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INDONESIA
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 341 Documents
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Role of Neuroprotective Agents in the Anesthetic Management of Brain Tumors for Patients with Recidive Cystic Tumor with Signs of Intracranial Hypertension Underwent Re-Craniotomy Decompression Tumor Resection: Case Report Utami, Yulia Kartika; Prihatno, Rudi; Suryani, Shila
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.66384

Abstract

Background: The management of brain tumor surgeries, particularly recurrent cystic tumors with cerebral edema, poses significant challenges. Elevated intracranial pressure (ICP) and the associated risk of ischemia necessitate a comprehensive neuroprotective approach during anesthesia to ensure optimal surgical and postoperative outcomes.Case: A 54-year-old male presented with two weeks history of headaches and dizziness. He had previously undergone a craniotomy six months ago for the removal of a metastatic right parieto-occipital adenocarcinoma. Imaging revealed tumor recurrence, and the patient was scheduled for a re-craniotomy. The anesthetic plan included neuroprotective strategies: thiopental for metabolic suppression, sufentanil for hemodynamic stability, and sevoflurane for neuroprotection. The surgery lasted 3.5 hours, with minimal intraoperative blood loss and stable perioperative hemodynamics. Postoperatively, the patient recovered without complications and was discharged in stable condition.Discussion: The anesthetic management prioritized maintaining ICP, cerebral perfusion pressure (CPP), and minimizing neuroinflammatory responses. Thiopental effectively reduced cerebral metabolic demands, sufentanil stabilized hemodynamics, and sevoflurane provided neuroprotective and anti-inflammatory benefits. hypothesis and principles. These strategies ensured cerebral autoregulation, controlled cerebral edema, and optimized recovery. The Monro-Kellie hypothesis and principles of neuroprotection were key guiding frameworks in this case.Conclusion: This case highlights the critical role of neuroprotective agents in the anesthetic management of brain tumor surgeries. The combination of thiopental, sufentanil, and sevoflurane contributed to a stable intraoperative course and uneventful recovery. Integrating these strategies ensures improved surgical outcomes and patient safety in challenging neurosurgical cases.
Thoracic Spinal Anesthesia (TSA) in Patients with Congestive Heart Failure and Pleural Effusion Undergoing Breast Tumor Surgery: A Case Report Wiedjaja, Aryasena Andhika; Rizqhan, Muhammad
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.67321

Abstract

Background: Thoracic spinal anesthesia (TSA) is a regional anesthesia technique that can serve as an alternative to general anesthesia, particularly for patients with cardiovascular and respiratory comorbidities, to reduce adverse effects and provide a more effective procedure.Case: A 55-year-old female patient with a left breast tumor and comorbidities including uncontrolled hypertension and type 2 diabetes mellitus, as well as congestive heart failure (CHF) and bilateral pleural effusion, scheduled for lumpectomy by a surgical specialist. The preoperative assessment showed stable hemodynamics with no significant changes in laboratory results. The patient received hyperbaric bupivacaine 5 mg (1cc), fentanyl 25 mcg (0.5cc), and an adjuvant of dexamethasone 5 mg (1cc) for the TSA procedure at the T4-T5 level. Intraoperatively, there were no significant hemodynamic changes, and postoperatively, the patient had a good recovery and mobilization.Discussion: The TSA procedure is an alternative anesthesia technique when patients undergoing general anesthesia have a high risk of morbidity and mortality, especially in geriatric patients with physiological body disorders and multiple comorbidities. TSA has been increasingly used as a safe anesthesia technique, capable of accelerating recovery time, minimizing side effects, and providing better outcomes in terms of perioperative morbidity and mortality compared to general anesthesia. The current limitations of the literature regarding TSA include the lack of large-scale studies, the absence of standardized protocols for TSA, a focus on specific surgeries only, and concerns about the safety of this procedure.Conclusion: The TSA can be used as a regional anesthesia procedure for patients undergoing breast tumor surgery. TSA has a simple technique and is efficient in providing sensory and motor blockade.
Intrathecal Dexmedetomidine-Fentanyl Combination versus Fentanyl Alone as Adjuvant to Bupivacaine in Spinal Anesthesia: A Comparative Study at Haji Adam Malik General Hospital Saputra, Firdaus; Hamdi, Tasrif; Irina, Rr Sinta
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.68960

Abstract

Background: Spinal anesthesia is a regional analgesia that blocks nerve cells in the subarachnoid space by local anesthetic drugs. Bupivacaine is the most common agent, however, the duration of analgesia is often short. However, this advantage is hampered by the limited duration of spinal anesthesia and the uncomfortable postoperative period when the effect wears off. To prolong the duration of analgesia, various drugs such as opioids and α2 adrenergic agonists can be used as adjuvants for intrathecal local anesthetics to improve the quality of spinal anesthesia. One of the most widely used opioids is fentanyl, while the α2 adrenergic agonist is dexmedetomidine.Objective: To analyze the difference in effectiveness of the combination of dexmedetomidine 5µg and fentanyl 25µg intrathecally with fentanyl 25µg as an adjuvant to bupivacaine in spinal anesthesia.Method: This study is a double-blind randomized clinical trial to assess the comparison of the combination of dexmedetomidine 5µg and fentanyl 25µg intrathecally with fentanyl 25µg as an adjuvant to bupivacaine on the onset of block, duration of action, and side effects in surgery with spinal anesthesia.Results: There were 32 samples with a distribution of 16 samples in each group. There was a significant difference in sensory and motor duration (p<0.001). The average sensory duration in the fentanyl group was 2 hours 45 minutes, and in dexmedetomidine + fentanyl, 4 hours 25 minutes. In comparison, the motor duration in the fentanyl group was 2 hours 30 minutes, and in the dexmedetomidine + fentanyl was 4 hours 2 minutes.Conclusion: There is a comparison of the effectiveness of administering dexmedetomidine 5 mcg + fentanyl 25 mcg intrathecally and fentanyl 25 mcg intrathecally as an adjuvant to 0.5% bupivacaine in the spinal, where the dexmedetomidine group had a longer duration of anesthesia than the fentanyl group.
Successful High-Risk Pulseless-Balloon Aortic Valvuloplasty Procedure in Uncorrected Pulmonary Atresia with Severe Congenital Aortic Stenosis and Low Left Ventricular Function Sofia, Sefri Noventi; Bahrudin, Bahrudin; Riwanto, Ignatius; Susanto, Hardhono; Soetadji, Anindita; Baskoro, Adhi Gunawan; Prawara, Ananta Sidhi; Satyagraha, Muhammad Thifan; Kurniawati, Yovie; Prakoso, Radityo
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.72347

Abstract

Background: Pulmonary atresia with ventricular septal defect (PA-VSD) and severe bicuspid aortic stenosis is an uncommon condition that presents significant surgical challenges. The dual obstruction leads to chronic pressure overload, resulting in ventricular hypertrophy and decreased systolic function. A low left ventricular ejection fraction (LVEF) increases the risk of mortality during surgical interventions. Percutaneous balloon aortic valvuloplasty (PBAV) poses additional risks due to the intentional induction of pulselessness during balloon inflation. This case report aims to detail the perioperative management strategies employed during PBAV in a patient with PA-VSD, severe aortic stenosis, and low LVEF.Case: We present a 19-year-old female patient weighing 45 kg with shortness of breath and fatigue. Her oxygen saturation was measured at 90% across all extremities. Electrocardiogram (ECG) findings indicated sinus rhythm with biventricular hypertrophy and incomplete left bundle branch block (LBBB). Chest X-ray revealed cardiomegaly and pulmonary artery dilation, while echocardiography confirmed PA-VSD, severe aortic stenosis with a mean pressure gradient (mPG) of 55 mmHg, and an LVEF of 41.3%. A percutaneous pulseless-BAV was performed using a Tyshak balloon via an antegrade transvenous femoral approach under fluoroscopy and transesophageal echocardiography guidance.Discussion: Anesthesia management focused on gradual medication titration, minimizing patient movement during the procedure, and ensuring comfort due to transesophageal echocardiogram (TEE) probe insertion. A temporary pacemaker was placed in the right ventricular apex for pacing at 220 beats per minute until cardiac arrest occurred post-balloon inflation, and defibrillation successfully restored spontaneous circulation.Conclusion: This case illustrates that PBAV in uncorrected PA-VSD with severe aortic stenosis and low LVEF is feasible despite its inherent risks when conducted by a skilled team utilizing careful judgment throughout the procedure.
Comparison of The Effects of Fentanyl versus Ketamine on The Quality of Recovery Post General Anesthesia with QoR-40 Scoring in Laparotomy Surgery Syahputra, Imam; Irina, Rr Sinta; Lubis, Bastian
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.68607

Abstract

Background: Evaluating recovery after general anesthesia is vital to assess the success of anesthesia procedures. The quality of recovery-40 (QoR-40) questionnaire comprehensively measures post-anesthesia recovery. Poor postoperative pain management can lead to complications and chronic pain. Researchers studied ketamine because of its potential to enhance standard analgesics, improve pain control, and promote better recovery outcomes.Methods: This double-blind, randomized controlled trial involved 42 patients undergoing laparotomy at Haji General Hospital, Medan. Participants were randomized into two groups: one receiving fentanyl at 0.7 µg/kg body weight (BW) and the other receiving ketamine at 0.2 mg/kg BW. Consecutive sampling was used for participant selection, including patients who met specific inclusion and exclusion criteria. The QoR-40 questionnaire, validated in Indonesian, was administered postoperatively to assess recovery across five dimensions: comfort, feelings, support, independence, and pain.Results: The results of the study showed that the total QoR-40 score for fentanyl use had an average of 172.4762 + 3.81601, while in the group using ketamine, the average score was 174.7619 + 3.37498, which had a significant difference between the fentanyl group and the ketamine group with p <0.05.Conclusion: Ketamine provides a superior quality of recovery compared to fentanyl, as evidenced by higher comfort and total QoR-40 scores. These findings support ketamine's use as an effective alternative in anesthetic protocols for laparotomy procedures, promoting better recovery and reducing dependence on opioids.
Colorado Pediatric Airway Score (COPUR) as a Predictor of Intubation Difficulty in Children Aged 1-8 Years Kapuangan, Christopher; Perdana, Aries; Fadhila, Fulki; Ramlan, Andi Ade Wijaya; Zahra, Raihanita; Ferdiana, Komang Ayu; Rahendra, Rahendra
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.70707

Abstract

Background: Airway management is critical in pediatric anesthesia, as failure can lead to severe complications, including cardiac arrest. Anticipating and preparing for difficult intubation is essential, particularly in children with unique anatomical and physiological characteristics. The Colorado Pediatric Airway Score (COPUR) is a predictive tool for assessing intubation difficulty in pediatric patients.Objective: This study evaluates the validity of COPUR in predicting difficult intubation in children.Methods: A cross-sectional diagnostic study was conducted on 121 pediatric patients (aged 1–8 years) undergoing general anesthesia at Cipto Mangunkusumo Hospital. COPUR assesses jaw structure, mouth opening, prior intubation history, uvula visibility, neck movement, and additional modifying factors (macroglossia, obesity, mucopolysaccharidosis, and protruding teeth). A COPUR score >7 was used to predict difficult intubation, while intubation difficulty was defined by an Intubation Difficulty Score (IDS) >5.Results: A COPUR score ≥8 predicted difficult intubation in 15.7% of patients, whereas actual difficult intubation occurred in 9.92%. A COPUR threshold of ≥7 provided optimal sensitivity (83.3%) and specificity (61.47%), outperforming the original cutoff of 8 (50% sensitivity, 87% specificity). The score demonstrated good discriminative ability (AUC-ROC: 0.770, 95% CI: 0.685–0.842) and suitable calibration (Hosmer-Lemeshow test, p = 0.584).Conclusion: The COPUR score is a valid tool for predicting difficult intubation in pediatric patients aged 1–8 years, demonstrating fairly good discrimination and calibration values.
Malignant Hyperthermia Fajri, Doni; Hidayat, Nopian; Masjkur, Diana
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.62676

Abstract

Malignant hyperthermia (MH) is a life-threatening clinical syndrome caused by hypermetabolism involving skeletal muscle. MH is very rare, but it is one of the causes of death in the operating room. MH is an autosomal dominant disease and can be triggered when exposed to certain anesthetic drugs. Genetic tests can help diagnose, but the gold standard is the caffeine halothane contracture test (CHCT). Initial symptoms are a decrease in pH and oxygen, as well as an increase in CO2, lactate, potassium, and temperature. The increase in lactate reflects tissue hypoxia. Dantrolene is an antidote to MH, by reducing calcium loss from the sarcoplasmic reticulum in skeletal muscle and returning metabolism to normal conditions. Immediate detection and treatment can improve MH outcomes.
Myocardial Injury after Noncardiac Surgery: A Case Report of Acute Chest Pain and Elevated Troponin Levels, Challenges and Management Strategies Ton, Yori Yarson; Anggraeni, Novita; Irawan, Dino; Hidayat, Nopian
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.68386

Abstract

Background: Perioperative myocardial injury is a common complication following noncardiac surgery, linked to significant morbidity and mortality. With over 300 million surgeries performed worldwide annually, this number has increased by more than 100 million in the past two decades.Case: A 42-year-old woman underwent elective craniotomy for a right cerebellar hemangioblastoma and was admitted to the intensive care unit (ICU) postoperatively. On day three, she developed typical chest pain, inferior ST-elevation myocardial infarction (STEMI), and cardiogenic shock. Her medical history included the use of euthyrox following a total thyroidectomy 15 years prior, with no prior cardiac issues. Upon examination, she was conscious but had low blood pressure (58/41 mmHg), an elevated heart rate (103 bpm), and cold extremities. Her troponin I level was elevated at 9383.0 ng/mL. The diagnosis was major postoperative myocardial infarction.Therapy: The patient received aspirin, atorvastatin, heparin, norepinephrine, and dobutamine for shock management, with close hemodynamic monitoring. By day six, her condition improved, and her electrocardiogram (ECG) was normal. By day nine, she was transferred to the high care unit.Discussion: Myocardial injury after noncardiac surgery (MINS) includes both myocardial infarction and ischemic myocardial injury, which may not meet the Universal Definition of Myocardial Infarction. MINS usually occurs within 30 days of surgery, especially within the first 72 hours. Its causes are multifactorial, including plaque rupture, oxygen supply-demand imbalance, arrhythmias, and pulmonary embolism. Studies suggest that cardiovascular therapy, including aspirin and statins, is effective. Aspirin reduces 30-day mortality, while statins offer long-term benefits through anti-inflammatory effects. Low-dose aspirin, statins, and Renin-Angiotensin System inhibitors are recommended.Conclusion: MINS is a serious postoperative complication, even in patients without a history of cardiovascular disease, as demonstrated in this case. Prompt recognition and appropriate therapy with aspirin, heparin, and statins, along with close monitoring, can lead to significant clinical improvement.
The Effect of Midazolam Sedation on Agitation Incidence in Post-Operative Patients Who Are Intubated in the ICU of Adam Malik General Hospital Medan Adnani, Muhammad Ivanny; Irina, Rr Sinta; Zainumi, Cut Meliza
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.68368

Abstract

Background: Agitation in critically ill patients is a phenomenon that can endanger patient safety and assistance during treatment in the intensive care unit (ICU). It is characterized by increased motor and mental activity that manifests as inappropriate behavior, disorganized thoughts, and loss of self-control over actions.Objective: Evaluating the effect of midazolam sedation on the incidence of agitation in post-operative intubated patients in the ICU at Adam Malik General Hospital, Medan.Methods: This is a retrospective analytical study with a cross-sectional design using a scoring approach to determine the relationship between midazolam use and agitation in postoperative patients intubated in the ICU after surgery at Adam Malik General Hospital, Medan. The subject selection technique used was non-probability sampling with a consecutive sampling method, where 115 subjects were needed. Bivariate analysis for numeric variables used the Independent T-test if the data were normally distributed, or the Mann-Whitney U test if the data were not normally distributed. The results of the analysis were said to be significant if p <0.05, with a confidence level of 95%.Result: The results of the study the dose of midazolam given to postoperative patients intubated in the ICU of Adam Malik General Hospital, Medan had a minimum dose of 0.017 mg/kg/hour, a maximum of 0.031 mg/kg/hour and an average of 0.023 mg/kg/hour which was related to the incidence of patient agitation during the ICU obtained a significant relationship p <0.05.Conclusion: The effect of midazolam sedation on the incidence of agitation in postoperative patients who were intubated in the ICU of Adam Malik General Hospital, Medan, patients who experienced agitation had a statistically significant difference in the dose of midazolam. And there were side effects of agitation in the form of release of invasive instruments/devices, such as endotracheal tubes, in patients who did not receive sufficient sedation.
Combination of Vitamin D and Vitamin E Against Bacterial Infections Bangun, Primta; Rusip, Gusbakti; Mutia, Maya Sari
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.69122

Abstract

Bacterial infections are a significant health problem worldwide, caused by various microorganisms that can infect different parts of the human body. Bacteria are single-celled microorganisms that can be found in various environments, including in the human body, and most of them are harmless. However, some species of bacteria can cause serious infections and inflammation that require proper medical attention. Some examples of bacteria that cause infections include Streptococcus pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, Vibrio cholerae, Mycobacterium tuberculosis, Escherichia coli, and Staphylococcus aureus. A sufficient vitamin D level in the body can enhance antimicrobial activity against various pathogens, including bacteria, viruses, and fungi. Vitamin E is known to be a powerful antioxidant and has a positive effect on the immune system. It plays a role in protecting immune cells from oxidative damage and enhancing the immune response to infection. The combination of vitamins D and E offers significant potential in the prevention and management of bacterial infections, as both contribute to improved immunological function through different and complementary mechanisms.

Page 32 of 35 | Total Record : 341

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