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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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Keberhasilan Early Goal-Directed Therapy dan Faktor Pengganggu pada Pasien Sepsis Berat di Instalasi Gawat Darurat Rumah Sakit Dr. Hasan Sadikin Bandung yang Akan Menjalani Pembedahan Silviana, Mira; Tavianto, Doddy; Kadarsah, Rudi Kurniadi
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Early goal directed therapy (EGDT) bertujuan menurunkan morbiditas dan mortalitas pada pasien sepsis berat dan syok sepsis namun pelaksanaannya sering menemukan kendala. Tujuan penelitian ini mengevaluasi keberhasilan EGDT pada pasien sepsis berat di Instalasi Gawat Darurat (IGD) Rumah Sakit Dr. Hasan Sadikin Bandung yang menjalani pembedahan serta mencari faktor-faktor yang memengaruhi keberhasilan EGDT. Penelitian dilakukan dengan metode deskriptif observasional pada bulan Juni–Agustus 2014 dengan subjek penelitian pasien IGD berusia >14 tahun dalam kondisi sepsis berat yang menjalani pembedahan. Keberhasilan EGDT ditentukan berdasar atas pedoman surviving sepsis campaign. Hasil penelitian dari 30 pasien didapatkan 27 pasien berhasil dilakukan EGDT, sedangkan 3 pasien meninggal. Faktor yang memengaruhi EGDT, yaitu faktor medis, kecepatan dalam mendiagnosis sepsis berat, lama pemeriksaan penunjang, faktor koagulasi yang memanjang, dan faktor nonmedis, yaitu lamanya keputusan keluarga, prosedur pengurusan administrasi, dan ketersediaan alat. Simpulan, keberhasilan EGDT di Rumah Sakit Dr. Hasan Sadikin dengan faktor medis dan nonmedis sebagai faktor pengganggu yang berperan dalam keberhasilan pelaksanaannya. Kata kunci:  Early goal directed therapy (EGDT), pembedahan, sepsis beratThe Success of Early Goal-Directed Therapy and its Confounding Factors in Patients with Severe Sepsis Admitted to the Emergency Room of Dr. Hasan Sadikin General Hospital for SurgeryEarly goal-directed therapy (EGDT) is conducted to reduce morbidity and mortality in patients with severe sepsis and septic shock. The purpose of this study was to evaluate the success of EGDT in patients with severe sepsis in the emergency room (ER) of Dr. Hasan Sadikin General Hospital Bandung who were going to undergo surgery and the factors that contributed to the success of EGDT. This study was a descriptive observational study that took place in June–August 2014. Subjects were ER patients, aged over 14 years old, who came with severe sepsis condition and were going to undergo surgery. The successful EGDT in this study was determined according to the surviving sepsis campaign (SSC) guideline such as a central venous pressure of 8–12 mmHg, mean arterial pressure of >65 mmHg, and central venous saturation of >70%. In this study, from 30 patients, 27 patients  successfully underwent EGDT and the remaining 3 patients did not survive. Factors that affect the implementation of EGDT were divided into two factors: medical and non-medical factors.  Medical factors were time needed to diagnose patient with severe sepsis, delay in laboratory findings, and abnormality of coagulation factors. The non-medical factors were family consent, procedures related to health insurance, and the availability of central venous catheter. In conclusions, EGDT is successfully achieved in 90% patients with severe sepsis in Dr. Hasan Sadikin General Hospital Bandung.  Factors that contribute to the successful achievement of EGDT include medical and non-medical factors.Key words: Early goal directed therapy, surgery, severe sepsis DOI: 10.15851/jap.v3n2.580
Perbandingan Kebutuhan Propofol dan Lama Bangun antara Kombinasi Propofol-Ketamin dan Propofol-Fentanil pada Pasien yang Dilakukan Kuretase yang Diukur dengan Bispectral Index (BIS) Anggorotomo, Wirawan; Kadarsah, Rudi K.; Oktaliansah, Ezra
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pemberian sedasi dan analgesi yang efektif, efisien, aman, mudah didapat, dan juga murah diperlukan untuk mengurangi nyeri serta kecemasan selama kuretase.  Tujuan penelitian ini adalah mengetahui perbedaan kebutuhan propofol dan lama bangun antara propofol-ketamin dan propofol-fentanil pada pasien yang dilakukan kuretase. Dilakukan penelitian uji klinis acak tersamar tunggal pada 60 pasien yang menjalani kuretase di Rumah Sakit Dr. Hasan Sadikin Bandung periode September–November 2014.  Pasien dibagi dalam dua kelompok, yaitu propofol-ketamin (PK) dan propofol-fentanil (PF). Data hasil penelitian  untuk tekanan darah, laju nadi, laju napas, saturasi oksigen, dan skor bispectral index (BIS) dianalisis dengan uji-t dan Uji Mann-Whitney. Hasil penelitian menunjukkan kebutuhan propofol berbeda secara sangat bermakna (p<0,001), pada kelompok PK terdapat 4/30 subjek yang mendapatkan tambahan propofol, sedangkan pada kelompok PF sebanyak 14/30 subjek. Lama bangun pada kelompok PK adalah 25,75±2,47 menit, sedangkan pada kelompok PF adalah 21,08±2,52. Secara statistik hasil tersebut berbeda secara sangat bermakna (p<0,001). Simpulan, kebutuhan propofol pada kelompok PK lebih sedikit dibanding dengan kelompok PF dan lama bangun pada kelompok PK lebih lama dibanding dengan kelompok PF. Kata kunci: Bispectral index, kebutuhan propofol, kuretase, lama bangun Comparison of Propofol Requirements and Emergence Time between Propofol-Ketamine and Propofol-Fentanyl Combinations in Patients Undergoing Curretage using Bispectral Index (BIS) MonitoringAdequate administration of safe, easy-to-obtain, and constantly available sedatives and analgesia, is needed for pain reduction throughout curettage procedures. The goal of this study was to examine differences in propofol requirements and emergence time between propofol-ketamine and propofol-fentanyl combinations in patients undergoing curettage. A single-blind randomized controlled trial study was performed on 60 patients who underwent curettage procedures. The patients were divided into two groups: propofol-ketamine (PK) and propofol-fentanyl (PF). Blood pressure, pulse rate, respiration rate, and oxygen saturation and BIS data were analysed using a t-test and Mann-Whitney test. This study showed that propofol requirements differ significantly (p<0.001) between the two groups where in PK group where 4/30 subjects received additional propofol, compared to PF group 14/30 subjects received additional propofol. The wake up time for PK group was 25.75±2.47 minutes compared to 21.08±2.52 minutes for the PF group. The difference was statistically significant (p<0.001). The conclusions of this study are propofol requirements for PK group is less compared to PF group and the emergence time for PK group is longer compared to PF group. Key words: Bispectral index, curettage, emergence time, propofol requirements DOI: 10.15851/jap.v3n3.611
Waktu Pulih Sadar pada Pasien Pediatrik yang Menjalani Anestesi Umum di Rumah Sakit Dr. Hasan Sadikin Bandung Dinata, Defri Aryu; Fuadi, Iwan; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Salah satu komplikasi utama pasca-anestesia pada pediatrik adalah keterlambatan pulih sadar. Penyebab keterlambatan pulih sadar pasca-anestesia adalah efek residual dari obat anestetik, sedatif, analgesik, durasi anestesi, dan hipotermia. Penelitian ini bertujuan mengetahui waktu pulih sadar pada pasien pediatrik yang menjalani anestesia umum di Rumah Sakit Dr. Hasan Sadikin Bandung dengan metode penelitian adalah observasional prospektif. Penelitian dilakukan pada bulan Mei–Agustus 2014 dengan sampel sebanyak 456 pasien pediatrik yang menjalani anestesia umum terdiri atas 3,9% neonatus, 24,6% infant, 17,3% batita, dan 54,2% anak. Parameter yang dicatat pada penelitian ini adalah usia, jenis kelamin, berat badan, jenis anestesia inhalasi, dosis fentanil, durasi anestesia, dan suhu inti tubuh pasca-anestesia. Data penelitian dianalisis secara deskriptif dalam ukuran jumlah dan persentase. Hasil penelitian ini adalah angka kejadian keterlambatan pulih sadar pada pasien pediatrik sebanyak 96 kasus (neonatus 16 kasus, infant 51 kasus, batita 12 kasus, dan anak 12 kasus). Faktor yang memengaruhi waktu pulih sadar pada neonatus adalah hipotermia, pada infant adalah dosis fentanil &gt;3 mg/kgBB, pada durasi anestesia &gt;210 menit dan hipotermia, pada batita adalah hipotermia, dan pada anak adalah dosis fentanil &gt;5 µg/kgBB dan hipotermia.  Simpulan, hipotermia merupakan faktor penyebab keterlambatan waktu pulih sadar pada semua kelompok usia.Kata kunci: Pasca-anestesi, pediatrik, waktu pulih sadar Recovery Time in Pediatric Patients Undergoing General Anesthesia in Dr. Hasan Sadikin General Hospital Bandung    The most common causes of prolong awakening are residual effects of drugs either anesthetics, sedatives or analgesics, length of anesthesia, and hypothermia. This study aimed to determine the recovery time to consciousness in pediatric patients undergoing general anesthesia in Dr. Hasan Sadikin General Hospital Bandung. This was an observational prospective study conducted in May until August 2014 on 456 patients consisting of 3.9% neonates, 24.6% infants, 17.3% toddlers and 54.2% children. Parameters recorded in this study were age, sex, weight, type of inhalation anesthetics, fentanyl dose, duration of anesthesia, and post-anesthesia temperature. Data were analyzed descriptively in number and percentage. The results showed that the average recovery time to consciousness in  neonatal patients was 50 minutes 40 seconds in which 88.3% of the neonatal age group suffered from post anesthesia hypothermia (core body temperature below 36⁰C). Factors that influenced recovery time in infants were fentanyl dose above 3 µg/kgBW, duration of anesthesia over 210 minutes, and hypothermia. The factors that caused delayed recovery were hypothermia in toddlers group and fentanyl doses above 5 µg/kgBW and hypothermia in children. Incidence of prolong awakening in pediatric patients undergoing general anesthesia in this study was 96 cases, consisting of 16 cases of neonates, 51 cases of infants, 12 cases of toddlers, and 17 cases of  children. In conclusion, the common factor causing delay in recovery in all age groups is hypothermia.Key words: Post-anesthesia, pediatric, recovery time DOI: 10.15851/jap.v3n2.576
Perbandingan antara Penggunaan Asam Amino dan Ringer Laktat terhadap Penurunan Suhu Inti Pasien yang Menjalani Operasi Laparotomi Ginekologi dengan Anestesi Umum Hujjatulislam, Agung; Pradian, Erwin; Redjeki, Ike Sri
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Pemberian asam amino intravena merangsang metabolisme oksidatif sekitar 20% dan mengurangi komplikasi hipotermia pascaoperasi. Tujuan penelitian ini mengetahui efek penggunaan asam amino preoperatif terhadap suhu inti tubuh. Penelitian menggunakan metode kuantitatif intervensi dengan rancangan uji klinis acak terkontrol buta tunggal pada 40 orang pasien berusia 18−57 tahun dengan status fisik American Society of Anesthesiologists (ASA) I dan II yang menjalani operasi laparotomi ginekologi di Rumah Sakir Dr. Hasan Sadikin Bandung periode Febuari–Mei 2014. Subjek dibagi menjadi 2 kelompok secara acak, yaitu kelompok yang mendapat asam amino 2 mL/kgBB/jam selama 2 jam preoperasi dan kelompok kontrol yang mendapat infus Ringer laktat. Pencatatan suhu timpani dilakukan setiap 10 menit dari awal induksi hingga akhir anestesi. Data hasil penelitian diuji dengan Uji Mann-Whitney. Hasil penghitungan statistika, didapatkan suhu inti rata-rata selama anestesi pada kelompok asam amino bermakna lebih tinggi dibanding dengan kelompok kontrol (p<0,05). Penurunan suhu rata-rata pada kelompok kontrol (0,11C) bermakna, lebih besar dibanding dengan kelompok asam amino (0,08C; p<0,05). Simpulan, pemberian cairan asam amino dua jam preoperasi dapat mencegah penurunan suhu yang lebih besar dibanding dengan kelompok kontrol selama operasi ginekologi laparotomi.Kata kunci: Asam amino, hipotermia, suhu inti tubuh Comparison between Amino Acids and Ringer Lactate Infusion on Body Core Temperature Decline in Patients Undergo Gynaecological Laparotomy Surgery under General AnesthesiaIntravenous administration of amino acids stimulates about 20% oxidative metabolism and reduces postoperative complications of hypothermia. The aim of this study was to determine the effects of preoperative amino acid infusion to core temperature. This was an observational analytic study with cross-sectional design to compare the reliability using the inter-rater reliability method. Subjects were 40 patients aged 18−57 years old with physical status ASA I and II who underwent gynaecological laparotomy at Dr. Hasan Sadikin General Hospital Bandung during February–May 2014. Subjects were devided randomly into 2 groups; one group was given 2 mL/kgBW/hour amino acid infusion for 2 hours before laparotomy and another group was the control group given ringer lactate infusion. Tympani membrane temperature was taken every 10 minutes throughout the anesthetic procedure. Data were statistically analyzed using Mann-Whitney test.The result of this study was the average of core temperature during anesthesia in amino acid group was significantly higher than control group (p<0.05). The average of temperature decline in the control group (0.11oC) was significantly higher (p<0.05) than the amino acid group (0.08oC). This study concludes that amino acid infusion two hours before surgery will prevent greater decrease in temperature compared to the control group during gynecological laparotomy surgery.Key words: Amino acids, body core temperature, hypothermia DOI: 10.15851/jap.v3n3.606
Efek Ondansetron Intravena terhadap Tekanan Darah dan Laju Nadi pada Anestesi Spinal untuk Seksio Sesarea Ismandiya, Annisa Isfandiary; Maskoen, Tinni T.; Sitanggang, Ruli Herman
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Hipotensi merupakan komplikasi anestesi spinal yang sering ditemukan pada seksio sesarea. Pencegahan hipotensi dapat dilakukan dengan pemberian cairan, vasopresor, dan memperbaiki posisi uterus ibu saat terlentang dengan mengganjal punggung. Penelitian ini bertujuan mengetahui pengaruh ondansetron 8 mg yang diberikan 5 menit sebelum spinal anestesi dalam menjaga kestabilan hemodinamik. Penelitian ini dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada Januari–Maret 2014 dengan desain eksperimental secara acak klinis terkontrol tersamar ganda yang mengikutsertakan 46 ibu hamil dengan status fisik American Society of Anesthesiologist (ASA) I−II yang menjalani seksio sesarea menggunakan anestesi spinal. Setelah randomisasi secara blok permutasi, subjek penelitian dikelompokkan menjadi 2, yaitu 23 subjek kelompok kontrol mendapat NaCl 0,9% dan 23 subjek kelompok perlakuan mendapat ondansetron intravena 8 mg. Tekanan darah dan laju nadi diperiksa setiap 1–15 menit setelah anestesia spinal, kemudian diperiksa tiap 3 menit sampai operasi selesai. Data hasil penelitian dianalisis dengan uji-t, Uji Mann-Whitney, dan Uji Kolmogorov-Smirnov. Analisis statistik menunjukkan perbedaan bermakna tekanan darah sistol, tekanan darah rata-rata, dan jumlah pemakaian efedrin antara kelompok kontrol dan kelompok ondansetron (p&lt;0,05). Simpulan, pemberian ondansetron 8 mg dapat mengurangi hipotensi dan menurunkan jumlah pemberian efedrin pasca-anestesi spinal pada operasi seksio sesarea.Kata kunci: Anestesi spinal, hipotensi, ondansetron, seksio sesareaIntravenous Ondansetron Effect on Blood Pressure and Heart Rate in Caesarean Section under Spinal AnesthesiaHypotension is the most common complication in spinal anesthesia during cesarean sections. One of the prevention efforts includes administering a fluid vasopressor or placing a wedge under the right hip for left uterine displacement. This study aimed to determine the effect of ondansetron 8 mg, 5 minutes before spinal anesthesia, to maintain maternal hemodynamic stability. This double-blind randomized control experimental study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of January to March 2014 on 46 pregnant women, American Society of Anesthesiologist (ASA) II, who underwent cesarean section with spinal anesthesia. After randomization, the subjects were grouped into two groups: 23 subjects were included in the control group receiving Nacl 0.9% and 23 subjects were included in the ondansetron group receiving 8 mg of ondansetro. Blood pressure and pulse rate were examined every minute until 15 minutes after spinal anesthesia and then every 3 minutes until the operation was complete. Data were analyzed statistically using t test, Mann Whitney Test, and Kolmogorov-Smirnov Test. The results show that there were significant differences in systol presure, average blood pressure, and use of ephedrine between the control and ondansetron group (p&lt;0.05). In conclusion, the provision of 8 mg ondansetron can prevent hypotension and reduce ephedrine use after spinal anesthesia in caesarean section.Key words:  Spinal anesthesia, caesarean section, hypotension, ondansetron, sectio sesareaspinal anesthesia  DOI: 10.15851/jap.v3n2.572
Perbandingan Kombinasi Tramadol Parasetamol Intravena dengan Tramadol Ketorolak Intravena terhadap Nilai Numeric Rating Scale dan Kebutuhan Opioid Pascahisterektomi Karmena, Dendi; Oktaliansah, Ezra; Surahman, Eri
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Nyeri pascabedah adalah masalah penting dalam pembedahan. Penelitian ini bertujuan membandingkan kombinasi tramadol parasetamol intravena dengan tramadol ketorolak intravena terhadap nilai numeric rating scale (NRS) dan kebutuhan opioid pascabedah histerektomi abdominal. Uji klinik acak terkontrol buta ganda dilakukan terhadap 42 wanita (18–60 tahun) status fisik American Society of Anesthesiologist (ASA) I–II yang menjalani pembedahan histerektomi abdominal dalam anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Agustus–November 2014. Pasien dibagi menjadi dua kelompok, yaitu 21 orang menerima kombinasi tramadol parasetamol intravena dan 21 orang menerima kombinasi tramadol ketorolak intravena yang diberikan saat dilakukan penutupan peritoneum. Penilaian skala nyeri dilakukan dengan menggunakan nilai numeric rating scale baik pada saat istirahat maupun saat mobilisasi. Analisis menggunakan Uji Mann-Whitney. Pada penelitian ini ditemukan nilai NRS pada kelompok tramadol parasetamol dan kelompok tramadol ketorolak tidak berbeda bermakna (p>0,05). Simpulan penelitian ini adalah pemberian kombinasi tramadol parasetamol intravena sebanding dengan kombinasi tramadol ketorolak terhadap nilai NRS dan kebutuhan opioid pascabedah histerektomi abdominal.Kata kunci: Kebutuhan opioid, ketorolak, numeric rating scale, parasetamol, tramadolComparison of Combined Intravenous Tramadol-Paracetamol Versus Tramadol-Ketorolac on Numeric Rating Scale and Opioid Requirement on Post Histerectomy PatientsPostoperative pain is an important problem in surgery. This study aimed to compare the combination of intravenous tramadol paracetamol and tramadol ketorolac to numeric rating scale (NRS) to postoperative opioid requirements in abdominal hysterectomy. Double blind randomized controlled trial was conducted on 42 women (18–60 years) with ASA physical status I–II who underwent abdominal hysterectomy surgery under general anesthesia in Dr. Hasan Sadikin General Hospital Bandung within the period of August–November 2014. Subjects  were divided into two groups: 21 subjects received a combination of intravenous tramadol paracetamol and 21 subjects received combination of intravenous  tramadol ketorolac that was given when peritoneum was closure. The assessment of postoperative pain was performed using a numeric rating scale  both at rest and during mobilization. Correlation analysis is conducted using Mann-whitney test. Result shows that the value of the NRS in group tramadol paracetamol compared to tramadol ketorolac  was not significantly different (p>0.05). This study concludes that the combinations of intravenous tramadol paracetamol and  tramadol ketorolac are the same in terms of the NRS and postoperative opioid requirement after abdominal hysterectomy.Key words: Ketorolac, numeric rating scale, opioid requirement, paracetamol,  tramadol DOI: 10.15851/jap.v3n3.612
Efek Penambahan Deksametason 5 mg pada Bupivakain 0,5% terhadap Mula dan Lama Kerja Blokade Sensorik Anestesia Epidural untuk Operasi Ortopedi Ekstremitas Bawah Irwan, -; Pradian, Erwin; Bisri, Tatang
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Operasi ortopedi ekstremitas bawah dengan anestesia regional epidural memiliki kelemahan yaitu mula kerja yang lama. Penelitian ini bertujuan melihat efek penambahan 5 mg deksametason pada bupivakain 0,5% terhadap mula kerja dan lama kerja blokade sensoris. Penelitian prospektif eksperimental menggunakan uji klinis acak buta ganda pada 32 pasien dengan American Society of Anesthesiologist (ASA) I–II yang menjalani operasi ortopedi ekstremitas bawah dengan anestesi epidural di RSUP Dr. Hasan Sadikin Bandung pada Februari–Mei 2014. Pengambilan sampel dilakukan secara consecutive sampling dan random blok permutasi. Kelompok I, deksametason 5 mg ditambahkan ke dalam bupivakain 0,5% 15 mL. Kelompok II, bupivakain 0,5% ditambah NaCl 0,9% 15 mL. Hasil penelitian diuji secara statistika menggunakan uji-t dan Uji Mann-Whitney. Hasil penelitian menunjukkan mula kerja blokade sensorik kelompok I tidak lebih cepat, yaitu 13,56 menit dibanding dengan kelompok II, yaitu 14,31 menit (p=0,27). Lama kerja blokade sensorik kelompok I lebih lama, yaitu 399,81 menit dibanding dengan kelompok II, yaitu 227,43 menit (p=0,00). Simpulan, penambahan deksametason 5 mg pada bupivakain 0,5% 15 mL tidak mempercepat mula kerja blokade sensorik tetapi memperpanjang lama kerja blokade sensorik bupivakain 0,5% yang diberikan secara epidural.Kata kunci: Anestesi epidural, blokade sensorik, bupivakain, deksametason, lama kerja, mula kerjaEffect of Dexamethasone 5 mg Addition to Bupivacaine 0.5% on Onset and Duration of Sensory Blockade in Epidural Anesthesia for Lower Extremity Orthopedic SurgeryLower extremity orthopedic surgery performed with regional epidural anesthesia was still have weakness which is long onset of time. This study was conducted to determine the onset time and duration time of sensory blockade epidural anesthesia  between the use of dexamethasone 5 mg addition to 0.5% bupivacaine for lower limb orthophedic surgery. The study was using randomized controlled blind method on 32 ASA I–II patients undergoing lower limb orthopedic surgery under epidural anesthesia. Consecutive sampling and random allocation of block of permutation groups was applied. In group I, dexamethasone 5 mg was added to bupivacaine 0.5% 15 mL while in group II NaCl 1 mL was added to bupivacaine 0.5% 15 mL. The results were statistically tested using t-test and Mann-Whitney test. It was shown that the onset time of sensory blockade was not significantly faster when dexamethasone was added in bupivacaine 0.5%, 13.56 minutes versus 14.31 minutes (p=0.27). The duration time of sensory blockade in dexamethasone in bupivacaine 0.5% group was longer 399.81 minutes, compared to the bupivacaine 0.5% group, 227.43 minutes (p=0.00). In conclusions, the addition of dexamethasone 5 mg to bupivacaine 0.5% 15 mL does not produced faster onset time. However, the duration sensory blockade time is longer than bupivacaine 0,5% 15 mL is usedKey words: Bupivacaine, dexamethasone, duration time, epidural anesthesia, onset, sensory blockade DOI: 10.15851/jap.v3n2.577
Perbandingan Pemberian Deksametason 10 mg dengan 15 mg Intravena sebagai Adjuvan Analgetik terhadap Skala Nyeri Pascabedah pada Pasien yang Dilakukan Radikal Mastektomi Termodifikasi Erlangga, M. Erias; Sitanggang, Ruli Herman; Bisri, Tatang
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Deksametason merupakan kortikosteroid yang memiliki efek anti-inflamasi paling kuat. Penelitian ini bertujuan membandingkan deksametason 10 mg dengan deksametason 15 mg intravena prabedah terhadap nyeri pascabedah dan kebutuhan analgetik opioid. Penelitian ini merupakan uji acak terkontrol buta ganda pada 60 wanita dengan status fisik American Society of Anesthesiologist (ASA) I–II yang menjalani pembedahan radikal mastektomi termodifikasi dalam anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung periode Desember 2013–April 2014. Pasien dibagi menjadi dua kelompok, yaitu 30 orang menerima deksametason 10 mg dan 30 orang menerima deksametason 15 mg yang diberikan 30 menit prabedah. Penilaian skala nyeri menggunakan nilai numeric rating scale (NRS) pada saat istirahat dan mobilisasi, pada jam ke-1, 2, 4, 12, dan 24 pascabedah. Pemberian analgetik tambahan opioid dilakukan bila nilai NRS>3. Analisis statistika data hasil penelitian menggunakan uji-t, chi-kuadrat, dan Mann-Whitney. Hasil penelitian menunjukan nilai NRS saat istirahat pada kelompok deksametason 10 mg dengan deksametason 15 mg tidak berbeda bermakna (p>0,05), sementara nilai NRS saat mobilisasi pada kelompok deksametason 10 mg lebih tinggi dibanding dengan kelompok deksametason 15 mg (p<0,05). Pemberian analgetik tambahan pascabedah tidak terdapat perbedaan secara bermakna antara kedua kelompok (p>0,05). Simpulan penelitian ini adalah pemberian deksametason 15 mg dapat diberikan karena mempunyai efek analgesia yang lebih baik.Kata kunci: Deksametason, numeric rating scale, nyeri pascabedahComparison between 10 mg and 15 mg of Intravenous Dexamethasone as Analgesia Adjunct on Post Operative Pain in Patients Undergo Modified Radical Mastectomy Dexamethasone is a glucocorticoid with the strongest anti-inflammatory property. The aim of this study was to compare the effect of 10 mg and 15 mg of intravenous dexamethasone on post operative pain and opioid analgetic need. This was a randomized double-blind study involving 60 females with physical status ASA I–II whom underwent modified radical mastectomy under general anesthesia at Dr. Hasan Sadikin General Hospital during December 2013–April 2014. Patients were divided into 2 groups where 30 patients received 10 mg dexamethasone and 30 patients received 15 mg dexamethasone 30 minutes prior to surgery. Pain assessment was performed using numeric rating scare (NRS) at rest and during activity, documented on the 1st, 2nd, 4th, 12th and 24th hour post operative. Additional analgesia was given if NRS >3. Data were analyzed statistically using Student’s t test, chi-square and Mann Whitney U test. Result showed that the difference between NRS at rest for 10 mg and 15 mg dexamethasone (p>0.05) was not significant, while the difference in NRS during activity at all time measurements were statistically significant (p<0.05). There was no statistical significant difference in additional opioid administered between the two groups (p>0.05). This study concludes that 15 mg dexamethasone has a better analgesia effect to reduce analgesic dose.Key words: Dexamethasone, numeric rating scale, post operative pain DOI: 10.15851/jap.v3n3.607
Perbandingan Parasetamol dengan Ketorolak Intravena Sebagai Analgesia Pre-emtif terhadap Skala Nyeri Pascabedah Labioplasti pada Pasien Pediatrik Boesoirie, Muhamad Adli; Oktaliansah, Ezra; Bisri, Tatang
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Parasetamol dan ketorolak merupakan analgetik yang biasa digunakan pada tatalaksana nyeri ringan hingga sedang. Penelitian ini bertujuan membandingkan efek analgesi pre-emtif parasetamol 20 mg/kgBB dengan ketorolak 0,5 mg/kgBB pada pasien pediatrik pascabedah labioplasti yang diukur menggunakan skala nyeri face, legs, activity, crying, consolability (FLACC). Penelitian eksperimental secara uji acak tersamar buta ganda terhadap 66 pasien pediatrik usia 6 bulan–12 tahun dengan status fisik American Society of Anesthesiology (ASA) I–II. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Oktober 2013–Mei 2014. Pasien dibagi menjadi dua kelompok perlakuan, yaitu kelompok parasetamol (P) dan ketorolak (K) yang diberikan 15 menit prabedah. Analisis statistika diuji menggunakan uji-t independen, Mann-Whitney, dan Eksak Fisher. Hasil penelitian menunjukkan bahwa skala FLACC pada kelompok ketorolak pada jam ke-1, 2, 4, 6, dan 24 lebih rendah secara bermakna (p&lt;0,05) dibanding dengan kelompok parasetamol. Simpulan, skala FLACC pemberian ketorolak 0,5 mg/kgBB prabedah pada pasien labioplasti lebih rendah dibanding dengan parasetamol 20 mg/kgBB.Kata kunci: Analgetik, analgesia pre-emtif, ketorolak, labioplasti, parasetamol, skala FLACCComparison between Intravenous Paracetamol and Ketorolac as Preemptive Analgesia on Postoperative Pain Scale in Pediatric Patients Undergo LabioplastyKetorolac and paracetamol are common analgetics used to treat mild to moderate pain. This study compared the efficacy of preemptive analgesia measured using face, legs, activity, crying, consolability (FLACC) scale between groups receiving 20 mg/kgBW paracetamol (P) and 0.5 mg/kgBW ketorolac (K) for pediatric labioplasty procedure. This experimental study is a are double-blind randomized trial against 66 pediatric patients aged 6 months–12 years with the physical status of the American Society of Anesthesiology (ASA) I–II. The study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of October 2013–May 2014. The P and K groups received 20 mg/kgBW paracetamol and 0.5 mg/kgBW ketorolac, respectively, 15 minutes preoperatively. Data were analyzed statistically using independent-t, Mann-Whitney, and Fischer’s Exact Test. Results showed that the difference between FLACC scale in P and K groups  was statistically significant (p&lt;0.05). In conclution, FLACC scale in patients who received ketorolac 0.5 mg/kgBW is lower than patients who received paracetamol 20 mg/kgBW.Key words: Analgetics, FLACC scale, ketorolac, labioplasty, paracetamol, preemptive analgesia DOI: 10.15851/jap.v3n1.573
Perbandingan Angka Keberhasilan Blokade Saraf Iskiadikus Pendekatan Parasakral dengan Labat Menggunakan Stimulator Saraf pada Operasi Daerah Kruris dan Pedis Yadi, Dedi Fitri; Maskoen, Tinni T.; Marlina, Rika
Jurnal Anestesi Perioperatif Vol 3, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Blokade saraf iskiadikus digunakan pada operasi daerah kruris dan pedis. Blokade saraf iskiadikus pendekatan Labat membutuhkan rangkaian penanda anatomis, sementara parasakral menggunakan penanda anatomis sederhana. Penelitian bertujuan membandingkan angka keberhasilan blokade saraf iskiadikus pendekatan parasakral dengan Labat. Penelitian uji acak terkendali tersamar ganda dilakukan pada 32 pasien dewasa di Rumah Sakit Dr. Hasan Sadikin Bandung dan Rumah Sakit Dr. Slamet Garut selama Desember 2014–Januari 2015. Tempat penyuntikan kelompok Labat pada 4 cm distal garis proyeksi tegak lurus terhadap pertengahan trokanter mayor dan spina iliaka superior posterior. Tempat penyuntikan kelompok parasakral pada 6 cm distal garis proyeksi antara spina iliaka superior posterior dan tuberositas iskiadikus. Penyuntikan 30 mL bupivakain 0,4% dilakukan bila terdapat respons motorik pada arus 0,3 mA. Perbandingan angka keberhasilan diuji dengan Uji Eksak Fisher, bermakna jika p<0,05. Blokade saraf iskiadikus kelompok parasakral berhasil pada 15 subjek, sedangkan Labat berhasil pada 8 subjek dengan nilai p=0,015. Angka keberhasilan blokade saraf iskiadikus pendekatan parasakral lebih tinggi dibanding dengan Labat menggunakan stimulator saraf pada operasi daerah kruris dan pedis.Kata kunci: Blokade saraf iskiadikus, keberhasilan, penanda anatomis, pendekatan parasakral, pendekatan LabatComparison of Success Rates between Parasacral Approach and Labat Approach Applied in Sciatic Nerve Block Using Nerve Stimulator in Leg and Foot SurgeriesAnesthesiologist uses sciatic block in leg and foot surgeries. Labat sciatic block uses a series of anatomical landmarks, while parasacral uses simple anatomical landmarks. This study compared the success rate of parasacral approach of sciatic block to Labat approach using nerve stimulator in leg and foot surgeries. A double-blind randomized controlled trial study was conducted on 32 adult patients at Dr. Hasan Sadikin General Hospital Bandung and Dr. Slamet General Hospital Garut during the period of December 2014 to January 2015. In Labat group, a line was drawn from greater trochanter to posterior superior iliac spine. Then, from the midpoint of this line, a second line was drawn perpendicularly and extended caudally to 4 cm. The end of this line represented the needle entry. In parasacral group, a line was drawn from posterior superior iliac spine to ischial tuberosity. The needle entry was then marked on this line at 6 cm from the posterior superior iliac spine. Thirty mL of 0.4% bupivacaine was injected when a proper motor response was elicited at 0.3 mA. Comparison of success rates were analyzed using Fisher’s exact Test with p-value<0.05 considered significant. Fifteen blocks in parasacral group were successful compared to 8 blocks in Labat group, with p-value of 0.015. The success rate of parasacral approach of sciatic block is higher than in the Labat approach when using nerve stimulator in leg and foot surgeries. Key words: Sciatic nerve block, success, anatomical landmarks, parasacral approach, Labat approach DOI: 10.15851/jap.v3n3.613

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