cover
Filter by Year
Articles
32
Articles
COMBINE MIDAZOLAM-FENTANYL-KETAMIN FOR EVISERATION SURGERY IN PATIENT WITH MULTIDRUG ALERGY IN ACUTE ON CHRONIC EXCACERBATION OF HIPERSENSITIVITY REACTION

Panji, Putu Agus Surya, Sudjana, Ida Bagus Gde, Suranadi, I Wayan, Tanggono, Aninda

Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

ABSTRACTMultidrug Alergy is a relatively rare imunology abnormality. Generally, it caused by congenital genotype and influence with environment. After treated the acute on chronic exacerbation of hypersensivity tipe 1, and the inflamation can alleviate, the patient schedule of eviseration oculi dextra with general anesthesia. And the opthamologist curious about the proceddure because eviseration need antibiotic to wash the oculi, but there are no antibiotic saved for the patient. For general anesthesia, the patient has no history so we can’t predicted about the anesthetic drug’s allergy. We choose combine ketamine-midazolamadn fentanyl to facilitate the anesthesia. Ketamine significantly reduces the production of inflammatory cytokines without affecting the production of anti-inflammatory cytokines. Fentanyl is the opioid which is the most rarely caused allergy and have strong potential. Midazolam can help the sedation

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 | Original Source | Check in Google Scholar |

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.

Supraspinal Modulation : Something to be Remembered

Parami, Pontisomaya, Senapathi, Tjokorda Gde Agung, Suarjaya, I Putu Pramana, Lolobali, Marilaeta Cindryani

Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

Pain had always been a challenging issue in patients with acute and chronic condition.  Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage. However, a direct correlation between activation and nociceptors and the sensory experience of pain is not always apparent. Emotional state, the degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience.Many active agents are used to block and alleviate pain sensation in acute and chronic settings. When an inadequate treatment for acute pain and neuralgia occurred, it would induce complex processes involving both central and peripheral sensitization contributing to persistent post-surgical pain and worsening neuralgia that would lead to chronic pain issue.The important thing to be considered is that this pain process is an intertwined and interconnecting and sustainable process that could not be cut abruptly. Our aim is to remind us to accept that pain pathway is merely not one straight way but still a convoluting idea which could still revolve and expand. Imagining areas could be defined surely one day through high technology advances and would lead us into defining the depth of this beautiful yet complex pathway.

LOW DOSE SPINAL ANESTHESIA FOR CESAREAN SECTION IN GRAVIDA WITH RHEUMATIC HEART DISEASE

Senapathi, Tjokorda Gde Agung, Budiarta, I Gede, Astuti, Mira Kusuma

Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

Cardiac disease in pregnancy remains an important etiology of maternal and fetal morbidity and mortality.1 Mitral stenosis is the most commonly acquired valve lesion encountered in pregnant women and is almost invariably caused by Rheumatic Heart Disease (RHD).1 Pregnancy and peripartum period represent a physiologic burden that may worsen symptoms in even moderate degrees of cardiac disease.1 Consequently, many women are first diagnosed with cardiac disease during pregnancy.1 In this case report, we describe peripartum management of a 38 years old woman with Congestive Heart Failure functional class II, severe Mitral Stenosis, moderate Mitral Regurgitation, moderate Tricuspid Regurgitation because of Rheumatic Heart Disease. She successfully underwent cesarean section in low dose spinal anesthesia using 7 mg hyperbaric bupivacaine intrathecally. This report highlights that low dose spinal anesthesia remains a good option in anesthesia management for cesarean section in gravida with rheumatic heart disease, especially with severe mitral stenosis. 

INCIDENCE AND RISK FACTOR OF ACUTE KIDNEY INJURY POST OPEN HEART SURGERY IN PAEDIATRIC PATIENTS

Heriwardito, Aldy, Alatas, Anas, Perdana, Aries, Sutedja, Anasthasia Devina

Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

Introduction: Acute Kidney Injury (AKI) was a frequently complication after open heart surgery, especially in paediatric patients < 2 years old and had been related with increased mortality and adverse renal outcomes. This study aimed to know the incidence of AKI post open heart surgery in paediatric patients and its relation with duration of cardiopulmonary bypass (CPB) and patient’s age in Indonesia tertiary national hospital.Methods: This was a cohort retrospective study, using medical record and Cardiac ICU chart data, of 195 paediatric patients who underwent open heart surgery from June 2014 - June 2015 in Integrated Cardiovascular Center Cipto Mangunkusumo hospital. After ethical approval from Research Ethic Committee, data were collected and sorted by inclusion and exclusion criteria. AKI was diagnosed based on RIFLE criteria. Data were analyzed by chi-square and multivariate analysis (SPSS software 22.0 version).Results: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB > 60 min had a significant correlation with increased incidence of AKI (p 0.043; RR 1.248). Patient’s age ≤ 2 years old also had a significant correlation with increased incidence of AKI (p<0.001; RR 2.431). Multivariate analysis results showed that both duration of CPB > 60 min and patient’s age ≤ 2 years old were significant risk factors of AKI (OR 2.951, OR 5.371).Conclusion: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB duration > 60 min and patient’s age < 2 years old were significant risk factors of AKI.

CASE REPORT ANESTHETIC MANAGEMENT OF ADRENAL TUMOR RESECTION

Widnyana, I Made Gede, Putra, Kadek Agus Heryana, Kurniyanta, Putu, Suarjaya, I Putu Pramana, Suranadi, I Wayan, Hartono, Budi

Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

ABSTRACTThe adrenal glands are secretory organs that are located above each kidney and produce hormones that play a major role in the metabolic processes. Tumors of the adrenal gland can cause metabolic abnormalities associated with hormonal disorders such as Cushings syndrome, pheochromocytoma, or Conns syndrome. To be able to give a good anesthetic management on resection of the adrenal tumor, it requires adequate preoperative evaluation. However, this will take large resources. Management of anesthesia in adrenal tumor with an unknown hormonal disorder should consider a variety of hormonal abnormalities that may present in the patient so it can be anticipated effectively.Keywords: incidentaloma, adrenalectomy, hormonal disorder, perioperative

ANESTHESIA MANAGEMENT OF ESOPHAGEAL ATRESIA REPAIR SURGERY: A CASE REPORT

Putra, Kadek Agus Heryana, Kurniyanta, Putu, Wiryana, Made, Sinardja, Ketut, Senapathi, Tjokorda Gde Agung, Widnyana, I Made Gede, Cindryani, Marilaeta, Kurnia, Prajnaariayi Prawira

Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

ABSTRACTEsophageal Atresia (EA)is a congenital anomaly commonly found with TracheoesophagealFistula (TEF) of neonates in the first week oflife. This anomaly can cause several complications includingaspiration, reduction in respiration, and other complication from other concomitant congenital anomaly, mostly from heart origin. The treatment for this anomaly is surgery.Intraoperatively, thepatient may develop hypoxia due to lung retraction and hemodynamic instability from bleeding or hypothermia. Anesthesiologists play important role in the management of EA during theperioperative period. Careful examination of the preoperative period must be done to discover any other concomitant anomaly and complication. Good anticipation of any complication during surgery and continuous monitoring post surgery can elevate the prognosis of the patient.

Case Series : Efficacy of Local Infiltration Analgesia with Lidocaine – Epinephrine 0.5% as Post Cesarean Section Pain Management in Kalabahi Public Hospital

Katipana, Madyline Victorya, Alphonso, Aloysius

Bali Journal of Anesthesiology Vol 2, No 1 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

Background: Caesarean section is one of the most commonly performed surgical operations in the world today. Caesarean section commonly induces moderate to severe pain for about 48 hours. It requires optimal perioperative pain management. Postoperative pain management is an important issue in clinic. Proper and efficient pain management is necessary during hospitalization for preventing the related complication which could affect mother and neonate health status. Recently, multimodal pain management has been tested as postoperative pain management. One of the alternatives that can be used is local infiltration analgesia (LIA) method. Local infiltration analgesia technique can provide an adequate effect of analgesia and reduced parenteral opioid consumption without any adverse effects.Case Presentations: Cases in this study collected from Kalabahi Public Hospital, East Nusa Tenggara, Indonesia. 42 patients who met the inclusion criteria   underwent caesarean section was injected with Lidocaine-Epinephrine 0.5% in abdominal muscle and subcutaneous layer as postoperative pain management. After that, the patients were observed to evaluate pain score with Visual Analog Scale (VAS), opioid consumption as the pain rescue, the level of satisfaction, and to evaluate post caesarean wound.Conclusion : This study showed that lidocaine-epinephrine 0.5% injection reduced postoperative pain, so allowed early mobilization and reduced the nurse’s  work, increased the patient’s satisfaction, and there were no report of wound complication. This study also showed the pain score of the first 24 hours was 2.095238 with standard deviation 0.878178, and just 4 patients who asked for rescue analgesic.

Effectiveness of Partial and Adjustment Neostigmine Dose as a Neuromuscular Reversal for Single Dose Rocuronium

Hidayat, Jefferson, Marsaban, Arif HM, Daryono, Maria Veronica Tita Ekaputri Hadi

Bali Journal of Anesthesiology Vol 2, No 1 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Original Source | Check in Google Scholar |

Abstract

Background: Routine reversal (neostigmine) and the use of quantitative monitoring of neuromuscular blockade (Train of Four Ratio (TOFR)) are recommended to prevent the occurrence of residual paralysis. This study attempted to determine the effectiveness between neostigmine partial dose 0.02 mg/kgbw and adjusted dose based on TOFR value in recovering neuromuscular blockade of single dose rocuronium 0.6 mg/kgbw.Methods: This randomized clinical trial was performed in the operating room of Integrated Surgical Care Unit of Cipto Mangunkusumo General Hospital and Kirana Clinic. Sixty-one patients who underwent elective surgery in general anesthesia were randomized in to 2 groups: administration of neostigmine in partial dose 0.02 mg/kgbw (group A) and adjusted dose based on TOFR value (group B). Quantitative monitoring evaluation of neuromuscular blockade was performed four times: after adequate spontaneous breathing, 5, 10, and 15 minutes after reversal.Result: The mean of TOFR values in group A and group B respectively: after spontaneous breathing 42% and 50% (p=0.436); 5 minutes after reversal 80.2% and 89.2% (p=0.083); 10 minutes after reversal 92.2% and 94% (p=0.399); 15 minutes after reversal 94.3% and 94.9% (p=0.526). After the 5 minutes of reversal, group B (80.6%) reaches TOFR value ≥ 90% many more than group A (63.3%) (p=0.132).Conclusion: Neostigmine partial dose 0.02 mg/kgbw was as effective as administering neostigmine in adjustment dose based on TOFR values to achieve complete recovery from the neuromuscular block effect of single-dose rocuronium 0.6 mg/kgbw. This study also show the complete recovery of neuromuscular block when TOFR value ≥ 90%.

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 | Original Source | Check in Google Scholar |

Abstract

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.