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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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Fascia Iliaca Compartment Block as Pain Management for Postoperative Femur Fracture in the Elderly: A Case Report Utama, Sigit Prasetya; Yuliana, Friskha; Kuntoadi, Danang
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.v0i0.66116

Abstract

Background: Femur fractures are most common in geriatric patients, necessitating careful consideration of perioperative medications. Effective pain management is crucial to minimize neurohormonal stress responses. Reducing opioid use in older patients can prevent side effects and complications. The fascia iliaca compartment block (FICB) is a safe and efficient nerve block method, known to decrease opioid needs in hip surgery. It is anticipated to enhance mobilization speed and ambulation and reduce postoperative nausea, vomiting, deep vein thrombosis (DVT), and pneumonia, thereby improving overall outcomes for geriatric patients undergoing hip surgery.Case: A 71-year-old female with a closed right intertrochanteric femur fracture underwent open reduction and internal fixation with a proximal femoral nail antirotation. Classified as ASA II, geriatric, with stage I hypertension, her preoperative vital signs included a blood pressure of 170/95 mmHg, heart rate of 65 beats per minute, respiration rate of 20 times per minute, and SpO2 of 98% with nasal cannula oxygen at 3 lpm. Spinal anesthesia was administered at L3-L4, and an FICB was performed postoperatively. Pain assessment, rescue analgesic use, and postoperative nausea were evaluated post-surgery, with monitoring at 6, 24, and 48 hours.Discussion: Pain management with regional FICB anesthesia can simultaneously block the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. Thus, minimizing systemic symptoms compared to analgesics administered intravenously. In this case, the administration of 30 cc of levobupivacaine via a FICB provided effective analgesia for up to 72 hours post-blockade in a geriatric patient without causing side effects, such as postoperative nausea.Conclusion: Postoperative FICB for hip surgery in geriatric patients provides effective analgesia with minimal side effects. 
Effect of Coloading Ringer Lactate on Blood Pressure Stability in Patients with Spinal Anesthesia Noprianty, Richa; Sijabat, Togi Riki Rikardo; Satriyanto, Muhammad Dwi; Valiani, Cici
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.v0i0.68598

Abstract

Background: The most common hemodynamic complication associated with spinal anesthesia is hypotension, hence the need for fluid coloading.Objective: The purpose of this study was to determine the effect of lactated ringer coloading fluid on blood pressure stability.Methods: This study was conducted using a quantitative method with a quasi-experimental design with a one-group pretest-posttest design. This study was conducted at X Hospital in the West Java region from March to April 2024. The research was carried out in the operating room after spinal anesthesia and after the administration of Ringer's lactate. The research instrument used an initial blood pressure observation sheet, blood pressure after spinal anesthesia, and after giving lactated ringer coloading with a calculation of 10 cc/kg of patient weight. The population in this study was all patients who underwent spinal anesthesia, and the sample of this study amounted to 60 patients with non non-probability sampling technique with purposive sampling. Data analysis in this study used univariate and bivariate analysis. This study has carried out data normality tests and research ethics. Bivariate analysis in this study used a Paired t-test.Results: The results showed that after spinal anesthesia, most (51.7%) patients had hypotension. After being given lactated ringer coloading, most patients (68.3%) had normal blood pressure. Systolic blood pressure increased by 9,750 mmHg, and diastolic also increased by 6,500 mmHg.Conclusion: This study concludes that lactated ringer coloading has a significant effect on both systolic and diastolic blood pressure stability after spinal anesthesia.
Comparison Between the Use of 10% Lidocaine Spray on the Mole Palate, Posterior Pharynx, Tonsillar Pillar, Hypopharynx, and Endotracheal Tube on Hemodynamics and Post-Intubation Throat Pain Wicaksono, Desmiko Haryo; Hamdi, Tasrif; Ihsan, Mhd; Amelia, Rina
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.v0i0.69005

Abstract

Background: Intubation causes various side effects such as pain and parasympathetic stimulation, hemodynamic changes, increased intracranial pressure, and increased risk of intracranial hemorrhage. Topical lidocaine has been applied for decades via intratracheal spray, oxygen atomization, intracuff filling, or gel lubrication due to its advantages in simplicity of operation. Topical lidocaine is one of the drugs of choice to prevent post-intubation sore throat by decreasing the permeability of nerve membrane cells to sodium ions.Objective: To determine the relationship between the use of 10% lidocaine spray on the mole palate, posterior pharynx, tonsillar pillar, hypopharynx, and endotracheal tube on hemodynamics and post-intubation throat pain.Methods: This study employed a single-blind, randomized clinical trial design with 17 research subjects per group. Group A was given xylocaine spray on the endotracheal tube, and 17 subjects belonging to group B were given xylocaine spray on the soft palate, hypopharynx, and tonsil pillars.Result: Mean arterial pressure in this study in group A was found to be 91.11 + 6.55 and in group B 91.11 + 6.55, for post-operative sore throat (POST) scores in group A 0.51 + 0.26 and for group B 1.21 + 0.13.Conclusion: There is a difference between the use of 10% lidocaine spray on the soft palate, posterior pharynx, tonsillar pillars, hypopharynx, and endotracheal tube on hemodynamics and the incidence of sore throat after endotracheal intubation in elective patients with general anesthesia at RS Adam Malik, Medan.
Comparison of Neck Circumference to Thyromental Distance as A Predictor of Difficulty Visualizing The Larynx in Elective Surgery Patients At Haji Adam Malik General Hospital Adzim, Teuku Fauzan; Winata, Ade; Irina, Rr Sinta
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.v0i0.69090

Abstract

Background: Airway management is the responsibility of anesthesiologists, but clinical assessment documentation is often incomplete. Difficult laryngoscopy and intubation occur in 1% to 15% of cases. Intubation is considered difficult if it takes more than ten minutes for a trained anesthesiologist to achieve successful endotracheal intubation. In Indonesia, difficult laryngeal visualization occurs in 10.1% of Malay patients. Common predictors include Mallampati classification, thyromental distance (TMD), obstructive sleep apnea (OSA), male gender, and age.Objective: This study aims to compare neck circumference (NC) to TMD as a predictor of difficulty visualizing the larynx.Methods: This diagnostic study aimed to evaluate the sensitivity and specificity of NC and TMD as predictors of difficult laryngeal visualization in patients undergoing elective surgery at Haji Adam Malik General Hospital, Medan. The sample consisted of 85 patients, aged 18 years or older, with ASA classifications of 1-2, who were undergoing general anesthesia. Exclusion criteria included limited mouth opening, acute burns, airway tumors, or anatomical abnormalities.Result: The mean age of participants was 54.97 ± 14.41 years, with a mean body mass index (BMI) of 26.63 ± 3.12 kg/m², and an average NC/TMD ratio of 6.37 ± 0.87. Patients with an NC/TMD ratio > 5 had difficult intubation in 87.5% of cases, while those with an NC/TMD ratio < 5 had easy intubation in 94.6% of cases. Fisher's Exact test showed a significant association (p < 0.001). The NC/TMD ratio had a sensitivity of 95.45%, specificity of 85.36%, positive predictive value (PPV) of 87.5%, negative predictive value (NPV) of 94%, and an area under the curve (AUC) of 90%.Conclusion: The NC/TMD ratio is a significant and accurate predictor of difficult intubation, supporting its use as a simple, non-invasive preoperative tool.
Intensive Care Management of a Patient With Pickwickian Syndrome, Obesity, and Congestive Heart Failure Cakradwipa, Mada Oktav; Adiyanto, Bowo; Prasamya, Erlangga
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.v0i0.74300

Abstract

Background: Pickwickian Syndrome is a condition of alveolar hypoventilation characterized by hypercapnia due to decreased ventilatory drive and capacity caused by obesity. The prevalence of this syndrome aligns with the increasing obesity rate in various countries, especially developed nations, and is associated with obstructive sleep apnea (OSA). Individuals with OSA have a 20–30% risk of developing Pickwickian Syndrome.Case: A 36-year-old male, weighing 160 kg and height 168 cm (body mass index (BMI): 56.69 kg/m²), presented with progressive dyspnea for one week. He had a history of hypertension and heart disease, managed with medication. On arrival at the emergency department (ED), he showed signs of hypoxemia with SpO₂ 80%, which improved to 97% after oxygen therapy with a non-rebreathable breathing mask at 10 L/min. Blood gas analysis revealed partially compensated respiratory acidosis. A Chest X-ray showed bilateral pulmonary edema and cardiomegaly. A diagnosis of Pickwickian Syndrome with congestive heart failure was established. The patient was managed in the intensive care unit (ICU) for 13 days with non-invasive ventilation (NIV) as ventilatory support.Discussion: This case illustrates the complex interplay among morbid obesity, hypoventilation, and cardiac dysfunction. Obesity leads to increased airway resistance and impaired thoracic compliance, resulting in reduced effective ventilation and CO₂ retention. When combined with congestive heart failure, pulmonary edema, and further hypoxemia may ensue. The successful outcome in this case underlines the importance of early diagnosis, targeted respiratory support, and effective fluid management.Conclusion: Intensive care of the patients with Pickwickian Syndrome and congestive heart failure requires a holistic multidisciplinary approach. Optimizing oxygenation, maintaining strict fluid balance, and administering appropriate pharmacologic therapy are crucial to preventing complications and improving prognosis.
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. 
A Comparison of Endotracheal Intubation Success Using Video Laryngoscopy and Reconstructed Laryngoscopes Among Health Workers in Nusa Penida Parami, Pontisomaya; Tethool, Heinz Fernando; Chandra, Steven
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.v0i0.70666

Abstract

Background: Endotracheal intubation is a critical procedure in the management of patients with respiratory distress. The two main methods used are video laryngoscopy and reconstructive laryngoscopy. This study aims to compare the duration and number of intubation attempts using video laryngoscopy and reconstructed laryngoscopy in health workers in Nusa Penida.Objective: This study aimed to compare the time and number of endotracheal intubations performed by healthcare workers in Nusa Penida using two strategies, video laryngoscopy and repeat laryngoscopy. The study involved healthcare specialists who performed intubations in the model, with two groups of 31 people each.Methods: This study used a quasi-experimental design involving health workers in Nusa Penida who performed endotracheal intubation using a video laryngoscope and a reconstructed laryngoscope on mannequins. Two groups of 31 samples were created for the study, and both were given intubation training using a laryngoscope video and direct laryngoscopy.Results: The outcomes of this study were the duration of intubation and the number of attempts required by each respondent to intubate successfully after training. The study used statistical analysis to compare outcomes, employing a paired t-test. The results indicated that the average duration of intubation using laryngoscopy was 31.7 seconds (range: 13 - 93 seconds), while video laryngoscopy took 22.9 seconds (range: 11-49 seconds), with a significance level of P < 0.014. Additionally, the average number of intubation trials was 1.29 (range: 1 - 3) for direct laryngoscopy and 1.03 (range: 1 - 2) for video laryngoscopy, with a significance level of P < 0.018.Conclusion:  There is a difference in the use of the video laryngoscope better in terms of duration and intubation attempts.
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.
Phenytoin Administration Following Early Postoperative Seizure After Brain Tumor Surgery Nugroho, Andy; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
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.v0i0.73402

Abstract

Background: Early postoperative seizures (EPS), defined as seizures occurring within seven days following brain surgery, are a common and serious complication, particularly in patients with high-grade gliomas. EPS can prolong hospitalization, impair neurological recovery, and increase the risk of further brain injury. The optimal prophylactic strategy for seizure prevention remains controversial, especially in settings where access to second-generation antiepileptic drugs is limited.Case: A 53-year-old female presented with progressive headaches and was diagnosed with a supratentorial intra-axial tumour consistent with high-grade glioma. She underwent subtotal tumour resection. Four hours postoperatively, the patient developed two episodes of generalized seizures. Immediate management included intravenous administration of midazolam, endotracheal intubation, and phenytoin administration. Diagnostic evaluations excluded metabolic or infectious causes. Near-infrared spectroscopy (NIRS) monitoring indicated stable cerebral oxygenation throughout the postoperative course. The patient experienced no further seizures and demonstrated full neurological recovery. Oral phenytoin was continued for 21 days.Discussion: EPS are associated with multiple risk factors, including tumour location, size, and incomplete resection. In this case, the tumour’s frontal and parietal lobe involvement, large volume, and subtotal excision likely contributed to seizure onset. Phenytoin, despite being a first-generation antiepileptic drug, proved effective in managing EPS and preventing recurrence in the absence of levetiracetam. NIRS served as a useful non-invasive adjunct to monitor cerebral oxygenation after a seizure.Conclusion: Effective early recognition and treatment of EPS are critical in preventing secondary neurological complications. In resource-limited settings, phenytoin remains a viable monotherapy for seizure control post-craniotomy. Individualized, protocol-driven management strategies, supported by neuromonitoring tools such as NIRS, can optimize outcomes in brain tumor surgery.

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