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The ultrasonic cardiac output monitor (USCOM) as a tool in evaluating fluid responsiveness in pediatric patients underwent emergency surgery Kurniyanta, Putu; Utariani, Arie; Hanindito, Elizeus; Ryalino, Christopher
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTBackground: Assessment fluid adequacy in pediatric patients underwent surgery is a challenge for anesthesiologists. Hemodynamic parameters used as fluid monitoring sometimes don’t accurately provide valid information. Ultrasonic Cardiac Output Monitor (USCOM) is one of the non-invasive methods that are easy to operate and may provide various hemodynamic parameters monitoring information.Objective: Analyze the effectiveness of Stroke Volume Variation (SVV) and Stroke Volume Index (SVI) by using USCOM in assessing fluid responsiveness in preoperative pediatric patients who underwent emergency surgeries. Method: This study was conducted on 16 pediatric patients underwent emergency surgeries. Before general anesthesia is given, blood pressure, mean arterial pressure, heart rate, cardiac index, SVV, SVI were recorded before and after administration of 10 mL/kg of fluid given within 20 minutes.Results: 10 subjects responded with SVV and SVI changes of more than 10% compared to 6 non-responders. SVV changes between responders and non-responders were 31.5±1.58 and 7.5±1.04, respectively. SVV percentage changes between responders and non-responders were 38.04±0.47 and 5.24±4.89, respectively.Conclusion: SVV and SVI recorded by USCOM showed significant fluid responsiveness changes in pediatric patients underwent emergency surgeries in 62.5% of the subjects.

Co-administration of dexmedetomidine and levobupivacaine results in better onset and duration of epidural anesthesia in lower extremity orthopedic surgery Zulkifli, H.; Affandi, Ihsan; Zainal, Rizal; ., Theodorus
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTBackground: The goal of this study is to know the efficacy of the addition of 0.5 mcg/kg dexmedetomidine to 15 mL isobaric 0.5% levobupivacaine on the onset and duration of sensory and motor blockade of epidural anesthesia in lower extremity orthopedic surgery.Methods: Randomized clinical double-blind trials were conducted in Dr. Mohammad Hoesin Hospital Palembang. A total of 34 patients underwent lower extremity surgery met the inclusion and exclusion criteria. Data were analyzed by independent t-test and Mann-Whitney test using SPSS 22.0 software.Result: The onset of sensory block in group D was 5.41±1.84 minutes compared to 17.59± 2.65 in Group C (p <0.001), as seen in Table 2. The sensory block duration was 362.41±25.66 minutes in Group D compared to 215.82±15.69 in Group C (p <0.001). The onset of the motoric block in group D was 16.53±1.81 minutes compared to 26.12±2.78 in Group C (p <0.001), while the motoric block duration was 301.29±20.55 minutes in Group D compared to 167.35±17.24 in Group C (p <0.001).Conclusion: The addition of 0.5mcg/kg dexmedetomidine to 15 ml isobaric 0.5% levobupivacaine in epidural anesthesia provide faster onset and prolonged duration in both motoric and sensory block in patients undergoing lower extremity surgery

Anesthesia management of a parturient with meningioma underwent elective c-section Chandra, Susilo
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v3i1.152

ABSTRACTThe occurrence of primary intracranial tumors in pregnancy is an extremely rare event. Symptoms of a brain tumor include nausea, vomiting, headache, visual disturbances and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. It is a well-established fact today that the technique of choice for elective cesarean section is regional anesthesia. However, in patients with intracranial hypertension and central nervous system infection, this technique should be avoided. General anesthesia poses high risks for pregnant patients. These patients have potentially difficult airways with delayed gastric emptying, which are factors increasing the possibility of pulmonary aspiration after general anesthetic induction. This paper aimed at reporting the anesthetic management of a parturient with intracranial hypertension due to meningioma submitted to elective cesarean section. This kind of surgery needs special attention and specific skill of the anesthesiologist.

The interaction of neuroimmunology, neuromodulator, and neurotransmitter with nociceptor and MAPK signaling Dewi, Dewa Ayu Mas Shintya; Wiryana, Made
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTPhysiological pain is a protection mechanism against tissue damage or potential tissue damage. Inflammation pain is followed by tissue damage due to temperature, mechanical and chemical stimuli which increase crosstalk between neuron nociceptor, immune system, neuromodulator and neurotransmitter, and MAPK (Mitogen Activating Protein Kinase) signal. Initially, immune cell is produced at the primary afferent nerve endings and spinal cord, modulate thermal sensitivity and mechanic through MAPK signaling, then neuromodulator and neurotransmitter at the afferent nerve endings will regulate the innate immune response, adaptive and vascular

Continuous caudal analgesia as a safe and effective method for pediatric post - chordectomy analgesia Senapathi, Tjokorda Gde Agung; Subagiartha, I Made; Widnyana, I Made Gede; Kurniyanta, Putu; Ryalino, Christopher; Estrada, Ronald
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTIt brings great satisfaction for medical officers to be able to see children smiling, laughing, and playing without pain after surgery, yet many children still experience inadequate postoperative pain management. This phenomenon could lead to serious immediate and long term effects in the pediatric patient. Disruption of the healing process caused by pain could become the source of morbidity and mortality in the early postoperative period. Opioid side effects and transformation from acute to chronic pain due to inadequate analgesia are other problems met when dealing with postoperative pain management. This is where regional analgesia takes advantage. Caudal analgesia is an old yet very popular method in pediatric anesthesia and has gained widespread use. It can be delivered as a single injection or continuous infusion. The continuous technique provides a longer duration of analgesia than single injection does. We report a satisfying result from using continuous caudal analgesia for post chordectomy pain management in a 5-year-old boy.

Combined morphine-clonidine adjuvant in epidural analgesia support role of supraspinal modulation in opioid tolerant patient Widnyana, I Made Gede; Cindryani, Marilaeta; Tanggono, Aninda
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACT Acute pain patients with complicated pain-related experiences would need more than just a pain reliever, especially those with behavioral opioid usage. Latest findings revolving supraspinal modulation are not only taking experts and pain physician into a different stage of understanding but also making theories and management revisited. A 41-years-old Australian male underwent plate and screw fixation of his right femur. He was overweight with a history of behavioral opioid usage. He was given epidural analgesia for postsurgical management with bupivacaine 0.1% with morphine 2 mg and clonidine 30 mcg every 12 hours as adjuvants. Hemodynamic curves were in normal limits, no paralysis, urinary difficulties, or pruritus. He was discharged on the fourth day. The combined morphine-clonidine adjuvant in epidural analgesia technique was an effective choice to alleviate pain response in this opioid-tolerant patient.

The use of echocardiography as a routine perioperative monitoring standard: The perspective of a cardiothoracic anesthesiologist Nada, I Ketut Wibawa; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

INTRODUCTIONIn the era of medicine that has been very advanced as it is today, we as anesthesiologists are required to be able to provide anesthetic services that are comfortable but still safe. Throughout the world, there are more than 300 million major surgery each year, and major cardiovascular adverse events are a significant cause of perioperative morbidity and mortality.1 This certainly relates to the nature of anesthetic agents that are mostly cardiovascular-depressant. Anesthetic agents such as propofol, ketamine, opioids, inhalation anesthetic agents, and many others, can directly affect the cardiovascular system.2While the major cardiac event occurred during perioperative events is also quite high. Especially for the patients in the perioperative period who will undergo non-cardiac surgery. This frequently reduces the alertness of an anesthesiologist, especially when performing perioperative monitoring. A study from Smilowitz et al.,1 showed that out of 10,581,621 patients admitted to hospital for major non-cardiac surgery plans, 317,479 (3%) patients had experienced major cardiac events. Which can be illustrated that major cardiac events occur in 1 in 33 patients treated for major non-cardiac surgery. Echocardiography is a safe, relatively inexpensive and well-tolerated action for patients.3Regular use of echocardiography in the perioperative period can certainly help to predict and even reduce major events adverse cardiac events. It is good to be used as a guide for making decisions in carrying out actions, as well as for monitoring the patient's condition regularly during the perioperative period. The use of echocardiography so far has been used for both diagnosis and management in the field of cardiology and is used by another specialist as well, although anesthesiologists do not use it in the perioperative period as a routine manner. Meanwhile, the role of an anesthesiologist as a perioperative doctor has become something that other specialties have begun to rely on.4

Udayana One Health Collaborating Center (OHCC) initiated Bali’s first mass, integrated basic life support training Sudewi, Anak Agung Raka; Budayanti, Nyoman Sri; Wiryana, Made; Senapathi, Tjokorda Gde Agung; Ryalino, Christopher; Pradhana, Adinda Putra
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTBasic Life Support (BLS) is a first-aid training that can be utilized in case of emergency until the victims are retained by medical professionals. Mastering BLS skills can be the difference between life and death. A cardiopulmonary resuscitation (CPR) performed by a passer-by is important to ensure a successful resuscitation in out-of-hospital cardiac arrest. Yet, improving the survival rate for out-of-hospital cardiac arrest is still a major problem. Starting in 2019, Udayana One Health Collaborating Center (Udayana OHCC) will implement the first mass and integrated BLS training in Bali. The goals are to introduce BLS to more people and to produce BLS-friendly environment in Bali.

The role of endothelial glycocalyx in sepsis Hartawan, I Nyoman Budi; Wiryana, Made
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTThe surface of endothelial cells is filled with various membrane-bound molecules that form the glycocalyx. The endothelial glycocalyx is a surface layer mainly consisted of glycosaminoglycans that include heparan sulfate, chondroitin sulfate, and hyaluronic acid and its core proteins. Previous studies suggest that endothelial surface glycocalyx shedding could play a role in endothelial dysfunction and inflammation. This article will review the endothelial glycocalyx and its role in sepsis.

Vecuronium in tuberculosis: a rare case report of reversible quadriparesis Kumar, Amarjeet; Kumar, Neeraj; Sinha, Chandni; Kirti, Ravi; Kumar, Sanjeev
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTTuberculosis is a major health burden worldwide. The National treatment regimens for tuberculosis (TB) patients recommend the use of the five first lines anti TB drugs: isoniazid (INH), rifampicin (R), ethambutol (E), pyrazinamide (P) and streptomycin (S). Maintaining of oxygenation are very much challenging in tuberculosis patients associated with Acute Respiratory Distress Syndrome (ARDS). Often we need muscle relaxation with adequate sedation for maintaining oxygen saturation and lung recruitment. Skeletal muscle weakness has a confusing list of names and syndromes, including Acute Quadriplegic Myopathy Syndrome (AQMS), floppy man syndrome, critical illness polyneuropathy (CIP), and acute myopathy of intensive care. In disseminated tuberculosis with ARDS, we recommend the use of short-acting muscle relaxant drugs like cisatracurium whose metabolism not depends upon the liver. Interrupting the vecuronium infusion (vecuronium holiday) as its action was potentiated by streptomycin and corticosteroid which may result in the development of Critical Illness Polyneuro Myopathy (CIPM). Targeting Train of Four (TOF) of two rather than zero of four has been shown to be beneficial for a period of fewer than 48 hours.

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Abstract

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Abstract

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Abstract

Contact Name
-

Contact Email
-

Phone
-

Journal Mail Official
-

Editorial Address
-

Location
Kota denpasar,

Bali

INDONESIA