Cynthia Dewi Sinardja, Cynthia Dewi
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Safety Timeout for Local Anesthetics and Regional Anesthesia Sinardja, Cynthia Dewi; Widnyana, I Made Gde; Lolobali, Marilaeta Cindryani
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.v1i3.38

Abstract

Our anesthesia practices are always based on patient safety in WHO surgical and anesthesia guidelines. Those guidelines are interpreted in checklists and protocols that could be applied in daily routine in every standard operating theaters. A surgical patient would be notified and identified during the surgery by all member of the operating room including the anesthesiologist through a specialized checklists which was called a safety surgical checklist usually done in the preparation room, signing in, 5 minutes for timeout before the incision, and the last sign out before closure stitching. Anesthesia conduct and monitoring is viewed as a part of the whole surgery practice.The safety timeout that has been elaborated in ASRA Regional Block Pre-Procedural Checklist is one important thing that needs to be encouraged and confirmed every time an anesthesiologist is getting ready to do a regional anesthesia.  The safety timeout is useful as a quick reminder for operating theater personnel especially anesthesiologist and the nurse anesthetists to do a double check and reassessment on patient condition, drug and adjuvant choice, labels, and other implicating factors. There are many contributing factors that could induced emergency and crisis situations in regional anesthesia conduct, and the safety timeout is an alternative way to eliminate and trace those factors in an appropriate way.
Anaesthesia Management of Patient at 16 Weeks Pregnancy with Primary Malignant Bone Tumour Underwent Hemipelvectomy Surgery Sinardja, Cynthia Dewi; Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Kusuma, Oscar Indra; D.H., Asterina
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.39

Abstract

Chondrosarcoma is a type of sarcoma that affects the bones and joints. It is a rare cancer that accounts for about 20% of bone tumours and is diagnosed in approximately 600 patients each year in the United States. Chondrosarcoma typically affects adults between the age of 20 and 60 years old. The disease usually starts in the bones of the arms, legs or pelvis, but it can be found in any part of the body that contains cartilage. Sometimes chondrosarcoma grows on an otherwise healthy bone or it grows on a benign bone tumour (an enchondroma or osteochondroma). Non-obstetric surgery during pregnancy is not uncommon and can have excellent outcomes with proper planning. Between 0.75% and 2% of pregnant women require non-obstetric surgery. Surgery can be required during any stage of pregnancy depending on the urgency of the indication. When caring for pregnant women undergoing non-obstetric surgery, safe anaesthesia must be provided for both the mother and the child. Thorough understanding of the physiological and pharmacological adaptations to pregnancy is required to ensure maternal safety. Fetal safety requires avoidance of potentially dangerous drugs at critical times during fetal development, assurance of continuation of adequate uteroplacental perfusion, and avoidance and/or treatment of preterm labour and delivery.Pregnant patients beyond 18–20 weeks of gestation should be positioned with a 15° left lateral tilt, to reduce aortocaval compression and supine hypotension syndrome. Regional anaesthesia with combined spinal epidural is an option for this case. Regional anaesthesia does reduce the exposure of foetus to potential teratogens, avoids the potential risk of failed intubation and aspiration, and provides excellent post-operative analgesia. The major concern with neuraxial anaesthesia is maternal hypotension, which may reduce placental perfusion.  During anaesthesia and surgery, foetal well-being is best ensured by careful maintenance of stable maternal haemodynamic parameters and oxygenation. Close monitoring of foetal responses for signs of distress is strongly advocated.
PERIOPERATIVE EFFECTS OF CO-ADMINISTRATION OF TCI PROPOFOL COMBINED WITH CLONIDINE AND KETAMINE Aryabiantara, I Wayan; Sinardja, I Ketut; Sutawan, Ida Bagus Krisna Jaya; Sinardja, Cynthia Dewi; Parami, Pontisomaya; Ryalino, Christopher; Junaedi, Made Darma
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (371.815 KB) | DOI: 10.15562/bjoa.v2i3.69

Abstract

Background: Propofol is often used in Total Intravenous Anesthesia (TIVA). Studies found that adding clonidine and ketamine can increase the potential to achieve an adequate level of anesthesia while reducing inflammation and post-operative pain. The goal of this study is to see if the combination of Target Controlled Infusion (TCI) propofol plus clonidine and ketamine is more effective in reducing the IL-6 level, maintaining intraoperative stability, and reducing postoperative pain and morphine consumption.Methods: Forty patients planned for major oncology surgery were divided into two groups. The treatment group (Group T) received pre-medication with clonidine, induction with TCI propofol, and intraoperative ketamine. The control group (Group C) received normal saline solution.Results: The difference of IL-6 level increase between the two groups was not statistically significant (13.6 vs. 16.6 pg/mL, p>0.05). Mean systolic blood pressure (SBP) and mean arterial pressure (MAP) in group T were higher in 5 and 10 minutes after incision, but lower in minutes 30, 60, and 120 (p <0.05). Heart rate in group T was higher in minutes 5, 10, 15, 30, 60, and 120. Visual analog scale (VAS) in 4, 8, 12, and 24 hours post-surgery were lower in group T compared to group C. And post-operative morphine consumptions in group T were also lower. (3.6 ± 1.5 vs 9.9 ± 3.3, p <0.05).Conclusion: TIVA using TCI propofol combined with preoperative clonidine and intraoperative ketamine is effective in maintaining hemodynamic stability, reducing post-operative and reducing morphine consumption compared to TCI propofol alone.
Acinetobacter baumannii Is an opportunistic pathogen as an MDRO especially on intensive ward Suranadi, I Wayan; Dwi Fatmawati, Ni Nengah; Aryabiantara, I Wayan; Sinardja, Cynthia Dewi; Saputra, Darmawan Jaya
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (169.797 KB) | DOI: 10.15562/bjoa.v3i2.199

Abstract

Acinetobacter baumannii is an opportunistic bacterial pathogen that is associated with hospital acquired infections and is a major cause of nosocomial infections especially in intensive spaces; this is becoming increasingly a widespread concern in various hospitals around the world. Acinetobacter baumannii, which is resistant to many antibiotics, is now recognized as clinically very important. Reports suggest that the spread of A. baumannii in the hospital environment led to an increase in nosocomial outbreaks associated with high mortality rates. However, many other Acinetobacter spp. can also cause nosocomial infections. This review focuses on the role of Acinetobacter spp. as nosocomial pathogens, resistance patterns and epidemiology.