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All Journal Jurnal Anestesiologi Indonesia Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Anestesi Perioperatif The Indonesian Journal of Public Health Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Anestesi Obstetri Indonesia Jurnal Kesehatan Tambusai Solo Journal of Anesthesi, Pain and Critical Care Journal of Anesthesiology and Clinical Research Majalah Anestesia & Critical Care (MACC) Jurnal Komplikasi Anestesi
Juni Kurniawaty Muhdar Abubakar Djayanti Sari
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Kesehatan Masyarakat Dan Keperawatan, Universitas Gadjah Mada, Yogyakarta|Universitas Gadjah Mada
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Hyperlactatemia Post-CABG: Case Studies in Three Patients Wardhana, Ardyan; Kurniawaty, Juni
Majalah Anestesia & Critical Care Vol 43 No 3 (2025): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i3.429

Abstract

Introduction: Hyperlactatemia after CABG may signal intra- or postoperative complications by reflecting a mismatch between tissue oxygen supply and metabolic demand, with potential for organ dysfunction and worse outcomes. This case report examined contributing factors—including metabolic acidosis, postoperative metabolic stress, and inotropic agents—to guide targeted interventions and improve clinical results. Case Description: Three patients underwent CABG, with the first and second remaining hemodynamically stable in the ICU on dobutamine and nitroglycerin, whereas the third required norepinephrine, epinephrine, and temporary pacing for instability. None exceeded 4 mmol/L during CPB or immediately after separation, yet all showed immediate-onset hyperlactatemia (IHL)—a phenomenon reported in 17% of cases, especially with longer CPB/cross-clamp times. All subsequently developed late-onset hyperlactatemia (LHL) at 4–12 hours: first and third patient had hyperglycemia, whereas the second reached the highest 12-hour lactate peak without hyperglycemia. LHL likely reflected type-B lactate from postoperative inflammatory/metabolic stress and insulin resistance, typically normalizing within 12–24 hours without a marked drop in base excess. Third patient’s sharp4-hour surge was plausibly epinephrine-related—more consistent with preserved metabolic reserve than with adverse prognosis. Conclusion: In post-CABG patients, hyperlactatemia may arise from non-hypoxic, multifactorial mechanisms (inflammation, metabolic stress, and inotropes) and thus warrants context-aware interpretation and targeted management rather than reflexive attribution to tissue hypoxia.
Validation of the APACHE IV Score for ICU Mortality Prediction in Dr. Sardjito Hospital During the Pandemic Era Rayhandika; Akhmad Yun Jufan; Widyastuti, Yunita; Juni Kurniawaty
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I22023.72-80

Abstract

Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objective: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Methods: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient's observed ICU Mortality was used. The model's predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.
The Effect of Music Listening on Anxiety Levels in Post-Subarachnoid Block Anaesthesia Patients Prandani, Muhammad Yogi; Kurniawaty, Juni; Apsari, Ratih Kumala Fajar
Jurnal Komplikasi Anestesi Vol 13 No 1 (2025)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i1.18170

Abstract

Background: The patients’ perioperative conditions can affect post-operative anxiety. Subarachnoid block anaesthesia can increase the incidence of post-operative anxiety. Methods to reduce post-operative anxiety are divided into pharmacological, with the administration of sedative drugs, and non-pharmacological, with holistic education, acupuncture, listening to music during surgery, and othersObjective: This study aims to observe the effect of listening to music on the anxiety level of surgical patients undergoing subarachnoid block anesthesia.Methods: This study was a Randomized Controlled Trial (RCT), with an intervention group (n=50) listening to music after subarachnoid block during surgery and a control group (n=50) receiving standard routine anesthetic care. Anxiety assessment using the STAI score and vital signs were performed at 3 different times in both groups.Results: There were no differences in patient characteristics between the two groups. Anxiety measurement in the reception room (X1) showed 37 patients (74%) and 31 patients (62%) with moderate anxiety in the intervention and control groups, respectively (p>0.05). There was no difference in patient anxiety levels between the two groups (p>0.05) in the operating room (X2). Post-operative anxiety measurement in the recovery room (X3) showed 43 patients (86%) with low anxiety in the intervention group, compared to 32 patients (64%) in the control group. Patients who listened to music during surgery had a lower level of post-operative anxiety compared to the control group (p=0.011). Conclusion: Listening to music can reduce post-operative anxiety in patients undergoing surgery with subarachnoid block, compared to patients receiving standard routine care
Transesophageal Echocardiography–Derived Renal Resistive Index after Cardiopulmonary Bypass: A Novel Hemodynamic Marker of Postoperative Renal Vulnerability Parna, Dian Raseka; Kurniawaty, Juni
Jurnal Komplikasi Anestesi Vol 13 No 1 (2025)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i1.27983

Abstract

Acute kidney injury (AKI) remains a frequent and clinically significant complication following cardiopulmonary bypass (CPB), often developing despite apparently stable systemic hemodynamics. Conventional renal monitoring relies on delayed biochemical markers that fail to capture early disturbances in renal microcirculation. The renal resistive index (RRI) has emerged as a dynamic indicator of renal vascular resistance and microcirculatory stress, but its perioperative application has been limited by the practicality of transabdominal ultrasonography. Transesophageal echocardiography (TEE), routinely used during cardiac surgery, offers a unique opportunity for real-time assessment of renal hemodynamics during and immediately after CPB. This literature review synthesizes current evidence on the feasibility, physiological basis, and clinical relevance of TEE-derived RRI measurement in the post-CPB setting. The reviewed studies suggest that elevated RRI values reflect a complex interaction of renal vascular resistance, venous congestion, altered pulsatility, and inflammatory endothelial dysfunction rather than isolated reductions in renal blood flow. Importantly, RRI elevation frequently precedes changes in serum creatinine or urine output and has been associated with an increased risk of postoperative renal dysfunction, even in patients without overt hypotension or low cardiac output. TEE-derived RRI therefore represents a promising, underutilized hemodynamic marker for early identification of postoperative renal vulnerability and may support more proactive, organ-protective hemodynamic management strategies following cardiopulmonary bypass
Anesthetic Management for Incomplete Atrioventricular Septal Defect Priambodo, Bhimo; Pratomo, Bhirowo Yudo; Kurniawaty, Juni
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.76955

Abstract

Background: Atrioventricular septal defect (AVSD) is a congenital heart anomaly that arises from the incomplete fusion of the endocardial cushions, resulting in communication between the atria and ventricles and abnormal development of the atrioventricular valves. Incomplete AVSD accounts for a smaller proportion of congenital heart defects but presents significant challenges in both surgical and anesthetic management due to complex pathophysiology and perioperative risks. This study to report and discuss the anesthetic management of a pediatric patient with incomplete AVSD undergoing surgical repair.Case: We report the case of a 7-year-old boy with incomplete AVSD who underwent surgical closure and mitral valve cleft repair. Preoperative evaluation included echocardiography and cardiac catheterization. General anesthesia was induced with fentanyl, propofol, and sevoflurane, and maintained during cardiopulmonary bypass (CPB). Intraoperative transesophageal echocardiography (TEE) confirmed effective repair. Postoperatively, the patient experienced transient arrhythmia that resolved with pacing and was successfully extubated on the first postoperative day without complications.Discussion: Children with congenital heart disease (CHD) are at higher risk of morbidity and mortality due to the complex physiological derangements caused by the defects. Anesthetic management in AVSD depends on the degree of left-to-right shunting and the presence and severity of pulmonary vascular hypertension. Important considerations include neonatal and pediatric anesthesia principles, congenital cardiac anatomy and physiology, CPB techniques, and potential postoperative complications.Conclusion: Anesthetic management in incomplete AVSD requires a comprehensive understanding of pediatric CHD, perioperative monitoring, and CPB protocols. Multidisciplinary collaboration and meticulous perioperative planning are crucial in improving outcomes and minimizing complications in pediatric cardiac surgery.
The Role of Central Venous Oxygen Saturation (ScvO₂) in Cardiac Surgery Wardhana, Ardyan Prima; Kurniawaty, Juni
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.64-72

Abstract

Introduction: Central venous oxygen saturation (ScvO₂) is generally more preferred over mixed venous oxygen saturation (SvO₂) for indirectly assessing tissue oxygenation due to its simplicity, cost-effectiveness, and routine use during cardiac surgery. Precise tissue oxygenation monitoring during cardiac surgery is crucial for optimizing patient management and improving perioperative outcomes. Objective: This literature review evaluates the role of ScvO₂ in managing and predicting outcomes in cardiac surgery patients. Review: From 93 identified articles, 38 studies met the inclusion criteria. These studies explored ScvO₂ as a postoperative outcome predictor and a perioperative therapeutic guide. These studies also explored its correlation with other parameters and its normal value ranges. Their findings indicate that using ScvO₂ as a guide for blood transfusion does not significantly alter postoperative outcomes compared to standard practices. Continuous ScvO₂ monitoring can also predict fluid responsiveness in critically ill patients. The value of ScvO₂ is less consistent in predicting poor postoperative outcomes and should therefore be combined with lactate level monitoring. When interpreting ScvO₂ values as a substitute for SvO₂, one must consider the variability between the two, especially in cases of severe hypoperfusion. Furthermore, although the recommended target for ScvO₂ is above 70%, an upper limit should also be established because ScvO₂ values exceeding 80% may actually indicate impaired oxygen extraction at the tissue level. Summary: ScvO₂ can be used as a guide for blood transfusion therapy and fluid administration in patients undergoing cardiac surgery. Furthermore, integrating ScvO₂ monitoring with lactate levels can enhance its predictive ability for poor postoperative outcomes in cardiac surgery.
Acid-Base Disorders: Interpretation of the Stewart Approach Stanie, Shianita; Juni Kurniawaty; Sudadi
Jurnal Komplikasi Anestesi Vol 13 No 2 (2026)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i2.28907

Abstract

Comprehension of physiological consequences arising from acid-base disturbances, together with manageable factors such as ventilation and perfusion that rapidly affect acid-base balance, is essential for anesthesiologists. The application of the Stewart acid-base model has advanced the mechanistic understanding of acid-base physiology. This model incorporates shifts in ions, including Cl-, K+, Na+, and PO43-, as well as the buffering capacity of albumin, to detect acid-base disorders. The Stewart approach is superior for identifying subtle and otherwise undetectable metabolic changes. It is founded on three core principles: electroneutrality, dissociation equilibria of incompletely dissociated substances, and mass conservation. In the Stewart method, [HCO3-] and pH in body fluids represent dependent variables determined by three independent variables: total CO2, strong ion difference (SID), and total weak non-volatile acid concentration (ATOT), which is primarily governed by albumin and phosphate levels.
The Correlation Between Syndecan-1 Post Cardiopulmonary Bypass and Duration of Ventilator Use in Open Heart Surgery Patients at Dr. Sardjito General Hospital, Yogyakarta Fatmi Eka Putri; Synthana, Meta Restu; Kurniawaty, Juni
Jurnal Komplikasi Anestesi Vol 13 No 2 (2026)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i2.29233

Abstract

Background: Open heart surgery involves the use of a cardiopulmonary bypass machine (CBP) to replace the heart and lungs during surgery. The use of CBP can damage the endothelial glycocalyx, which triggers increased levels of syndecan-1, an indicator of endothelial degradation. Elevated syndecan-1 levels are associated with various complications, such as coagulation disorders, edema, and organ dysfunction. In the lungs, endothelial glycocalyx damage can lead to edema and lung parenchymal damage, which can impair overall lung function and lead to a decreased PaO2/FiO2 ratio, requiring prolonged postoperative ventilator use.Objective: This study aimed to determine the relationship between post-CBP syndecan-1 levels and the duration of ventilator use in open heart surgery patients at Dr. Sardjito General Hospital, Yogyakarta.Methods: This study was a prospective, analytical, observational cohort study conducted at Dr. Sardjito General Hospital, Yogyakarta. The sample consisted of adult patients undergoing open heart surgery, with the exclusion criteria being patients using preoperative mechanical assist devices. Syndecan-1 levels were measured using the ELISA method using the Elabscience Human SDC1 kit. Data were analyzed using SPSS. Bivariate and multivariate analyses were also performed to evaluate factors influencing ventilator duration.Results: The study was conducted on 34 subjects with a mean age of 46 ± 13.71 years. The average CPB duration was 92.94 ± 47.57 minutes, with preoperative syndecan-1 levels of 8.86 ± 5.08 ng/ml, while post-CPB levels were 11.74 ± 3.71 ng/ml, with delta syndecan-1 levels of 2.87 ± 4.18 ng/ml.
Co-Authors . Supomo Akhmad Yun Jufan Alqustar, Adam Ancilla, Cornelia Anindita, Mohammad Pradhana Baskoro, Ronggo BHIMO PRIAMBODO Bhirowo Yudo Pratomo Bowo Adiyanto Budi Yuli Setianto Calcarina Fitriani Retno Wisudarti Cindy Elfira Boom Cornelia Ancilla Daniswara Dewi, Baiq Dessy Resmana Djayanti Sari Fadinie, Wulan Fatmi Eka Putri Gentong, Metia Gledis Gilang Hartiah Haroen Herdono Poernomo Hermawan, Hendra Joni, Rendy Pranda Khoeri, Fatkhur Roofi Kurniaji Kurniaji Kusuma, Danur Adi Kusumandaru , Novierta Prima Meta Restu Synthana Muhammad Mufti Sofyanoor Muhdar Abubakar Novita Intan Arovah Nurdiansyah, Elba Oktavian Rizki Ilahi Pambudi, Estu Agung Parna, Dian Raseka Prandani, Muhammad Yogi R W, Calcarina Fitriani Rani, Hajar Rafika Ratih Kumala Fajar Apsari Rayhandika Ridha, Ihsanur Rifdhani Fakhrudin Nur Rifdhani Fakhrudin Nur Sadewo, Yuri Sari, Dhanty Dwita SATRIYAS ILYAS Setiandari, Kristina Sofwan, Fachruddin Stanie, Shianita Sudadi Utomo, F uad Cipto Wardhana, Ardyan Wardhana, Ardyan Prima Wibowo, Erry Alamsyah Asjhuri yudihart, Subhan Yunita Widyastuti Yusmein Uyun