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Managemen Anestesi pada Congenital Diapragmatic Hernia dengan Ventrikel Septal Defek dan Atrium Septal Defek pada Pasien Pediatrik : Laporan Kasus Mauritius Septa; Adinda Putra Pradhana; I Putu Kurniyanta; Ketut Wibawa Nada; Novandi Kurniawan; Tjokorda Gde Agung Senapathi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 2 (2025): JATI Agustus 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.i02.p06

Abstract

Congenital diaphragmatic hernia (CDH) merupakan kelainan kongenital pada diafragma yang terjadi pada pediatri. Insiden terjadinya hernia tipe Borchdalek lebih sering terjadi pada sisi kiri dari pada sisi kanan. Penyulit lain pada CDH adalah hipoplasia paru, hipertensi paru dan kelainan pada jantung. Pada kasus ini kami mendiskusikan bayi 12 hari dengan kelainan CDH sisi kanan dengan kelainan jantung berupa ventrikel septal defek (VSD) dan atrium septal defek (ASD) yang dilakukan operasi laparotomi hernia. Manajemen anestesi pada pasien ini menggunakan  inhalasi sevoflurane, fentanil, volume tidal rendah, obat inotropik dengan kondisi hemodinamik yang stabil selama pembedahan. Kami melaporkan management anestesi dengan  sevoflurane yang dikombinasi dengan volume tidal rendah dan inotropik dobutamine pada operasi congenital diaphragmatic herdia dengan VSD dan ASD membantu dalam keberhasilan intraoperatif. Setelah operasi, pasien dilakukan perawatan di NICU untuk  perawatan secara ketat.
External Oblique Intercostal Plane Block (EOIPB) sebagai Tambahan Analgesia Multimodal Pasca Laparoskopi Kolesistektomi: Tinjauan Naratif David Rendra Mahardika; Made Agus Kresna Sucandra; Tjokorda Gde Agung Senapathi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 2 (2025): JATI Agustus 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.i02.p07

Abstract

Pendahuluan: Nyeri pascaoperasi, terutama setelah kolesistektomi laparoskopi, adalah masalah signifikan yang meningkatkan morbiditas dan memperpanjang masa rawat inap. Penanganan nyeri sering kali melibatkan opioid sistemik yang memiliki efek samping merugikan. Oleh karena itu, pendekatan analgesia alternatif yang minim opioid sangat dibutuhkan. Tinjauan naratif ini bertujuan mengevaluasi efektivitas External Oblique Intercostal Plane Block (EOIPB) sebagai tambahan analgesia multimodal pasca kolesistektomi laparoskopi, berfokus pada kualitas analgesia, pemulihan pasien, dan respons inflamasi sistemik. Metode: Tinjauan naratif ini didasarkan pada penelusuran literatur terstruktur dari PubMed, Scopus, ScienceDirect, Cochrane Library, dan Google Scholar. Pencarian menggunakan kombinasi kata kunci seperti "external oblique intercostal plane block", "laparoscopic cholecystectomy", "postoperative pain", "quality of recovery", "neutrophil to lymphocyte ratio", dan "platelet to lymphocyte ratio". Publikasi dibatasi pada tahun 2019–2024, berbahasa Inggris atau Indonesia. Kriteria inklusi meliputi studi primer peer-reviewed (RCT, kohort, observasional) yang mengevaluasi EOIPB atau blok interfasial sebanding, serta melaporkan skor nyeri pascaoperasi, konsumsi opioid, skor quality of recovery (QoR-15), dan/atau nilai neutrophil to lymphocyte ratio (NLR) / platelet to lymphocyte ratio (PLR). Hasil: EOIPB secara konsisten memperpanjang durasi analgesia, menurunkan intensitas nyeri dengan skor visual analog scale (VAS), dan mengurangi konsumsi opioid pascaoperasi secara signifikan. Studi juga menunjukkan profil keamanan EOIPB yang baik dengan insiden efek samping minimal. Bupivakain, agen anestesi lokal yang umum digunakan, tidak hanya memblok transmisi nyeri tetapi juga menunjukkan sifat anti-inflamasi. Meskipun demikian, terdapat heterogenitas dalam teknik dan jenis anestesi yang digunakan antar studi. Kesimpulan: EOIPB adalah teknik blok interfasial yang efektif dan aman untuk manajemen nyeri pasca kolesistektomi laparoskopi, memberikan analgesia yang lebih baik dan mengurangi kebutuhan opioid. Namun, masih diperlukan penelitian lanjutan berskala besar, terstandarisasi, dan multicenter untuk memperkuat bukti ilmiah dan mengevaluasi dampak jangka panjangnya.
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

Abstract

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 (ASA III) 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 with oxygen via nasal cannula, oxygen saturation dropped to 84-88% without dyspnea and promptly improved after returning to the supine position. Ancillary evaluation revealed preserved biventricular systolic function (left ventricular ejection fraction 60%, TAPSE 19 mm). Lung ultrasound showed 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 then proceeded with a supine-position modification, and hemodynamic and respiratory status remained stable without intraoperative complications.Discussion: In unilateral pneumonia, placing the diseased lung dependent can worsen ventilation-perfusion (V/Q) mismatch through the bad lung down phenomenon, leading to reversible position-dependent hypoxemia. In this case, desaturation occurred before intrathecal injection and before administration of sedatives or systemic opioids, making drug-induced hypoventilation unlikely. The absence of hypercapnic symptoms, preserved cardiac function, and lack of ultrasound evidence of pulmonary edema supported a predominantly pulmonary V/Q mechanism and illustrated silent hypoxemia in an older adult.Conclusion: Positioning should be regarded as a critical step in neuraxial anesthesia, particularly in frail or elderly patients with unilateral lung disease. In such patients, early detection of position-dependent desaturation and prompt correction of posture can allow surgery to proceed safely under regional anesthesia without the need to convert to general anesthesia. 
Combined Lumbar Plexus and Sciatic Nerve Blocks Improve Postoperative Recovery in Lower Extremity Surgery: A Randomized Controlled Trial Wiranata, Jeremia Alvian; Aribawa, I Gusti Ngurah Mahaalit; Parami, Pontisomaya; Senapathi, Tjokorda Gde Agung; Hartawan, I Gusti Agung Gede Utara; Adi, Made Septyana Parama; Kurniajaya, I Gusti Agung Made Wibisana; Pradhana, Adinda Putra
Journal of Anaesthesia and Pain Vol. 7 No. 1 (2026): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Patients undergoing lower extremity orthopedic surgery often experience moderate to severe postoperative pain, commonly managed with opioids. Regional anesthesia techniques, such as peripheral nerve blocks, offer promising alternatives. This study evaluates the efficacy of combined lumbar plexus block (LPB) and sciatic nerve block (SNB) versus intravenous opioid analgesia in enhancing postoperative recovery and pain control. Methods: In a single-blind, randomized controlled trial, 42 patients scheduled for lower extremity orthopedic surgery under spinal anesthesia were allocated to two groups. Group P1 received postoperative LPB and SNB using 20 mL of 0.25% bupivacaine, while group P2 received intravenous opioids. Outcomes at 24 hours included quality of recovery (QoR-40) scores, total morphine consumption, duration of analgesia, and monitored adverse events. Result: Group P1 showed significantly better recovery scores [QoR-40: 183 (178–188) vs. 152 (136–161.5), p < 0.001], reduced morphine consumption [4 (4–6.5) mg vs. 18 (16–22) mg, p < 0.001], and longer analgesia duration [480 (340–600) min vs. 75 (60–110) min, p < 0.001]. No adverse events were observed. Conclusion: Combined LPB and SNB significantly improve postoperative recovery quality and analgesia in patients undergoing lower extremity orthopedic surgery, reducing opioid requirements and extending pain-free duration compared to intravenous opioids.
Keberhasilan Blok Saraf Kombinasi Femoral-Sciatic Popliteal pada Pasien Chronic Limb-Threatening Ischemia Berisiko Tinggi: Case Report Putu Gede Ary Sanjaya; I Gusti Ngurah Mahaalit Aribawa; Tjokorda Gde Agung Senapathi
Sehat Rakyat: Jurnal Kesehatan Masyarakat Vol. 5 No. 1 (2026): Februari 2026
Publisher : Yayasan Pendidikan Penelitian Pengabdian Algero

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54259/sehatrakyat.v5i1.6205

Abstract

Patients with Critical Limb-Threatening Ischemia (CLTI) accompanied by sepsis and complex comorbidities such as diabetes mellitus, coronary artery disease, and metastatic malignancy are at high risk for hemodynamic instability when undergoing general anesthesia. In such clinical circumstances, regional anesthesia becomes a safer alternative, as it helps maintain cardiovascular stability, minimizes respiratory depression, and reduces exposure to systemic anesthetic agents that may further compromise organ function. a 61-year-old male with left foot CLTI classified as Rutherford V, sepsis, and hypoactive delirium underwent a below-knee amputation. The patient had significant comorbidities, including type 2 diabetes mellitus, hypertension, coronary artery disease, and papillary thyroid carcinoma with pulmonary metastases, with a functional status of 4-5 METs and ASA III. Laboratory evaluation revealed marked leukocytosis, hypoalbuminemia, hypoglycemia, primary hypothyroidism, and mild renal impairment, while echocardiography demonstrated preserved left ventricular systolic function. Considering the substantial risks associated with general anesthesia, a combined peripheral nerve block technique femoral and sciatic–popliteal was selected using 0.375% ropivacaine. The procedure proceeded uneventfully, with stable vital signs and no episodes of hypotension, desaturation, or block-related complications. Postoperatively, the patient experienced adequate pain control and maintained stable hemodynamic recovery. The use of regional anesthesia via combined femoral and sciatic–popliteal nerve blocks proved to be safe and effective for a high-risk patient with sepsis and CLTI. This approach preserved hemodynamic stability, provided optimal analgesia, and minimized the need for general anesthesia, making it a viable option for similarly complex cases.
Hemodynamic Stability with Intrathecal Prilocaine 2% in Caesarean Section Patient with Ebstein’s Anomaly: A Case Report Rasyid, Rifqi Taufiq; Sudiantara, Putu Herdit; EM, Tjahya Ariyasa; Senapathi, Tjokorda Gde Agung
Majalah Anestesia & Critical Care Vol 44 No 1 (2026): Februari
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.v44i1.479

Abstract

Introduction: Ebstein’s anomaly is a rare congenital malformation of the tricuspid valve that predisposes pregnant patients to significant hemodynamic instability due to increased circulating volume, cardiac output, and catecholamine levels during pregnancy. Anesthetic management in this population requires careful maintenance of preload, afterload, and sinus rhythm to avoid worsening right-to-left shunting and arrhythmias. Case Description: A 31-year-old gravida 2 para 1 woman (G2P1001) at 37 weeks of gestation with Ebstein’s anomaly type C and severe tricuspid regurgitation who underwent cesarean section due to fetal distress. Spinal anesthesia was performed using hyperbaric prilocaine 2% (80 mg), followed by bilateral ultrasound-guided transversus abdominis plane block for postoperative analgesia. Throughout the 45-minute procedure, the patient maintained stable hemodynamics without episodes of hypotension or arrhythmias. Postoperative recovery in the Obstetric High Dependency Unit remained uneventful, with consistent vital signs and adequate pain control. A healthy neonate was delivered. Conclusion: This case demonstrates that intrathecal prilocaine 2% can provide effective surgical anesthesia while preserving hemodynamic stability in selected parturients with Ebstein’s anomaly. The pharmacological characteristics of prilocaine, rapid onset, intermediate duration, and a favorable sympathetic profile, make it a potential alternative to longer-acting agents in patients at risk of hemodynamic compromise. Further studies are needed to validate its safety and efficacy in parturients with congenital cardiac disease.
TRIAL FIBRILASI SETELAH INFILTRASI EPINEFRIN PADA PEMBEDAHAN RINOTOMI : SEBUAH LAPORAN KASUS Sunto, Sunto; Dewi, Dewa Ayu Mas Shintya; Senapathi, Tjokorda Gde Agung
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 10 No. 1 (2026): APRIL 2026
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v10i1.54234

Abstract

Atrial fibrilasi merupakan salah satu aritmia supraventrikular yang paling sering ditemukan pada periode perioperatif. Penggunaan agen vasokonstriktor seperti epinefrin dalam pembedahan, khususnya pada pasien dengan riwayat penyakit kardiovaskular atau aritmia, dapat menimbulkan perubahan hemodinamik dan gangguan irama jantung yang bermakna. Laporan kasus ini bertujuan untuk menggambarkan kejadian atrial fibrilasi dengan respons ventrikel cepat setelah infiltrasi epinefrin pada tindakan rinotomi. Kami melaporkan seorang pria berusia 56 tahun dengan diagnosis karsinoma sinonasal bilateral stadium IVc dengan metastasis tulang yang menjalani pembedahan rinotomi bilateral. Pasien memiliki riwayat gagal jantung kelas fungsional II dan atrial fibrilasi normoventrikular pada EKG praoperasi. Anestesi umum dilakukan dengan teknik standar dan pemeliharaan menggunakan sevofluran. Selama pembedahan dilakukan infiltrasi submukosa epinefrin 1:200.000. Setelah infiltrasi epinefrin, irama jantung berubah menjadi atrial fibrilasi dengan respons ventrikel cepat dengan frekuensi 120–140 kali per menit. Pasien segera ditangani dengan pemberian amiodaron intravena bolus 150 mg sehingga irama kembali menjadi atrial fibrilasi normoventrikular. Operasi dapat diselesaikan tanpa komplikasi lanjutan dan pasien dirawat di HCU tanpa kejadian ulang. Infiltrasi epinefrin dapat memicu atrial fibrilasi dengan respons ventrikel cepat pada pasien berisiko. Kewaspadaan anestesiologis dan penatalaksanaan aritmia yang cepat sangat penting untuk mencegah komplikasi serius perioperatif.
The Association Between Preoperative Anxiety and Pain Severity, Opioid Requirement, Neutrophil-to-Lymphocyte Ratio, and Postoperative Blood Glucose After Gynecologic Laparotomy at Ngoerah Hospital Bora, Fivilia Anjelina; Dewi, Dewa Ayu Mas Shintya; Kurniyanta, I Putu; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Suarjaya, Putu Pramana; Aribawa, I Gusti Ngurah Mahaalit; EM, Tjahya Aryasa; Parami, Pontisomaya; Labobar, Otniel Andrians
Medicinus Vol. 15 No. 2 (2026): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v15i2.10969

Abstract

Background: We assessed whether preoperative anxiety is associated with postoperative pain severity, opioid requirement, neutrophil-to-lymphocyte ratio (NLR), and blood glucose after gynecologic laparotomy. Methods: Prospective cohort at Ngoerah Hospital (May to June 2025). Anxiety was measured preoperatively with APAIS and categorized as non-anxious, mild, moderate, or severe. Outcomes were NRS pain at 6, 12, and 24 hours, total fentanyl in the first 24 hours, and NLR and blood glucose at 6 hours postoperatively. Multivariable analysis used MANCOVA (99% confidence intervals). Result: Fifty-four patients were included (mean age 41.78 ± 10.58 years). Anxiety distribution was 46.3% non-anxious, 25.9% mild, 24.1% moderate, and 3.7% severe. Higher anxiety was associated with higher NRS at 6 hours (B 0.842; 99% CI 0.475 to 1.209; p < 0.001), 12 hours (B 0.381; 0.247 to 0.515; p < 0.001), and 24 hours (B 0.158; 0.048 to 0.269; p = 0.048). Anxiety was associated with higher 24-hour fentanyl requirement (B 147.8 microg; 99% CI 124.062 to 171.651; p < 0.001), higher postoperative NLR (B 4.31; 99% CI 0.609 to 8.027; p = 0.024), and higher postoperative blood glucose (B 19.4 mg/dL; 99% CI 7.912 to 30.912; p = 0.001). Conclusions: Higher preoperative anxiety was independently associated with worse pain, greater opioid requirement, and higher postoperative NLR and blood glucose after gynecologic laparotomy.
Co-Authors A A Gde Putra Semara Jaya Adi, Made Septyana Parama Adinda Putra Pradhana Adistaya, Anak Agung Gde Agung Albert Albert Anak Agung Gde Agung Adistaya Andi Irawan Andi Kusuma Wijaya, Andi Anggreni, Anak Agung Ayu Aprilnita, Aida Aryasa EM, Tjahya Aryawangsa, Anak Agung Ngurah Astawa N. M., Astawa N. Astawa P., Astawa Astuti, Mira Kusuma Astuti, Mira Kusuma Bayu Saputra, Ida Bagus Prema Satia Bora, Fivilia Anjelina 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 Ariyasa 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 Kurniajaya, I Gusti Agung Made Wibisana Kurniyanta, I P Kurniyanta, I Putu Kusuma, Oscar Indra Labobar, Otniel Adrians Labobar, Otniel Andrians 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 Gede Ary Sanjaya Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Raka-Sudewi A. A. Rasyid, Rifqi Taufiq 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 Sudiantara, Putu Herdit Sumanti, Alan F. A. Sunanda Naibaho Sunto, Sunto 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 Wirananggala, Nyoman Bendhesa Wiranata, Jeremia Alvian Wiryana M., Wiryana Yadikusumo, Andrian Yustisia, Putu Ngurah Krisna Denta