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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Komplikasi Anestesi
Wijaya, Indriyani
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Medicine & Pharmacology

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Epidural Volume Extension (EVE) Sudadi; Mahmud; Wijaya, Indriyani
Jurnal Komplikasi Anestesi Vol 8 No 2 (2021): Volume 8 Number 2 (2021)
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.v8i2.8365

Abstract

Epidural Volume Extension (EVE) technique injects normal saline into the epidural chamber immediately after the injection of local anesthesia into the intrathecal space. Normal saline injection will increase the epidural space thus increasing the spreading of local anesthesia in previous intrathecal injections and making the distribution of cerebrospinal fluid to be higher. It can be said that EVE technique utilizes the volume effect of normal saline that decreases the volume of intrathecal space. The EVE technique may be useful for reducing the dose of local anesthesia injected intrathecally by still reaching a stronger block height for surgery, as well as for faster recovery of motor blockades. Unfortunately, the EVE technique does not significantly reduce the risks of hypotension. Hypotension persists even though the hemodynamics change is more stable.
Epidural Volume Extension (EVE) Wijaya, Indriyani; Mahmud
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
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.v11i1.12598

Abstract

Epidural Volume Extension (EVE) technique injects normal saline into the epidural chamber immediately after injection of local anesthesia into the intrathecal (or after subarachnoid/spinal block). Normal saline injection would widen the epidural space thus making the spread of local anesthesia in previous intrathecal injections and the distribution of cerebrospinal fluid to be higher (more cephalad), or it could be said that this EVE technique utilizes the volume effect of normal saline that decreases the volume of intrathecal space. The EVE technique may be useful for reducing the dose of local anesthesia injected intrathecally while still achieve an adequate block height for surgery, as well as for faster recovery of motor blockades. Unfortunately, for the risk of hypotension, the EVE technique does not significantly reduce this risk. Hypotension persists even though the hemodynamics (arterial blood pressure drop mean) is observed to be more stable.
Anesthetic Management of A Patient with Henoch-Schonlein Purpura for Caesarean Section Wijaya, Indriyani
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): 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.V4I22022.107-114

Abstract

Introduction: Henoch-Schonlein Purpura or Immunoglobulin-A vasculitis is a systemic vasculitis caused by immune complexes that attack small blood vessels. The classic symptoms of Henoch-Schonlein Purpura include erythema purpura,  arthralgia, gastrointestinal complaints, and renal involvement. Some cases show that pregnancy itself could be the trigger for its recurrence and lead to early delivery. Case report: A 33-year-old patient, G2P1A0 and 35 weeks and 4 days pregnant complained of diarrhea 8 days before hospital admission (8-15 times per day). The patient was diagnosed with Henoch-Schonlein Purpura 3 years ago. Upon monitoring in the ward, the fetus was found to be in a compromised condition and an emergency cesarean section was needed. The patient was assessed as having an ASA II physical status and was anesthetized with regional anesthesia epidural in the sitting position, with a median approach, puncture at L3-L4 level, and with 12 ml of Bupivacaine 0.5% isobaric. Postoperative care was continued in the ward. As long as there are no contraindications, a neuraxial block could be performed on parturient patients with Henoch-Schonlein Purpura who would undergo a cesarean section. Neuraxial block, namely epidural block, has the added advantage of being a postoperative analgesic and helps to avoid the use of Non-Steroidal Anti Inflammatory Drugs (NSAIDs) in Henoch-Schonlein Purpura patients who often have renal complications. Conclusion: Caesarean Section with  Henoch-Schonlein Purpura disease has been reported with Epidural Block Anesthesia without complications.
Using Multimodal Analgesia for Breakthrough Pain in Stage IV Breast Cancer Patient Wijaya, Indriyani; Mahmud
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (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.V5I12023.37-44

Abstract

Introduction: Breakthrough Pain (BTP) is experienced as mild to moderate-severe pain, from only a few seconds to hours. It causes a decrease in the quality of life and functional capacities. Furthermore, BPT must be recognizable, assessed, and controlled to prevent its relapse and severity. Case report: A woman, 45 years old, having breast cancer along with pulmonary, femur, and cervical metastases, came with the main complaint of pain. The patient had a pain score of NRS 9, which was felt intermittently for the last 3 months. Treatment has been carried out with MST 10 mg/8 hours and a Durogesic® patch (fentanyl 50 mcg/h) but the pain did not subside. Moreover, the patient was unable to identify any precipitating factors or pain relievers, while the diagnosis confirmed BTP. The rescue dose was administered in a range of 10 – 20% of the total daily dose in the last 24 hours equivalent to 11 – 22 mg intravenous Morphine or equianalgesic with 110 – 220 mcg of fentanyl. For immediate effect, transmucosal fentanyl was recommended, but this preparation is currently unavailable. Moreover, therapy was carried out with the continuous administration of Morphine, and the pain reduced to NRS 0 – 3 on the second day. Conclusion: Transmucosal fentanyl, either buccal, sublingual, oral, or nasal mucosa, was proven to be effective in treating BTP. However, when transmucosal fentanyl is not available, multimodal analgesia is an effective alternative.
Co-Authors Anastasia Susty Ambarriani Nurwijayanti Putri, Ni Luh Putu Eka Siti Helmyati Sudadi