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All Journal International Journal of Public Health Science (IJPHS) Journal of Anaesthesia and Pain Jurnal Komplikasi Anestesi
Sukmono, Raden Besthadi
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Health Professions Medicine & Pharmacology

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Influencing factors of patient safety in anesthesia services in a low- and middle-income country Heriwardito, Aldy; Ramlan, Andi Ade Wijaya; Zahra, Raihanita; Martira, Amelia; Pramodana, Bintang; Bintartho, Agung; Sukmono, Raden Besthadi; Lasanudin, Joshua Eldad Frederich
International Journal of Public Health Science (IJPHS) Vol 14, No 4: December 2025
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v14i4.26631

Abstract

Patient safety in anesthesia remains a concern in low- and middle-income countries due to workforce shortages, limited equipment, and inconsistent protocols. In Jakarta, where demand for anesthesia is rising, baseline data on these parameters are lacking. This study aimed to identify gaps in human resources, equipment availability, and safety protocol adherence. A cross-sectional survey of all actively practicing anesthesiologists in Jakarta was conducted in January 2024, yielding 115 responses. The questionnaire, developed and face-validated through a focus group with senior anesthesiologists, covered three domains: human resources, facilities and equipment, and protocols. Internal reliability was assessed using Cronbach’s alpha. Participation was voluntary, responses were anonymous, and data were analyzed using descriptive statistics. Prolonged work hours were reported by a minority of respondents (6.1-7%), with 22.7% agreeing that anesthesiologists' workload is too high. Most rated human resource parameters positively (median 4/5), but access to basic monitoring devices for oxygenation, ventilation, circulation, and temperature was limited. Protocol adherence was generally high (median 4-5/5), though a small minority of institutions lacked incident reporting pathways, patient risk assessment, and post-surgical recovery rooms. Improving patient safety in Jakarta requires ensuring essential monitoring equipment, optimizing staffing to manage workload, and mandating full perioperative safety protocols across facilities.
Intraoperative Anaphylaxis Reaction Due to Suspected Anesthesia Agent Sukmono, Raden Besthadi; Febri, Rafli Nur
Jurnal Komplikasi Anestesi Vol 13 No 1 (2025)
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.v13i1.14971

Abstract

Background: Intraoperative anaphylaxis is a life-threatening condition that may present atypically without cutaneous or respiratory manifestations, making early diagnosis challenging. Case Presentation: A 24-year-old male (ASA II) with sinus bradycardia and three previous uneventful general anesthetics underwent left auricular mass extirpation under general anesthesia. Approximately 90 minutes after induction, the patient developed sudden tachycardia despite minimal surgical stimulation. No additional epinephrine infiltration had been administered. Body temperature was normal and sevoflurane MAC was 0.7. Initial management included a 200 mL crystalloid fluid challenge, fentanyl 2 µg/kg IV bolus, and reduction of sevoflurane MAC to 0.5; however, tachycardia persisted and severe hypotension ensued (from 100/60 mmHg to 50/30 mmHg). No rash, bronchospasm, or fever was observed. Suspected intraoperative anaphylaxis was treated with epinephrine 0.1 mg IV (two doses), 500 mL crystalloid bolus, and supine positioning. Tachycardia resolved after the first epinephrine dose, and blood pressure improved after the second dose. Conclusion: This case highlights that intraoperative anaphylaxis can occur without skin or airway manifestations, consistent with World Allergy Organization (WAO) criteria. Prompt recognition and early epinephrine administration are crucial to improving patient outcomes
Persistent Post-Dural Puncture Headache in an Autoimmune Patient: Diagnostic Challenges and Successful Management with Epidural Blood Patch Mangkuwerdojo, Liliana; Pryambodho; Sukmono, Raden Besthadi
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): In Press
Publisher : Faculty of Medicine, Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Epidural blood patch (EBP) remains the gold-standard intervention for post-dural puncture headache (PDPH), offering rapid and substantial symptom relief. Case: A female in her 20s underwent diagnostic lumbar puncture for evaluation of suspected autoimmune disease. Approximately three days following the procedure, she developed a progressively worsening orthostatic headache (Visual Analogue Scale [VAS] 3–4 at baseline, escalating to 8–9 with positional changes), accompanied by photophobia, nausea, and pain with eye movement. Conservative management and transnasal sphenopalatine ganglion (SPG) block provided only partial and transient relief. An EBP was subsequently performed using 10 mL of autologous blood, resulting in complete bilateral resolution of headache at 24-hour follow-up without significant adverse effects. Conclusion: This case highlights the effectiveness of EBP in managing refractory PDPH unresponsive to conservative treatments and SPG block, even in patients with complex autoimmune backgrounds. EBP remains the definitive treatment for refractory PDPH as a safe and effective option, including in selected patients with underlying autoimmune disease.
Co-Authors Agung Bintartho Aldy Heriwardito Febri, Rafli Nur Lasanudin, Joshua Eldad Frederich Mangkuwerdojo, Liliana Martira, Amelia Pramodana, Bintang Pryambodho Ramlan, Andi Ade Wijaya Zahra, Raihanita