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All Journal E-Jurnal Medika Udayana Syntax Literate: Jurnal Ilmiah Indonesia Medicinus : Jurnal Kedokteran PREPOTIF : Jurnal Kesehatan Masyarakat Indonesian Journal of Anesthesiology and Reanimation (IJAR) JOURNAL LA MEDIHEALTICO Majalah Anestesia & Critical Care (MACC)
Kurniyanta, I Putu
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Humanities Education Environmental Science Health Professions Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary Other

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Optimizing Anesthesia for a Pediatric Patient with Cyanotic Heart Disease: Pulmonary Atresia with MAPCAs Putra, Kadek Agus Heryana; Kurniyanta, I Putu; Subagiartha, I Made; Akbar, Lalu Reza Aldira
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i2.57739

Abstract

Pulmonary atresia with major aortopulmonary collateral arteries (MAPCAs) is a rare and complex congenital heart anomaly marked by the absence of a direct connection between the right ventricle and the pulmonary arteries. The pulmonary blood supply originates via collateral arteries that arise from the aorta. Pulmonary atresia with major aortopulmonary collateral arteries (MAPCAs) poses considerable difficulties in perioperative management, especially during general anesthesia for dental procedures in pediatric patients. This case report details the anesthetic management of a 5-year-old male with pulmonary atresia and MAPCAs undergoing dental extractions under general anesthesia. The anesthetic plan prioritized maintaining systemic blood pressure to ensure pulmonary perfusion, avoiding increases in pulmonary vascular resistance, and preventing myocardial depression. Anesthesia was induced with ketamine and fentanyl, while maintenance was achieved using sevoflurane and dexmedetomidine, with pressure-controlled ventilation to optimize hemodynamics. Postoperative recovery was uneventful, with the patient monitored in the pediatric intensive care unit. The management of patients with pulmonary atresia and MAPCAs requires careful planning and a multidisciplinary approach. A tailored anesthetic strategy emphasizing hemodynamic stability and oxygenation is critical. This report underscores the importance of understanding the pathophysiology of MAPCAs to optimize perioperative outcomes.
The Association Between Preoperative Anxiety and Pain Severity, Opioid Requirement, Neutrophil-to-Lymphocyte Ratio, and Postoperative Blood Glucose After Gynecologic Laparotomy at Ngoerah Hospital Bora, Fivilia Anjelina; Dewi, Dewa Ayu Mas Shintya; Kurniyanta, I Putu; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Suarjaya, Putu Pramana; Aribawa, I Gusti Ngurah Mahaalit; EM, Tjahya Aryasa; Parami, Pontisomaya; Labobar, Otniel Andrians
Medicinus Vol. 15 No. 2 (2026): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v15i2.10969

Abstract

Background: We assessed whether preoperative anxiety is associated with postoperative pain severity, opioid requirement, neutrophil-to-lymphocyte ratio (NLR), and blood glucose after gynecologic laparotomy. Methods: Prospective cohort at Ngoerah Hospital (May to June 2025). Anxiety was measured preoperatively with APAIS and categorized as non-anxious, mild, moderate, or severe. Outcomes were NRS pain at 6, 12, and 24 hours, total fentanyl in the first 24 hours, and NLR and blood glucose at 6 hours postoperatively. Multivariable analysis used MANCOVA (99% confidence intervals). Result: Fifty-four patients were included (mean age 41.78 ± 10.58 years). Anxiety distribution was 46.3% non-anxious, 25.9% mild, 24.1% moderate, and 3.7% severe. Higher anxiety was associated with higher NRS at 6 hours (B 0.842; 99% CI 0.475 to 1.209; p < 0.001), 12 hours (B 0.381; 0.247 to 0.515; p < 0.001), and 24 hours (B 0.158; 0.048 to 0.269; p = 0.048). Anxiety was associated with higher 24-hour fentanyl requirement (B 147.8 microg; 99% CI 124.062 to 171.651; p < 0.001), higher postoperative NLR (B 4.31; 99% CI 0.609 to 8.027; p = 0.024), and higher postoperative blood glucose (B 19.4 mg/dL; 99% CI 7.912 to 30.912; p = 0.001). Conclusions: Higher preoperative anxiety was independently associated with worse pain, greater opioid requirement, and higher postoperative NLR and blood glucose after gynecologic laparotomy.
Co-Authors Akbar, Lalu Reza Aldira Bora, Fivilia Anjelina Burhan Dewi, Dewa Ayu Mas Shintya EM, Tjahya Aryasa Fikrawan, Putu Filla Jaya Giovanni, Malvin I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Made Gede Widnyana I Made Prema Putra I Made Subagiartha I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan Jimmy Wongkar Kadek Agus Heryana Putra, Kadek Agus Labobar, Otniel Andrians Made Wiryana Paskalis, Timothy Pontisomaya Parami Pratiwi, Made Sindy Astri Putu Herdita Sudiantara, Putu Herdita Putu Pramana Suarjaya Senapathi, Tjokorda Sidemen, I Gusti Putu Sukrama Sidemen, IGP Sukrana Suranadi , I Wayan Thomas, Vinsensius Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa Widyana, I Made Gede Yustisia, Putu Ngurah Krisna Denta