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Antimicrobial susceptibility patterns of Acinetobacter baumanii isolates from ICU and non-ICU wards Budayanti, Ni Nyoman Sri; Suranadi, I Wayan; Tarini, Made Adi; Violentina, Gusti Ayu Dianti; Sathya Deva, I Dewa Gde
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTIntroduction: Acinetobacter baumanii is the most common agent of hospital-acquired infection with the increasing fatality rate due to multidrug-resistant (MDR) strain infection. The magnitude of the problem in Indonesia is unknown. Here, we provide data regarding susceptibility pattern of A. baumanii isolated from a tertiary referral hospital in Bali, Indonesia between 2012 and 2014.Methods: Data were collected retrospectively from culture-based records in the Clinical Microbiology department, Sanglah General Hospital during 2012-2014. A. baumanii was isolated from clinical specimens. Identification and antimicrobial susceptibility test were conducted using micro-dilution method (Vitek-2 Compact system). Isolates that resistant to ≥ 3 antibiotic classes were categorized as multi-drug resistant (MDR) A. baumanii.Results: A. baumanii collected from sputum in intensive care unit (ICU) wards were 7.9%, 11.1%, and 7.0%, while the isolates from sputum in non-ICU wards were 13.1%, 15.6%, and 19.9% in 2012, 2013, and 2014, respectively. There was a reduced susceptibility of A. baumanii to ciprofloxacin, levofloxacin, ceftazidime, aztreonam, imipenem, ampicillin-sulbactam, and piperacillin-tazobactam in ICU ward. Meanwhile, the susceptibility of A. baumanii to Cotrimoxazole remained high in both ICU and non-ICU ward. MDR A. baumanii is found to be resistant to fluoroquinolones, cephalosporins, aztreonam, aminoglycosides, beta-lactamase inhibitors, and carbapenem. Data were analyzed and presented in a descriptive manner.Conclusion: Three years surveillance showed that the susceptibility of A. baumanii to most common antibiotics was decreasing. MDR A. baumanii was found to be resistant to all classes of common antibiotics mostly from ICU ward isolates.

A comparative study between supraclavicular brachial plexus block and Infraclavicular brachial plexus block for upper limb orthopedic surgeries: A prospective, randomized, double-blind study Sarkar, Siddharth; Doshi, Shilpa Mitul
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Introduction: Supraclavicular brachial plexus block is a common approach as it provides faster and dense blockade. In the past few years, infraclavicular brachial plexus block has become a method of increased interest as it has a lower complication rate and near to equal efficacy. The goal of this study was to compare block performance time, block characteristics, quality of block, patient’s satisfaction, and complications between infraclavicular and supraclavicular techniques for brachial plexus block.Patients and Methods: 100 subjects were randomized in a double-blind fashion, to receive either an infraclavicular block (Group I, n=50) or supraclavicular block (Group S, n=50) using nerve locator apparatus. Block performance time, onset, peak, duration of sensory and motor blockade, any change in hemodynamics, complications were recorded at scheduled intervals intra-operatively and post-operatively as per study protocol. Data were analyzed using GraphPad INSTAT version 3.06 software by Chi-square test or Mann-Whitney U test to compare categorical variables.Results: The block performance time was faster in the Group S compared to the Group I (4.8±4.4 minutes vs. 6.3±1.39 minutes, p <0.001). The sensory block onset time was faster in Group S compared to the Group I (6.9±1.58 minutes vs. 7.6±1.34 minutes, p=0.019). Other observed variables were considered statistically not significant.Conclusion: From our study, it is inferred that nerve locator guided Infraclavicular block by a vertical coracoid approach using multineurostimulation method is less rapidly executed as nerve locator guided supraclavicular block with a similar degree of surgical anesthesia and lesser complication rate.

The correlation between the depth extent of Tuohy epidural needle with body mass index (BMI) to achieve loss of resistance in patients undergoing epidural anesthesia Hartawan, I Gusti Agung Gede Utara; Senapathi, Tjokorda Gde Agung; Aribawa, I Gusti Ngurah Mahaalit; Parami, Pontisomaya; Pradhana, Adinda Putra; Syamsuddin, Johanis Bosco Troy
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTBackground: Anesthesia management in obesity is quite challenging. Epidural anesthesia become one of the choices. The attention should be addressed in order to prevent the misidentification of epidural space. The estimation of the depth extent of epidural space becomes crucial, especially in obese patients due to an accumulation of subcutaneous and epidural adipose tissue, which consequently complicate the epidural catheter insertion. This study aimed to analyze the correlation of the depth extent of Tuohy epidural needle to achieve loss of resistance between normal-weighted and obese patients.Method: This study was conducted with 56 adult patients aged 17 to 65 years who underwent elective surgery by epidural anesthesia inserted at level L2-L3 or L3-L4 interspace. Subjects are divided into normal and obese groups. Shapiro-Wilk and chi-square tests were used in the normality test. For normally distributed data, an independent t-test was used to test the hypothesis, otherwise, we used Mann-Whitney test Results: The results showed that the loss of resistance in epidural needle insertion procedures was 60 mm in a patient with BMI more than 30 kg/m2 and 50 mm in those with BMI <30 kg/m2 (p<0.001).Conclusion: The loss of resistance depth in epidural Tuohy needle insertion is significantly determined by BMI.

The relationship between nutritional status based on nutritional risk index (NRI) and length of stay of digestive surgery patients Kusuma, Dian Reginalda; Putra, Kadek Agus Heryana; Kurniyanta, I Putu
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

ABSTRACTBackground: Malnutrition is a common concomitant illness that can be found in digestive surgery patients.The risk of malnutrition in digestive surgery patients is often overlooked even though malnutrition has beenknown to be associated with poor postoperative outcomes. The study aimed to analyze the relationship of nutritional status based on the Nutritional Risk Index (NRI) and length of stay of digestive surgery patientsin Sanglah General Hospital. Patients and Methods: The design of this study is an analytical cross-sectional using secondary data fromthe medical record of the digestive surgery patients in Sanglah General Hospital. Data on body weight andserum albumin level were used to identify the preoperative nutritional status of the patients based on NRI. Results: Of the 42 patients involved in this study, 54.8% of patients have poor nutritional status and the remainder 45.2% of patients have good nutritional status. The result of the statistical analysis showed asignificant relationship between nutritional status and length of stay. The result of the logistic regressiontest showed that the prevalence of long hospitalizations (≥11 days) were 5.2 times greater in digestivesurgery patients with poor preoperative nutritional status compared to patients with good nutritionalstatus. Conclusion: This study shows that poor nutritional status is a significant problem for digestive surgery patients and it is one of the factors that contribute to a longer hospital stay.

Ketamine: old drug, a new option Chandra, Susilo
Bali Journal of Anesthesiology Vol 3, No 1 (2019)
Publisher : DiscoverSys Inc.

Unique properties and recent development in the areas of clinical properties of ketamine make this agent to be popular for a long time. This anesthetic agent has wide range of indications. Many areas of clinical application of ketamine are explored in many studies. However, not many clinicians are familiar with the wide range of clinical applications of ketamine. As time passes there are many new alternative use of ketamine, a well-established anesthetic agent. The analgesic profile of ketamine is explored to have more benefits, such as postoperative pain control and as preemptive analgesia. The other aspect, which has been studied extensively, is the neuroprotective profile of ketamine. The administration of ketamine is not associated with increased intracranial pressure if normocapnia is achieved, making it possible anesthetic for neurosurgery. The other areas to explore include the role of ketamine to prevent opioid-induced acute tolerance and treat major depressive disorder.

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.

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OAI Link

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Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
-

Contact Email
-

Phone
-

Journal Mail Official
-

Editorial Address
-

Location
Kota denpasar,

Bali

INDONESIA