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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Majalah Anestesia & Critical Care (MACC) Jurnal Komplikasi Anestesi
Wardhana, Ardyan
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Medicine & Pharmacology

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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.
Three-Way Stopcock as Breathing Circuit in Anesthetic Procedures on Wistar Rats as Animal Models in Research Wardhana, Ardyan; Nugroho, Johanes
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 1 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (256.612 KB) | DOI: 10.20473/ijar.V4I12022.55-61

Abstract

Introduction: General anesthesia in experimental animals is not limited in the field of anesthesia research. In Indonesia, ventilators and breathing circuit systems utilized in research involving anesthesia in rats are not widely available. The limitations in using ventilators and breathing circuit systems in research are one of the reasons why Indonesia is lacking complex and advanced animal experimental studies. Objective: This study aimed to examine a general anesthesia procedure for intubation in rats using tools and materials commonly discovered in clinical settings. Method: A search on the PubMed database using keywords consisting of animal study, rats, anesthesia, breathing circuit was performed. Review and Discussion: An endotracheal tube insertion procedure may utilize a Miller size 0 laryngoscope, while the endotracheal tube may use a 16 G intravenous cannula in which the needle is replaced by a small wire. The 3-way stopcock system may be considered as a replacement for the Mapleson E system for the breathing circuit system. The Fresh Gas Flow (FGF) source needs to be connected to the angled port, while the other two ports are connected to the reservoir and the intravenous cannula which would be delivered to the experimental animals. FGF three to five times as much as the minute ventilation may be used and the use of a reservoir capacity is similar to the tidal volume of spontaneous ventilation. Therefore, the oxygen flow rate is set to approximately 1-1.5 L per minute. A reservoir is not required for controlled ventilation. Conclusion: The use of a 3-way stopcock as a non-rebreathing circuit system is effective because it utilizes the similar principle as Mapleson E. The ability to use common tools and materials for general anesthesia procedures would significantly boost research of animal models in Indonesia to a further level.
Analgesia Strategy on Cognitive Impairment after Spinal Anesthesia in Hip Surgery: A Meta-Analysis Wardhana, Ardyan; Wika Pratama, Violetta; Yusuf, Muhammad; Faisal Aga, Mohammad
Jurnal Komplikasi Anestesi Vol 12 No 3 (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.v12i3.14642

Abstract

Background: Previous studies have indicated no significant difference in the incidence of cognitive impairment between general anesthesia and spinal anesthesia for hip surgery. However, the debate between general and spinal anesthesia merely scratches the surface. Within spinal anesthesia, components like pre- or post-surgery analgesia warrant consideration in optimizing strategies for geriatric patients. Objective: Hence, our study aims to analyze cognitive impairment incidence across various analgesia strategies as adjuncts to spinal anesthesia for hip surgery.Subject and Methods: We systematically conducted a search across two databases for randomized trials that investigated the incidence of cognitive impairment following hip surgery with spinal anesthesia. We analyzed pooled data for distinct pre or post-operative analgesia approaches. The primary outcome of this review was the occurrence of post-operative delirium (POD) within 7 days post-surgery and delayed neurocognitive recovery (DNCR), defined as cognitive impairment within the first 30 days after surgery.Results: A systematic search yielded 13 studies comparing analgesia modalities. Based on our meta-analysis results, we demonstrated that adequate analgesia administration could decrease the incidence of POD (RR: 0.37, 95% CI: 0.20 – 0.68; p < 0.05, moderate quality of evidence), DNCR at 24 hours post-operatively, 72 hours, and 4-7 days post-operatively.
Co-Authors Faisal Aga, Mohammad Juni Kurniawaty Muhdar Abubakar Djayanti Sari Muhammad Yusuf Nugroho, Johanes Wika Pratama, Violetta