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Management of Anesthesia in Laparoscopic Cholecystectomy During First Trimester Pregnancy Sudiantara, Putu Herdita; Juwita, Nova; Ariyasa EM, Tjahya; Senapathi, Tjok Gede Agung
Majalah Anestesia & Critical Care Vol 41 No 2 (2023): 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 | DOI: 10.55497/majanestcricar.v41i2.292

Pregnant women increase the risk of gallbladder disease. Acute cholecystitis occurs 1-6 per 10.000 pregnancy and Cholecystectomy is the second most frequent procedure in pregnancy. Biliary stasis and biliary smooth muscle relaxation due to elevated estrogen and progesterone hormones during pregnancy can lead to gallstones formation. Cholelithiasis complications associated with choledocholithiasis, acute cholecystitis, cholangitis and, gallstone pancreatitis that posing significant morbidity and mortality like spontaneous abortion, preterm labor, and fetal loss. Laparoscopic surgical techniques are no longer a contraindication to non-obstetric surgery for pregnant women although they still have a risk of developing fetal development disorders. Management of anesthesia in laparoscopic cholecystectomy during pregnancy must consider the risk of anesthesia surgery, from the disease, maternal and fetal condition, and manipulation when surgeon performing laparoscopic. This report presenting a 33-years-old woman with 10-week pregnancy who undergoes laparoscopic cholecystectomy followed by symptomatic cholelithiases. It was done with general anesthesia combined with epidural analgesia. After the procedure, there is no complaint about abdominal pain or vaginal bleeding. The patient was discharged 3 days aftercare.

Efficacy of Quadratus Lumborum Block Compared to Paravertebral Block on Pediatric Patients Undergoing Abdominal Surgery Sudiantara, Putu Herdita; Widnyana, I Made Gede; Putra, Kadek Agus Heryana; Kurniyanta, I Putu; Senapathi, Tjokorda Gde Agung
Majalah Anestesia & Critical Care Vol 42 No 3 (2024): Oktober
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.v42i3.415

Background: Abdominal surgery is a major procedure associated with severe postoperative pain in pediatric patients. Quadratus lumborum block (QLB) is considered an effective pain control in such cases. Paraverterbral block (PVB) is another option for postoperative pain management. The aim of this study was to compare the effectiveness of quadratus lumborum block with paravertebral block. Methods: This single-blind randomized controlled trial included 22 pediatric patients who underwent abdominal surgery at Sanglah Hospital, Denpasar between August – October 2022. Research subjects were divided into 2 treatment groups; group A consisted of general anesthesia combined with quadratus lumborum block and group B consisted of general anesthesia combined with paravertebral block. Duration of analgesia was recorded based on the time to analgesic rescue, FLACC pain scale at 0, 2, 4, 6, 12 and 24 hours and total opioid consumption 24 hours after surgery. Statistical analyses were performed using SPSS. Results: Eleven patients received QLB and PVB respectively. There was a significant difference in mean analgesia duration of 1287 ± 129.69 minutes compared to 750 ± 122.22 minutes (p < 0.001) (CI 95%: 425.18 – 649.36), median FLACC pain scale at 12 (1 (IQR 2) vs 4 (IQR 1)) and 24 hours postoperative (1 (IQR 2) vs 3 (IQR 1)) between QLB and PVB (p < 0.001 and p < 0.007). Mean 24-hour postoperative opioid consumption was significantly lower in the QLB compared to the PVB. Conclusion: QLB has better effectiveness than PVB in pediatrics undergoing abdominal surgery.

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 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

Bad Lung Down Phenomenon During Spinal Positioning for Hip Hemiarthroplasty: A Case Report Putra, I Made Prema; Sudiantara, Putu Herdita; Aryawangsa, Anak Agung Ngurah; Wirananggala, Nyoman Bendhesa; Adistaya, Anak Agung Gde Agung; Senapathi, Tjokorda Gde Agung
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.80577

Background: Position-dependent hypoxemia during spinal anesthesia positioning is uncommon but may pose safety concerns in older patients with unilateral lung disease.Case: An 84-year-old woman with a proximal femoral fracture and clinical radiographic features consistent with left-sided pneumonia was scheduled for bipolar hip hemiarthroplasty. Fracture-related pain and positioning limitations precluded the sitting position and right lateral decubitus, making the left lateral decubitus (LLD) position the only feasible option for spinal anesthesia. During LLD positioning, oxygen saturation dropped to 84-88% without dyspnea and promptly improved after returning to the supine position. Ancillary evaluation showed preserved biventricular systolic function (left ventricular ejection fraction 60%, TAPSE 19 mm), and no sonographic evidence of pulmonary edema. Spinal anesthesia was performed in the LLD position using 7.5 mg of 0.5% hyperbaric bupivacaine with 50 mcg intrathecal morphine. The surgery proceeded with a supine-position modification and remained hemodynamically and respiratory stable without intraoperative complications.Discussion: In unilateral pneumonia, placing the diseased lung in the dependent position can exacerbate ventilation perfusion mismatch and functional shunt, leading to reversible positional hypoxemia. Older adults may exhibit silent hypoxemia without overt dyspnea, so continuous monitoring during positioning for neuraxial anesthesia is crucial. In this case, the reproducible pattern of desaturation confined to the LLD position, with rapid improvement in supine and absence of cardiac decompensation or pulmonary edema, strongly supported a positional ventilation perfusion mechanism rather than primary cardiac failure or global ventilatory impairment.Conclusion: This case highlights the “bad lung down” phenomenon as a cause of silent, position-dependent hypoxemia during spinal positioning in an octogenarian with left-sided pneumonia. Early recognition of positional desaturation and simple modification of the operative position can help maintain intraoperative safety without abandoning regional anesthesia.

COMPARATIVE EFFECTIVENESS OF OPIOID-FREE ANESTHESIA AND OPIOID-BASED ANESTHESIA ON THE INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING: A SYSTEMATIC REVIEW Adi Widarma, I Made Agus; Sudiantara, Putu Herdita; Ulandari, Komang Sherly; Habisena, Cokorda Gde Waesa; Pratama, Pande Putu Arista Indra
International Journal of Health Science & Medical Research Vol 5, No 1 (2026): February 2026
Publisher : UNG

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37905/ijhsmr.v5i1.33731

Perioperative pain management commonly relies on opioids, which are associated with significant adverse effects, particularly postoperative nausea and vomiting (PONV), affecting up to 80% of high-risk surgical patients. This systematic review aimed to compare the effectiveness of opioid-free anesthesia (OFA) and opioid-based anesthesia (OBA) in reducing PONV incidence. This systematic review followed the PRISMA guidelines. A comprehensive literature search was conducted in PubMed, EuropePMC, and OpenAlex. Randomized controlled trials (RCTs) published between 2015 and 2025 that compared OFA and OBA in adult patients (18 years) and reported PONV outcomes were included. Results of the 117 articles identified, five RCTs met the inclusion criteria. Although the limited number of studies limits the generalizability of the findings, this reflects the application of strict inclusion criteria that prioritize high-quality RCTs. Four studies (Clanet et al., 2024; Choi et al., 2022; Chen et al., 2023; Pratyusha et al., 2025) reported a statistically significant reduction in PONV in patients receiving OFA. In contrast, Yu et al. (2023) found no significant difference between OFA and OBA. Additionally, OFA was associated with reduced postoperative opioid consumption, which may contribute to lower PONV rates. Conclusion OFA demonstrates promising potential as a safe and effective alternative to OBA in reducing PONV. However, larger, well-designed randomized controlled trials are needed to confirm these findings and to further evaluate the impact of OFA on postoperative pain control and recovery quality.

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