Garuda - Garba Rujukan Digital

Effective Pain Management in a Patient with Colon Cancer: A Case Report of Combined Quadratus Lumborum and Transabdominal Plane Blocks Shallahudin; Ristiawan Muji Laksono; Taufiq Agus Siswagama; Aswoco Andyk Asmoro; Buyung Hartiyo Laksono
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 2 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i2.703

Cancer-related pain, particularly in cases of advanced colon cancer, presents a significant challenge to healthcare providers. Traditional pain management strategies, including opioids, often prove inadequate or are associated with undesirable side effects. Quadratus lumborum block (QLB) is an emerging regional anesthesia technique offering potential benefits in managing abdominal pain. This case report describes the successful implementation of combined QLB and transabdominal plane (TAP) blocks for effective pain management in a patient with colon cancer. A 53-year-old male patient with a history of colon cancer presented with severe abdominal pain at the site of his stoma radiating to his back. The pain was exacerbated by movement and significantly impacted his quality of life. Despite receiving a multimodal analgesic regimen, including a fentanyl patch and oral medications, his pain remained poorly controlled. After careful consideration, a combined QLB and TAP block was performed using ultrasound guidance. Following the procedure, the patient experienced significant pain relief, with his Numerical Rating Scale (NRS) score decreasing from 7-9 to 1-2 at rest and from 5-6 to 2-3 during movement. He reported no nausea or vomiting and was able to mobilize comfortably. This improvement in pain control facilitated his recovery and enhanced his overall well-being. In conclusion, this case report highlights the potential of combined QLB and TAP blocks as an effective pain management strategy for patients with colon cancer. This approach may offer a valuable alternative or adjunct to traditional methods, particularly in cases where opioid use is limited by side effects or tolerance. Further research is warranted to investigate the long-term efficacy and safety of this technique in a larger patient population.

Injection of the Sphenopalatine Ganglion With C-Arm And Radiofrequency For Trigeminal Neuralgia Satriyanto, Muhammad Dwi; Ketut Ngurah Gunapriya; Ristiawan Muji Laksono; Saiful Anwar
International Journal of Psychology and Health Science Vol. 2 No. 1 (2024): International Journal of Psychology and Health Science (January-March 2024)
Publisher : Greenation Publisher & Yayasan Global Research National

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/ijphs.v2i1.459

Trigeminal Neuralgia (TN) is the most severe pain in the world, where patients experience a painful condition from the face that significantly impacts the quality of life and socio economic function of affected patients. The pathophysiology of TN is still unclear, it is thought that TN occurs due to compression of the root entry zone of the trigeminal nerve near the origin of the brain stem and this local pressure causes demyelination which leads to abnormal depolarization which results in ectopic impulses. The sphenopalatine ganglion is a parasympathetic ganglion that is connected to the trigeminal, facial, and sympathetic systems and consists of somatosensory, sympathetic, and parasympathetic nerve fibers. This ganglion receives sensory impulses from around the face. TN Management can in a way pharmacological and surgical; however, it is not capable in a way of effectively relieving, since the technology of radiofrequency ablation, TN patients can be done with radiofrequency ablation with satisfactory results, even one daycare.

Epidural Tunneling for Effective Management of Severe Cancer Pain: A Case Report Imam Safi'i; Ristiawan Muji Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.714

Introduction: Severe pain is a common and debilitating symptom for many cancer patients, often requiring multimodal approaches for effective management. While oral opioids and adjunctive therapies are frequently the first line, some patients with refractory pain necessitate interventional procedures. This case report describes the successful use of epidural tunneling for long-term pain management in a patient with severe cancer pain due to bone metastases. Case presentation: A 55-year-old woman with severe cancer pain secondary to bone metastases from breast cancer presented with intractable pain in her hips, buttocks, and legs, radiating to her feet with associated numbness. Despite high doses of oral opioids, paracetamol, amitriptyline, and a fentanyl syringe, her pain remained poorly controlled, significantly impacting her sleep and quality of life. A lumbosacral X-ray revealed osteolytic-blastic lesions with vertebral compression and other metastatic involvement. Given the severity and refractory nature of her pain, an epidural tunneling procedure was performed. Conclusion: Epidural tunneling proved to be a safe and effective method for managing severe, chronic cancer pain in this patient, leading to a substantial reduction in pain intensity and a decreased need for systemic opioids. This technique offers a valuable option for patients with persistent pain who have failed conventional analgesic therapies, particularly in advanced stages of cancer.

Dexmedetomidine versus Lidocaine for Hemodynamic Stability During Airway Management in Patients with Traumatic Brain Injury: A Randomized Clinical Trial Shallahudin; Aswoco Andyk Asmoro; Ristiawan Muji Laksono; Buyung Hartiyo Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.787

Introduction: The profound sympathoadrenal stress response to endotracheal intubation in patients with traumatic brain injury (TBI) presents a significant risk for secondary brain injury by inducing perilous hemodynamic instability. Pharmacological attenuation is critical, yet direct comparative evidence between commonly used agents is lacking. This study aimed to rigorously compare the efficacy of dexmedetomidine, a central sympatholytic, versus lidocaine, a peripheral membrane stabilizer, in maintaining hemodynamic stability during airway management in the TBI population. Methods: In this prospective, randomized, double-blind clinical trial, seventy-one adult patients with TBI (ASA I-III) were allocated to receive either intravenous dexmedetomidine (1 μg/kg over 10 minutes; n=37) or intravenous lidocaine (1.5 mg/kg over 2 minutes, with total infusion time matched to 10 minutes with saline; n=34) prior to a standardized anesthesia induction. The prespecified primary outcome was the change in mean arterial pressure (MAP) from baseline to one minute post-intubation. Secondary outcomes included changes in heart rate (HR) and hemodynamic profiles over 10 minutes. Results: Baseline patient characteristics, including TBI severity, were well-balanced between groups. Both interventions effectively blunted the pressor response, causing a significant decrease in MAP and HR from baseline (p<0.001 for all). The primary outcome, the change in MAP at one minute post-intubation, was not statistically different between the dexmedetomidine and lidocaine groups (-12.8 ± 6.1 mmHg vs. -11.5 ± 5.9 mmHg, respectively; p=0.412). Similarly, no significant differences in HR or MAP were observed between groups at any time point up to 10 minutes post-intubation. The incidence of rescue therapy for hypotension or bradycardia was low and comparable. Conclusion: In patients with TBI, both dexmedetomidine and lidocaine are effective and safe for attenuating the hemodynamic stress of intubation. At the doses studied, neither agent demonstrated clinical superiority, providing clinicians with two valid, mechanistically distinct options. The choice can therefore be guided by the specific clinical context, including desired onset, duration of action, and sedative profile.

Early Risk Stratification in a High-Mortality Study of Adult Trauma Patients: A Comparative Validation of RTS, SI, and ISS Denny Prasetyo; Arie Zainul Fatoni; Ristiawan Muji Laksono; Buyung Hartiyo Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.788

Introduction: Accurate, early risk stratification is paramount in managing severe trauma, especially in resource-limited settings. This study aimed to compare the predictive performance of the revised trauma score (RTS), shock index (SI), and injury severity score (ISS) for in-hospital mortality in a group of severely injured adult trauma patients at a tertiary center in Indonesia. Methods: A retrospective analysis was conducted on a purposively selected study population of 100 adult trauma patients (age 20-60) admitted to the Emergency Department of Dr. Saiful Anwar Regional General Hospital over a three-month period in 2023. This selection method yielded a high-mortality sample (50% mortality) to ensure sufficient statistical power for analyzing fatal outcomes. The predictive performance of RTS, SI, and ISS was evaluated using individual logistic regression models. Discriminatory ability was assessed by calculating the area under the receiver operating characteristic curve (AUC-ROC) for each score. Model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Results: All three scoring systems were significant predictors of mortality in individual regression analyses. The injury severity score (ISS) demonstrated the highest discriminatory power for predicting mortality with an AUC of 0.88 (95% CI, 0.81-0.95). The revised trauma score (RTS) also showed good discrimination with an AUC of 0.83 (95% CI, 0.75-0.91). The Shock Index (SI) was a significant predictor but had the most modest discriminatory ability with an AUC of 0.76 (95% CI, 0.67-0.85). All models were well-calibrated. Conclusion: In this study of severely injured adult trauma patients, the anatomically-based ISS was the most accurate predictor of mortality. The physiological scores, RTS and SI, remain valuable for their utility in rapid, initial patient assessment. The findings support a complementary approach, using the simple physiological scores for immediate triage and the more comprehensive ISS for definitive prognostication.

Preoperative Fasting Duration as a Potential Predictor of Glycemic Instability in Non-Diabetic Emergency Surgery Patients: A Prospective Observational Pilot Study Mustaqiem Isda; Aswoco Andyk Asmoro; Ristiawan Muji Laksono; Rudy Vitraludyono
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.789

Preoperative fasting is a cornerstone of anesthetic safety, yet in emergency surgery, fasting periods are frequently prolonged and unregulated. The metabolic consequences of such extended fasting in non-diabetic patients, who are often assumed to be metabolically resilient, are poorly understood. This pilot study aimed to investigate the association between prolonged fasting and pre-induction glycemic instability. We conducted a prospective, observational pilot study at a tertiary referral hospital, enrolling 30 non-diabetic adult patients (ASA I-E/II-E) undergoing emergency surgery. The primary exposure was preoperative fasting duration, analyzed as both a continuous variable and a dichotomized category (≤8 vs. >8 hours). The primary outcomes were pre-induction blood glucose levels, analyzed continuously and with two categorical thresholds: glycemic instability (<85 mg/dL) and clinically significant hypoglycemia (<70 mg/dL). Associations were assessed using Chi-Square tests and Spearman's rank correlation. A majority of patients (60%) fasted for >8 hours. A strong negative correlation was found between the duration of fasting and pre-induction blood glucose levels (Spearman's ρ = -0.78, p<0.001). Using the <85 mg/dL threshold, 83.3% of patients fasting >8 hours exhibited glycemic instability, compared to 25% of those fasting ≤8 hours (p=0.002). Using the standard <70 mg/dL threshold, 55.6% of patients fasting >8 hours developed clinically significant hypoglycemia, compared to 8.3% of those fasting ≤8 hours (p=0.011). In conclusion, this pilot study provides a strong preliminary signal that prolonged preoperative fasting is significantly associated with a decline in blood glucose and an increased incidence of both glycemic instability and clinically significant hypoglycemia in non-diabetic emergency surgical patients. These findings challenge the assumption of metabolic security in this population and underscore the urgent need for larger, definitive studies. Routine pre-induction glucose monitoring should be strongly considered as a potential safety standard in this vulnerable group.

The Novice Overshoot: A Bispectral Index-Based Analysis of the Anesthesiology Resident Learning Curve for Anesthetic Depth Control in Supervised Practice Rizki Suhadayanti; Isngadi; Buyung Hartiyo Laksono; Ristiawan Muji Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.790

Introduction: The skillful management of anesthetic depth is a cornerstone of anesthesiology, yet the objective characterization of the resident learning curve remains underexplored. This study aimed to quantitatively map the developmental trajectory of anesthetic depth control among anesthesiology residents in a supervised clinical environment. Methods: We conducted a prospective, cross-sectional, observational study involving 21 anesthesiology residents (from seven sequential semesters of training) and 105 ASA I-II adult patients at a tertiary academic hospital. Under standardized supervision, residents induced general anesthesia. The primary outcome was the Bispectral Index (BIS) value and its categorical distribution (Deep: <40, General: 40-60, Sedation: >60) at 2 minutes post-intubation. Secondary outcomes included propofol induction dose and hemodynamic responses. Data were analyzed using ANOVA, Kruskal-Wallis, and Chi-square tests. Results: Post-intubation mean BIS values showed a non-significant trend towards being lower in junior residents compared to seniors (p=0.088). However, the categorical distribution of BIS values differed significantly across training levels (p=0.015). Junior residents (Semesters I-II) induced a state of deep anesthesia (BIS < 40) in 46.7% of their patients, compared to only 11.1% for senior residents (Semesters V-VII) (p<0.001). This correlated with junior residents using significantly higher weight-adjusted propofol doses (2.4 ± 0.3 mg/kg vs. 1.9 ± 0.2 mg/kg; p<0.001). Conclusion: The anesthesiology resident learning curve is characterized by a distinct pattern of initial over-titration, or a "novice overshoot," leading to a higher incidence of unnecessarily deep anesthesia. While mean BIS values did not differ significantly, the distribution of hypnotic states reveals a critical educational target. BIS monitoring serves as a valuable objective tool for tracking the performance of the resident-supervisor dyad, offering data-driven insights for enhancing competency-based training and patient safety.

Title

Found 7 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 7 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 7 Documents
Search