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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 97 Documents
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Using Multimodal Analgesia for Breakthrough Pain in Stage IV Breast Cancer Patient Indriyani Wijaya; Mahmud
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.37-44

Abstract

Introduction: Breakthrough Pain (BTP) is experienced as mild to moderate-severe pain, from only a few seconds to hours. It causes a decrease in the quality of life and functional capacities. Furthermore, BPT must be recognizable, assessed, and controlled to prevent its relapse and severity. Case report: A woman, 45 years old, having breast cancer along with pulmonary, femur, and cervical metastases, came with the main complaint of pain. The patient had a pain score of NRS 9, which was felt intermittently for the last 3 months. Treatment has been carried out with MST 10 mg/8 hours and a Durogesic® patch (fentanyl 50 mcg/h) but the pain did not subside. Moreover, the patient was unable to identify any precipitating factors or pain relievers, while the diagnosis confirmed BTP. The rescue dose was administered in a range of 10 – 20% of the total daily dose in the last 24 hours equivalent to 11 – 22 mg intravenous Morphine or equianalgesic with 110 – 220 mcg of fentanyl. For immediate effect, transmucosal fentanyl was recommended, but this preparation is currently unavailable. Moreover, therapy was carried out with the continuous administration of Morphine, and the pain reduced to NRS 0 – 3 on the second day. Conclusion: Transmucosal fentanyl, either buccal, sublingual, oral, or nasal mucosa, was proven to be effective in treating BTP. However, when transmucosal fentanyl is not available, multimodal analgesia is an effective alternative.
Regional Anesthesia Subarachnoid Blockade (RASAB) in Scoliosis Patients Eko Setijanto; Kiel Pino Putra
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.51-63

Abstract

Introduction: Scoliosis is a three-dimensional spinal deformity that is mainly determined based on the lateral curvature of the spine. Furthermore, regional anesthesia often infiltrates the peripheral nerves with an anesthetic agent and blocks transmission to avoid or relieve pain. A previous study revealed that scoliosis in patients is one of the factors affecting the success of spinal anesthesia. Objective: To obtain a theoretical basis that can support the solution to the RASAB problem. The acceptance of the theory is the first step to providing a better understanding of the study problem based on the scientific framework of thinking. Furthermore, the similarities, differences, and views of several pieces of literature that discussed related issues were evaluated in this review. Review: Regional anesthesia subarachnoid blockade (RASAB) or spinal anesthesia, is a procedure, which involves the administration of local anesthetic drugs into the subarachnoid space. Furthermore, the process is carried out between the lumbar (L) vertebrae L2-L3, L3-L4, or L4-L5. Spinal anesthesia is often used in surgical procedures involving the lower abdomen, pelvis, perineum, and lower extremities. Conclusion: In the setting of scoliosis, spinal anesthesia is challenging, but is not an absolute contraindication. Patients with scoliosis have unique characteristics, hence, anesthetists need to understand the impact of the disease on the body.
Blood Transfusion Practices at The Intensive Observation Unit (Ruang Observasi Intensif/ROI) of Dr. Soetomo General Academic Hospital Surabaya Almira Saskia Sabila; Maulydia; Betty Agustina Tambunan; Edward Kusuma
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.1-10

Abstract

Introduction: Blood transfusion is the process of transferring blood or its components, such as red blood cells, plasma, and platelets, from donor to recipient. The major reason for blood transfusion is anemia and bleeding, frequently seen in critically ill trauma patients in Intensive Observation Unit (Ruang Observasi Intensif/ROI). One of the most prevalent causes of potentially preventable death in trauma patients is uncontrolled bleeding. In addition to controlling the bleeding by surgical or interventional procedures, blood transfusion is carried out to maintain oxygenation to tissue, preventing organ dysfunction due to hypoxia. Objective: This study aimed to determine the profile of blood transfusion carried out on the patients in the ROI of Dr. Soetomo General Academic Hospital. Methods: This retrospective descriptive study was conducted using medical records involving 258 patients who met the inclusion criteria. Results: The result showed that the majority of patients were female, aged 26-35 years, had blood type O, and Rhesus (Rh)-positive, accounting for 55.04%, 26.36%, 39.53%, and 100%, respectively. The most common indication for transfusion was anemia, with a percentage of 69.10%, particularly severe anemia, accounting for 48.45%. Furthermore, 57.36% of patients were from the surgery department, and 36.05% stayed in ROI for 2-3 days. The most common blood component and unit transfused was packed red blood cells (PRC), with a percentage of 57.50% and 439 units at 47.82%. Most of the transfusions, with a percentage of 37.80%, were carried out within 3-4 hours. Some patients were experiencing pruritus, febrile, urticaria, and chills, accounting for 0.39%, 0.39%, 0.39%, and 0.39%, respectively. Conclusion: Understanding transfusion practices, including blood type distribution, can prevent blood shortage, estimate the need for blood among ROI patients in Dr. Soetomo General Academic Hospital, and further ensure that all transfusions are ABO and Rh compatible.
Pediatric Shock Profile in The Pediatric Intensive Care Unit (PICU) of Dr. Soetomo General Academic Hospital Rafida Anshori; Arina Setyaningtyas; Arie Utariani; Neurinda Permata Kusumastuti
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.11-17

Abstract

Introduction: Shock is a life-threatening condition caused by circulatory failure which increases morbidity and mortality rate. According to the western literature, about 2% of children are admitted to hospitals worldwide due to shock. Objective: This study aimed to describe the pediatric shock profile of patients in the Pediatric Intensive Care Unit (PICU) of Dr. Soetomo General Academic Hospital between 1 January to 1 December 2019. Methods: A total of 60 patients were selected as the participants using a descriptive method. Data collection was carried out by recording the exact time the participants first entered the PICU. Furthermore, data were collected based on gender, age, physical and laboratory examination, diagnosis of shock, patients' outcomes, as well as PRISM III score. Results: The results of this study that the males and children are 51.7% and 53.3%, respectively. At an infant age, the distribution of the highest average pulse and breathing frequency was 135 and 32.2, respectively. The highest average body temperature at the age of adolescents was 37.19°C. Furthermore, the patients' diagnoses were dominated by distributive shock with the highest PRISM III score ≥8 and deaths recorded of 76.6%, 60%, and 61.7%, respectively. The diagnosis results showed that distributive shock leads to the highest mortality with a PRISM III score of 51.7% and 53.3%. Conclusion: Distributive shock contributes to the patient's diagnoses and mortality rate with the highest score of PRISM III being ≥8. From this conclusion, the PICU needs to be more responsive to detect distributive shock in children.
Basic Life Support Training: The Effectiveness and Retention of The Distance-Learning Method Rifdhani Fakhrudin Nur; Erlangga Prasamya; Arief Ikhwandi; Prattama Santoso Utomo; Sudadi
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.18-26

Abstract

Introduction: Basic Life Support (BLS) training during the COVID-19 pandemic needed to be effective as well as prevent disease transmission between trainers and participants. The distance-learning method is one of the recommended modified training methods. However, there is still limited research that evaluates the effectiveness of the distance-learning method for BLS training for laypersons during the COVID-19 pandemic. Objective: To evaluate the effectiveness and retention of the distance-learning method for BLS training in improving the participant's knowledge and skills. Methods: This is a non-randomized quasi-experimental study (one group pre-test and post-test design). A total of 64 TAGANA (Taruna Siaga Bencana/disaster volunteer) members of Sleman Regency who had undergone the distance learning method for BLS training were the participants of this study. A knowledge questionnaire and observation checklist were prepared and tested for context validity by an expert group. Data on the participant's knowledge were collected before and after the training session, and data on the participant's skills were recorded after the training session. After the training, a social media group was created to provide a periodical refresher of the BLS materials and facilitate discussions between the speakers and the study's samples. Data on knowledge retention and skills were recorded six months post-training. Results: The distance-learning method for BLS training effectively increased the participants' knowledge of BLS, indicated by a significantly higher final knowledge score than before the training (Z=-6.904, p <0.001). The method also provided sufficient BLS skills, indicated by most of the samples (93.7%) passing the skill observation test even though no participant had attended a similar training before. Moreover, the participant's knowledge and skills scores were significantly lower six months after the training session than immediately after training (Z=-5.157, p <0.001; Z=-4.219, p <0.001). Conclusion: The distance-learning method for BLS training effectively increased the participant's BLS knowledge and skills. However, their knowledge and skills decreased at six months post-training. Overall, the distance-learning method has been proven as a promising alternative to BLS training during and after the COVID-19 pandemic.
Administration of Nitrates After Spontaneous Delivery in Rheumatic Heart Disease Mirza Koeshardiandi; Muhammad Wildan Afif Himawan; Fajar Perdhana; Zulfikar Loka Wicaksana
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.45-50

Abstract

Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.
Association Between Shock Index and Post-Emergency Intubation Hypotension in Patients Who Called the Rapid Response Team at Dr. Cipto Mangunkusumo Hospital Herlina Rahmah; Asri Adisasmita; Sidharta Kusuma Manggala; Adhrie Sugiarto; Fadiah Zahrina; Prita Rosdiana
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.27-36

Abstract

Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p <0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.
Front Matter IJAR Vol 5 (1) January 2023
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.%p

Abstract

Back Matter IJAR Vol 5 (1) January 2023
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): 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.V5I12023.%p

Abstract

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Anesthetic Considerations in Patients with Mitochondrial Disorders Ziske Maritska; Nita Parisa; Mathius Karina; Marco Manza Putra; Noviyanti Eliska; Muhammad Irga; Maya Rina Santara Manurung; Andre Saputra
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.102-111

Abstract

Introduction: Mitochondrial Disorders (1/4,000 patients) are rare and caused by dysfunctional mitochondria. Anesthetic consideration in patients with Mitochondrial Disorders involves careful preoperative and perioperative observations. Objective: To provide a brief insight into how general anesthetics interfere with mitochondrial energy formation pathways and help form precautions for anesthesiologists when managing patients with Mitochondrial Disorder. Review: Mitochondrial Disorder patients would experience various health problems, such as damaged cardiac functions, neurology systems, and musculoskeletal functions due to energy production disruptions by dysfunctional mitochondrial processes. Moreover, patients with Mitochondrial Disorders exhibit hyperreactivity to volatile anesthetics. Conclusion: No anesthetic strategies are found to be safe in patients with Mitochondrial Disorder yet. Therefore, anesthesiologists should remain alert when monitoring fluid choices and managing patient temperature with Mitochondrial Disorders.

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