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Tantri, Aida Rosita
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran Univesitas Indonesia – Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Jakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Opioid-Free Anesthesia in Ophthalmic Surgeries Tantri, Aida Rosita; Angkasa, Hansen; Firdaus, Riyadh; Claudia, Tasya; Tantri, Ignatia Novianti
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.V5I22023.81-87

Abstract

Introduction: Opioid-free anesthesia (OFA) is an alternative to Opioid based anesthesia (OBA) which uses multimodal analgesia to replace opioids. However, its feasibility, safety, and exact recommended combination remain debatable. Case Series: We administered OFA in 5 types of elective ophthalmic surgeries under general anesthesia in ASA 1-2 adult patients (evisceration, ocular exenteration, periosteal graft, scleral buckling, vitrectomy, and dacryocystorhinostomy) to assess the feasibility of OFA. We gave preoperative Paracetamol and Pregabalin with Dexmedetomidine as a loading dose (1 mcg/kg in 10 minutes) and maintenance at 0.7 mcg kg-1 per hour. Induction was performed using Propofol 1-2 mg kg-1, Lidocaine 1-1.5 mg kg-1 IV, and Rocuronium. Before the incision, Dexamethasone and Ranitidine were given. Maintenance was done using Dexmedetomidine and Sevoflurane. Fentanyl was used as rescue analgesia if required. Dexmedetomidine was stopped 15-30 minutes before the procedure ended. Metoclopramide and Ketorolac were given as postoperative management. Throughout the procedure, our patients had stable hemodynamics, did not experience life-threatening bradycardia, and did not require rescue analgesia. All patients regained full consciousness and did not experience postoperative nausea and vomiting, emergency delirium, or coughing. Conclusion: Multimodal analgesia was an excellent intraoperative OFA regimen as an alternative to OBA and provided controlled hypotension in ocular surgery. Safe OFA is possible with combined analgesia regimens, strict intraoperative monitoring, and adequate anesthesia depth.
Nyeri Pasca Operasi Dekompresi dan Stabilisasi Vertebra: Sampai Dimana Kita Saat Ini? Aida Rosita Tantri
Majalah Anestesia & Critical Care Vol 40 No 2 (2022): Juni
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 | Full PDF (199.801 KB) | DOI: 10.55497/majanestcricar.v40i2.272

Abstract

Pembedahan dekompresi dan stabilisasi tulang belakang ini berkaitan dengan nyeri perioperatif yang cukup signifikan. Nyeri pascabedah dekompresi dan stabilisasi tulang belakang lumbal dapat disebabkan oleh kerusakan jaringan yang terjadi selama pembedahan dan melibatkan aktivasi berbagai mekanisme nyeri. Nyeri dapat berasal dari struktur vertebra, diskus intervertebralis, ligamen, dura, sarung saraf, kapsula sendi faset dan otot. Struktur ini diinervasi oleh ramus posterior nervus spinalis yang memiliki hubungan erat dengan saraf simpatis dan parasimpatis. Selain akibat kerusakan jaringan selama pembedahan, nyeri pascabedah juga dapat disebabkan oleh iritasi mekanis, kompresi atau inflamasi pascabedah. Kegagalan dalam penanganan nyeri intraoperatif akan menyebabkan stimulasi simpatis, ditandai dengan timbulnya gangguan hemodinamik intraoperatif seperti takikardia, peningkatan tekanan darah, peningkatan isi sekuncup, dan peningkatan konsumsi oksigen jantung. Nyeri yang dialami pada pasien risiko tinggi dapat berakibat terjadinya iskemia atau bahkan infark miokard. Selain itu, nyeri akut pascabedah yang tidak tertangani dengan baik dapat menjadi nyeri kronik pascabedah. Oleh karena itu, manajemen nyeri intraoperatif yang baik dapat menurunkan angka morbiditas dan mortalitas pasien, memperbaiki kualitas hidup pasien, mempercepat pemulihan, mobilisasi dan mencegah timbulnya nyeri kronis. Analgesia multimodal saat ini merupakan pilihan manajemen nyeri perioperatif terbaik dalam pembedahan dekompresi dan stabilisasi tulang belakang. Analgesia multimodal mencakup pemberian obat-obatan intravena maupun analgesia regional selama periode perioperatif. Analgesia berbasis anestesia regional yang dapat digunakan adalah blok interfasia, yaitu infiltrasi dan pemberian anestetika lokal di antara fasia otot. Teknik ini mulai banyak digunakan baik sebagai suplementasi analgesia maupun anestesi tunggal pada berbagai pembedahan.
CONTINUOUS ADDUCTOR CANAL BLOCK IN A MORBIDLY OBESE HYPERTENSIVE PATIENT UNDERGOING POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE REPORT Yohanes Suandrianno; Aida Rosita Tantri
Journal of Society Medicine Articles in Press
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Morbid obesity with uncontrolled hypertension presents significant challenges in anesthetic management due to increased risks of perioperative respiratory complications and hemodynamic instability. This case report aims to describe the use of combined spinal anesthesia and continuous adductor canal block (ACB) in a morbidly obese patient undergoing posterior cruciate ligament reconstruction. A 31-year-old male weighing 130 kg with a height of 173 cm (BMI 43.4 kg/m²) was diagnosed with right posterior cruciate ligament rupture and had a preoperative blood pressure of 168/102 mmHg. Physical and laboratory examinations were otherwise unremarkable. Spinal anesthesia was performed using 15 mg of 0.5% hyperbaric bupivacaine at the L2–L3 interspace. Prior to surgical incision, ultrasound-guided ACB was performed and a continuous catheter was inserted. Postoperatively, a loading dose of 15 mL of 0.25% levobupivacaine was administered via the catheter, followed by continuous infusion of 0.125% levobupivacaine at 5 mL/hour for 48 hours. The three-hour surgery proceeded with stable hemodynamics and no vasopressor requirement. Postoperative pain scores ranged from NRS 1–2 without the need for rescue opioids and without complications. The combination of spinal anesthesia and continuous ACB provided hemodynamic stability and effective analgesia while preserving motor function and minimizing opioid use, suggesting its suitability for patients with similar risk profiles.
Co-Authors , Pryambodho Agusta, Laksmi Senja Ahmad Pasha Natanegara Alatas, Anas Anakotta, Vircha Anasthasia Devina Sutedja Anne Suwan Djaja Arni Diana Fitri Asmara, Yoseph Rohedi Auerkari, Aino Nindya Clarissa Emiko Talitaputri Claudia, Tasya Darto Satoto Edwin, Fahmi Agnesha Ekowati Handharyani Fadhila, Fulki Firdaus, Riyadh Franciscus Dhyana Giri Suyatna Hansen Angkasa Hansen Angkasa Hirda, Reni Ignatia Novita Tantri Irawan Mangunatmadja Kapuangan, Christopher Kurniawan, Teddy Kwan, Lawrence Muhammad A. I. Maulana Muhammad Indera Ramadani Muncieto Andreas Muzal Kadim Prawiro, Eric Priyono, Harim Pryambodho Pryambodho Putri, Armitha Rachmat, Linda Rahendra Rahendra Ratna Farida Soenarto Reza, Harris Putra Riyadh Firdaus Riyadh Firdaus Riyadh Firdaus Ruth Evlin Margaretha Satoto, Darto Saur Maruli Evan Johannes Sri Rejeki Sukmono, R. Besthadi Sukoco, Gunawan Tantri, Ignatia Novianti Tasya Claudia Taufiqo Nugraha S Theresia, Sandy Tri Asmaningrum Larasati Wicaksana, Daffa Abhista Yetty Ramli Yohanes Suandrianno