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All Journal The Indonesian Biomedical Journal Majalah Anestesia dan Critical Care World Nutrition Journal Journal of Anaesthesia and Pain Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Jurnal Komplikasi Anestesi Frontiers on Healthcare Research
Rudyanto Sedono
Intensive Care Medicine, Department Of Anesthesiology And Intensive Care, Faculty Of Medicine Universitas Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Effect of Preoperative Lactobacillus acidophilus Supplementation on Postoperative Gastric Residual Volume after Lower Digestive Laparotomy: A Randomized, Double-Blind, Controlled Trial Christophorus Simadibrata; Rudyanto Sedono; Sidharta Kusuma Manggala; Wifanto Saditya Jeo
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p22-30.2026

Abstract

Background: Gastrointestinal dysmotility is among the most common complications after abdominal surgery and is reflected clinically by an elevated gastric residual volume (GRV), which increases the risk of aspiration and delays enteral feeding. Lactobacillus acidophilus is thought to improve gut motility through luminal acidification, competitive exclusion of pathogens, and direct stimulation of smooth-muscle contractility, but whether this translates into a lower GRV after digestive laparotomy has not been tested. Objective: To determine whether preoperative Lactobacillus acidophilus supplementation reduces postoperative GRV after lower digestive laparotomy. Methods: In this randomized, double-blind, placebo-controlled trial at Dr. Cipto Mangunkusumo National General Hospital, Indonesia, adults scheduled for elective laparotomy of the jejunum, ileum, colon, or rectum received oral Lactobacillus acidophilus 10⁹ CFU or an identical placebo capsule three times daily for three days before surgery. A nasogastric tube inserted during surgery was aspirated every 6 hours after ICU admission; GRV was categorized as normal (<250 mL/24h) or increased (≥250 mL/24h) at 24 and 48 hours. Results: Fifty-five participants were randomized (27 probiotic, 28 placebo); one placebo-group participant was withdrawn because of sepsis, leaving 54 participants analyzed per protocol. GRV was increased in 4/27 (14.8%) probiotic recipients versus 2/27 (7.4%) placebo recipients at 24 hours (p = 0.669; risk ratio for normal GRV 0.92, 95% CI 0.76–1.11) and in 1/27 versus 0/27 at 48 hours (p = 1.000). Stratified analysis identified age, neurological comorbidity, obesity, vasopressor use, opioid exposure, hypercapnia, and hyperglycemia as confounders that shifted the crude risk estimate by more than 10%; opioid and vasopressor exposure were also unevenly distributed between groups at baseline (p = 0.006 and p = 0.026, respectively). Conclusion: A 3-day preoperative course of Lactobacillus acidophilus did not significantly reduce postoperative GRV after lower digestive laparotomy. The trial was underpowered relative to its planned sample size, and an uneven distribution of opioid and vasopressor exposure between groups may have obscured a true effect.
Dexmedetomidine versus Propofol or Midazolam for Sedation in Neurocritical Care: A Systematic Review and Meta-analysis Indrawan, Khadafi; Sedono, Rudyanto; Wulung, Navy Gerard H. M. Lolong
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): May
Publisher : Faculty of Medicine, Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2026.007.02.02

Abstract

Background: Sedation in neurocritical care must provide adequate comfort and ventilator tolerance while preserving neurological assessment and minimizing hemodynamic instability. Dexmedetomidine, propofol, and midazolam are widely used, but their comparative effects on clinically important outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate whether dexmedetomidine improves hemodynamic outcomes, intensive care unit (ICU) length of stay, and duration of mechanical ventilation.Methods: This systematic review and meta-analysis included randomized controlled trials and observational studies involving adult neurocritical care patients that compared dexmedetomidine with propofol or midazolam, reported hemodynamic outcomes, ICU length of stay, or duration of mechanical ventilation.  We pooled continuous outcomes as mean differences (MDs) and categorical outcomes as odds ratios (ORs), with 95% confidence intervals (CIs).Results: Of 2,113 records identified, nine studies met the eligibility criteria. Compared with propofol, dexmedetomidine showed no significant difference in bradycardia (OR 2.72; 95% CI 0.62–11.93; p=0.18), hypotension (OR 0.89; 95% CI 0.64–1.25; p=0.51), or mean arterial pressure change (MD 1.12; 95% CI −5.11 to 7.35; p=0.72). ICU length of stay was similar versus propofol (MD −3.21 days; p=0.40) and midazolam (MD −5.97 days; p=0.09). Mechanical ventilation duration was also not significantly reduced versus propofol (MD −1.36 days; p=0.08) or midazolam (MD −2.00 days; p=0.22).Conclusion: Dexmedetomidine showed no significant superiority over propofol or midazolam in neurocritical care. Sedative selection should therefore be individualized according to neurological status, hemodynamic profile, ventilation requirements, and patient-specific risks.
Co-Authors ., Safroni Agustina Haloho Alfan Mahdi Nugroho Amir S. Majdid Andi Yasmon Anis Karuniawati Baktiar, Yoshua Baktiar, Yoshua Ceva W. Pitoyo Christophorus Simadibrata Cleopas M. Rumende Delly Chipta Lestari Dita Aditianingsih Farahniar Hamidiana Gestina Aliska Hafidz, Noor Haloho, Agustina Br Harijanto, Eddy Heni Pujiastuti Jeo, Wifanto Saditya Khadafi Indrawan Luciana Budiati Sutanto Lucky Hartati Moehario Manggala, Sidharta Kusuma Muhammad K Azwar, Muhammad K Niken Churrniadita Nurul Huda El Muhammady Purwantyastuti Purwantyastuti Putranto, Qudsiddik Unggul Raden Besthadi Sukmono Riahdo J. Saragih Rianto Setiabudi, Rianto Solly Aryza Sugiarto, Adhrie Thomas Robertus Trisni U Dewi, Trisni U Wulung, Navy Gerard H. M. Lolong Yulia Rosa Saharman Zulkifli Zulkifli Amin