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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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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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (119.783 KB) | DOI: 10.15562/bjoa.v3i1.67

Abstract

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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (161.163 KB) | DOI: 10.15562/bjoa.v3i1.144

Abstract

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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (174.494 KB) | DOI: 10.15562/bjoa.v3i1.136

Abstract

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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (205.173 KB) | DOI: 10.15562/bjoa.v3i1.114

Abstract

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. 
General anesthesia combined with thoracic epidural anesthesia: an anesthesia technique option in modified radical mastectomy Sidemen, I Gusti Ayu Eka Para Santi; Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Aribawa, I Gusti Ngurah Mahaalit; Ryalino, Christopher
Bali Journal of Anesthesiology Vol 3: in press (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/bjoa.v3i0.128

Abstract

The incidence of breast cancer has been increasing, and currently, it is the most common cancer in females. Surgery is the primary treatment, and the current tendency is toward less extensive procedure with axillary dissection for removal of lymph nodes to guide further treatment, in this case, the method called modified radical mastectomy (MRM).  The anesthetic technique for MRM should provide adequate intraoperative anesthesia, muscle relaxation, and postoperative analgesia without collateral effects, nausea, and vomiting with the minimum hospitalization time. In this report, we present a case of a woman who underwent MRM under general anesthesia combined with thoracic epidural anesthesia.
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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (174.103 KB) | DOI: 10.15562/bjoa.v3i2.155

Abstract

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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (198.556 KB) | DOI: 10.15562/bjoa.v3i2.159

Abstract

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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (183.448 KB) | DOI: 10.15562/bjoa.v3i2.187

Abstract

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 – 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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (177.723 KB) | DOI: 10.15562/bjoa.v3i0.161

Abstract

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.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (185.798 KB) | DOI: 10.15562/bjoa.v3i2.165

Abstract

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.

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