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Bali Journal of Anesthesiology
Published by Bali Journal of Anesthesiology
ISSN : -     EISSN : -     DOI : -
Core Subject : Health, Education,
Health Professions Medicine & Pharmacology Other
Arjuna Subject : -
Articles 83 Documents
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Anaesthesia For ECT In Neuroleptic Malignant Syndrome - What Is Ideal? Baskaran, Priyaneka; Santhirasegaran, Jaishree; @ Julaihi, Norhuzaimah Bt Julai
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.41

Abstract

We report a case involving a 46 year old male with schizophrenia who presented with fever, inability to speak, sialorrhoea, limb stiffness, profuse sweating, tremors and rigidity of bilateral upper and lower limbs following an increase in dosage of his antipsychotics.  A provisional diagnosis of neuroleptic malignant syndrome (NMS) was made based on the Levensen criteria. His anti psychotics were promptly discontinued and he was transferred to ICU for critical care support. We utilised lorazepam and prescribed bromocriptine and his NMS symptoms improved. However, in view of residual catatonic symptoms, decision was made to commence ECT. A combination of rocuronium sugammadex was used successfully in all his ECT procedures and found to be an excellent alternative to succinycholine in this patient.
LOW FLOW ANESTHESIA WILL GAIN ERAS (ENHANCED RECOVERY AFTER SURGERY) Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Pradhana, Adinda Putra; Makmur, Eric
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.24

Abstract

ABSTRACT As we know, the volatile agent needs fresh gas flow to be carried out to the patient. It is very common in anesthesia practice, we use the fresh gas flow more than 2 liters per minute. In recent practice, the more flow we gave, the more volatile agent blew out to the patient. The present of APL (adjustable pressure limit) also leaks out of the circuit, we spend more gases, volatile agent, hence gave more pollutant to the operating theater. The consequences of those are an increase of anesthesia expenses and change the way of health care being delivered.ERAS (Enhanced Recovery After Surgery) is popular with its quick recovery after surgery, include quick emergence post anesthesia, that will reduce the time in the operating theater, recovery room, and as results, reduce the cost of anesthesia and surgery. 
“ICE” – A rare cause for coagulopathy in a case of massive post-partum hemorrhage Singh Gill, Navkiran; Jaan Perng, Cheow; Vong Liew, Alice
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.12

Abstract

A case of massive post-partum hemorrhage in East-Malaysia, associated with 3-4 methylene-dioxy-methamphetamine (MDMA) abuse otherwise known as Ecstasy or locally as “ICE”, injected by the patient as a means to suppress labor pains prior to hospital presentation. We report a rare case of substance abuse that lead to life threatening hemorrhage in a maternal patient of productive age group. Presenting to the labor suite in second stage of labor in breech presentation, exhibiting active neuropsychiatric symptoms of intoxication like euphoria, drowsiness, mydriasis but able to obey commands. A rapid response by the Obstetric on-call team proceeded with an assisted-breech delivery. Post-delivery, a baby girl with poor Apgar score was born and intubated. The mother was then posted for an Examination Under Anesthesia as she was noted to have slow blood oozing per-vaginally using a single shot spinal as she exhibited features of difficult intubation and high risk of aspiration. During the procedure, she tipped into massive PPH complicated with DIVC, and was rushed into the intensive care unit for stabilization and back into the operation theatre, needing a total abdominal hysterectomy (TAH) as definitive bleeding control. She required large scale resuscitative efforts peri-operatively including continuous veno-venous hemofiltration (CVVH) as well as regional intensive care consultation. We describe, chronologically the anesthetic challenges faced in managing a patient in acute substance intoxication at presentation to our district hospital during twilight hours. We then explain the pharmacodynamics of MDMA in provoking coagulopathy. No reports of similar cases in the South-East Asia region.
Low Dose Ketamin Wiryana, Made; Sinardja, I Ketut; Budiarta, I Gede; Agung Senapathi, Tjokorda Gde; Widnyana, Made; Aryabiantara, I Wayan; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Novita Pradnyani, Ni Putu; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.4

Abstract

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Low-dose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psikomimetik like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.
EXTENDED GLASGOW OUTCOME SCALE AND CORRELATION WITH BISPECTRAL INDEX Senapathi, Tjokorda Gde Agung; Suarjaya, I Putu Pramana; Sutawan, Ida Bagus Krisna Jaya; Arparitna, Ketut Yudi
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.9

Abstract

Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long-term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their caregivers and society as a whole. Clinicians and researchers require reliable and valid measures of long-term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high-quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we will describe the measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe) in correlation with bispectral index (BIS).
SPONTANEOUS RUPTURE OF ARTERIOVENOUS MALFORMATION: ICU BASED BRAIN RESUSCITATION Panji, Putu Agus Surya; Aryabiantara, I Wayan; Suranadi, I Wayan; Parami, Pontisomaya; Wibisana Kurniajaya, I Gusti Agung Made
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.25

Abstract

Arteriovenous malformations (AVM) is a relatively rare intracranial abnormality. Generally, it caused by congenital abnormalities that recognized after the bleeding started. Spontaneous intracranial bleeding after AVM rupture is an emergency condition and require immediate treatment to reduce mortality rate. After stabilization of intracranial bleeding due to AVM rupture, secondary injury may occur hours or even days after the inciting traumatic event. The injury may result from impairment or local declines in cerebral blood flow (CBF) after brain injury. The decrease in CBF is the result of local edema, hemorrhage, or increased intracranial pressure (ICP). An adequate brain resuscitation is needed to decrease brain edema and intracranial pressure by achieving several targets and avoid things that can interfere with CBF. A recovery phase should be given to the patient with rupture of AVM before going to definitive therapy.
Leadership in anesthesiology: not just a one man show GA Senapathi, Tjokorda; Widnyana, IMG; Cindryani, Marilaeta
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.13

Abstract

Anesthesiology had been one of highly skilled professional specialty with diversity of training but with a structured model of leadership culture. The culture which could be drawn back since medical training to become a medical doctor. School of medicine had already established a standard model of teaching and training. The tutoring method is implemented mostly based on classroom meetings in traditional basic lesson, bedside teaching for clerkship and internship and lately adopted method of case-based discussion
Non-Convulsive Status Epilepticus (NCSE) in ICU Wiryana, Made; Sinardja, I Ketut; Aryabiantara, I Wayan; GdeAgung Senapathi, Tjokorda; Gede Widnyana, I Made; Utara Hartawan, I Gusti Agung Gede; Parami, Pontisomaya; Ryalino, Christopher; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 1 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i1.5

Abstract

Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long,  associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes of. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended asthe first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis.  This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response.
Venous Air Embolism (VAE) during Craniotomy of Supratentorial Meningioma in Supine Position Sutawan, Ida Bagus Krisna Jaya; Bisri, Tatang; Rahardjo, Sri; Lalenoh, Diana
Bali Journal of Anesthesiology Vol 1, No 3 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i3.26

Abstract

AbstractVenous Air Embolism (VAE) is one of the most serious complications in neuroanesthesia case. The highest number of VAE incident is during neurosurgery procedure with sitting position, even tough VAE may occur during craniotomy of supratentorial tumor in the supine position. VAE occurs due to the pressure differential between open vein in the surgical field and right atrium. A 46 years old woman underwent craniotomy for supratentorial meningioma in the supine position. Intraoperative, the patient was experiencing a decrease in end-tidal CO2 pressure about 6 mmHg in 5 minutes. Therefore, management of acute VAE was proceed to the patient, such as informed the surgeon immediately, discontinued N2O and increased flow of O2, modified the anesthesia technique, asked the surgeon to irrigate the surgical field with fluids, gave compression on jugular vein, aspirated the right atrial catheter, prepared drugs to support the hemodynamic, and changed the patient’s position if possible. 
Programmed intermittent epidural bolus improves efficacy of patient controlled epidural analgesia in postoperative pain management Agung Senapathi, Tjokorda Gde; Gede Widnyana, I Made; Wiryana, Made; Mahaalit Aribawa, I Gusti Ngurah; Surya Panji, Putu Agus; Soetjipto, Sonni; Putra Pradhana, Adinda
Bali Journal of Anesthesiology Vol 1, No 2 (2017)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v1i2.14

Abstract

Background: Postoperative acute pain will have negative impacts if not handled properly so it must be treated effectively. Patient Controlled Epidural Analgesia (PCEA) allows the patient to have an active role in determining the need of analgesia personally. Programmed Intermittent Epidural Bolus (PIEB) is a new method which proven better than Continuous Epidural Infusion. Ropivacaine has similar characteristic to Bupivacaine but with minimal cardiotoxic effect. Fentanyl as an adjuvant can accelerate the onset of action of local anesthetics in epidural analgesia. The purpose of this study was to compare the efficacy of PCEA+PIEB with PCEA as a modality of postoperative analgesia. Methods: Total 54 patients undergoing major surgery of the abdomen and lower extremities were divided into 2 groups randomly: PIEB+PCEA and PCEA. Then we did an evaluation of VAS, PCA demand, and total consumption of solution Ropivacaine 0.1% + Fentanyl 2  mcg/mL at 4 hours, 8 hours, and 24 hours postoperative. Results: VAS at resting and at moving in both groups were found clinically comparable, although statistically, VAS at moving at 4 hours and 24 hours postoperative were lower in PCEA+PIEB group (p < 0.01). PCA attempted and PCA given were lower in PCEA+PIEB group (p ≤ 0.05). Total consumption of solution until 8 hours postoperative was comparable in both groups but at 24 hours postoperative it was much greater in PCEA+PIEB group (p < 0.01). Conclusions: PCEA+PIEB have greater efficacy than PCEA. VAS (at resting and at moving), PCA attempted, and PCA given were lower in PCEA+PIEB group. Total consumption of solution RopivacaineFentanyl until 8 hours postoperative was comparable, but at 24 hours postoperative it was much greater in PCEA+PIEB group. In orthopedic surgery, VAS at resting was obtained below 30 mm in PCEA+PIEB group but VAS at moving was obtained in the category of moderate pain in both groups.

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