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Anesthetic Approach In A Patient With A Left Submandibular Colli Abscess and Multiple Comorbidities Richard, Richard; Mas Shintya Dewi, Dewa Ayu; Gede Widnyana, I Made
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i7.60694

Submandibular–colli abscess accompanied by comorbidities such as diabetic ketoacidosis (DKA), airway obstruction, and chronic heart failure (CHF) presents a complex anesthetic challenge. Patients with maxillofacial abscesses and comorbidities such as impending airway obstruction, diabetic ketoacidosis (DKA), and chronic heart failure pose significant challenges to anesthetic management. Each comorbidity significantly influences perioperative management and increases the risk of morbidity and mortality. The goal of preoperative management is to stabilize the patient prior to surgery and reduce the risk of perioperative complications. Preoperative management includes ensuring adequate oxygenation, optimizing and monitoring hydration status, and controlling blood glucose levels. Objectives: To describe the perioperative anesthetic approach in a patient with a left submandibular abscess and multiple comorbidities, emphasizing the importance of a holistic strategy in managing complex surgical cases. Case Report: A 51-year-old female presented with progressive swelling of the left face and neck for two weeks. Examination revealed a submandibular abscess, DKA, and a known history of CHF. The patient reported trismus and odynophagia with marked hyperglycemia. Imaging showed tracheal deviation and abscess extension to the retropharyngeal space. Preoperative management focused on metabolic stabilization and cardiovascular optimization. Awake fiberoptic intubation (AFOI) with dexmedetomidine sedation was performed due to the anticipated difficult airway. Surgery proceeded uneventfully for 2 hours and 10 minutes, followed by intensive postoperative monitoring. Discussion: Anesthetic management in patients with deep neck abscesses and comorbid DKA and CHF requires comprehensive perioperative planning. Metabolic and hemodynamic stability must be achieved prior to induction. Careful airway planning, the use of cardiovascularly stable anesthetic agents, and vigilant glucose and fluid monitoring are essential to prevent complications. Conclusion: Successful anesthetic care in patients with submandibular abscess and complex comorbidities demands coordinated, individualized perioperative strategies to minimize risk and optimize outcomes.

Axillary Plexus Block for Anesthesia Management in Patients with Acute Compartment Syndrome after Primary Percutaneous Coronary Intervention (PCI) Transradial Approach: A Case Report Renaldi; I Made Gede Widnyana; Otniel Adrians Labobar
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.v8i2.917

Background: Acute compartment syndrome is a rare complication of the percutaneous Coronary Intervention (PCI) transradial approach but it is very hand-threatening. Treatment for acute compartment syndrome is emergent fasciotomy of the affected compartments to reduce intracompartmental pressure. Axillary plexus block is an excellent choice of anesthesia technique for elbow, forearm, and hand surgery. Case presentation: An 80-year-old, 60 kg, 168 cm man was consulted to our department with a painful swelling on his right upper arm and hand that began three hours after a primary PCI procedure. Previously, the patient had a history of hypertension and diabetes mellitus. The supporting examination results were notable for anemia (Hemoglobin 7,5 g/dL), thrombocytopenia (78 x103/uL), elevated hemostasis function (International Normalized Ratio 1.43), and high blood sugar (360 mg/dL) from echocardiography results anteroseptal and lateral hypokinetic. Before we did block, the patient was given ketamine 10 mcg IV and fentanyl 25 mcg IV for sedation. Axillary plexus block, as a type of regional anesthesia under ultrasound guidance, is a reliable substitute for general anesthesia in high-risk patients, and we do it with a dose of 20 ml of solution (50 mg (10 ml) isobaric bupivacaine 0.5% + 200 mg lidocaine 2% diluted with 20 ml normal saline). During the surgery, the patient was hemodynamically stable. After the operation, the patient was readmitted to the intensive cardiac care unit (ICCU). Conclusion: Axillary plexus block can be an alternative to general anesthesia in patients who will undergo fasciotomy surgery after percutaneous coronary intervention transradial approach with stable hemodynamics during surgery and well-controlled pain after the surgery.

Dexmedetomidine pada Blok Torakolumbar Interfasial Plane Modifikasi: Tinjauan Naratif Ariyasa, I Putu Eka; I Made Gede Widnyana; I Made Agus Kresna Sucandra
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/s4tbj786

Nyeri pascaoperasi merupakan tantangan klinis utama pada pasien yang menjalani bedah tulang belakang lumbal. Pendekatan analgesia multimodal semakin berkembang, dan blok interfasial torakolumbal (Thoracolumbar Interfascial Plane/TLIP) menjadi salah satu teknik yang efektif dalam mengurangi nyeri dengan risiko minimal terhadap fungsi motorik. Modifikasi teknik TLIP, terutama dengan penambahan adjuvan seperti dexmedetomidine, menawarkan potensi peningkatan durasi dan kualitas analgesia. Tinjauan naratif ini bertujuan merangkum bukti terkini mengenai efektivitas, mekanisme, dan keamanan penggunaan dexmedetomidine sebagai adjuvan pada TLIP modifikasi untuk bedah lumbal. Pencarian literatur dilakukan melalui basis data PubMed, Scopus, dan Google Scholar dengan menggunakan kata kunci “modified TLIP block”, “dexmedetomidine”, “lumbar spine surgery”, dan “postoperative analgesia” untuk artikel berbahasa Inggris atau Indonesia yang diterbitkan antara tahun 2013 hingga 2024. Hasil sintesis menunjukkan bahwa penambahan dexmedetomidine (0,5–1 µg/kg) pada anestesi lokal dapat memperpanjang durasi analgesia hingga 6–8 jam, menurunkan skor nyeri pascaoperasi, serta mengurangi konsumsi opioid tanpa menimbulkan efek samping berat, seperti bradikardia atau hipotensi yang signifikan. Efek analgesik ini terkait dengan aktivasi reseptor α₂-adrenergik di perifer dan spinal yang menghambat transmisi nyeri. Tinjauan ini membahas secara komprehensif dasar fisiologi dan farmakologi kombinasi TLIP–dexmedetomidine, perbandingan dengan blok interfasial lain, bukti klinis terkini, serta arah penelitian yang diperlukan untuk penerapan optimal dalam praktik anestesiologi modern.

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

Dexmedetomidine pada Blok Torakolumbar Interfasial Plane Modifikasi: Tinjauan Naratif Ariyasa, I Putu Eka; I Made Gede Widnyana; I Made Agus Kresna Sucandra
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/s4tbj786

Nyeri pascaoperasi merupakan tantangan klinis utama pada pasien yang menjalani bedah tulang belakang lumbal. Pendekatan analgesia multimodal semakin berkembang, dan blok interfasial torakolumbal (Thoracolumbar Interfascial Plane/TLIP) menjadi salah satu teknik yang efektif dalam mengurangi nyeri dengan risiko minimal terhadap fungsi motorik. Modifikasi teknik TLIP, terutama dengan penambahan adjuvan seperti dexmedetomidine, menawarkan potensi peningkatan durasi dan kualitas analgesia. Tinjauan naratif ini bertujuan merangkum bukti terkini mengenai efektivitas, mekanisme, dan keamanan penggunaan dexmedetomidine sebagai adjuvan pada TLIP modifikasi untuk bedah lumbal. Pencarian literatur dilakukan melalui basis data PubMed, Scopus, dan Google Scholar dengan menggunakan kata kunci “modified TLIP block”, “dexmedetomidine”, “lumbar spine surgery”, dan “postoperative analgesia” untuk artikel berbahasa Inggris atau Indonesia yang diterbitkan antara tahun 2013 hingga 2024. Hasil sintesis menunjukkan bahwa penambahan dexmedetomidine (0,5–1 µg/kg) pada anestesi lokal dapat memperpanjang durasi analgesia hingga 6–8 jam, menurunkan skor nyeri pascaoperasi, serta mengurangi konsumsi opioid tanpa menimbulkan efek samping berat, seperti bradikardia atau hipotensi yang signifikan. Efek analgesik ini terkait dengan aktivasi reseptor α₂-adrenergik di perifer dan spinal yang menghambat transmisi nyeri. Tinjauan ini membahas secara komprehensif dasar fisiologi dan farmakologi kombinasi TLIP–dexmedetomidine, perbandingan dengan blok interfasial lain, bukti klinis terkini, serta arah penelitian yang diperlukan untuk penerapan optimal dalam praktik anestesiologi modern.

Korelasi Pulsatile Index dan Optic Nerve Sheath Diameter terhadap Tekanan Intrakranial Pasien Preeklamsia: Studi Analitik Observasional Mark Christsatya Bolla; Jonathan, Jeremy; I Made Gede Widnyana
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 1 (2025): JATI April 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/JATI.2025.v01.i01.p03

Pendahuluan: Peningkatan tekanan intrakranial (TIK) menjadi pertimbangan penting dalam penanganan pasien preeklamsia. Manifestasi klinis peningkatan TIK pada preeklamsia sulit untuk dideteksi secara klinis, dan pemeriksaan baku emasnya memiliki keterbatasan. Adapun modalitas non-invasif yang memiliki potensi sebagai pengukuran TIK yaitu pulsatile index (PI) dengan transcranial doppler (TCD) dan optic nerve sheath diameter (ONSD). Penelitian ini bertujuan untuk mengetahui korelasi pulsatile index dengan ONSD terkait nilai TIK. Pasien dan Metode: Penelitian ini merupakan penelitian analitik observasional potong lintang, melibatkan 29 subjek yang terbagi menjadi preeklamsia ringan (PER), preeklamsia dengan gejala berat tanpa gejala neurologis (PEB) dan PEB dengan gejala neurologis (PEBn). Hasil: Pada ketiga kelompok tidak ditemukan adanya perbedaan variasi data demografis. Prevalensi peningkatan TIK menurut ONSD dan pulsatile index (PI) berturut-turut adalah 31% dan 20,7%. Perbedaan nilai rerata ONSD ketiga kelompok secara statistik tidak bermakna (p = 0,134), namun setelah dilakukan analisis Post-hoc, didapatkan perbedaan bermakna antara PER dan PEBn (CI -2,58-0,01 mm, p = 0,048). Rerata PI pada ketiga kelompok tidak berbeda bermakna (p = 0,866). Korelasi tekanan arteri rerata (TAR) baik terhadap ONSD (p =0,054) dan PI (p = 0,403) tidak ditemukan bermakna. Pada studi ini didapatkan korelasi positif sedang antara TCD terhadap ONSD pada pasien dengan preeklamsia (r = 0,657, p = 0,001). Kesimpulan: Pengukuran PI berpotensi untuk menjadi metode pengukuran TIK non-invasif selain ONSD. Studi lebih lanjut diperlukan untuk membandingkan antara pengukuran baku emas dengan TCD dan ONSD pada populasi preeklamsia.

Perkembangan Terkini dalam Painless Labour: Tinjauan Naratif Ganakin, Acuyta; Jonathan, Jeremy; I Made Gede Widnyana
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 1 (2025): JATI April 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/JATI.2025.v01.i01.p06

Pendahuluan: Persalinan merupakan proses fisiologis yang sering kali disertai dengan nyeri hebat, yang dapat menyebabkan stres fisik dan psikologis pada ibu. Manajemen nyeri yang tidak optimal dapat berkontribusi terhadap peningkatan angka morbiditas dan mortalitas ibu serta mempengaruhi kesejahteraan neonatal. Oleh karena itu, pemilihan metode analgesia yang efektif dan aman menjadi perhatian utama dalam praktik obstetri modern.Metode: Tinjauan naratif ini didasarkan pada penelusuran literatur terstruktur dari PubMed, Scopus, ScienceDirect, Cochrane Library, dan Google Scholar. Pencarian menggunakan kombinasi kata kunci seperti "painless labour", "labour analgesia", "obstetric analgesia", "pain management in labour", "epidural analgesia", “non-pharmacological pain relief in labour” dan "neuraxial analgesia". Publikasi dibatasi pada tahun 2018–2022, berbahasa Inggris atau Indonesia. Kriteria inklusi meliputi studi primer peer-reviewed (RCT, kohort, observasional) yang mengevaluasi painless labour atau labour analgesia, serta melaporkan skor nyeri pasca melahirkan, dan kepuasan persalinan.Hasil: Kajian ini adalah untuk mengevaluasi berbagai metode manajemen nyeri persalinan, baik melalui pendekatan farmakologis maupun non-farmakologis, serta menyoroti keunggulan dan keterbatasan masing-masing pendekatan. Metode farmakologis seperti anestesi epidural, analgesia intravena, dan blok saraf telah terbukti efektif dalam mengurangi intensitas nyeri, sementara pendekatan non-farmakologis seperti teknik pernapasan, hidroterapi, akupunktur, dan stimulasi listrik saraf transkutan (TENS) juga memberikan manfaat tambahan dalam meningkatkan kenyamanan ibu selama persalinan. Kajian ini menekankan pentingnya pendekatan multidisiplin dalam manajemen nyeri persalinan guna memastikan pengalaman persalinan yang lebih aman, nyaman, dan sesuai dengan kebutuhan individual pasien. Kesimpulan: Pemilihan metode yang tepat harus mempertimbangkan kondisi medis ibu, preferensi pasien, serta ketersediaan fasilitas kesehatan. Dengan pemahaman yang lebih baik tentang metode analgesia yang tersedia, diharapkan pelayanan obstetri dapat semakin optimal dalam meningkatkan kualitas persalinan bagi ibu dan bayi.

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

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