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Jurnal Anestesiologi Indonesia
Published by Universitas Diponegoro
ISSN : 23375124     EISSN : 2089970X     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology Public Health
Jurnal Anestesiologi Indonesia (JAI) diterbitkan oleh Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) dan dikelola oleh Program Studi Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Diponegoro (UNDIP) bekerjasama dengan Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) cabang Jawa Tengah.
Arjuna Subject : -
Articles 18 Documents
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Search results for , issue "publication in-press" : 18 Documents clear
Manajemen Anestesi pada Pasien Wanita dengan Kehamilan 29 Minggu dengan SOL Intrakranial, Invasive Carcinoma Mammae dan Bronkopneumonia Dina Paramita; Irfani Kurniawan
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.52627

Abstract

Latar Belakang: Kehamilan merupakan tantangan tersendiri bagi seorang anestesiologi karena kita menghadapi dua kehidupan di waktu yang bersamaan. Tumor otak pada kehamilan berkorelasi dengan mortalitas ibu, prematuritas dan intra uterine growth restriction (IUGR). Hal ini membuat waktu persalinan dan teknik anestesi yang digunakan bergantung dari situasi yang ada.Kasus: Pada kasus ini kami melaporkan teknik anestesi menggunakan general anesthesia (GA) untuk sectio caesarea transperitoneal profunda (SCTP) pada seorang pasien wanita G1P0A0 usia kehamilan 29 minggu ASA IIIE dengan space occupied lesion (SOL) intracranial suspek multipel abses serebri dd/ tuberkuloma, karsinoma mammae invasif dan bronkopneumonia.Pembahasan: SOL merupakan lesi pada ruang intrakranial terutama mengenai otak. Pada pasien kami terdapat SOL dari multipel abses serebri dd/ tuberkuloma. Hal ini menyebabkan terjadinya peningkatan tekanan intrakranial dan juga hemiparese dextra spastik. Terminasi kehamilan dilakukan berdasarkan kondisi hamil 29 minggu dengan adanya SOL pada pasien ini. Kami menggunakan general anesthesia (GA) untuk melakukan SC. Teknik anestesi dianggap berhasil jika hasil activity, pulse, grimace, appearance, and respiration (APGAR) bayi baru lahir tersebut baik.Kesimpulan: Wanita G1P0A0, 32 tahun, usia kehamilan 29 minggu, janin 1 hidup intrauterin, dengan SOL intrakranial suspek multipel abses serebri dd/ tuberkuloma, karsinoma mammae invasif dan bronkopneumonia dikonsultasikan oleh teman sejawat obsgyn kepada dokter anestesi untuk dilakukan sectio caesarea (SC) dengan GA. Selama pembiusan dan operasi berlangsung, tidak didapatkan adanya komplikasi. Pada kasus ini, terminasi dilakukan untuk kesejahteraan bayi dan ibu.
Analisis Terhadap Faktor Risiko Yang Berhubungan Dengan Mortalitas Pasien Sindrom Guillain-Barré Yang Dilakukan Plasmaferesis Primta Bangun; Reza Widianto Sudjud; Ardi Zulfariansyah
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.56915

Abstract

Latar Belakang: Guillain-Barré Syndrome (GBS) merupakan penyakit autoimun yang mengenai sistem saraftepi yang banyak ditemukan di dunia. Penyakit inimemiliki manifestasi berupa kelemahan, arefleksia ototsecara progresif dan dapat menyebabkan kelemahan pada otot-otot pernapasan. Hal ini menyebabkan penderitamembutuhkan bantuan ventilasi mekanik. AmericanSociety for Apheresis (ASFA) menyatakan pengobatan linipertama krisis Guillain-Barré Syndrome (GBS) fase akutadalah dengan pemberian Therapeutic Plasma Exchange/Plasmaferesis. Therapeutic Plasma Exchange merupakan prosedur yang relatif aman dan sudah seringdilakukan di General Intensive Care Unit (GICU) RumahSakit Hasan Sadikin (RSHS) Bandung.Tujuan: Penelitian ini dilakukan untuk menganalisisfaktor-faktor risiko yang berhubungan dengan mortalitaspasien GBS yang telah menjalani terapi plasmaferesis.Metode: Penelitian ini merupakan penelitian analitikmultivariat dengan desain kasus kontrol yang dilakukanpada 55 sampel pasien GBS yang mendapatkan terapiplasmaferesis di GICU RSHS Bandung dan Rumah Sakit(RS) Bhayangkara Tingkat II Medan. Penelitian inibersifat retrospektif dengan mengambil data dari rekammedis serta menyajikan karateristik dasar subjek.Hasil: Penelitian ini mendapatkan hasil bahwa diantarafaktor-faktor risiko yaitu usia, komorbid, dan lama penggunaan ventilasi mekanik, yang paling berhubungandengan mortalitas pasien GBS yang telah menjalani terapiplasmaferesis adalah faktor lamanya penggunaan ventilasimekanik >14 hari.Kesimpulan: Faktor risiko penggunaan mesin ventilasimekanis berkepanjangan (>14 hari) berhubungan dengantingginya kejadian mortalitas/kematian pada pasien GBS yang menjalani terapi di RSHS Bandung, maupun di RS Bhayangkara Tingkat II Medan. 
Pain Severity in Post-Caesarean Section and Its Preoperative Factors Derajad Bayu Atmawan; Hanifa Agung Kurniawan; Reza Ishak Estiko; Trisya Allinda
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.57730

Abstract

Background: According to World Health Organization (WHO), the global prevalence of cesarean section (C-section) reaches 21% of all deliveries and is expected to increase to 29% by 2030. This major surgery is associated with moderate to severe postoperative pain, which can affect postoperative recovery.Objective: This study aims to identify preoperative factors that affect post-cesarean pain with numeric rating scales 12 and 24 hours postoperative.Methods: A cross-sectional study was conducted at dr. Soehadi Prijonegoro Hospital, Sragen, Indonesia. The subject criteria are: (1) willing to participate in this study, (2) age more than 18 years old, (3) cooperative and communicative, and (4) not in disability condition. This research has conducted ethical approval by the Ethics Committee of dr. Soehadi Prijonegoro Hospital prior to the study.Results: We obtained 30 subjects, with no dropouts, aged 22 to 44 years, with 20% being older than 35 years pregnant women. Preoperative factors were multigravida, previous C-section, overweight to severe obesity, preeclampsia, fetal malposition, preterm premature rupture of the membranes, human immunodeficiency, malnutrition, preterm labor, hepatitis B, and anemia. Also, 83.3% of patients underwent emergency surgery. Most patients experienced moderate to severe pain 2 hours postoperation, and mild to moderate pain 24 hours postoperation.Conclusion: No significant correlation was found between preoperative factors and postoperative pain (p>0.05). Nonetheless, pain management should be tailored to each patient’s clinical condition.
Interlaminar Cervical Epidural Non-Particulate Steroid Injection for Acute Cervical Radicular Pain: A Case Study of Clinical Effectiveness Kamala Kan Nur Azza; Noor Alia Susianti; Mahmud Mahmud; Caroline Evanthe Nathania
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.73464

Abstract

Background: Cervical radicular pain is pain that arises in the upper extremities caused by ectopic activities of afferent nociceptive or radix medulla spinalis. The pain intervention which can be done is interlaminar cervical epidural steroid injection (ICESI), transforaminal epidural steroid injection (TFSI), thermal radio frequency (TRF), pulse radio frequency (PRF), spinal cord stimulation (SCS), or surgery. Each modalities have different benefits and side effects. The success of ICESI is still debatable. This case report aimed to evaluate the success of ICESI for cervical radicular pain.Case: A woman, 71 years old, suffered from neck pain with radicular pain along the arm, until the palm, thumbs, and index finger on both right and left sides. The patient reported persistent pain predominantly in the palms, with an intensity of 7 out of 10 on the numeric rating scale (NRS). She felt the pain for 2 months, and it wasn’t relieved with pharmacotherapy and physiotherapy. The cervical magnetic resonance imaging (MRI) showed entrapment at the radix C6. The patient was advised to undergo an operative procedure, but the patient refused it and was offered an ICESI.Discussion: The ICESI approach has been proven to be effective in managing acute cervical radicular pain. By delivering corticosteroids into the epidural space, ICESI reduces inflammation around the affected nerve roots, leading to significant pain relief and improved functional outcomes, and allows for a broader spread of medication across multiple levels.Conclusion: ICESI is effective for cervical radicular pain.
Target-Controlled Infusion (TCI) Propofol in Ventriculoperitoneal (VP) Shunt Surgery during the First Trimester of Pregnancy Albinus Yunus Cobis; Dewi Yulianti Bisri; Iwan Abdul Rachman
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.73897

Abstract

Background: The use of target-controlled infusion (TCI) propofol in pregnant patients undergoing ventriculoperitoneal (VP) shunt surgery during the first trimester due to hydrocephalus presents a rare and complex challenge in neuroanesthesia. TCI propofol is favoured for its ability to maintain hemodynamic stability and effectively control intracranial pressure (ICP), both of which are crucial in neuro-obstetric management.Case: A 23-year-old woman, five weeks pregnant, with a history of communicating hydrocephalus and bilateral VP shunts, presented with severe headache. She underwent emergency VP shunt revision under general anesthesia using TCI propofol (Schnider model, target effect-site concentration 2.5–5 mcg/mL), fentanyl (2 mcg/kg), atracurium (0.5 mg/kg), and lidocaine (1.5 mg/kg). Intraoperative hemodynamics remained stable throughout the two-hour procedure. Postoperatively, her neurological status improved significantly, and no complications were observed.Discussion: Compared to inhalational agents such as sevoflurane, TCI propofol demonstrates superior control of ICP, maintains cerebral blood flow stability, and facilitates faster postoperative recovery. Fentanyl, atracurium, and lidocaine were selected due to their favourable safety profiles for short-term use in pregnancy. Postoperatively, progesterone was administered to support pregnancy maintenance by reducing uterine contractility and mitigating the risk of miscarriage associated with surgical and anesthetic stress.Conclusion: TCI propofol is an effective and safe anesthetic strategy for managing VP shunt procedures during the first trimester of pregnancy. A multidisciplinary approach is essential to achieve optimal neurological and obstetric outcomes. 
ERECTOR SPINAE PLANE BLOCK IN THORACOTOMY SURGERY Tendi Novara; Iwan Dwi Cahyono; Rania Adeastri Hapsari
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.76227

Abstract

Background: Post-thoracotomy pain management remains a major challenge in anesthesia. Thoracic epidural and paravertebral blocks are effective but technically demanding. The erector spinae plane (ESP) block offers a simpler and safer alternative for postoperative analgesia. This case report presents the anesthetic and analgesic management using ESP block in a patient undergoing thoracotomy decortication.Case: A 60-year-old male with spontaneous right pneumothorax and pulmonary atelectasis underwent thoracotomy decortication under general anesthesia. An ultrasound-guided ESP block was performed at T5–T6 using 0.25% levobupivacaine (20 mL). Intraoperative hemodynamics were stable, and the patient was extubated 14 hours postoperatively. Pain scores remained low without additional opioids. No complications were observed during postoperative monitoring.Discussion: Spontaneous pneumothorax and pulmonary atelectasis frequently necessitate surgical intervention, demanding complex anesthetic management. This patient presented with a right-sided pneumothorax, compounded by atelectasis resulting from prior trauma. After the surgery. The patient underwent an erector spinae plane (ESP) block at T5-T6 under general anesthesia for postoperative analgesia. Postoperatively, the patient exhibited satisfactory oxygenation, low pain scores, and no complications associated with the ESP block, indicating effective pain control.Conclusion: This case report illustrates that an ESP block administered postoperatively can offer effective analgesia management for patients with spontaneous pneumothorax and pulmonary atelectasis undergoing decortication thoracotomy. This strategy not only ensures adequate pain relief but also facilitates early mobilization and reduces postoperative opioid use. These findings endorse the integration of the ESP block into a multimodal anesthetic approach for thoracic surgery.
Bad Lung Down Phenomenon During Spinal Positioning for Hip Hemiarthroplasty: A Case Report I Made Prema Putra; Putu Herdita Sudiantara; Anak Agung Ngurah Aryawangsa; Nyoman Bendhesa Wirananggala; Anak Agung Gde Agung Adistaya; Tjokorda Gde Agung Senapathi
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.80577

Abstract

Background: Position-dependent hypoxemia during spinal anesthesia positioning is uncommon but may pose safety concerns in older patients with unilateral lung disease.Case: An 84-year-old woman (ASA III) with a proximal femoral fracture and clinical-radiographic features consistent with left-sided pneumonia was scheduled for bipolar hip hemiarthroplasty. Fracture-related pain and positioning limitations precluded the sitting position and right lateral decubitus, making the left lateral decubitus (LLD) position the only feasible option for spinal anesthesia. During LLD positioning with oxygen via nasal cannula, oxygen saturation dropped to 84-88% without dyspnea and promptly improved after returning to the supine position. Ancillary evaluation revealed preserved biventricular systolic function (left ventricular ejection fraction 60%, TAPSE 19 mm). Lung ultrasound showed no sonographic evidence of pulmonary edema. Spinal anesthesia was performed in the LLD position using 7.5 mg of 0.5% hyperbaric bupivacaine with 50 mcg intrathecal morphine. The surgery then proceeded with a supine-position modification, and hemodynamic and respiratory status remained stable without intraoperative complications.Discussion: In unilateral pneumonia, placing the diseased lung dependent can worsen ventilation-perfusion (V/Q) mismatch through the bad lung down phenomenon, leading to reversible position-dependent hypoxemia. In this case, desaturation occurred before intrathecal injection and before administration of sedatives or systemic opioids, making drug-induced hypoventilation unlikely. The absence of hypercapnic symptoms, preserved cardiac function, and lack of ultrasound evidence of pulmonary edema supported a predominantly pulmonary V/Q mechanism and illustrated silent hypoxemia in an older adult.Conclusion: Positioning should be regarded as a critical step in neuraxial anesthesia, particularly in frail or elderly patients with unilateral lung disease. In such patients, early detection of position-dependent desaturation and prompt correction of posture can allow surgery to proceed safely under regional anesthesia without the need to convert to general anesthesia. 
Anesthetic Management for Sternotomy in a Patient with Anterior Mediastinal Tumor: A Case Report Joseph Rusli; Arfian Pascalis Kurniawan; Indra Hapdijaya; Julia Windi Gunadi
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.72407

Abstract

Background: Anterior mediastinal masses (AMMs) pose significant anesthetic challenges, risking airway obstruction, cardiovascular collapse, and hemodynamic instability, especially in the supine position. Preoperative assessment, including imaging and cardiopulmonary evaluation, is crucial. Anesthetic management prioritizes spontaneous ventilation (SV), airway patency, and hemodynamic stability, often employing awake intubation, inhalational induction, and neuromuscular blockade avoidance. A multidisciplinary, individualized anesthetic management of the sternotomy approach optimizes outcomes.Case: 50-year-old male with anterior mediastinal tumor (AMT) scheduled for elective sternotomy. The patient experienced chest pain and a persistent cough with displacement and indentation of the aorta and inferior vena cava as observed on contrast-enhanced computed tomography (CT) scan, indicating high surgical risk. Anesthesia induction involved fentanyl, midazolam, atracurium, and propofol, followed by intubation with a left-sided double-lumen tube (DLT) for one-lung ventilation.Discussion: Mediastinal masses pose significant anesthetic risks, primarily due to the potential for mediastinal mass syndrome (MMS). Preoperative imaging and symptom-based risk stratification are critical. Anesthetic goals include maintaining SV and avoiding neuromuscular blockade when possible, as loss of SV is often linked to MMS onset. However, in procedures like sternotomy requiring deep anesthesia and muscle relaxation, airway control may necessitate neuromuscular agents. In such cases, preparedness for difficult ventilation is essential. We utilized a left-sided DLT to facilitate one-lung ventilation and surgical access. Postoperative intensive care unit (ICU) monitoring is advised for high-risk patients.Conclusion: This case's importance lies in the complex anesthetic management of sternotomy for anterior mediastinal mass resection, requiring meticulous planning to prevent airway and cardiovascular compromise. A multidisciplinary approach and early diagnosis are key to optimizing patient safety and outcomes.
Safe and Effective Perioperative Management in Patients with Atrial Septal Defect and Pulmonary Contusion: A Case Study with Supraclavicular Block RTH Supraptomo; Andy Nugroho; Muhammad Baihaqi Siddik
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.78083

Abstract

Background: Peripheral nerve blocks offer a safer anesthetic alternative in patients with congenital heart disease (CHD) by reducing cardiovascular and pulmonary risks associated with general anesthesia. The supraclavicular brachial plexus block provides effective anesthesia for upper limb surgery with improved hemodynamic stability, reduced complications, and better postoperative analgesia. This case report aims to demonstrate the safety and effectiveness of supraclavicular brachial plexus block as a perioperative anesthetic strategy in a high-risk patient with CHD and pulmonary contusion.Case: A 67-year-old woman with a large secundum atrial septal defect (ASD), severe pulmonary hypertension, right ventricular dysfunction, and bilateral lung contusions on day 10 was scheduled for open reduction internal fixation (ORIF) of a distal radius fracture. Due to high cardiopulmonary risk, regional anesthesia was chosen. An ultrasound- and nerve stimulator-guided supraclavicular block using 20 mL of levobupivacaine 0.375% was performed. The procedure was completed successfully with stable hemodynamics and preserved spontaneous ventilation. Postoperatively, the patient was monitored in a high-care unit (HCU).Discussion: Maintaining hemodynamic stability and avoiding increases in pulmonary vascular resistance (PVR) are critical in acyanotic left-to-right shunt CHD. General anesthesia and mechanical ventilation may disrupt Qp:Qs balance and worsen pulmonary function, especially in pulmonary contusion. Regional anesthesia minimizes these risks while providing adequate surgical conditions.Conclusion: Supraclavicular brachial plexus block is a safe and effective alternative for upper limb surgery in high-risk CHD patients with acyanotic shunt lesions and pulmonary complications.
The Role of CRRT in Optimizing the Management of Septic Shock in Patients with Myasthenia Gravis Improves Outcomes Robby Al Amin; Vera Irawany
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.83434

Abstract

Background: Septic shock is a life-threatening condition arising from an uncontrolled host response to infection, leading to organ dysfunction and high mortality. Patients with myasthenia gravis are more susceptible to respiratory infections, particularly pneumonia, which can aggravate their clinical condition and increase the risk of severe complications.Case: We report a case of a 47-year-old woman with a known history of myasthenia gravis who developed septic shock secondary to pneumonia, accompanied by acute kidney injury (AKI). The patient presented with respiratory distress and hemodynamic instability requiring mechanical ventilation and vasopressor support. She was managed with a comprehensive approach including fluid resuscitation, broad-spectrum antibiotics, ventilatory support, and continuous renal replacement therapy (CRRT). Immunomodulatory therapies such as plasmapheresis or intravenous immunoglobulin (IVIG) were not administered.Discussion: During the course of treatment, the patient showed gradual clinical improvement, as indicated by stabilization of hemodynamic status, correction of metabolic and electrolyte imbalances, recovery of renal function, and successful weaning from mechanical ventilation. The improvement observed may be related to adequate control of the underlying infection and optimization of organ support, including the use of CRRT, which may help maintain metabolic stability and contribute to the removal of inflammatory mediators. This case also suggests that in certain clinical settings, management focused on the underlying cause of deterioration may be sufficient without immediate use of immunomodulatory therapy.Conclusion: Comprehensive management of septic shock, including infection control, hemodynamic stabilization, and organ support with CRRT, may lead to favorable clinical outcomes in patients with myasthenia gravis. Further studies are needed to better define the role of CRRT as an adjunctive therapy in this context.

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