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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 22 Documents
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Search results for , issue "Publication In-Press" : 22 Documents clear
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 Incomplete Atrioventricular Septal Defect Priambodo, Bhimo; Pratomo, Bhirowo Yudo; Kurniawaty, Juni
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.v0i0.76955

Abstract

Background: Atrioventricular septal defect (AVSD) is a congenital heart anomaly that arises from the incomplete fusion of the endocardial cushions, resulting in communication between the atria and ventricles and abnormal development of the atrioventricular valves. Incomplete AVSD accounts for a smaller proportion of congenital heart defects but presents significant challenges in both surgical and anesthetic management due to complex pathophysiology and perioperative risks. This study to report and discuss the anesthetic management of a pediatric patient with incomplete AVSD undergoing surgical repair.Case: We report the case of a 7-year-old boy with incomplete AVSD who underwent surgical closure and mitral valve cleft repair. Preoperative evaluation included echocardiography and cardiac catheterization. General anesthesia was induced with fentanyl, propofol, and sevoflurane, and maintained during cardiopulmonary bypass (CPB). Intraoperative transesophageal echocardiography (TEE) confirmed effective repair. Postoperatively, the patient experienced transient arrhythmia that resolved with pacing and was successfully extubated on the first postoperative day without complications.Discussion: Children with congenital heart disease (CHD) are at higher risk of morbidity and mortality due to the complex physiological derangements caused by the defects. Anesthetic management in AVSD depends on the degree of left-to-right shunting and the presence and severity of pulmonary vascular hypertension. Important considerations include neonatal and pediatric anesthesia principles, congenital cardiac anatomy and physiology, CPB techniques, and potential postoperative complications.Conclusion: Anesthetic management in incomplete AVSD requires a comprehensive understanding of pediatric CHD, perioperative monitoring, and CPB protocols. Multidisciplinary collaboration and meticulous perioperative planning are crucial in improving outcomes and minimizing complications in pediatric cardiac surgery.
Comparison of Inferior Vena Cava Distensibility Index and Pulse Pressure Variation as Predictors of Fluid Responsiveness in Sepsis Patients at the ICU Evandrian, Difa Aulia; Soesilowati, Danu; Rakhmajati, Pradana Bayu
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.v0i0.69705

Abstract

Background: Sepsis is a major global health challenge with an estimated 49 million incident cases and 11 million deaths each year, which requires appropriate fluid management to improve patient prognosis.Objective: This study aims to compare the effectiveness of the inferior vena cava distensibility index (IVC-DI) and pulse pressure variation (PPV) as predictors of fluid responsiveness in sepsis patients in the intensive care unit (ICU).Methods: This study used an experimental design with a sample of 36 sepsis patients selected through consecutive sampling. Fluid administration of 500 ml RL was carried out for 15 minutes, followed by measurement of IVC-DI and PPV, and evaluation of an increase in stroke volume (SV) > 15% as an indicator of fluid responsiveness.Results: The study showed that PPV had a sensitivity of 93% and specificity of 90%, with a positive predictive value of 87.5% and a negative predictive value (NPV) of 95%. The overall accuracy of PPV was 91.6%. PPV showed a very strong correlation with SV increase > 15% (r = 0.832, p < 0.001). On the other hand, IVC-DI had a sensitivity of 80% and specificity of 71%, with a positive predictive value of 66% and a NPV of 83%. The overall accuracy of the IVC-DI was 75%. The IVC-DI showed moderate correlation with SV increase > 15% (r = 0.507, p = 0.002). Inter-observer agreement in IVC-DI measurements also showed excellent results with a Kappa value of 1.00, indicating perfect agreement. From the results of this study, PPV proved to be more accurate in predicting fluid responsiveness compared to IVC-DI in sepsis patients in the ICU. These two methods, although equally useful, showed different levels of effectiveness in this clinical context.Conclusion: PPV showed better performance than IVC-DI in predicting fluid responsiveness in mechanically ventilated sepsis patients in the ICU. PPV demonstrated higher accuracy, sensitivity, specificity, and a stronger correlation with SV improvement, indicating that PPV may serve as a more reliable predictor in this clinical setting.
Comparison of the Success of Emergency Intubation with the Heaven Score and The Lemon Score in Critically Ill Patients Who Require Mechanical Ventilation Johan, T. Abdurrahman; Lubis, Andriamuri Primaputra; Ihsan, Muhammad
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.v0i0.73108

Abstract

Background: The LEMON and HEAVEN scores are currently used only to assess airway difficulties in emergency patients. This research was conducted to evaluate the success of emergency intubation using the LEMON and HEAVEN scores in critically ill patients who require mechanical ventilation.Objective: The objective of this study is to compare the success of emergency intubation with the HEAVEN score with the LEMON score in critically ill patients requiring mechanical ventilation.Methods: This research employed a cross-sectional observational analytical design and took place at Adam Malik General Hospital, Medan, Dr. Pirngadi Medan, and RSU Haji Medan from January to March 2024. All critically ill patients aged 18-64 years requiring emergency intubation were included, excluding those with prior tracheotomy or intubation experience who refused to participate. A minimum sample size of 70 participants was obtained, with statistical analysis planned using SPSS version 26 software.Results: A total of 76 patients were included in this study. According to the LEMON score, 5 patients (6.6%) were identified as having difficult intubation, whereas the HEAVEN score categorized 30 patients (39.5%) as difficult cases. Following emergency intubation, only 3 patients (3.9%) experienced initial intubation failure. The LEMON score demonstrated an area under the curve (AUC) of 0.984, indicating excellent accuracy, while the HEAVEN score had an AUC of 0.911, also demonstrating excellent accuracy. Both scores proved equally effective in assessing intubation success, with statistical analysis favoring the superiority of the LEMON score. However, the HEAVEN score can serve as a viable alternative in critically ill patients.Conclusion: The LEMON score and HEAVEN score can be used to evaluate the success of emergency department intubation in critically ill patients who require mechanical ventilation.
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.
Prognostic Value of the Lactate/Albumin Ratio for Mortality in Sepsis-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis Tanjung, Fariz Fadhly
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.v0i0.76698

Abstract

Introduction: Sepsis-associated acute kidney injury (SA-AKI) is a frequent and life-threatening complication in critically ill patients, associated with high morbidity and mortality. While traditional prognostic tools provide valuable risk stratification, there remains a need for practical and universally available biomarkers to identify high-risk patients early in their clinical course. The lactate/albumin ratio (LAR) has emerged as a promising candidate for this purpose. This meta-analysis aimed to comprehensively evaluate the prognostic utility of LAR in predicting mortality among patients with SA-AKI.Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Electronic databases (PubMed, Embase, and Web of Science) were searched through July 2025 for observational studies reporting hazard ratios (HRs) for the association between LAR and mortality in adult patients with sepsis-associated AKI. Studies were included if they reported adjusted HRs for mortality and used established criteria for sepsis and AKI. Data extraction and quality assessment were performed independently by two reviewers. Random-effects meta-analysis was used to pool effect estimates, with heterogeneity assessed by the I² statistic.Results: Six large retrospective cohort studies, encompassing over 25,000 ICU patients, were included in the quantitative synthesis. Elevated LAR at or near ICU admission was independently associated with an increased risk of mortality. The pooled hazard ratio for the highest versus lowest LAR group was 1.97 (95% CI: 1.42–2.73), indicating nearly double the risk of death for patients with the highest LAR values. The association remained robust across varying patient populations, study designs, adjustment covariates, and mortality endpoints, despite moderate to high heterogeneity (I² = 91%). Sensitivity analyses confirmed the stability of the main findings. Additional narrative synthesis of recent prospective and perioperative studies, as well as studies in related critical illness populations, further supported the generalizability of LAR as a prognostic biomarker.Conclusion: This meta-analysis confirms that the lactate/albumin ratio is a powerful, accessible, and cost-effective biomarker for early mortality risk stratification in sepsis-associated acute kidney injury. Routine LAR measurement at ICU admission can facilitate timely identification of high-risk patients, guide clinical decision-making, and improve outcomes. Prospective validation, establishment of standardized thresholds, and integration into multimodal risk prediction tools are warranted to optimize the application of LAR in critical care practice.
Anesthesia for ASD Closure in Robotic-Assisted Cardiac Surgery: A Case Report Rizqhan, Muhammad; Hadinata, Yudi
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.v0i0.70958

Abstract

Background: Minimally invasive cardiac surgery (MICS) utilizes small chest incisions without sternotomy, offering faster recovery, reduced physiological stress, shorter hospitalization, and better cosmetic results. Robotic-assisted surgery is a modern approach within MICS that provides enhanced precision. However, literature on anesthesia management in robotic-assisted atrial septal defect (ASD) closure remains limited. This case report aims to provide clinical insights and support the safe adoption of such techniques.Case: A 51-year-old male with an ASD secundum and a left-to-right (L-R) shunt measuring 22x29 mm, without comorbidities, was scheduled for general anesthesia. The patient was classified as American Society of Anesthesiologists (ASA) physical status III. Monitors applied included electrocardiogram (ECG), nasopharyngeal thermometer, arterial line, central venous pressure (CVP), EtCO₂, near-infrared spectroscopy (NIRS), and transesophageal echocardiography (TEE). The patient was placed in a supine position and intubated with a 37 Fr left-sided double-lumen endotracheal tube (DLT) at a depth of 31 cm, followed by one-lung ventilation. General anesthesia was induced using midazolam 5 mg, sufentanil 10 mcg, propofol 50 mg, and rocuronium 50 mg, maintained with 1% sevoflurane and rocuronium at 10 mg/hour. A regional block was performed using a deep serratus anterior plane block (DSAPB) with a regimen of 10 ml of 0.5% isobaric bupivacaine (50 mg), 5 ml of 10% lignocaine (500 mg), and epinephrine 1:200,000, with a total volume of 40 ml. The surgery was performed on a beating heart with right femoral artery, right femoral vein, and right jugular vein cannulation. The procedure lasted 12 hours.Discussion: Robotic-assisted cardiac surgery enhances surgical accuracy but presents unique anesthetic challenges due to patient positioning, limited access, and cardiopulmonary dynamics. Anesthesiologists must optimize monitoring and maintain close team coordination.Conclusion: Robot-assisted MICS represents a significant advancement in MICS. However, anesthesiologists must pay close attention to preoperative, intraoperative, and postoperative assessments to ensure patient safety and optimal outcomes.
Assessment of Clinical Ethics Application and Patient Satisfaction in Anesthesiology Services: A Cross-Sectional Study Forensa, Habibie Arzt; Suryadi, Taufik; Kulsum, Kulsum
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.v0i0.71867

Abstract

Background: Clinical ethics is currently widely discussed in anesthesiology practice in hospitals. The implementation of clinical ethics is very important in providing patient care. Anesthesiology services are a type of medical service that is full of ethical dimensions because each procedure, from pre-operative, perioperative, and post-operative, is directly correlated with the four quadrants of clinical ethics. There have been few studies conducted regarding the implementation of clinical ethics and the quality of patient satisfaction.Objective: The purpose of this study was to describe the implementation of clinical ethics in anesthesiology and the quality of patient satisfaction.Methods: An observational study using cross sectional design was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, in October-December 2023 on 111 patients receiving anesthesiology services, male and female, aged 2-65 years, who will undergo elective surgery.Result: The present study found that the implementation of clinical ethics in anesthesiology services was 62.45%, with each category being medical indications (72.26%), patient preferences (66.21%), quality of life (60.21%), and contextual features (51.12%). Meanwhile, the level of patient satisfaction with anesthesiology services was as follows: strongly satisfied (69.37%), satisfied (18.02%), neutral (8.10%), not satisfied (2.71%), and strongly not satisfied (1.80%). Factors influencing the lack of implementation of clinical ethics in anesthesiology services include short consultation times, inadequate patient understanding of clinical ethics issues, and excessively detailed information. One way to improve the implementation of clinical ethics is by providing comprehensive clinical ethics information during anesthesia consultations and pre-operative care.Conclusion: The implementation of clinical ethics in anesthesiology services was moderate. Higher perceived clinical ethics practices may be associated with increased patient satisfaction; however, causal conclusions cannot be drawn from this study.
The Efficacy of High-Albumin Formula Supplementation (Albumed milk) on Serum Albumin Levels in Critically Ill Patients with Sepsis Jaya, Wiwi; Fatoni, Arie Zainul; Iradat, Prataganta; Laksono, Buyung Hartiyo
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.v0i0.71031

Abstract

Background: Septic, an infection-induced condition, triggers an inflammatory response leading to life-threatening organ dysfunction and hypoalbuminemia. Albumed milk, containing extracts from egg whites and sprouts, has been considered a potential intervention to prevent hypoalbuminemia.Objective: This study aimed to evaluate the impact of albumed milk on elevating serum albumin levels in septic patients in the intensive care unit (ICU).Methods: An experimental study involved two groups totaling 40 patients. The control group received a standard ICU diet, while the treatment group received half of the regular ICU diet supplemented with 30 grams of albumed milk every 8 hours. Albumin levels were measured on days 0 and 3.Results: A significant reduction in average albumin levels occurred in the control group at 0.605 units (p-value = 0.006). Conversely, the treatment group showed a non-significant decrease, with an average reduction in albumin level of 0.03 units (p = 0.839).Conclusion: Albumed milk administration preserves albumin levels in septic patients compared to control patients without albumed, who show albumin level reduction. This highlights the potential utility of albumed milk as a supplementary measure in mitigating septic-related hypoalbuminemia. 
Lower Preoperative and Postoperative Hemoglobin Levels in Patients with Postoperative Cognitive Dysfunction Compared to Those Without Postoperative Cognitive Dysfunction Following Heart Valve Replacement Nurcahyo, Widya Istanto; Manapa, Chandra Hermawan; Muttaqin, Zainal; Boom, Cindy Elfira; Farhan, Muhammad; Harahap, Mohamad Sofyan; Tugasworo, Dodik; Sianturi, Rea Sava Kinanti
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.v0i0.79631

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a prevalent complication that occurs after surgery, impacting cognitive function. Cognitive performance may be hindered by anemia, as it reduces the delivery of oxygen to the brain and leads to tissue hypoxia, affecting metabolism and ultimately diminishing cognitive function.Objective: The objective of this study is to examine the potential correlation between hemoglobin levels and the occurrence of POCD in individuals undergoing heart valve replacement surgery.Methods: This retrospective cohort study included all individuals aged 20 years and above who underwent heart valve replacement surgery from July to December 2021. Hemoglobin levels were assessed both before and after the surgical procedure, and cognitive function was evaluated using the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third day after the operation. Statistical analysis involved the use of either Student's t-test or the Mann–Whitney nonparametric test.Results: A total of 70 participants were included in the study from July to December 2021. The majority of the participants were female (57.1%), and a significant proportion were below 60 years old (81.4%). The average preoperative hemoglobin levels were higher (13.30 g/dL) than the average postoperative hemoglobin levels (10.78 g/dL). In terms of cognitive function, 61.4% of participants experienced postoperative cognitive dysfunction (POCD), with a higher mean MoCA-INA score before surgery (28.41) than after surgery (22.37), along with a delta Hb of -0.27. Furthermore, postoperative hemoglobin levels were significantly lower in POCD patients than preoperatively (p = 0.003).Conclusion: The occurrence of postoperative cognitive dysfunction (POCD) was linked to the hemoglobin levels after heart valve replacement.

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