Jurnal Komplikasi Anestesi https://jurnal.ugm.ac.id/v3/jka <p>JURNAL KOMPLIKASI ANESTESI (<a href="https://issn.brin.go.id/terbit/detail/1520308325" target="_blank" rel="noopener"><strong>e-ISSN 2354-6514</strong></a>) is a <strong>scientific</strong> and <strong>original</strong> journal which published as a forum for various scientific articles including research, literature reviews, case reports and recent book reviews. The presence of this journal, it is hoped that it can provide input of knowledge and knowledge in the field of Anesthesiology and Intensive Therapy for medical personnel.</p> This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Branch. en-US Jurnal Komplikasi Anestesi 2354-6514 <p>The Contributor and the company/institution agree that all copies of the Final Published<br>Version or any part thereof distributed or posted by them in print or electronic format as permitted herein will include the notice of copyright as stipulated in the Journal and a full citation to the Journal.</p> MANAJEMEN AKHIR HAYAT PASIEN SAKIT KRITIS DI ICU COVID-19 https://jurnal.ugm.ac.id/v3/jka/article/view/8654 <p>End-of-life condition was showed with symptoms of brain-stem death and functional impairment of breathing effort that persisted at fifth day of care. Physician explained to patient’s family about end-of-life condition, prognose, probability, and a desicion making that would had to make. Family decided to accept this condition, wish to continue medication but not to resuscitate if patient’s condition became worst. A chaplain gave spiritual care, end-of-life counceling, and praying to patient. Unfortunately, there was no intensive communication among medical teams about end-of-life condition. Patient care was underwent until the time of death with permitted family at patient’s bedside, not gave cardiopulmonal resuscitation as family’s wishes and pronaounced death in front of family.</p> Bowo Adiyanto Untung Widodo Agung Diky Hernawan Copyright (c) 2019 Bowo Adiyanto, Untung Widodo, Agung Diky Hernawan https://creativecommons.org/licenses/by-sa/4.0 2023-06-22 2023-06-22 9 1 1 9 10.22146/jka.v9i1.8654 Penggunaan Non-Invasive Ventilation pada Pasien COVID-19 https://jurnal.ugm.ac.id/v3/jka/article/view/8499 <p>COVID-19 patients with acute respiratory distress require hospitalization and require invasive and/or non-invasive mechanical ventilation support. NonInvasive Ventilation (NIV) is used in cases requiring escalation of standard oxygen therapy to a higher level. NIV can also reduce early intubation, but long-term use of NIV is not recommended. NIV also does not decrease intubation rates. We report a 52-year-old female patient with a confirmed diagnosis of severe COVID-19. Our patient was admitted to the ICU with the use of HFNC and NIV during treatment. The use of NIV at the right time could determine the patient's prognosis. Persistent weaning of NIV could maintain PO2 and reduce the patient's oxygen fraction requirements. This patient’s condition could improve and become a survivor of COVID-19.</p> Juni Kurniawaty Bowo Adiyanto Yuri Sadewo Copyright (c) 2023 Juni Kurniawaty, Bowo Adiyanto, Yuri Sadewo https://creativecommons.org/licenses/by-sa/4.0 2023-06-09 2023-06-09 9 1 10 17 10.22146/jka.v9i1.8499 MANAJEMEN INTENSIF PERIPARTUM PADA PASIEN COVID-19 https://jurnal.ugm.ac.id/v3/jka/article/view/8521 <p>COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Pregnant women in the third trimester and after delivery are at risk for severe COVID19. Intensive management of pregnant women with COVID-19 consists of a variety of steps. Key points of intensive management include fluid management, steroids, thromboprophylaxis, antibiotics, monoclonal antibodies, and ventilation management. Laboratory, radiological, and clinical examination monitoring should be carried out as needed. In pregnant women with severe COVID-19, there are critical targets that must be achieved. Patient management must be adjusted to achieve these targets. This case report discusses a 23-year-old woman who was 30 weeks pregnant who experienced severe COVID-19 and eventually died. There is much to be learned about the intensive management of pregnant women with COVID19 from this case.</p> Ratih Kumala Fajar Apsari Calcarina Fitriani Retno Wisudarti Adista Yugadhyaksa Gupta Negara Copyright (c) 2021 Ratih Kumala Fajar Apsari, Calcarina Fitriani Retno Wisudarti, Adista Yugadhyaksa Gupta Negara https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 18 34 10.22146/jka.v9i1.8521 Hubungan Thoracic Fluid Content Cardiometry dengan Lung Ultrasound Score untuk Menilai Lung Water pada Pasien Pascaoperasi Mayor di ICU https://jurnal.ugm.ac.id/v3/jka/article/view/8519 <p><strong>Background:</strong> Perioperative fluid management in patients undergoing major surgery is important. Excessive administration of fluid can cause atrial natriuretic peptide release and iatrogenic glycocalyx/vascular endothelial junction dysfunction which can cause intravascular fluid shifting to the extravascular space. This fluid shifting can occur in the pulmonary interstitial space. Lung Ultrasound Score (LUS) score and Thoracic Fluid Content (TFC) examination with ICON is considered suitable to assess Extravascular Lung Water (EVLW).</p> <p><strong>Objective:</strong> To determine the correlation between the LUS score with TFC using ICON in post-operative major patients in the ICU.</p> <p><strong>Methods</strong>: A prospective observational research design with a cross-sectional study design. The sample size was 30 adult post-major surgery patients who were treated in the ICU of Dr. Sardjito. The LUS score was obtained from an ultrasound examination of the lungs and TFC was assessed with the ICON device. LUS examination was performed at 3-4 and 7-8 intercostal space between the parasternal-mid clavicular line, and on the lateral side at the level of the mid-axillary line. Correlation analysis was conducted to determine the degree of correlation between LUS score and TFC.</p> <p><strong>Results:</strong> The sample of this study was 30 patients. Mean age 46.40±12.30 years, P/F ratio 411,21±77,64, AaDO2 121,20±53,4, LUS score 3.30±2.58, and TFC 24.56±10.30. Fluid balance during operation 194,2±756,65. The Spearman correlation test between LUS score and TFC showed a positive and significant correlation between LUS score and TFC, p&lt;0.001 and r=0.703. The Spearman correlation test for LUS score and P/F ratios, LUS score and AaDO2, LUS score and fluid balance in the operating room showed no significant relationship (p&gt;0.05).</p> <p><strong>Conclusions:</strong> The correlation between LUS score and TFC values in postmajor surgery patients treated in the ICU was statistically significant (p&lt;0.001) and the correlation was positive (r=0.703).</p> Gilar Rizki Aji Pradana Akhmad Yun Jufan Calcarina Fitriani Retno Wisudarti Copyright (c) 2021 Gilar Rizki Aji Pradana, Akhmad Yun Jufan, Calcarina Fitriani Retno Wisudarti https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 35 41 10.22146/jka.v9i1.8519 Hubungan Kadar Interleukin-6 terhadap Luaran Mortalitas dan Hari Rawat serta Hari Penggunaan Oksigenasi Tekanan Positif Pasien COVID-19 di RSUP Dr. Sardjito https://jurnal.ugm.ac.id/v3/jka/article/view/8518 <p><strong>Background:</strong> COVID-19 is a disease caused by the SARS-CoV-2 virus with the main clinical manifestations of respiratory disorders. Patients with severe and critical symptoms require oxygenation therapy during treatment. Interleukin-6 (IL-6) plays a role in the course of the disease and is associated with the clinical severity of COVID-19. IL-6 has the potential as one of the test parameters to estimate the outcome of COVID-19 patients.</p> <p><strong>Objective:</strong> To know the relationship between IL-6 levels and the outcome of mortality, length of stay (LOS) and positive pressure oxygenation days of COVID-19 patients during hospitalization at Dr. Sardjito hospital.</p> <p><strong>Methods:</strong> The study design was a retrospective observational cohort by taking secondary data from the medical records of hospitalized COVID-19 confirmed patients who were examined for serum IL-6 during April 2020- March 2021 at dr.Sardjito Hospital. Data collection was carried out at the Medical Records Instalation of Dr. Sardjito Hospital. The relationship of the IL-6 variable to the outcome was tested by logistic regression method and further analyzed with Kaplan-Meier and Cox regression analysis of survival.</p> <p><strong>Results:</strong> There were 302 research subjects with a mean age of 55.45 (+14.79) years, 183 male (60.6%) and 119 female (39.4%). Subjects with IL-6 &gt;80 pg/mL had a higher risk of death than those with IL-6 &lt;80 (p=0.000, HR=4.68). As many as 87.4% of the subject required oxygenation therapies during hospitalization. Group of subjects with an IL-6 value &gt;80 was significantly required more positive pressure oxygenation therapy (p=0.000) and require longer (p=0.005) duration of positive pressure oxygenation (9.36(+5,9) days) compared to the group of subjects with IL-6 &lt;80 (6(+2,98) days). The difference in LOS was significantly different between groups of subjects, with the median LOS for subjects with IL-6 &gt;80 was 25 days, while for subjects with IL-6 &lt;80 was 13 days (p= 0.000).</p> <p><strong>Conclusion:</strong> There was a significant relationship of IL-6 levels &gt;80 pg/mL with increased risk of &nbsp;mortality, LOS and the requirement of positive pressure oxygenation therapies in COVID-19 patients.</p> Kusuma Edhi Kuncoro Sudadi Djayanti Sari Calcarina Fitriani Retno Wisudarti Copyright (c) 2021 Kusuma Edhi Kuncoro, Sudadi, Djayanti Sari, Calcarina Fitriani Retno Wisudarti https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 42 49 10.22146/jka.v9i1.8518 Identifikasi Faktor Risiko Prediktif Prolonged Length of Stay (PLOS) di ICU RSUP Dr. Sardjito Yogyakarta https://jurnal.ugm.ac.id/v3/jka/article/view/8517 <p><strong>Background:</strong> One method to improve the service quality in the Intensive Care Unit (ICU) is to develop a risk prediction system to assess and analyze associated risk factors that cause the prolonged length of stay (PLOS) at the ICU. In Indonesia, there is no risk prediction system developed from the population of Indonesians themselves who have different disease characteristics and patterns from European countries that have developed risk prediction such as APACHE IV and SAPS II.</p> <p><strong>Objective:</strong> This study aims to identify the predictive factors of PLOS in ICU RSUP Dr. Sardjito. The long-term goal of this research is to develop a PLOS risk prediction model in the ICU based on the patient population treated at RSUP Dr. Sardjito.</p> <p><strong>Methods:</strong> A retrospective cohort study was conducted on 451 patients in the ICU RSUP Dr. Sardjito. Variables that are thought to have a relationship with PLOS were tested using bivariate and multivariable logistic regression tests. After that, an assessment of the power of discrimination and calibration of the new PLOS predictive risk scoring system was carried out using the Area Under the Curve (AUC) method. A calibration test with Hosmer-Lameshow was done to get a comparison value between the observed and expected PLOS.</p> <p><strong>Results:</strong> Factors identified as risk factors for PLOS in the ICU RSUP Dr.Sardjito were the medical cases, GCS value &lt;8, use of vasoactive or inotropic drugs, sepsis, respiratory failure, and renal failure in both univariate and multivariate tests. Factors that have passed the multivariable test were used as predictors of PLOS in the ICU and a discrimination test was performed with the AUC. The discriminatory ability of the PLOS predictive model was 0,878 (95% CI). This value is classified as strong as a predictor model. The calibration test with Hosmer-Lameshow obtained a p-value of 0.547 (p&gt;0.05) which means that this model was good.</p> <p><strong>Conclusion:</strong> The medical cases, GCS value &lt;8, use of vasoactive or inotropic drugs, sepsis, respiratory failure, and renal failure are predictive factors for PLOS in the ICU RSUP Dr. Sardjito. The discriminatory ability of these factors is strong and is able to predict the incidence of PLOS in the ICU RSUP Dr.Sardjito.</p> Rizqi Ahmad Fauzi Akhmad Yun Jufan Yunita Widyastuti Copyright (c) 2021 Rizqi Ahmad Fauzi, Akhmad Yun Jufan, Yunita Widyastuti https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 50 57 10.22146/jka.v9i1.8517 Hubungan Fungsi Absorbsi Gastrointestinal dengan Lama Rawat Inap dan Mortalitas pada Pasien Pascaoperasi Kraniotomi di ICU RSUP Dr. Sardjito Yogyakarta https://jurnal.ugm.ac.id/v3/jka/article/view/8516 <p><strong>Background:</strong> Nutrition is an important part of patient management in the intensive care unit. Nutritional factors need to be known, whether there is a relationship between nutrition and ICU outcome in post craniotomy patients in ICU.</p> <p><strong>Objective:</strong> The aim of this study is to know the relationship between gastrointestinal absorption function with the length of stay (LOS) and mortality in post-operative craniotomy patients in ICU RSUP Dr. Sardjito.</p> <p><strong>Methods:</strong> Prospective cohort observational study design with the number of the sample was 60 post craniotomy surgery patients older than 18 years old hospitalized in ICU RSUP Dr. Sardjito. The gastrointestinal absorption function was assessed from the parameters of blood sugar examination before and after the administration of enteral nutrition. The association of gastrointestinal absorption function related to the LOS and mortality in ICU RSUP Dr. Sardjito Yogyakarta was analyzed.</p> <p><strong>Results:</strong> There were 60 patients enrolled in this study. GCS values 13-15 were 45 patients (75%), GCS values 9-12 were 6 patients (10%), GCS values 3-8 were 9 patients (15%). The average LOS in the ICU was 3.4±5.13 days. The outcome was 58 patients (96.7%) survived and 2 patients (3.3%) died. The 2002 NRS average score was 3.2 ± 0.4, average APACHE II score was 6.53±4.7. There were 47 patients (78.3%) with good absorption and 13 patients (21.7%) with poor absorption. Vomiting occurred in 14 patients (23.35%), diarrhea 6 patients (10%), constipation 10 patients (16,7%). Spearman's correlation test showed a significant correlation of GCS and APACHE II score with LOS (p&lt;0.05). While age, gender, weight, height, and BMI were not significant (p&gt;0.05). A significant variable in multivariate analysis was the gastrointestinal absorption function(p&lt;0.05) with a regression coefficient of -9.3. Conclusion: There was a significant relationship between gastrointestinal absorption function with length of stay and mortality, If the gastrointestinal absorption function was good the length of stay and mortality were decreased in post craniotomy patients in the ICU RSUP DR. Sardjito. &gt; &lt;0.05) with a regression coefficient of -9.3.</p> <p><strong>Conclusion</strong>: There was a significant relationship between gastrointestinal absorption function with length of stay and mortality, If the gastrointestinal absorption function was good the length of stay and mortality were decreased in post craniotomy patients in the ICU RSUP DR. Sardjito.</p> Teguh Setiadi Untung Widodo Akhmad Yun Jufan Copyright (c) 2021 Teguh Setiadi, Untung Widodo, Akhmad Yun Jufan https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 58 65 10.22146/jka.v9i1.8516 Terapi Opioid pada Kasus COVID-19 https://jurnal.ugm.ac.id/v3/jka/article/view/8515 <p>One-third of COVID-19 patients experience a variety of neurological symptoms involving the central and peripheral nervous systems. These symptoms include headache, dizziness, loss of consciousness, impaired smell, neuralgia, and skeletal muscle damage. Myalgia is the most common symptom in cases of COVID-19. Therefore, adequate pain management is<br>needed, one of the choices is using opioids. Opioid receptor agonists are a group of drugs that stimulate opioid receptors and produce their effects by mimicking endogenous opioid peptides known as endorphins.</p> Akhmad Yun Jufan Juni Kurniawaty Baiq Dessy Resmana Dewi Copyright (c) 2023 Akhmad Yun Jufan, Juni Kurniawaty, Baiq Dessy Resmana Dewi https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 66 76 10.22146/jka.v9i1.8515 Konsiderasi Anestesi pada Pasien Seksio Sesarea dengan COVID-19 https://jurnal.ugm.ac.id/v3/jka/article/view/8522 <p>COVID-19 infection in pregnant patients can lead to premature labor. The most common method of delivery is by caesarean section. There are many aspects that must be considered in carrying out anesthesia for COVID-19 patients, including physiological changes that occur due to pregnancy and the effects of COVID-19 infection which can aggravate the condition of pregnant patients. Maintaining adequate oxygenation in the blood, choosing the right anesthetic agent, considering its effect on the fetus, and mechanical ventilation management related to ARDS caused by COVID-19 infection are the main things that should be of concern in anesthesia management</p> Calcarina Fitriani Retno Wisudarti Akhmad Yun Jufan Christiana Trijayanti Copyright (c) 2021 Calcarina Fitriani Retno Wisudarti, Akhmad Yun Jufan, Christiana Trijayanti https://creativecommons.org/licenses/by-sa/4.0 2023-06-10 2023-06-10 9 1 77 83 10.22146/jka.v9i1.8522