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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 17 Documents
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Search results for , issue "Publication In-Press" : 17 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 Nur Azza, Kamala Kan; Susianti, Noor Alia; Mahmud, Mahmud; Nathania, Caroline Evanthe
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 Cobis, Albinus Yunus; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
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 Novara, Tendi; Cahyono, Iwan Dwi; Hapsari, Rania Adeastri
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.
Management of Continuous Renal Replacement Therapy Following Coronary Artery Bypass Grafting in the Intensive Care Unit Synthana, Meta Restu; Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno
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.v0i0.76588

Abstract

Background: Acute kidney injury (AKI) after cardiac surgery is a serious complication with a high occurrence, leading to increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is the preferred method for replacing kidney function in patients with hemodynamic instability, especially during the critical postoperative period in the intensive care unit (ICU).Case: A 76-year-old man with a history of ischemic heart disease and chronic heart failure underwent off-pump coronary artery bypass grafting (CABG). The patient had comorbidities including obesity, obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), pneumonia, and chronic kidney disease (CKD). During intensive postoperative care, the patient experienced a progressive decrease in urine output, rising urea and creatinine levels, and significant fluid overload. CRRT with continuous venovenous hemodiafiltration (CVVHDF) mode was started on the first day of ICU admission, and clinical improvement was observed after four days of therapy.Discussion: Patients with multiple comorbidities often experience a deterioration in kidney function after surgery, requiring prompt intervention. The critical role of CRRT in stabilizing fluid and metabolic balance, while simultaneously maintaining hemodynamic stability, cannot be overstated. Careful monitoring of volume status, hemodynamics, and laboratory results is essential to determine the duration of therapy and evaluate its effectiveness.Conclusion: CRRT is an effective treatment for patients after CABG with AKI and hemodynamic instability. A team-based approach and proper monitoring are crucial for the success of therapy and patient recovery.
Bad Lung Down Phenomenon During Spinal Positioning for Hip Hemiarthroplasty: A Case Report Putra, I Made Prema; Sudiantara, Putu Herdita; Aryawangsa, Anak Agung Ngurah; Wirananggala, Nyoman Bendhesa; Adistaya, Anak Agung Gde Agung; Senapathi, Tjokorda Gde Agung
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 Rusli, Joseph; Kurniawan, Arfian Pascalis; Hapdijaya, Indra; Gunadi, Julia Windi
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.
Effects of Dexmedetomidine Versus Propofol–Fentanyl on QoR-15 Recovery in Cranioplasty Fadli, Mhd; Irina, Rr Sinta; Bisono, Luwih
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.v0i0.79220

Abstract

Background: Optimizing postoperative recovery is essential in neurosurgical anesthesia. Dexmedetomidine, a selective α2-adrenergic agonist, may improve sedation and recovery outcomes. This study compared intraoperative dexmedetomidine versus propofol-fentanyl in cranioplasty patients using the Quality of Recovery-15 (QoR-15) score.Methods: A prospective comparative study was conducted at Adam Malik General Hospital and Haji Medan Hospital from May - August 2025 involving 42 adult patients undergoing elective cranioplasty. Subjects were divided into two groups: dexmedetomidine (n=21) and propofol-fentanyl (n=21). Quality of Recovery-15 (QoR-15), a validated 15-item questionnaire assessing five domains of postoperative recovery (pain, physical comfort, emotional state, psychological support, and physical independence; total score range 0–150), was recorded at 12 and 24 hours postoperatively. Hemodynamic parameters, sedation depth, and operator satisfaction were assessed. Data were analyzed using t-tests and Fisher’s exact test with p < 0.05.Results: Patients receiving dexmedetomidine showed higher QoR-15 scores at 12 hours (p = 0.045) and 24 hours (p = 0.003). Heart rate was significantly lower (p = 0.02), while systolic and diastolic pressures showed no significant differences. Sedation depth and operative duration were comparable. Operator satisfaction reached 100% in both groups.Discussion: Dexmedetomidine improved recovery quality compared to propofol-fentanyl, with better hemodynamic stability and fewer sympathetic responses. These findings align with previous studies supporting its use in enhanced recovery anesthesia. Limitations include a small sample size and a lack of intraoperative sedation monitoring.Conclusion: Intraoperative dexmedetomidine offers superior recovery quality and stable hemodynamics, suggesting its potential for broader use in neurosurgical anesthesia.

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