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Jurnal Anestesiologi Indonesia
Published by Universitas Diponegoro
Jurnal Anestesiologi Indonesia (JAI) diterbitkan oleh Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) dan dikelola oleh Program Studi Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Diponegoro (UNDIP) bekerjasama dengan Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) cabang Jawa Tengah.
Articles by issue : Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
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Articles
Perbedaan Pengaruh Pemberian Propofol Dan Etomidat Terhadap Agregasi Trombosit

Tabahhati, Sri, Budiono, Uripno, Harahap, Mohamad Sofyan

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Background: Perioperative bleeding is a serious and common problem in surgery. Induction anesthetic agent usage is known for the inhibition of platelet aggregation. Objective: To determine the difference effect of propofol and penthotal administration on platelet aggregation. Method: An experimental study on 40 patients who received general anesthesia. Samples were divided into two groups (n:20, each). The first group received propofol and the second group received etomidat as the induction anesthetic agent during the procedure, and five minutes post induction, with the rate of administration propofol 2,5 mg/ body weight, etomidat 0,3 mg/ body weight and O₂ : N₂O ratio 50% : 50%. A specimens were taken to the Clinical Pathology Laboratory for Platelet Aggregation testing. Statistical analyses were performed using Paired T-Test and Independent T-Test (with level of significance p<0,05). Result: The result showed significant difference in percentage of maximal platelet aggregation before and after the administration of propofol (p=0,001) and not significant for etomidat group (p=0,089). In the propofol and etomidat group, the mean percentage of maksimal platelet aggregation was 66,07 ± 18,04. Statistically, propofol caused less significant hypo aggregation of plateled compared to etomidate, with (p=0,053). Conclusion: Propofol significantly decreased the percentage of maximal plateled aggregation, however the difference was not significant between two experiment groups.Keywords : Propofol, etomidate, ADP, platelet aggregationABSTRAKLatar belakang penelitian: Perdarahan perioperatif merupakan masalah yang sering dihadapi dalam setiap operasi. Penggunaan obat anestesi induksi dikatakan mempunyai pengaruh dalam agregasi trombosit Tujuan: Untuk mengetahui perbedaan pengaruh pemberian propofol dan etomidat terhadap agregasi trombosit. Metode: Merupakan penelitian eksperimental pada 40 pasien yang menjalani anestesi umum. Penderita dibagi 2 kelompok (n=20), kelompok I menggunakan propofol dan kelompok II menggunakan etomidat, yang diberi sejak awal induksi dengan besar pemberian propofol 2,5 mg/kg intravena, etomidat 0,3 mg/kg intravena bersama O2 : N2O = 50% : 50%. Masing-masing kelompok akan diambil spesimen sebelum induksi dan 5 menit setelah induksi. Semua spesimen dibawa ke Laboratorium Patologi Klinik untuk dilakukan pemeriksaan Tes Agregasi Trombosit. Uji statistik menggunakan Paired T-Test dan Independent T-Test (dengan derajat kemaknaan <0.05). Hasil: Karakteristik data penderita maupun data variabel yang akan dibandingkan terdistribusi normal. Pada penelitian ini didapatkan perbedaan persen agregasi maksimal trombosit yang bermakna sebelum dan sesudah pemberian propofol (p=0,001) dan tidak bermakna untuk sebelum dan sesudah pemberian etomidat (p=0,089). Pada kelompok propofol didapatkan rerata persen agregasi maksimal trombosit 66,07±8,28 dan etomidat 56,29+18,04 dan menunjukkan perbedaan yang bermakna antara keduanya (p=0,053). Kesimpulan: Propofol secara bermakna menurunkan persen agregasi maksimal trombosit, dibandingkan etomidat.

Perbedaan Efektifitas Oral Hygiene Antara Povidone Iodine Dengan Chlorhexidine Terhadap Clinical Pulmonary Infection Score Pada Penderita Dengan Ventilator Mekanik

Sebayang, Kurniadi, Pujo, Jati Listiyanto, Arifin, Johan

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Background : Oral hygiene antiseptic can reduce incidence of Ventilator Associated Pneumonia (VAP) that reduce Clinical Pulmonary Infection Score (CPIS) in patients with mechanical ventilation. Chlorhexidine can prevent formation of biofilm compare with povidone iodine. Objectives : This study was performed to find out wether chlorhexidine 0, 3 % was better than povidone iodine 1 % on Clinical Pulmonary Infection Score in patients with mechanical ventilation. Methods : An experimental study, as consecutive sampling on 32 subjects was decided in two groups (n = 16). Povidone iodine 1% was administrated in first group and cholrhexidin 0,2 % in second group. Clinical Pulmonary Infection Score was determined using Mann-Whitney before and after treatment in each group temperature, blood gas analysis, tracheal secretion, blood analysis and chest x-ray. Statistical analysis was performed with Wilcoxon test to compare CPIS and corelative test to analyzed GC plaque and spearman test to analyzed the correlation between GC plaque score and CPIS. Result : There were significant diference in the first group on CPIS (p<0,05) and no difference in the second group (p>0,05). The difference score before and after treatment in both group were significantly different (p=0,05). GC plaque score in chlorhexidinee group were significantly different (p=0, 0000). There were no correlation between GC plaque score and CPIS. Conclusion : Chlorhexidinee 0,3% is more effective in oropharing decontaminated antisepcic that decrease CPIS than povidone iodine on patients with mechanical ventilation. No correlation between GC plaque score with score of CPIS.Keywords : Povidone iodine 1 %, chlorhexidine 0, 2%, CPIS, mechanical ventilation, GC plaqueABSTRAKLatar belakang : Antiseptik oral hygiene merupakan salah satu cara non farmakologi yang dapat menurunkan insiden Ventilation Associated Pneumonia (VAP) dengan menurunkan skor Clinical Pulmonary Infection Score (CPIS) pada penderita dengan ventilator mekanik. Chlorhexidine adalah antiseptik yang lebih mampu mencegah pembentukan biofilm dibandingkan dengan povidone iodine. Tujuan : Mengetahui chlorhexidine 0,2% lebih efektif menurunkan angka Clinical Pulmonary Infection Score (CPIS) dibandingkan dengan povidone iodine 1% pada penderita dengan ventilator mekanik. Metode : Merupakan penelitian eksperimental, dua subjek dibagi dua kelompok sama besar (n =16). Kelompok chlorhexidinee 0,2 % dan kelompok kontrol povidone iodine 1%. Kedua kelompok sebelum dan setelah perlakuan dilakukan pemeriksaan CPIS, yaitu: suhu, analisa gas darah, sekret trakea, darah rutin dan foto ronsen dada. Uji wilcoxon adalah uji korelatif untuk melihat GC plaque sebelum dan setelah perlakuan.Sedangkan uji spearman melihat korelasi GC plaque dan skor CPIS pada kelompok perlakuan. Hasil : Hasil skor CPIS berbeda makna pada kelompok I (p<0,05). Analisis komparatif selisih skor sebelum dan sesudah perlakuan kedua kelompok berbeda bermakna (p<0,05). Skor GC plaque sebelum [6,00 (5,60-7,00)] dan setelah aplikasi chlorhexidinee 0,2% [7,00 (6,80-7,20)] menunjukkan hasil berbeda bermakna (p= 0,000). Uji spearman skor GC plaque dan CPIS menunjukkan hasil berbeda tidak bermakna, hasil korelatif negatif. Kesimpulan : Chlorhexidinee 0,2% merupakan antiseptik orofaring yang lebih efektif menurunkan skor CPIS dibandingkan dengan povidone iodine 1% pada pasien dengan ventilator mekanik. Tidak ada korelasi antara kenaikan skor GC plaque dengan penurunan skor CPIS.

Pengaruh Pretreatment Vitamin C 200 Miligram Terhadap Kadar Cortisol Serum Pada Induksi Etomidat

Anggraeni, Ratna, Satoto, Hariyo, Nurcahyo, Widya Istanto

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Backgrounds: Etomidate is one of anesthetic agent which has minimal effect on cardiovascular function. However, etomidate depress cortisol production. Vitamin C is one of the agent that hamper the effect of etomidate toward cortisol production. Objectives: To analyze the effect of pre-treatment with vitamin C 200 mg on cortisol serum concentration in elective surgery under general anesthesia. Method: This double blind, Randomized Controlled Trial with 30 subjects which divided into two groups (n=15), control group and treatment group which received etomidate 0,2 mg/kgBW and combination of etomidate and vitamin C 200 mg in pre-operation respectively. Each group was then examined for cortisol serum concentration pre-anesthesia, 2 hours post induction, and 8 hours post induction. Wilcoxon Signed Rank Test and Paired T Test was performed to compare cortisol serum concentration in each group. While Mann Whitney and Independent Sample T Test was used to compare between control and treatment group. Results: Cortisol serum concentration in control group between pre-anesthesia ;244,15 (181,39-382,75)] and 2 hours post induction [185,52 ± 35,88]; and between 2 hours and 8 hours post induction [349,81 ± 121,28] was significantly different with value 0,002 and 0,000 respectively. It showed that decrement of etomidate dosage mo 0,2 mg/kgBW still able to decrease cortisol serum production significantly. However, in treatment group cortisol serum concentration pre-anesthesia [258,49 1"5,45-369,09)] and 2 hours post induction [202,14 ± 45,3]; and between 2 hours and 8 hours post induction [251,39 ± 122,91] was non significant, with p value 0,256 and 0,691 respectively. It proved the negative effect of vitamin C on cortisol depression effect of etomidate. Cortisol serum concentration between control and treatment group was significantly different on 2 hours post induction, but non significant on 8 hours post induction. It showed that the negative effect of vitamin C in cortisol depression because of etomidate only significant during 8 hours post eduction Conclusions: The effect of Vitamin C 200 mg iv 30 minutes pre-operation can minimize Cortisol depression on administration of etomidate 0,2 mg/kgBWKeywords : Pretreatment, vit c 200 mg, cortisol serum, etomidateABSTRAKLatar Belakang: Etomidat adalah salah satu agen anestesi yang berefek minimal terhadap kardiovaskular. Namun, etomidat mendepresi produksi kortisol. Salah satu agen yang dapat meminimalisir efek depresi tersebut adalah vitamin C. Tujuan: Tujuan penelitian ini adalah menganalisis pengaruh pretreatment vitamin C 200 mg pada operasi elektif dengan anestesi umum terhadap kadar kortisol serum. Metode: penelitian ini merupakan penelitian Randomized Contolled Trial dengan 30 subjek yang dibagi dalam dua kelompok sama besar (n=15), yaitu kelompok kontrol yang menerima etomidat 0,2 mg/kgBB dan kelompok perlakuan yang menerima etomidat dan vitamin C 200 mg iv preoperasi. Masing-masing kelompok tersebut selanjutnya diperiksa kadar kortisolnya pre anestesi, 2 jam pasca induksi, 8 jam pasca induksi. Uji statistik Wilcoxon Signed Rank Test dan Paired T Test digunakan untuk membandingkan kadar kortisol di masing-masing kelompok. Uji Mann Whitney dan Independent Sample T Test digunakan untuk membandingkan antar kelompok kontrol dan perlakuan. Hasil: Hasil penelitian menunjukkan pada kelompok kontrol, kadar kortisol preanestesi 244,15 dan 2 jam pasca induksi 185,52 + 35,88 berbeda bermakna (p=0,002). Begitu pula antara kadar 2 jam dengan 8 jam pasca induksi 349,81 + 121,28 (p=0,000). Sedangkan pada kelompok perlakuan, kadar kortisol antara pre anestesi 258,49 (175,45-369,09) dan 2 jam pasca induksi 202,14 + 45,3 tidak berbeda bermakna (p=0,256), begitu pula 2 jam pasca induksi dengan 8 jam pasca induksi 251,39 + 122,91 (p=0,691). Kesimpulan: Dari penelitian ini dapat disimpulkan bahwa pemberian vitamin C 200 mg intra vena 30 menit pre operasi dapat menurunkan efek depresi kortisol oleh pemberian etomidat 0,2 mg/kgBB.Kata kunci : pretreatment, vit c 200 mg, cortisol serum, etomidat

Pengaruh Nitrous Oxide Pada Induksi Sevofluran 8% Dengan Tehnik Single Breath Terhadap Kecepatan Induksi Anestesi

Anindita, Tinon, ., Witjaksono, Primatika, Aria Dian

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Backgrounds: The addition of Nitrous Oxide increase induction time of anesthesia agent,because of second gas effect and concentration effect. Objectives: The aims of this study is to compare induction time of 8% sevoflurane with and without Nitrous oxide using a single-breath vital capacity induction. Methods: Seventy two healthy unpremedicated patients were randomized to inhale a single-breath, one of three gas mixture : 8% sevoflurane in Oksigen (group I), 8% sevoflurane in 50% Nitrous oxide (group II) and 8% sevoflurane in 66 2/3% Nitrous oxide (group 111).The time to absent of the eyelash reflex and induction-related complications, if present, were noted by independent observer. Blood pressure (systolic, diastolic and mean arterial pressure/MAP), and heart rate were measured pre and post induction. Data was analyzed using student T-Test and ANOVA at significancy level of 0,05. Results: Three groups had similar distribution on sex,age,body weight, and early clinical state. The time to absent of the eyelash reflex with 8% sevofllurane in 50% Nitrous oxide, 24,96 ± 4,14 second ,and for 8% sevoflurane in 66 2/3% Nitrous oxide , 24,81 ± 3,85 second, were less than that with 8% sevoflurane in Oksigen, 27,21 ± 4,14 second, but this was no significant (p = 0,098). Changes in blood pressure (systolic,diastolic, mean arterial pressure), heart rate and oksigen saturation were no significant different on three groups. The induction-related complications in the sevoflurane with Nitrous oxide groups were less than that in the sevoflurane without Nitrous oxide group, but this was no significant different. Conclusions: The addition of Nitrous oxide do not increase induction time of anesthesia with a single - breath of 8% sevoflurane.Keywords : Sevoflurane,nitrous oxide, induction time.ABSTRAKLatar Belakang: Penambahan nitrous oxide pada induksi anestesi akan mempercepat waktu induksi, oleh karena adanya second gas effect dan concentration effect. Tujuan: Membandingkan kecepatan induksi anestesi sevofluran 8% dengan atau tanpa nitrous oxide, dengan menggunakan tehnik single breath vital capacity induction. Metode: Tujuh puluh dua pasien tanpa diberikan premedikasi , dibagi dalam 3 kelompok secara random dan diminta untuk menghirup salah satu dari tiga campuran gas dengan tehnik single breath vital capacity : kelompok I diberikan sevofluran 8% + Oksigen, keiompok II diberikan sevofluran 8% + 50% nitrous oxide dan kelompok III diberikan sevofluran 8% + 66 2/3% nitrous oxide. Dicatat waktu saat hilangnya reflek bulu mata dan komplikasi yang terjadi. Tekanan darah (sistolik, diastolik, tekanan arteri rerata), laju jantung dan saturasi oksigen diukur sebelum dan sesudah induksi. Data diuji dengan Student T Test dan ANOVA dengan derajat kemaknaan < 0,05. Hasil: Karakteristik penderita (umur, usia, berat badan dan lain-lain) pada ketiga kelompok berbeda tidak bermakna. Waktu saat hilangnya reflek bulu mata untuk kelompok sevofluran 8% + 50% nitrous oxide (24,96 ±4,14 detik), dan untuk kelompok sevofluran 8% + 66 2/3% nitrous oxide (24,81 ± 3,85 detik) lebih sepat dibandingkan dengan kelompok sevofluran 8% + Oksigen (27,21 ±4,14 detik) , tetapi perbedaan ini tidak bermakna (p=0,098), Perubahan tekanan darah (sistolik, diastolik, tekanan arteri rerata), laju jantung dan saturasi oksigen yang terjadi pada ketiga kelompok berbeda tidak bermakna. Komplikasi induksi anestesi yang terjadi pada kelompok sevofluran 8% dengan nitrous oxide lebih sedikit dibandingkan dengan kelompok sevofluran 8% tanpa nitrous oxide , tetapi perbedaan ini tidak bermakna. Kesimpulan: Penambahan Nitrous oxide pada induksi anestesi dengan sevofluran 8% dengan tehnik single-breath, tidak mempercepat waktu induksi anestesi.Kata kunci : sevofluran, nitrous oxide, waktu induksi

Pengaruh Anestesi Epidural Terhadap Supresi Imun Yang Diinduksi Stres Operasi Selama Pembedahan

Yudhowibowo, Ifar Irianto, Sutiyono, Doso, Villyastuti, Yulia Wahyu

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Major surgery associated with dysfunction of the innate immune system. More recently, demonstrated that the stress of surgery can rapidly induce a temporary reduction of the blood response to endotoxin from 2 hours after incision and that plasma IL-10 increased during surgery, contributes to reducing the response. It has been reported that epidural anesthesia has beneficial effects on immune reactions and response to the stress of surgery. Some researchers have reported that epidural anesthesia maintains NK cell activity and reduced stress response in patients undergoing hysterectomy. Epidural block from T4 to S5 dermatomal segments, starting before surgery, to prevent an increase in cortisol and glucose concentrations in the hysterectomy. Regional anesthesia techniques for major surgery may reduce the release of cortisol, adrenaline (epinephrine) and other hormones, but has little effect on the cytokine response. Recent studies (Kawasaki et al., 2007) suggests that the innate immune system, such as phagocytosis, suppressed by the stress of surgery and that epidural anesthesia did not prevent this decline in immune responsiveness during upper abdominal surgery.ABSTRAKOperasi besar berhubungan dengan disfungsi sistem kekebalan tubuh bawaan. Baru-baru ini, dibuktikan bahwa stres akibat pembedahan dapat dengan cepat menginduksi penurunan respon sementara dari darah terhadap endotoksin sejak 2 jam setelah insisi dan bahwa IL-10 plasmayang meningkat selama pembedahan, berperan dalam penurunan respon ini. Telah dilaporkan bahwa anestesi epidural memiliki efek menguntungkan pada reaksi imunitas dan respon terhadap stres akibat pembedahan. Beberapa peneliti telah melaporkan bahwa anestesi epidural mempertahankan aktivitas sel NK dan mengurangi respon stres pada pasien yang menjalani histerektomi. Blok epidural dari segmen dermatom T4 sampai S5, dimulai sebelum pembedahan, mencegah peningkatan konsentrasi kortisol dan glukosa pada histerektomi. Teknik anestesi regional untuk operasi besar dapat mengurangi pelepasan kortisol, adrenalin (epinefrin) dan hormon lain, namun memiliki pengaruh kecil pada respon sitokin. Penelitian terbaru (kawasaki et al.,2007) menunjukkan bahwa sistem kekebalan tubuh bawaan, misalnya fagositosis, ditekan oleh stres akibat pembedahan dan bahwa anestesi epidural tidak mampu mencegah penurunan respon kekebalan tubuh ini selama operasi perut bagian atas.

Mekanisme Kerja Obat Anestesi Lokal

Samodro, Ratno, Sutiyono, Doso, Satoto, Hari Hendriarto

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Regional anesthesia is growing and expanding its use, given the variety of benefits offered, such as relatively cheap, minimal systemic effects, produce adequate analgesia and the ability to prevent the stress response is more perfect. Local anesthetic drug is chemically divided into two major categories, namely the class of Amide and ester groups. These chemical differences are reflected in differences in the metabolism of the place, where the ester group is mainly metabolized by the enzyme pseudo-cholinesterase in the plasma while the Amide groups mainly through enzymatic degradation in the liver. This difference is also related to the magnitude of the possibility of allergies, in which the ester group derived from p-amino-benzoic acid has a greater frequency of allergic tendencies. Local anesthetic commonly used in our country for the class of esters are procaine, whereas the Amide groups are lidocaine and bupivacaine. Mechanism of action of local anesthetic drugs to prevent transmission of nerve impulses (conduction blockade) by inhibiting the delivery of sodium ions through selective sodium ion gates in neuronal membranes. Failure of the sodium ion permeability of the gate to increase the speed of depolarization of the slowdown as a potential threshold was not reached so that action potentials are not propagated. Local anesthetic did not alter the resting potential or transmembrane potential threshold. Pharmacokinetics of the drug include absorption, distribution, metabolism and excretion. Complications of local anesthetic is a local side effects can occur at the injection site hematoma and abscess while systemic side effects such as neurological in the central nervous, respiratory, cardiovascular, immunological, musculoskeletal, and hematologic Some local anesthetic drug interactions include coadministration may increase the potency of each drug. decreased metabolism of local anesthetics as well as increase the potential for intoxication.ABSTRAKAnestesi regional semakin berkembang dan meluas pemakaiannya, mengingat berbagai keuntungan yang ditawarkan, diantaranya relatif lebih murah, pengaruh sistemik yang minimal, menghasilkan analgesi yang adekuat dan kemampuan mencegah respon stress secara lebih sempurna. Secara kimiawi obat anestesi lokal dibagi dalam dua golongan besar, yaitu golongan ester dan golongan amide. Perbedaan kimia ini direfleksikan dalam perbedaan tempat metabolisme, dimana golongan ester terutama dimetabolisme oleh enzim pseudo-kolinesterase di plasma sedangkan golongan amide terutama melalui degradasi enzimatis di hati. Perbedaan ini juga berkaitan dengan besarnya kemungkinan terjadinya alergi, dimana golongan ester turunan dari p-amino-benzoic acid memiliki frekwensi kecenderungan alergi lebih besar. Obat anestesi lokal yang lazim dipakai di negara kita untuk golongan ester adalah prokain, sedangkan golongan amide adalah lidokain dan bupivakain. Mekanisme kerja obat anestesi local mencegah transmisi impuls saraf (blokade konduksi) dengan menghambat pengiriman ion natrium melalui gerbang ion natrium selektif pada membrane saraf. Kegagalan permeabilitas gerbang ion natrium untuk meningkatkan perlambatan kecepatan depolarisasi seperti ambang batas potensial tidak tercapai sehingga potensial aksi tidak disebarkan. Obat anestesi lokal tidak mengubah potensial istirahat transmembran atau ambang batas potensial. Farmakokinetik obat meliputi absorpsi, distribusi, metabolisme dan ekskresi. Komplikasi obat anestesi lokal yaitu efek samping lokal pada tempat suntikan dapat timbul hematom dan abses sedangkan efek samping sistemik antara lain neurologis pada Susunan Saraf Pusat, respirasi, kardiovaskuler, imunologi ,muskuloskeletal dan hematologi Beberapa interaksi obat anestesi lokal antara lain pemberian bersamaan dapat meningkatkan potensi masing-masing obat. penurunan metabolisme dari anestesi lokal serta meningkatkan potensi intoksikasi.