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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 Solo Journal of Anesthesi, Pain and Critical Care Journal of Anesthesiology and Clinical Research 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 Chemical Engineering, Chemistry & Bioengineering Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences 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.
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.
Acute Asthma Exacerbation and Thrombocytopenia in Pregnancy: an Emergency Cesarean Case Report David, David; Aribawa, I Gusti Ngurah Mahaalit
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.109302

Abstract

Background: Asthma exacerbation and thrombocytopenia during pregnancy present significant anesthetic challenges, particularly when urgent cesarean delivery is required. In addition, acute asthma exacerbation may compromise maternal oxygenation and necessitate immediate airway control. In such complex conditions, anesthetic management must be individualized to optimize maternal and fetal outcomes.Case Illustration: We report the case of a 26-year-old pregnant woman (G4P1021) at 38 weeks and 4 days of gestation who was referred with premature rupture of membranes, acute asthma exacerbation, and severe thrombocytopenia. On admission, the patient had mild wheezing, respiratory rate of 24 breaths per minute, and oxygen saturation ranging from 93–96% on room air. Laboratory evaluation revealed severe thrombocytopenia with a platelet count of 38 × 10⁹/L and mild anemia (hemoglobin 9.7 g/dL). Preoperative optimization included nebulized salbutamol and intravenous corticosteroids. Due to the high risk of spinal or epidural hematoma and the potential for respiratory deterioration, general anesthesia with rapid sequence induction and intubation was selected. Ketamine and propofol were used for induction to provide bronchodilation, hemodynamic stability, and reduced airway reactivity. Anesthesia was maintained with propofol infusion, fentanyl, and rocuronium. The cesarean delivery proceeded uneventfully without intraoperative bronchospasm or hemodynamic instability.Conclusion:  This case demonstrates that in obstetric emergencies complicated by acute asthma exacerbation and severe thrombocytopenia, general anesthesia can provide safer airway control and hemodynamic stability when regional anesthesia is contraindicated.
Co-Authors Adi, Made Septyana Parama Adinda Putra Pradhana Anak Agung Gde Adistaya Bora, Fivilia Anjelina Christopher Ryalino David David 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