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Perioperative anesthetic management in pediatric with pheochromocytoma tumor resection Thius, Adi Dharma; Kurniyanta, Putu; Putra, Kadek Agus Heryana; Sinardja, I Ketut
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Pheochromocytomas (PCC) is rare neuroendocrine tumors which present as the malignant and familial features. These catecholamine-secreting tumors have triad classical symptoms of headache, sweating, and palpitation primarily due to the release of catecholamines and their metabolites in the body with hypertensive crisis become its predominant clinical symptoms. The excessive release of catecholamines may produce a life-threatening hemodynamic surge during the intraoperativeperiod, therefore preoperative preparation and intraoperative monitoring become an essential point. Nevertheless, postoperative care is also a critical issue in order to further curtail its morbidity and mortality rates.

The effectivity of ear plug utilization on emergence delirium incidence in pediatric patient undergoing general inhalated anesthesia Perdana, Aries; Kapuangan, Christopher; Zahra, Raihanita
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Background. Emergence Delirium (ED) also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors such as agitation, irritable, uncompromising, uncooperative, inconsolably crying following general anesthesia. The incidence of ED in pediatric patients in Dr. Cipto Mangunkusumo hospital was 39,7%. During emergence state, auditory stimulation induces thalamic synapse in lateral amygdala which leads to over response of fear (one of the risk factor of ED). A high noise level in operating room can be reduced with ear plug application to the patient. Design and Method. A double blind randomized clinical trial towards 1-5 years old pediatrics who underwent inhalation general anesthesia in Dr. Cipto Mangunkusumo hospital from September-December 2018. One hundred and seven subjects were randomized after a consecutive sampling into two groups. Earplug group (n=53) with application of ear plug at the end of surgery, while in control group (n=54) without application of ear plug. The incidence of ED and time to extubation were recorded. ED was measured using Pediatric Anesthesia Emergence Delirium (PAED) scale. All the data was analyzed using multivariate logistic regression and ANCOVA. Result. Incidence of ED in ear plug group was 16.7% while in control group was 32.1% (OR = 0.402; CI 95% 0.152-1.062; p=0.066). Mean value of time to extubation in ear plug vs control group (5.76+3.23 minutes) vs (6.54+ 3.67 minutes) with mean difference of 0.825(0.530-2.180); p=0.230. Conclusion. Ear plug application at the end of anesthesia was not statistically effective. However, it was clinically effective in reducing the incidence of ED in pediatric patient underwent inhalation anesthesia.

Isobaric levobupivacaine for intrathecal anesthesia as an effective and safe option in transurethral resection of the prostate surgery Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Nada, I Ketut Wibawa; Astuti, Mira Kusuma
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

The search for safer anesthetic solutions has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, emerged as a safer alternative for intrathecal anesthesia than its racemic parent (bupivacaine). Levobupivacaine shows a lower risk of the central nervous system and cardiovascular toxicity.However, in many countries, levobupivacaine is only available in isobaric solution, where the isobaric solution for intrathecal anesthesia is still often be questioned its effectiveness because of the fear that the block spreading is unpredictable. In this case series, we describe sensory and motor block characteristics, hemodynamics profile and adverse effects of isobaric levobupivacaine in intrathecal anesthesia for six patients with American Society of Anesthesiology physical status II-III whose undergo transurethral endoscopic surgery.

Salmonella Typhi â€“ a Quiet Bacteria with a Loud Message: an ICU Case Report Adu-Gyamfi, Rossi; Hoosain, Fatima; Chetty, Sean
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Typhoid fever, caused by Salmonella enterica, serovar Typhi, is restricted to humans as its host and evades the human immune system with ease. This quality has been one of the many reasons why it is commonly found as an endemic bacterium in emerging economies. Also, due to a remarkably low yield from blood cultures (median of 1 CFU/mL of blood), Salmonella septicemia is uncommon. New evidence gathered together with clinical investigations have provided insight into the mechanisms that underlie the pathogenesis of typhoid, host restriction as well as antibiotic and vaccine susceptibility. However, very little has been done to curb the persistence of disease and emergence of resistant strains. We discuss a case of Salmonella Septic Shock in the Intensive Care Unit (ICU) that takes us through various aspects in diagnosis, the treatment potential and the problems surrounding prevention.

Characteristics of patients requiring non-invasive ventilation in pediatric intensive care unit Estina, Vania Catleya; Wati, Dyah Kanya; Suparyatha, Ida Bagus; Hartawan, I Nyoman Budi
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Background: Non-invasive ventilation (NIV) has become an essential tool in the treatment of both acute and chronic respiratory failure in children. This study aimed to determine the efficacy of NIV usage in pediatric patients who were admitted to the Pediatric Intensive Care Unit (PICU) with respiratory failure.Patients and Methods: This study is a retrospective, cross-sectional review. The data were collected from the medical record of PICU patients at our hospital from 2017 to 2018. Successful NIV was defined as patients who survived without intubation. Failure was defined as worsened patients and needed intubation for the rescue.Results: The total subjects of this study was 78 patients. The most common indication for NIV was ARDS (78.1%), and CPAP was the most common frequently used (78.68%). The data shows that the NIV was commonly used after extubation (52.56%) than for the first-time rescue (47.44%). The success rate of NIV after extubation were 65.85% and 34.15% failed and shifted to mechanical ventilation. The duration of NIV usage was less than three days (73.77%).Conclusion: NIV is a useful tool for the treatment of respiratory failure in pediatrics. The use of post-extubation NIV may be a valuable tool to prevent reintubation.

Succinylcholine used for difficult airway lead to difficult airway- a case report Nazir, Nazia; Jain, Shruti; Singh, Shipra
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Succinylcholine (Sch) is usually given for intubation in suspected difficult airway due to its fast onset and short duration of action. We report a case of Masseter Muscle Rigidity (MMR) after giving Sch to a patient for lap cholecystectomy with difficult airway.A healthy, 40 year old female weighing 85 kg was posted for laparoscopic cholecystectomy. She was Mallampatti grade III, mouth opening 4.5 cm, upper lip bite test class I, thyromental distance 6.5 cm and neck circumference 55 cm. She had no medical illness, no previous exposure to anaesthetic agents or family history of myopathy with normal investigations.In operating room (OR), difficult intubation cart was kept ready. Pre-medication was done with glycopyrrolate 0.2 mg intravenous (IV), midazolam 1 mg IV and fentanyl 100 µg IV. After pre-oxygenation with 100% O2, patient was induced with propofol 120mg IV. On confirming adequacy of bag and mask ventilation, Sch 120 mg IV was given. Laryngoscopy was attempted once Sch induced fasciculations were over. However, teeth were tightly clenched and it was impossible to open the mouth to allow advancement of the laryngoscope. Again, after few moments, attempt to open the mouth failed. Keeping masseter spasm in mind, mask ventilation was continued with 100 % oxygen and no further anaesthetics were administered. There was no disproportionate increase in EtCO2 or body temperature during this period. After 5 minutes, jaw started relaxing and patient resumed spontaneous respiration. She was sent to the ICU for observation without surgery being performed.In ICU, after 1st post operative hour, blood test revealed normal ABG, slightly raised serum potassium (5.8meq/l) and creatinine phosphokinase (CPK) levels (188 IU/L). Patient remained afebrile throughout with clear urine. Next day, patient was discharged with a special note regarding not to use Sch and counselling for risk of malignant hyperthermia (MH) in future anaesthesia. Muscle biopsy for halothane caffeine test was advised. The case was done at a later date under Total intravenous anaesthesia uneventfully.Our patient presented with difficult airway on account of Mallampati III, increased body weight and neck circumference. In our institute, Sch is routinely used in suspected difficult airway cases as newer short acting non depolarizing muscle relaxants (NDMR) are not available. A rare adverse effect of Sch is MMR which can occur in isolation or can be an early indicator of malignant hyperthermia (MH).(1) Recent findings state that increased tone in the masseter muscle after giving Sch may be a normal pharmacological response of masseter muscle to Sch.(2). MMR causes difficult or impossible laryngoscopy leading to difficult or failed intubation. Alternative techniques like retrograde endotracheal intubation, fiberoptic nasotracheal intubation, trachlight?, laryngeal mask airway and surgical cricothyroidotomy (3) may be required to secure airway. In our patient, though Sch triggered MMR leading to difficult intubation, we were able to ventilate the patient with bag and mask.Surgery was abandoned and patient monitored as there is a possibility of development of MH even after a lag of 20 -30 min (4). Patient did not develop any signs and symptoms of MH during ICU stay. Mild elevation in CPK and K levels could suggest rhabdomyolysis secondary to MMR.To summarize, this case highlights that Sch may produce isolated MMR leading to difficult laryngoscopy and intubation. In such patients, trigger factors of MH should be avoided during maintenance of anaesthesia and availability of dantrolene in OR ensured. We also suggest that the use of Sch is fraught with too much potential for a disastrous outcome and should not be relied upon in cases where difficult intubation is suspected.

Acinetobacter baumannii Is an opportunistic pathogen as an MDRO especially on intensive ward Suranadi, I Wayan; Dwi Fatmawati, Ni Nengah; Aryabiantara, I Wayan; Sinardja, Cynthia Dewi; Saputra, Darmawan Jaya
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Acinetobacter baumannii is an opportunistic bacterial pathogen that is associated with hospital acquired infections and is a major cause of nosocomial infections especially in intensive spaces; this is becoming increasingly a widespread concern in various hospitals around the world. Acinetobacter baumannii, which is resistant to many antibiotics, is now recognized as clinically very important. Reports suggest that the spread of A. baumannii in the hospital environment led to an increase in nosocomial outbreaks associated with high mortality rates. However, many other Acinetobacter spp. can also cause nosocomial infections. This review focuses on the role of Acinetobacter spp. as nosocomial pathogens, resistance patterns and epidemiology.

Fibreoptic intubation under conscious sevoflurane sedation in anticipated difficult intubation cases with unfavorable conventional airway preparation Karim, Habib Md Reazaul; Panda, Chinmaya Kumar; Arora, Prateek; Basumatary, Kartik
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Airway management in maxillofacial and head and neck cancer patients has remained a challenge even after significant development towards difficult airway management. When such patients have multiple difficult intubation predictors, management becomes more thought-provoking. Mucosal preparation and sedation play a vital role in producing co-operative patient and successful procedure but is not always feasible. On the other hand, intravenous sedation lacks titratability and reversibility. We describe awake fiberoptic intubation in three adult patients having multiple difficult intubation predictors whose airway preparation was not feasible due to obscured surface anatomy and nil mouth opening. The cases were done under titrated conscious sevoflurane sedation of MACage 0.4-0.6 using nasopharyngeal airway and closed circuit. This report highlights that Sevoflurane based conscious sedation is a feasible alternative for awake fiberoptic intubation in patients whose airway anesthesia and blocks are not possible.

Comparative evaluation of low-dose levobupivacaine and ropivacaine in patients undergoing inguinal herniorrhaphy under walking spinal anaesthesia as daycare surgery Singh, Priyanka; Kapur, Anu; Gupta, Sanjay Kumar
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Background: Ropivacaine and levobupivacaine possess the property of sensory-motor dissociation. Hence these drugs allow a faster recovery of motor function and hence, these are potentially useful agents for walking spinal anaesthesia in daycare surgeries.Patients and Methods: This is a prospective, double-blind, randomized study involving 120 adult ASA 1 and 2 patients who were randomly allocated into two groups. Group R (n = 60) received 7.5 mg 0.75% ropivacaine + 25 ?g fentanyl + 1.5 ml sterile water. Group L (n = 60) received 5 mg 0.5% levobupivacaine + 25 ?g fentanyl + 1.5 ml sterile water. Each solution was made to a total volume of 3 ml, administered intrathecally. Sensory and motor block characteristics, hemodynamic changes and postoperative recovery profile characteristics were noted. Paired/unpaired t-test and chi-square test were used wherever applicable for statistical analysis using SPSS version 15.0. Results: Sensory block onset time and time to reach the maximal cephalic spread were comparable in both the groups, whereas time to the two-segment regression and time to first analgesic requirement were significantly shorter in group RF. Out of 60 patients in each group, 59 patients in group RF and 57 patients in group LF were MBS grade 5. Time to home discharge was also significantly shorter in group RF.Conclusion: We concluded that both local anaesthetics could be used in the walking spinal technique; however, ropivacaine is preferred because of its favourable block characteristics and early ambulation time.

Clinical profile comparison of cisatracurium and rocuronium in elective surgery Meena, Reema; Jain, Priyanka; Rana, Divya; Verma, Indu; Chauhan, Sunil
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Background: Most surgeries are carried out with ease using neuromuscular blocking agents. This study was aimed to compare the intubating dose of cisatracurium and rocuronium regarding the onset of action, clinical duration, recovery index, intubating conditions, efficacy, and safety in elective surgery.Method: 60 adult patients of American Society Anesthesiology (ASA) grade I & II, underwent elective laparoscopic surgery were randomized to receive either cisatracurium 0.1 mg/kg (Group C) or rocuronium 0.6 mg/kg (Group R). Neuromuscular monitoring was done using STIMPOD Xavant NMS450. Relaxogram interpretation was carried out for the onset of action, clinical duration, and recovery index.Results: Cisatracurium had significant longer onset (233.33±62.31 vs. 86.66±28.62 seconds, p <0.001) and significant longer clinical duration (40±3.56 vs. 27.46±2.14 minutes, p <0.001) than rocuronium. Recovery index was significantly longer in the cisatracurium group (12.23±1.54 vs. 8.30±1.80 minutes, p <0.001). Clinically acceptable intubating conditions were achieved in 180 seconds (C group) compared to 60 seconds in the R group. No untoward or adverse response and complications were distinguished in either group.Conclusion: Cisatracurium 0.1 mg/kg exhibited a slower onset of action than rocuronium 0.6 mg/kg and provided excellent intubating conditions in the majority of patients after 180 seconds. The clinical duration and recovery index were significantly longer in cisatracurium compared to rocuronium. Both are potent and safe agents with excellent cardiovascular stability.

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Contact Name
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Contact Email
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Journal Mail Official
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Location
Kota denpasar,

Bali

INDONESIA