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Departemen Anestesiologi dan Reanimasi Fakultas Kedokteran Universitas Airlangga-RSUD Dr Soetomo Surabaya Gedung Anestesi Baru-RSUD Dr Soetomo Surabaya Jl. Mayjen Prof. Dr. Moestopo No 6-8, Airlangga, Gubeng, Surabaya, 60286, Indonesia
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INDONESIA
Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Published by Universitas Airlangga
ISSN : 27224554     EISSN : 2686021X     DOI : 10.20473/ijar.V2I12020.1-7
Core Subject : Health,
Medicine & Pharmacology
IJAR is a scientific journal published by Department of Anesthesiology and Reanimation, Faculty of Medicine Universitas Airlangga. IJAR is an English language journal. IJAR FOCUSES original research, review article, case report, and correspondence, on anesthesiology; pain management; intensive care; emergency medicine; disaster management; pharmacology; physiology; clinical practice research; and palliative medicine. This journal is a peer-reviewed journal established to improve the understanding of factors involved in anesthesiology and emergency medicine.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 117 Documents
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Idiopathic Intracranial Hypertension (IIH) After Spinal Surgery Due to Spondylitis Tuberculosis Akhyar Nur Uhud; Hamzah; Anang Maulana Yusuf
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.53-58

Abstract

Introduction: Idiopathic intracranial hypertension (IIH) is a rare syndrome with an unclear etiology but causes clinically increased intracranial pressure (ICP). This disorder is diagnosed by ruling out the possibility of a diagnosis that can cause intracranial hypertension. Idiopathic intracranial hypertension that appears after spinal surgery is one of the rare occurrences. Objective: This report describes a rare presentation of postoperative idiopathic intracranial hypertension with Cushing’s reflex and highlights the clinical utility of noninvasive intracranial pressure monitoring using transcranial Doppler and optic nerve sheath diameter measurement. Case Report: We present a case of a 21-year-old woman with tuberculous spondylitis who underwent spinal surgery. After surgery, the patient showed signs of intracranial hypertension with Cushing reflex. Then, the patient was managed with intracranial control with adequate sedation and analgesia and monitored using transcranial Doppler (TCD) and optical nerve sheath diameter (ONSD). Dexamethasone and acetazolamide were also administered to the patient to lower ICP. The patient was then released from the hospital without any complications or morbidities. Discussion: Idiopathic intracranial hypertension after spinal surgery is a rare condition with high morbidity due to high ICP. Appropriate and prompt treatment could reduce morbidity, and ICP could be monitored using TCD and ONSD. Conclusion: Idiopathic intracranial hypertension is a rare syndrome with high morbidity due to increased ICP. The key to managing IIH is to decrease ICP and avoid morbidity due to high ICP through close monitoring of ICP. Early recognition combined with noninvasive ICP monitoring may help guide timely management and prevent neurological morbidity.
Obesity Hypoventilation Syndrome with Cardiogenic Pulmonary Edema: Clinical Challenges in Airway and Ventilation Management in Critical Care Settings Putri Rizkiya; Fajar Perdhana
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.48-52

Abstract

Introduction: Obesity hypoventilation syndrome (OHS) manifests as a triad of obesity, chronic daytime hypercapnia, and disrupted breathing during sleep. These patients frequently present with respiratory complications that complicate airway management and increase the risk of atelectasis during mechanical ventilation. Objective: To present a clinical case involving a patient with obesity hypoventilation syndrome. Case Report: A 36-year-old female with morbid obesity arrived at the emergency department exhibiting acute dyspnea. Initial examination revealed shallow respirations and a respiratory rate of 40/min. Her oxygen saturation was 82%, which improved to 88–90% with high-flow nasal cannula (HFNC) at 60 L/min and FiO₂ 80%. A pulmonary exam indicated dullness to percussion and bilateral basal rales. Cardiovascular findings suggested inadequate cardiac compensation. A chest radiograph showed cardiomegaly and pulmonary congestion suggestive of edema. Arterial blood gas (ABG) analysis revealed acute hypoxemic respiratory failure with pH 7.09, PaCO₂ 135 mmHg, and PaO₂ 145 mmHg. Due to declining oxygen saturation and consciousness, the patient was intubated. Intubation was complicated by difficult mask ventilation and positioning challenges. Post-intubation atelectasis resolved after 48 hours of recruitment maneuvers. Acute pulmonary edema due to cardiogenic shock was treated with a negative fluid balance and continuous inotropic support, which led to better oxygenation as the doses of inotropes were lowered. Discussion: Patients with OHS admitted in critical condition often face more than just dyspnea. Management must also address cardiometabolic dysfunctions and complex respiratory challenges that necessitate advanced airway strategies and ICU-level care. Conclusion: This case highlights the complexity and clinical considerations required in the management of obesity hypoventilation syndrome.
Comparison of Safety Margins and Airway Performance Between Air-Q And I-Gel as Conduits for Microcuff Endotracheal Tube Placement in Pediatric Surgeries: A Randomized Interventional Study Pratibha Rathore; Ritesh Kumar Sompura; Neelam Dogra; Rama Chatterjee; Ram Kishan Vyas; Harshita Rai
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.22-31

Abstract

Introduction: Supraglottic airway devices (SADs) play a crucial role as conduits for blind endotracheal intubation, bridging ventilation, and intubation. This study aimed to compare the safety margins of Air-Q and I-Gel devices when used as conduits for Microcuff endotracheal tube placement in pediatric patients, utilizing both in vivo and in vitro assessments. Objective: This study aimed to compare the safety margin between Air-Q and I-Gel supraglottic airway devices when used as conduits for Microcuff endotracheal tube placement in pediatric patients, and to evaluate secondary outcomes including fiberoptic grade of view, oropharyngeal leak pressure at specified intervals, and intraoperative haemodynamic changes. Methods: After ethics committee clearance and informed consent, 60 children aged 5-10 years, weighing 13-38 kg, of American Society of Anesthesiologists grade I and II, posted for elective surgeries, were randomly allocated into two groups, Air-Q and I-Gel. Study parameters assessed. Statistical analysis involved independent sample t-tests and chi-square tests (significant p-value < 0.05). Results: Demographic parameters were comparable in both groups. Both devices were successfully inserted in all patients. The safety margin (cm) was significantly higher in the Air-Q group compared to the I-Gel group for the largest endotracheal tube (ETT) (7.6 ± 0.91 vs. 5.91 ± 0.52; p<0.001), one size small ETT (6 ± 0.42 vs. 4.36 ± 0.73; p<0.001), and two sizes small ETT (4.7 ± 0.84 vs. 3.16 ± 1.19; p<0.001). The fiberoptic grades of view were significantly better in the Air-Q group (p<0.001). In contrast, the mean OLP was significantly higher in the I-Gel group immediately (18.57±1.59 vs. 24.1±1.49, p<0.001) and 10 minutes post-insertion of the devices (25.7±1.88 vs. 31.1±1.9, p<0.001). Conclusion: The Air-Q group demonstrated a better safety margin than the I-Gel group; both devices were well-tolerated intubating conduits. A larger safety margin with Air-Q may reduce the risk of cuff-related laryngeal injury and accidental extubation during SAD removal.
Comparing The Efficacy and Safety of Intrathecal Hyperbaric Ropivacaine and Bupivacaine for Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial Vandna Arora; Roopa; Suresh Kumar Singhal; Nidhi Bangarwa; Priya
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.32-41

Abstract

Introduction: Ropivacaine is a long-acting amide local anesthetic that is relatively less potent than bupivacaine and has a higher therapeutic index and better safety profile. Hyperbaric ropivacaine prepared by adding glucose to ropivacaine has been used for spinal anesthesia in cesarean section and lower limb surgeries. Objective: Recently with commercially available hyperbaric ropivacaine, the present study aims to compare the efficacy and safety of hyperbaric ropivacaine vs hyperbaric bupivacaine in patients undergoing cesarean section under spinal anesthesia. The primary objective was to compare the onset and duration of sensory and motor block between the two groups. Secondary objectives included comparison of the maximum level of sensory block achieved and frequency of adverse effects. Material and Method: The present prospective, randomized, double-blind study was conducted after institutional ethical clearance. We included 90 pregnant females belonging to American Society of Anesthesiologists class II, scheduled to undergo lower segment cesarean section under spinal anesthesia. Patients were randomized into two groups of 45 each; Group R received 2 mL of intrathecal hyperbaric ropivacaine (0.75%), and Group B received 2 mL of intrathecal hyperbaric bupivacaine (0.5%). A standardized routine protocol was used for anesthesia including the technique of subarachnoid block in all patients. Result and Discussion: Demographic parameters were comparable between the two groups. The onset of sensory block at the T10 level was significantly faster with bupivacaine as compared to ropivacaine (p=0.026). The maximum level of sensory block (T4) achieved was significantly faster in bupivacaine than ropivacaine (p=0.013). The mean duration of analgesia was comparable in both the groups (p=0.58). The mean duration of motor block was significantly shorter with ropivacaine as compared to bupivacaine. The incidence of hypotension and bradycardia was comparable between both the groups. Conclusion: Hyperbaric ropivacaine provides comparable sensory anesthesia with significantly shorter motor block duration compared to bupivacaine, making it a suitable alternative for elective cesarean sections where early ambulation is desired.
Association Between Burn Excision Timing and Mortality in ICU Burn Patients: A Two-Year Retrospective Study Aditya Wardhana; Nadya Farhana; Tiara Putri Leksono
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.17-21

Abstract

Introduction: Severe burn injuries requiring Intensive Care Unit (ICU) admission are strongly associated with high mortality, particularly in patients with extensive total body surface area (TBSA) involvement, sepsis, and mechanical ventilation. Surgical excision is widely recommended as a component of burn care. However, its association with survival in critically ill burn patients remains debated, especially in low-resource settings. Objectives: To evaluate the association between burn excision timing and mortality outcomes in ICU-admitted burn patients. Methods: This retrospective cohort study was conducted at a burn unit referral hospital in Jakarta, Indonesia, from January 2023 to December 2024, and included 130 ICU-admitted burn patients. The intervention was burn excision, either early or delayed, compared with nonoperative management. Data were analyzed to determine mortality outcomes using chi-square testing, with p < 0.05 considered significant. Results: Among the included patients, most sustained flame burns involving more than 40% TBSA, with burn depth ranging from superficial dermal to full-thickness. Surgical burn excision was performed in 71.5% of cases. Mortality occurred in 44 patients in the early excision group, with early tangential excision conducted in 52.3% (68/130). Delayed excision, primarily due to late presentations and referral system delays, was performed in 25 patients with 10 deaths. Of the 35 patients who did not undergo excision, 32 died prior to surgical intervention. Statistical analysis revealed a significant association between excision timing and mortality outcome (p < 0.001), suggesting that surgical excision was associated with improved survival compared to non-operative care. Conclusion: These findings suggest that burn excision is associated with improved survival in critically ill populations. However, the retrospective design and survivor bias mean this association is not causal.
Association Between Pediatric Sofa Score and Coagulation Abnormalities in Critically Ill Children at Dr. Soetomo General Hospital: A Retrospective Study Saskia Putri Fadillah; Arina Setyaningtyas; Pradana Zaky Romadhon; Bambang Pujo Semedi
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.9-16

Abstract

Introduction: Coagulation disorder is a common complication related to mortality in pediatric patients at the intensive care unit. It is characterized by prolongation of blood clotting time as reflected in activated partial thromboplastin time (APTT) and prothrombin time (PT) values. Organ dysfunction, often found in a patient with critical illness, is one of the causes of coagulation disorder. The degree of organ dysfunction in pediatric patients can be assessed using the pediatric sequential organ failure assessment (pSOFA) score. Objective: To analyze the association of pSOFA score with coagulation disorder and the association of thrombocytopenia with mortality in critically ill children at the PICU. Methods: This study used a retrospective analytical observational design involving 43 critically ill pediatric patients with organ dysfunction treated in the PICU of Dr. Soetomo General Hospital in 2023. The associations between pSOFA score and coagulation parameters, as well as thrombocytopenia and mortality, were statistically analyzed using the chi-square test. The pSOFA cutoff value for predicting coagulation disorder was determined by the ROC curve. Results: The pSOFA score was significantly associated with prolonged APTT (p= <0.001; φ= 0.506) and PT (p= 0.018; φ= 0.362). The cutoff point of a pSOFA score ≥6.5 for APTT prolongation showed 86.7% sensitivity and 71.4% specificity (AUC= 0.804). With a pSOFA score cutoff point of ≥8.5 for PT prolongation, the sensitivity was 56.3% and the specificity was 85.2% (AUC= 0.720). Subanalysis showed a significant association between thrombocytopenia and mortality (p= 0.017; φ= 0.365). Conclusions: The pSOFA score was significantly associated with APTT and PT prolongation, and thrombocytopenia was significantly associated with mortality in critically ill children.
A Rapid Onset Refractory Perioperative Anaphylaxis: A Case of Fulminant Collapse Despite Aggressive Therapy Yafi Rushan Rusli; Retti Kartika Bakti
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 1 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V8I12026.59-63

Abstract

Introduction: Perioperative refractory anaphylaxis is a rare but potentially catastrophic event that can rapidly progress to life-threatening cardiovascular and respiratory failure. Early recognition and prompt management are essential to prevent morbidity and mortality. Objective: This case report aims to report a rare case of rapid-onset refractory perioperative anaphylaxis with a fatal outcome despite prompt and aggressive resuscitative management. Case Report: A 35-year-old woman, classified as ASA Physical Status I, underwent an elective ovum pick-up procedure while receiving total intravenous anesthesia. She had no history of drug allergies and had previously tolerated general anesthesia without complications. Standard monitoring was applied, and intravenous cefazolin was administered preoperatively according to institutional protocol. Anesthesia was induced with fentanyl, propofol, and ketamine, followed by ketorolac and ondansetron. Approximately 20 minutes after induction, while the cefazolin infusion was ongoing, the patient developed a progressive decline in oxygen saturation despite a patent airway and effective assisted ventilation, followed by diffuse violaceous flushing of the trunk and extremities, raising strong suspicion of severe anaphylaxis. Immediate resuscitative measures were initiated, including Code Blue activation, escalating intravenous adrenaline boluses, and endotracheal intubation with confirmed bilateral breath sounds and no evidence of bronchospasm. Despite high-flow oxygen, aggressive fluid resuscitation, and corticosteroid administration, oxygen saturation continued to deteriorate and became unobtainable. Hemodynamics later progressed to cardiac arrest with documented asystole. Prolonged advanced cardiopulmonary resuscitation was performed without returning spontaneous circulation. During resuscitation, fresh blood was noted from the endotracheal tube, suggesting catastrophic capillary leak and disseminated intravascular coagulation. Resuscitative efforts were terminated, and the patient was pronounced deceased. Conclusion: Perioperative anaphylaxis may progress rapidly to fatal refractory shock, even in healthy patients. High clinical suspicion, early recognition, and institutional preparedness are essential despite prompt and aggressive management.
Association Between Serum TLR-4 Levels and Severity Scores in Adult Sepsis Patients Peter Leonardo; Novita Anggraeni; Vera Muharrami
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 2 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

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Abstract

Introduction: Toll-like receptor-4 (TLR-4) is a proximal innate-immune sensor implicated in sepsis pathophysiology. Whether circulating TLR-4 levels track organ dysfunction and bedside severity scores remain clinically relevant. Objective: To examine the correlation between serum TLR-4 and (i) acute physiology and chronic health evaluation (APACHE) II and (ii) sequential organ failure assessment (SOFA) scores among adults with sepsis admitted to a provincial referral intensive care unit (ICU). Methods: We conducted an analytic cross-sectional study at Arifin Achmad General Hospital, Riau, Indonesia (February to September 2025). Adults (≥18 years) with Sepsis-3 were enrolled consecutively. Exclusions included cardiogenic shock, end-stage kidney disease, and pregnancy. Serum TLR-4 was measured in duplicate using enzyme linked immunosorbent assay (ELISA) (450 nm). APACHE II (worst values in first 24 h) and baseline SOFA were recorded the same day. Normality was tested with Shapiro–Wilk; Spearman’s rho assessed associations (two-tailed, α=0.05). Result and Discussion: Thirty-nine patients were included. Median (range) of TLR-4 was 1.8 (0.18–7.03) ng/mL, Median (range) of SOFA total was 9 (4–17) and APACHE II total was 21 (10–44). TLR-4 correlated positively with APACHE II total (r=0.470, p=0.003) and SOFA total (r=0.458, p=0.003). TLR-4 also correlated with SOFA coagulation (r=0.380, p=0.017), liver (r=0.438, p=0.005), and renal (r≈0.43, p<0.01) subscores. These findings demonstrate moderate positive correlations, suggesting that TLR-4 may complement established severity assessment tools in monitoring physiologic derangement and multi-organ dysfunction in sepsis. The findings should be interpreted considering the relatively small sample size and single-center cross-sectional design. Conclusion: Serum TLR-4 associates with APACHE II and SOFA at presentation and may complement early risk stratification in adult sepsis.
Effect of Dexmedetomidine on Hyperdynamic Responses During Electroconvulsive Therapy: A Randomized Double-Blind Crossover Study Simran Nathani; Neha Panse
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 2 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

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Abstract

Introduction: Electroconvulsive therapy (ECT) is always followed by a transient vigorous pressor response in terms of raised pulse rate and blood pressure. Several anesthetic agents have been used to blunt this transient hyperdynamic response. Objective: We conducted this study with the primary aim to evaluate the efficacy of dexmedetomidine in blunting the hyperdynamic response following ECT. Secondly, we aimed to study if the administration of dexmedetomidine causes any alteration in duration of ECT seizures and any other untoward effects. Methods: This is a crossover randomized control study that included 35 patients who were scheduled to undergo 4 cycles of ECT and were ready to participate in the study. Each patient was included in the study for 2 cycles of ECT. Each patient acted as a control for themselves, and hence any bias based on patient selection was avoided. Group A: 0.5 mcg/kg dexmedetomidine in 100 ml saline was administered 15 min before ECT. Group B: 100 ml of 0.9% saline was administered 15 min before ECT. We evaluated the variations in patients’ heart rate and blood pressure, duration and intensity of motor seizures, recovery parameters & side effects, if any. Results: Dexmedetomidine significantly reduced heart rate and blood pressure during the early post-ECT period compared with placebo (p<0.001), effectively attenuating the hyperdynamic pressor response. No significant differences were observed in motor seizure duration or recovery parameters between the groups. Bradycardia requiring intervention occurred in one patient receiving dexmedetomidine. Conclusion: Dexmedetomidine effectively blunts the hyperdynamic pressor response following ECT without altering the motor seizure characteristics; thus, it is recommended as a safe premedicant before ECT without affecting the therapeutic efficacy of ECT.
Severe Metabolic Alkalosis and Thyroid Storm Mimicking Eclampsia in Pregnancy: A Case Report Diego Rafi Putra Uta; Dela Putri Pratikno; Hammam Arif Shabri; Muhammad Isra Rafidin Rayyan; Safinaz Safinaz; Achmad Wahib Wahju Winarso
Indonesian Journal of Anesthesiology and Reanimation Vol. 8 No. 2 (2026): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

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Abstract

Introduction: Seizures during pregnancy are most attributed to eclampsia, a significant cause of maternal mortality. However, other severe conditions, such as metabolic and endocrine disorders, can present similar clinical features, creating diagnostic dilemmas. Among these, thyroid storm and severe metabolic alkalosis are rare but critical differential diagnoses that demand accurate identification to prevent inappropriate treatment and adverse outcomes. To our knowledge, few reports have described the simultaneous occurrence of thyroid storm and severe metabolic alkalosis presenting as eclampsia and successfully managed without pregnancy termination. Objective: This case report aims to present a challenging case of pregnancy-related seizures, highlighting the diagnostic difficulties that arise when severe metabolic alkalosis and thyroid storm mimic the clinical manifestations of eclampsia. Case Report: A 27-year-old woman at 27 weeks of gestation, with a history of untreated hyperthyroidism, presented with recurrent tonic-clonic seizures. The diagnosis of thyroid storm was established using the Burch-Wartofsky Point Scale (BWPS score = 60). While eclampsia was initially suspected due to severe hypertension, the absence of proteinuria prompted further investigation. Laboratory tests revealed severe metabolic alkalosis secondary to persistent vomiting, along with profound hypokalemia and hypomagnesemia, which were identified as contributors to the seizure activity. A multidisciplinary team initially considered pregnancy termination but opted for aggressive metabolic stabilization in the ICU. The patient was managed with intensive electrolyte correction, antihypertensives, and antithyroid medications. This approach led to significant clinical improvement and the stabilization of her metabolic state. Consequently, the pregnancy was preserved, and the patient was discharged in stable condition without further complications. Conclusion: This case suggests that aggressive metabolic stabilization may allow pregnancy preservation in selected patients who present with seizures due to concurrent thyroid storm and severe metabolic alkalosis. This approach can successfully prevent the unnecessary termination of pregnancy, leading to favorable outcomes for both the mother and fetus. It underscores the importance of considering a broad differential diagnosis in pregnant patients with seizures.

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