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All Journal BALI MEDICAL JOURNAL (BMJ) E-Jurnal Medika Udayana MNJ (Malang Neurology Journal) Bali Journal of Anesthesiology Syntax Literate: Jurnal Ilmiah Indonesia Medicinus : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico Journal of Anaesthesia and Pain Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research Sehat Rakyat: Jurnal Kesehatan Masyarakat Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
I Gusti Ngurah Mahaalit Aribawa
Department Of Anesthesiology, Pain Management, And Intensive Care, Faculty Of Medicine, Udayana University, Sanglah General Hospital, Denpasar-Bali, Indonesia
Humanities Biochemistry, Genetics & Molecular Biology Dentistry 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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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.
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.
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.
Epidural Anesthesia for Elective Cesarean Section in a Parturient with Noonan Syndrome and Severe Pulmonary Stenosis: A Case Report Kadek Agus Putra Udayana; I Gusti Ngurah Mahaalit Aribawa; I Ketut Wibawa Nada
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.v5i1.5940

Abstract

Pregnancy complicated by congenital heart disease (CHD) presents significant anesthetic challenges, particularly in syndromic conditions such as Noonan syndrome characterized by pulmonary stenosis and multiple right-sided valvular abnormalities. We report a 27-year-old primigravida at 37+5 weeks of gestation with a clinical suspicion of Noonan syndrome, severe pulmonary stenosis, tricuspid and pulmonary valve regurgitation, and right heart failure classified as New York Heart Association (NYHA) class II, who underwent an elective cesarean section combined with intrauterine device (IUD) insertion. An incremental epidural block using 0.5% bupivacaine was selected to provide adequate anesthesia, prevent airway manipulation, and maintain optimal hemodynamic stability under continuous invasive monitoring, including arterial and central venous pressure assessment. The intraoperative and postoperative periods proceeded uneventfully, with stable maternal parameters and a vigorous neonate, both demonstrating favorable recovery and no postoperative complications. This case underscores the importance of an individualized anesthetic approach, meticulous titration of anesthetic agents, and comprehensive perioperative monitoring to ensure safety and positive outcomes in parturients presenting with complex congenital cardiac conditions such as Noonan syndrome.
Manajemen Anestesi Perioperatif pada Kraniotomi pada Pasien dengan Tetralogy of Fallot: Laporan Kasus Faridatun Hasanah; I Ketut Wibawa Nada; I Gusti Ngurah Mahaalit Aribawa
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.v5i1.6098

Abstract

Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease characterized by a right-to-left shunt, predisposing patients to complications such as brain abscess due to paradoxical emboli and chronic hypoxemia. Perioperative anesthetic management in non-cardiac neurosurgery presents a dual challenge: maintaining stable TOF hemodynamics while ensuring neuroanesthetic safety. This report describes an 18-year-old female presenting with progressive headache and a single episode of generalized seizure. Baseline oxygen saturation was 71% on 4 L/min O₂, hemoglobin 16.1 g/dL, and hematocrit 52.6%. Computed tomography revealed a right frontotemporal brain abscess with subfalcine herniation, and echocardiography confirmed classic TOF with severe pulmonic stenosis. The patient, classified as ASA III, underwent abscess-evacuation craniotomy under invasive monitoring. Anesthetic strategy included premedication with midazolam and sufentanil, induction with titrated ketamine and rocuronium, and maintenance with ≤1 MAC sevoflurane without N₂O. Protective ventilation targeted normocapnia (ETCO₂ 35–40 mmHg) and oxygen saturation of 72–78%. Hemodynamic stability was achieved using titrated vasopressors and isotonic fluids. The four-hour surgery proceeded uneventfully, with no occurrence of tet spells or arrhythmias. Key perioperative principles emphasized preserving systemic over pulmonary vascular resistance, maintaining neuroprotection through normocapnia, normothermia, and adequate analgesia, and individualized hemodynamic management. The patient was successfully extubated on postoperative day two and discharged from the ICU on day four without complications. This case underscores the critical importance of a structured, multidisciplinary approach in managing perioperative anesthesia for TOF patients undergoing neurosurgery, balancing cardiac physiology and neuroanesthetic safety.
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.
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 Adi, Made Septyana Parama Adinda Putra Pradhana Anak Agung Gde Adistaya Bora, Fivilia Anjelina Christopher Ryalino Dewi, Dewa Ayu Mas Shintya Dewi, Putu Utami Doddy Setiawan Eka Nantha Kusuma, Putu Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Faridatun Hasanah Gede Semarawima, Gede Gusti Agung Made Wibisana Kurniajaya Hengky Hengky, Hengky I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Agung Made Wibisana Kurniajaya I Ketut Sinardja I Ketut Wibawa Nada I Made Gede Widnyana I Made Prema Putra I Putu Agus Surya Panji I Putu Fajar Narakusuma I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Ayu Sri Wijayanti Ida Bagus Krisna Jaya Sutawan IGNA Putra Arimbawa, IGNA Putra Indah, Carolin Tiara Lestari Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Kadek Agus Putra Udayana Ketut Semara Jaya, Ketut Semara Komang Ady Widayana Komang Alit Artha Wiguna Komang Alit Artha Wiguna Krisnawardhani Kumbara, Cokorda Istri Yuliandari Kurniajaya, I Gusti Agung Made Wibisana Kurniyanta, I Putu Labobar, Otniel Andrians Leton, Yohanes PT Made Agus Kresna Sucandra, Made Agus Kresna Made Bagus Cahya Maha Putra Made Septyana Parama Adi Made Wiryana Mahadewi, Ni Putu Ayu Putri Merry Ni Made Ayu Candrayuni Pande Nyoman Kurniasari, Pande Parama Adi, Made Septyana Pontisomaya Parami Pramaswari, Anak Ayu Agung Putu Gede Ary Sanjaya Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Riko Riko Saputra, Darmawan Jaya Sidemen, I Gusti Ayu Eka Para Santi Siska Permanasari Sinardja Sonni Soetjipto, Sonni Susilawathi, Ni Made Syamsuddin, Johanis Bosco Troy Tini, Kumara Tjokorda Gde Agung Senapathi Togi Stanislaus Patrick Wiranata, Jeremia Alvian Yuliana, Astrid