ≥4. Hasil penelitian didapatkan jenis analgesik terbanyak yang digunakan pada pasien pascaoperasi elektif adalah kombinasi petidin dan ketorolak i.v. dan derajat nyeri pada jam ke-24 pascaoperasi elektif yang dialami pasien adalah nyeri ringan NRS 1–3 (57,8%), nyeri sedang NRS 4–6 (26,9%), dan nyeri berat NRS 7–10 (2,7%). Simpulan penelitian ini adalah efektivitas analgesik pascaoperasi di RSUP Dr. Hasan Sadikin Bandung masih belum baik karena masih terdapat sepertiga pasien mengalami nyeri NRS ≥4 dari target rumah sakit 100% bebas nyeri.Kata kunci: Analgesik pascaoperasi, derajat nyeri pascaoperasi, efektivitas analgesik pascaoperasi Effectiveness of Analgesics 24 Hours Post-Post-Elective Surgery in Dr. Hasan Sadikin General Hospital in 2017Acute post-operative pain is still a worldwide issue in healthcare services. Nearly 50% of post-elective surgery patientspost- experience post-post-operative pain, causing increased chronic pain and decreased patient satisfaction towards healthcare services. This study aimed to provide  description on the types of analgesics used in Dr,Hasan Sadikin General Hospital and their effectiveness on post-operative pain. This  was a cross-sectional descriptive observational prospective study performed on 476 patients aged 18–65 years old with a physical status American Society of Anaesthesiologist (ASA) class I–III, treated in the ward 24 hours post- surgery in 2017. Subjects were classified based on the type of surgery that induced mild, moderate, and severe pain. The types of post-operative analgesics used and post-surgery Numeric Rating Scale (NRS) were documented. Analgesics was considered effective if the 24 hour post-surgery NRS was <4 and ineffective if the NRS was ≥4. This study showed that the type of analgesicsa mostly used for post-operative pain  was the combination of pethidine and ketorolac i.v. Pain scales experienced by patients at 24 hours post- surgery were mild withNRS 1–3 (57.8%), moderate pain with NRS 4–6 (26.9%), and severe pain with NRS 7–10 (2.7%). In conclusion, the post-operative analgesics provided in Dr. Hasan Sadikin General Hospital has not met the 100% pain free target set by the hospital target because some patients still experience pain with NRS ≥4.  . Hence, the effectiveness is still not adequate. Key words: Effectivity of post- operative analgesia, post- operative analgesia, post- operative pain scale
Penggunaan Skor Apfel Sebagai Prediktor Kejadian Mual dan Muntah Pascaoperasi di RSUP Dr. Hasan Sadikin Bandung Hendro, Rachmad Try; Pradian, Erwin; Indriasari, Indriasari
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (818.136 KB) | DOI: 10.15851/jap.v6n2.1425

Abstract

Post operative nausea and vomiting (PONV) merupakan kejadian mual dan atau muntah setelah tindakan operasi menggunakan anestesi pada 24 jam pertama pascaoperasi. Kejadian PONV dilaporkan memiliki perbedaan pada berbagai bangsa dan etnis. Skor Apfel merupakan salah satu prediktor PONV yang objektif dan paling sederhana. Sebelum menggunakannya sebagai prosedur rutin di RSHS, dilakukan penelitian ini yang bertujuan menilai apakah skor Apfel dapat digunakan sebagai prediktor PONV pada pasien yang menjalani operasi dengan anestesi umum di RSHS. Dilakukan suatu studi diagnostik secara potong lintang pada 100 pasien yang menjalani operasi elektif dengan anestesi umum di RSHS pada bulan September–Oktober 2017. Subjek penelitian dikelompokkan dalam 5 kelompok skor Apfel, yaitu perempuan, tidak merokok, menggunakan opioid pascaoperasi, dan memiliki riwayat PONV sebelumnya. Hasil penelitian ini menunjukkan terdapat 42% angka kejadian PONV, terdiri atas skor Apfel 0 (8,3%), skor 1 (19,04%), skor 2 (36,6%), skor 3 (63,63%), dan skor 4 (80%) yang sesuai dengan nilai prediktif skor Apfel. Angka kejadian PONV pada skor Apfel risiko tinggi (≥3) 61,9%, bermakna secara signifikan dapat membedakan kejadian PONV dengan nilai sensitivitas 61,9%, spesifisitas 81,0%, dan nilai AUC 0,777. Hasil ini menunjukkan bahwa skor Apfel memiliki validitas yang baik untuk membedakan antara pasien yang akan mengalami PONV dan yang tidak. Simpulan penelitian ini, skor Apfel dapat dipakai untuk memprediksi kejadian PONV di RSHS. Kata kunci: Post operative nausea and vomiting, prediktor, skor Apfel, validitas  Use of Apfel Score as a Predictor for Post-Post-operative Nausea and Vomiting in Dr. Hasan Sadikin General HospitalPost-operative nausea and vomiting (PONV) is defined as any nausea, retching, or vomiting that occurs  during the first 24 hour after surgery. Previous studies have reported that nationality and ethnicity influence the incidence of PONV. Apfel score is one of the objective and best simplified predicting PONV scoring systems available. Until recently, no predicting PONV score is used in Dr. Hasan Sadikin General Hospital (RSHS). Before implementing any scoring system as a protocol in this hospital, validation of the clinical risk assessment score in the hospital setu is needed. This was a cross-sectional diagnostic study on 100 patients underwentpost- various elective surgeries under general anesthesia. Subjects were divided into five groups, based on the Apfel risk scoring system. Factors observed consisted of four factors: female gender, nonsmoking status, post-operative use of opioids, and history of PONV or motion sickness. The results  were analyzed for total incidence of PONV in each Apfel score group. Of 100 patients assessed, a total of 42% experienced PONV. Patients  in Apfel score 0, 1, 2, 3, and 4 presented a PONV incidence score of 8.3%, 19.04%, 36.6%, 63.63%, and 80%, respectively. This incidence corresponds to the previous predicted values Apfel score. The incidence of PONV in patients  under high risk Apfel score (≥3) was 61.9%, showing a significant correlation with PONV. The sensitivity was 61.9%, the specificity was 81.0%, and the AUC value was 0.777. This confirms that Apfel score has good validity to predict the incidence of PONV. In conclusion, Apfel scoring system is useful for identifying patients with PONV in RSHS.Key words: Apfel score, post-post-operative nausea and vomiting, predictor, validity
Perbandingan Bupivakain 0,25% dengan Kombinasi Bupivakain 0,25% dan Deksametason 8 mg pada Blok Transversus Abdominis Plane dengan Panduan Ultrasonografi sebagai Analgesia Pascahisterektomi Delis, Eddo Alan; Pradian, Erwin; Yadi, Dedi Fitri
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (843.499 KB) | DOI: 10.15851/jap.v6n2.1240

Abstract

Analgesia dinding abdomen anterior dan lateral dapat dilakukan dengan blok transversus abdominis plane (TAP). Penelitian ini bertujuan menilai waktu kebutuhan analgesik pertama dan skor nyeri 2, 4, 6, 12, 24 jam pascahisterektomi antara bupivakain 0,25% dengan kombinasi bupivakain 0,25% dan deksametason 8 mg pada blok TAP. Penelitian menggunakan uji klinis acak terkontrol buta tunggal, dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan Oktober–Desember 2017. Pasien dibagi menjadi grup bupivakain 0,25% (grup B, n=20) dan grup kombinasi bupivakain 0,25% deksametason 8 mg (grup BD, n=20). Uji statistik menggunakan uji-t berpasangan, Uji Wilcoxon, dan uji chi-square. Hasil penelitian mengungkapkan waktu kebutuhan analgesik pertama lebih lama pada grup BD (866,45±98,11 menit) dibanding dengan grup B (352,75±43,32 menit) dengan perbedaan signifikan (p<0,05). Median skor nyeri  pascahisterektomi grup BD pada 4 jam (1), 6 jam (2), 12 jam (2), dan 24 jam (2) lebih rendah dibanding dengan grup B dengan median skor nyeri 4 jam (2), 6 jam (3), 12 jam (4), dan 24 jam (3), dengan perbedaan signifikan (p<0,05). Simpulan penelitian ini adalah kombinasi bupivakain 0,25% dan deksametason 8 mg pada blok TAP menghasilkan waktu kebutuhan analgesik pertama lebih lama dan skor nyeri pascahisterektomi lebih rendah dibanding dengan bupivakain 0,25%.Kata kunci: Blok transversus abdominis plane, deksametason, skor nyeri, waktu kebutuhan analgesik pertamaComparison between 0.25% Bupivacaine  and Combination of 0.25% Bupivacaine and 8 mg Dexamethasone  on Transversus Abdominis Plane Block Ultrasound-guided as Post- Hysterectomy Analgesia Analgesia for  anterior and lateral abdominal walls can be provided through transversus abdominis plane (TAP) block. This study aimed to evaluate the timing of first analgesic requirement and post- hysterectomy pain scores at 2, 4, 12, 24 hours between 0.25% bupivacaine and combination of 0.25% bupivacaine and 8 mg dexamethasone on TAP block. This was a randomized single-blind controlled trial study on patients Dr. Hasan Sadikin Hospital (RSHS) Bandung in the period of October–December 2017. Patients were randomly divided into 0.25% bupivacaine (B group, n=20) and o0.25% bupivacaine 8 mg dexamethasone combination (BD group, n=20). Statistical test was performed using paired t test, Wilcoxon test, and chi-square test. It was revealed that the time to first analgesic requirement was longer in BD group (866.45±98.11 minutes) than in B group (352.75±43.32 minutes) with a significant difference (p<0.05). The post-hysterectomy pain score medians in BD group at 4 hours (1), 6 hours (2), 12 hours (2), and 24 hours (2) were lower than those of B group with a significant difference (p<0.05). Therefore, 0.25% bupivacaine and 8 mg dexamethasone combination for ultrasound-guided TAP block presents longer time to first analgesic requirement and lower pain score compared to  0.25%. bupivacaine Key words:  Dexamethasone, pain  score, time  to  first  analgesic requirement,   transversus abdominis plane  block 
Perbandingan Kedalaman Sedasi antara Deksmedetomidin dan Kombinasi Fentanil-Propofol Menggunakan Bispectral Index Score pada Pasien yang Dilakukan Kuretase Daniel Asa Singarimbun; Indriasari Indriasari; Tinni T. Maskoen
Jurnal Anestesi Perioperatif Vol 6, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (929.029 KB) | DOI: 10.15851/jap.v6n2.1424

Abstract

Kuretase tergolong bedah minor yang menyebabkan nyeri dan ketidaknyamanan pasien sehingga memerlukan tindakan sedasi-analgesi. Tujuan penelitian adalah membandingkan kedalaman sedasi antara deksmedetomidin dan kombinasi fentanil-propofol menggunakan bispectral index score (BIS) pada pasien yang dilakukan kuretase. Penelitian ini merupakan penelitian randomized controlled trial dengan teknik double blind pada 36 pasien dengan status fisik American Society of Anesthesiologists (ASA) I−II yang menjalani kuretase di ruangan Obstetri dan Ginekologi RSUP Dr. Hasan Sadikin Bandung periode Juli sampai Oktober 2017. Kelompok deksmedetomidin mendapatkan loading dose deksmedetomidin 1 mcg/kgBB dalam waktu 10 menit dilanjutkan dosis pemeliharaan 0,5 mcg/kgBB/jam. Kelompol fentanil-propofol mendapatkan loading dose propofol 1 mg/kgBB dalam 10 menit diikuti dosis pemeliharaan 50 mcg/kgBB/jam ditambah fentanil 1 mcg/kgBB dalam 5 menit, lalu dicatat nilai BIS. Data dianalisis dengan uji-t dan Uji Mann-Whitney dengan p<0,05 dianggap bermakna. Analisis data statistik nilai BIS kelompok deksmedetomidin 79,50±2,121 dan fentanil-propofol 85,22±0,732 dengan perbedaan bermakna (p<0,05). Simpulan, penelitian ini menunjukkan kedalaman sedasi pada kelompok deksmedetomidin menghasilkan nilai BIS lebih rendah dibanding dengan fentanil-propofol pada pasien yang dilakukan kuretase. Kata kunci: Bispectral index score(BIS), dexmedetomidine, fentanil, kuretase, propofol Comparison of Sedation Depth between Dexmedetomidine and Fentanyl-Propofol using Bispectal Index Score in Patients Undergoing Curettage Curettage is a minor surgical procedure that can cause pain and anxiety. Therefore, analgesia and sedation are needed. The purpose of this research was to compare the depth of sedation using bispectral index score (BIS) scale between dexmedetomidine and fentanyl-propofol combination in patients undergoing curettage. This was a double blind randomized controlled trial on 36 patients with American Society of Anesthesiologists (ASA) physical status I−II at the delivery room of Dr. Hasan Sadikin General Hospital  from July to October 2017. Subjects were randomized into two groups: dexmedetomidine group receiving a loading dose of 1 mcg/kgBW dexmedetomidine in 10 minutes followed by 50 mcg/kgBW/hour for maintenance and fentanyl-propofol group receiving a loading dose of 1 mg/kgBW propofol in 10 minutes and fentanyl 1 mcg/kg within 5 minutes followed by a maintenance dose of propofol 50 mcg/kgBW/hour. The BIS score in dexmedetomidine group (79.0±2.121) was significantly lower than in fentanyl-propofol group (85.22±0.732) with p<0.05. Hence, the sedation depth observed through BIS score evaluation shows that the score in dexmedetomidine group is lower than in fentanyl-propofol group in patients undergoing curettage. Key words: Bispectral index score (BIS), curettage, dexmedetomidine, fentanyl, propofol 

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