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Effectiveness of Dexmedetomidine Compared to Midazolam for Sedation in Mechanically Ventilated Patients: A Narrative Review Haithami, Guntur Mu Ammar; Putu Agus Surya Panji; Ida Bagus Krisna Jaya Sutawan; Christopher Ryalino
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/359b8m36

Delirium is a common and clinically significant neuropsychiatric complication in mechanically ventilated adult ICU patients, contributing to prolonged hospitalization, increased morbidity, and long-term cognitive impairment. The choice of sedative agent plays a pivotal role in preventing delirium, with dexmedetomidine and midazolam representing the most commonly used drugs with contrasting mechanisms. This narrative review evaluates the clinical efficacy, safety profile, neurocognitive outcomes, and cost-effectiveness of dexmedetomidine compared with midazolam in mechanically ventilated ICU patients. Literature was searched through PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar for studies published between 2020 and 2025 using the keywords dexmedetomidine, midazolam, sedation, mechanical ventilation, delirium, and intensive care units. Seventeen peer-reviewed publications were included and analyzed narratively. Dexmedetomidine consistently reduced the incidence and duration of delirium (RR 0.55–0.65; 95% CI 0.4–0.8), shortened mechanical ventilation by 0.7–1.5 days, and facilitated earlier extubation compared to midazolam. Its α₂-adrenergic agonism at the locus coeruleus produces a sleep-like, cooperative sedation, with mild, dose-dependent bradycardia as the most frequent adverse effect. Despite higher acquisition cost, economic analyses reported average savings of US$ 450–700 (≈ IDR 7–10 million) per patient through reduced ICU stay and delirium-related complications. Overall, dexmedetomidine demonstrates superior efficacy and safety compared with midazolam for ICU sedation, providing both clinical and economic advantages. Integration into light-sedation and delirium-prevention bundles may improve ICU outcomes, particularly in resource-limited settings.

Dexmedetomidine as Adjuvant in Scalp Nerve Block for Craniotomy: A Double-Blind Randomized Clinical Trial Eka Nantha Kusuma, Putu; I Putu Pramana Suarjaya; Parami, Pontisomaya; IGAG Utara Hartawan; I Gusti Ngurah Mahaalit; I Putu Kurniyanta; Ida Bagus Krisna Jaya Sutawan; Sudiantara, Putu Herdita; I Made Gede Widnyana; Gde Agung Senapathi, Tjokorda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/q23wyc88

Introduction: Scalp nerve block (SNB) is an effective adjunct for attenuating hemodynamic responses and reducing postoperative pain in craniotomy. Dexmedetomidine (DEX), with its analgesic and anti-inflammatory properties, may enhance the quality of SNB. This study evaluated the effects of adding DEX to SNB on hemodynamic stability, postoperative pain, inflammatory response, and analgesic duration in craniotomy patients. Methods: A double-blind, parallel-group randomized clinical trial was conducted on 36 adult patients undergoing elective craniotomy (July–September 2025) at a tertiary hospital Denpasar. Participants received SNB using 0.375% ropivacaine (20 mL) with or without DEX 1 µg/kg under standardized general anesthesia. Outcomes included mean arterial pressure (MAP), Visual Analog Scale (VAS) scores at 12 and 24 hours, neutrophil-to-lymphocyte ratio (ΔNLR), and time to first rescue analgesic (TTFAR). Statistical analyses used mixed ANOVA and Mann–Whitney U tests. Ethical approval number was 2159/UN14.2.2.VII.14/LT/2025. Results: MAP was significantly lower in the DEX group at 10 minutes (Δ = 4.89 mmHg; 95% CI 1.62–8.16), 20 minutes (Δ = 4.83; 95% CI 1.57–8.10), 30 minutes (Δ = 3.67; 95% CI 0.40–6.94), and upon PACU arrival (Δ = 3.72; 95% CI 0.45–6.99) (all p < 0.05). Median VAS scores were significantly lower with DEX at 12 hours (1.50 vs 3.00; p < 0.001) and 24 hours (1.00 vs 2.00; p < 0.001). ΔNLR was reduced in the DEX group (−0.56 vs 3.08; p = 0.004). TTFAR was markedly prolonged (554 vs 257 minutes; p < 0.001). No adverse events were reported. Conclusion: Dexmedetomidine added to scalp nerve block enhances hemodynamic stability, reduces postoperative pain for up to 24 hours, suppresses early systemic inflammation, and prolongs analgesic duration in craniotomy without observed complications. DEX–SNB represents a beneficial component of multimodal analgesia in neuroanesthesia and may support enhanced recovery pathways

Effectiveness of Dexmedetomidine Compared to Midazolam for Sedation in Mechanically Ventilated Patients: A Narrative Review Haithami, Guntur Mu Ammar; Putu Agus Surya Panji; Ida Bagus Krisna Jaya Sutawan; Christopher Ryalino
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/359b8m36

Delirium is a common and clinically significant neuropsychiatric complication in mechanically ventilated adult ICU patients, contributing to prolonged hospitalization, increased morbidity, and long-term cognitive impairment. The choice of sedative agent plays a pivotal role in preventing delirium, with dexmedetomidine and midazolam representing the most commonly used drugs with contrasting mechanisms. This narrative review evaluates the clinical efficacy, safety profile, neurocognitive outcomes, and cost-effectiveness of dexmedetomidine compared with midazolam in mechanically ventilated ICU patients. Literature was searched through PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar for studies published between 2020 and 2025 using the keywords dexmedetomidine, midazolam, sedation, mechanical ventilation, delirium, and intensive care units. Seventeen peer-reviewed publications were included and analyzed narratively. Dexmedetomidine consistently reduced the incidence and duration of delirium (RR 0.55–0.65; 95% CI 0.4–0.8), shortened mechanical ventilation by 0.7–1.5 days, and facilitated earlier extubation compared to midazolam. Its α₂-adrenergic agonism at the locus coeruleus produces a sleep-like, cooperative sedation, with mild, dose-dependent bradycardia as the most frequent adverse effect. Despite higher acquisition cost, economic analyses reported average savings of US$ 450–700 (≈ IDR 7–10 million) per patient through reduced ICU stay and delirium-related complications. Overall, dexmedetomidine demonstrates superior efficacy and safety compared with midazolam for ICU sedation, providing both clinical and economic advantages. Integration into light-sedation and delirium-prevention bundles may improve ICU outcomes, particularly in resource-limited settings.

Dexmedetomidine as Adjuvant in Scalp Nerve Block for Craniotomy: A Double-Blind Randomized Clinical Trial Eka Nantha Kusuma, Putu; I Putu Pramana Suarjaya; Parami, Pontisomaya; IGAG Utara Hartawan; I Gusti Ngurah Mahaalit; I Putu Kurniyanta; Ida Bagus Krisna Jaya Sutawan; Sudiantara, Putu Herdita; I Made Gede Widnyana; Gde Agung Senapathi, Tjokorda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/q23wyc88

Introduction: Scalp nerve block (SNB) is an effective adjunct for attenuating hemodynamic responses and reducing postoperative pain in craniotomy. Dexmedetomidine (DEX), with its analgesic and anti-inflammatory properties, may enhance the quality of SNB. This study evaluated the effects of adding DEX to SNB on hemodynamic stability, postoperative pain, inflammatory response, and analgesic duration in craniotomy patients. Methods: A double-blind, parallel-group randomized clinical trial was conducted on 36 adult patients undergoing elective craniotomy (July–September 2025) at a tertiary hospital Denpasar. Participants received SNB using 0.375% ropivacaine (20 mL) with or without DEX 1 µg/kg under standardized general anesthesia. Outcomes included mean arterial pressure (MAP), Visual Analog Scale (VAS) scores at 12 and 24 hours, neutrophil-to-lymphocyte ratio (ΔNLR), and time to first rescue analgesic (TTFAR). Statistical analyses used mixed ANOVA and Mann–Whitney U tests. Ethical approval number was 2159/UN14.2.2.VII.14/LT/2025. Results: MAP was significantly lower in the DEX group at 10 minutes (Δ = 4.89 mmHg; 95% CI 1.62–8.16), 20 minutes (Δ = 4.83; 95% CI 1.57–8.10), 30 minutes (Δ = 3.67; 95% CI 0.40–6.94), and upon PACU arrival (Δ = 3.72; 95% CI 0.45–6.99) (all p < 0.05). Median VAS scores were significantly lower with DEX at 12 hours (1.50 vs 3.00; p < 0.001) and 24 hours (1.00 vs 2.00; p < 0.001). ΔNLR was reduced in the DEX group (−0.56 vs 3.08; p = 0.004). TTFAR was markedly prolonged (554 vs 257 minutes; p < 0.001). No adverse events were reported. Conclusion: Dexmedetomidine added to scalp nerve block enhances hemodynamic stability, reduces postoperative pain for up to 24 hours, suppresses early systemic inflammation, and prolongs analgesic duration in craniotomy without observed complications. DEX–SNB represents a beneficial component of multimodal analgesia in neuroanesthesia and may support enhanced recovery pathways

Evaluating the Efficacy of Nerve Blocks in Chronic Pain: A Comprehensive Systematic Review Martin Gabe Tua Sihotang; Ida Bagus Krisna Jaya Sutawan
The International Journal of Medical Science and Health Research Vol. 21 No. 4 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/tdx2y710

Introduction: Chronic pain, defined as persistent pain lasting beyond three months, represents a formidable global health challenge, contributing to profound disability, diminished quality of life, and immense socioeconomic burdens. Within the multidisciplinary management armamentarium, interventional pain management techniques, particularly nerve blocks, have emerged as critical therapeutic options for patients unresponsive to conservative measures. However, the literature on the efficacy of these procedures is characterized by significant heterogeneity, with variable reported success rates, durations of benefit, and levels of evidence across different anatomical targets and chronic pain conditions. This necessitates a comprehensive, systematic, and critical synthesis of the available evidence to guide clinical practice and future research directions (Manchikanti et al., 2024; Kaye et al., 2015; Boswell et al., 2015). Methods: This systematic review was conducted following a rigorous, multi-stage methodology. Across PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library. For the final report, the 40 sources with the highest screening scores were synthesized. Results: The synthesis of 40 high-quality sources reveals a nuanced landscape of efficacy. For spinal facet joint pain, therapeutic lumbar and cervical medial branch blocks, especially when preceded by positive diagnostic blocks, demonstrate Level II evidence for sustained, long-term improvement. RCTs report 82-90% of patients achieving ≥50% pain relief at 2-year follow-up, with each treatment providing a mean relief duration of 15-19 weeks, necessitating approximately 3-6 treatments over two years for sustained benefit (Manchikanti et al., 2007, 2008, 2010; Falco et al., 2012). Radiofrequency neurotomy for facet joint pain shows good to Level II evidence (Janapala et al., 2021). For chronic migraine, greater occipital nerve blocks (GONB) demonstrate significant efficacy, with meta-analyses showing a pooled reduction of 3.6 headache days per month and a 2.2-point reduction in pain severity (Shauly et al., 2019; Mustafa et al., 2024). In knee osteoarthritis, genicular nerve radiofrequency ablation (GnRFA) shows moderate-certainty evidence, with approximately 51% of patients achieving ≥50% pain reduction at 6 months; notably, large lesion techniques (55% success) significantly outperform small lesion techniques (34% success) at 12 months (Kanjanapanang et al., 2025; Zeitlinger et al., 2019). For vertebrogenic low back pain with Modic changes, basivertebral nerve ablation (BVNA) shows robust superiority over standard care (RR 4.16 for ≥50% pain reduction) but a much more modest advantage over sham procedures (RR 1.25), indicating a substantial placebo component (Khalil et al., 2019; Conger et al., 2021). Suprascapular nerve blocks are superior to both placebo (SMD=0.70) and physical therapy (SMD=0.75) for chronic shoulder pain at 12 weeks (Chang et al., 2016). Epidural steroid injections show variable evidence, with transforminal approaches having stronger long-term support for radicular pain than interlaminar approaches (Abdi et al., 2007). Specialized blocks for cancer pain (splanchnic neurolysis) and other conditions (cryoneurolysis, impar ganglion block) also show promising results. The safety profile across all modalities is favorable, with minimal serious adverse events reported. Discussion: The discussion reconciles the apparent heterogeneity in findings by analyzing key moderating variables. Efficacy is profoundly context-dependent, influenced by anatomical precision, technical parameters (e.g., lesion size in GnRFA, approach in epidurals), and rigorous patient selection via diagnostic blocks. A universal finding is the temporal decay of therapeutic effect, underscoring that nerve blocks often provide time-limited relief, logically leading to a paradigm of planned, repeat interventions for chronic conditions. A critical appraisal reveals the powerful influence of the placebo effect, particularly evident in BVNA trials, and highlights concerns regarding evidence quality, including potential bias from industry funding and a relative paucity of high-quality, independent, long-term, sham-controlled RCTs. The evidence hierarchy established allows for condition-specific, evidence-based recommendations. Conclusion: Nerve block interventions are effective and safe for a range of specific, well-defined chronic pain conditions, including facet joint-mediated spinal pain, chronic migraine, knee osteoarthritis (with optimized technique), and vertebrogenic back pain. However, their benefits are frequently not permanent, and optimal outcomes depend on accurate diagnosis, precise technique, and realistic expectation management involving potential repeat treatments. Future research must prioritize independent, sham-controlled RCTs with long-term follow-up, direct comparative effectiveness studies, and investigations into predictive biomarkers to personalize therapy.

Manajemen Anestesi pada Pasien Glioblastoma Multiforme Recurrent yang Menjalani Sitoreduksi Tumor dengan Menggunakan Teknik Bebas Opioid: Laporan Kasus Adhiwirawan, Christina Angelia Maharani Dewi; Suarjaya, I Putu Pramana; Sutawan, Ida Bagus Krisna Jaya; Hartawan, I Gusti Agung G Utara; Ryalino, Christopher
Majalah Anestesia & Critical Care Vol 44 No 1 (2026): Februari
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.v44i1.476

Pendahuluan: Glioblastoma Multiforme (GBM) adalah jenis glioma yang sangat agresif dan memiliki prognosis yang buruk. Dalam beberapa tahun terakhir, didapati dampak anestesi dan analgesik terhadap progresivitas kanker. Paparan jangka pendek terhadap agen anestesi, yaitu anestesi inhalasi, dapat mempercepat pertumbuhan tumor. Selain itu, pasien yang terpapar dengan opioid pada kuantitas besar dalam beberapa hari setelah operasi akan mengalami progresivitas kanker lebih cepat daripada mereka yang mengonsumsi obat analgesik dalam jumlah terbatas dan dalam jangka waktu lebih pendek. Deskripsi Kasus: Pasien berusia 17 tahun dengan keluhan benjolan pada kepala sisi kanan yang progresif membesar dan tidak nyeri sejak satu bulan sebelum masuk rumah sakit. Kelemahan separuh tubuh kiri dan ptosis pada mata kanan sejak bulan Mei 2024. Pada bulan Juni 2024 telah dilakukan operasi reseksi tumor dan kraniektomi dekompresi dengan pembiusan umum diikuti dengan operasi sitoreduksi tumor pada bulan September 2024. Hasil CT kepala tanpa kontras didapatkan massa padat heterogen intra-aksial supratentorial pada thalamus kanan yang meluas ke lobus temporal kanan menyebabkan pergeseran struktur midline ke kiri sejauh 0,9 cm yang mengesankan massa residual dengan diagnosis banding massa residif. Tindakan anestesi dilakukan dengan pembiusan umum dengan teknik anestesi bebas opioid (opioid free) dan dikombinasikan dengan regional anestesi menggunakan scalp block. Kesimpulan: Teknik anestesi bebas opioid dapat digunakan sebagai modalitas dalam operasi GBM.

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