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Jurnal Anestesi Perioperatif
ISSN : 23377909     EISSN : 23388463     DOI : 10.15851/jap
Core Subject : Health, Education,
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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perbandingan angka keberhasilan dan lama intubasi antara metode laringoskopi direk dan videolaringoskopi pada pasien obesitas Riri Lestari; Ezra Oktaliasah; Dhany Budipratama
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2426

Abstract

Obesitas merupakan salah satu prediktor independen jalan napas sulit. Laringoskopi direk menggunakan laringoskop Macintosh merupakan teknik standar yang paling sering digunakan untuk intubasi endotrakeal. Penggunaan videolaringoskop (VL) telah meningkatkan angka keberhasilan intubasi pada pasien dengan jalan napas sulit dan memberikan waktu intubasi yang lebih singkat dibanding dengan laringoskopi direk. Penelitian ini bertujuan mengetahui perbandingan angka keberhasilan dan lama intubasi antara metode laringoskopi direk dan videolaringoskopi pada pasien obesitas. Penelitian ini menggunakan metode prospektif analitik komparatif eksperimental, randomized single blind study dengan jumlah sampel sebanyak 22 pasien di Instalasi Bedah Sentral RSUP Dr. Hasan Sadikin Bandung pada periode November 2020–Januari 2021. Analisis statistik menggunakan Uji Eksak Fisher dan t dua kelompok independen. Dilakukan penilaian keberhasilan dan lama waktu intubasi endotrakeal setiap kelompok yang diuji. Pada kelompok VL, intubasi endotrakeal berhasil dilakukan pada 11 subjek dengan tidak ada subjek gagal, sementara pada kelompok direk didapatkan 6 subjek berhasil dan 5 subjek gagal. Lama intubasi pada kelompok VL rerata 27,69±7,73  detik dan kelompok direk 26,73±4,53 detik. Penelitian ini memberikan hasil angka keberhasilan intubasi endotrakeal dengan metode videolaringoskopi lebih tinggi secara signifikan (p<0,05) dengan waktu intubasi lebih lama yang tidak signifikan secara statistik (p>0,05). Simpulan, penggunaan metode videolaringoskopi pada saat intubasi pada pasien obesitas meningkatkan keberhasilan intubasi, namun tidak mempersingkat lama waktu intubasi. Comparison of Success Rate and Intubation Time between Direct Laryngoscopy and Videolaryngoscopy Methods on Obese Patients Obesity is one of independent predictors of difficult airway. Direct laryngoscopy with Macintosh blade is the frequent standard technique for endotracheal intubation. The use of videolaryngoscope has increased the success rate of intubation in patients with difficult airway and provided a shorter intubation time compared to direct laryngoscopy. The purpose of the study was to compare the result and time discrepancy when intubating obese patients with direct laryngoscopy and videolaryngoscopy methods. This study used prospective analytical comparative experimental, randomized single blind methods, on 22 patients at the central operating theatre Dr. Hasan Sadikin Hospital, Bandung during November 2020–January 2021. The study assessed the successful result and duration in doing endotracheal intubation from each study groups. In videolaryngoscopy group, 11 subjects were intubated successfully with no subject failed, while in group with direct laryngoscopy, 6 subjects were intubated successfully and 5 subjects failed. The mean time duration rate used to intubate in videolaryngoscopy group was 27.69±7.73 seconds, meanwhile in group with direct laryngoscopy was 26.73±4.53 seconds. The study shows higher successful rate of endotracheal intubation significantly (p<0.05) and longer time duration of intubation that is not significant statistically (p>0.05) in videolaryngoscopy group. In conclusion, intubation using videolaryngoscope increase the success of intubation but not  lessen the duration of  intubation time in  obese patients.
PENGARUH PREMEDIKASI KETAMIN 0,3 MG/KGBB TERHADAP RESPONS TUBUH PASIEN SAAT INSERSI JARUM SPINAL DAN KEPUASAN PASIEN Ardi Janardika; Ezra Oktaliansah; M. Andy Prihartono
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2419

Abstract

Pemberian premedikasi dapat mengurangi kecemasan preoperatif dan respons tubuh pasien saat insersi jarum spinal. Premedikasi membuat intervensi spinal menjadi lebih nyaman bagi pasien, pasien kooperatif selama penyuntikan, dan mengurangi respons saat insersi jarum spinal. Tujuan penelitian ini mengetahui pengaruh premedikasi ketamin 0,3 mg/kgBB yang diberikan 3 menit sebelum dilakukan anestesi spinal terhadap respons tubuh pasien saat insersi jarum spinal dan penerimaan pasien terhadap anestesi spinal. Penelitian dilakukan periode Agustus–Desember 2020 di RSUP Dr. Hasan Sadikin Bandung. Penelitian bersifat komparatif eksperimental dengan menggunakan uji klinis acak buta ganda terhadap 46 subjek yang dibagi acak ke dalam 2 kelompok, yaitu kelompok kontrol (kelompok C, n=23) dan kelompok premedikasi ketamin (kelompok K, n=23). Pascapemberian premedikasi ketamin dinilai respons tubuh pasien saat insersi jarum spinal menggunakan prick response score dan penerimaan pasien dengan numeric rating scale. Analisis statistik untuk respons penyuntikan dan penerimaan pasien diuji dengan tes chi-square. Hasil penelitian menunjukkan respons tubuh pasien saat insersi jarum spinal berkurang (p<0,01) dan penerimaan pasien meningkat (p<0,01) pada kelompok perlakuan. Simpulan penelitian, yaitu premedikasi ketamin 0,3 mg/kgBB yang diberikan 3 menit sebelum anestesi spinal menurunkan respons tubuh pasien saat insersi jarum spinal dan meningkatkan penerimaan pasien terhadap anestesi spinal. The Effect of Ketamine Premedication 0.3 mg/kgBW before Spinal Anesthesia to Body Response during Spinal Needle Insertion and SatisfactionPremedication may reduce preoperative anxiety and response during spinal needle insertion. Premedication leads to a more comfortable spinal intervention for the patients, making them more cooperative and allaying response during spinal needle insertion. The aims of this study were to determine the effects of 0.3 mg/kgBW ketamine premedication administered 3 minutes before spinal anesthesia on the patient`s body response during spinal needle insertion and patient satisfaction. The study was conducted in August–December 2020 in Dr. Hasan Sadikin General Hospital Bandung. This was a comparative experimental study with a randomized, double blinded clinical trial on 46 subjects randomly divided into 2 groups, a control group (group C, n=23), and a ketamine premedication group (group K, n=23). After premedication with ketamine, the patient`s body response were evaluated during spinal needle insertion using the prick response score and their satisfaction using the numeric rating scale. Statistical analysis for response during needle insertion and patient satisfaction was evaluated using the chi-square test. Results of the study showed that patient`s body response during spinal needle insertion were reduced (p<0.01) and patient satisfaction was increased (p<0.01) in the ketamine premedication group. In conclusion, 0.3 mg/kgBW ketamine premedication administered 3 minutes before spinal anesthesia reduces patient body response during spinal needle insertion and increases patient satisfaction on spinal anesthesia.
Perbandingan Pemberian Ketorolak dengan Parecoxib Intravena Terhadap Kadar Trombosit, Aggregasi Trombosit dan Profil Koagulasi pada Operasi Seksio Sesarea Hendra Salim; Muhammad Ramli Ahmad; Syafri Kamsul Arif; Syamsul Hilal Salam; Zulkarnain Arrasjid; Charles Wijaya Tan
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2395

Abstract

Pengelolaan nyeri pascabedah bertujuan menghasilkan analgesia yang optimal serta menghambat respons stres akibat pembedahan. Pengaruh OAINS baik COX 1 dan COX 2 terhadap trombosit baik jumlah maupun aggregasinya perlu dinilai untuk menentukan obat terpilih yang aman dalam mengatasi nyeri pascabedah. Penelitian ini bertujuan membandingkan pemberian ketorolak dengan parecoxib intravena terhadap jumlah trombosit, aggregasi trombosit, dan profil koagulasi pada operasi seksio sesarea. Penelitian ini menggunakan uji klinis acak tersamar ganda. Penelitian dilakukan di RSUP Wahidin Sudirohusodo Makassar pada bulan Oktober 2020–Maret 2021. Pengukuran dilakukan di awal dan setelah perlakuan dengan jumlah sampel masing-masing 11 orang. Data dianalisis menggunakan uji statistik Independen T-Test. Tidak berbeda bermakna perubahan kadar trombosit pada pemberian ketorolak dengan parecoxib sebagai analgesia pascabedah seksio pasca 24 jam dan pasca 48 jam (p>0,05). Berbeda bermakna perubahan agregasi trombosit pada pemberian ketorolak dengan parecoxib sebagai analgesia pascabedah seksio pasca 48 jam (p<0,05). Parecoxib tidak menyebabkan penurunan agregasi trombosit sehingga dapat digunakan sebagai alternatif untuk analgetik pascabedah terutama untuk pasien yg mengalami gangguan hemostatis. Parecoxib tidak menyebabkan gangguan faal hemostasis dibanding dengan ketorolak. Parecoxib dan ketorolak tidak memengaruhi jumlah trombosit Comparison of Intravenous Ketorolac with Parecoxib on Platelet Count, Platelet Aggregation and Coagulation Profile in Caesarean SectionPost-surgical pain management aims to produce optimal analgesia and also inhibit the stress response due to surgery. The effect of NSAIDs, both COX-1 and COX-2, on thrombosis, both in amount and aggregation, need to be assessed to determine which drug is safe for postoperative pain management to compare the administration of intravenous ketorolac with intravenous parecoxib on the platelet count, platelet aggregation and coagulation profile in cesarean section surgery. This study was a randomized double-blind clinical trial. Research site was at Wahidin Sudirohusodo Hospital Makassar from October 2020 to March 2021. Measurements were made at the beginning and after treatment with 11 samples on each group. Data were analyzed using the Independent T-Test. There was no significant difference in platelet count in the administration of ketorolac and parecoxib as analgesia after 24 hours post cesarean section surgery and 48 hours post cesarean section surgery (p>0.05). There was a significant difference in platelet aggregation between ketorolac and parecoxib group after 48 hours of post cesarean section surgery (p<0.05). Parecoxib does not cause a decrease in platelet aggregation; therefore, it can be used as an alternative for post-surgical analgesics, especially for patients with hemostatic disorders. Parecoxib does not cause hemostatic physiological disorders compared to ketorolac. Both parecoxib and ketorolac do not affect the platelet count.
Perbandingan Angka Keberhasilan, Waktu Dan Kenyamanan Intubasi Endotrakea Antara Operator Posisi Berdiri Dan Duduk Pada Pasien Posisi Sniffing Naftalena Naftalena; Ezra Oktaliansah; Ricky Aditya
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2424

Abstract

Kemampuan untuk visualisasi glotis saat melakukan tindakan laringoskopi direk merupakan kunci untuk melakukan tindakan intubasi endotrakea. Posisi sniffing dan ketinggian meja berpengaruh pada visualisasi glotis dan kenyamanan operator saat intubasi endotrakea. Namun, meja operasi sering ditemukan tidak berfungsi dengan baik. Ketersediaan kursi ergonomis diharapkan sebagai alternatif untuk menjawab permasalahan yang terjadi. Tujuan penelitian ini mengetahui perbandingan keberhasilan, waktu, dan kenyamanan operator pada intubasi endotrakea dengan pasien posisi sniffing menggunakan bantal kepala antara operator posisi berdiri dan duduk. Penelitian ini merupakan penelitian prospective randomized paralel trial, dilakukan pada 44 pasien yang menjalani operasi elektif dan emergensi dengan anestesi umum yang memenuhi kriteria inklusi dan tidak termasuk kriteria eksklusi. Penelitian dilakukan di ruang operasi elektif dan emergensi RSUP Dr. Hasan Sadikin pada bulan Oktober 2020. Analisis statistik menggunakan t independent test untuk lama intubasi dan kenyamanan pasien, sedangkan untuk data kategorik dengan uji chi-square. Keberhasilan dan lama waktu intubasi endotrakea pada pasien posisi sniffing menggunakan bantal dengan operator posisi berdiri dan duduk tidak terdapat perbedaan yang signifikan (p>0,05). Pada variabel skor kenyamanan intubasi endotrakea pada pasien posisi sniffing menggunakan bantal dengan operator posisi berdiri dan duduk terdapat perbedaan rerata yang sangat signifikan (p<0,01). Skor kenyamanan intubasi endotrakea posisi duduk lebih baik dibanding dengan posisi berdiri. Comparison of Success Rate, Time and Comfort of Endotracheal Intubation between Operator Standing and Sitting Position with Patient Sniffing Position The ability to visualize the glottis during direct laryngoscopy is the key to perform endotracheal intubation. Sniffing position and table height affect visualization of glottis and comfort of the operator. However, the operating table often does not function properly. This study aims to determine the correlation of intubation success rate, intubation time, and operator’s comfort in performing endotracheal intubation on a patient in a sniffing position using a head cushion between standing and sitting position of the operator. This was a prospective randomized trial. The study was conducted on 44 patients who underwent elective and emergency surgery under general anesthesia who qualified the inclusion criteria and did not include the exclusion criteria. The research was conducted in the elective operating room and emergency Dr. Hasan Sadikin Hospital in October 2020. Statistical analysis used the independent t test for intubation time and patient comfort, while for categorical data using the chi-square test. There was no significant difference (p>0.05) in intubation time and success rate of endotracheal intubation on patients in sniffing position using a head cushion between sitting and standing position of the operator. There was a significant mean difference (p<0.01) in operator’s comfort in performing endotracheal intubation on patients in sniffing position using a head cushion between sitting and standing position of the operator. The operator’s comfort score in performing endotracheal intubation was higher in sitting position compared to standing position. 
Perbandingan Numeric Rating Scale Nyeri Pascaoperasi Kolesistektomi Laparoskopik Antara Blokade Erector Spinae Plane Dan Pethidine Intravena Arrys Prabowo; Reza Widianto Sudjud; Ricky Aditya
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2405

Abstract

Nyeri pascaoperasi harus diatasi dengan baik. Berbagai metode analgetik dilakukan untuk mengatasi nyeri pascaoperasi kolesistektomi laparoskopik, namun tidak ada yang ideal dalam menangani nyeri pascaoperasi. Blokade erector spinae plane adalah teknik baru untuk penanganan nyeri pascaoperasi kolesistektomi laparoskopik. Penelitian ini bertujuan mengetahui perbedaan nyeri pascaoperasi kolesistektomi laparoskopik yang dinilai dengan NRS nyeri antara pasien yang menggunakan blokade erector spinae plane dan petidin intravena. Penelitian dilakukan pada periode Juni–Oktober 2020 di RSUP Dr. Hasan Sadikin Bandung. Penelitian ini menggunakan metode uji klinis acak terkontrol buta tunggal terhadap 30 pasien. Pasien dibagi menjadi dua kelompok, kelompok petidine intravena (kelompok A, n=15) dan kelompok blokade erector spinae plane (kelompok B, n=15). Nyeri pascaoperasi dinilai dengan NRS pada 0–1 jam, 1–6 jam, 6–12 jam, dan 12–24 jam. Analisis data numerik dengan uji T tidak berpasangan dan Mann Whitney. Data kategorik dengan uji chi square. Skor NRS pada kelompok blokade erector spinae plane lebih rendah dibanding dengan kelompok petidin intravena pada 6–12 jam pascaoperasi (p=0,002) dan kebutuhan rescue analgetik pada 6–12 jam lebih rendah pada kelompok blokade. Metode analgetik blokade erector spinae plane pada pasien pascaoperasi kolesistektomi laparoskopik lebih baik daripada petidin intravena. Comparison of Pain Numeric Rating Scale between Erector Spinae Plane Block and Intravenous Pethidine Post-Laparoscopic Cholecystectomy Postoperative pain is a complaint that must be properly managed. Various analgesic methods are implemented to alleviate laparoscopic cholecystectomy postoperative pain, but none are ideal in managing postoperative pain. Erector spinae plane block is a new technique in laparoscopic cholecystectomy postoperative pain.  This study aims to discover the difference in post laparoscopic cholecystectomy pain measured using the NRS pain scale in patients with erector spinae plane block and intravenous pethidine. The study was conducted between June–October 2020 in Dr. Hasan Sadikin General Hospital Bandung. This was a single blind control trial in 30 patients. Patients were divided into two groups, an intravenous pethidine group (group A, n=15) and an erector spinae plane block group (group B, n=15). Postoperative pain was measured using the NRS pain scale on hour 0–1, 1–6, 6–12, and 12–24. Numerical data was analyzed using the unpaired T test and the Mann Whitney test. Categorical data using the chi square test. NRS measurements in the erector spinae plane block group were lower compared to the intravenous pethidine group in hour 6–12 postoperation (p=0.002) and the need for a rescue analgesic in hour 6–12 lower in the blokade group. The analgesic method erector spinae plane block in patients post laparoscopic cholecystectomy is better than intravenous pethidine. 
Efektivitas oksigenasi dan ventilasi saat induksi anestesi umum menggunakan masker bedah dinilai berdasarkan SpO2 dan EtCO2 Linggih Panji Nugraha; Ezra Oktaliansah; Ricky Aditya
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2401

Abstract

Anestesiolog memiliki risiko tinggi terpapar aerosol pada saat melakukan tindakan ventilasi maupun intubasi. Anestesiolog harus dapat melakukan ventilasi dengan baik selama induksi anestesi umum. Tujuan penelitian ini adalah mengetahui efektivitas oksigenasi dan ventilasi saat induksi anestesi umum pada pasien yang menggunakan masker bedah dinilai berdasar atas SpO2 dan EtCO2. Penelitian ini merupakan penelitian analisis numerik berpasangan dengan rancangan eksperimental pada pasien yang dilakukan operasi elektif dengan anestesi umum di Instalasi Bedah Sentral RSUP Dr. Hasan Sadikin Bandung pada bulan November–Desember 2020. Selama induksi anestesi, pasien menggunakan masker bedah kemudian dilakukan penilaian SpO2 dan EtCO2 pada saat sebelum induksi dan selama induksi menit ke-1, 2, dan 3. Hasil penelitian mengungkapkan nilai SpO2 dan EtCO2  preinduksi dan pada menit ke-1, 2, dan 3 diperoleh nilai rerata SpO2 dan EtCO2 induksi menit ke-1, ke-2, dan ke-3 tidak lebih inferior dibanding dengan nilai pra induksi (p<0,05) dengan nilai rerata SpO2 dan EtCO2 dalam batas normal.Simpulan penelitian adalah penggunaan masker bedah selama induksi tidak mengurangi efektivitas oksigenasi dan ventilasipada pasien yang dilakukan anestesi umum dinilai berdasar atas SpO2 dan EtCO2. Effectiveness of Oxygenation and Ventilation During General Anesthesia Induction Using Surgical Mask Assessed by SpO2 and EtCO2 Anesthesiologist have high risk for exposure of aerosol during ventilation or intubation. They must do ventilation during induction of general anesthesia effectively. The study was aimed to know how effective the oxygenation and ventilation during induction of general anesthesia while using surgical mask assessed by SpO2 and EtCO2. The research was a numerical analytic with experimental design performed on elective surgery patients done by general anesthesia in central operating theatre Dr. Hasan Sadikin General Hospital Bandung in November–December 2020. During induction of anesthesia, patient were using surgical mask and assessment of SpO2 and EtCO2 was done before induction and during induction in the 1st, 2nd, and 3rd minute induction. The result of the study revealed SpO2 and EtCO2  preinduction and 1st, 2nd, and 3rd minute induction had SpO2 and EtCO2 value in 1st, 2nd, and 3rd minute induction not inferior to pre induction value, with SpO2 and EtCO2 value within normal limit.The study has concluded that using surgical mask during induction does not decrease the effectiveness of oxygenation and ventilation in patient with general anesthesia assessed by SpO2 and EtCO2.
perbandingan excessive daytime sleepiness dengan normal daytime sleepiness terhadap fungsi kognitif serta waktu reaksi peserta ppds anestesiologi dan terapi intensif Army Zaka Anwary; Iwan Fuadi; Ardi Zulfariansyah
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2391

Abstract

Excessive daytime sleepiness (EDS) adalah ketidakmampuan untuk tetap terjaga pada siang hari yang menghasilkan rasa kantuk berlebih dan tertidur pada waktu yang tidak tepat. Prevalensi EDS yang tinggi ditemukan pada tenaga medis seperti peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif. Kondisi EDS dapat memengaruhi fungsi kognitif dan waktu reaksi. Tujuan penelitian ini adalah  membandingkan EDS dengan normal daytime sleepiness (NDS) terhadap fungsi kognitif serta waktu reaksi peserta PPDS Anestesiologi. Penelitian ini merupakan penelitian analitik komparatif numerik dengan rancangan potong lintang yang dilakukan pada peserta PPDS Anestesiologi Fakultas Kedokteran Universitas Padjadjaran di bulan November 2020. Seluruh PPDS Anestesiologi mengisi kuisioner Epworth Sleepiness Scale (ESS) agar terbagi menjadi dua kelompok, kelompok EDS (n=23) dan kelompok NDS (n=23). Fungsi kognitif diukur menggunakan tes Montreal Cognitive Assessment versi Bahasa Indonesia dan waktu reaksi menggunakan perangkat lunak Personal Computer-Psychomotor Vigilance Task. Hasil penelitian menunjukkan fungsi kognitif lebih rendah pada kelompok EDS (26,74±1,096) dibanding dengan kelompok NDS (28,65±1,191) dan waktu reaksi lebih lambat pada kelompok EDS (337,38±62,021) dibanding dengan kelompok NDS (298,81±34,225). Simpulan penelitian adalah peserta PPDS Anestesiologi kelompok EDS memiliki fungsi kognitif lebih rendah dan waktu reaksi lebih lambat dibanding dengan peserta PPDS Anestesiologi kelompok NDS. Comparison between Excessive Daytime Sleepiness and Normal Daytime Sleepiness on Cognitive Function and Reaction Time of Anesthesiology and Intensive Care Residents Excessive daytime sleepiness (EDS) is the inability to stay alert during the day due to sleepiness during daytime, often associated with the tendency of falling asleep during inappropriate times. High prevalence of EDS was found among medical workers, such as anesthesiology residents. The condition is associated with increased secretion of cathecholamines, cortisol, and inflammatory mediators that may affect the prefrontal cortex, area of the brain that acts as a center for cognitive function and reaction time. The study aimed to compare EDS with normal daytime sleepiness (NDS) on cognitive function and reaction time of anesthesiology residents. The research was a numerical comparative analytic study with a cross-sectional design performed on anesthesiology residents of Faculty of Medicine Universitas Padjadjaran in November 2020. All residents in the department were instructed to complete the Epworth Sleepiness Scale (ESS) questionnaire. After completion, the respondents were randomized using simple random sampling into two groups: the EDS group (n=23) and NDS group (n=23). Each group was assessed for cognitive function using the Indonesian version of the Montreal Cognitive Assessment and reaction time using the Personal Computer-Psychomotor Vigilance Task software. Lower cognitive function scores were found in EDS group (26.74±1.096) compared to NDS group (28.65±1.191); slower reaction time were found in EDS group (337.38±62.021) compared to NDS group (298,81±34.225). Both variables had shown significant differences between both groups  (p<0.05). The study had concluded that anesthesiology residents with EDS have lower cognitive scores and slower reaction time compared to anesthesiology residents with NDS.     
A Case Series of COVID-19 with Severe ARDS and Comorbidities who Survived without Invasive Mechanical Ventilation in ICU at Wisma Atlet Kemayoran COVID-19 Field Hospital, Jakarta Made Yudha Asrithari Dewi; Ahmad Irfan
Jurnal Anestesi Perioperatif Vol 9, No 2 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v9n2.2457

Abstract

Sebagian besar orang yang terinfeksi COVID-19 asimtomatis ataupun bergejala ringan. Namun tidak sedikit juga yang mengalami acute respiratory distress syndrome (ARDS), membutuhkan perawatan ICU bahkan berakhir dengan kematian. Indonesia bahkan telah melampaui angka dunia dengan angka 2,7%. Keadaan ini lebih berisiko dialami oleh pasien dengan komorbid seperti hipertensi (50,1%), diabetes (36,6%), dan obesitas (13,3%). Kebutuhan terapi oksigen dengan ventilasi mekanik hingga tindakan intubasi meningkat pada kebanyakan kasus dengan komorbid. Serial kasus ini melaporkan dua pasien terkonfirmasi COVID-19 dengan komorbid yang memenuhi kriteria intubasi, namun tidak dilakukan. Dalam perjalanannya kedua kasus mengalami perbaikan klinis dan sembuh. Beberapa kemungkinan yang dapat dijelaskan, yaitu terdapat perbedaan antara ARDS pada COVID-19 (CARDS) dan ARDS klasik. Selain itu, prone position yang membantu meningkatkan oksigenasi dan mengatasi hipoksemia melalui beberapa mekanisme. Penggunaan HFNC dini pada pasien COVID-19 dan pemberian regimen kombinasi terapi antibiotik, antivirus, antikoagulan, serta antiinflamasi dinilai dapat menurunkan morbiditas pasien. Tujuan penanganan ARDS ialah menangani hipoksemia dengan meningkatkan oksigenasi. Selain dengan pemberian terapi oksigen untuk meningkatkan FiO2, dapat juga dilakukan dengan prone position. Prone position pada kasus dengan kombinasi HFNC dinilai berhasil karena pasien mampu bertahan tanpa penggunaan ventilasi mekanik dan mengalami perbaikan klinis hingga sembuh. Two Reported Cases of COVID-19 with Severe ARDS and Comorbidities who Survived without Invasive Mechanical Ventilation in ICU at Wisma Atlet Kemayoran COVID-19 Field Hospital, JakartaMost patients with COVID-19 are either asymptomatic or have mild symptoms. However, many also experience acute respiratory distress syndrome (ARDS), requiring ICU, or even lead to death. Indonesia’s case fatality rate of 2.7% has exceeded the global case. Patients with comorbidities such as hypertension (50.1%), diabetes (36.6%), and obesity (13.3%) are at higher risk of experiencing this situation. The need for oxygen therapy with mechanical ventilation or even intubation is increased in most cases with previously mentioned comorbidities. These serial cases reported two confirmed COVID-19 patients with comorbidities that fulfilled intubation criteria; however, the intubation procedures were not performed. Both cases experienced clinical improvement and improved throughout the treatment period. Several possible explanations include that there are differences between ARDS in COVID-19 (CARDS) and classic ARDS. Moreover, the prone position helps in increasing oxygenation and reducing hypoxemia through several mechanisms. Early HFNC in COVID-19 patients and treatment regimen consisting of antibiotics, antivirus, anticoagulant, and anti-inflammatory drugs are considered to reduce morbidity. The goal of ARDS treatment is to treat hypoxemia by increasing oxygenation. In addition, giving oxygen therapy to increase FiO2 can also be done by prone positioning. Combining prone position and HFNC in these cases was considered successful because the patient were able to survive without the use of mechanical ventilation and experienced clinical improvement until they recovered.

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