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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina E-Jurnal Medika Udayana Jurnal Anestesiologi Indonesia Bali Journal of Anesthesiology Syntax Literate: Jurnal Ilmiah Indonesia ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico JOURNAL LA MEDIHEALTICO Archives of The Medicine and Case Reports Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Journal of Global Pharma Technology Eduvest - Journal of Universal Studies Jurnal Komplikasi Anestesi Journal of Medicine and Health Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Tjokorda Gde Agung Senapathi
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Udayana – RSUP Sanglah Denpasar, Indonesia
Aerospace Engineering Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Veterinary Other

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Efficacy of Subcutaneous Morphine Patient Controlled Analgesia Compared to Intravenous Morphine Patient Controlled Analgesia on Cesarean Section Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gde; Aribawa, I Gusti Ngurah Mahaalit; Nainggolan, Elisma
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.27

Abstract

Background: Cesarean section causes moderate to severe pain in the first 48 hours postoperatively, thus requiring an adequate perioperative pain management, not only so that the mother can be quickly discharged but also to perform daily activities after surgery such as breastfeeding and nurse the baby.Objective: To determine the efficacy of subcutaneous morphine patient controlled analgesia (SC-PCA) in lowering VAS (visual analogue score), total morphine consumption and postoperative side effect on cesarean section compared with intravenous morphine patient controlled analgesia (IV- PCA).Methods: This study is an experimental clinical trial using consecutive sampling technique. Sixty-four subjects were allocated into two groups of PCA morphine subcutaneously (SC-PCA) and the group PCA morphine intravenously (IV-PCA), each consisting of 32 subjects using permuted block randomization. Morphine concentration was 5 mg/ml (group SC-PCA) or the concentration of 1mg/ml (group IV-PCA). Both groups were then analyzed for VAS ratings, total morphine consumption, and adverse effects, post operatively at 4th, 8th, and 24th hour. Statistic analysis using repeated ANOVA test and t-test with p <0.05 onsidered significant.Result: Morphine consumption in IV-PCA group showed lower needs than SC-PCA (9.41 mg vs 4,9mg) p <0.001 24 at 24 hours postoperatively. The VAS at resting at 4th hours statistically significantly lower in IV-PCA group (1.06 ± 0.71 vs 0.81 ± 1.40, p=0.029) and at 8th hours (1.03 ± 0.59 vs 0.94 ± 0,9, p=0.048). The moving VAS at 4th hours statistically significant lower in IV-PCA group (2.31 ± 0.47 vs 1.45 ± 2.06, p=0.019) but the static or VAS at moving are not different clinically. Side effects of nausea and vomiting are more common in IV-PCA group. We conclude that SC-PCA provide analgesia more effective and decreases side effects in patients undergo sectio cesarea with spinal anesthesia.
REGIONAL ANESTHESIA IN MOLAR PREGNANCY WITH THYROTOXICOSIS IN A REMOTE HOSPITAL Ryalino, Christopher; Aryasa, Tjahya; Budiarta, I Gede; Senapathi, Tjokorda Gde Agung
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.22

Abstract

Hydatidiform mole or molar pregnancy is a benign Gestational Trophoblastic Disease (GTD) that originates from the placenta. Treatment consists of vacuum evacuation but rarely hysterectomy may be required. One common complication of molar pregnancy is hyperthyroid. Anesthetic management is often complicated by the associated systemic complications. These complications cannot be prevented, but with a better understanding of the disease, some measurements to avoid maternal mortality can be performed.  
LOW FLOW ANESTHESIA WILL GAIN ERAS (ENHANCED RECOVERY AFTER SURGERY) Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Pradhana, Adinda Putra; Makmur, Eric
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.24

Abstract

ABSTRACT As we know, the volatile agent needs fresh gas flow to be carried out to the patient. It is very common in anesthesia practice, we use the fresh gas flow more than 2 liters per minute. In recent practice, the more flow we gave, the more volatile agent blew out to the patient. The present of APL (adjustable pressure limit) also leaks out of the circuit, we spend more gases, volatile agent, hence gave more pollutant to the operating theater. The consequences of those are an increase of anesthesia expenses and change the way of health care being delivered.ERAS (Enhanced Recovery After Surgery) is popular with its quick recovery after surgery, include quick emergence post anesthesia, that will reduce the time in the operating theater, recovery room, and as results, reduce the cost of anesthesia and surgery. 
EXTENDED GLASGOW OUTCOME SCALE AND CORRELATION WITH BISPECTRAL INDEX Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Sutawan, Ida Bagus Krisna Jaya; Arparitna, Ketut Yudi
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.9

Abstract

Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long-term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their caregivers and society as a whole. Clinicians and researchers require reliable and valid measures of long-term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high-quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we will describe the measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe) in correlation with bispectral index (BIS).
Programmed intermittent epidural bolus improves efficacy of patient controlled epidural analgesia in postoperative pain management Agung Senapathi, Tjokorda Gde; Gede Widnyana, I Made; Wiryana, Made; Mahaalit Aribawa, I Gusti Ngurah; Surya Panji, Putu Agus; Soetjipto, Sonni; 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.v1i2.14

Abstract

Background: Postoperative acute pain will have negative impacts if not handled properly so it must be treated effectively. Patient Controlled Epidural Analgesia (PCEA) allows the patient to have an active role in determining the need of analgesia personally. Programmed Intermittent Epidural Bolus (PIEB) is a new method which proven better than Continuous Epidural Infusion. Ropivacaine has similar characteristic to Bupivacaine but with minimal cardiotoxic effect. Fentanyl as an adjuvant can accelerate the onset of action of local anesthetics in epidural analgesia. The purpose of this study was to compare the efficacy of PCEA+PIEB with PCEA as a modality of postoperative analgesia. Methods: Total 54 patients undergoing major surgery of the abdomen and lower extremities were divided into 2 groups randomly: PIEB+PCEA and PCEA. Then we did an evaluation of VAS, PCA demand, and total consumption of solution Ropivacaine 0.1% + Fentanyl 2  mcg/mL at 4 hours, 8 hours, and 24 hours postoperative. Results: VAS at resting and at moving in both groups were found clinically comparable, although statistically, VAS at moving at 4 hours and 24 hours postoperative were lower in PCEA+PIEB group (p < 0.01). PCA attempted and PCA given were lower in PCEA+PIEB group (p ≤ 0.05). Total consumption of solution until 8 hours postoperative was comparable in both groups but at 24 hours postoperative it was much greater in PCEA+PIEB group (p < 0.01). Conclusions: PCEA+PIEB have greater efficacy than PCEA. VAS (at resting and at moving), PCA attempted, and PCA given were lower in PCEA+PIEB group. Total consumption of solution RopivacaineFentanyl until 8 hours postoperative was comparable, but at 24 hours postoperative it was much greater in PCEA+PIEB group. In orthopedic surgery, VAS at resting was obtained below 30 mm in PCEA+PIEB group but VAS at moving was obtained in the category of moderate pain in both groups.
Non-Convulsive Status Epilepticus (NCSE) in ICU Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Ryalino, Christopher; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.5

Abstract

Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long,  associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes of. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended asthe first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis.  This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response.
Anaesthesia Management of Patient at 16 Weeks Pregnancy with Primary Malignant Bone Tumour Underwent Hemipelvectomy Surgery Sinardja, Cynthia Dewi; Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Suranadi, I Wayan; Kusuma, Oscar Indra; D.H., Asterina
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.v2i2.39

Abstract

Chondrosarcoma is a type of sarcoma that affects the bones and joints. It is a rare cancer that accounts for about 20% of bone tumours and is diagnosed in approximately 600 patients each year in the United States. Chondrosarcoma typically affects adults between the age of 20 and 60 years old. The disease usually starts in the bones of the arms, legs or pelvis, but it can be found in any part of the body that contains cartilage. Sometimes chondrosarcoma grows on an otherwise healthy bone or it grows on a benign bone tumour (an enchondroma or osteochondroma). Non-obstetric surgery during pregnancy is not uncommon and can have excellent outcomes with proper planning. Between 0.75% and 2% of pregnant women require non-obstetric surgery. Surgery can be required during any stage of pregnancy depending on the urgency of the indication. When caring for pregnant women undergoing non-obstetric surgery, safe anaesthesia must be provided for both the mother and the child. Thorough understanding of the physiological and pharmacological adaptations to pregnancy is required to ensure maternal safety. Fetal safety requires avoidance of potentially dangerous drugs at critical times during fetal development, assurance of continuation of adequate uteroplacental perfusion, and avoidance and/or treatment of preterm labour and delivery.Pregnant patients beyond 18–20 weeks of gestation should be positioned with a 15° left lateral tilt, to reduce aortocaval compression and supine hypotension syndrome. Regional anaesthesia with combined spinal epidural is an option for this case. Regional anaesthesia does reduce the exposure of foetus to potential teratogens, avoids the potential risk of failed intubation and aspiration, and provides excellent post-operative analgesia. The major concern with neuraxial anaesthesia is maternal hypotension, which may reduce placental perfusion.  During anaesthesia and surgery, foetal well-being is best ensured by careful maintenance of stable maternal haemodynamic parameters and oxygenation. Close monitoring of foetal responses for signs of distress is strongly advocated.
Low Flow Practice for Laparoscopic Colorectal Surgery in Pediatric Patients Yadikusumo, Andrian; Senapathi, Tjokorda Gde Agung; Shintya Dewi, Dewa Ayu Mas; Pradhana, Adinda Putra; Sumanti, Alan F. A.
Bali Journal of Anesthesiology Vol 2, No 1 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v2i1.56

Abstract

Low flow anesthesia and laparoscopic technique in pediatric patients are kinds many kind of modern medical field development.  Both technique were made to support environment friendly, safety, and comfortable anesthesia practice for patients.  In three cases presented in this case series, laparoscopy was done in all three cases (two digestive cases, and one urology case).  All three cases performed with general anesthesia by low flow anesthesia technique with volatile sevoflurane combined with caudal block regional anesthesia.  In all those cases, no morbidity was found after anesthesia or operation that influence in patient’s outcome.  Improvement in outcome of pediatric patients was seen with low flow anesthesia technique, which are significant reduction of volatile used, faster wake up time, and reduction of agitation condition after anesthesia.
Establishing good rapport in anesthesiarelated doctor-patient communication: bridging the triangular communication between anesthesiologist-surgeon-patient Widnyana, IMG; GA Senapathi, Tjokorda; Cindryani, Marilaeta
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.6

Abstract

Doctor-patient communication is central in clinical practice. Communication skill has been an essential component of clinical competence to become a five-star doctor. In the other hand, there are major problems in doctor-patient communication that would lead to medical disputes even malpractice suspicions. With effective communication, a definitive theory would turn into high-quality medical practice and improve patient safety and satisfaction to a whole new level. Based on the Calgary-Cambridge observation guide, there is five point plan of tasks that embrace doctor and patient in daily interviews starting from initiating the session, gathering information, building the relationship, explanation, and planning, and closing. Those tasks would have been easily introduced when you are dealing with a good healthy patient. But in anesthesia-related, wide range of patients are met in different settings and conditions
Supraspinal Modulation : Something to be Remembered Suarjaya, I Putu Pramana; Lolobali, Marilaeta Cindryani; Parami, Pontisomaya; Senapathi, Tjokorda Gde Agung
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.v2i2.57

Abstract

Pain had always been a challenging issue in patients with acute and chronic condition.  Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage. However, a direct correlation between activation and nociceptors and the sensory experience of pain is not always apparent. Emotional state, the degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience.Many active agents are used to block and alleviate pain sensation in acute and chronic settings. When an inadequate treatment for acute pain and neuralgia occurred, it would induce complex processes involving both central and peripheral sensitization contributing to persistent post-surgical pain and worsening neuralgia that would lead to chronic pain issue.The important thing to be considered is that this pain process is an intertwined and interconnecting and sustainable process that could not be cut abruptly. Our aim is to remind us to accept that pain pathway is merely not one straight way but still a convoluting idea which could still revolve and expand. Imagining areas could be defined surely one day through high technology advances and would lead us into defining the depth of this beautiful yet complex pathway.
Co-Authors A A Gde Putra Semara Jaya Adinda Putra Pradhana Albert Albert Anak Agung Gde Agung Adistaya Andi Irawan Andi Kusuma Wijaya, Andi Anggreni, Anak Agung Ayu Aprilnita, Aida Aryasa EM, Tjahya Astawa N. M., Astawa N. Astawa P., Astawa Astuti, Mira Kusuma Astuti, Mira Kusuma Bayu Saputra, Ida Bagus Prema Satia Brillyan Jehosua Toar Budiadnyana, I Made Pasek Budiarta, Gede Cahyono, Ardy Wibowo Christopher Ryalino Christopher, Michael Cindryani Ra Ratumasa, Marilaeta Cung Flavyanto, Eugenius Silvester Cynthia Dewi Sinardja D.H., Asterina David Rendra Mahardika Dewa Ayu Mas Shintya Dewi Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Doddy Setiawan Ekaputra Ekaputra, Ekaputra Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Eric Makmur, Eric Ery Oktadiputra Estrada, Ronald Eugenia, Michelle Ferry, Ferdinand Gede Semarawima, Gede Gede Wirya Kusuma Duarsa Giovanni, Malvin Hadiwijono, Vanessa Juventia Hartanto, Wijaya Hartawan , I.G.A.G. Utara Hartawan, IGAG Utara Hengky Hengky, Hengky Humianto, Michael I Dewa Made Sukrama I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ayu Putri Purwanthi I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Wibawa Nada I Made Agus Kresna Sucandra I Made Bakta I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Prema Putra I Made Subagiartha I Made Wiryana, I Made I Putu Agus Surya Panji I Putu Fajar Narakusuma I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan IGNA Putra Arimbawa, IGNA Putra Jayantha Ananda, I Gusti Ngurah Bagus Jeanne, Bianca Jhoni Pardomuan Pasaribu Jimmy Wongkar Johanes, Kevin Paul Junaedi, I Made Darma Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Kamaswari, Ida Ayu Dwi Kenzi, Ignatio Armando Ketut Semara Jaya, Ketut Semara Ketut Wibawa Nada Ketut Yudi Arparitna, Ketut Yudi Komang Ady Widayana Komang Alit Artha Wiguna Komang Alit Artha Wiguna Kurnia, Prajnaariayi Prawira Kurniyanta, I P Kurniyanta, I Putu Kusuma, Oscar Indra Labobar, Otniel Adrians Leo, Joseph Nelson Lesmana, Pita Mora Leton, Yohanes PT Made Agus Kresna Sucandra Made Agus Kresna Sucandra, Made Agus Kresna Made Bagus Cahya Maha Putra Made Widnyana Made Wiryana Marilaeta Cindryani Marilaeta Cindryani Lolobali, Marilaeta Cindryani Marilaeta Cindryani, Marilaeta Marting, Millenia Mauritius Septa Murti, Dede Taruna Kreisnna Nada, I Ketut Wibawa Nandaswari, Ni Made Nilam Narakusuma, I Putu Fajar Ni Nyoman Sri Budayanti Ni Putu Novita Pradnyani, Ni Putu Novandi Kurniawan Pande Nyoman Kurniasari, Pande Panji, I PAS Patricia, Yoshie Pontisomaya Parami Pramana, Putu Bagus Gin Gin Pranoto, Theodorus Pascalis Yullie Pratana, Yolanda Jenny Putu Agus Surya Panji Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Raka-Sudewi A. A. Ratumasa, Marilaeta Cindryani Ra Reynaldi Reiky Hadiwijaya Riko Riko Santo, Budi Saputra, Darmawan Jaya Satoto D., Satoto Satria Pinanditas S Sidabutar, Beny Pratama Sidemen, I Gusti Ayu Eka Para Santi Sidemen, I.G.P.Sukrana Sidemen, IGP Sukrana Sonni Soetjipto, Sonni Sri Maliawan Stefanus Taofik stefanus taofik, stefanus Suarjaya, I PP Suastika, I Gede Juli Sucandra, I Made Agus Kresna Sucandra, I MK Sumanti, Alan F. A. Sunanda Naibaho Suranadi , I Wayan Suryadi N. T., Suryadi N. Suryana, I Ketut Syamsuddin, Johanis Bosco Troy Tanuwijaya, Tommy M Tirta, Ian Tjahya Aryasa Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Bagus Mahadewa Togi Stanislaus Patrick Virayanti, Luh Putu Diah W. A., W. Wardani, Dinar Kusuma Welly, Julian Widnyana, I MG Widyana, I Made Gede Wiryana M., Wiryana Yadikusumo, Andrian Yustisia, Putu Ngurah Krisna Denta