Iwan Fuadi
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung

Published : 60 Documents
Articles

Gambaran Acute Physiologic and Chronic Health Evaluation (APACHE) II, Lama Perawatan, dan Luaran Pasien di Ruang Perawatan Intensif Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung pada Tahun 2017

Jurnal Anestesi Perioperatif Vol 6, No 3 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Skor acute physiologic and chronic health evaluation (APACHE) II, lama perawatan, dan luaran pasien merupakan indikator penting di Intensive Care Unit (ICU). Ketiga indikator ini dapat berbeda dari satu dengan tempat lain. Ketiga indikator ini dapat dibandingkan di tempat lain untuk meningkatkan pelayanan ICU. Tujuan penelitian ini adalah mengetahui gambaran skor APACHE II, lama perawatan, dan angka mortalitas pada pasien yang dirawat di ICU RSUP Dr. Hasan Sadikin Bandung pada tahun 2017. Metode yang digunakan adalah deskriptif observasional yang dilakukan secara retrospektif terhadap 303 objek penelitian. Objek penelitian diambil di bagian rekam medis pada bulan April 2018. Penelitian ini memperoleh hasil skor APACHE II berkisar 0−56  dengan rerata 16,68, angka mortalitas sebesar 130 (42,3%), dan lama perawatan berkisar 2−79 hari dengan rerata 9,89 hari. Data skor APACHE II terhadap angka kematian berbeda dengan Amerika Serikat yang dapat dikarenakan perbedaan acuan prediksi mortalitas, underestimation derajat keparahan pasien cedera kepala, bias yang disebabkan oleh penatalaksanaan pasien pre-ICU, dan satu waktu pemeriksaan skor APACHE II.Kata kunci: APACHE II, ICU, lama perawatan, luaran pasienOverview of Acute Physiologic and Chronic Health Evaluation (APACHE) II, Length of Stay, and Patient Outcome in the Intensive Care Unit of Dr. Hasan Sadikin General Hospital in 2017The APACHE II score, length of stay, and patient outcome are important indicators in Intensive Care Unit (ICU). Those indicators could be different from one place to another and can be compared to increase the quality of health services in ICU. The purpose of this study was to describe acute physiologic and chronic health evaluation (APACHE) II, length of stay, and mortality rate of patients at the ICU of Dr. Hasan Sadikin General Hospital Bandung from January 1 to December 31, 2017. This was a retrospective descriptive observational study on 303 patient medical records. It was revealed that the APACHE score was ranging from 0−56 (mean =16.68); the mortality rate was 42.9% (n=130); and the length of stay was 2−79 days (mean 9.89 days). This suggests a gap in these indicators between Dr. Hasan Sadikin General Hospital and hospitals in the United States of America which may be due to differences in the the standard that is used to predict the mortality rate, underestimation of severity of head injury, treatment before admission to ICU, and single time assessment of APACHE II.Key words: APACHE II, ICU, length of stay, outcome

Penatalaksanaan Anestesi Pasien Tetralogy of Fallot pada Operasi Mouth Preparation

Jurnal Anestesi Perioperatif Vol 1, No 2 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tetralogy of Fallot (TOF) merupakan kelainan jantung bawaan yang terdiri atas ventricular septal defect, overriding aorta, stenosis pulmonal, dan hipertrofi ventrikel kanan. Tetralogy of Fallot termasuk kelainan jantung bawaan tipe sianotik. Seorang anak laki-laki 9 tahun datang untuk perawatan dan pencabutan gigi sebagai persiapan untuk operasi koreksi TOF di Rumah Sakit Dr. Hasan Sadikin Bandung pada Februari 2012. Anamnesis didapatkan riwayat kebiruan sejak bayi dan pada pemeriksaan fisis didapatkan anak yang tampak sianosis, SpO2 70–75%, murmur sistol, dan jari tabuh. Pada pemeriksaan ekokardiografi didapatkan kelainan TOF. Manajemen anestesi pada pasien ini dilakukan dengan menggunakan ketamin dan vekuronium untuk induksi serta pemeliharaan dengan O2, N2O, dan halotan. Serangan sianotik dapat terjadi preoperatif, intraoperatif, dan pascaoperatif yang diatasi dengan meningkatkan systemic vascular resistance (SVR) dibandingkan dengan pulmonary vascular resistance (PVR). Simpulan, prinsip pengelolaan perioperatif pembedahan nonkardiak pada pasien tetralogy of Fallot (TOF) adalah mencegah terjadi peningkatan shunt dari kanan ke kiri dengan menjaga agar tidak terjadi penurunan SVR, peningkatan PVR, dan menurunkan spasme infundibular.Kata kunci: Kelainan jantung kongenital sianotik, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), tetralogy of Fallot (TOF)Management of Anesthesia in Patients Tetralogy of Fallot which Undergo Mouth PreparationTetralogy of Fallot (TOF) is a congenital heart disease consisting of a ventricular septal defect, overridingaorta, pulmonary stenosis and right ventricular hypertrophy. Tetralogy of Fallot, including the type of cyanotic congenital heart defects. A boy of 9 years came for treatment and tooth extraction as preparation for the surgical correction of TOF at the Dr. Hasan Sadikin Hospital-Bandung whitin February 2012. Patients with a history of blue as a baby, and on physical examination found the child looking cyanosis, SpO2 70–75%, systolic murmur and finger clubbing. Abnormalities on echocardiography obtained TOF. Anesthetic management of these patients was performed using ketamine and vecuronium for induction and maintenance with O2, N2O and halothane. Cyanotic attacks can occur preoperative, intraoperative and postoperative, who treated by increasing systemic vascular resistance (SVR) compared to pulmonary vascular resistance (PVR). In conclusions, perioperatif mangement principal for non cardiac surgery on tetralogy of fallot (TOF) is to prevent shunting from right to left by keep the SVR from decline, increase on PVR, and reduce infundibular spasme.Key words: Cyanotic congenital heart defects, pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), tetralogy of Fallot (TOF) DOI: 10.15851/jap.v1n2.123

Efek Lidokain Intravena terhadap Nilai Numeric Rating Scale dan Kebutuhan Fentanil Pascaoperasi dengan Anestesi Umum

Jurnal Anestesi Perioperatif Vol 1, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Lidokain intravena mempunyai efek analgesia, antihiperalgesia, dan antiinflamasi. Penelitian ini bertujuan untuk mengetahui efek pemberian lidokain intravena terhadap nilai numeric rating scale (NRS) dan kebutuhan fentanil pascaoperasi eksisi fibroadenoma mammae. Penelitian ini merupakan uji klinis acak terkontrol buta ganda terhadap 40 orang pasien wanita usia 18–60 tahun dengan status fisik ASA I–II yang dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode September 2011–Februari 2012. Sampel dikelompokkan random menjadi kelompok lidokain dan kontrol. Penilaian nyeri menggunakan numeric rating scale. Data dianalisis menggunakan uji chi-kuadrat, uji-t, dan Mann Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila p<0,05. Hasil penelitian menunjukkan nilai NRS kelompok lidokain lebih rendah dan berbeda bermakna pada 30 menit (p<0,001), 60 menit (p<0,001), 90 menit (p=0,003), dan 120 menit (p=0,011) pascaoperasi, penggunaan fentanil pertolongan pada kelompok lidokain adalah 0–25 µg dan pada kelompok kontrol 25–75 µg selama 3 jam pascaoperasi. Simpulan penelitian adalah lidokain intravena 1,5 mg/kgBB bolus sebelum induksi dilanjutkan dosis rumatan 1 mg/kgBB/jam sampai 1 jam pascaoperasi mampu menurunkan nilai numeric rating scale dan mengurangi kebutuhan fentanil pascaoperasi.Kata kunci: Kebutuhan fentanil pascaoperasi, lidokain intravena, numeric rating scaleThe Effect of Intravenous Lidocaine on Numeric Rating Scale Value and Postoperative Fentanyl Requirement in General AnesthesiaAbstractLidocain has analgesic, antihyperalgesic and antiinflamatory properties. This was a double blind randomized controlled trial study on 40 female patients, aged 18–60 years old with ASA physical status I–II who underwent excisional biopsy for fibroadenoma mammae at Dr. Hasan Sadikin General Hospital Bandung between September 2011–February 2012. The samples randomly divided into the lidocaine and the control group. Quality of postoperative pain was assessed using the numeric rating scale (NRS). The result were analyzed with chi-square test, t-test, and Mann Whitney Test with 95% confidence interval and considered significant if the p value <0.05. The result showed that in comparison to the control group, the NRS values obtained from the lidocaine group was significantly different in postoperative measurement time, 30 minutes (p<0.001), 60 minutes (p<0.001), 90 minutes (p=0.003) and 120 minutes (p=0.011) and the dose range of fentanyl as a rescue analgesic in 3 hours postoperative period for the lidocaine group was 0–25 µg and 25–75 µg for the control group. This study concluded that administration of 1,5 mg/kgBW lidocaine intravenous before induction and continued with 1 mg/kgBW/hour as maintenance dose until 1 hour postoperative is able to reduce the NRS score and the requirement of postoperative fentanyl.Key words: Intravenous lidocaine, numeric rating scale, post operative fentanyl requierement DOI: 10.15851/jap.v1n3.195

Perbandingan Penambahan PePerbandingan Penambahan Petidin 0,25 mg/kgBB dengan Klonidin 1 µg/kgBB pada Bupivakain 0,25% untuk Blok Infraorbital pada Labioplasti Anak terhadap Lama Analgesia Pascaoperasi

Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Nyeri pascalabioplasti dapat dicegah dengan blok infraorbital bilateral. Penelitian bertujuan membandingkan lama analgesi blok infraorbital pascalabioplasti anak antara penambahan petidin 0,25 mg/kgBB dan klonidin 1 µg/kgBB pada bupivakain 0,25% menggunakan skala nyeri skor face, leg, activity, cry, consolability (FLACC). Penelitian prospektif, uji klinis acak terkontrol tersamar tunggal dilakukan bulan Maret–September 2013 pada 30 pasien status fisik American Society of Anesthesiologist (ASA) II, usia 3 bulan–1 tahun yang menjalani labioplasti dengan blok infraorbital bilateral di Rumah Sakit Dr. Hasan Sadikin Bandung. Subjek dibagi dua kelompok, masing-masing 15 orang. Kelompok BP menerima blok infraorbital dengan adjuvan petidin dan kelompok BK dengan klonidin. Setelah induksi anestesi, dilakukan blok infraorbital sebanyak 1 mL pada tiap sisi wajah. Analisis data dengan uji t menunjukkan perbedaan lama analgesi pascaoperasi yang sangat bermakna (p<0,01) antara kelompok BP (1.828 menit) dan kelompok BK (1.072 menit). Simpulan penelitian ini adalah penambahan petidin 0,25 mg/kgBB pada bupivakain 0,25% untuk blok infraorbital labioplasti anak memberikan analgesi pascaoperasi lebih lama dibandingkan dengan klonidin 1 µg/kgBB. Kata kunci: Blok infraorbital, bupivakain, klonidin, labioplasti, petidinComparison Addition of  Pethidine 0.25 mg/kgBW  with Clonidine 1 µg/kgBW in Bupivacaine 0.25%  to Infraorbital Block in Paediatric Labioplasty for Duration Post Operative Analgesia Post operative pain for labioplasty can be prevented by bilateral infraorbital block. This study aimed to compare the effectiveness addition of pethidine 0.25 mg/kgBW and clonidine 1 µg/kgBW to bupivacaine 0.25%  for postoperative analgesia using infraorbital block in paediatric labioplasty with a pain scale score face, leg, activity, cry, consolability (FLACC). The study was a single-blind randomized controlled trial from March to September 2013 involving  30 pediatric patients, physical status American Society of Anesthesiologist (ASA) II, ages 3 months–1 year for labioplasty surgery with bilateral infraorbital block  at  Dr. Hasan Sadikin Hospital  Bandung. Subjects were grouped into two groups: 15 subjects using adjuvant pethidine 0.25 mg/kgBW (BP) and 15 subjects using adjuvant clonidine 1 ug/kgBW (BK). After induction of anesthesia, infraorbital block done 1 mL on each side of the face. Data were analyzed by t test, showed a highly significant difference (p<0.01) in BP group compared with BK, the average length of postoperative analgesia 1.828 minutes (30 hours) vs 1072 minutes (18 hours). The conclusions is the addition of pethidine 0.25 mg/kgBW in bupivacaine 0.25%  to infraorbital block in paediatric labioplasty provide postoperative analgesia longer than of clonidine 1 µg/kgBW.Key words: Bupivacaine, clonidine, infraorbital block, labioplasty, pethidine DOI: 10.15851/jap.v2n2.302

Perbandingan Efek Pregabalin 150 mg dengan 300 mg Dosis Tunggal terhadap Nilai Numeric Rating Scale dan Kebutuhan Analgetik Pascabedah pada Pasien Histerektomi Abdominal

Jurnal Anestesi Perioperatif Vol 2, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pregabalin memiliki efek antihiperalgesia, antialodinia, dan antinosiseptif. Penelitian bertujuan untuk membandingkan pregabalin 150 mg dengan 300 mg dosis tunggal 1 jam prabedah terhadap nyeri pascabedah dan kebutuhan opioid pada operasi histerektomi abdominal dalam anestesi umum. Uji klinik acak terkontrol buta ganda dilakukan terhadap 60 wanita (18–60 tahun) status fisik American Society of Anesthesiologist (ASA) I–II di Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Mei–Agustus 2013. Pasien dibagi menjadi dua kelompok yang menerima pregabalin 150 mg atau 300 mg. Analisis statistik data hasil penelitian menggunakan uji-t, chi-kuadrat, dan Uji Mann-Whitney. Pada penelitian ini ditemukan nilai numeric rating scale (NRS) saat mobilisasi pada kelompok pregabalin 150 mg dan pregabalin 300 mg  berbeda bermakna (p<0,05). Pemberian analgetik tambahan pascabedah antara kedua kelompok tidak berbeda bermakna (p>0,05). Simpulan penelitian adalah pregabalin dosis 150 mg memiliki efek analgesia dan penambahan opioid yang tidak jauh berbeda dibandingkan dengan dosis 300 mg.Kata kunci: Histerektomi abdominal, numeric rating scale, nyeri pascabedah, pregabalinComparison Between the Effect of Single Dose 150 mg and 300 mg Pregabalin of Numeric Rating Scale Value and Post operative Analgesia Requirement  in Abdominal Hysterectomy PatientsPregabalin has the effect of anti hyperalgesia, anti allodynia, and anti nociception. This study aimed to compare single dose of 150 mg pregabalin with 300 mg pregabalin given 1 hour preoperatively in regards to postoperative pain and opioid requirements in abdominal hysterectomy patients. Double blind randomized controlled trial has been conducted on 60 women (18–60 years),  American Society of Anesthesiologist (ASA) physical status I-II, who underwent abdominal hysterectomy in a double-blind randomized controlled trial under general anesthesia in Dr. Hasan Sadikin Hospital-Bandung within May to August 2013. Patients were divided into two groups whose received 150 mg pregabalin or 300 mg pregabalin pre operatively. Statistical analysis of research data is performed using the student’s t-test, chi square, and Mann-Whitney U-test. This study found that numeric rating scale (NRS) scores during mobilization in the 150 mg pregabalin group and 300 mg pregabalin were significantly different (p<0.05). There was no significant differences in postoperative supplemental analgesic administration between the two groups (p>0.05). The conclusion of the study is preoperative pregabalin dosage 150 mg and 300 mg has insignificant differences in its therapeutic effect and supplemental opioid.Key words: Abdominal hysterectomy, numeric rating scale, postoperative pain, pregabalin DOI: 10.15851/jap.v2n2.308

Perbandingan Anestesi Spinal Menggunakan Ropivakain Hiperbarik 13,5 mg dengan Ropivakain Isobarik 13,5 mg terhadap Mula dan Lama Kerja Blokade Sensorik

Jurnal Anestesi Perioperatif Vol 2, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Penyebaran obat anestesi lokal pada anestesi spinal terutama ditentukan oleh barisitas dan posisi. Penelitian ini bertujuan membandingkan mula dan lama kerja blokade sensorik antara anestesi spinal menggunakan ropivakain hiperbarik 13,5 mg dan ropivakain isobarik 13,5 mg. Penelitian dilakukan dengan uji acak terkontrol buta ganda mengikutsertakan 32 pasien usia 50–70 tahun, ASA I–II yang menjalani transurethral resection of prostate (TURP) dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung pada April– Juli 2012. Data hasil penelitian dianalisis menggunakan Uji Mann-Whitney dengan tingkat kepercayaan 95% dan dianggap bermakna bila p<0,05. Hasil penelitian didapatkan mula kerja blokade sensorik pada ropivakain hiperbarik 5,00 (SB 1,03) menit lebih cepat secara bermakna dibandingkan dengan ropivakain isobarik 10,25 (SB 1,23) menit dan terdapat perbedaan lama kerja blokade sensorik secara bermakna, dengan lama kerja ropivakain hiperbarik adalah 89,38 (SB 5,12) menit dibandingkan dengan ropivakain isobarik 125,94 (SB 7,57) menit. Simpulan penelitian ini adalah anestesi spinal menggunakan ropivakain hiperbarik menghasilkan mula kerja blokade sensorik yang lebih cepat dan lama kerja blokade sensorik yang lebih pendek bila dibandingkan dengan ropivakain isobarik pada pasien yang menjalani operasi TURP.Kata kunci: Anestesi spinal, barisitas, lama kerja, mula kerja, ropivakain, transurethral resection of prostateComparison of Onset and Sensory Blockade Duration of Spinal Anesthesia between 13.5 mg Hyperbaric Ropivacaine and 13.5 mg Isobaric RopivacaineThe spread of the local anesthetic drug in spinal anesthesia is primarily determined by baricity and position. The aim of this study was to compare the onset and duration of sensoric blockade in spinal anaesthesia using 13.5 mg hyperbaric ropivacaine and 13.5 mg isobaric ropivacaine. This was a double blind randomized trial involving 32 patients aged between 50–70 years with ASA I–II whom underwent TURP surgery with spinal anesthesia at Dr. Hasan Sadikin Hospital Bandung within April–July 2012. Data was analyzed using Mann-Whitney Test with level of confidence 95% and p<0.05 was significant. The result showed that onset of sensory blockade in hyperbaric ropivacaine 5.00 (SB 1.03) minutes was significantly faster compared to isobaric ropivacaine 10.25 (SB 1,23) minutes and there was significant difference on sensory blockade duration, where hyperbaric ropivacaine 89.38 (SB 5.12) minutes was shorter than isobaric ropivacaine 125.94 (SB 7.57) minutes. The conclusions of this study shown spinal anesthesia using hyperbaric ropivacaine produced faster onset and shorter duration of sensory block compared to isobaric ropivacaine in TURP surgery.Key words: Baricity, duration, onset, spinal anesthesia, ropivacaine, transurethral resection of prostate DOI: 10.15851/jap.v2n1.232

Insidensi dan Faktor Risiko Hipotensi pada Pasien yang Menjalani Seksio Sesarea dengan Anestesi Spinal di Rumah Sakit Dr. Hasan Sadikin Bandung

Jurnal Anestesi Perioperatif Vol 4, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hipotensi merupakan komplikasi yang sering terjadi setelah tindakan anestesi spinal pada pasien seksio sesarea. Hipotensi terjadi akibat blokade simpatis terhadap aktivitas vasomotor pembuluh darah serta penekanan aorta dan vena kava inferior oleh uterus yang membesar terutama pada saat pasien telentang. Tujuan penelitian ini adalah mengetahui insidensi hipotensi dan faktor risiko yang berhubungan dengan kejadian hipotensi pada pasien yang menjalani seksio sesarea dengan anestesi spinal di Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian observasional potong lintang (cross sectional) ini dilakukan pada 90 subjek pasien yang menjalani seksio sesarea dengan anestesi spinal pada periode bulan April–Mei 2015. Pengolahan data dengan analisis univariabel untuk melihat gambaran proporsi variabel masing-masing yang disajikan secara deskriptif. Hasil penelitian menunjukkan insidensi hipotensi 49%. Faktor risiko yang menyebabkan hipotensi maternal menunjukkan hasil yang tidak signifikan berhubungan dengan kejadian hipotensi (p>0,05). Perbedaan insidensi hipotensi maternal setelah tindakan anestesi spinal dan faktor risiko yang memengaruhinya dengan penelitian sebelumnya karena perbedaan jumlah sampel penelitian, perbedaan definisi hasil yang digunakan, perbedaan tempat penelitian, dan perbedaan metode pengumpulan data.Kata kunci: Anestesi spinal, faktor risiko, hipotensi, insidensi, seksio sesareaIncidence and Risk Factors of Hypotension in Patients Undergoing Cesarean Section with Spinal Anesthesia in Dr. Hasan Sadikin General Hospital BandungAbstractThe most common serious complication associated with spinal anesthesia for C-section is hypotension. These hemodynamic changes result from a blockade of sympathetic vasomotor activity that is accentuated by the compression of the aorta and inferior vena cava by the gravid uterus when the patient is in the supine position. The purpose of this study was to describe the incidence of hypotension in patients undergoing cesarean section with spinal anesthesia in Dr. Hasan Sadikin General Hospital Bandung and to obtain a description of risk factors associated with the incidence of hypotension. A cross–sectional observational study was conducted on 90 subjects consisting of patients undergoing cesarean section with spinal anesthesia during the period of April–May 2015. The data processing performed was the univariable analysis to see the picture of the proportion of each variable, which were presented descriptively. The results showed 49% incidence of hypotension. There was an insignificant association between the risk factors of maternal hypotension after spinal anesthesia for cesarean section insignificant association with the incidence of hypotension (p>0.05). Differences in the incidence of maternal hypotension after spinal anesthesia and risk factors as stated in this study when compared to previous studies are due to differences sample size, definitions, place, and data collection methods.Key words: Cesarean section, hypotension, incidence, risk factors, spinal anesthesia DOI: 10.15851/jap.v4n1.745

Perbandingan Pemberian Parecoxib Na 40 mg Intravena Preoperatif dengan Pascaoperatif dalam Penatalaksanaan Nyeri Pascaoperatif pada Operasi Laparotomi Ginekologis

Jurnal Anestesi Perioperatif Vol 2, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Multimodal analgesia dan preemptive analgesia menjadi terapi yang efektif dalam penatalaksanaan nyeri pascaoperatif. Tujuan penelitian ini adalah untuk menganalisis perbandingan pemberian parecoxib Na 40 mg intravena preoperatif dengan pascaoperatif terhadap nilai NRS. Penelitian ekperimental dengan rancangan analisis komparatif dilaksanakan dari Maret–Juni 2013. Subjek adalah wanita usia 18-60 tahun yang menjalani operasi laparatomi ginekologis dengan anestesi umum di Rumah Sakit Dr. Hasan Sadikin Bandung. Subjek terdiri atas 18 orang pada masing masing kelompok. Parecoxib Na 40 mg diberikan pada dua kelompok perlakuan, yaitu pre atau pascaoperatif. Tramadol 200 mg diberikan pascaoperatif pada semua kelompok dan dilakukan penilaian NRS di ruang pemulihan. Nilai NRS 1 lebih banyak ditemukan pada kelompok I, nilai NRS 3 lebih banyak didapatkan pada kelompok II. Nilai NRS pada kelompok I didapatkan nyeri ringan 15 orang dan nyeri sedang 3 orang. Pada kelompok II didapatkan nyeri ringan 15 orang dan nyeri sedang 3 orang, berdasarkan analisis uji chi-kuadrat tidak terdapat perbedaan nilai NRS kedua kelompok. Tidak didapatkan subjek yang memerlukan analgetik tambahan. Simpulan penelitian ini adalah bahwa tidak terdapat perbedaan antara pemberian parecoxib Na 40 mg preoperatif dan pascaoperatif dalam penatalaksanaan nyeri pascaoperatif. Efek analgetik yang lebih baik didapatkan pada pemberian parecoxib Na preoperatif dengan nilai NRS yang lebih rendah. Kata kunci: Laparatomi ginekologis, numerical rating scale, parecoxib Na, preoperatif, pascaoperatifComparison of Pre-operative and Post-operative Intravenous 40 mg Parecoxib Na in Gynecologic Laparatomy Surgery Post-Operative Pain Management AbstractMultimodal analgesia regimens  and preemptive analgesia will improve post- operative  pain relief. The purpose of this study was to compare pre- and post- operative parecoxib 40 mg intravenous to NRS value. This experimental study with comparative analytical method was conducted in women 18 to 60 years old who underwent gynecologic laparatomy at Dr. Hasan Sadikin General Hospital Bandung during the period of March to June 2013. Subjects consisted of 18 women for each pre-operative and post-operative group. Parecoxib 40 mg were given to the two groups, pre-operative (group I) and post-operative (group II), while intravenous tramadol 200 mg was also also given to all groups post-operatively. The NRS was calculated at recovery room. NRS value 1 was more frequent in group I while the NRS value 3 more frequent in group II. NRS values  in group I: 15 with mild pain (83.3%), 3 with moderate pain (16.7%). In group II the values were 15 with mild pain (83.3%), 3 with moderate pain (16.7%), which was not significant. In conclusion, there is no difference between pre-operative and post-operative parecoxib sodium 40 mg for post operative pain management. There is a better analgetic effect in the group with pre-operative parecoxib which is apparent from lower NRS.Key words: Gynecological laparatomy, numerical rating scale, parecoxib Na, post operative, pre operative DOI: 10.15851/jap.v2n3.327

Perbandingan Penggunaan Topikal Spray Benzidamin HCl 0,15% dan Gel Lidokain 2% pada Pipa Endotrakeal terhadap Kejadian Nyeri Tenggorok Pascaintubasi Endotrakeal

Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Nyeri tenggorok setelah operasi sering terjadi dan merupakan hal yang tidak menyenangkan setelah tindakan anestesia dengan intubasi endotrakeal. Penelitian ini dilakukan untuk mengetahui apakah penggunaan benzidamin HCl 0,15% lebih menurunkan angka kejadian nyeri tenggorok dibanding dengan lidokain gel 2% pada pasien pascaintubasi endotrakeal. Penelitian eksperimental secara randomized control trial (RCT) dilakukan pada 90 pasien dengan status fisik American Society of Anesthesiologists (ASA) I–II, usia 18–60 tahun yang menjalani operasi elektif di ruang operasi bedah sentral Rumah Sakit Dr. Hasan Sadikin Bandung pada Juni–Agustus 2014. Pasien dibagi dalam kelompok benzidamin, kelompok lidokain, dan kelompok NaCl. Selama operasi dicatat perubahan hemodinamik, tekanan balon pipa endotrakeal dipertahankan di bawah 25 mmHg, dinilai skala nyeri tenggorok pada 2 jam, 6 jam, dan 24 jam (T2, T6, T24) setelah operasi dan dilakukan uji statistik dengan uji-t, Uji Kruskal-Wallis, chi-kuadrat. Dari hasil penelitian didapatkan angka kejadian nyeri tenggorok kelompok benzidamin lebih rendah dibanding dengan kelompok lidokain pada 6 jam setelah operasi (T6) dengan perbedaan yang bermakna (p<0,05). Simpulan penelitian ini menunjukkan spray benzidamin Hcl0,15% mampu mengurangi angka kejadian nyeri tenggorok pasca-anestesia endotrakeal dibanding dengan lidokain gel 2%.Kata kunci:  Anti-inflamasi, benzidamin HCl, lidokain gel, nyeri tenggorok pascaintubasiEffectiveness of Benzydamine HCl 0.15% Spray and Lidocaine 2% Gel on Post-operative Sore Throat IncidencePostoperative sore throat is common and unpleasant after endotracheal anesthesia. This study was conducted to determine whether the use of benzydamine hcl 0.15% can further reduce the incidence of sore throat compared to lidocaine gel 2% in patients under endotracheal anesthesia. This experimental study was a randomized control trial (RCT) in 90 patients with ASA physical status I–II, aged 18–60 years who underwent elective surgery in the central surgical operating room of Dr. Hasan Sadikin General Hospital during the period of June to August 2014. Patients were divided in benzydamine group, lidocaine group, and NaCl group. The hemodynamic changes were noted during surgery. The endotracheal tube cuff pressure was maintained below 25 mmHg and a graded scale for sore throat was performed at 2 hours, 6 hours, and 24 hours (T2, T6, T24) after surgery. Statistical tests using t-test, Kruskal-Wallis, and chi-square test were conducted. From the results, the incidence of sore throat in the benzydamine HCL group was significantly lower than in the lidoccaine HCL  group at 6 hours after surgery (T6; p<0.05). It is concluded that benzydamin HCL  0.15% spray is able to reduce the incidence of postoperative sore throat when compared to lidocaine 2% gel.Key words: Anti-inflammation, benzydamine HCL, lidocaine HCL , postoperative sore throat DOI: 10.15851/jap.v3n2.579

Waktu Pulih Sadar pada Pasien Pediatrik yang Menjalani Anestesi Umum di Rumah Sakit Dr. Hasan Sadikin Bandung

Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

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 >3 mg/kgBB, pada durasi anestesia >210 menit dan hipotermia, pada batita adalah hipotermia, dan pada anak adalah dosis fentanil >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