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LOW FLOW ANESTHESIA WILL GAIN ERAS (ENHANCED RECOVERY AFTER SURGERY) Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Pradhana, Adinda Putra; Makmur, Eric
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.v1i3.24

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ABSTRACT As we know, the volatile agent needs fresh gas flow to be carried out to the patient. It is very common in anesthesia practice, we use the fresh gas flow more than 2 liters per minute. In recent practice, the more flow we gave, the more volatile agent blew out to the patient. The present of APL (adjustable pressure limit) also leaks out of the circuit, we spend more gases, volatile agent, hence gave more pollutant to the operating theater. The consequences of those are an increase of anesthesia expenses and change the way of health care being delivered.ERAS (Enhanced Recovery After Surgery) is popular with its quick recovery after surgery, include quick emergence post anesthesia, that will reduce the time in the operating theater, recovery room, and as results, reduce the cost of anesthesia and surgery. 
EGDT MODIFICATIONS USING IVC DIAMETER AND IVC COLLAPSIBILITY INDEX TO PROVIDE INTRAVASCULAR ADEQUACY FOR SEPSIS MANAGEMENT IN REMOTE AREA Irawan, Andi; Pradhana, Adinda Putra; Senapathi, Tjokorda Gde Agung
Bali Journal of Anesthesiology Vol 2, No 1 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i1.49

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Early Goal Directed Therapy (EGDT) protocols can still be considered to provide clear guidelines for bedside clinicians to treat sepsis. The use of EGDT protocol requires Central Venous Catheter (CVC) installation to calculate Central Venous Pressure (CVP). In the field, especially in the remote area, the installation of CVC often cannot be done because of the unavailability of tools or other reasons. Wiryana, et al. found that there was a strong negative correlation between CVP and collapsibility index of Inferior Vena Cava (IVC) and that IVC Collapsibility Index (IVC CI) could replace CVP(1), so it could be used to replace the role of CVP on modified EGDT protocol. Five patients were measured IVC diameter and IVC CI after initial fluid therapy and had an expiratory IVC diameter and a collapsibility index belonging to the CVP group of 11-15cmH2O according to Katja, et al(2).
Low Flow Practice for Laparoscopic Colorectal Surgery in Pediatric Patients Yadikusumo, Andrian; Senapathi, Tjokorda Gde Agung; Shintya Dewi, Dewa Ayu Mas; Pradhana, Adinda Putra; Sumanti, Alan F. A.
Bali Journal of Anesthesiology Vol 2, No 1 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i1.56

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Low flow anesthesia and laparoscopic technique in pediatric patients are kinds many kind of modern medical field development.  Both technique were made to support environment friendly, safety, and comfortable anesthesia practice for patients.  In three cases presented in this case series, laparoscopy was done in all three cases (two digestive cases, and one urology case).  All three cases performed with general anesthesia by low flow anesthesia technique with volatile sevoflurane combined with caudal block regional anesthesia.  In all those cases, no morbidity was found after anesthesia or operation that influence in patient’s outcome.  Improvement in outcome of pediatric patients was seen with low flow anesthesia technique, which are significant reduction of volatile used, faster wake up time, and reduction of agitation condition after anesthesia.
Udayana One Health Collaborating Center (OHCC) initiated Bali’s first mass, integrated basic life support training Sudewi, Anak Agung Raka; Budayanti, Nyoman Sri; Wiryana, Made; Senapathi, Tjokorda Gde Agung; Ryalino, Christopher; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (174.494 KB) | DOI: 10.15562/bjoa.v3i1.136

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ABSTRACTBasic Life Support (BLS) is a first-aid training that can be utilized in case of emergency until the victims are retained by medical professionals. Mastering BLS skills can be the difference between life and death. A cardiopulmonary resuscitation (CPR) performed by a passer-by is important to ensure a successful resuscitation in out-of-hospital cardiac arrest. Yet, improving the survival rate for out-of-hospital cardiac arrest is still a major problem. Starting in 2019, Udayana One Health Collaborating Center (Udayana OHCC) will implement the first mass and integrated BLS training in Bali. The goals are to introduce BLS to more people and to produce BLS-friendly environment in Bali.
SURGEONS BEHAVIOR TOWARD PROPHYLAXIS ANTIBIOTICS IN SANGLAH HOSPITAL Suranadi, I Wayan; Sukrama, Dewa Made; Budayanti, Ni Nyoman Sri; Pradhana, Adinda Putra; Amin, Yusuf Sidang
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (188.011 KB) | DOI: 10.15562/bjoa.v2i3.102

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 Background: The emergence of antibiotic resistance is a complicated problem due to many factors, especially its use and abuse. Inappropriate use of antibiotics is very common in both developed and developing countries. The goal of this study was to see the knowledge of the surgeons toward prophylaxis antibiotic at Sanglah Hospital.Methods: This is a descriptive study of 55 surgeons who performed elective surgery at Sanglah Hospital. A questionnaire was filled by the surgeons randomly without prior notice about the study. The information about their behavior toward prophylaxis antibiotics was gathered from medical record of the day.Result: Out of the 55 surgeons participated in this study, 85.5% have followed a training on rational antibiotic use. The level of knowledge about factors that can increase surgical wound infections is quite good (94.4%), while the knowledge regarding factors that can reduce surgical wound infections very low (16.4%). Almost all (92.7%) clean-surgery patients were given prophylactic antibiotics. The most given antibiotic was ceftriaxone (72.7%), the third generation of cephalosporins.Conclusion: The mean knowledge of the surgeons toward antibiotic prophylaxis was 59.8%. The most used antibiotic as pre-surgical prophylaxis was ceftriaxone. And the time of administration for prophylaxis antibiotic was 16-60 minutes prior to surgical incision.
Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center Parami, Pontisomaya; Suranadi, I Wayan; Utara Hartawan, I Gusti Agung Gede; Mahaalit, I Gusti Ngurah; Ryalino, Christopher; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (175.516 KB) | DOI: 10.15562/bjoa.v3i1.116

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ABSTRACTPain is a common complaint found in the population. Inadequate knowledge about pain management is the most common reason that triggers the inadequate management of pain. Pharmacological pain management is also not without risk. Various risks from the use of pharmacological agents related to side effects that can arise may also cause new problems. Several medical intervention techniques with invasive procedures for pain have also been carried out, although they are still less popular, due to a lack of public knowledge of this technique. We conducted a cost-free, minimally invasive pain procedure in people with chronic musculoskeletal pain in a public health center in a rural area in Bali Island to alleviate their pain-associated symptoms and to introduce this minimally invasive pain management 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

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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. 
The use of echocardiography as a routine perioperative monitoring standard: The perspective of a cardiothoracic anesthesiologist Nada, I Ketut Wibawa; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (161.163 KB) | DOI: 10.15562/bjoa.v3i1.144

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INTRODUCTIONIn the era of medicine that has been very advanced as it is today, we as anesthesiologists are required to be able to provide anesthetic services that are comfortable but still safe. Throughout the world, there are more than 300 million major surgery each year, and major cardiovascular adverse events are a significant cause of perioperative morbidity and mortality.1 This certainly relates to the nature of anesthetic agents that are mostly cardiovascular-depressant. Anesthetic agents such as propofol, ketamine, opioids, inhalation anesthetic agents, and many others, can directly affect the cardiovascular system.2While the major cardiac event occurred during perioperative events is also quite high. Especially for the patients in the perioperative period who will undergo non-cardiac surgery. This frequently reduces the alertness of an anesthesiologist, especially when performing perioperative monitoring. A study from Smilowitz et al.,1 showed that out of 10,581,621 patients admitted to hospital for major non-cardiac surgery plans, 317,479 (3%) patients had experienced major cardiac events. Which can be illustrated that major cardiac events occur in 1 in 33 patients treated for major non-cardiac surgery. Echocardiography is a safe, relatively inexpensive and well-tolerated action for patients.3Regular use of echocardiography in the perioperative period can certainly help to predict and even reduce major events adverse cardiac events. It is good to be used as a guide for making decisions in carrying out actions, as well as for monitoring the patient's condition regularly during the perioperative period. The use of echocardiography so far has been used for both diagnosis and management in the field of cardiology and is used by another specialist as well, although anesthesiologists do not use it in the perioperative period as a routine manner. Meanwhile, the role of an anesthesiologist as a perioperative doctor has become something that other specialties have begun to rely on.4
Role of flow velocity and transient hyperemic response evaluated by transcranial doppler for assesing brain autoregulation in mild traumatic brain injury: a case report Demoina, I Gede Patria; Wiryana, Made; Suarjaya, Putu Pramana; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (159.837 KB) | DOI: 10.15562/bjoa.v3i2.174

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Head injuries are a common case throughout the world, based on data from the Centers for Disease Control, emergency cases, hospitalization cases, and also deaths due to head injuries have increased in the decade 2001-2010. Cerebral autoregulation (CA) is a mechanism for cerebral blood flow (CBF) regulation if there is a change from cerebral perfusion pressure (CPP). The mechanism of brain autoregulation is negative feedback that holds back the increase in mean arterial pressure (MAP) by reducing the diameter of blood vessels so that CBF returns to normal, whereas if MAP falls, brain autoregulation tends to widen blood vessel diameter so that CBF is normal. Transcranial doppler examination can be one of the modalities of investigation that is very useful in patients with head injuries. Transcranial doppler in patients with a head injury can be used to measure mean flow velocity of cerebral artery media and transient hyperemic response test, both of which can assess the prognosis of a course of head injury.
EXCISION OF GIANT CELL TUMOR FOLLOWED BY RECONSTRUCTION OF DISTAL RADIUS USING FREE VASCULARIZED FIBULAR GRAFT Sutanto, Prisca Oriana; Hamid, Agus Roy Rusli; Pradhana, Adinda Putra
Neurologico Spinale Medico Chirurgico Vol 1 No 4 (2018)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1046.532 KB)

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Giant cell tumor (GCT) of the distal radius is a rare and unpredictable lesion. The aim of treatment is complete removal of the tumor and preservation of the maximum function of the extremity. Lower rates of local recurrence have been noted after wide resection of the diseased bone. Its standard treatment has ranged from surgical curettage to wide resection. One method for closing the defect is using the head of the fibula as a substitute for the distal radius. The healing of vascularized fibular graft is very quick and without bone resorption. Thus, in the procedure for reconstruction and limb salvage after bone tumor resection of the distal radius, the free vascularized fibular graft with the fibular head is an ideal substitute. This case report will show a patient with GCT that successfully treated by an excision of GCT followed by reconstruction of distal radius using free vascularized fibular graft.