Indonesian Journal of Anesthesiology and Reanimation (IJAR)
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.
Articles
97 Documents
<![CDATA[The Role of "Robotic Assisted Intensivist” As Solution Of Resources Management In Covid-19 Pandemic Era ]]>
<![CDATA[Anna Surgean Veterini]]>;
<![CDATA[Bambang Pujo Semedi]]>;
<![CDATA[Cita Rosita Sigit Prakoeswa]]>;
<![CDATA[Damayanti Tinduh]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 1 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V3I12021.34-38
<![CDATA[Providing expertise in the care of critically ill patients is one of the main needs of critical care medicine, especially in the COVID-19 pandemic era. This goal is particularly challenging, given the acknowledged shortage of intensive care specialists. We need the bedside nurse to have real-time access to get continuous reporting monitoring. The intensivist also has access to bed site examination at some time when they are not possible for coming to the intensive care unit (ICU). The big problems during COVID-19 are the limited personal protective equipment, the limited number of intensivist doctors, and the nature of the disease was very contagious and deadly. It is necessary to find a solution so as not to cause new problems, namely the death of medical staff and nurses due to frequent contact with Covid-19 patients. In this article, the author wants to open a view to getting solutions to problems in the field by presenting human replacement technology.]]>
<![CDATA[Profile of Airway Patency, Respiratory Rate, PaCO2, and PaO2 in Severe Traumatic Brain Injury Patients (GCS ]]>
<![CDATA[Maria Marind Desrianti Hutauruk]]>;
<![CDATA[Ira Dharmawati]]>;
<![CDATA[Philia Setiawan]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 1 No. 2 (2019): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V1I22019.32-37
<![CDATA[Introduction: Traumatic Brain Injury (TBI) is the most common neurotrauma with high morbidity and mortality. Many guidelines recommend the use of mechanical ventilation for severe TBI patients, but there are limited resources of procuring ventilator machine in hospitals especially in developing countries. Yet it is not comparable with the number of TBI patients. Objective: This study is purposed to provide the profile of ventilation and oxygenation (airway patency, RR, PaCO2, and PaO2) in severe TBI patients (GCS<9) admitted in the Emergency Room (ER) of Dr. Soetomo General Academic Hospital Surabaya. Method and Material: This is a retrospective study using medical records of patients with TBI who were admitted in the ER of Dr. Soetomo General Academic Hospital from January to December 2017. The patient's general characteristics, blood gas analysis (PaCO2, PaO2), airway patency were recorded and analyzed. Results and Discussion: Thirty-seven severe TBI patients were included in the analysis. 30 men (81.1%) and 7 women (18.9%) with an average of 37±16 years old (range: 5-65) were studied. Most of the patients (94.6%) had MAP between 60 and 160 mmHg, PaCO2<35 mmHg (72.9%), PaO2>60 mmHg (100%), RR>20 breaths per minute (70.2%), and patent airways (64.9%) with simple support of oxygen. 8.1% of all of those patients had PaCO2>45 mmHg. Conclusion: Most of the severe TBI admitted in the ER of Dr. Soetomo General Academic Hospital had hypocapnia or respiratory rate higher than the normal range. Though one-third of the patient has partial obstruction of the airway, no significant hypoxemia is found.]]>
<![CDATA[Triage Knowledge of Emergency Rooms Nurses at Dr Soetomo Regional General Hospital ]]>
<![CDATA[Fariza Nur Aini Widyani]]>;
<![CDATA[April Poerwanto Basuki]]>;
<![CDATA[Djohar Nuswantoro]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 2 No. 1 (2020): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V2I12020.13-19
<![CDATA[Introduction: Triage is a system to sort patients based on their urgency for care during an emergency. In addition, to determine patient's severity, triage reduces time wasted and overcrowding in the emergency room.1 Triage errors such as over-triage or under-triage must not exceed 35% and 5% of the total numbers of patients respectively. Dr. Soetomo General Hospital of Surabaya with its status as one of type "A” hospital in Indonesia that has good amenities, facilities, and infrastructures which is also the main referral hospital from Primary or Secondary Health Care, is prone to patients overcrowding. The high number of patients and the demands for high-quality service as the main referral hospital require higher qualification from health care professionals in term of cognitive, skills, and attitude. Objective: This study conducted to evaluate the level of knowledge of the ER (Emergency Room) nurses at Dr. Soetomo General Hospital in 2019 towards triage. Methods and Materials: This study is a quantitative descriptive study using a validated questionnaire with 32 nurses as the samples. Results and Discussion: Demographic profile showed that majority of nurses are: female (52%), age 26 – 35 years old (46 %), graduated from D3 (61%), have been working in this field for >15 years (46%), attended Basic Life Support Training (33%), and have moderate knowledge in triage (61%). Conclusion: Emergency room nurses of Dr Soetomo General Hospital had adequate knowledge in triage. The researcher considers there might be some factors influencing nurse's knowledge in triage.]]>
<![CDATA[Modified Infant Feeding Tube as an Indigenous Endotracheal Tube in Unanticipated Congenital Subglottic Stenosis ]]>
<![CDATA[Rahul Gupta]]>;
<![CDATA[Rama Chatterjee]]>;
<![CDATA[Neelam Dogra]]>;
<![CDATA[Dinesh Kumar Barolia]]>;
<![CDATA[Pratibha Rathore]]>;
<![CDATA[Pooja Mongia]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 1 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V3I12021.1-9
<![CDATA[Introduction: In neonates with an unanticipated difficult airway, there is an increased probability of failed intubation even with highly trained hands while performing direct laryngoscopy. Aims: We describe our experience of using a modified infant feeding tube (IFT) as an indigenous endotracheal tube (ETT) in a series of paediatric surgical patients with congenital subglottic stenosis (SGS). Material and Methods: A retrospective study was performed in our institute from January 2018 to December 2019. ETT with modified 6 and 8 French (Fr) sized IFT's were used. A stylet obtained from the VP shunt system was used to aid in intubation. Results: Out of 12,500 admissions in our department, there were 5 pediatric cases with SGS which were managed using modified IFT. Four were neonates and 1 infant (M:F = 2:3). Modified IFT(s) were used after failed intubation with ETT of size 2.5 mm in 4 patients (non-availability of ETT of size 2 mm), while in one neonate, even 2 mm ETT could not be negotiated due to SGS. In all the 5 children, successful intubation was finally performed with modified 8 French (Fr) IFT in 3, and with modified 6 Fr IFT in two cases. The surgical procedure was completed in 4 neonates out of 5 cases, while in one infant it was deferred due to the clinical condition of the patient and significant SGS. Conclusion: All 5 patients with SGS were managed without performing a tracheostomy. Modified IFT(s) is an effective alternative if smaller sized ETT(s) cannot be negotiated or unavailable in difficult neonatal and paediatric airway. This modified IFT as ETT has to be an important part of the emergency airway tray. It should not be considered as a replacement for routine use of standard ETT.]]>
<![CDATA[Ketamine Versus Tramadol Effectiveness as Postoperative Oral Analgesics on Pediatric Patients Age 5-10 Years in Elective Surgery at Dr. Soetomo Hospital Surabaya ]]>
<![CDATA[Herdiani Sulistyo Putri]]>;
<![CDATA[Elizeus Hanindito]]>;
<![CDATA[Herdy Sulistyono]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 2 No. 2 (2020): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V2I22020.38-46
<![CDATA[Introduction: The use of ketamine and tramadol as postoperative analgesics for pediatric are still relatively rare, especially orally administrated. As an analgesic, ketamine blocks the NMDA receptor, the main excitatory transmitter in CNS; whereas tramadol blocks serotonin and norepinephrine uptake, thus preventing pain transmission on the spinal cord. Objective: The aim of this study is to compare the effectiveness of oral ketamine and oral tramadol as analgesics for postoperative acute pain in children. Method: A double-blind randomized clinical trial was conducted at Dr. Soetomo Hospital. The hospital ethical committee had approved this study. The subject includes thirty children aged 5-10 years old who fulfilled the inclusion criteria. They were divided into either ketamine groups or the tramadol group, in which each group consisting of fifteen patients. The regimen dosage that been given was 2mg/kg tramadol and ketamine as postoperative oral analgesics in the form of simple syrup. The FLACC table was used to evaluate pain score before and after administration of drugs (30-minutes, 1-hour, 2-hours, 3-hours, 4-hours, and at discharge from the recovery room). Result and Discussion: Based on the quantitative parameter of the FLACC (scale 0-10), there was a significant difference (p<0.05) between the first-hour postoperative administration and patient discharge from the recovery room. The patient of ketamine group had far lower FLACC value compared to the tramadol group. Rescue analgesics in the form of intravenous fentanyl were given to one patient (6.7%) in the ketamine group and four patients (26.7%) in the tramadol group. Conclusion: Ketamine proved to be a better and more effective postoperative oral analgesic compared to tramadol in this study.]]>
<![CDATA[Pain Level of Postoperative Orthopedic Patients at Dr. Soetomo General Hospital ]]>
<![CDATA[David Wicaksono]]>;
<![CDATA[Lilik Herawati]]>;
<![CDATA[Herdy Sulistyono]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 1 No. 1 (2019): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V1I12019.19-25
<![CDATA[Introduction: Postoperative pain is the most undesirable consequence of the surgery. If it is not managed properly, it can lead to a long healing. However, assessment and treatment of postoperative pain in surgical wards still have not received attention. Differences in patient's pain level after surgery and after being transferred to the surgical ward is very important in monitoring the effectiveness postoperative pain management. Objective: This study was conducted to determine the overview of pain level experienced by patients following orthopedic surgery and to know the individual factors that can affect the patient's pain level. Method and Material: This research was observational analytic with 43 orthopedic postoperative patients as a sample. The Patients' pain level was measured by the Numeric Rating Scale (NRS) at one hour after surgery and 24 hours after surgery. Result and Discussion:The Pain level one hour after surgery varied between pain level 0 as much as 53% to pain level 8 as much as 4.7%. The results of measurements of pain 24 hours after surgery only 23.3% of the patients who did not complain of pain, and there was a patient who experienced pain level 10. The results of the statistical calculation, the difference between the level of pain one hour and 24 hours post-surgery obtained value of p=0.037 (p<0.05). Conclusion: There was a significant difference between the pain level at one hour and 24 hours post-surgery. It might be due to the process of peripheral and central sensitization in patients with delayed pain management. It also may be influenced by individual factors as well as medical personnel.]]>
<![CDATA[In Pursuit of Phrenic Nerve-Sparing Regional Anesthesia For Awake Shoulder Manipulation In Patients With Adhesive Capsulitis ]]>
<![CDATA[Syahrul Mubarak Danar Sumantri]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 2 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V3I22021.71-80
<![CDATA[Introduction. While interscalene brachial plexus block remains the gold standard of any shoulder procedure, including shoulder manipulation in patients with adhesive capsulitis, anesthesiologists are reluctant to face the risk of phrenic nerve paresis, especially in patients with preexisting pulmonary conditions. Hence, many studies have targeted specific regional anesthesia of the shoulder low enough by the blockade level, leaving phrenic nerve function intact but still providing satisfying anesthesia for shoulder procedures. Until recently, no comparison between these regional anesthesia techniques focusing on shoulder manipulation for adhesive capsulitis has been published. Case Report. We compared the profiles between suprascapular nerve block, shoulder interfascial plane block, and superior trunk block as the sole anesthesia technique in patients with adhesive capsulitis undergoing awake shoulder manipulation. Conclusion. This report descriptively signifies superior trunk block excellence among other regional anesthesia techniques in achieving complete anesthesia for awake shoulder manipulation in patients with adhesive capsulitis while sparing the phrenic-nerve function]]>
<![CDATA[Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula ]]>
<![CDATA[Christya Lorena]]>;
<![CDATA[Hamzah Hamzah]]>;
<![CDATA[Maulydia Maulydia]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 2 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V3I22021.54-61
<![CDATA[Introduction: Intubation mistakes, such as ETT malposition, will result in serious complications. Endobronchial intubation can cause pneumothorax and contralateral lung collapse (atelectasis). On the contrary, superficial ETT could increase the risk of being released easily, leading to desaturation or even cardiac arrest. A shallow ETT position could cause the compression of the vocal cord and laryngeal nerve by ETT's cuff. An optimal position can be reached if the cuff position is 1.5-2.5 cm under the vocal cord and the tip is 3-5 cm above the carina. Several methods of ETT depth measurement based on airway length data can be an alternative, especially during the COVID-19 era, where the use of a stethoscope to check ETT depth is limited. Objectives: To analyze the accuracy of ETT depth placement using Chula and MSJ formula. Methods: We conducted the prospective comparative analytic research on 50 patients who had elective surgery in GBPT operating room at Dr. Soetomo Hospital Surabaya. The research data during the intubation and FOL (Fyber Optic Laryngoscope) from each patient were height, MSJ length, initial ETT length, the distance of carina-ETT tip, the distance of cuff-vocal cord, and final ETT length. Result: In the Chula formula group, the average patients' height was 160.60cm ± 9.738 for men and 157.76 cm ± 8.604 for women. The average MSJ length was 20.28 cm. The application of the Chula formula is more accurate because ETT revision was carried out in only 8.0% of the samples, with an average revision is 0.04. On the other hand, the ETT revision with an average of 0.868 on the MSJ formula group was conducted in 84% of the samples. This research also found a linear correlation between increasing ETT depth and body height. Conclusion: Applying the Chula formula to measure the ETT depth for Indonesian (Javanese) people is more appropriate than the MSJ formula.]]>
<![CDATA[Validity of Urine Syndecan-1 as A Predictor of Acute Kidney Injury In Pediatric Sepsis Patients ]]>
<![CDATA[Bambang Pujo Semedi]]>;
<![CDATA[Arie Utariani]]>;
<![CDATA[Nugroho Setia Budi]]>;
<![CDATA[Ninik Asmaningsih]]>;
<![CDATA[Lucky Andriyanto]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 2 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V3I22021.62-70
<![CDATA[Introduction: AKI (Acute Kidney Injury) complications in sepsis patients generally occur 24 hours after admission to ICU. Creatine Serum Concentration is a standard parameter to diagnose AKI. Unfortunately, the changes in creatine serum concentration will only be seen several days after the decrease of renal function to 50%. The low detection ability has been linked with time loss before preventive therapy is commenced. Furthermore, this instigates the need for biomarkers to ensure early detection. Objective: This study aimed to identify cut-off points of urine syndecan-1 and to measure the prediction ability of urine syndecan-1 towards the AKI occurrence in pediatric sepsis patients. Materials and methods: This study was a prospective cohort study performed at a single center in Dr. Soetomo General Hospital, Surabaya. The inclusion criterion was all children admitted to the resuscitation room from October until December 2019. Furthermore, urine sampling is carried out at 0, 6, 12, and 24 hours for a syndecan-1 urine examination, and every procedure performed on the patient will be recorded. This action was continued up to the third day and aimed to evaluate some factors related to AKI at 48-72 hours of admission. Result and Discussion: Out of 41 pediatric sepsis patients, 30 patients fulfilled the inclusion criteria and 57% had AKI. The value of urine syndecan-1 at hour-0 and hour-6 was significantly featured a cut-off point. Conclusion: The value of urine syndecan-1 at hour-0 and hour-6 are valid parameters to predict the occurrence of AKI grades 1, 2, and 3 in pediatric septic patients at 48-72 hours after their hospital admission. The best cut-off value of urine syndecan-1 at the 0th hour was 0.67 ng/ml.]]>
<![CDATA[Effectiveness Comparison of Using Macintosh Blade and Mccoy Blade For Endotracheal Intubation In Anesthesia Residents ]]>
<![CDATA[Christya Lorena]]>;
<![CDATA[Agustina Salinding]]>;
<![CDATA[Prananda Surya Airlangga]]>
<![CDATA[ Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 2 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR) ]]>
Publisher : <![CDATA[Faculty of Medicine-Universitas Airlangga ]]>
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DOI: 10.20473/ijar.V3I22021.46-53
<![CDATA[Introduction: Laryngoscopy is one of the critical points in the intubation process and a mechanical trauma that provides noxious stimulation, affecting cardiovascular, respiratory, and intracranial changes. Practitioner competence is a significant factor that supports laryngoscope intubation procedures. That can influence the intubation duration and amount of mechanical trauma besides caused by laryngoscope type. Objective: To analyze the effectiveness of using Macintosh blade compared to McCoy blade in intubation laryngoscopy by Anesthesia Residents. Materials and Methods: This research is an experimental study in adult patients who underwent elective surgery at GBPT Dr. Soetomo Hospital. Intubation did by Anesthesia Residents at levels 5-9 using Macintosh or McCoy Laryngoscope and chosen randomly. The data of laryngeal visualization (Cormack Lehane), hemodynamics (blood pressure, pulse), pain scale (qNOX), intubation time length, and pain scale data (VAS) after extubation were taken during intubation laryngoscope. Result and Discussion: The study was conducted on 28 samples that met the criteria. Anesthesia Resident's competence levels based on the semester in both groups laryngoscopes were not different (p 0.868). Based on laryngeal visualization data laryngoscopy, the McCoy's blade had better visualization with CL 1 at 85.7% of the samples and p-value 0.020. This good visualization makes it possible to speed up the laryngoscope-intubation in the McCoy blade group with a significant difference of time compared to the Macintosh blade group. Hemodynamic parameters, there were significant differences for hemodynamics increase. In the Macintosh blade group, the blood pressure and pulse were significantly increased after laryngoscopy intubation. The pain scale during the intubation procedure, which was rated based on the qNOx score, showed a significant increase in the Macintosh blade group with a p-value of 0.003. The postoperative pain scale (VAS) was smaller in the McCoy blade group compared to the Macintosh group (p-value <0.001). Conclusion: The ability to use both laryngoscopes at some levels of Anesthesia residents was equally good, and the use of McCoy Blade is more effective than Macintosh Blade in the intubation laryngoscopy procedure.]]>
