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Bali Journal of Anesthesiology
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Core Subject : Health, Education,
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Articles 65 Documents
Establishing good rapport in anesthesiarelated doctor-patient communication: bridging the triangular communication between anesthesiologist-surgeon-patient Widnyana, IMG; GA Senapathi, Tjokorda; Cindryani, Marilaeta
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.6

Abstract

Doctor-patient communication is central in clinical practice. Communication skill has been an essential component of clinical competence to become a five-star doctor. In the other hand, there are major problems in doctor-patient communication that would lead to medical disputes even malpractice suspicions. With effective communication, a definitive theory would turn into high-quality medical practice and improve patient safety and satisfaction to a whole new level. Based on the Calgary-Cambridge observation guide, there is five point plan of tasks that embrace doctor and patient in daily interviews starting from initiating the session, gathering information, building the relationship, explanation, and planning, and closing. Those tasks would have been easily introduced when you are dealing with a good healthy patient. But in anesthesia-related, wide range of patients are met in different settings and conditions
Anesthesia on Pediatric Laproscopy Wiryana, Made; Sinardja, I Ketut; Kurniyanta, Putu; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Darma Junaedi, I Made; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.1

Abstract

Laparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patients age, cardiovascular function, and anesthetic agents are used. Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by insufflation gas or penetration laparoscopic and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery.
CASE SERIES: DEEP SEDATION FOR PAEDATRIC PATIENTS WITH PERICARDIAL EFFUSION Soenarto, Ratna Farida; Hidayat, Jefferson; Zaintama, Hendy Armanda
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.33

Abstract

Background: Pericardial effusion is an abnormal fluid accumulation in the pericardial space that potentially compromises cardiovascular function, thus it needs a prompt treatment. Pericardial effusion evacuation in paediatrics can be done by subxyphoid pericardiotomy, which requires patient’s cooperation. General anaesthesia for paediatrics with pericardial effusion has been reported unfavourable. This case series reports safe anaesthesia procedures done for pericardiocentesis through both sedation and general anaesthesia. Case Presentations: Cases were taken from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 6 patients underwent sedation and 3 patients underwent general anaesthesia. Both groups used ketamine, midazolam and fentanyl. Sevoflurane was used as inhalation agent for maintenance. Blood pressure, heart rate, and SpO2 were recorded before and after pericardiocentesis. In both groups, there were no significant different between systolic and diastolic blood pressure, heart rate, and SpO2 before and after the procedure (p>0.05). Immobilization through sedation or general anaesthesia is required to perform an optimal pericardiotomy. Anaesthetic agents were chosen based on their minimal effects toward myocardial depression. Fluids balance before and after the procedure was crucial to prevent hemodynamic instability during effusion evacuation. Conclusion: Both sedation and general anaesthesia were safe for pericardiocentesis, with concern toward anaesthetic agents that were minimally depressive to myocardium, combined with opioid analgesics and other sedative agents, with balanced anaesthesia principle. Optimal intravenous fluid therapy with echocardiography monitoring is crucial. Sedation is more advantageous for patients requiring pericardiocentesis without preoperative preparation for general anaesthesia.
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 | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.27

Abstract

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.
Perioperative management of patient with hemophilia a underwent orthopedic surgery Senapathi, Tjokorda GA; Gede Widnyana, I Made; Mahaalit Aribawa, I Gusti Ngurah; Ryalino, Christopher
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.10

Abstract

Hemophilia presents challenging consideration for anesthesiologists. In non emergency cases it is essential that factor VIII is raised to its optimal activity prior to surgery. Intra operative bleeding is a fatal complication in hemophilia. Certain measurements must be taken under considerations to manage this case for anesthesia. Peripheral lines should be secured with utmost care. Intramuscular injections and arterial punctures must be avoided. Intubation and airway positioning should be done gently in deep plane anesthesia. Small vessels hemostatis must be taken care of by the surgeon. A multidisciplinary team has to be involved when patients with hemophilia are planned for surgery. The knowledge related to replacement therapy should be mastered not only by hematologist, but also by the whole team involved in patient management.
Central Venous Pressure Correlates with Inferior Vena Cava Collapsibility Index in Patient Treated in Intensive Care Unit Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Mahaalit Aribawa, I Gusti Ngurah; Gede Utara Hartawan, I Gusti Agung; Parami, Pontisomaya; Perangin Angin, Emkel
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.2

Abstract

Background: Intravascular volume status is an important parameter in monitoring the patients treated at intensive care unit (ICU), so accuracy and strict monitoring of fluid volume is one factor that influence patient’s health status. Amongst others, two ways to monitor body fluid volume status is central venous pressure (CVP) and collapsibility index of inferior vena cava (IVC) diameter. The purpose of this study is to determine the correlation between CVP with the IVC collapsibility index in patients treated in ICU Sanglah Hospital in Denpasar. Method: Seventy patients treated at Sanglah Hospital ICU with already inserted CVC for appropriate indication, were measured for CVP, then followed by examination the diameter of IVC with ultrasound to measure the maximum and minimum collapsibility index. Spearman’s correlation coefficients was used to assess the correlation between CVP and collapsibility index of the IVC. Results: In 70 patients, we found a very strong negative correlation between CVP and IVC’s collapsibility index (Spearmans rho = -0.854; p <0.001). Conclusion: This study found that there is a very strong negative correlation between CVP and collapsibility index of IVC. This finding indicates that the collapsibility index of the IVC may substitute CVP in determining the status of the intravascular volume.
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 | 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.
REGIONAL ANESTHESIA IN MOLAR PREGNANCY WITH THYROTOXICOSIS IN A REMOTE HOSPITAL Ryalino, Christopher; Aryasa, Tjahya; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.22

Abstract

Hydatidiform mole or molar pregnancy is a benign Gestational Trophoblastic Disease (GTD) that originates from the placenta. Treatment consists of vacuum evacuation but rarely hysterectomy may be required. One common complication of molar pregnancy is hyperthyroid. Anesthetic management is often complicated by the associated systemic complications. These complications cannot be prevented, but with a better understanding of the disease, some measurements to avoid maternal mortality can be performed.  
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 | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.11

Abstract

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<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.
Effectiveness of Infusion Warmer Use to Prevent the Occurrence of Hypothermia and Shivering After General Anesthesia Action in General Hospital Center Sanglah Denpasar Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Kusuma Wijaya, Andi; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.3

Abstract

Introduction: Shivering and hypothermia after general anesthesia is a common complication in the recovery room. Heating methods and drugs  widely used, but not yet effective. The purpose of this study was to evaluate the effectiveness of using the infusion warmer in maintaining normal core temperature and prevent shivering. Materials and Methods: The study was a non blindnes randomized control trial study. This study aimed to compare the effectiveness of the use of infusion warmer in preventing the incidence of hypothermia and shivering after general anesthesia. Research conducted at the Sanglah Hospital in October 2016, with sample calculations 58 people who meet the inclusion and exclusion criteria. Both were divided into 2 groups, 29 groups of infusion warmer and 29 people without the infusion warmer Recording the results of assessing multiple parameters vital signs, hemodynamic, aldrette score, body temperature, and shivering from the beginning, after induction, and minutes to 5, 15, 30 , 60 in the recovery room. The data obtained were analyzed with SPSS software with a significance level of p <0.005 expressed significantly, with a relative risk <1 as a preventive. Results: From a comparative picture of events shivering and hypothermia in minutes to 5, 15, 30, 60 in the recovery room seen that the treatment group based on the group lower warmer than in the non warmer. This shows that the use of warmer can prevent the incidence of shivering and hypothermia in patients after general anesthesia. In test statistically significant with p <0.05. Conclusions: The use of infusion warmer can help reduce the incidence of hypothermia and shivering after general anesthesia action.