Hari Bagianto
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ANESTESI EPIDURAL THORAKAL PADA TUMOR PHYLLODES Hadinata, Yudi; Basuki, Djudjuk Rahmad; Bagianto, Hari
JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 1 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (645.381 KB) | DOI: 10.14710/jai.v5i1.6555

Abstract

Latar Belakang: Perkembangan teknik anestesi neuroaksial telah memberikan kontribusi yang bermanfaat untuk prosedur anestesi dan analgesia, baik selama prosedur operasi maupun tatalaksana nyeri pasca operasi. Anestesi epidural merupakan salah satu teknik anestesi yang telah digunakan secara umum. Teknik anestesi tersebut bisa dilakukan dengan melihat dermatom area operasi yang dipersarafi sesuai regio servikal, torakal, lumbal maupun caudal.Kasus: Pada kasus ini kami melaporkan penggunaan anestesi epidural mid-thorakal dengan insersi pada ruang intervertebra torakal 7-8 untuk mengakomodasi prosedur operasi mastektomy pasien wanita ASA II dengan tumor payudara phyllodes kiri.
THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 1 Januari 2010
Publisher : Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
The influence of zinc deficiency on chronic pain in Sprague Dawley rats Bagianto, Hari
Medical Journal of Indonesia Vol 19, No 2 (2010): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (266.266 KB) | DOI: 10.13181/mji.v19i2.388

Abstract

Aim Zinc (Zn) deficiency remains a problem in most developing countries, including Indonesia, especially in the East Nusa Tenggara (NTT) Islands. Zinc plays a major role in pain through the modulation process by the N-methyl-Daspartate (NMDA) receptors, which also includes neuronal nitric oxide synthase (nNOS) as a pain parameter. The purpose of this study is to reveal the effects of Zn towards pain response and modulation stage at the spinal cord level in rats.Methods Twenty Sprague Dawley (SD) rats were divided into two groups, a deficient group and a normal group. The deficient group was fed on an IRI-OB diet. Every group was further divided into two more groups, the acute pain group (transient noxious stimuli), and the chronic pain group (continuous noxious stimuli). The rats in chronic pain group were subjected to CCI Bennet operation. The pain thresholds in the deficient group and normal group were measured clinically using a modified Ugo Basille plantar test (thermal transient noxious stimuli). Measurement of chronic pain level was carried out by measuring the nNOS level by immunohistochemistry.Results Deficient group showed an insignificant decrease in pain threshold (P= 0.251). However, there is a significant increase in nNOS (P= 0.027) especially in the deficient group with continuous noxious stimulation.Conclusions These results suggest that Zn deficiency increases pain response, especially in chronic pain. (Med J Indones 2010; 19:88-95)Keywords: continuous noxious stimuli, nNOS, plantar test, transient noxious stimuli
PERBEDAAN TEKANAN BALON PIPA ENDOTRAKEAL SETELAH PERUBAHAN POSISI SUPINE KE LATERAL DECUBITUS Handayanto, Anton Wuri; Bagianto, Hari; Isngadi, Isngadi
JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 1 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (658.276 KB) | DOI: 10.14710/jai.v5i1.6554

Abstract

Latar belakang: Tekanan balon pipa endotrakeal (ETT) akan menimbulkan komplikasi bila diberikan lebih atau kurang dari batas aman yang direkomendasikan. Perubahan tekanan ini, dapat disebabkan oleh perubahan posisi.Tujuan: Penelitian ini bertujuan mengetahui perbedaan tekanan balon ETT setelah perubahan posisi supine ke lateral decubitus.Metode: Penelitian ini merupakan uji klinis eksperimental untuk mengetahui perbedaan tekanan balon ETT setelah perubahan posisi supine ke lateral decubitus pada pasien yang menjalani anestesi umum. Sampel diambil dengan cara consecutive sampling dalam satu kelompok (n=40). Variabel yang diukur pada penelitian ini adalah tekanan balon ETT pada saat posisi supine dan pada saat setelah posisi lateral decubitus.Hasil: Didapatkan sampel sebanyak 40 subjek. Rerata tekanan balon ETT pada posisi supine adalah 25±0,00 mmHg dan pada posisi lateral decubi tus 31,3±2,88 mmHg. T erdapat perbedaan yang signifikan pada tekanan balon ETT saat diposisikan supine dan lateral decubitus (p=0,00), dimana pada saat diposisikan lateral decubitus tekanan balon ETT lebih tinggi daripada tekanan balon ETT saat diposisikan supine.Simpulan: Terdapat perbedaan yang signifikan pada tekanan balon ETT setelah perubahan posisi pasien dari supine ke lateral decubitus. Perubahan posisi ini terbukti dapat meningkatkan tekanan balon ETT. Berdasarkan penelitian ini, disarankan perlu penggunaan alat pengukur tekanan balon ETT pada setiap tindakan anestesi umum dengan intubasi ETT khususnya untuk operasi yang memerlukan posisi pasien lateral decubitus, guna memastikan tekanan balon ETT selalu dalam batas aman. Sehingga komplikasi akibat tekanan balon ETT diluar batas aman tidak terjadi dan keamanan pasien tetap terjaga.
THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
EFEK PEMBERIAN PRE-EMPTIVE FENTANYL 25 μG TERHADAP KEJADIAN BATUK SETELAH BOLUS FENTANYL 2 μG/KG IV (FENTANYL INDUCED COUGH) Siswagama, Taufiq Agus; Bagianto, Hari; Laksono, Ristiawan Muji
JAI (Jurnal Anestesiologi Indonesia) Vol 5, No 1 (2013): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (656.784 KB) | DOI: 10.14710/jai.v5i1.6419

Abstract

Latar belakang: Fentanyl merupakan opioid sintetik yang poten, dengan berbagai kelebihannya sehingga fentanyl dijadikan pilihan utama agen premedikasi dan induksi anestesi umum. Kejadian batuk setelah pemberian bolus fentanyl intravena/ fentanyl induce cough (FIC) merupakan sesuatu yang tidak diharapkan pada kasus pembedahan tertentu sehingga pencegahan FIC haruslah dilakukan. Beberapa penelitian telah dilakukan namun kurang efisien, oleh karenanya pada penelitian ini dilakukan pemberian pre-emptive fentanyl dosis 25 ?g untuk menurunkan FIC.Tujuan: Mengetahui efek pemberian pre-emptive fentanyl 25 ?g intravena terhadap insiden batuk setelah bolus fentanyl 2 ?g/kgBB intravena.Metode: Empat puluh pasien yang menjalani operasi dengan anestesi umum dipilih secara acak untuk diikutkan dalam penelitian. Dibagi menjadi dua kelompok, kelompok pertama (20 pasien) mendapat injeksi intravena normal salin 0,5 ml dan diikuti fentanyl 2 ?g/kgBB dalam 2 detik, dan kelompok sisanya mendapatkan injeksi intravena fentanyl 25 ?g sebelum fentanyl induksi. Digunakan tes Mann-Whitney dan uji korelasi Spearman untuk membandingkan dan menilai hubungan variabel.Hasil: Pemberian pre-emptive fentanyl menunjukkan nilai signifikansi 0.183 pada timbulnya batuk dibandingkan kelompok yang mendapat normal saline namun berkorelasi negatif. Hubungan insiden batuk diantara kedua kelompok bernilai tidak signifikan (p=0,08). Dari derajat batuknya, berbeda signifikan (p=0,043), dengan nilai koefisien korelasi negatif (-0,326) dan nilai yang signifikan (p=0,04).Simpulan: Pemberian pre-emptive fentanyl 25 ?g dapat menurunkan insiden FIC namun secara statistik tidak bermakna.Perlu penelitian selanjutnya untuk mengetahui rentang dosis pre-emptive fentanyl yang tepat serta teknik lainnya sebagai alternative untuk menurunkan insiden FIC