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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 363 Documents
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The Role of CRRT in Optimizing the Management of Septic Shock in Patients with Myasthenia Gravis Improves Outcomes Robby Al Amin; Vera Irawany
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.v0i0.83434

Abstract

Background: Septic shock is a life-threatening condition arising from an uncontrolled host response to infection, leading to organ dysfunction and high mortality. Patients with myasthenia gravis are more susceptible to respiratory infections, particularly pneumonia, which can aggravate their clinical condition and increase the risk of severe complications.Case: We report a case of a 47-year-old woman with a known history of myasthenia gravis who developed septic shock secondary to pneumonia, accompanied by acute kidney injury (AKI). The patient presented with respiratory distress and hemodynamic instability requiring mechanical ventilation and vasopressor support. She was managed with a comprehensive approach including fluid resuscitation, broad-spectrum antibiotics, ventilatory support, and continuous renal replacement therapy (CRRT). Immunomodulatory therapies such as plasmapheresis or intravenous immunoglobulin (IVIG) were not administered.Discussion: During the course of treatment, the patient showed gradual clinical improvement, as indicated by stabilization of hemodynamic status, correction of metabolic and electrolyte imbalances, recovery of renal function, and successful weaning from mechanical ventilation. The improvement observed may be related to adequate control of the underlying infection and optimization of organ support, including the use of CRRT, which may help maintain metabolic stability and contribute to the removal of inflammatory mediators. This case also suggests that in certain clinical settings, management focused on the underlying cause of deterioration may be sufficient without immediate use of immunomodulatory therapy.Conclusion: Comprehensive management of septic shock, including infection control, hemodynamic stabilization, and organ support with CRRT, may lead to favorable clinical outcomes in patients with myasthenia gravis. Further studies are needed to better define the role of CRRT as an adjunctive therapy in this context.
Background: Prolonged post-anesthesia care unit (PACU) stay is a critical indicator of postoperative efficiency and hospital resource utilization. Delayed recovery may compromise patient flow, increase the risk of complications, and strain perioperative s Richa Noprianty; Tia Anjelita; Ahmad Mustopa; Fikri Mourly Wahyudi
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.v0i0.76066

Abstract

Background: Prolonged Post-Anesthesia Care Unit (PACU) stay represents a critical indicator of postoperative care efficiency and resource utilization. Extended PACU duration can lead to patient accumulation, increased complication risks, and healthcare system strain.Objective: To identify and analyze risk factors associated with prolonged PACU stay following general anesthesia, with particular emphasis on surgery type as a dominant predictor.Methods: A cross-sectional observational study was conducted using modified data from 96 patients undergoing general anesthesia. Data collection included patient demographics, ASA physical status, pain scores, surgical duration, comorbidities, surgery type, anesthesia technique, and patient transfer timing. Statistical analysis employed chi-square tests and logistic regression to identify significant predictors of prolonged PACU stay (≥30 minutes).Result: Among 96 patients, 37.5% experienced prolonged PACU stay (≥30 minutes). Significant predictors included age (p=0.011), ASA physical status (p=0.012), anesthesia technique (p=0.035), and surgery type (p=0.001). Multivariate logistic regression identified surgery type as the dominant factor (p=0.004, OR=2.524, 95% CI: 1.355-4.700). Major surgeries demonstrated 60% prolonged stay rates compared to 21.8% for minor procedures. Pain intensity, surgical duration, comorbidities, and patient pickup time showed no significant association.Conclusion: Surgery type emerges as the primary determinant of prolonged PACU stay, with major surgical procedures significantly increasing recovery duration. These findings provide evidence-based guidance for perioperative planning, resource allocation, and quality improvement initiatives in postoperative care.
Retrospective Study: Effectiveness of the Surgical Safety Checklist in Reducing Surgical Site Infections Richa Noprianty
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.v0i0.80047

Abstract

Background: Surgical site infection (SSI) is one of the major challenges in healthcare, increasing patient morbidity and mortality. The global incidence of SSI has risen to 23.6 cases per 100 surgical procedures. Therefore, prevention and control of surgical site infections are essential patient‑safety efforts.Objective: This study aims to evaluate the implementation of the Surgical Safety Checklist in relation to SSI occurrence at the hospital.Methods: This research method A quantitative correlational research design was employed, utilizing a retrospective case-control approach. The study population comprised all patients who underwent surgery with indications of SSI, totaling 63 medical records, with total sampling conducted from January 2024 to April 2025. Data collection instruments included an observation checklist based on WHO guidelines and patient medical records.Results: Data analysis using the independent t-test revealed a significance value of 0.00 (p < 0.05), indicating a statistically significant difference in the mean incidence of SSI between groups with good and poor SSC implementation. Among the 63 patients diagnosed with wound dehiscence, the average onset of infection was 9 days postoperatively, with a mean surgical duration of 142 minutes.Conclusion: The findings suggest that enhancing the quality of SSC implementation may serve as an effective strategy to reduce the incidence of HAIs in hospitals, particularly within central surgical installations. The results also underscore the importance of strengthening supervision, implementing preventive measures, and integrating the use of electronic medical records (EMR) to improve infection control and patient safety.
Efficacy of Ultrasound-Guided Bilateral Infraorbital Nerve Block Combined with General Anesthesia on Postoperative Pain and Quality of Recovery in Patients Undergoing Nasal Surgery: A Randomized Controlled Trial Christine Christine; IGAG Utara Hartawan; I Putu Kurniyanta; Tjokorda Gde Agung Senapathi; I Putu Pramana Suarjaya; I Made Gede Widnyana; Dewa Ayu Mas Shintya Dewi; Ida Bagus Krisna Jaya Sutawan; Tjahya Aryasa E.M.; Putu Herdita Sudiantara
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.v0i0.82363

Abstract

Background: Postoperative pain following nasal surgery is frequently moderate to severe, often necessitating high doses of opioids, which subsequently increase the risk of adverse clinical effects.Objective: This study aimed to evaluate the clinical impact of integrating ultrasound-guided bilateral infraorbital nerve blocks with general anesthesia on the quality of analgesia and postoperative recovery in patients undergoing nasal procedures.Methods: A single-blind randomized controlled trial was conducted involving 38 patients at Ngoerah Hospital between June and August 2025. Participants were randomly assigned to either Group P1 (general anesthesia with bilateral infraorbital block using 2 mL of 0.5% bupivacaine per side) or Group P2 (general anesthesia only). Measured outcomes included numerical rating scale (NRS) scores at 12 and 24 hours, time to first patient-controlled analgesia (PCA) demand, 24-hour total fentanyl consumption, and quality of recovery-15 (QoR-15) scores.Results: Baseline characteristics were comparable between groups. Group P1 demonstrated significantly lower NRS scores at 12 hours and 24 hours (p<0.001) compared to Group P2. Furthermore, P1 required significantly less PCA intervention (31.6% vs 100%, p<0.001), exhibited a longer duration before the first analgesic demand (p=0.008), and consumed less total fentanyl over 24 hours (p<0.001). The QoR-15 scores were also significantly higher in Group P1 (p<0.001), indicating superior recovery quality.Conclusion: Supplementing general anesthesia with bilateral infraorbital nerve blocks effectively mitigates postoperative pain, reduces opioid dependency, and enhances the overall quality of recovery after nasal surgery.
Comparison Between Ketamine and Paracetamol in The Prevention of Post-Spinal Anesthesia Shivering in Caesarean Section Procedures Candra Ristiana; Himawan Sasongko; Yulia Wahyu Villyastuti
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.v0i0.68651

Abstract

Background: Shivering is a common complication associated with spinal anesthesia during cesarean sections, leading to discomfort and potential cardiac ischemia. While intravenous paracetamol is known to prevent shivering, it has potential peripheral limitations and may be costly. Conversely, ketamine administration inhibits norepinephrine reuptake, potentially reducing heat redistribution and serving as a more affordable alternative.Objective: Assessing the comparison of ketamine and paracetamol on the incidence, onset, and degree of post-spinal anaesthesia shivering in caesarean section procedures.Methods: An experimental design was employed with a sample size of 52 patients, divided into two groups: one receiving intravenous ketamine (0.25 mg/kg) alongside intrathecal bupivacaine (15 mg), and the other receiving intravenous paracetamol (1000 mg) with intrathecal bupivacaine (15 mg). The incidence, onset, and degree of shivering were observed and recorded every 3 minutes for 90 minutes.Results: The incidence of shivering in the ketamine group was 3 samples while in the paracetamol group there were 10 samples. The mean time of onset of shivering in the ketamine group was 55.00 minutes, and in the paracetamol group was 27.30 minutes (p<0.05). While the degree of shivering in the ketamine group was 1 sample of degree 1 and 2 samples of degree 2, the paracetamol group was 4 samples of degree 2, 3 samples of degree 3 and 3 samples of degree 4 (p<0.05).Conclusion: Ketamine proved to be more effective in preventing shivering than paracetamol after spinal anesthesia in caesarean section procedures.
Early Percutaneous Dilatational Tracheostomy to Facilitate Ventilator Weaning in a Patient with Blunt Abdominal Trauma and Hemorrhagic Shock: A Case Report Adrian Nugraha Putra; Wisnu Budi Pramono
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.v0i0.82634

Abstract

Background: Hemorrhagic shock and the requirement for continuous mechanical ventilation are frequent outcomes of blunt abdominal injuries, a dangerous illness. Long-term endotracheal intubation increases the risk of ventilator-related problems. In critically ill patients, percutaneous dilatational tracheostomy (PDT) has been proposed to facilitate their transition off the ventilator and reduce the risk of pulmonary complications.Case: A 53-year-old woman presented after falling from around 10 meters in the air. It was discovered that she had suffered blunt abdominal trauma, which caused hemorrhagic shock and extensive brain bruising. An exploratory laparotomy was done in an emergency. This treatment included fixing a left kidney tear, restoring the bladder, and establishing a transverse colostomy because of colon damage. She needed continuous mechanical ventilation in the intensive care unit after surgery. On the seventh day of intubation, an early PDT was performed because the patient was having trouble detaching from the ventilator. Fifteen days after the PDT was implanted, the patient's respiratory state gradually improved, and she was successfully decannulated. She spent 23 days in the hospital overall.Discussion: In trauma patients who need continuous mechanical ventilation, tracheostomy may result in improved comfort, less sedation, simpler pulmonary toileting, and perhaps a decrease in ventilator-associated pneumonia (VAP). In this instance, successful ventilator weaning without major complications was made possible by early performance of PDT.Conclusion: Early PDT is a safe and efficient way to help trauma patients who have been on mechanical ventilation for a long time facilitate ventilator weaning. For best results, time and patient selection are crucial.
Therapeutic Plasma Exchange (PE) and Non-Invasive Ventilation in Guillain-Barré Syndrome (GBS): A Case Report Ratno Samodro; Erlangga Prasamya; Bowo Adiyanto
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.v0i0.82495

Abstract

Background: Guillain-Barré Syndrome (GBS) is a progressive acute inflammatory polyradiculopathy caused by immune system dysregulation that carries a high risk of triggering respiratory failure. In its management, plasma exchange (PE) and intravena imunoglobulin (IVIG) is an essential primary therapeutic modality to eliminate pathological autoantibodies and inhibit disease progression. Although impending respiratory failure in GBS patients has been widely reported and is generally managed with invasive mechanical ventilation, literature discussing the successful use of an alternative approach utilizing non-invasive ventilation (NIV) combined with PE therapy remains highly limited.Case: We report a case of a 34-year-old male diagnosed with flaccid tetraparesis accompanied by dyspnea, suspected to be GBS. The clinical features, cerebrospinal fluid (CSF) analysis, and Electroneuromyography (ENMG) are indicative of GBS. During treatment in the intensive care unit (ICU), the patient received intravenous methylprednisolone therapy, PE, and respiratory support via NIV. The patient underwent intensive care for 13 days. Post-PE, the patient's clinical condition showed significant improvement, allowing for transfer to the general ward.Discussion: Managing respiratory weakness in GBS demands a delicate balance in ventilatory strategy: weighing the hazards of early invasive intubation against the high risk of aspiration or sudden failure when utilizing non-invasive support. Since the therapeutic benefits of PE are gradual, patients face a precarious window. Consequently, rigorous risk stratification and precisely tailored airway interventions are imperative to safely bridge the patient to recovery.Conclusion: In this case, the combination of PE therapy and appropriate airway management gradually improved clinical outcomes. A collaborative approach through a multidisciplinary team is essential in planning and executing optimal treatment strategies.
Opioid-Sparing Thoracotomy Analgesia Using an Erector Spinae Plane Block in an Infant with Autosomal Recessive Congenital Ichthyosis: A Case Report Cipta Suryadinata; Raden Besthadi Sukmono
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.v0i0.84100

Abstract

Background: The erector spinae plane (ESP) block is increasingly used for pediatric thoracic analgesia, yet evidence in infants under one year remains limited. Thoracotomy is associated with severe postoperative pain and high opioid requirements. Autosomal recessive congenital ichthyosis (ARCI), characterized by impaired epidermal barrier function, raises concerns regarding the safety of regional anesthesia. No previous report has described the use of regional anesthesia in patients with ARCI.Case: A 10-month-old, 9.2 kg male infant with genetically confirmed ARCI (PNPLA1 mutation) underwent left posterolateral thoracotomy and decortication for loculated empyema. A pre-incision ultrasound-guided ESP block was performed at T4 using 0.25% bupivacaine (4.5 mL; 1.22 mg/kg). Intraoperative opioid use was limited to fentanyl 25 mcg for intubation, with no additional analgesic requirement or hemodynamic response to surgical incision. Postoperative pain scores assessed using the face, legs, activity, cry, consolability (FLACC) scale remained 1/10 during the first 24 hours, increased to 6/10 on post-operative day (POD)-1, and subsequently decreased to 4/10 on POD-2 and 3/10 on POD-3 under multimodal non-opioid analgesia. No rescue opioids or opioid-related adverse effects occurred. The patient was extubated in the operating room and discharged from the pediatric intensive care unit (PICU) after 58 hours. No block-related complications were observed, and puncture-site healing was uneventful.Discussion: This case demonstrates that the ESP block provided effective opioid-sparing analgesia in an infant and suggests that ARCI-related epidermal barrier dysfunction did not appear to adversely affect the safety or technical performance of an interfascial plane block in this case.Conclusion: ESP block appeared to be a feasible, effective, and safe analgesic option for thoracotomy in this infant with ARCI and may serve as an opioid-sparing strategy in high-risk pediatric patients.
The analysis comparing the use of the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) for measuring pain in post-cesarean section (C-section) patients under spinal anesthesia mhd noer ibrahim; Tasrif Hamdi; dadik wahyu wijaya
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.v0i0.79878

Abstract

ABSTRACKPostoperative pain following Caesarean Section (CS) is a significant clinical issue that requires effective assessment and management to accelerate healing and improve patient comfort. This study aimed to compare the effectiveness of the Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS) in measuring pain intensity in patients after CS with spinal anesthesia. A quantitative research approach was applied, involving a sample of 90 patients from several hospitals in Medan, including Prof. Dr. Chairuddin P. Lubis Hospital, Dr. Pirngadi Regional General Hospital, and Haji Medan General Hospital. Data were collected through interviews and pain measurements using both instruments.The results showed that most respondents experienced moderate pain according to VAS (75%) and NRS (77%). Seventy-nine percent of respondents perceived VAS as a more effective method for pain assessment compared to 21% for NRS. Statistical analysis indicated no significant difference between pain measurements using VAS and NRS (p = 0.832). This study confirms that both tools can be used to measure pain intensity after CS, but VAS tends to be preferred by patients due to its more concrete visual representation of pain 
Intraoperative Use of Veno-Arterial ECMO in Tracheal Surgery: Two Case Reports Bambang Novianto Putro; Eko Setijanto; Elizabeth P. Yanti
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.v0i0.81843

Abstract

Introduction: Tracheal tumors and stenosis are rare but potentially life-threatening conditions due to severe airway obstruction. Anesthetic management during tracheal surgery is particularly challenging because of the high risk of hypoxia and ventilation failure during airway manipulation. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a supportive strategy to maintain oxygenation and circulation during high-risk procedures, although clinical experience remains limited.Case: We report two cases of tracheal surgery performed with perioperative VA-ECMO support. The first case involved a 55-year-old man presenting with progressive dyspnea and cough for three months. Bronchoscopic examination revealed a tumor in the distal third of the trachea, and the patient underwent tumor resection with tracheal reconstruction. The second case was a 15-year-old male with hoarseness and respiratory symptoms following prolonged intubation. Bronchoscopy demonstrated cicatricial tracheal stenosis in the proximal third of the trachea, and the patient underwent endobronchial laser therapy followed by tracheal bougienage. In both patients, VA-ECMO with femorofemoral cannulation was established preemptively before anesthetic induction, with a single bolus of systemic heparinization (400 IU/kg). During airway manipulation, mechanical ventilation was suspended and oxygenation was maintained through ECMO. An episode of Harlequin syndrome was managed by increasing ECMO blood flow. Both procedures were completed without major perioperative complications.Discussion: These cases illustrate the complexity of anesthetic management in high-risk tracheal surgery. VA-ECMO facilitated airway manipulation by maintaining adequate oxygenation and hemodynamic stability during critical intraoperative periods, while requiring close monitoring for ECMO-related complications.Conclusion: VA-ECMO may be considered as a intraoperative support strategy in tracheal surgery with a high risk of airway obstruction. This case report highlights the potential role of VA-ECMO in increasing the safety margin of anesthetic management, although further evaluation is needed to define optimal indications and protocols.

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