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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina Jurnal Anestesi Perioperatif Bali Journal of Anesthesiology Syntax Literate: Jurnal Ilmiah Indonesia 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 Journal of Social Research COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat Journal of Anesthesiology and Clinical Research Majalah Anestesia & Critical Care (MACC) Cerdika: Jurnal Ilmiah Indonesia International Journal of Psychology and Health Science Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif

I Made Gede Widnyana

Department Of Anesthesiology And Intensive Therapy, Faculty Of Medicine, Udayana University - Central General Hospital Prof. I.G.N.G. Ngoerah, Denpasar, Indonesia

Author-ID : 416041

Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Economics, Econometrics & Finance Education Environmental Science Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Veterinary Other

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CASE REPORT ANESTHETIC MANAGEMENT OF ADRENAL TUMOR RESECTION Widnyana, I Made Gede; Putra, Kadek Agus Heryana; Kurniyanta, Putu; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Hartono, Budi
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.28

ABSTRACTThe adrenal glands are secretory organs that are located above each kidney and produce hormones that play a major role in the metabolic processes. Tumors of the adrenal gland can cause metabolic abnormalities associated with hormonal disorders such as Cushings syndrome, pheochromocytoma, or Conns syndrome. To be able to give a good anesthetic management on resection of the adrenal tumor, it requires adequate preoperative evaluation. However, this will take large resources. Management of anesthesia in adrenal tumor with an unknown hormonal disorder should consider a variety of hormonal abnormalities that may present in the patient so it can be anticipated effectively.Keywords: incidentaloma, adrenalectomy, hormonal disorder, perioperative

The effectiveness of Patient Controlled Analgesia (PCA) morphine-ketamine compared to Patient Controlled Analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery Mahaalit Aribawa, I Gusti Ngurah; Agung Senapathi, Tjokorda Gde; Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Gede Widnyana, I Made; Aryabiantara, I Wayan; Parami, Pontisomaya; Nyoman Kurniasari, Pande; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.11

Background: Laparotomy may cause moderate to severe after surgery pain, thus adequate pain management is needed. The addition of ketamine in patient controlled analgesia (PCA) morphine after surgery can be the option. This study aims to evaluate the effectiveness of PCA morphine-ketamine compared to PCA morphine in patient postoperative laparotomy surgery to reduce total dose of morphine requirement and pain intensity evaluated with visual analog scale (VAS). Methods: This study was a double-blind RCT in 58 patients of ASA I and II, age 18-64 years, underwent an elective laparotomy at Sanglah General Hospital. Patients were divided into 2 groups. Group A, got addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) and patients in group B received morphine (1mg/ml) by PCA. Prior to surgical incision both group were given a bolus ketamine 0,15mg/ kg and ketorolac 0,5mg/kg. The total dose of morphine and VAS were measured at 6, 12, and 24 hours postoperatively. Result: Total dose of morphine in the first 24 hours postoperatively at morphine-ketamine group (5,1Â±0,8mg) is lower than morphine only group (6,5Â±0,9mg) p<0,001. VAS (resting) 6 and 12 hour postoperative in morphine-ketamine group (13,4Â±4,8 mm) and (10,7Â±2,6 mm) are lower than morphine (17,9Â±4,1mm) pâ¤0,05 and (12,8Â±5,3mm) pâ¤0,05. VAS (moving) 6, 12, and 24 hour postoperative morphineketamine group (24,8Â±5,1mm), (18Â±5,6mm) and (9Â±5,6mm) are lower than morphine (28,7Â±5,2mm) pâ¤0,05, (23,1Â±6,0mm) pâ¤0,05, and (12,8Â±5,3mm) pâ¤0,05. Conclusions: Addition of ketamine in PCA morphine for postoperative laparotomy surgery reduces total morphine requirements in 24 hours compared to PCA morphine alone.

ANESTHESIA MANAGEMENT OF ESOPHAGEAL ATRESIA REPAIR SURGERY: A CASE REPORT Putra, Kadek Agus Heryana; Kurniyanta, Putu; Wiryana, Made; Sinardja, Ketut; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Cindryani, Marilaeta; Kurnia, Prajnaariayi Prawira
Bali Journal of Anesthesiology Vol 2, No 2 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i2.31

ABSTRACTEsophageal Atresia (EA)is a congenital anomaly commonly found with TracheoesophagealFistula (TEF) of neonates in the first week oflife. This anomaly can cause several complications includingaspiration, reduction in respiration, and other complication from other concomitant congenital anomaly, mostly from heart origin. The treatment for this anomaly is surgery.Intraoperatively, thepatient may develop hypoxia due to lung retraction and hemodynamic instability from bleeding or hypothermia. Anesthesiologists play important role in the management of EA during theperioperative period. Careful examination of the preoperative period must be done to discover any other concomitant anomaly and complication. Good anticipation of any complication during surgery and continuous monitoring post surgery can elevate the prognosis of the patient.

Leadership in anesthesiology: not just a one man show GA Senapathi, Tjokorda; Widnyana, IMG; Cindryani, Marilaeta
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.13

Anesthesiology had been one of highly skilled professional specialty with diversity of training but with a structured model of leadership culture. TheÂ culture which could be drawn back since medical training to become a medical doctor. School of medicine had already established a standard model of teaching and training. The tutoring method is implemented mostly based on classroom meetings in traditional basic lesson, bedside teaching for clerkship and internship and lately adopted method of case-based discussion

A PRELIMINARY STUDY ON THE PECTORALIS BLOCK II AS A PART OF MULTIMODAL ANALGESIA FOR INTRA AND POSTOPERATIVE PAIN MANAGEMENT IN MODIFIED RADICAL MASTECTOMY Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Ryalino, Christopher; Junaedi, I Made Darma
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Background: Inadequate acute postoperative pain management is the main risk factor for chronic pain after breast surgery. Pectoralis blocks I and II (pecs block I and II) are novels peripheral nerves block techniques introduced since 2011 by Blanco et al.Methods: Ten patients diagnosed with breast cancer planned for modified radical mastectomy (MRM), from preoperative evaluation patients with a physical status of American Society of Anesthesiologist (ASA) I and II. Anesthesia management under general anesthesia with an endotracheal tube and we performed PECS block II after general anesthesia. We recorded the systolic blood pressure, mean arterial pressure (MAP), and heart rate intraoperatively, and the pain scale at 4th, 6th, 12th, and 24th hours postoperatively.Results: The pain scale at 4th and 6th hours postoperatively were 0.3±0.5 and 0.6±0.5 respectively. The pain scale at resting starts to increase at the 12th and 24th hours (1.2±0.4 and 1.1±0.6). The mean total use of morphine recorded on PCA was 3.3 ± 0.9 (mg). No pecs block II complications were recorded in this study.Conclusion: Pecs block II is a relatively easy, safe, and effective for MRM surgeries. Further larger and double-blinded studies are needed to know its effectiveness compared to other techniques available.

Continuous caudal analgesia as a safe and effective method for pediatric post - chordectomy analgesia Senapathi, Tjokorda Gde Agung; Subagiartha, I Made; Widnyana, I Made Gede; Kurniyanta, Putu; Ryalino, Christopher; Estrada, Ronald
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTIt brings great satisfaction for medical officers to be able to see children smiling, laughing, and playing without pain after surgery, yet many children still experience inadequate postoperative pain management. This phenomenon could lead to serious immediate and long term effects in the pediatric patient. Disruption of the healing process caused by pain could become the source of morbidity and mortality in the early postoperative period. Opioid side effects and transformation from acute to chronic pain due to inadequate analgesia are other problems met when dealing with postoperative pain management. This is where regional analgesia takes advantage. Caudal analgesia is an old yet very popular method in pediatric anesthesia and has gained widespread use. It can be delivered as a single injection or continuous infusion. The continuous technique provides a longer duration of analgesia than single injection does. We report a satisfying result from using continuous caudal analgesia for post chordectomy pain management in a 5-year-old boy.

Combined morphine-clonidine adjuvant in epidural analgesia support role of supraspinal modulation in opioid tolerant patient Widnyana, I Made Gede; Cindryani, Marilaeta; Tanggono, Aninda
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACT Acute pain patients with complicated pain-related experiences would need more than just a pain reliever, especially those with behavioral opioid usage. Latest findings revolving supraspinal modulation are not only taking experts and pain physician into a different stage of understanding but also making theories and management revisited. A 41-years-old Australian male underwent plate and screw fixation of his right femur. He was overweight with a history of behavioral opioid usage. He was given epidural analgesia for postsurgical management with bupivacaine 0.1% with morphine 2 mg and clonidine 30 mcg every 12 hours as adjuvants. Hemodynamic curves were in normal limits, no paralysis, urinary difficulties, or pruritus. He was discharged on the fourth day. The combined morphine-clonidine adjuvant in epidural analgesia technique was an effective choice to alleviate pain response in this opioid-tolerant patient.

General anesthesia combined with thoracic epidural anesthesia: an anesthesia technique option in modified radical mastectomy Sidemen, I Gusti Ayu Eka Para Santi; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Aribawa, I Gusti Ngurah Mahaalit; Ryalino, Christopher
Bali Journal of Anesthesiology Vol 3: in press (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v3i0.128

The incidence of breast cancer has been increasing, and currently, it is the most common cancer in females. Surgery is the primary treatment, and the current tendency is toward less extensive procedure with axillary dissection for removal of lymph nodes to guide further treatment, in this case, the method called modified radical mastectomy (MRM). The anesthetic technique for MRM should provide adequate intraoperative anesthesia, muscle relaxation, and postoperative analgesia without collateral effects, nausea, and vomiting with the minimum hospitalization time. In this report, we present a case of a woman who underwent MRM under general anesthesia combined with thoracic epidural anesthesia.

Isobaric levobupivacaine for intrathecal anesthesia as an effective and safe option in transurethral resection of the prostate surgery Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Nada, I Ketut Wibawa; Astuti, Mira Kusuma
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

The search for safer anesthetic solutions has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, emerged as a safer alternative for intrathecal anesthesia than its racemic parent (bupivacaine). Levobupivacaine shows a lower risk of the central nervous system and cardiovascular toxicity.However, in many countries, levobupivacaine is only available in isobaric solution, where the isobaric solution for intrathecal anesthesia is still often be questioned its effectiveness because of the fear that the block spreading is unpredictable. In this case series, we describe sensory and motor block characteristics, hemodynamics profile and adverse effects of isobaric levobupivacaine in intrathecal anesthesia for six patients with American Society of Anesthesiology physical status II-III whose undergo transurethral endoscopic surgery.

Correlation Between Protein Intake and Nitrogen Balance of Surgical Patients in Anesthesiology and Intensive Care Installation, Sanglah General Hospital, Denpasar, Bali, Indonesia Wiryana, Made; Sinardja, I Ketut; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Panji, Putu Agus Surya; Aryabiantara, I Wayan; Cindryani, Marilaeta
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (361.832 KB)

Background: A cell injury from surgical stress in a trauma or a non-trauma case will induce a hyper metabolic response in which the protein degradation increases, the somatic protein synthesis decreases and the amino acid catabolism increases. Thus, the pyper metabolic response contributes to nitrogen loss in urine. This response, without an adequate nutrition, will lead an iatrogenic malnutrition and deterioration. A balance nitrogen formula through urinary urea nitrogen is one of many nutrition evaluation methods. This method aids in evaluating the daily nutrition status and it can be the baseline data for daily intake. Objective: To find a correlation between the protein intake and the nitrogen balance of the surgical patients in anesthesiology and intensive care installation, Sanglah General Hospital, Denpasar, Bali. Methods: Fifty-one surgical patients with trauma and non-trauma cases were observed for their protein intake for 2-3 days continuously. Moreover, they were evaluated for their nitrogen balance based on the urinary urea nitrogen per 24 hours for 2-3 days. For statistical analysis, we utilized Shapiro-Francia, Shapiro-Wilk, Spearman Frank correlation, two-sample t test, and multivariate regression analysis in Strata SE 12.1. Results: The correlation between the protein intake and the nitrogen balance on the first day was ra=0.50 (p<0.05), on the second day ra=0.70 (p<0,05), and on the third day ra=0.740 (p<0,05) Conclusions: There is a correlation between the protein intake and the nitrogen balance of surgical patients in Anesthesiology and Intensive Care Installation Sanglah General Hospital Denpasar.

Co-Authors Adinda Putra Pradhana Agrasidi, Putu Anindya Anak Agung Gde Agung Adistaya Ari Andayani Ariyasa, I Putu Eka Aryasa EM, Tjahya Astuti, Mira Kusuma Bora, Fivilia Anjelina Christopher Ryalino Cynthia Dewi Sinardja Damayanti, Elok Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Eka Nantha Kusuma, Putu Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Estrada, Ronald Ganakin, Acuyta Gde Agung Senapathi, Tjokorda Gede Semarawima, Gede Hartawan , I.G.A.G. Utara Hartawan, IGAG Utara Hengki Irawan Hengki Irawan Hengky Hengky, Hengky I Dewa Gede Tresna Rismantara, I Dewa Gede Tresna I Gde Raka Widiana I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Wibawa Nada I Made Agus Kresna Sucandra I Made Darma Junaedi, I Made I Made Subagiartha I Nyoman Hariyasa Sanjaya I Putu Agus Surya Panji I Wayan Aryabiantara, I Wayan I Wayan Suranadi IB Krisna, IB Ida Bagus Krisna Jaya Sutawan IGNA Putra Arimbawa, IGNA Putra Jeanne, Bianca Jim Anthonio, Jim Jimmy Wongkar Johanes, Kevin Paul Jonathan, Jeremy Junaedi, I Made Darma Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Kenzi, Ignatio Armando Ketut Semara Jaya, Ketut Semara Kurnia, Prajnaariayi Prawira Kurniyanta, I Putu Labobar, Otniel Andrians Made Adi Kusuma Made Agus Kresna Sucandra, Made Agus Kresna Made Wiryana Madyline Victorya Katipana Marilaeta Cindryani Marilaeta Cindryani Lolobali, Marilaeta Cindryani Marilaeta Cindryani, Marilaeta Mark Christsatya Bolla Mas Shintya Dewi, Dewa Ayu Nada, I Ketut Wibawa Otniel Adrians Labobar Pande Nyoman Kurniasari, Pande Pemayun, Cok Istri Dewiyani Pontisomaya Parami Putra, Agung Manik Septiana Putrawan, I Wayan Eka Putu Agus Surya Panji Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Renaldi Reynaldi Reiky Hadiwijaya Richard Richard Riko Riko Satria Pinanditas S Sidemen, I Gusti Ayu Eka Para Santi Sidemen, I.G.P.Sukrana Sidemen, IGP Sukrana Sonni Soetjipto, Sonni Sri Astuti Srinami Dewi Suastika, I Gede Juli Sutyawan, I Wayan Eka Tanggono, Aninda Tirta, Ian Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Agung Senapathi Tjokorda Gde Agung Senapathi Wanda, Aprilia Wardani, Dinar Kusuma Win Muliadi

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