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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Majalah Anestesia & Critical Care (MACC) Jurnal Komplikasi Anestesi
Lesmana, Pita Mora
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Quadratus Lumborum Block as Intraoperative Analgesic Treatment in Pediatric with Hirschprung’s disease Lesmana, Pita Mora; Ratumasa, Marilaeta Cindryani Ra; Subagiartha, I Made; Senapathi, Tjokorda Gde Agung
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i1.14973

Abstract

Overview: A 4-year-old boy diagnosed with Hirschsprung's disease since birth will undergo a planned Duhamel procedure. Internationally, the prevalence of Hirschsprung's disease is approximately 1 in 1,500 to 1 in 7,000 live births and usually requires immediate intervention through surgical procedures. The extended length of pediatric surgeries presents a unique challenge for anesthesiologists aiming to minimize the use of opioids, considering their less desirable effects in this patient population. In this case, we opted for the use of quadratus lumborum block (QLB) as intraoperative analgesia. This refers to a meta-analysis by Wen-li Zhao et al, all suggest that QL block offers more effective postoperative pain relief in children after lower abdominal surgeries. Management: After the patient was intubated, we performed a quadratus lumborum block using an anterior approach as an intraoperative analgesia technique. The local anesthetic used was 0.375% ropivacaine + 4 mg dexamethasone, volume 10 ml on both sides. Dermatom covered anterior QL block includes T4 to T12-L1, blocks the anterior and the lateral cutaneous branches of the nerves Result: No additional opioid dose administered during the surgical procedure. Conclusion: The QLB in pediatric patients is quite effective in managing pain during surgery for patients undergoing the Duhamel procedure.
Efektivitas Blok Nervus Maksilaris Suprazigomatika pada Pasien Miastenia Gravis yang Menjalani Functional Endoscopic Sinus Surgery (FESS) Kadek Agus Heryana Putra; Lesmana, Pita Mora; Tjokorda Gde Agung Senapathi
Majalah Anestesia & Critical Care Vol 43 No 3 (2025): Oktober
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.v43i3.422

Abstract

Pendahuluan: Secara global, prevalensi dan insidensi miastenia gravis meningkat, dengan tingkatinsidensi 5,3 orang per juta dan prevalensi 77,7 orang per juta. Dengan meningkatnya prevalensi,penting bagi seorang anestesiolog untuk mengetahui patofisiologi dan komplikasinya, terutamakrisis miastenia. Salah satu pencetus terjadinya krisis adalah berupa nyeri pascaoperasi. Padakasus ini, kami memilih teknik pembiusan tanpa pelumpuh otot dan teknik blok nervus maksilarissuprazigomatika sebagai teknik analgetik pascaoperasi pasien miastenia yang menjalani functionalendoscopic sinus surgery (FESS).Deskripsi Kasus: Pasien perempuan usia 32 tahun didiagnosis pansinusitis dan riwayat miasteniagravis terkontrol dengan terapi direncanakan menjalani FESS bilateral. Induksi dilakukan dengankombinasi agen anestesi sevofluran dan propofol serta analgetik fentanyl. Sebelum ekstubasi,pasien diberikan blok maksilaris dengan pendekatan suprazigomatik menggunakan bupivakain0,25% sebanyak 5 ml pada masing-masing sisi. Ekstubasi dilakukan berdasarkan penilaian kekuatanotot menggunakan Train of Four (TOF). Pasien berhasil diekstubasi tanpa komplikasi, dengan nilaiNumeric Rating Scale (NRS) 0/10 pada 48 jam pascaoperasi.Simpulan: Kombinasi sevofluran dan propofol dengan blok maksilaris pendekatan suprazigomatikefektif untuk manajemen anestesi dan nyeri akut pascaoperasi pada pasien miastenia yang menjalaniFESS.
Anesthetic Management of a Single Ventricle in Pediatric Patient Undergoing Open Duodeno–Duodenostomy Surgery: A Case Report Lesmana, Pita Mora; I Putu Kurniyanta; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1045

Abstract

Background: Duodenal atresia is a rare congenital disorder characterized by blockage of the small intestine. Open duodeno-duodenostomy is the surgery of choice to correct this condition. Case presentation: We report the case of a three-day-old baby girl with duodenal atresia and a functional single ventricle who underwent open duodeno-duodenostomy. The patient was born via caesarean section due to indications for a previous caesarean section in the mother and congenital abnormalities in the fetus. At birth, the patient showed signs of intestinal obstruction and cyanosis. Preoperative physical and laboratory examinations confirmed duodenal atresia and cardiac abnormalities. The patient underwent an open duodeno-duodenostomy without complications. The patent ductus arteriosus must be kept open to maintain systemic perfusion by maintaining PaO2 at 40 to 45 mmHg and SaO2 at 70% to 80%, along with the administration of prostaglandin agents. Good perioperative management and improvements in surgical procedures will increase the life expectancy of patients with single ventricle problems, especially hypoplastic left heart syndrome. The use of low-dose fentanyl induction agent, 1 MAC sevoflurane, and atracurium has been proven to produce favorable outcomes in these patients. Conclusion: Open duodeno-duodenostomy is a safe and effective operation for duodenal atresia. The patient in this case recovered well after surgery. Open duodeno-duodenostomy should be considered as the primary treatment option for duodenal atresia.
Anesthetic Management of a Single Ventricle in Pediatric Patient Undergoing Open Duodeno–Duodenostomy Surgery: A Case Report Lesmana, Pita Mora; I Putu Kurniyanta; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1045

Abstract

Background: Duodenal atresia is a rare congenital disorder characterized by blockage of the small intestine. Open duodeno-duodenostomy is the surgery of choice to correct this condition. Case presentation: We report the case of a three-day-old baby girl with duodenal atresia and a functional single ventricle who underwent open duodeno-duodenostomy. The patient was born via caesarean section due to indications for a previous caesarean section in the mother and congenital abnormalities in the fetus. At birth, the patient showed signs of intestinal obstruction and cyanosis. Preoperative physical and laboratory examinations confirmed duodenal atresia and cardiac abnormalities. The patient underwent an open duodeno-duodenostomy without complications. The patent ductus arteriosus must be kept open to maintain systemic perfusion by maintaining PaO2 at 40 to 45 mmHg and SaO2 at 70% to 80%, along with the administration of prostaglandin agents. Good perioperative management and improvements in surgical procedures will increase the life expectancy of patients with single ventricle problems, especially hypoplastic left heart syndrome. The use of low-dose fentanyl induction agent, 1 MAC sevoflurane, and atracurium has been proven to produce favorable outcomes in these patients. Conclusion: Open duodeno-duodenostomy is a safe and effective operation for duodenal atresia. The patient in this case recovered well after surgery. Open duodeno-duodenostomy should be considered as the primary treatment option for duodenal atresia.
Co-Authors I Made Subagiartha Kadek Agus Heryana Putra Putu Kurniyanta Ratumasa, Marilaeta Cindryani Ra Tjokorda Gde Agung Senapathi