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All Journal Medicina E-Jurnal Medika Udayana Jurnal Anestesiologi Indonesia Bali Journal of Anesthesiology Medicinus : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico JOURNAL LA MEDIHEALTICO Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Putu Pramana Suarjaya
Faculty Of Medicine Anesthesiology & Therapy Intensif Universitas Udayana Denpasar
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Physics Public Health Veterinary Other

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Pain Management in Blast Crisis Phase of Chronic Myeloid Leukemia: A Case Report Soerodjotanojo, Simson Samuel; Michael Humianto; I Putu Pramana Suarjaya; Made Septyana Parama Adi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i2.921

Abstract

Background: Chronic myeloid leukemia (CML) is a slow-growing type of cancer that begins in the bone marrow's blood-forming cells and is caused by a chromosomal mutation that is assumed to develop spontaneously. As CML advances into the rapid or blast phase, it can cause significant pain. This study aimed to describe pain management in the blast crisis (BC) phase of CML. Case presentation: A 48-year-old female diagnosed with CML in the BC phase complained of severe pain in the head, shoulders, back, and tailbone area with a numeric rating scale (NRS) of 9/10. The patient received multimodal analgesic therapy with continuous IV fentanyl at a rate of 0.25 mcg/kg/hour and ketamine at 1.3 mcg/kg/minute for 24 hours. The dosage was gradually increased through titration with a target NRS of 4/10. On the fifth day, we replaced fentanyl with morphine at 0.04 mg/kg/hour and ketamine at 1.3 mcg/kg/minute, and we reduced the titration dose according to the patient’s NRS, and her pain was controlled with NRS 3-4/10 after 7 days of treatment. On the 9th day, she was discharged with oral therapy. Conclusion: Multimodal analgesia has been shown to effectively reduce the intensity of the pain in blast crisis phase.
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

Abstract

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
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

Abstract

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
Neuromonitoring on The 3rd Redo Craniotomy for Removal of Infratentorial Tumors Allan, Alma Hepa; Kulsum, Kulsum; Suarjaya, I Putu Pramana; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.744

Abstract

Infratentorial brain tumors such as medulloblastoma have serious neurological implications, particularly in children and adolescents. Re-craniotomy for infratentorial lesions increases the risk of anesthetic complications due to altered anatomy, tissue adhesions, and proximity to vital structures such as the brainstem and cranial nerves. The anesthetic approach must be tailored to support real-time intraoperative monitoring, such as Intraoperative Neurophysiological Monitoring (IONM), to prevent neurological injury. A 16-year-old male with a WHO Grade IV medulloblastoma in the left cerebellum extending to the vermis underwent re-craniotomy tumor removal. The patient presented with balance disturbances, diplopia, and dysphagia. CT scan revealed a solid mass measuring 6.6 × 5.96 × 6.71 cm with peritumoral edema and compression of the fourth ventricle. Anesthetic management included TIVA using propofol TCI Schneider 2–4 mcg/ml, dexmedetomidine 0.2–0.7 mcg/kg/hr, and intermittent rocuronium. The surgery lasted 8 hours and was complicated by cerebral edema managed with mannitol 1 g/kgBW. IONM detected prolonged activation of the left cranial nerve VIII. Intraoperative bleeding reached 1600 ml, managed with 465 ml of PRC. Hemodynamics remained stable with ConnX ranging from 34 to 80. Postoperatively, the patient was admitted to the ICU with mechanical ventilation and continuous sedation. Anesthetic management of infratentorial re-craniotomy requires an individualized approach encompassing hemodynamic stability, neural protection through IONM, and multimodal strategies to prevent postoperative complications. TIVA techniques and ConnX monitoring play an important role in maintaining optimal anesthetic balance and neurological function.
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

Abstract

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.
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 A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Himendra Wargahadibrata Adhiwirawan, Christina Angelia Maharani Dewi Adi, Made Septyana Parama Adinda Putra Pradhana Adityawarma, Anak Agung Ngurah Agung Harawikrama Agung Bagus S. Satyarsa Aldy, Aldy Allan, Alma Hepa Andika Metrisiawan Aryasa EM, Tjahya Aulyan Syah, Bau Indah Aulyan Syah, Bau Indah Bora, Fivilia Anjelina Brillyan Jehosua Toar Budiarta, Gede Chandra, Steven Okta Christanto, Sandhi Christanto, Sandhi Christopher Ryalino Christopher, Michael Chriswidarma, Dewa Gede Cynthia Dewi Sinardja D.H., Asterina Damayanti, Elok Demoina, I Gede Patria Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Eka Nantha Kusuma, Putu EM, Tjahya Aryasa Eric Makmur, Eric Firdaus, Riyadh Firdaus, Riyadh Gd. Harry Kurnia Prawedana Gde Agung Senapathi, Tjokorda Giovanni, Malvin Hartawan, I Gusti Agung G Utara Hartawan, IGAG Utara Hendrikus Gede Surya Adhi Putra Hengky Hengky, Hengky I Gede Catur Wira Natanagara I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Made Gede Widnyana I Made Stepanus Biondi Pramantara I Putu Agus Surya Panji I Wayan Ade Punarbawa I Wayan Niryana I Wayan Suranadi I. D. G. Tresna Rismantara Ida Bagus Alit Saputra Ida Bagus Krisna Jaya Sutawan J Sutawan, Ida Bagus Krisna J. Sutawan, IB Krisna J. Sutawan, Ida Bagus Krisna Jeanne, Bianca Jimmy Wongkar Johanes, Kevin Paul Juwita, Nova Kadek Agus Heryana Putra, Kadek Agus Katipana, Madyline Victorya Ketut Yudi Arparitna, Ketut Yudi Khamandanu, Kadek Fabrian Kharisma, Chau Febriani Krisna J. Sutawan, Ida Bagus Krisnayanti, Ida Ayu Arie Kulsum Kulsum, Kulsum Kumaat, Garry D. Chrysogonus Kurniawan Komala, Tomas Ari Kurniawan Komala, Tomas Ari Kurniyanta, I Putu Kusuma, Oscar Indra Labobar, Otniel Andrians Laksono, Buyung Hartiyo Lauren, Christopher Made Septyana Parama Adi Made Wiryana Marilaeta Cindryani Lolobali, Marilaeta Cindryani MD, Burhan MD, Patricia Michael Humianto Muhammad Aris Sugiharso, Muhammad Aris Muliadi, Win Mulyadi, Win Narakusuma, Fajar Ni Made Supradnyawati, Ni Made Ni Putu Wardani Nova Juwita Nyoman Golden Paramartha, Bagus Patricia, Yoshie Permatasari, Endah Permatasari, Endah Pontisomaya Parami Prabowo, Pratama Yulius Pranata, I Made Harry Pratana, Yolanda Jenny Purwanto, Osmond Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Ratu, Tiffani Richard Richard Saleh, Siti Chasnak Saleh, Siti Chasnak Santo, Budi Sidabutar, Beny Pratama Sidemen, IGP Sukrana Sista Satyarsa, Agung Bagus Sista Soerodjotanojo, Simson Samuel Sri Maliawan Sri Rahardjo Suastika, I Gede Juli Sucandra, I Made Agus Kresna Supradnyana, I Nyoman Novi Suranadi , I Wayan Sutawan, IB Krisna Krisna Jaya Taopan, Damatus Try Hartanto Tatang Bisri Tini, Kumara Tirta, Ian Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa Virayanti, Luh Putu Diah Wanda, Aprilia Wargahadibrata, A. Hmendra Widyana, I Made Gede Wiryawan, I Nyoman Wisnu Wardhana Wundiawan, Kristian Felix Yani, Jancolin Yani