Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang: Aritmia jantung merupakan komplikasi yang sering terjadi pada operasi jantung. Stroke merupakan komplikasi penting dari fibrilasi atrial pascaoperasi (FAPO). Lama rawat di rumah sakit bertambah dengan adanya FAPO. Terapi medikamentosa yang sudah ada untuk penanganan FAPO belum memuaskan hasilnya. Neuromodulasi saraf vagus menggunakan Transcutaneous Vagus Nerve Stimulation (TVNS) berpotensi untuk mengurangi FAPO dan inflamasi pascaoperasi jantung sehingga layak untuk diteliti.Metodologi: Penelitian ini merupakan uji klinis acak tersamar tunggal yang dilakukan terhadap pasien dewasa yang menjalani operasi jantung pintas koroner dan katup elektif di Rumah Sakit Umum Pusat Dr. Kariadi Semarang pada bulan April-Juli 2023. Sebanyak 66 subjek yang memenuhi kriteria inklusi dibagi secara acak menjadi dua kelompok secara tersamar. Kelompok pertama mendapat perlakuan TVNS dan kelompok kedua sham TVNS. Perekaman dan pengamatan EKG kontinyu selama 3 hari pasca operasi dan kadar IL-6 diukur 24 jam praoperasi dan 72 jam pascaoperasi. Uji statistik menggunakan Chi Square dan Mann Whitney.Hasil penelitian: Pada luaran primer, tidak didapatkan perbedaan yang bermakna durasi per episode FAPO (p=0,069) dan peningkatan kadar IL-6 pascaoperasi (p=0,64) pada kelompok TVNS dan sham TVNS. Demikian juga pada luaran sekunder, tidak didapatkan perbedaan bermakna pada durasi awal tanpa terapi standar fibrilasi atrial (p=0,64), kebutuhan vasopressor inotropik (p = 0,517 dan 0,619) dan beban fibrilasi atrial (p=0,07).Kesimpulan: TVNS tidak memberikan perbedaan bermakna pada durasi per episode FAPO dan derajat inflamasi pascaoperasi bedah jantung dewasa.

---

Background: Postoperative arrhythmia is a frequent complication in cardiac surgery. Stroke is an important complication of postoperative atrial fibrillation (POAF). The length of hospital stay increases with POAF. Existing medical therapy for POAF has not shown satisfactory results. Vagus nerve neuromodulation using Transcutaneous Vagus Nerve Stimulation (TVNS) has a potential effect to reduce FAPO and inflammation after cardiac surgery, so it is beneficial to study.

Methodology: This study was a single-blind randomized control trial conducted on adult patients undergoing elective coronary bypass graft and heart valve surgery at Dr. Kariadi General Hospital in April-July 2023. A total of 66 subjects who met the inclusion criteria were randomly divided into two groups in a blinded manner. The first group received TVNS treatment and the second group received sham TVNS. Continuous ECG recording and reading for 3 days after surgery and IL-6 levels were measured 24 hours preoperatively and 72 hours postoperatively. Statistical analysis using Chi-Square and Mann-Whitney test.

Results: In the primary outcome, there was no significant difference in duration per episode of POAF (p=0.069) and the increase of postoperative IL-6 levels (p=0.64) in the TVNS and sham TVNS groups. Similarly in secondary outcomes, there were no significant differences in the initial duration without standard therapy of atrial fibrillation (p=0.64), the need for inotropic vasopressors (p = 0,517 and 0,619), and the burden of atrial fibrillation (p=0.07).

Conclusion: No significant difference in the duration per episode of FAPO and the degree of inflammation after adult cardiac surgery with TVNS treatment."

"Latar Belakang: Cedera reperfusi akibat dilepaskannya reactive oxygen species(ROS) saat penggunaan Cardiopulmonary bypass(CPB) dan kembalinya mengalir darah yang kaya oksigen pada miokard yang iskemia, dapat menyebabkan kerusakan miokard. Allopurinol sebagai penghambat xanthine oksidase, telah diteliti sebelumnya mengenai efektivitas dalam mengurangi cedera reperfusi pada bedah jantung terbuka yang belum menunjukkan hasil yang konklusif, meskipun pada beberapa penelitian memberikan hasil yang cukup baik pada pemulihan dari stunningmiokard, biomarker cedera reperfusi maupun kejadian atrial fibrilasi pascabedah (AFPB). Metilprednisolon juga dipakai untuk mengurangi efek inflamasi dan cedera reperfusi pada pasien bedah jantung terbuka karena perannya dalam menghambat secara indirek pengaktifan enzim NADPH oksidase.Tujuan penelitianini adalah untuk membandingkan efektifitas pemberian allopurinol peroral 600 mg pada malam hari dan 1 jam sebelum pembedahan dengan metilprednisolon intravena 15 mg/kgbb saat induksi anestesi dalam mengurangi cedera reperfusi pada bedah pintas arteri koroner.Metode: Telah dilakukan penelitian uji klinis acak tersamar ganda pada 42 pasien yang menjalani bedah pintas arteri koroner menggunakan CPB antara bulan Oktober 2019 hingga Maret 2020, yang dialokasikan ke dalam kelompok allopurinol atau kelompok metilprednisolon.Pemeriksaan biomarker cedera reperfusi dilakukan dengan pemeriksaan sampel darah malondialdehyde(MDA) yang dilakukan sesaat setelah pemasangan kateter vena sentral (basal) dan 5 menit setelah klem jepit aorta dilepas (pascareperfusi). Pemeriksaan MDA dilakukan dengan metode ELISA. Penilaian skor inotropik dan vasoaktif (SIV) dilakukan pada 24 jam pertama perawatan pascabedah. Sedangkan penilaian kejadian atrial fibrilasi pascabedah dilakukan selama 48 jam pertama pascabedah. Data yang diperoleh dianalisis dengan uji statistik yang sesuai dengan piranti lunak program SPSS 21. Uji hipotesis pada variabel kadar MDA akan menggunakan uji T tes tidak berpasangan bila sebaran data normal. Pada variabel skor inotropik dan vasoaktif akan menggunakan uji T test tidak berpasangan (bila sebaran data normal) atau dengan uji mann whitney(bila sebaran data tidak normal). Dan uji hipotesis untuk variabel kejadian AFPB menggunakan uji chi-squared(bila syarat x2terpenuhi) atau dengan uji fisher(bila syarat x2tidak terpenuhi).Hasil : 42 pasien yang menjalani bedah pintas arteri koroner yang memenuhi kriteria penerimaan, 40 pasien dianalisis karena 2 pasien meninggal sebelum 48 jam pertama pascabedah. Karakteristik demografi dan kadar MDA basal seimbang pada kedua kelompok. Peningkatan kadar MDA pascareperfusi lebih rendah pada pemberian allopurinol, namun secara statistik tidak berbeda bermakna (p=0,379). Nilai SIV pascabedah pada pemberian allopurinol secara statistik lebih rendah bermakna (median 6 vs 22, p=0,009). Kejadian AFPB pada kedua kelompok menunjukkan perbedaan yang tidak bermakna secara statistik (p=0,231).Simpulan : Allopurinol tidak lebih efektif daripada metilprednisolon dalam upaya mengurangi cedera reperfusi pada bedah pintas arteri koroner.

---

Background: Reperfusion injury due to the release of reactive oxygen species (ROS) when using cardiopulmonary bypass (CPB) and the return of oxygen-rich blood flow to ischemic myocardium after the release of aortic clamps, can cause myocardial damage. Allopurinol as an inhibitor of xanthine oxidase, has been studied previously about its effectiveness in reducing reperfusion injury in open heart surgery which shows inconclusive results, although in some studies it has given quite good results in recovery from myocardial stunning, biomarkers of reperfusion injuries and postoperative atrial fibrilation (POAF). Methylprednisolone is also used to reduce the effects of inflammation and reperfusion injury in open heart surgery patients because of its role in indirectly inhibiting the activation of the enzyme NADPH oxidase. The aim of this study was to compare the effectiveness of oral administration of allopurinol 600 mg at night and 1 hour before surgery with 15 mg/kg intravenous methylprednisolone during anesthesia induction in reducing reperfusion injury in coronary artery bypass surgery.

Methods: A double-blind randomized clinical trial study was conducted on 42 patients undergoing coronary artery bypass surgery using CPB between October 2019 and March 2020, which was allocated to the allopurinol group or the methylprednisolone group. Examination of biomarkers of reperfusion injury is carried out by examination of a blood sample of malondialdehyde (MDA) which is performed shortly after the installation of a central venous catheter (basal) and 5 minutes after the aortic clamp are removed (post-reperfusion). MDA examination is done by the ELISA method. Assessment of vasoactive-inotropic scores (VIS) was carried out in the first 24 hours of post-surgical treatment. While the assessment of the incidence of POAF was performed during the first 48 hours after surgery. The data obtained were analyzed by the appropriate statistical tests using SPSS 21 software program. Hypothesis testing on MDA variables will use the T test unpaired if the data distribution is normal. In the VIS variables will use the T test unpaired (if the data distribution is normal) or with the Mann Whitney test (if the data distribution is not normal). And hypothesis testing for POAF variables will use the chi-square test (if the x2 requirement are met) or with the fisher test (if the x2requirements are not met).

Results:42 patients who underwent coronary artery bypass surgery who met the admission criteria, 40 patients were analyzed because 2 patients died before the first 48 hours after surgery. Demographic characteristics and basal MDA levels were balanced in both groups. The increased levels of MDA post-reperfusion were lower in allopurinol administration, but the statistics were not significantly different (p = 0.379). The postoperative VIS value in the administration of allopurinol was significantly lower than in the administration of methylprednisolone (median 6 vs 22, p = 0.009). The incidence of AFPB in the two groups showed no differences were statistically significant (p = 0.231).

Conclusion:Allopurinol is not more effective than methylprednisolone in an effort to reduce reperfusion injury in coronary artery bypass surgery. "

"Latar Belakang: Disfungsi kognitif pascabedah (postoperative cognitivedysfunction/POCD) merupakan komplikasi pascabedah yang sering ditemui padapasien yang menjalani bedah jantung terbuka yang mengganggu fungsi sosial danekonomi serta berkaitan dengan peningkatan mortalitas. Patofisiologi POCD belumdiketahui secara jelas, namun diperkirakan melibatkan hipoksia serebral.Penurunan kandungan oksigen dan penurunan ekstraksi oksigen perioperatifdiperkirakan berkontribusi terhadap POCD. Penggunaan pemantauan nearinfraredspectroscopy (NIRS) memungkinkan pengukuran status oksigenasi padajaringan otak. Protein S100B adalah penanda biologis kerusakan jaringan otak.Penelitian ini bertujuan meneliti pengaruh kandungan oksigen dan ekstraksioksigen intra dan pascabedah, desaturasi serebral dan peningkatan kadar proteinS100B terhadap kejadian POCD.Metode: Rancangan penelitian ini adalah kohort prospektif di unit Pelayanan JantungTerpadu RS dr. Cipto Mangunkusumo. Penelitian dimulai setelah mendapatkan persetujuankomite etik dan ijin lokasi. Kriteria penerimaan adalah pasien berusia ≥18 tahun yangdijadwalkan menjalani bedah jantung terbuka dengan menggunakan mesincardiopulmonary bypass (CPB), sehat secara mental, dapat membaca dan berbahasaIndonesia. Pasien akan menjalani evaluasi kognitif menggunakan 6 tes psikometrik pada 1hari prabedah dan diulang pada 5 hari pascabedah. POCD didefinisikan sebagai penurunan>20% skor kognitif pascabedah dibandingkan prabedah pada 2 atau lebih tes. Sampel daraharteri dan vena diambil untuk menilai kandungan dan ekstraksi oksigen pada 5 waktu: (1)sebelum induksi, (2) intra-CPB, (3) pasca-CPB, (4) enam jam pascabedah, dan (5) 24 jampascabedah. Pemantauan saturasi serebral menggunakan NIRS dilakukan sepanjang pembedahan. Kadar protein S100B diukur pada 2 waktu: sebelum induksi dan 6 jampascabedah. Data dianalisis dengan uji statistik yang sesuai menggunakan piranti lunak SPSSversi 20.Hasil:Lima puluh lima subyek mengikuti penelitian ini. POCDditemukan pada 31 (56,4%)subyek. Kandungan oksigen dan ekstraksi oksigen ditemukan tidak berbeda bermakna diantara kedua kelompok pada seluruh waktu. Desaturasi serebral ditemukan lebih lama (55[0-324] vs. 6 [0-210], p=0,03) dan nilai AUC rScO2 lebih tinggi (228 [0-4875] vs. 33 [0-1100], p <0,01) pada pasien yang mengalami POCD dibandingkan yang tidak. Dengananalisis ROC ditemukan nilai AUC rScO2 >80 menit% berpengaruh terhadap kejadianPOCD (RR 3,38, IK 95%: 1,68-6,79, p <0,01). Kadar protein S100Bmeningkat 1,5x lebihtinggi pada pasien POCD, namun tidak mencapai kemaknaan statistik.Simpulan:Desaturasi serebral yang diukur menggunakan NIRS berpengaruh pada kejadianPOCD.

---

Background: Postoperative cognitive dysfunction/POCD is commonly found

postoperative complication after cardiac surgery with profound social and

economic effect and also known correlated with mortality. The pathophysiology

remains unclear and multifactorial, but hipoxia have been postulated as one of the

mechanisms. Reduced arterial oxygen content (CaO2) and reduced oxygen

extraction perioperatively may contribute to POCD. Use of near-infrared

spectroscopy (NIRS) monitoring may provide oxygenation status on brain tissue.

S100B protein is known brain injury biological marker. This trial aims to

investigate effects of perioperative oxygen content and extraction, cerebral

oxygenation status and S100B protein level changes to POCD.

Methods: This prospective cohort study was conducted at Integrated Heart Service unit of

RS dr. Cipto Mangunkusumo, a tertiary teaching hospital in Jakarta, Indonesia. This study

was started after ethical approval obtained. Inclusion criteria was 18 years old or above

patients scheduled for open-heart surgery using cardiopulmonary bypass machine, healthy

mental status, and can speak/read Indonesian language. Subjects were undergone 6

psychometric evaluation on day prior to surgery and 5 days after surgery. POCDdefined as

decrease of >20% score from baseline on 2 or more tests. Arterial and venous blood samples

were taken on 5 moments: (1) before induction of anesthesia, (2) during CPB, (3) After

separation of CPB, (4) six hours after surgery, and (5) 24 hours after surgery. NIRS

monitoring was applied continously during surgery. S100B protein level was measured on

before induction of anesthesia and 6 hours after surgery.Data was analyzed with appropriate

statistical tests using SPSS 20 software.

Results: Fifty-five subjects were included in this study. POCD was found in 31 (56.4%)

subjects. Oxygen contents and extractions were found not differ in both groups at all times.

Cerebral desaturation was found more longer (55 [0-324] vs. 6 [0-210]mins, p = 0.03) and

severe (AUC rScO2 228 [0-4875] vs. 33 [0-1100] min%, p <0,01) in subjects with POCD

compared to non-POCD. Using ROC analysis, it is determined subjects with AUC rScO2

>80 min% were exposed with higher risk of POCD(RR3.38x, 95%CI: 1.68-6.79, p <0.01).

S100B protein level increased higher in subjects with POCDbut no statistical significant was

found.

Conclusion: Cerebral desaturation measured by NIRSmonitoring contributes to POCD."