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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 346 Documents
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Comparison of The Efficacy of Intravenous Norepinephrine and Phenylephrine as Vasopressor Agents in The Management of Septic Shock in ICU Patients at Haji Adam Malik General Hospital Using Lactate and Stroke Volume Variation Indicators Attamimi, Fandy Faidhul; Wijaya, Dadik Wahyu; Tanjung, Qadri Fauzi; Amelia, Rina
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.67835

Abstract

Background: Septic shock is a life-threatening complication of sepsis, characterized by refractory hypotension and tissue hypoperfusion, requiring rapid vasopressor therapy. Norepinephrine is the drug of choice, but phenylephrine is still used in certain conditions, such as tachyarrhythmia or high output. Evidence comparing the effectiveness of the two is still limited, especially in Indonesian ICUs. Therefore, this study assessed the efficacy of norepinephrine and phenylephrine using lactate clearance and stroke volume variation (SVV) as indicators of perfusion and hemodynamic response in the intensive care unit (ICU) of Adam Malik General Hospital, Medan.Methods: This study was a prospective, double-blind, randomized controlled clinical trial conducted in the ICU of Adam Malik General Hospital, Medan, involving 32 adult patients (aged 18–65 years) with septic shock, as defined by the Sepsis-3 criteria. Patients were randomly assigned to two groups receiving norepinephrine infusion (n = 16) or phenylephrine infusion (n = 16) as the primary vasopressor. Lactate levels and SVV were measured at baseline (T0) and 6 hours after therapy (T1). The primary outcome was the change in lactate and SVV, with analysis using paired and independent t-tests at a significance level of p < 0.05.Results: 32 patients were divided into two groups, each with 16 patients receiving norepinephrine or phenylephrine. After 6 hours of therapy, norepinephrine reduced lactate levels from 8.41±1.88 to 5.76±1.99 mmol/L and SVV from 14.25±2.17 to 8.18±1.90 mmHg (p<0.001). Phenylephrine also reduced lactate from 7.40±1.77 to 6.70±1.77 mmol/L and SVV from 15.93±2.56 to 12.50±2.63 mmHg (p<0.001).Conclusions: Intravenous norepinephrine is more effective than phenylephrine in lowering lactate and improving SVV in septic shock patients in the ICU, thus supporting its use as the primary vasopressor. Phenylephrine remains an alternative with close hemodynamic monitoring. Further studies are needed to confirm these findings and understand the mechanism behind the difference in effectiveness between the two.
Effectiveness of 0.25% vs 0.375% Ropivacaine for Incisional Infiltration in Cesarean Delivery with Spinal Anesthesia Siregar, Ahmad Habibi; Hamdi, Tasrif; Nadeak, Rommy F.; Wahyuni, Arlinda Sari
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.67832

Abstract

Background: Postoperative discomfort subsequent to a caesarean delivery significantly influences the recuperation process and necessitates efficacious therapeutic intervention. Ropivacaine is a local anesthetic used to manage this pain, but there is limited comparison between its 0.25% and 0.375% concentrations.Objective: To evaluate the comparative efficacy of varying dosages of ropivacaine, specifically 0.25% and 0.375% concentrations, as local anesthetic infiltrates during the surgical procedure of Cesarean section incision.Methods: This randomized controlled trial (RCT) encompassed a cohort of 60 patients who underwent cesarean sections utilizing spinal anesthesia at Adam Malik Hospital, Medan, Haji Hospital Medan, Prof. Chairuddin P. Lubis USU Hospital Medan, and Putri Hijau Hospital Medan. The participants were stratified into three distinct groups: ropivacaine 0.25% (n=20), ropivacaine 0.375% (n=20), and a control group (n=20). Pain intensity was quantitatively assessed employing the numerical rating scale (NRS) at intervals of 2, 6, 12, and 24 hours postoperatively. Furthermore, the utilization of supplementary analgesics and the occurrence of adverse effects were meticulously documented. Statistical analysis of the data was conducted utilizing the Kruskal-Wallis test (p<0.05).Results: Both ropivacaine 0.25% and 0.375% groups demonstrated significantly lower NRS pain scores at 2, 6, 12, and 24 hours postoperatively compared to the control group (p<0.05). Patients receiving ropivacaine infiltration also showed a significantly reduced need for additional analgesics compared to those who did not receive ropivacaine. However, no statistically significant differences in postoperative pain scores or supplemental analgesic requirements were observed between the 0.25% and 0.375% ropivacaine groups (p>0.05).Conclusions: Both 0.25% and 0.375% ropivacaine effectively reduce postoperative pain and the need for additional analgesics compared to the control group. However, there was no significant difference between the two ropivacaine concentrations.
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 Incomplete Atrioventricular Septal Defect Priambodo, Bhimo; Pratomo, Bhirowo Yudo; Kurniawaty, Juni
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.76955

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) Vol 18, No 1 (2026): 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.v0i0.69705

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.
HEAVEN versus LEMON Score in Predicting Emergency Intubation Success in Critically Ill Patients Johan, T. Abdurrahman; Lubis, Andriamuri Primaputra; Ihsan, Muhammad
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.73108

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; Wijaya, Wan Novriza; Anggraeni, Novita; Hidayat, Nopian; Muharrami, Vera; Irawan, Dino
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.76698

Abstract

Objectives: Early risk stratification in patients with sepsis-associated acute kidney injury (SA-AKI) remains challenging because conventional clinical markers have limited prognostic accuracy. The lactate/albumin ratio (LAR), reflecting metabolic stress and systemic inflammation, has emerged as a potential prognostic biomarker. This systematic review and meta-analysis aimed to evaluate the prognostic value of LAR for mortality prediction in adult patients with SA-AKI.Study design: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational cohort studies reporting adjusted hazard ratios (HRs) for the association between LAR and mortality in adult patients with SA-AKI were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Pooled effect estimates were calculated using a random-effects inverse-variance model.Data sources: The PubMed, Embase, and Web of Science were systematically searched from database inception to July 2025 without language restrictions. Reference lists of relevant articles were also screened to identify additional studies.Data synthesis: Eight studies were included in the systematic review, and six retrospective cohort studies involving more than 25,000 critically ill patients were eligible for meta-analysis. Elevated LAR measured during early ICU admission was independently associated with increased mortality. The pooled hazard ratio comparing the highest versus lowest LAR categories was 1.97 (95% CI: 1.42–2.73), indicating nearly a twofold higher risk of death. This association remained consistent across different populations and mortality endpoints, although substantial heterogeneity was observed (I² = 91%).Conclusions: LAR is a simple, accessible, and cost-effective biomarker for early mortality risk stratification in SA-AKI. Early measurement of LAR in ICU settings might improve the prognosis of mortality risk, thereby helping with timely decision-making.Registration: The protocol for this systematic review was prospectively registered in PROSPERO.
Anesthesia for ASD Closure in Robotic-Assisted Cardiac Surgery: A Case Report Rizqhan, Muhammad; Hadinata, Yudi
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.70958

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.

Page 34 of 35 | Total Record : 346

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