I Gusti Ngurah Mahaalit Aribawa
Department Of Anesthesiology, Pain Management, And Intensive Care, Faculty Of Medicine, Udayana University, Sanglah General Hospital, Denpasar-Bali, Indonesia

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EFFECTIVENESS OF SUPRAZYGOMATIC MAXILLARY BLOCK SUPPLEMENTATION IN GENERAL ANESTHESIA FOR MIDFACIAL SURGERY Hengky, Hengky; Parami, Pontisomaya; Aribawa, I Gusti Ngurah Mahaalit; Widnyana, I Made Gede; Senapathi, Tjokorda Gde Agung
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 3 (2025): DESEMBER 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i3.42890

Abstract

Operasi midfasial sering menimbulkan nyeri hebat yang dapat mempengaruhi durasi perawatan pascaoperasi. Opioid tetap menjadi standar utama dalam mengelola nyeri akut pascaoperasi, namun penggunaannya terkait dengan efek samping seperti mual, muntah, sedasi, dan risiko komplikasi pernapasan. Oleh karena itu, blok saraf regional seperti Suprazygomatic Maxillary Block (SMB) menawarkan alternatif untuk mengurangi dosis opioid dan efek sampingnya, mendukung konsep Enhanced Recovery After Surgery (ERAS). Penelitian ini merupakan uji coba terkontrol secara acak, single-blind, dan dilakukan di satu lokasi dengan 40 sampel yang dibagi menjadi dua kelompok: Kelompok P1 (anestesi umum dengan SMB menggunakan 5 ml ropivakain 0,375%) dan Kelompok P2 (anestesi umum tanpa SMB). Parameter yang dianalisis meliputi kebutuhan fentanyl intraoperatif, waktu pemberian analgesik penyelamat pertama, total kebutuhan opioid dalam 24 jam, kejadian mual dan muntah, serta kualitas pemulihan pascaoperasi (QoR-40), menggunakan SPSS versi 26. Hasil penelitian menunjukkan bahwa kebutuhan fentanyl intraoperatif lebih rendah pada Kelompok P1 (2,10 mcg/kgBB vs. 2,61 mcg/kgBB, p<0,001). Waktu pemberian analgesik penyelamat pertama lebih lama pada Kelompok P1 (13 jam vs. 2 jam, p=0,004), dan total kebutuhan opioid dalam 24 jam lebih rendah (0 mcg vs. 180 mcg, p<0,001). Kelompok P2 memiliki risiko mual dan muntah yang lebih tinggi (RR 2,54, p=0,004) dan skor QoR-40 pascaoperasi yang lebih rendah (198 vs. 162, p<0,001). Kesimpulannya, suplementasi SMB secara efektif mengurangi kebutuhan opioid intra dan pascaoperasi, menunda waktu pemberian analgesik penyelamat pertama, serta menurunkan risiko mual dan muntah pascaoperasi.
COMPARISON OF CONTINUOUS SUPRAINGUINAL FASCIA ILIACA COMPARTMENT BLOCK (S-FICB) WITH CONTINUOUS EPIDURAL IN PATIENTS UNDERGOING CEPHALOMEDULLARY NAILING SURGERY Riko, Riko; Aribawa, I Gusti Ngurah Mahaalit; Widnyana, I Made Gede; Senapathi, Tjokorda Gde Agung
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 3 (2025): DESEMBER 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i3.42923

Abstract

Penelitian ini bertujuan untuk membandingkan efektivitas analgesia pascaoperasi, kadar inflamasi, stabilitas hemodinamik, dan kualitas pemulihan pada pasien yang menjalani operasi cephalomedullary nailing dengan menggunakan analgesia terkendali pasien (patient-controlled analgesia atau PCA) berupa blok suprainguinal fascia iliaca compartment block (S-FICB) dan blok epidural kontinu. Penelitian ini merupakan uji klinis komparatif dengan desain single-blind yang melibatkan 46 pasien yang memenuhi kriteria inklusi, dan secara acak dibagi menjadi dua kelompok: kelompok S-FICB dan kelompok epidural. Setelah operasi dengan anestesi spinal, kelompok S-FICB menerima bolus interfascial hydrodissection sebanyak 30 ml ropivakain 0,2%, sementara kelompok epidural menerima bolus awal ropivakain 0,2% sebanyak 10 ml. Infus ropivakain 0,2% kemudian diberikan secara kontinu dengan laju 2 ml/jam selama 24 jam melalui kateter.Kadar Interleukin-6 diukur sebelum dan 24 jam setelah operasi. Kualitas pemulihan pascaoperasi dievaluasi menggunakan skor QoR-40. Hasil penelitian menunjukkan tidak terdapat perbedaan yang signifikan dalam kualitas analgesia pascaoperasi antara kedua kelompok. Namun, penurunan kadar Interleukin-6 secara signifikan lebih besar pada kelompok S-FICB. Ketidakstabilan hemodinamik lebih sering terjadi pada kelompok epidural. Selain itu, skor median total QoR-40 pada 24 jam menunjukkan bahwa kelompok S-FICB memiliki kualitas pemulihan yang lebih baik. Sebagai kesimpulan, S-FICB memberikan analgesia yang sebanding dengan epidural, namun lebih efektif dalam menurunkan kadar Interleukin-6, meningkatkan stabilitas hemodinamik, dan memperbaiki kualitas pemulihan pascaoperasi.
Fibrinolytic and Anticoagulant Therapy in COVID-19 Associated Pulmonary Embolism: A Case Report Eka Nantha Kusuma, Putu; I Made Prema Putra; I Gusti Ngurah Mahaalit Aribawa
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.p04

Abstract

Pulmonary thromboembolism is a complication that can occur in coronavirus disease-2019 (COVID-19). Efforts to prevent and therapy for thromboembolism have been a challenge to this date. The side effects of fibrinolytic, anticoagulant, and platelet anti-aggregation therapies, such as hemorrhage, are some of the causes of morbidity and mortality that must be addressed immediately. In this case, the patient received prophylaxis with the anticoagulant enoxaparin and platelet anti-aggregation agents with aspirin and clopidogrel. The COVID-19 patient presented a complication of pulmonary thromboembolism that was established using a computed tomography pulmonary angiography (CTPA) performed on his third day of care (day 14 of onset treatment) due to the patient’s clinical aggravation of pulmonary manifestation. After fibrinolytic therapy had been given, the patient’s clinical condition improved. However, on the 7th day after the provision of recombinant tissue plasminogen activator (r-TPA), the patient experienced a side effect of hemorrhage, and management was undertaken to address these issues by transfusions of blood components, such as cryoprecipitates, thrombocyte concentrate, fresh frozen plasma, and packed red cell. Thromboembolism occurring in COVID-19 patients is based on the Virchow triad concept, comprising endothelial injury, static blood flow, and hypercoagulation. The principle of prevention and management of thromboembolism refers to this concept. Currently, further studies are required to treat thromboembolism and the side effects of fibrinolytic and anticoagulant therapies on COVID-19 patients.
Ultrasound-Guided Neuraxial Precision in a High-Risk Adolescent Parturient: Navigating Anesthetic Management in the Confluence of Nephrotic Syndrome, Diastolic Heart Failure, and Anasarca Made Bagus Cahya Maha Putra; Tjokorda Gde Agung Senapathi; I Gusti Ngurah Mahaalit Aribawa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1480

Abstract

Background: Anesthetic management for cesarean delivery in parturients with concurrent nephrotic syndrome and decompensated heart failure presents a profound clinical challenge. Severe anasarca can obliterate anatomical landmarks, while complex cardiorenal pathophysiology creates a state of extreme hemodynamic fragility. This case report describes a systematic, ultrasound-guided approach to overcome these obstacles. Case presentation: A 15-year-old primigravida at 33 weeks gestation, with new-onset nephrotic syndrome and decompensated heart failure (NYHA Class III), required an emergency cesarean section. Clinical examination revealed severe anasarca, rendering lumbar spinal landmarks impalpable. A systematic pre-procedural lumbar ultrasound examination was performed using a low-frequency curvilinear transducer. This allowed for precise identification of the L3-L4 interspace and an accurate skin-to-dura depth measurement of 4.6 cm. A single-attempt subarachnoid block was successfully performed with a reduced dose (10 mg) of hyperbaric bupivacaine. An adequate T4 sensory block was achieved for surgery. The patient remained remarkably hemodynamically stable throughout the procedure, with no episodes of hypotension requiring vasopressor support. A healthy infant was delivered, and both maternal and neonatal outcomes were excellent. Conclusion: This case demonstrates that a systematic pre-procedural ultrasound protocol is an indispensable tool for enhancing the safety and success of neuraxial anesthesia in high-risk obstetric patients. By enabling precise anatomical localization and informed dose reduction, it mitigates procedural risk and supports hemodynamic stability in the face of distorted anatomy and severe cardiorenal comorbidities.
THE EFFECTIVENESS OF POSTOPERATIVE PERICAPSULAR NERVE GROUP ANALGESIA BLOCK IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENT WITH REGIONAL ANESTHESIA SUBARACHNOID BLOCK I Gede Prima Julianto; I Made Gede Widnyana; Kadek Agus Heryana Putra; I Ketut Wibawa Nada; I Gusti Ngurah Mahaalit Aribawa; Ida Bagus Krisna Jaya Sutawan; Made Wiryana; Tjokorda Gde Agung Senapathi
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 1 (2024): APRIL 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i1.27258

Abstract

Penggunaan blok saraf kelompok perikapsular (PENG) dapat menjadi alternatif analgesia post-operatif yang efektif untuk Penggantian Sendi Panggul Total, dengan komplikasi rendah. Penelitian ini bertujuan untuk menentukan efektivitas analgesia blok PENG terhadap tingkat nyeri, jumlah konsumsi opioid dalam 24, 48, dan 72 jam serta analgesia post-operatif THR di Rumah Sakit Prof. Dr. I. G. N. G. Ngoerah Denpasar. Penelitian ini adalah studi eksperimental dengan desain uji acak terkontrol buta tunggal yang dilakukan di ruang operasi Instalasi Bedah Sentral Rumah Sakit Prof. Dr. I. G. N. G Ngoerah, Denpasar. Uji perbandingan rata-rata menggunakan uji Mann-Whitney jika distribusi data tidak normal. Seluruh proses analisis data di atas menggunakan perangkat lunak statistik SPSS 26. Ada 48 subjek yang menjalani THR dan dibagi menjadi 2 kelompok. Ada perbedaan yang signifikan secara statistik antara kelompok-kelompok tersebut. Berdasarkan hasil analisis non-parametrik, NRS saat istirahat dan bergerak di kelompok perlakuan lebih rendah daripada kontrol dengan nilai p <0,001. Jumlah opioid yang diperoleh memiliki nilai p <0,001 dalam 24 jam pertama, 48 jam, dan 72 jam. Durasi efek ditemukan lebih lama pada kelompok PENG dibandingkan dengan kontrol (p <0,001). Pemberian blok PENG selama prosedur THR menghasilkan NRS yang lebih rendah pada 24 jam, penggunaan opioid yang lebih rendah pada 24 jam, 48 jam, dan 72 jam pascaoperatif, dan durasi efek bebas nyeri yang lebih lama.
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report Parama Adi, Made Septyana; I Gusti Ngurah Mahaalit Aribawa; I Gusti Agung Gede Utara Hartawan; I Putu Fajar Narakusuma; Gusti Agung Made Wibisana Kurniajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (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.v8i4.977

Abstract

Background: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space. Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10. Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions.
Manajemen Perioperatif Pembedahan Video-Assisted Thoracoscopy (VATS) Dekortikasi dan Biopsi Pada Pasien dengan Kecurigaan Keganasan Paru Kiri dengan Atrial Septal Defect Yuliana, Astrid; Dewi, Dewa Ayu Mas Shintya; Aribawa, I Gusti Ngurah Mahaalit
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i7.60745

Abstract

Video-Assisted Thoracoscopy (VATS) is a minimally invasive procedure that can reduce postoperative pain, shorter hospitalizations, and faster recovery. The use of Double Lumen Tube (DLT) in this procedure is with the aim of optimizing the visualization of the surgical field. However, patients with cardiac disorders, such as Atrial Septal Defect (ASD) that can lead to shunt disorders, require adjustments to anesthesia management in terms of ventilation, especially in preventing shunts from right to left. Case Report. The male patient, 30 years old, came in with massive exudative pleural effusion and a history of ASD Secundum. The patient showed significant weight loss and spirometry results showed pulmonary restriction. Preoperative evaluation showed ASA III, with a risk of respiratory and cardiovascular impairment. Anesthesia is performed with left DLT for OLV and thoracic epidural for multimodal analgesation. Postoperatively, the patient is admitted to the ICU on a ventilator and given analgesia via an epidural. Postoperative monitoring showed stable hemodynamics. Discussion. VATS allows thoracic surgery with minimal incision, reducing postoperative pain and speeding up recovery. DLT selection is important for OLVs that require single-lung ventilation, taking into account risk factors such as ASD that can lead to hemodynamic disorders. Anesthesia management in patients with ASD needs to consider cardiac shunt and pulmonary and systemic blood vessel resistance. The anesthesia technique in VATS can be general anesthesia with ventilation of one lung, accompanied by an epidural block for analgesia. Conclusion. Anesthesia management in patients with ASD undergoing VATS requires special attention to ventilation in order to prevent shunts in the heart and pulmonary and systemic blood vessel resistance.
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report Parama Adi, Made Septyana; I Gusti Ngurah Mahaalit Aribawa; I Gusti Agung Gede Utara Hartawan; I Putu Fajar Narakusuma; Gusti Agung Made Wibisana Kurniajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (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.v8i4.977

Abstract

Background: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space. Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10. Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions.
Ultrasound-Guided Neuraxial Precision in a High-Risk Adolescent Parturient: Navigating Anesthetic Management in the Confluence of Nephrotic Syndrome, Diastolic Heart Failure, and Anasarca Made Bagus Cahya Maha Putra; Tjokorda Gde Agung Senapathi; I Gusti Ngurah Mahaalit Aribawa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1480

Abstract

Background: Anesthetic management for cesarean delivery in parturients with concurrent nephrotic syndrome and decompensated heart failure presents a profound clinical challenge. Severe anasarca can obliterate anatomical landmarks, while complex cardiorenal pathophysiology creates a state of extreme hemodynamic fragility. This case report describes a systematic, ultrasound-guided approach to overcome these obstacles. Case presentation: A 15-year-old primigravida at 33 weeks gestation, with new-onset nephrotic syndrome and decompensated heart failure (NYHA Class III), required an emergency cesarean section. Clinical examination revealed severe anasarca, rendering lumbar spinal landmarks impalpable. A systematic pre-procedural lumbar ultrasound examination was performed using a low-frequency curvilinear transducer. This allowed for precise identification of the L3-L4 interspace and an accurate skin-to-dura depth measurement of 4.6 cm. A single-attempt subarachnoid block was successfully performed with a reduced dose (10 mg) of hyperbaric bupivacaine. An adequate T4 sensory block was achieved for surgery. The patient remained remarkably hemodynamically stable throughout the procedure, with no episodes of hypotension requiring vasopressor support. A healthy infant was delivered, and both maternal and neonatal outcomes were excellent. Conclusion: This case demonstrates that a systematic pre-procedural ultrasound protocol is an indispensable tool for enhancing the safety and success of neuraxial anesthesia in high-risk obstetric patients. By enabling precise anatomical localization and informed dose reduction, it mitigates procedural risk and supports hemodynamic stability in the face of distorted anatomy and severe cardiorenal comorbidities.
Low-Flow Anesthesia Management in Pediatric Laparoscopic Choledochal Cyst Excision and Hepaticojejunostomy: A Case Report Togi Stanislaus Patrick; Aribawa, I Gusti Ngurah Mahaalit; Ra Ratumasa, Marilaeta Cindryani; Anak Agung Gde Adistaya
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/xqsck350

Abstract

Laparoscopic surgery offers significant benefits in pediatric populations but presents anesthetic challenges, especially during prolonged procedures. This case report describes the anesthetic management of an 11-year-old boy who underwent nearly 12 hours of laparoscopic choledochal cyst excision, Roux-en-Y hepaticojejunostomy, and cholecystectomy. Low-flow anesthesia using sevoflurane was administered via a Dräger Perseus A500, enabling precise control of anesthetic delivery, oxygenation, and ventilation. Throughout the procedure, inspired oxygen fraction (FiO₂) was maintained above 30%, and end-tidal CO₂ (EtCO₂) remained stable around 35 mmHg. Volatile agent consumption was reduced, with age-adjusted MAC (xMAC) consistently between 0.85 and 0.90. Intraoperative hemodynamics and postoperative recovery were stable, with no immediate complications. This case highlights the safety, efficiency, and cost-effectiveness of low-flow anesthesia in complex pediatric laparoscopic surgery when guided by advanced monitoring systems and supports its broader adoption in resource-limited healthcare settings.