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Pengaruh Diabetes Mellitus Gestasional Terhadap Sirkulasi Uteroplasenta Isngadi, Isngadi; Sindharta, Redhy; Uyun, Yusmein; Rahardjo, Sri
Jurnal Anestesiologi Indonesia Vol 7, No 1 (2015): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Diabetes mellitus pada kehamilan (Gestational diabetes mellitus/GDM) adalah intoleransi glukosa yang ditemukan pertama kali pada masa kehamilan dan sering menimbulkan komplikasi pada ibu yang mengandung maupun janin yang dikandung. Beberapa organ pada GDM mengalami perubahan struktur dan perubahan fungsi termasuk disfungsi endothel mikrosirkulasi dan makrosirkulasi fetoplasenta. Endothelium-derived Relaxing Factors (EDRF) khususnya prostasiklin dan nitrik oksid berperan penting dalam mengontrol sirkulasi fetoplasental. Endothel vaskuler pasien GDM mengalami disfungsi,  sehingga  sintesa dan pelepasan prostasiklin dan nitrik oksid (NO) mengalami gangguan sehingga tonus arteria meningkat. Peningkatan tonus arteri yang menuju uterus akan menurunkan aliran darah uteroplasenta dan akhirnya menurunkan umbilical blood flow (UmBF). Endothel  pembuluh darah merupakan target utama dari stress oksidatif. Sintesa NO merupakan mekanisme penting yang mendasari perubahan pembuluh darah sistemik dan pembuluh darah uterine selama kehamilan. Beberapa evidensi penelitian membuktikan peranan NO dan ADMA pada kehamilan normal dan insufiensi plasenta. Dengan berkembangnya pengetahuan akan mekanisme gangguan jalur ADMA-NO, pilihan tambahan untuk intervensi terapetik akan dapat ditemukan. Tatalaksana GDM secara umum adalah dengan pengaturan diet, latihan fisik selama tidak ada kontraindikasi, pengawasan dan kontrol gula darah, dan terapi farmakologi Berbagai penelitian lain terus berusaha menemukan terapi-terapi baru untuk memperbaiki endothel dan sirkulasi uteroplasenta pada pasien GDM.
Comparison of giving ephedrine 30 μg/kgbw iv and lidocaine 2% 40 mg iv to educe pain induction propofol 2 mg/kgbw iv in general anesthesia Mujahidin, .; Suryono, Bambang; Uyun, Yusmein
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 45, No 01 (2013)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (402.446 KB) | DOI: 10.19106/JMedScie004501201303

Abstract

The administration of propofol often causes burning sensation in the area of injection. There have been efforts to reduce discomfort, but the result remains unsatisfactory. The main purpose of this study is to find objective evidence of whether the administration of ephedrine 30μg/kgBB IV is more effective than 40mg 2% lidocaine in order to reduce propofol 2mg/kgBB injection pain.This study was conducted in the double blind Randomized Controlled Trial (RCT) to 128 patients, with the range of age 18-60 years, physical status ASA I and II, BMI 17.5 – 24.5 kg/m2 which had been done elective surgery in the Intergrated Surgery Center of Dr. Sardjito Hospital Yogyakarta and other education network (Banyumas Hospital, Panembahan Senopati Bantul Hospital, Orthopedi Solo Hospital, Saras Husada Purworejo Hospital) and carried out in 2-4 months, general anaesthesia has been done with endotracheal intubation technic. Subjects have been divided into 2 groups, group A (lidokain 40 mg) and group B (efedrin 30μg/ kgBB). All of the patients have been given at the vena sefalikabasalika with 18G needle and RL. After one of the drugs has been given, the patient will be inducted with propofol 60 seconds later. The measurement of discomfort caused by propofol injection has been marked with discomfort scoring system (score 0-3), the blood pressure measurement has been taken before and after propofol administration. The results showed no statistically significant difference in the two study groups (2% lidocaine 40 mg IV vs ephedrine 30μg/kgbb IV) on pain response measured when patients received propofol 2mg/kgbb IV, p > 0.05 (P = 0.068) In group A there were 52 patients (81.3%), pain-free, while for group B there were 59 patients (92.2%). The pain response obtained was varies, in group A obtained a scale of 1-3, while in group B obtained a scale of 1-2. It can be concluded that administration of IV ephedrine 30μg/kgBB is not a significantly different effect compared with 2% lidocaine 40 mg IV to prevent response to pain during injection of propofol 2 mg / kg IV, P> 0.05 (P = 0.068), but clinically group B have the ability to eliminate pain in 59 patients (92.2%) compared with group A in 52 patients (81.3%), while the possibility of causing pain in group A were 12 patients (7.8%) and group B were 5 patients (18.7%).
PHARMACOKINETIC PROFILE OF LUMBAR EPIDURAL BUPIVACAINE INJECTION IN PREECLAMPSIA PATIENTS DURING CESAREAN SECTION: CASE STUDY IN DR. SARDJITO HOSPITAL YOGYAKARTA Wati, Helmina; Wahyono, Djoko; Hayati, Farida; Uyun, Yusmein
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 3, No 1
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.102

Abstract

Preeclamsia patient experienced deterioration of glomerolus filtration and plasma protein concentration. Bupivakain is bound strongly with the plasma protein that is 95%. This research was aimed to know the pharmacokinetics profiles of isobaric bupivacaine with the noncompartemen model in preeclampsia patients who underwent Sectio Caesarea (SC) with lumbar epidural technique in RSUP Dr. Sardjito and to know correlation between protein levels and pharmacokinetics profiles of isobaric bupivacaine in preeclampsia patients. Firstly, albumin concentration of patients was checked in the laboratory and then isobaric bupivacaine 0.5% in 15ml (75mg) was given by lumbar epidural technique. The samples of blood were taken through veins vessels at 0; 15; 20; 25; 30; 45; 60 and 90 minutes. The concentration of 0.5% isobaric bupivacaine in those samples of blood was determined with High Performance Liquid Chromatography (HPLC) methods. Furthermore, pinprick test was taken to measure block sensoric effect in T10-T6 areas. Pharmacokinetics parameters of bupivacaine (AUC, AUMC, MRT) were calculated based on data of bupivakain concentration in the blood versus time. The results of this research showed that the AUC0-∞ (total AUC) was 116±37,6 (μg/ml) minutes; AUMC0-∞ (total AUMC) was 9187,5 (μg/ml) minutes2; and MRT0-∞ was 102,5 minutes. Average block sensoric effect was at T8. There was no linear correlation between the protein levels and pharmacokinetics profiles of bupivacaine (p>0,05). The conclusion was that there was no linear correlation between the protein levels and pharmacokinetics profiles of bupivacaine that was given by lumbar epidural in preeclampsia patientswho underwent section caesarea.Keywords : bupivakaine, pharmacokinetic profile, lumbar epidural, section caesarea.
Pengaruh Diabetes Mellitus Gestasional Terhadap Sirkulasi Uteroplasenta Isngadi, Isngadi; Sindharta, Redhy; Uyun, Yusmein; Rahardjo, Sri
JAI (Jurnal Anestesiologi Indonesia) Vol 7, No 1 (2015): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (71.575 KB)

Abstract

Diabetes mellitus pada kehamilan (Gestational diabetes mellitus/GDM) adalah intoleransi glukosa yang ditemukan pertama kali pada masa kehamilan dan sering menimbulkan komplikasi pada ibu yang mengandung maupun janin yang dikandung. Beberapa organ pada GDM mengalami perubahan struktur dan perubahan fungsi termasuk disfungsi endothel mikrosirkulasi dan makrosirkulasi fetoplasenta. Endothelium-derived Relaxing Factors (EDRF) khususnya prostasiklin dan nitrik oksid berperan penting dalam mengontrol sirkulasi fetoplasental. Endothel vaskuler pasien GDM mengalami disfungsi, sehingga sintesa dan pelepasan prostasiklin dan nitrik oksid (NO) mengalami gangguan sehingga tonus arteria meningkat. Peningkatan tonus arteri yang menuju uterus akan menurunkan aliran darah uteroplasenta dan akhirnya menurunkan umbilical blood flow (UmBF). Endothel pembuluh darah merupakan target utama dari stress oksidatif. Sintesa NO merupakan mekanisme penting yang mendasari perubahan pembuluh darah sistemik dan pembuluh darah uterine selama kehamilan. Beberapa evidensi penelitian membuktikan peranan NO dan ADMA pada kehamilan normal dan insufiensi plasenta. Dengan berkembangnya pengetahuan akan mekanisme gangguan jalur ADMA-NO, pilihan tambahan untuk intervensi terapetik akan dapat ditemukan. Tatalaksana GDM secara umum adalah dengan pengaturan diet, latihan fisik selama tidak ada kontraindikasi, pengawasan dan kontrol gula darah, dan terapi farmakologi Berbagai penelitian lain terus berusaha menemukan terapi-terapi baru untuk memperbaiki endothel dan sirkulasi uteroplasenta pada pasien GDM.
THE PHARMACOKINETIC PROFILE OF BUPIVACAINE IN NORMOTENSIVE PREGNANT PATIENT DURING CAESAREAN SECTION Sandi, Dita Ayulia Dwi; Wahyono, Djoko; Hayati, Farida; Uyun, Yusmein
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 3, No 2
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.105

Abstract

Bupivacaine is used as a local anesthetic with Epidural Lumbal Anasthesia (ELA) for Caesarean Section (CS) in Indonesia. During pregnancy, there are changes in pharmacokinetic parameter values, as a result of changes in the physiology of the body. This study was designed to determine the pharmacokinetic parameters of isobaric bupivacaine 0.5% with non-compartment model and to monitor its effectiveness. The study was conducted on 7 normotensive pregnant patients who treated with 0.5% bupivacaine doses 75 mg at Integrated Central Surgery Building in Dr. Sardjito Hospital. Blood samples (3 mL) from each patients were drawn at the following intervals: 0, 15, 20, 25, 30, 45, 60, 75 and 90 minutes, then the plasma bupivacaine consentration were measured using HPLC and pharmacokinetic parameters were calculated with non-compartment models, i.e. AUC(0-~), AUMC(0-~) and the MRT. Monitoring the effectiveness was conducted by Pinprick test. Relationship of AUC(0-~) with maximum sensory block was analyzed by Pearson correlation. The results of pharmacokinetic parameters of isobaric bupivacaine 0.5% for 7 normotensive pregnant patients with non-compartment model were AUC(0-~) 101,25 ± 15,07 μg.mL-1.min; AUMC(0-~) 6.431,92 ± 2.212,96 μg.mL-1.min2 and MRT 63,74 ± 20,52 minutes. Bupivacaine 0,5% doses 75 mg as an anesthetic for CS with ELA in 7 normotensive pregnant patients was effective for pain blockade, with maximum sensory block was T6. There was no correlation between AUC(0-~) and sensory block (p>0,05).Keywords: Bupivacaine 0.5%, Sectio Caesarea, Pharmacokinetics, Sensory bloc
Penatalaksanaan Anestesi pada Seksio Sesarea Penderita HIV/AIDS dengan Space Occupying Lession (SOL) Mafiana, Rose; Uyun, Yusmein
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

Kehamilan mempunyai dampak terhadap perubahan anatomi, fisiologi, farmakologi dan psikis pada sang ibu sehingga seksio sesarea pada ibu hamil merupakan tantangan tersendiri untuk spesialis anestesiologi, karena pertimbangannya terhadap keselamatan ibu dan anak. Apabila kehamilan disertai dengan penyulit yang lain, maka kondisi ini akan semakin kompleks. Kasus ini mengemukakan ibu hamil penderita HIV/AIDS dengan penyulit Space Occupying Lession (SOL), pertimbangan seksio sesarea dilakukan sebagai terminasi kehamilan untuk mengurangi paparan Maternal to Child Transmission (MTCT) terhadap anak yang dilahirkan. Pertimbangan pemilihan tehnik anestesinya berdasarkan fisiologi kehamilan, patofisiologi HIV/AIDS, efek samping obat Anti Viral (ARV), interaksi obat ARV dengan obat anestesi, komplikasi HIV/AIDS pada otak berupa SOL yang berhubungan dengan peningkatan TIK, dampak infeksius penyakot ini kepada lingkungannya serta antisipasi terhadap medis/paramedic yang ikut menangani tindakan terminasi. Pada penderita ini kami lakukan tehnik anestesi edpidural dengan bupivacaine 0,5 % sebagai bfasilitas anestesi selama seksio sesarea. Pascaoperasi dilanjutkan nyeri melalui kateter epiduralnya.Anesthesia Management of Sectio Caesaria HIV/AIDS Patient with Space Occupying Lession (SOL)Sectio caesarea on prenatal vidual have challenge in anaesthesia because influence safety mothers and children. Pregnancy to changes anatomy, physiology, pharmacology and psychology on the mother moreover that’s can accompanied by another complications, and make change this increasingly complex. In this case was pregnant mothers HIV/AIDS sufferes with a  complication space occupying lesion (SOL). Sectio caesaria done to termination of pregnancy to reduce exposure transmission against children born gord loan-to- maternal child transmission (MCTC), Consideration of anestesinya technique based on pregnancy, physiology, pahtopfisiologi HIV/AIDS, adverse side effects anti retro viral (ARV) and interaction with medicine. Anaethetic complication SOL in HIV/AIDS in the brain associated with increased intracranial pressure. The impact of infectious disease that contaminate the environment and anticipations for medical paramedics / anaesthetic to prevent its. We did the patient  with ep[idural anaethetic technique and used bupivacaine 0.5 % as facilitate anesthesia during section caesaria. Postoperaive continued pain releave through her catheter epidural.
Patofisiologi Serebrovaskuler dan Implikasi Anestesi pada Preeklampsia/Eklampsia Septica, Rafidya Indah; Uyun, Yusmein; Suryono, Bambang
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v4i2.118

Abstract

Preeklampsia adalah kelainan multisistim unik pada ibu hamil. Preeklampsia terjadi pada sekitar 3-8% kehamilan, dengan angka mortalitas akibat gangguan serebrovaskuler yang cukup tinggi (67%). Adanya 2 protein antiangiogenik yang diproduksi berlebihan oleh plasenta yang memberi akses masuk ke sirkulasi maternal merupakan molekul yang bertanggung jawab terhadap munculnya preeklampsia, yaitu soluble Fms-like tyrosine kinase, yang merupakan inhibitor endogen vascular endothelial growth factor dan placental growth factor, dan endoglin terlarut (sEng). Faktor-faktor tersebut menyebabkan disfungsi endotel sistemik yang berefek terutama ke hati, otak, dan ginjal. Disfungsi endotel pada otak diasumsikan berperan melalui 2 teori, yaitu sebagai respon terhadap hipertensi berat akut, sehingga regulasi berlebihan serebrovaskuler memicu terjadinya vasospasme; dihipotesakan aliran darah otak (ADO) hilang akibat iskemia, edema sitotoksik, infark dan terjadinya peningkatan mendadak tekanan darah sistemik melebihi kapasitas autoregulasi serebrovaskuler normal, sehingga terjadi kerusakan tekanan ujung kapiler yang menyebabkan kenaikan tekanan hidrostatik, hiperperfusi, ekstravasasi plasma dan sel darah merah melalui endothelial tight junctions yang terbuka mengakibatkan akumulasi edema vasogenik. Walaupun demikian perubahan serebrovaskuler tidak selalu menyebabkan peningkatan tekanan intrakranial. Dengan bantuan teknologi yang lebih baik dan canggih, abnormalitas serebrovaskuler yang dipicu oleh preeklampsia-eklampsia, juga efek hipertensi pada perfusi serebral dapat dijelaskan dengan lebih baik. Pertimbangan khusus pemilihan teknik anestesi pada preeklampsia dimulai dengan persiapan preoperatif berupa penilaian preanestesi, pemilihan manajemen anestesi, teknik induksi pada anestesi umum, dan interaksi antara MgSO4 dan pelumpuh otot nondepolarisasi. Teknik anestesi sesuai kaidah neuroanestesi adalah teknik terpilih pada preeklampsia/eklampsia dengan kenaikan tekanan intrakranial Cerebrovascular Pathophysiology and Anesthetic Implication in Preeclampsia/EclamsiaPreeclampsia is a uniqe multisystem disorder in pregnant women. Preeclampsia affecting 3-8% of pregnancies, with high maternal mortality related to cerebrovascular accident (67%). The over produced two antiangiogenic proteins by placenta that gain access to the maternal circulation have become the main molecules responsible for phenotype of preeclampsia; which are soluble Fms-like tyrosine kinase, endogenous inhibitor of vascular endothelial growth factor and placental growth factor, and soluble endoglin (sEng). All these factors cause systemic endothelial dysfunction, mostly affected liver, brain, and kidney. Endothelial cell dysfunction may play role in two theories: as respon to acute severe hypertension thus cerebrovascular overregulation leads to vasospasm; as hypothesized,the diminished cerebral blood flow (CBF) resulted in ischaemia, cytotoxic edema, and infarct and a sudden elevation in systemic blood pressure exceeded the normal cerebrovascular autoregulatory capacity, and lead to disruption of the end-capillary pressure which causes increased hydrostatic pressure, hyperperfusion, and extravasation of plasma as well as red cells through disruption of the endothelial tight junctions leading to the accumulation of vasogenic edema. Nevertheless, cerebrovascular changes not always increase intracranial pressure. With the new and better technologies, the abnormal cerebrovascular related to preeclampsia-ecclampsia, and hypertension effect on cerebral perfusion can be more clearly explained. Special consideration for anesthesia technique in preeclampsia should be begin with preoperative preparation as pre-anesthestia assesment, choosing the anesthestia technique, induction technique and consideration of MgSO4 and nondepolarising muscle relaxant interaction when using general anesthesia. If intracranial pressure increased, neuroanesthesia technique is recommended. In preeclampsia/eclampsia cases.