I Wayan Aryabiantara, I Wayan
Anesthesiology and Intensive Care Department, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

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PROFIL PENGGUNAAN ANTIKOAGULAN PADA PASIEN KARDIOVASKULAR YANG DIRAWAT DI RUANG ICCU RSUP SANGLAH PERIODE JANUARI 2016 - JUNI 2016 Giti Livia Devi, Gusti Ayu Putu; Aryabiantara, I Wayan; Hartawan, IGAG Utara
E-Jurnal Medika Udayana Vol 7 No 10 (2018): Vol 7 No 10 (2018): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Penyakit kardiovaskular di Indonesia merupakan salah satu penyebab kematian terbesar, dengan prevalensi yang cukup tinggi dan angka kejadian yang diperkirakan akan meningkat setiap tahunnya. Salah satu obat yang digunakan dalam menangani penyakit kardiovaskular adalah antikoagulan. Namun, pencatatan penggunaan antikoagulan yang diselenggarakan oleh Badan Penelitian dan Pengembangan Kesehatan di Indonesia masih kurang lengkap. Maka dari itu, tujuan dari penelitian ini adalah untuk mengetahui profil penggunaan antikoagulan pasien kardiovaskular yang dirawat di Ruang ICCU dimulai dari Ruang ICCU RSUP Sanglah. Metode yang digunakan adalah deskriptif retrospektif dimana data berasal dari rekam medis pasien kardiovaskular yang dirawat di ICCU RSUP Sanglah pada periode Januari 2016 ? Juni 2016, dengan menggunakan teknik total sampling. Dari 85 pasien yang memenuhi kriteria, 55 orang diantara menggunakan antikoagulan dan 30 orang tidak menggunakan antikoagulan. Sehingga didapatkan angka proporsi 64,7% untuk pasien dengan antikoagulan yang dirawat di ICCU RSUP Sanglah dan 35,3% untuk pasien tanpa antikoagulan yang dirawat di ICCU RSUP Sanglah. Profil penggunaan antikoagulan pada pasien yang dirawat di ICCU RSUP Sanglah memiliki karakteristik subyek pasien kardiovaskular mayoritas dengan jumlah 40 (72,7%), usia 65-74 tahun dengan jumlah 17 subyek (30,9%), dan merupakan pasien infark miokard dengan jumlah subyek 22 (40%), dengan jenis antikoagulan terbanyak menggunakan enoxaparin sebanyak 36 subyek (60%). Kata kunci: antikoagulan, ICCU
STUDI POLA PENANGANAN NYERI BERAT KANKER DI RSUP SANGLAH OLEH TIM ANESTHESIA PAIN SERVICE (APS) Candrayuni, Ni Made Ayu; Aribawa, IGN Mahaalit; Aryabiantara, I Wayan
E-Jurnal Medika Udayana Vol 8 No 8 (2019): Vol 8 No 8 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2019.V8.i8.P16

Abstract

Nyeri kanker merupakan salah satu manifestasi klinis yang kerap dirasakan oleh pasien kanker,baik berupa akut maupun kronis. Rumah Sakit Umum Pusat Sanglah sebagai rumah sakit rujukandiharapkan dapat memberikan penanganan nyeri yang efektif kepada pasien dan diwujudkan denganterbentuknya tim Anesthesia Pain Service (APS). Tujuan dari penelitian ini untuk mengetahui polapenanganan nyeri berat kanker di RSUP Sanglah dan tingkat kepuasan pasien. Penelitian ini merupakanlongitudinal non-eksperimental. Pengambilan data dilakukan secara prospektif terhadap pasien pada bulanJuni hingga Agustus 2017. Sampel berjumlah 50 orang yang ditentukan dengan teknik total populationsampling. Responden terbanyak merupakan pasien perempuan dengan kelompok umur lansia awal.Regimen analgetika yang diberikan adalah opioid kuat dan kombinasi yang diberikan dengan teknik yangberagam meliputi Patient Controlled Analgesia (PCA), oral, IV, syringe pump, dan patch. Penanganannyeri berat kanker di RSUP Sanglah menggunakan analgetika opioid dan kombinasi dengan konsepmultimodalitas dengan berbagai teknik dan pola perubahannya. Kata kunci: Nyeri kanker, teknik pemberian analgetik, tingkat kepuasan.
CORRELATION BETWEEN PROTEIN INTAKE AND NITROGEN BALANCE OF SURGICAL PATIENTS IN ANESTHESIOLOGY AND INTENSIVE CARE INSTALLATION, SANGLAH GENERAL HOSPITAL, DENPASAR, BALI, INDONESIA Wiryana, Made; Sinardja, I Ketut; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Panji, Putu Agus Surya; Aryabiantara, I Wayan; Cindryani, Marilaeta
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

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Abstract

Background: A cell injury from surgical stress in a trauma or a non-trauma case will induce a hyper metabolic response in which the protein degradation increases, the somatic protein synthesis decreases and the amino acid catabolism increases. Thus, the pyper metabolic response contributes to nitrogen loss in urine. This response, without an adequate nutrition, will lead an iatrogenic malnutrition and deterioration. A balance nitrogen formula through urinary urea nitrogen is one of many nutrition evaluation methods. This method aids in evaluating the daily nutrition status and it can be the baseline data for daily intake. Objective: To find a correlation between the protein intake and the nitrogen balance of the surgical patients in anesthesiology and intensive care installation, Sanglah General Hospital, Denpasar, Bali. Methods: Fifty-one surgical patients with trauma and non-trauma cases were observed for their protein intake for 2-3 days continuously. Moreover, they were evaluated for their nitrogen balance based on the urinary urea nitrogen per 24 hours for 2-3 days. For statistical analysis, we utilized Shapiro-Francia, Shapiro-Wilk, Spearman Frank correlation, two-sample t test, and multivariate regression analysis in Strata SE 12.1. Results: The correlation between the protein intake and the nitrogen balance on the first day was ra=0.50 (p<0.05), on the second day ra=0.70 (p<0,05), and on the third day ra=0.740 (p<0,05) Conclusions: There is a correlation between the protein intake and the nitrogen balance of surgical patients in Anesthesiology and Intensive Care Installation Sanglah General Hospital Denpasar.
INSIDEN DELIRIUM BERDASARKAN SKOR CAM-ICU PADA PASIEN DENGAN VENTILATOR DI RUANG TERAPI INTENSIF RSUP SANGLAH DENPASAR PERIODE JANUARI 2017 – MARET 2017 Wijaya, Maya Paramita; Aryabiantara, I Wayan
E-Jurnal Medika Udayana Vol 8 No 8 (2019): Vol 8 No 8 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2019.V8.i8.P13

Abstract

Delirium adalah gangguan pada fungsi kognitif dan perhatian yang terjadi secara akut dan fluktuatif. Insiden delirium tertinggi terjadi di Ruang Terapi Intensif (RTI) yaitu antara 70% hingga 87%. Delirium yang terjadi pada pasien yang dirawat di RTI berkaitan dengan peningkatan mortalitas dan gangguan fungsi kognitif permanen. Akan tetapi, penilaian delirium tidak secara rutin dilakukan padahal tinggi atau rendahnya angka delirium dapat dijadikan indikator dalam menilai kualitas rumah sakit. Tujuan dari penelitian ini adalah untuk mengetahui insiden delirium pada pasien dengan ventilator di RTI RSUP Sanglah. Metode yang digunakan adalah potong lintang deskriptif. Pasien yang memenuhi kriteria inklusi dan eksklusi dinilai skor Richmond Agitation-Sedation Scale (RASS) dan Behavioral Pain Scale (BPS) untuk menyingkirkan diagnosis banding agitasi dan nyeri. Kemudian pasien yang memenuhi kriteria dilanjutkan dengan pemeriksaan Confusion Assessment Method-Intensive Care Unit (CAM-ICU) untuk mengetahui apakah pasien sedang mengalami delirium atau tidak. Data yang terkumpul kemudian dianalisis dengan menggunakan IBM SPSS Statistik, versi 21 dimana Descriptive Statistics digunakan untuk menghitung distribusi dan karakteristik pasien. Sedangkan perhitungan insiden delirium dengan 95% IK dihitung menggunakan metode Robert Newcombe. Sebanyak 24 pasien memenuhi kriteria penelitian dimana 4 orang mengalami delirium dan 20 orang tidak mengalami delirium. Angka insiden delirium untuk pasien dengan ventilator adalah 16,7% (95% IK: 5,48% - 38,19%). Sedangkan angka insiden untuk pasien dengan ventilator yang tidak mengalami delirium adalah 83,3% (95% IK: 61,81% - 94,52%). Berdasarkan penelitian sebelumnya angka kejadian delirium di RTI dapat mencapai 83% sehingga dapat disimpulkan bahwa insiden delirium yang terjadi di RTI RSUP Sanglah tergolong rendah.   Kata kunci: insiden delirium, ventilator, RTI
The effectiveness of Patient Controlled Analgesia (PCA) morphine-ketamine compared to Patient Controlled Analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery Mahaalit Aribawa, I Gusti Ngurah; Agung Senapathi, Tjokorda Gde; Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Gede Widnyana, I Made; Aryabiantara, I Wayan; Parami, Pontisomaya; Nyoman Kurniasari, Pande; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.11

Abstract

Background: Laparotomy may cause moderate to severe after surgery pain, thus adequate pain management is needed. The addition of ketamine in patient controlled analgesia (PCA) morphine after surgery can be the option. This study aims to evaluate the effectiveness of PCA morphine-ketamine compared to PCA morphine in patient postoperative laparotomy surgery to reduce total dose of morphine requirement and pain intensity evaluated with visual analog scale (VAS). Methods: This study was a double-blind RCT in 58 patients of ASA I and II, age 18-64 years, underwent an elective laparotomy at Sanglah General Hospital. Patients were divided into 2 groups. Group A, got addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) and patients in group B received morphine (1mg/ml) by PCA. Prior to surgical incision both group were given a bolus ketamine 0,15mg/ kg and ketorolac 0,5mg/kg. The total dose of morphine and VAS were measured at 6, 12, and 24 hours postoperatively. Result: Total dose of morphine in the first 24 hours postoperatively at morphine-ketamine group (5,1±0,8mg) is lower than morphine only group (6,5±0,9mg) p<0,001. VAS (resting) 6 and 12 hour postoperative in morphine-ketamine group (13,4±4,8 mm) and (10,7±2,6 mm) are lower than morphine (17,9±4,1mm) p≤0,05 and (12,8±5,3mm) p≤0,05. VAS (moving) 6, 12, and 24 hour postoperative morphineketamine group (24,8±5,1mm), (18±5,6mm) and (9±5,6mm) are lower than morphine (28,7±5,2mm) p≤0,05, (23,1±6,0mm) p≤0,05, and (12,8±5,3mm) p≤0,05. Conclusions: Addition of ketamine in PCA morphine for postoperative laparotomy surgery reduces total morphine requirements in 24 hours compared to PCA morphine alone.
Effectiveness of Infusion Warmer Use to Prevent the Occurrence of Hypothermia and Shivering After General Anesthesia Action in General Hospital Center Sanglah Denpasar Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Kusuma Wijaya, Andi; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.3

Abstract

Introduction: Shivering and hypothermia after general anesthesia is a common complication in the recovery room. Heating methods and drugs  widely used, but not yet effective. The purpose of this study was to evaluate the effectiveness of using the infusion warmer in maintaining normal core temperature and prevent shivering. Materials and Methods: The study was a non blindnes randomized control trial study. This study aimed to compare the effectiveness of the use of infusion warmer in preventing the incidence of hypothermia and shivering after general anesthesia. Research conducted at the Sanglah Hospital in October 2016, with sample calculations 58 people who meet the inclusion and exclusion criteria. Both were divided into 2 groups, 29 groups of infusion warmer and 29 people without the infusion warmer Recording the results of assessing multiple parameters vital signs, hemodynamic, aldrette score, body temperature, and shivering from the beginning, after induction, and minutes to 5, 15, 30 , 60 in the recovery room. The data obtained were analyzed with SPSS software with a significance level of p <0.005 expressed significantly, with a relative risk <1 as a preventive. Results: From a comparative picture of events shivering and hypothermia in minutes to 5, 15, 30, 60 in the recovery room seen that the treatment group based on the group lower warmer than in the non warmer. This shows that the use of warmer can prevent the incidence of shivering and hypothermia in patients after general anesthesia. In test statistically significant with p <0.05. Conclusions: The use of infusion warmer can help reduce the incidence of hypothermia and shivering after general anesthesia action.
SPONTANEOUS RUPTURE OF ARTERIOVENOUS MALFORMATION: ICU BASED BRAIN RESUSCITATION Panji, Putu Agus Surya; Aryabiantara, I Wayan; Suranadi, I Wayan; Parami, Pontisomaya; Wibisana Kurniajaya, I Gusti Agung Made
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.25

Abstract

Arteriovenous malformations (AVM) is a relatively rare intracranial abnormality. Generally, it caused by congenital abnormalities that recognized after the bleeding started. Spontaneous intracranial bleeding after AVM rupture is an emergency condition and require immediate treatment to reduce mortality rate. After stabilization of intracranial bleeding due to AVM rupture, secondary injury may occur hours or even days after the inciting traumatic event. The injury may result from impairment or local declines in cerebral blood flow (CBF) after brain injury. The decrease in CBF is the result of local edema, hemorrhage, or increased intracranial pressure (ICP). An adequate brain resuscitation is needed to decrease brain edema and intracranial pressure by achieving several targets and avoid things that can interfere with CBF. A recovery phase should be given to the patient with rupture of AVM before going to definitive therapy.
Non-Convulsive Status Epilepticus (NCSE) in ICU Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Ryalino, Christopher; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.5

Abstract

Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long,  associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes of. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended asthe first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis.  This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response.
Low Dose Ketamin Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Novita Pradnyani, Ni Putu; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.4

Abstract

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Low-dose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psikomimetik like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.
Central Venous Pressure Correlates with Inferior Vena Cava Collapsibility Index in Patient Treated in Intensive Care Unit Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Mahaalit Aribawa, I Gusti Ngurah; Gede Utara Hartawan, I Gusti Agung; Parami, Pontisomaya; Perangin Angin, Emkel
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.2

Abstract

Background: Intravascular volume status is an important parameter in monitoring the patients treated at intensive care unit (ICU), so accuracy and strict monitoring of fluid volume is one factor that influence patient’s health status. Amongst others, two ways to monitor body fluid volume status is central venous pressure (CVP) and collapsibility index of inferior vena cava (IVC) diameter. The purpose of this study is to determine the correlation between CVP with the IVC collapsibility index in patients treated in ICU Sanglah Hospital in Denpasar. Method: Seventy patients treated at Sanglah Hospital ICU with already inserted CVC for appropriate indication, were measured for CVP, then followed by examination the diameter of IVC with ultrasound to measure the maximum and minimum collapsibility index. Spearman’s correlation coefficients was used to assess the correlation between CVP and collapsibility index of the IVC. Results: In 70 patients, we found a very strong negative correlation between CVP and IVC’s collapsibility index (Spearmans rho = -0.854; p <0.001). Conclusion: This study found that there is a very strong negative correlation between CVP and collapsibility index of IVC. This finding indicates that the collapsibility index of the IVC may substitute CVP in determining the status of the intravascular volume.