Made Wiryana
Bagian Pendidikan Kedokteran dan Bagian/SMF Anestesi dan Terapi Intensif Fakultas Kedokteran Universitas Udayana/Rumah Sakit Umum Pusat Sanglah Denpasar Bali

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OSMOLALITAS PLASMA SEBAGAI ALTERNATIF ACUTE PHYSIOLOGIC AND CHRONIC HEALTH EVALUATION II UNTUK MEMPREDIKSI MORTALITAS PADA PASIEN KRITIS YANG DIRAWAT DI INTENSIVE CARE UNIT RSUP SANGLAH Wardani, Ni Putu; Wiryana, Made; Suarjaya, Putu Pramana
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

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Abstract

Prediksi mortalitas bersifat esensial pada manajemen perawatan intensif. Acute Physiologic and Chronic Health Evaluation II merupakan sistem skor kompleks yang umum digunakan di Intensive Care Unit (ICU), sedangkan osmolalitas plasma merupakan salah satu sistem skor parameter tunggal yang diketahui dapat menjadi alternatif prediktor mortalitas di ICU. Tujuan penelitian untuk mengetahui besar nilai area undercurve (AUC), sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif dari kedua prediktor dan mengetahui adanya perbedaan bermakna dari nilai AUC kedua prediktor tersebut. Penelitian merupakan uji diagnostik metode cross sectional yang melibatkan 134 subjek. Uji diagnostik menggunakan kurva ROC dan tabel 2x2. Perhitungan data didapatkan nilai AUC osmolalitas plasma sebesar 75,9% (IK95% 67,7 sampai 84,3%), dengan cut off point 297 mOsm/kg, sensitifitas 70,0%, spesifisitas 79,7%. Tabel 2x2 menghasilkan NDP sebesar 79,0% (IK95% 66,8 sampai 88,3%), NDN 70,8% (IK95% 58,9 sampai 81%). Nilai AUC APACHE II sebesar 83,4% (IK95% 76,5 sampai 90,3%) dengan cut off point sebesar 24, sensitifitas 72,9%, spesifisitas 81,3%. Tabel 2x2 menghasilkan NDP 81,0% (IK95% 69,1 sampai 89,8%), NDN 73,2% (IK95% 61,4 sampai 83,1%). Analisis ROC didapatkan nilai P=0,19. Nilai AUC osmolalitas plasma tergolong level sedang (>70-80%), APACHE II tergolong level baik (>80-90%). Analisis ROC dengan P>0,05 menyatakan tidak terdapat perbedaan bermakna antara kurva ROC kedua prediktor. Sekalipun osmolalitas plasma memiliki nilai diagnostik sedang, dibandingkan APACHE II dengan nilai diagnostik baik tetapi perbedaan nilai tersebut tidak bermakna sehingga osmolalitas plasma dapat digunakan sebagai alternatif APACHE II untuk prediktor mortalitas di ICU. Prediction of in-hospital mortality is essential for management of intensive care. Complex scoring system commonly used is APACHE II, meanwhile plasma osmolality is a single parameter scoring system that has known to be an alternative for mortality predictors in the Intensive Care Unit (ICU). The objective of this study was to determine the area undercurve (AUC) value, sensitivity, specificity, positive predictive value, negative predictive value for both predictors and to determine significant differences in AUC values in both scoring system. This was a diagnostic test with cross-sectional method that included 134 subjects. Diagnostic test using ROC curves and 2x2 tables. Result of plasma osmolality with AUC 75.9% (95%CI 67.7 to 84.3%). Cut off point was 297 mOsm/kg, sensitivity was 70.0%, and specificity was 79.7%. Two point two table with PPV 79.0% (95%CI 66.8 to 88.3%) and NPV 70.8% (95%CI 58.9 to 81%). The AUC for APACHE II was 83.4% (95%CI: 76.5 to 90.3%). Cut off point was 24, sensitivity was 72.9%, and specificity was 81.3%. Two point two table with PPV 81.0% (95%CI 69.1 to 89.8%) and NPV 73.2% (95%CI 61.4 to 83.1%). ROC analysis with P value=0.19. AUC values of plasma osmolality was at moderate level (>70 to 80%), APACHE II at good level (>80 to 90%). ROC analysis with P>0.05 states there was no significant difference between the ROC curves in both predictors. Although plasma osmolality has moderate diagnostic value, compared with APACHE II, with a good diagnostic value but the value differences was unsignificant thus plasma osmolality can be used as an alternative of APACHE II for mortality predictors in critically ill patients in the ICU.
The role of endothelial glycocalyx in sepsis Hartawan, I Nyoman Budi; Wiryana, Made
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

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ABSTRACTThe surface of endothelial cells is filled with various membrane-bound molecules that form the glycocalyx. The endothelial glycocalyx is a surface layer mainly consisted of glycosaminoglycans that include heparan sulfate, chondroitin sulfate, and hyaluronic acid and its core proteins. Previous studies suggest that endothelial surface glycocalyx shedding could play a role in endothelial dysfunction and inflammation. This article will review the endothelial glycocalyx and its role in sepsis. 
COST MINIMIZATION ANALYSIS OF HYPNOTIC DRUG: TARGET CONTROLLED INHALATION ANESTHESIA (TCIA) SEVOFLURANE AND TARGET CONTROLLED INFUSION (TCI) PROPOFOL Wiryana, Made; Aribawa, I Gusti Ngurah Mahaalit; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Hartawan, I Gusti Agung Gede Utara; Sucandra, Made Agus Kresna; Parami, Pontisomaya; Putra, Kadek Agus Heryana; Sutawan, IB Krisna Jaya; Arimbawa, IGNA Putra; Jaya, Ketut Semara; Semarawima, Gede
BALI MEDICAL JOURNAL Vol 5 No 3 (2016)
Publisher : BALI MEDICAL JOURNAL

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Background: Cost minimization analysis is a pharmaco-economic study used to compare two or more health interventions that have been shown to have the same effect, similar or equivalent. With limited health insurance budget from the Indonesian National Social Security System implementation in 2015, the quality control and the drug cost are two important things that need to be focused. The application of pharmaco-economic study results in the selection and use of drugs more effectively and efficiently. Objective: To determine cost minimization analysis of hypnotic drug between a target controlled inhalation anesthesia (TCIA) sevoflurane and a target controlled infusion (TCI) propofol in patients underwent a major oncologic surgery in Sanglah General Hospital. Methods: Sixty ASA physical status I-II patients underwent major oncologic surgery were divided into two groups. Group A was using TCIA sevoflurane and group B using TCI propofol. Bispectral index monitor (BIS index) was used to evaluate the depth of anesthesia. The statistical tests used are the Shapiro-Wilk test, Lavene test, Mann- Whitney U test and unpaired t-test (? = 0.05). The data analysis used the Statistical Package for Social Sciences (SPSS) for Windows. Results: In this study, the rate of drug used per unit time in group A was 0.12 ml sevoflurane per minute (± 0.03) and the group B was 7.25 mg propofol per minute (±0.98). Total cost of hypnotic drug in group A was IDR598.43 (IQR 112.47) per minute, in group B was IDR703.27 (IQR 156.73) per minute (p>0.05). Conclusions: There was no statistically significant difference from the analysis of the drug cost minimization hypnotic drug in a major oncologic surgery using TCIA sevoflurane and TCI propofol.
THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 1 Januari 2010
Publisher : Udayana University

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Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
VENTILATOR ASSOCIATED PNEUMONIA Wiryana, Made
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia that occurred 48 hours afterthe patient had a mechanical ventilation support either from endotracheal tube or tracheostomy tube. VAPussually charactherized by 3 component sign of systemic infection: fever, tachycardia and leukocytosisfollowed by new infiltrate sign or a worsening scheme on the chest x ray and bacteriologic findings of thecausal of lung infection, but acctually we can diagnosed a VAP based on the findings of a number ofcriteria: histopathologic examination of the lung tissue from an open biopsy, a fast cavity formation of alung infiltrate without any sign of tuberculosis or malignancy and a positive pleural fluid culture, in whichthe species that found on the blood culture and airway were the same.The insidens of VAP are high, according to the foreign literature approximately between 9 ? 27 % from allIntensive Care Unit population. This condition made VAP as the first causal of a nosocomial infection inthe Intensive Care Unit. The mortality rate of VAP is also high, Chastre and Fagon stated that the crudemortality rate can reach of 76%. Early onset VAP which occurred on the first 4th day after admission in theIntensive Care Unit ussually had a better prognosis because of caused by a still antibiotic sensitivepathogens. The Late onset VAP which occurred after 5 days or more after hospitalization, has worseprognosis because of caused by a multidrug resistance (MDR) pathogens. In order to define the pathogensthat caused VAP, some scientist made a classification of VAP patient based on the degree of disease, riskfactor and the onset, which is the group I with mild-moderate degree, common risk factor and the onset isanytime during hospitalization or a severe degree with an early onset, ussually caused by a gram negativebacteria. The group II, patient with a mild-moderate degree, specific risk factor that happened anytimeduring hospitalization, ussually caused by all bacteria in the group I added with an anaerob bacteria. Thegroup III, patient with a severe degree, early onset with specific risk factor or a late onset, ussually caused by Pseudomonas aeruginosa, Acinetobacter sp and MRSA. Other approach is by classifying the bacteriacausing VAP in a primary endogen, secondary and eksogen type.Prevention of VAP can be done by 2 different ways, first by a non pharmachologic way, routine andstandard things that ussually done in the ICU, but this action still could not enough in lowering the insidensof VAP. Second, by a pharmachologic way, Selective Decontamination of the Digestive Tract (SSD) andOropharyngeal Decontamitation (OD). SSD is proven effective empirically in preventing VAP but the usedof antimicrobial can caused a higher risk on resistention. SDD is not recommended as a routine action inpreventing VAP so that OD with the used of antiseptic is preferred as another alternative.
PERBANDINGAN DOSIS INDUKSI DAN PEMELIHARAAN PROPOFOL PADA OPERASI ONKOLOGI MAYOR YANG MENDAPATKAN PEMEDIKASI GABAPENTIN DAN TANPA GABAPENTIN Okta, Ida Bagus; Subagiartha, I Made; Wiryana, Made
JAI (Jurnal Anestesiologi Indonesia) Vol 9, No 3 (2017): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (348.671 KB) | DOI: 10.14710/jai.v9i3.19837

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Latar Belakang : Anestesi umum merupakan teknik anestesi yang paling sering dikerjakan dibandingkan dengan teknik anestesi lain. Total Intravena Anestesi menggunakan propofol telah dikembangkan secara luas, karena menurunnya angka insiden PONV, biaya anestesi yang lebih murah, dan waktu pulih yang cepat. Berbagai teknik, alat dan obat-obatan diteliti untuk mengurangi dosis propofol yang diperlukan durasi operasi karena efek samping propofol yang berbahaya, yang dikenal PRIS (Propofol Related Infusion Syndrome), yang dapat menyebabkan morbiditas dan mortalitas yang tinggi.   Tujuan : Untuk membandingkan dosis induksi dan pemeliharaan propofol yang diperlukan intraoperatif antara kelompok gabapentin dan kelompok kontrol. Selanjutnya hasil penelitian dapat digunakan secara umum dalam penggunaan gabapentin sebagai obat akut pada periode perioperatif.Metode : Penelitian ini adalah double blind clinical trial. Teknik penelitian ini dapat mengkontrol ekspektasi dan  manipulasi subjek penelitian terhadap prosedur penelitian sehingga dapat menghasilkan hasil yang valid dan terpercaya. Penelitian dibagi menjadi dua kelompok, kelompok gabapentin dan kelompok kontrol. 32 sampel tiap kelompok telah menjalani operasi onkologi mayor dengan teknik anestesi yang sama total intravena propofol dengan TCI. Hasil : Dosis induksi kelompok gabapentin memiliki 1,15 mg/kgbb dibandingkan dengan kelompok kontrol yang memiliki median 1,48 mg/kgbb (p < 0,001). Dosis pemeliharaan kelompok gabapentin memiliki median 93,27 mcg/kgbb/menit dibandingkan kelompok kontrol yang memiliki median 123,80 mcg/kgbb/menit (p < 0,001).Simpulan : Premedikasi oral gabapentin 600 mg efektif menurunkan dosis induksi dan pemeliharaan propofol yang digunakan pada teknik TIVA untuk menjaga operasi mayor onkologi. Selanjutnya premedikasi gabapentin dapat digeneralisir penggunaannya pada operasi lain untuk menurunkan kebutuhan propofol intraoperatif.
Efektivitas Magnesium Sulfat 30 mg/kgBB Intravena Dibanding dengan Fentanil 2 mcg/kgBB Intravena dalam Menekan Respons Kardiovaskular pada Tindakan Laringoskopi dan Intubasi Yehezkiel, -; Wiryana, Made; Sujana, Ida Bagus Gde; Sidemen, I Gusti Putu Sukrana
Jurnal Anestesi Perioperatif Vol 3, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Laringoskopi dan intubasi merupakan tindakan rutin yang berisiko menyebabkan respons kardiovaskular berupa peningkatan tekanan darah dan laju denyut jantung terutama pada pasien risiko tinggi seperti kelainan jantung. Penelitian ini bertujuan mengetahui efektivitas MgSO4 30 mg/kgBB intravena dibanding dengan fentanil 2 mcg/kgBB  intravena dalam menekan respons kardiovaskular pada  tindakan laringoskopi dan intubasi sehingga dapat menjadi obat altenatif. Penelitian ini dilakukan secara uji klinis  acak terkontrol tersamar ganda terhadap 42 pasien dengan status fisik American Society of Anesthesiologist (ASA) I–II yang dilakukan operasi dengan anestesi umum intubasi trakea di RSUP Sanglah Denpasar Bali pada Agustus–September 2014. Subjek dibagi menjadi dua kelompok, MgSO4 30 mg/kgBB (n=21) dan fentanil 2 mcg/kgBB (n=21) secara acak. Perubahan tekanan darah dan laju denyut jantung yang terjadi sebelum dan setelah tindakan dicatat sebagai data penelitian. Data penelitian dianalisis dengan uji repeated ANOVA, dengan p&lt;0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak terdapat perbedaan bermakna antara kedua kelompok perlakuan. Simpulan, pemberian MgSO4 30 mg/kgBB sama efektif dengan fentanil 2 mcg/kgBB dalam menekan respons kardiovaskular pada tindakan laringoskopi dan intubasi.Kata kunci: Fentanil, intubasi, laringoskopi, magnesium sulfat, respons kardiovaskularComparison of Intravena Magnesium Sulfate 30 mg/kgBW and Intravena Fentanil 2 mcg/kgBW  Effectiveness for Attenuating Cardiovascular Response in Laryngoscopy and Tracheal IntubationLaryngoscopy and intubation are routine actions which cause the risk of cardiovascular responses, including increased blood pressure and heart rate, especially in high-risk patients such as patients with heart disorders. The aim of this study was to determine the effectiveness of intravenous MgSO4 30 mg/kgBW compared to that of intravenous fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation to assess its possibility as an alternative drug. This study was a clinical trial with randomized double-blind controlled to 42 patients with physical status of the American Society of Anesthesiologists (ASA) I–II who underwent tracheal intubation under general anesthesia in Sanglah Denpasar Hospital Bali in the period of  August–September 2014. Subjects were divided into two groups, MgSO4 30 mg/kgBW (n=21) and fentanyl 2 mcg/kgBW (n=21) groups. Changes in blood pressure and heart rate that occured before and after the action were recorded as research data. Data were analyzed with repeated ANOVA test, with p&lt;0.05 considered significant. Statistical analysis showed that there was no significant difference between the two treatment groups. it is concluded that the administration of MgSO4 30 mg/kgBW is as effective as fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation.Key words: Cardiovascular response, fentanyl, intubation, laryngoscopy, magnesium sulfate DOI: 10.15851/jap.v3n2.574
NUTRISI PADA PENDERITA SAKIT KRITIS Wiryana, Made
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Malnutrition is always been being associated with the increase of morbidity and mortality rate due to lack of immunesystem, depending on ventilator, high rate of infection, and delayed healing process, so it will increase the cost and length of stayof the patients. Clinician need to have right information about how to manage nutrition for critical ill patient because it willinfluence the outcome of ICU patient.Objective measurement nutritional status of the patient is difficult because process of illnesses itself will disturb themethod that will be used in the population. Nutritional status is multidimension phenomenon that need several methods formeasurement, including associated factors of nutrition, nutrition intake, and energy expenditure.Nitrogen balance can be used to determine effectiveness of nutritional therapy. Nitrogen balance can be counted by formulathat count nitrogen in 24 hours from patch urine, especially urine urea nitrogen (UUN), minus nitrogen intake from the food.Resting Energy Expenditure (REE) must be determined for nutritional therapy in critical ill patients. Acuracy estimation REE willhelp to reduce complications due to overfeeding, such as infiltration fat to liver and pulmonyary compromise. Several methods areavailable to predict REE such as Calorimetry, and Harris-Benedict equation.The goal in nutritional therapy in critical ill patient is to support metabolic, not to complete their need in that time. Becausein critical ill patient there is no metabolic condition is able to metabolize total amount of calories to fulfill lack of energy expenses.Ideally the route of nutritional therapy is able to supply nutrition with minimal morbidity. Each routes (parenteral andenteral) have advantages and disadvantages, and the choice is depend on patient condition. In critical ill patient care, enteralnutrition is always being the first choice and parenteral nutrition become the next alternative.
Efficacy of Subcutaneous Morphine Patient Controlled Analgesia Compared to Intravenous Morphine Patient Controlled Analgesia on Cesarean Section Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gde; Aribawa, I Gusti Ngurah Mahaalit; Nainggolan, Elisma
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.v1i3.27

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Background: Cesarean section causes moderate to severe pain in the first 48 hours postoperatively, thus requiring an adequate perioperative pain management, not only so that the mother can be quickly discharged but also to perform daily activities after surgery such as breastfeeding and nurse the baby.Objective: To determine the efficacy of subcutaneous morphine patient controlled analgesia (SC-PCA) in lowering VAS (visual analogue score), total morphine consumption and postoperative side effect on cesarean section compared with intravenous morphine patient controlled analgesia (IV- PCA).Methods: This study is an experimental clinical trial using consecutive sampling technique. Sixty-four subjects were allocated into two groups of PCA morphine subcutaneously (SC-PCA) and the group PCA morphine intravenously (IV-PCA), each consisting of 32 subjects using permuted block randomization. Morphine concentration was 5 mg/ml (group SC-PCA) or the concentration of 1mg/ml (group IV-PCA). Both groups were then analyzed for VAS ratings, total morphine consumption, and adverse effects, post operatively at 4th, 8th, and 24th hour. Statistic analysis using repeated ANOVA test and t-test with p &lt;0.05 onsidered significant.Result: Morphine consumption in IV-PCA group showed lower needs than SC-PCA (9.41 mg vs 4,9mg) p &lt;0.001 24 at 24 hours postoperatively. The VAS at resting at 4th hours statistically significantly lower in IV-PCA group (1.06 ± 0.71 vs 0.81 ± 1.40, p=0.029) and at 8th hours (1.03 ± 0.59 vs 0.94 ± 0,9, p=0.048). The moving VAS at 4th hours statistically significant lower in IV-PCA group (2.31 ± 0.47 vs 1.45 ± 2.06, p=0.019) but the static or VAS at moving are not different clinically. Side effects of nausea and vomiting are more common in IV-PCA group. We conclude that SC-PCA provide analgesia more effective and decreases side effects in patients undergo sectio cesarea with spinal anesthesia.
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

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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&lt;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.
Co-Authors - Yehezkiel, - Adinda Putra Pradhana, Adinda Adinda Putra Pradhana, Adinda Putra Andi Kusuma Wijaya, Andi Christopher Ryalino, Christopher Darminta, I Ketut Demoina, I Gede Patria Dewi, Dewa Ayu Mas Shintya Elisma Nainggolan, Elisma Emkel Perangin Angin, Emkel Gede Semarawima, Gede Hari Bagianto I Gede Budiarta, I Gede I Gusti Agung Gede Utara Hartawan, I Gusti Agung I Gusti Agung Gede Utara Hartawan, I Gusti Agung Gede I Gusti Agung Gede Utara Hartawan, I Gusti Agung Gede Utara I Gusti Ngurah Mahaalit Aribawa, I Gusti Ngurah I Gusti Ngurah Mahaalit Aribawa, I Gusti Ngurah Mahaalit I Gusti Putu Sukrana Sidemen, I Gusti Putu Sukrana I Ketut Sinardja I Made Darma Junaedi, I Made I Made Gde Widnyana, I Made Gde I Made Gede Widnyana I Made Gede Widnyana I Made Subagiartha I Nyoman Budi Hartawan I Nyoman Hariyasa Sanjaya I Wayan Aryabiantara, I Wayan IB Krisna Jaya Sutawan, IB Krisna Jaya Ida Bagus Gde Sujana, Ida Bagus Gde IGNA Putra Arimbawa, IGNA Putra Kadek Agus Heryana Putra, Kadek Agus Heryana Ketut Semara Jaya, Ketut Semara Ketut Suastika Kurnia, Prajnaariayi Prawira Made Adi Kusuma Made Agus Kresna Sucandra, Made Agus Kresna Made Bakta Made Widnyana, Made Marilaeta Cindryani, Marilaeta Ni Putu Novita Pradnyani, Ni Putu Ni Putu Wardani, Ni Putu Nyoman Sri Budayanti Okta, Ida Bagus Pande Nyoman Kurniasari, Pande Pontisomaya Parami, Pontisomaya Putu Agus Surya Panji, Putu Agus Putu Agus Surya Panji, Putu Agus Surya Putu Kurniyanta Putu Pramana Suarjaya Sinardja, Ketut Sonni Soetjipto, Sonni Sudewi, Anak Agung Raka Tjokorda Gde Agung Senapathi, Tjokorda Gde Tjokorda Gde Agung Senapathi, Tjokorda Gde Agung Tjokorda GdeAgung Senapathi, Tjokorda Usdyanto, Heavy Pradana