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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.
Arjuna Subject : -
Articles 484 Documents
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EFEKTIVITAS DEXMEDETOMIDINE TERHADAP KADAR KORTISOL PADA PASIEN YANG MENJALANI OPERASI GINEKOLOGI DALAM ANESTESI UMUM Yuliana Yuliana; Rose Mafiana; Agustina Br. Haloho; Theodorus Theodorus
Jurnal Anestesi Perioperatif Vol 7, No 3 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (123.812 KB) | DOI: 10.15851/jap.v7n3.1800

Abstract

Respons stres adalah perubahan hormon dan metabolik yang terjadi setelah trauma seperti pembedahan, salah satunya terjadi peningkatan kadar kortisol. Dexmedetomidine dapat menurunkan respons stres dengan menghambat sintesis kortisol. Tujuan penelitian ini adalah mengetahui efek dexmedetomidine terhadap kadar kortisol pada pasien yang menjalani operasi ginekologi dalam anestesi umum yang dilakukan di RSUP dr. Mohammad Hoesin Palembang dari Januari–Maret 2018. Jumlah sampel 30 orang yang dibagi menjadi 2 kelompok, kelompok dexmedetomidine dan kelompok plasebo. Kelompok dexmedetomidine mendapatkan dosis dexmedetomidine awal 1 µg/kgBB selama 10 menit dilanjutkan 0,5 µg/kgBB/jam, 20 menit sebelum induksi. Pada kelompok plasebo menggunakan NaCl 0,9%. Induksi menggunakan propofol, fentanil 2 µg/kgBB, dan atrakurium 0,5 µg/kgBB serta pemeliharaan menggunakan sevofluran 3% dalam O2 dan N2O 50%:50%. Kemudian 1 jam pascaekstubasi diambil sampel darah kembali untuk pemeriksaan kadar kortisol. Hasil penelitian pada kedua kelompok terjadi peningkatan kadar kortisol saat 1 jam pascaekstubasi dibanding dengan awal (9,638±7,082 µg/dL menjadi 14,503±7,082 µg/dL pada kelompok dexmedetomidine dan 10,276±3,166 µg/dL menjadi 19,99±6,273 µg/dL pada kelompok placebo). Namun, kadar kortisol signifikan lebih tinggi pada kelompok plasebo. Simpulan, pada kedua kelompok terjadi peningkatan kadar kortisol dibanding dengan nilai awal, tetapi kadar lebih rendah pada kelompok dexmedetomidine. Effectiveness of Dexmedetomidine on Cortisol Level in Patients Undergoing Gynecologic Surgery under General AnesthesiaStress response is a term used to define the metabolic and hormonal changes following an injury or trauma, including as surgery. One of the responses is an increase in cortisol release. Dexmedetomidine may attenuate stress response by inhibiting cortisol synthesis. The aim of this study was to determine the effects of dexmedetomidine on cortisol level, compared to placebo, in patients undergoing major gynecological surgery under general anesthesia. A double-blind randomized clinical trial was performed at Mohammad Hoesin General Hospital from January to March 2018. There were thirty samples that were divided into two groups, dexmedetomidine group and placebo group. The dexmedetomidine group received an initial dexmedetomidine loading dose of 1 µg kg -1 over 10 min, followed by 0.5 µg kg-1h-1 20 minutes before induction. In the placebo group, 0.9% sodium chloride was administered. Anesthesia was induced with propofol, 2 µg/kgBW fentanyl, and 0.5 mg/kgBW atracurium and was maintained with 3% sevoflurane in O2 and N2O 50%:50%. After standard monitoring was established, blood samples were collected for cortisol plasma testing at baseline and 1 hour post-extubation. Hemodynamic data were recorded intraoperatively and postoperatively. Results in both groups presented a significant increase in cortisol level relative to the baseline at 1 hour post-extubation (9.638±7.082 µg/dL to 14.503±7.082 µg/dL in dexmedetomidine group and 10.276±3.166 µg/dL to 19.99±6.273 µg/dL in placebo group [P value<0.05]) with a significantly higher corticsol level in the placebo group when compared to the dexmedetomidine group (P value<0.05). In conclusion, the plasma cortisol level was found to increase significantly relative to baseline level in both groups. However, the increase was significantly lower in the dexmedetomidine group.
Perbandingan Preemptive Analgesia Kombinasi Ibuprofen 75 Miligram dan Parasetamol 250 Miligram per Oral dengan Parasetamol 1 Gram per Oral Terhadap Numeric Rating Scale pada Pasien Pascabedah Odontektomi Hilmy Manuapo; Doddy Tavianto; Reza Widianto Sudjud
Jurnal Anestesi Perioperatif Vol 7, No 3 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v7n3.1834

Abstract

Analgesik dosis tinggi dapat menimbulkan berbagai efek samping. Penggunaan kombinasi analgesik bekerja melalui mekanisme yang berbeda dan memiliki efek sinergis. Penelitian ini bertujuan mengetahui perbedaan lama analgesik antara kombinasi ibuprofen 75 mg dan parasetamol 250 mg per oral dibanding dengan parasetamol 1 g per oral terhadap nyeri pascabedah odontektomi. Penelitian eksperimental dengan uji klinis acak tersamar buta ganda terhadap 26 subjek penelitian yang menjalani odontektomi di RSUP Dr. Hasan Sadikin Bandung pada bulan Juli–Oktober 2019. Subjek dibagi menjadi kelompok P (Parasetamol) dan kelompok K (Kombinasi). Data hasil penelitian diuji secara statistik menggunakan Uji Mann-Whitney. Hasil penelitian ini didapatkan perbandingan lama analgesik pascabedah kelompok K (74,23±15,79 menit) lebih lama dibanding dengan kelompok P (50,76±17,22 menit) dengan p<0,05. Hasil skor nyeri pascabedah odontektomi pada kelompok K (2,92±0,75) lebih rendah dibanding dengan kelompok P (3,92±0,86) dengan p<0,05. Simpulan penelitian ini adalah kombinasi preemptive analgesia ibuprofen dan parasetamol per oral memiliki efek analgesik yang lebih lama dibanding dengan parasetamol per oral pada pascabedah odontektomi. Comparison of Preemptive Analgesia using Oral Combination of Ibuprofen 75 Milligrams and Paracetamol 250 Milligram and Oral Paracetamol 1 Gram on Duration of Analgesics After OdontectomyHigh dose analgesic can cause multiple side effects. Use of analgesics combination enable analgesics to work through different mechanisms and produce a synergistic effect. This study aimed to evaluate the analgesic effects of oral 75 mg ibuprofen and 250 mg paracetamol combination in comparison to oral 1 g paracetamol on post-odontectomy pain. This study was an experimental double blind randomized clinical trial conducted on 26 subjects who underwent odontectomy in Dr. Hasan Sadikin General Hospital Bandung during the period of July‒October 2019. Subjects were divided into P (Paracetamol) group and K (combination) group. Data collected were statistically tested using the Mann-Whitney test. Results showed that the time when post-odontectomy pain started in K group (74.23±15.79 minutes) was significantly longer when compared to that of P group (50.76±17.22 minutes) with p<0.05. The post-odontectomy pain score in K group (2.92±0.75) was also lower than that of P group (3.92±0.86), with p<0.05. In conclusion, oral analgesic agent combinations have a longer analgesic effect than oral paracetamol only in post-odontectomy patients.
PERBANDINGAN METODE PENGAJARAN REVIEW VIDEO DENGAN TANPA REVIEW VIDEO TERHADAP KEBERHASILAN DAN LAMA INTUBASI PADA MAHASISWA PROGRAM STUDI PENDIDIKAN DOKTER Ferawati Ferawati; Erwin Pradian; Dedi Fitri Yadi
Jurnal Anestesi Perioperatif Vol 7, No 3 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (291.678 KB) | DOI: 10.15851/jap.v7n3.1807

Abstract

Metode pengajaran yang inovatif dan efektif dalam pengajaran intubasi endotrakeal dibutuhkan untuk untuk menghasilkan mahasiswa kedokteran yang memiliki keterampilan memadai. Metode pengajaran review video yang melibatkan dual coding theory menggunakan kombinasi antara gambar dan suara akan mengaktifkan saluran kognitif verbal dan nonverbal sehingga dapat membantu memahami informasi dengan lebih baik. Penelitian ini bertujuan mengetahui perbandingan keberhasilan dan lama intubasi endotrakeal pada manekin menggunakan metode pengajaran review video dengan tanpa review video yang dilakukan oleh mahasiswa Program Studi Pendidikan Dokter (PSPD). Penelitian menggunakan metode randomized crossover study, dilakukan di RSUP Dr. Hasan Sadikin (RSHS) Bandung pada bulan Juli–September 2019 dan melibatkan 60 mahasiswa PSPD. Data kategorik dianalisis menggunakan Uji Eksak Fisher dan data numerik menggunakan Uji Mann Whitney. Penelitian ini memberikan hasil keberhasilan intubasi kelompok metode pengajaran review video 96,7% dan metode pengajaran tanpa review video 73,3% (p<0,05), lama intubasi rerata kelompok metode pengajaran review video 101,1 detik dan metode pengajaran tanpa review video 126,8 detik (p<0,05). Simpulan penelitian adalah penggunaan metode pengajaran review video meningkatkan keberhasilan intubasi dan mempersingkat lama intubasi oleh mahasiswa kedokteran. Comparison of Teaching Method with and without Video Review on Intubation Success Rate and Time Performed by Medical Students Innovative and effective teaching methods in teaching endotracheal intubation are needed to produce sufficient skills among medical students. Video review teaching methods that involve a dual coding theory using a combination of images and sound activate verbal and nonverbal cognitive channels, leading to better understanding of the information conveyed. This study aimed to compare the success and duration of endotracheal intubation in mannequins using the video review teaching method compared to teaching without video review to students of the Medical Education Study Program (Program Studi Pendidikan Kedokteran, PSPD). This was a randomized crossover study conducted in Dr. Hasan Sadikin General Hospital Bandung in July–September 2019 on 60 PSPD students. Categorical data collected were analyzed using the Fisher’s Exact Test while Mann Whitney test was used for numerical data. It was identified that the success rate of intubation performed by the group receiving video review was 96.7% while the non-video review group achieved a success rate of 73.3% (p<0.05). The average length of intubation in the video review group was 101.1 seconds while the non-video review group performed intubation in 126.8 seconds (p<0.05). Therefore, the use of video review teaching method increases the success of intubation and shorten the length of time intubation by medical students.
PERBANDINGAN KEJADIAN POSTOPERATIVE COGNITIVE DYSFUNCTION (POCD) FASE AKUT PADA JOINT ARTHROPLASTY DENGAN ANESTESI UMUM DAN ANESTESI EPIDURAL PADA PASIEN USIA LANJUT Syahpikal Sahana; Iwan Abdul Rachman; Dewi Yulianti Bisri
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (603.309 KB) | DOI: 10.15851/jap.v8n1.1990

Abstract

Usia lanjut merupakan faktor risiko terjadinya postoperative cognitive dysfunction (POCD). Pemilihan teknik anestesi yang tepat pada usia lanjut akan menurunkan risiko kejadian POCD. Penelitian ini bertujuan untuk membandingkan angka kejadian POCD pada pasien usia lanjut yang menjalani operasi joint arthroplasty antara anestesi umum dan anestesi epidural. Penelitian berlangsung pada bulan Juli–Oktober 2019 di RSUP Dr. Hasan Sadikin Bandung. Penelitian dilakukan menggunakan metode randomized control trial dengan melibatkan 48 pasien yang menjalani tindakan joint arthroplasty. Subjek penelitian dibagi menjadi kelompok anestesi umum (GA) dan anestesi epidural (EA) menggunakan bilangan acak. Penilaian status mental pasien dilakukan menggunakan Mini mental state examination (MMSE) pada saat preoperasi dan tujuh hari pascaoperasi. Perbandingan proporsi kajadian POCD pada kedua kelompok dianalisis dengan menggunakan uji chi-square. Kejadian POCD pada kelompok GA (37,5%) lebih tinggi dari kelompok EA (8,3%) dan secara statistik perbedaan proporsi kejadian POCD pada kedua kelompok bermakna signifikan p=0,016 (p<0,05). Simpulan penelitian bahwa kejadian postoperative cognitive dysfunction (POCD) pada pasien usia lanjut yang menjalani joint arthroplasty dengan anestesi epidural lebih kecil dibanding dengan anestesi umum. Comparison of General Anesthesia on Postoperative Cognitive Dysfunction (POCD) in Joint Arthroplasty with Epidural Anesthesia in Elderly PatientsOld age is a risk factor for postoperative cognitive dysfunction (POCD). Elder people often have to undergo many surgeries, one of which is joint arthroplasty surgery. Selecting appropriate anesthetic techniques for elderly patients to reduce POCD is always controversial. The study aimedto compare the POCD incidence in elderly patients who underwent joint arthroplasty surgery using the general anesthesia and epidural anesthesia. The study was conducted in July–October 2019 at the RSUP Dr. Hasan Sadikin Bandung. This study used a randomized control trial method involving 48 elderly patients who underwent joint arthroplasty using randomized control trial method. Research subjects were divided into the General Anesthesia group (GA) and the Epidural Anesthesia group (EA) using random numbers. Both groups mental status was assessed using the mini mental state examination (MMSE) during preoperative and seven days postoperatively. A comparison of the proportion of POCD incidence in the two groups were analyzed using the chi-square test. The result showed that the proportion of POCD incidence in the GA group (37.5%) was higher than the EA group (8.3%), and the difference was statistically significant p=0.016 (p<0.05). The study concludes that epidural anesthesia in the joint arthroplasty procedure of elderly patients is superior vs. general anesthesia.
Gambaran Skor Apgar Pada Seksio Sesarea Dengan Anestesi Spinal dan Anestesi Umum di RSUP Dr. Hasan Sadikin Periode Januari – Juni 2019 Muhammad Adjie Pratama; Iwan Fuadi; Dzulfikar D. L. Hakim
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (195.89 KB) | DOI: 10.15851/jap.v8n1.1822

Abstract

Angka kelahiran melalui tindakan seksio sesarea di Indonesia terus meningkat. Penggunaan anestesi saat dilakukan seksio sesarea dapat memengaruhi luaran bayi yang dilahirkan. Tujuan penelitian ini adalah melihat gambaran skor Apgar pada tindakan seksio sesarea antara anestesi spinal dan anestesi umum di RSUP Dr. Hasan Sadikin Bandung. Penelitian dilakukan dengan metode potong lintang deskriptif dengan menggunakan teknik total sampling. Data didapatkan dari rekam medis pasien yang menjalani tindakan seksio sesarea di RSUP Dr. Hasan Sadikin pada periode 1 Januari 2019 hingga 30 Juni 2019. Hasil penelitian didapatkan 368 bayi dan 345 ibu dengan sebaran 248 (73,4%) ibu menggunakan anestesi spinal dan 90 (26,6%) menggunakan anestesi umum. Skor Apgar 5 menit bayi dengan anestesi spinal pada kategori 0–3 sebanyak 3 (1,1%), 4–7 sebanyak 18 (6,6%), dan 8–10 sebanyak 251 (92,3%). Skor Apgar 5 menit bayi dengan anestesi umum pada kategori 0–3 sebanyak 7 (7,3%), 4–7 sebanyak 14 (14,6%), dan 8–10 sebanyak 75 (78,1%). Simpulan dari penelitian ini adalah persentase skor Apgar bayi yang lahir melalui seksio sesarea dengan ibu diberi anestesi spinal lebih tinggi dibandingkan dengan anestesi umum. Overview of Apgar Score in Cesarean Section between Spinal Anaesthesia and General Anaesthesia at RSUP Dr. Hasan Sadikin inJanuary–June 2019The birth rate through the cesarean section in Indonesia continues to increase. The use of anaesthesia during cesarean section can affect the outcome of the newborns. The purpose of this study was to look at the description of Apgar’s score on the cesarean section between spinal anaesthesia and general anaesthesia at Dr. RSUP. Hasan Sadikin. The study was conducted with a cross-sectional descriptive method using a total sampling technique. Data were obtained from medical records of patients undergoing cesarean section at RSUP Dr. Hasan Sadikin in the period 1 January, 2019, to 30 June, 2019. The results showed 368 infants and 345 mothers with a distribution of 248 (73.4%) mothers using spinal anaesthesia and 90 (26.6%) using general anaesthesia. The 5-minute Apgar score of infants with spinal anaesthesia in the 0–3 category was 3 (1.1%), 4–7 was 18 (6.6%), and 8–10 was 251 (92.3%). Apgar scores for 5 minutes of infants with general anaesthesia in the 0–3 category were 7 (7.3%), 4–7 were 14 (14.6%), and 8–10 were 75 (78.1%). The conclusion of this study is the percentage of Apgar score of babies born through the cesarean section with mothers given spinal anaesthesia is higher compared with those given general anaesthesia.
HUBUNGAN PROTEIN CARBONYL DENGAN KEJADIAN KEMATIAN 28 HARI PASIEN SEPSIS DI RUANG RAWAT INTENSIF DAN RESUSITASI Tengku Arfi Sulaiman; Zulkifli Zulkifli; Agustina Br Haloho; M Irsan Saleh
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (682.892 KB) | DOI: 10.15851/jap.v8n1.1993

Abstract

Kondisi sepsis yang memburuk dapat mengarah ke disfungsi multiorgan, syok, dan berujung pada kematian. Beberapa marker yang menandai kerusakan organ pada sepsis diantaranya penurunan kadar glutathione, peningkatan kadar malondialdyhide serum, dan protein carbonyl (PCO). Namun, konsentrasi PCO lebih dikaitkan dengan mortalitas pasien dengan syok sepsis yang dirawat di ruang rawat intensif dan resusitasi. PCO terbentuk lebih awal dan stabil dibandingkan produk peroksidasi lipid. Tujuan penelitian ini untuk mengetahui hubungan kadar PCO dengan kematian pasien sepsis. Penelitian ini merupakan kohort retrospektif. Data penelitian merupakan data sekunder dari rekam medis Rumah Sakit Mohammad Hoesin (RSMH). Sampel penelitian adalah seluruh rekam medik pasien terdiagnosis sepsis dan dirawat di ruang kritikal RSMH Palembang selama periode Februari–Agustus 2019, yang memenuhi kriteria inklusi dan eksklusi. Hasil penelitian dianalisa dengan uji chi-square, Fisher’s Exact Test. Didapatkan 59 subjek penelitian yang memenuhi kriteria penelitian mayoritas berjenis kelamin laki-laki (50,8%), dirawat di ruang Resusitasi (57,6%), diagnosis medikal (62,7%), dan meninggal (67,8). Dari uji analisis ROC didapatkan bahwa cut-off point PCO terletak pada nilai >20,33 dengan sensitivitas sebesar 72,50% dan spesifisitas 84,21% dengan nilai Area Under Curve sebesar 0,735 yang menunjukkan bahwa PCO memiliki kemampuan memprediksi mortalitas yang kuat. PCO memiliki hubungan dengan kejadian kematian pasien sepsis di RSMH Palembang dan dapat dijadikan suatu biomarker untuk memprediksi tingkat mortalitas pada pasien sepsis. Correlation of Carbonyl Protein with the 28-Day Death Incidence of Sepsis Patients in the Intensive Care Unit and Resuscitation RoomDeteriorating sepsis can lead to multi-organ dysfunction, shock, and death. Some indictors that mark organ damage in sepsis include decreased glutathione levels, increased serum malondialdehyde levels, and Carbonyl protein (PCO). However, the concentration of carbonyl protein is more associated with the mortality of patients with septic shock treated in the intensive care unit and resuscitation room. PCO is formed earlier and more stable than lipid peroxidation products. The purpose of this study was to determine the relationship of PCO levels with the death of sepsis patients. This study was a retrospective cohort. Research data were secondary data from RSMH medical records. The study sample was all medical records of patients diagnosed with sepsis, which met the inclusion and exclusion criteria and treated in the critical room of Mohammad Hoesin Hospital Palembang (RSMH) from February toAugust 2019. The data analysis used the chi-square test, Fisher’s Exact Test. A total of 59 research subjects met the research criteria the majority subjects were male (50.8%), treated in the resuscitation room (57.6%),diagnosed medically (62.7%), and died (67.8). From the ROC analysis test, it was found that the PCO cut-off point was at a value >20.33 with a sensitivity of 72.50% and a specificity of 84.21% with an area under curve value of 0.735, which showed that the PCO had a strong ability to predict mortality. PCO has a relationship with the incidence of mortality of sepsis patients in RSMH and can be used as a biomarker to predict the mortality rates in sepsis patients.
Effect of Preoperative Anti Tuberculosis Drug Administration Duration on Tuberculous Spondylitis Surgical Treatment Outcomes Preodita Agradi; Nucki Nursjamsi Hidajat; Ahmad Ramdan
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v8n1.1964

Abstract

Preoperative anti-tuberculosis (TB) drugs play a role in surgery of TB spondylitis patients to prevent transmission in the operating room, reduce inflammatory processes and prevent relapse. Currently, there is no study on effects of preoperative anti TB drugs administration duration on the spinal TB patients surgical outcome at Dr. Hasan Sadikin Hospital (RSHS). This study used retrospective method by analyzing medical record data of TB spondylitis patients operated at RSHS, January 2014–May 2018. Based on the preoperative TB drugs duration, patients were divided into 2 groups: preoperative TB drugs group <2 and 2–4 weeks. Data analyzed were identity, duration of preoperative TB drugs administration, preoperative neurologic grade, preoperative CRP and ESR level, and postoperative data at 2 month follow up consisted of neurologic grade, postoperative CRP and ESR levels. The 58 patients consisted of 25 males and 33 females, Kolmogorov-Smirnov test showed a significant difference (p<0.05) in postoperative neurologic grade between preoperative TB drugs administration <2 vs 2-4 weeks. Unpaired T-Test showed postoperative CRP and ESR levels were significant (p<0.05). Postoperative neurologic grade in the preoperative TB drugs <2 weeks group was better vs the 2–4 week group. Operative procedure is more important in TB spondylitis patients treatment compared to a prolonged preoperative TB drugs administration. Pengaruh Lama Pemberian Obat Anti Tuberkulosis Preoperatif Terhadap Hasil Pengobatan Spondilitis Tuberkulosis yang Mengalami Tindakan OperatifObat anti tuberkulosis (OAT) preoperatif memiliki peranan penting dalam pembedahan pasien spondilitis tuberkulosis sebagai pencegahan penularan di kamar operasi, menurunkan proses inflamasi, dan mencegah relaps. Sampai saat ini belum terdapat penelitian mengenai pengaruh lama pemberian OAT preoperatif terhadap hasil pembedahan pasien spondilitis tuberkulosis di Rumah Sakit Dr. Hasan Sadikin Bandung (RSHS). Penelitian ini menggunakan metode retrospektif dengan menganalisisa data rekam medis pasien spondilitis tuberkulosis yang dioperasi di RSHS periode Januari 2014–Mei 2018. Berdasar atas lama pemberian OAT preoperatif, sampel dibagi menjadi 2 kelompok, yaitu kelompok pemberian OAT preoperatif <2 dan 2–4 minggu. Data yang dianalisis berupa identitas, lama pemberian OAT preoperatif, tingkat neurologis preoperatif, kadar CRP dan LED preoperatif, dan data post-operatif saat follow up 2 bulan berupa tingkat neurologis, kadar CRP, dan kadar LED. Terdapat 58 pasien terdiri 25 laki-laki dan 33 perempuan, uji Kolmogorov-Smirnov menunjukkan bahwa terdapat perbedaan yang signifikan (p<0,05) pada tingkat neurologis post-operatif antara kelompok OAT <2 vs. 2–4 minggu. Uji-t tidak berpasangan memperlihatkan bahwa kadar CRP dan LED post-operatif ditemukan bermakna secara signifikan (p<0,05). Tingkat neurologis postoperatif pada kelompok pemberian OAT preoperatif <2 minggu lebih baik bila dibandingkan dengan kelompok 2–4 minggu. Tindakan operasi lebih berperan penting terhadap hasil pengobatan pasien spondilitis tuberkulosis jika dibanding dengan lama pemberian OAT preoperatif.
Angka Kejadian Ventilasi Mekanis Berkepanjangan pada PAscabedah Pintas Arteri Koroner di RSUP Dr. Hasan Sadikin Bandung Tahun 2014-2016 Reza Widianto Sudjud; Rudi Kurniadi Kadarsah; Esther Dian Cahyaningtyas Hintono
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v8n1.2015

Abstract

Bedah Pintas Arteri Koroner adalah salah satu tindakan intervensi untuk mengembalikan perfusi koroner. Pascabedah jantung membutuhkan bantuan ventilasi mekanis yang apabila berkepanjangan akan meningkatkan mortalitas dan morbiditas. Tujuan penelitian ini adalah mengetahui angka kejadian ventilasi mekanis berkepanjangan pascabedah pintas arteri koroner berdasar atas usia, jenis kelamin, fraksi ejeksi ventrikel kiri preoperatif, waktu pintas jantung paru, kadar hemoglobin pascaoperasi, dan komorbiditas pada pasien di RSUP Dr. Hasan Sadikin Bandung tahun 2014–2016. Metode yang digunakan adalah deskriptif observasional dengan pendekatan retrospektif berdasar data rekam medis. Dari hasil penelitian ini diperoleh hasil angka kejadian ventilasi mekanis berkepanjangan adalah 69,7%. Penelitian ini menunjukkan angka kejadian ventilasi mekanis berkepanjangan pascabedah pintas arteri koroner berdasarkan usia ≤65 tahun adalah 68,1%, usia >65 tahun 75,7%, laki-laki 69,1%, perempuan 73,1%, fraksi ejeksi >50% sebesar 73,3%, fraksi ejeksi sebesar 66,3%, waktu pintas jantung paru ≤90 menit 47,7%, waktu pintas jantung paru >90 menit 81,6%, kadar hemoglobin pascaoperasi <10 g/dL sebesar 75%, kadar hemoglobin ≥10 g/dL sebesar 66,9%, pasien dengan komorbiditas 69,7% dan tanpa komorbiditas 69,8%. Sebagai simpulan, didapatkan angka kejadian ventilasi mekanis berkepanjangan lebih tinggi pada pasien usia >65 tahun, pasien perempuan, pasien dengan fraksi ejeksi ≤50%, waktu pintas jantung paru >90 menit dan kadar Hb pascaoperasi <10 g/dL Incidence Rates of Prolonged Mechanical Ventilation in Patients Post Coronary Arterial Bypass Grafting at Dr. Hasan Sadikin General Hospital Bandung in 2014–2016Coronary Artery Bypass Grafting (CABG) is an intervention to restore coronary perfusions. Postcardiac surgery requires mechanical ventilation, which, if prolonged, will increase morbidity and mortality.The purpose of this study was to determine the incidence of prolonged mechanical ventilation post-CABG based on age, sex, preoperative left ventricular ejection fraction (LVEF), cardio pulmonary bypass (CPB) time, postoperative hemoglobin levels, and patient comorbidity at Dr. Hasan Sadikin General Hospital Bandung in 2014-2016. The method used in this study was an observational descriptive retrospective approach based on medical records. The results of this study showed the incidence of prolonged mechanical ventilation incidence was 69.7%. This study showed that incidence of post-CABG prolonged mechanical ventilation based on age ≤65 years old were 68.1%, age >65 years old were 75.7%, men were 69.1%, women were 73.1%, LVEF ≤50% were 73.3%, LVEF >50% were 66.3%, CPB time <90 minutes were 47.5%, CPB time >90 minutes were 81.6%, postoperative hemoglobin level <10 g/dL were 75%, hemoglobin level ≥10 g/dL were 66.9%, patients with comorbidities were 69.7% and without comorbidities were 69.8%. In conclusion, there was higher incidence of prolonged mechanical ventilation in patients >65 years old, woman, with LVEF ≤50%, CPB time >90 minutes and postoperative hemoglobin level <10 g/dL.
PLASMAFARESIS PADA PASIEN STATUS EPILEPTIKUS AKIBAT ENSEFALITIS ANTI- NMDAR DI UNIT PERAWATAN INTENSIF Olivia Des Vinca; Nurita Dian Kestriani; Dhany Budipratama
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (428.474 KB) | DOI: 10.15851/jap.v8n1.1978

Abstract

Sejak tahun 2007 penyebab lain ensefalitis diketahui adalah autoimmun selain virus sebagai penyebab terbanyak (69%) dengan angka kematian di dunia 8–18,45%. Ensefalitis anti-NMDAR adalah ensefalitis autoimun akibat reaksi antibodi terhadap antigen membran ekstraseluler, subunit NR1, yaitu reseptor glutamat NMDA di sinapsis susunan saraf pusat. Kasus ensefalitis NMDAR sangat jarang dijumpai, berdasarkan penelitian yang teridentifikasi hanya 1% pasien usia 18–35 tahun yang dirawat di Unit Perawatan Intensif (UPI), namun dengan penatalaksanaan yang tepat dapat meningkatkan prognosis pasien. Pasien laki-laki, usia 36 tahun dikonsulkan ke UPI RSHS setelah 10 hari rawatan di Neuro High Care (NHC) pada bulan Agustus 2019 dengan penurunan kesadaran disertai riwayat kejang berulang dengan diagnosis ensefalitis anti-NMDAR. Kombinasi obat anti-viral, anti-epilepsi, dan metilprednisolon yang diberikan sebelumnya di ruangan tidak memberikan perbaikan klinis bermakna. Selama perawatan di UPI pasien diberikan terapi plasmafaresis dan menunjukkan perbaikan secara signifikan. Bangkitan kejang berulang dapat berupa kejang parsial, kejang generalisata dan status epileptikus. Manifestasi kejang diduga terjadi karena terbentuknya antibodi yang menyerang reseptor glutamat NMDA dengan target utama NR1. The American Society for Apheresis merekomendasikan plasmaferesis sebagai pilihan terapi utama. Simpulan, terapi plasmafaresis dalam tata laksana kasus ensefalitis anti- NMDAR merupakan pilihan tepat karena terbukti efektif dan efisien dalam perbaikan klinis pasien melalui mekanisme penurunan titer antibodi terhadap reseptor NMDA. Plasmapheresis in Patients of Epilepticus Status Patients Due to Anti-NMDAR Encephalitis in Intensive Care UnitsSince 2007 another known cause of encephalitis is autoimmune other than viruses as the most common cause (69%) with a mortality rate in the world of 8-18.45%. Anti-NMDAR encephalitis (n-Methyl-D-Aspartate receptor) is an autoimmune encephalitis due to an antibody reaction to the extracellular membrane antigen, NR1 subunit, the NMDA glutamate receptor at the synapses of the central nervous system. Cases of NMDAR encephalitis are very rare, based on studies that identified only 1% of patients aged 18-35 years who were treated in the Intensive Care Unit (ICU), but with proper management could improve the patient's prognosis.Male patient, 36 years old, was admitted to ICU RSHS after 10 days of treatment at Neuro High Care (NHC) in August 2019 with decreased consciousness accompanied by a history of recurrent seizures with a diagnosis of anti-NMDAR encephalitis. The combination of anti-viral, anti-epileptic, and methylprednisolone drugs given previously at NHC did not provide clinically meaningful improvement. During treatment at ICU, patients were given plasmafaresis therapy and showed significant improvement. Recurrent seizures can be partial seizures, generalized seizures and status epilepticus. Seizure manifestations are thought to occur due to the formation of antibodies that attack NMDA glutamate receptors with the main target NR1. The American Society for Apheresis recommends plasmapheresis as the main therapeutic choice. In conclusion, plasmafaresis therapy in the management of anti-NMDAR encephalitis cases is the right choice because it is proven effective and efficient in the clinical improvement of patients through the mechanism of decreasing antibody titers to NMDA receptors.
Iron as Preoperative Antituberculosis Supplement Increases Interleukin-12 Level in Spinal Tuberculosis and Iron Deficiency Patients Anggi Fauziani; Nucki Nursjamsi Hidajat; Ahmad Ramdan; Agus Hadian Rahim
Jurnal Anestesi Perioperatif Vol 8, No 1 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (552.14 KB) | DOI: 10.15851/jap.v8n1.1965

Abstract

Iron deficiency remains the most prevalent micronutrient deficiency worldwide. Iron deficiency in TB patients, causes a poor outcome, reccurency, and treatment failure. Iron supplements on TB patients with iron deficiency will activate macrophage-derived monocytes (MDM) and interferon-gamma (IFN-γ), with a positive feedback mechanism pushing interleukin-12 (IL-12). This study is a single-blind randomized control trial comparing the effectivity of preoperative iron supplementation in IL-12 level between two different groups in Dr. Hasan Sadikin General Hospital Bandung, conducted from November 2018 until March 2019. Respondents are those having Spondylitis TB, with sTfR > 21,7 pg/mL and IL-12 <41 pg/mL, intensive phase antituberculosis drugs category 1. The experimental group, comprised 17 respondents, was treated with 2RHZE and 357mg iron (III) hidroxy polymaltosa. The control group was treated with 2RHZE. The sTfR and IL-12 levels were performed before and after treatment. The increase of IL-12 in the experimental group was +364,53% higher than in the control group (p<0.05). The decrease of sTfR in the experimental group was -60,68% higher than in the control group (p<0.05). The result of the Pearson correlation test was a coefficient correlation of - 0,73, this showed that a decrease in the sTfR level correlated with an increase in the Il-12 level. Iron supplement in Spondylitis TB with iron deficiency in the experimental group increases the IL-12 level. Preoperative iron supplementation on spondylitis TB with iron deficiency, increases the immune system with higher levels of IL-12.Perbedaan Kadar IL-12 pada Terapi Pre-Operatif Spondilitis TB dengan Defisiensi Zat Besi yang diberikan Suplementasi Zat BesiDefisiensi Fe merupakan defisiensi mikronutrien paling sering di seluruh dunia, jika terjadi pada penderita TB akan meningkatkan risiko prognosa buruk, rekurensi, MDR, dan gagal terapi. Suplementasi besi pada tuberkulosa dengan defisiensi besi akan meningkatkan sistem imun dengan mengaktivasi macrophage derived monocyt, dan interferon-gamma, dengan mekanisme umpan balik positif memacu interleukin-12. Single blind randomized control trial untuk membandingkan efektivitas Fe terhadap kenaikan IL-12 pada terapi preoperatif spondilitis TB di RSHS periode Nopember 2018- Maret 2019. Metode sampling;consecutive sampling. Subjek sebanyak 34 orang; Penderita spondilitis TB, sTfR >21,7 pg/ml dan IL-12< 41 pg/mL. fase intensif OAT kategori 1sesuai dengan standar WHO. Kelompok eksperimen, 17responden diterapi 2 RHZE + tablet iron (III) hidroksi polimaltosa357 mg selama 2 bulan. Kelompok kontrol 17 responden diterapi 2RHZE. Peningkatan IL-12 pada kelompok eksperimen sebesar +364,53% lebih besar dari kelompok kontrol (p<0,05) dan; Penurunan kadar sTfR pada kelompok eksperimen sebesar –60,68% (p<0,05) lebih besar dari kontrol. Uji korelasi sTfR dan IL-12 dengan Pearson ; korelasi -0,763, menunjukkan korelasi kuat antara penurunan sTfR dan kenaikan nilai IL-12. Suplementasi Fe pada terapi preoperatif spondilitis TB dengan defisiensi Fe meningkatkan respon imun yang ditandai dengan meningkatnya IL-12.

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