I Gusti Ngurah Mahaalit Aribawa, I Gusti Ngurah Mahaalit
Anesthesiology and Intensive Care Department, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

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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 <0.05 onsidered significant.Result: Morphine consumption in IV-PCA group showed lower needs than SC-PCA (9.41 mg vs 4,9mg) p <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.
COMPARISON OF EPIDURAL CATHETER TIP PLACEMENT BETWEEN MEDIAN AND PARAMEDIAN TECHNIQUES WITH FLUOROSCOPY Senapathi, Tjokorda Gde Agung; Aribawa, I Gusti Ngurah Mahaalit; Ryalino, Christopher; Leton, Yohanes PT
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (188.09 KB) | DOI: 10.15562/bjoa.v2i3.99

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Introduction: The installation of an epidural catheter can be perform by median or paramedian techniques with the aim of position the epidural catheter tip being posterior to the epidural space. The goal of this study was to compare the location and position of the epidural catheter tip placed by the median technique compared to the paramedian technique by using fluoroscopy method.Patients and Methods: Fifty patients aged 18- 65 years who underwent lower abdominal surgery and lower extremities surgery are classified into two groups by consecutive sampling. The first group consists of those who were inserted epidural catheter by median technique approach, and the second group by paramedian technique approach. From the fluoroscopy imaging, the catheter position was classified into one the the following: anterior, posterior, and lateral. Result: In median approach, the epidural catheter tip were placed 16% anteriorly, 20% posteriorly, and 64% laterally. In the paramedian approach, the epidural catheter tip were placed 4% anteriorly and 96% posteriorly. The paramedian approach is more superior to median technique in terms of expected epidural catheter tip position (p <0.001, RR 4.8, CI95%=2.183-10.556). Conclusion: Placement of the catheter tip in the epidural space using paramedian technique is a better option than the median technique.
The correlation between the depth extent of Tuohy epidural needle with body mass index (BMI) to achieve loss of resistance in patients undergoing epidural anesthesia Hartawan, I Gusti Agung Gede Utara; Senapathi, Tjokorda Gde Agung; Aribawa, I Gusti Ngurah Mahaalit; Parami, Pontisomaya; Pradhana, Adinda Putra; Syamsuddin, Johanis Bosco Troy
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (172.208 KB) | DOI: 10.15562/bjoa.v3i1.119

Abstract

ABSTRACTBackground: Anesthesia management in obesity is quite challenging. Epidural anesthesia become one of the choices. The attention should be addressed in order to prevent the misidentification of epidural space. The estimation of the depth extent of epidural space becomes crucial, especially in obese patients due to an accumulation of subcutaneous and epidural adipose tissue, which consequently complicate the epidural catheter insertion. This study aimed to analyze the correlation of the depth extent of Tuohy epidural needle to achieve loss of resistance between normal-weighted and obese patients.Method: This study was conducted with 56 adult patients aged 17 to 65 years who underwent elective surgery by epidural anesthesia inserted at level L2-L3 or L3-L4 interspace. Subjects are divided into normal and obese groups. Shapiro-Wilk and chi-square tests were used in the normality test. For normally distributed data, an independent t-test was used to test the hypothesis, otherwise, we used Mann-Whitney test  Results: The results showed that the loss of resistance in epidural needle insertion procedures was 60 mm in a patient with BMI more than 30 kg/m2 and 50 mm in those with BMI <30 kg/m2 (p<0.001).Conclusion: The loss of resistance depth in epidural Tuohy needle insertion is significantly determined by BMI. 
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.
General anesthesia combined with thoracic epidural anesthesia: an anesthesia technique option in modified radical mastectomy Sidemen, I Gusti Ayu Eka Para Santi; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Aribawa, I Gusti Ngurah Mahaalit; Ryalino, Christopher
Bali Journal of Anesthesiology Vol 3: in press (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v3i0.128

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The incidence of breast cancer has been increasing, and currently, it is the most common cancer in females. Surgery is the primary treatment, and the current tendency is toward less extensive procedure with axillary dissection for removal of lymph nodes to guide further treatment, in this case, the method called modified radical mastectomy (MRM).  The anesthetic technique for MRM should provide adequate intraoperative anesthesia, muscle relaxation, and postoperative analgesia without collateral effects, nausea, and vomiting with the minimum hospitalization time. In this report, we present a case of a woman who underwent MRM under general anesthesia combined with thoracic epidural anesthesia.
Awake Intubation Fiberoptic Bronchoscope on Pregnancy Patient Undergo Decompression Laminectomy and Cervical Fusion Stabilization Saputra, Darmawan Jaya; Senapathi, Tjokorda Gde Agung; Aribawa, I Gusti Ngurah Mahaalit; Ryalino, Christopher
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (160.816 KB) | DOI: 10.15562/bjoa.v3i2.185

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The traumatic and ankylosing cervical spine being rare in pregnancy can cause serious problems continuing pregnancy. Extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression. We present a case of a patient in the 19th weeks with diagnosis C5 compression fracture and paracervical abscess C5 et causa suspect TB spondylosis, complaints with paralysis in all four limbs. Surgical intervention was deemed necessary and was performed in the prone position. The early operative treatment and appropriate anaesthetic procedure resulted in good clinical outcome with improvement of neurological recovery.
Antifungals patterns in critical patients with candidiasis in the intensive care units at Sanglah General Hospital 2019 Ady Widayana, Komang; Aryabiantara, I Wayan; Senapathi, Tjokorda Gde Agung; Suranadi, I Wayan; Aribawa, I Gusti Ngurah Mahaalit
Neurologico Spinale Medico Chirurgico Vol 2 No 3 (2019)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (378.685 KB) | DOI: 10.36444/nsmc.v2i3.83

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Abstract Introduction: The prompt initiation of appropriate antifungal therapy is essential in controlling invasive candidiasis and improving the prognosis in critical patients undergoing treatment in the Intensive Care Unit. Candida Score can assess patients at risk of candidiasis and is expected to assist clinicians in starting antifungal therapy in patients suspected Candidiasis. The purpose of this study was to determine the pattern of antifungal administration in critically ill patients with candidiasis in the Intensive Care Unit at Sanglah General Hospital. Patients and Methods: The design of this study is a cross-sectional descriptive study involving critically ill patients who were under treatment in Intensive Care Unit of Sanglah General Hospital from Januari to June 2019. The patients included in this study were patients who were ? 18 years old and under treatment in ICU for at least 7 days. Results: There are 64 patients undergoing treatment in the Intensive Care Unit. From 64 patients, 6 pasien had CS = 0, 29 patients had CS = 1, 13 patients had CS = 2, 11 patients had CS = 3, 5 patients had CS = 4, and  no patients had CS = 5. Eleven patients received empirical antifungal therapy. All empirical antifungal therapies use the Triazole group. Conclusion: In this study was found that 11 of 16 patients with a CS value of ? 2.5 were given empirical antifungal therapy, while 48 patients with a CS value of <2.5 were not given empirical antifungal therapy. Keywords: Invasive Candidiasis, Candida Score, Empirical Antifungal Therapy.