Jurnal Komplikasi Anestesi

Efikasi Profilaksis Granisetron 40 mcg/kgBB Dibandingkan Ondansetron 8 mg dan Meperidine 0,4 mg/kgBB dalam Mencegah Shivering Paska Anestesi Spinal di RSUP Dr. Sardjito

Metia Gledis Gilang Gentong, Juni Kurniawaty, Sudadi Sudadi — Fri, 02 Aug 2024 00:00:00 +0700

Background. Spinal anesthesia induced hypothermia resulting in shivering and inducing adverse complications for the patient. Meperidine effectively prevent the incidence of shivering but has many side effects. Granisetron and ondasetron are known to prevent shivering with minimal side effects when working in thermoregulation.

Aim. Efficacy of granisetron compared to ondansetron and meperidine in preventing shivering after spinal anesthesia.

Method. The study was a double-blind randomized clinical trial of 97 male/female subjects, aged 18-65 years, physical status ASA I and II with emergency or elective surgery in RSUP Dr. Sardjito Yogyakarta. Subjects divided into three groups: Granisetron 40 mcg/kgbw (group G), Ondansetron 8 mg (Group O) and Meperidine 0.4 mg/kgbw (group M).

Results. We found shivering in Group G showed 10 subjects (31.3%), group O showed 15 subjects (45.5%) and group M showed 10 subjects (31.3%) (p=0.386). Group G decreased the severity of shivering because grade 3 and 4 did not occur at 60 minutes, better than group O, which showed 5 subjects (15.2%) experiencing grade 3 and 1 subject (5%) experiencing grade 4. (p=0.044).

Conclusion. Prophylactic granisetron 40 mcg/kgbw before spinal anesthesia reduces the severity of shivering compared to ondansetron 8 mg. Prophylactic granisetron 40 mcg/kgbw and ondansetron 8 mg reduced the incidence of shivering same as meperidine 0.4 mg/kgbw.

Keywords. Shivering, Spinal Anesthesia, Granisetron, Ondansetron, Meperidine.

Bronkoskopi pada Pasien Kritis dengan Atelektasis di ICU

Nurfitriani, Syamsul H Salam — Tue, 03 Sep 2024 00:00:00 +0700

Bronchoscopy in critical ill patients in ICU is a procedure may carry higher risk considering that patients are often in unstable hemodynamic and hypoxemia which may increase morbidity rates, so the decision for bronchoscopy must be deeply considered with risks and benefits. We report a female patient admitted to the ICU with loss consciousness and acute respiratory failure. Patients with previous history of myasthenia gravis that reduce her ability to cough. From the physical and radiologic examination, we found signs of lower airway obstruction. The patient underwent bronchoscopy. We found mucus plugs obstructing both the upper and lower lobe of the left bronchus. During the procedure the patient is sedated. Mucus plugs were aspirated and microbiological culture were performed. The patient's condition was stable and clinical improvement was obtained.

Manajemen Anestesi pada Pasien Patent Ductus Arteriosus dengan Hipertensi Pulmonal Berat dan Regurgitasi Trikuspid Berat

Tomi Sugiarto, Iwan Abdul Rachman — Tue, 03 Sep 2024 00:00:00 +0700

Patent ductus arteriosus (PDA) merupakan penyakit jantung bawaan asianotik yang didefinisikan sebagai persistensi dari pintasan janin antara arteri pulmonalis dan aorta, menyebabkan terjadinya oversirkulasi pulmoner dan hipoperfusi sistemik. Pasien PDA yang menjalani operasi nonkardiak memiliki resiko morbiditas dan mortalitas yang tinggi. Kondisi diperberat dengan adanya hipertensi pulmonal yang diketahui memberi kontribusi kasus henti jantung perioperatif, dan regurgitasi tricuspid menimbulkan overload volume ventrikel kanan dan meningkatkan resiko gagal jantung kanan.

Dilaporkan satu kasus multiple karies dengan PDA disertai hipertensi pulmonal berat dan regurgitasi tricuspid berat pada anak usia 6 tahun yang akan menjalani operasi mouth preparation. Pasien datang dengan keluhan gigi berlubang sejak 1 tahun, disertai dengan sesak nafas dan batuk. Pemeriksaan fisik menunjukkan adanya peningkatan denyut nadi dan laju nafas disertai dengan penurunan saturasi oksigen perifer, bunyi jantung tambahan dan clubbing finger disertai akral cyanosis. Foto rontgent thoraks menunjukkan kesan kardiomegali disertai bronkopneumonia bilateral dd/ edema paru perbaikan, efusi pleura kiri perbaikan. Hasil echokardiografi didapatkan PDA 7-8 mm bidirectional shunt, RV dan RA dilatasi dengan TR severe, dengan EF 52,6%. Pasien dikategorikan status ASA III. Pasien diberikan premedikasi intravena dengan midazolam 0,5 mg, dilakukan anestesi umum, preoksigenasi dengan oksigen 100%, diinduksi secara intravena dengan fentanyl 35 mcg dan midazolam 3 mg, dan diberikan pelumpuh otot atracurium 6 mg. Pasien diintubasi dengan menggunakan endotracheal tube no. 5,0. Saat operasi diberikan rumatan anestesi dengan sevoflurance 2-3vol% dalam O2:udara. Paska operasi pasien dipindahkan ke ruang semiintensif dengan oksigenasi nasal kanul dan diberikan analgetik berupa paracetamol 240mg/6 jam secara intravena dan ketoprofen supositoria 25mg.

Operasi dengan kondisi PDA, hipertensi pulmonal berat dan perlu dipastikan agar tercapai keseimbangan aliran darah, sehingga tidak terjadi peningkatan aliran darah pulmonal yang dapat menyebabkan desaturasi dan penurunan perfusi oksigen ke jaringan. Ventilasi perlu diberikan secara cukup; tidak hipoventilasi yang memicu peningkatan PVR, dan tidak berlebihan agar menghindari overdistensi alveolar yang dapat berakibat meningkatkan tekanan arterial paru. Anestesi umum menjadi pilihan agar tercapai kontrol ketat oksigenasi dan ventilasi.

Management of Anesthesia in Patients with Adrenal Tumor Accompanied by Cushing's Syndrome

Roufisma Abdi Pratama, Ruli Herman — Thu, 08 Aug 2024 00:00:00 +0700

Tumor kelenjar adrenal dengan prevalensi sekitar 532/100.000 yang merupakan neoplasma jinak yang berasal dari korteks adrenal. Kondisi ini meningkatkan produksi kortikosteroid dan aldosteron yang mengakibatkan komplikasi seperti hipertensi, hiperglikemi, hingga cushing sindrom. Seorang perempuan 29 tahun dengan keluhan wajah bengkak, rambut rontok, perut membesar, dan mudah memar pada ekstremitas, dikonsultasikan untuk tindakan adrenalektomi. Pada pasien dilakukan tindakan anestesi umum. Intra-operatif pasien didapatkan hemodinamik stabil. Pasca operasi pasien dirawat di ruangan ICU. Kontrol perioperatif hipertensi, hiperglikemi, hipokalemi, dan kortisol sebagai akibat dari reseksi adrenal menjadi peran anestesiologis pada pasien dengan tumor kelenjar adrenal yang disertai dengan cushing sindrom.

Penggunaan Magnesium Sulfat pada Pasien dengan Asma Persisten Sedang Menjalani Operasi Elektif Tiroidektomi Total

Ni Putu Ade Tiwi Tyastarini, Aries Perdana — Wed, 14 Aug 2024 00:00:00 +0700

Case: Female, 45 years old, with a history of moderate persistent asthma, type 2 diabetes mellitus, and bilateral struma multiple nodusa nontoxic (SMNT), planned to undergo a total thyroidectomy procedure. During the pre-anesthesia visit, it was found that the patient's condition

was in acute exacerbation, then the night before the surgical procedure, the patient was given 2.5 mg salbutamol and Budesonide 5 mg inhalation. Magnesium sulfate (MgSO4) 25 mg/kg/kg intraveously in normal saline solution 100ml drip in 10 minutes, and continued with the administration of MgSO4 5 mg/kg/hour drip intravenously intra-operative. Post-operative, deep extubation was performed on the patient and monitored in the ICU for <24 hours, and continued in ward until allowed outpatient discharge on the second postoperative day.

Discussion: In elective surgery particularly in the airway area, the risk of bronchospasm increases and optimal perioperative management is required as well as in patients with comorbid asthma. The administration of magnesium sulfate has several advantages in this case, in terms of the bronchodilation effect produced, as an adjuvant analgesia and also hypomagnesemia therapy related to diabetes mellitus. In conclusion, MgSO4 can be used as an alternative in the anesthetic modality of patients with a history of moderate persistent asthma who will undergo surgery.

Penatalaksanaan Konservatif Pasien Cidera Kepala Traumatik dengan Perdarahan Intrakranial Di Rumah Sakit dengan Fasilitas Terbatas

Joshua Roberto Pratama, Ronggo Baskoro — Tue, 03 Sep 2024 00:00:00 +0700

Kasus : Pasien seorang pria usia 62 tahun dibawa ke IGD setelah terjatuh dari ketinggian 10 meter. Pada pemeriksaan fisik didapatkan tingkat kesadaran pasien dengan GCS adalah Eye

(E) 1, Verbal (V) 1, Motoric (M) 2 dan tekanan darah 80/50 mmHg tanpa ditemukan lateralisasi pada pemeriksaan fisik. Pasien kemudian dilakukan intubasi dan dirawat di ICU. Pemeriksaan CT-Scan kepala ditemukan beberapa titik perdarahan intrakranial dengan volume perdarahan terbesar berada pada kornu anterior ventrikel lateral dekstra. Terapi : Pasien diberikan terapi drip Norepinefrin 0.01 meq dan drip Dopamine 5 meq dengan target MAP >65mmHg selain itu pasien juga diberikan terapi Asam Traneksamat 500 mg / 8 jam, Deksametason 10 mg / 8 jam, Mannitol 500 cc / 8 jam, Citicholine 500 mg / 12 jam dan dengan pengaturan ventilator SIMV TV 400 cc, RR 16, FIO2 50%, PEEP 5, Inspirasi : Ekspirasi 1:2. Hasil : Pasien mengalami perbaikan selama rawatan. Pasien di ekstubasi dan keluar rawatan ICU setelah 2 hari dengan peningkatan kesadaran GCS E4,V5,M6 dan hemiparese ekstrimitas kiri.

Manajemen Anestesi pada Pasien Anak yang Menjalani Operasi Coloboma dengan Penyakit Jantung Bawaan Asianotik

Thu, 22 Aug 2024 00:00:00 +0700

Anesthesia for pediatric patients with acyanotic congenital heart disease demands a specialized approach due to complex cardiac anatomy and physiology interactions and the risk of perioperative hemodynamic instability. A two-month-old, five-kilogram child presented with a congenital heart disorder and a left eyelid anomaly since birth. Physical examination revealed superior palpebral coloboma with symblepharon and exposure keratitis. Scheduled for surgical repair, the preoperative assessment included anemia and thrombocytosis. Anesthesia management involved fasting, fluid calculation, and premedication with atropine sulfate 0.1 mg and intravenous analgesic fentanyl 15 mcg (2-3 mcg/kgBW). Intubation proceeded with atracurium, and maintenance included sevoflurane and fentanyl. Monitoring ensured proper EtCO2 and oxygen saturation levels. The one-hour surgery addressed the eyelid issue, followed by post-operative analgesia. The patient was monitored for three days post-op and discharged on the fourth day. Previous studies showed that children with congenital heart disease undergoing noncardiac surgery face increased perioperative risks, influenced by factors such as general condition and disease status, so clinical outcomes during surgery are greatly influenced by anesthesia management that adapts to these factors. Pediatric patients with congenital heart disease can safely undergo general anesthesia for noncardiac surgeries by requiring comprehensive preoperative preparation and careful intraoperative monitoring.

Continous Renal Replacement Therapy pada Pasien Sepsis, Respiratory Failure, Acute Kidney Injury, dan Asidosis Metabolik

Dendi Septian, Ezra Oktaliansah — Fri, 23 Aug 2024 00:00:00 +0700

Sepsis is a life-threatening organ dysfunction resulting from dysregulation of the body's response to infection. The hypermetabolic response results in an imbalance between oxygen supply to tissues while oxygen demand in peripheral organs increases. Acute Kidney Injury (AKI) is one of the most common and severe complications of sepsis, and is associated with high mortality and poor outcomes. If pharmacological therapy has been given but there is no clinical improvement, Continuous Renal Replacement Therapy (CRRT) with Continuous Venovenous Hemodiafiltration (CVVHDF) modality can be considered.

A 31-year-old male patient came with complaints of shortness of breath, the patient was diagnosed with septic shock accompanied by acute kidney injury and chronic kidney disease. The patient's condition worsened with unstable hemodynamics. CRRT is performed as an option for AKI management in critically ill patients with unstable hemodynamics. There was improvement in renal function, acidosis, and hemodynamics in patients.

Renal Replacement Therapy (RRT) is an option for treating AKI in critically ill patients with unstable hemodynamics. CRRT plays an important role in treating septic shock patients with AKI in the intensive care unit.

Epidural Anesthesia Management for Unilateral Salpingo-Oophorectomy in Patients with Ovarian Mass : A Case Report

Alesandro Ksatriaputra, Taufik Saputra, Dina Paramita — Sat, 24 Aug 2024 00:00:00 +0700

with sedation and mainly used in elderly patients or those with medical problems, including those who had ovarian mass. Epidural administration of amide local anesthetics in combination with opioids is widely used for pain relief because of the dose minimizing and side effects reducing benefits.

Case: Patient was diagnosed with ovarian mass. The patient also had pleural effusion, ascites, and hypoalbuminemia. Epidural anesthesia used in this patient as a resource for perioperative and postoperative pain management.

Discussion: Patient underwent unilateral salpingo-oophorectomy for her ovarian mass. Anesthetic doses were given carefully due to patient conditions with pleural effusion and ascites. Opioid and Neuromuscular Blocking Agents (NMBAs) effects were absolutely decreased due to hypoalbuminemia, but were overcome with Naloxone and Sugammadex. Epidural anesthesia used to stabilize the drugs and pain management for this patient.

Conclusion: Epidural anesthesia is an excellent choice for unilateral salpingo-oophorectomy in patients with ovarian mass. It has been proven to provide excellent pain control after major surgeries and may be associated with a lower incidence of postoperative complications.

Perioperatif Morbid Obese dengan OHS yang Menjalani Laparoskopi Bariatrik

Dya Restu Saputra, Erlangga Prasamya, Pinter Hartono — Fri, 30 Aug 2024 00:00:00 +0700

Introduction: Laparoscopy, a minimally invasive surgical procedure that uses CO2 gas to create space between the abdominal wall and internal organs for endoscopic access. The main challenges include cardiopulmonary effects from pneumoperitoneum, systemic absorption of CO2, gas embolism, and injuries to intra-abdominal structures. General anesthesia is often the preferred choice, especially in high-risk cases like obesity, to avoid complications like reflux and aspiration. The author intends to discuss with the aim of understanding physiological changes, complications, and specific management strategies for laparoscopic bariatric surgery.

Case Description: A 30-year-old woman with significant weight gain underwent treatment for obesity but made no progress. She was referred for surgery and underwent a specific procedure called sleeve gastrectomy on October 5, 2022. Medical history included controlled hypertension and diabetes, and emerging symptoms were uncontrolled appetite, fatigue, and shortness of breath. The operation was performed under general anesthesia, and her care included detailed monitoring and prevention of complications. This case highlights a comprehensive approach to treating morbid obesity.

Discussion: Obesity is often associated with hypertension and changes in heart response. In the context of bariatric laparoscopy, physiological changes associated with pneumoperitoneum and patient positioning may cause cardiorespiratory compromise, especially in obese patients who already have pre-existing cardiopulmonary dysfunction. The balanced general anesthesia technique with mechanical ventilation is considered the best for minimally invasive surgery requiring CO2 insufflation. A multimodal approach in analgesia and antiemetic prophylaxis is needed to reduce postoperative side effects, and early diagnosis of complications.

Conclusion: Minimally invasive surgery, such as bariatric laparoscopy, aids in pain reduction and faster recovery, especially important for patients with obesity. The balanced general anesthesia technique with mechanical ventilation is considered optimal for this procedure. Proper monitoring and maintenance after surgery are key to preventing postoperative complications and side effects.