cover
Contact Name
Prihatma Kriswidyatomo
Contact Email
ijar@fk.unair.ac.id
Phone
+628123008875
Journal Mail Official
ijar@fk.unair.ac.id
Editorial Address
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
Location
Kota surabaya,
Jawa timur
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,
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
Surface Anatomy-Based Clavipectoral Fascia Plane Block for Clavicle Surgery Purnomo, Heri Dwi; Witjaksana, Risnu
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.30-34

Abstract

Introduction: Clavicular fractures are often observed cases. In the majority of clavicle fractures, both in adults and children, the fracture is located in the midshaft. Generally, General Anesthesia techniques are usd in such instances, as regional anesthesia through peripheral nerve block often presents its own challenges. The clavipectoral fascial plane block was first introduced in 2017. Apart from its ease of implementation, the Surface Anatomy-Based Clavipectoral Plane Block can avoid the risks associated with other regional anesthesia techniques such as Plexus Brachialis Block or Interscalene Block. Objective: This report aims to provide an overview of the procedures for carrying out surface anatomy-based clavipectoral fascia plane block for clavicle surgery. Case Report: A 33-year-old man with the primary complaint of pain in the right shoulder following a fall while playing football. The patient was diagnosed with closed re-fracture of the clavicle (D) Allman Group I. Clavicle surgery was conducted with the Surface Anatomy-Based Clavipectoral Fascia Plane Block technique. In this patient, local anesthetic agents were administered as Levobupivacaine 0.375% in a volume of 20 cc. The operation lasts approximately 1.5 hours. The Patient’s hemodynamic condition was stable during the surgery. The patient had no complaints and post-operative pain was effectively managed. Conclusion: The surface Anatomy-based Clavipectoral fascia plane block can be considered for clavicular surgery, especially in Allman Group type 1. Besides being easy to implement, this technique also poses fewer risks compared to other regional anesthesia techniques.
A Diagnostic Challenge in the Differential Diagnosis of Recurrent Seizures During Pregnancy: Epilepsy Versus Eclampsia Andri Subiantoro; Sugiharto, Wahyu; Khaidar, Reyfal
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.35-44

Abstract

Introduction: Seizures during pregnancy are associated with adverse outcomes for mothers and infants. Seizures during pregnancy can be associated with multiple factors. To establish effective treatment and management of seizures, it is important to identify all of the factors that may contribute to seizures during pregnancy. Objective: This study aimed to evaluate and identify the cause of seizures in pregnancy to facilitate appropriate treatment. Case Report: We present a case of a 32-week pregnant woman who experienced eclampsia and recurrent seizures during the peripartum period. The patient had a history of inadequately managed epilepsy. Seizure management required multiple medications, including magnesium sulfate, benzodiazepine, and phenytoin. The patient underwent an emergency caesarean utilizing the Rapid Sequence Intubation (RSI) procedure and general anesthesia to rescue the baby. Nicardipine, furosemide, isosorbide dinitrate, captopril, spironolactone, and hydrochlorothiazide were used to manage blood pressure. The patient needs to be continuously observed, and the therapy should be adjusted according to the patient’s condition. Discussion: The patient had a history of epilepsy and had experienced two bouts of generalized seizures with characteristics of eclampsia before being arrived at the emergency room. Determining how to control the seizures in this spesific individual was a challenge. The primary therapy of patients with active seizures should include maintaining the airway, respiration, and circulation. The therapeutic objectives are immediate delivery of a viable fetus and maintenance of maternal health. Perioperative management aims to control blood pressure and seizures, maintain hemodynamics, manage anesthesia for terminating a pregnancy, and support critical care management for any potentially fatal complications from this condition. Conclusion: Seizures in pregnancy are attributable not just to eclampsia but can also cause by another or concurrently together with other causes. Early diagnosis and appropriate treatment are required to achieve the best outcome for this patient.
Cerebral Oxygenation Monitoring During Coronary Artery Bypass Grafting and Its Correlation with Hematocrit, Mean arterial pressure, and Partial pressure of Oxygen in Arterial Blood Sharma, Jai; Verma, Indu; Agarwal, Swati; Dagar, Nivedita
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.1-11

Abstract

Introduction: Optimal cerebral oxygenation is vital during coronary artery bypass grafting (CABG) to prevent neurological complications like cognitive decline and stroke. Non-invasive monitoring methods include near-infrared spectroscopy (NIRS), electroencephalography (EEG), and transcranial doppler (TCD). It offers real-time rSO2 assessment, detecting critical thresholds and reducing risks during cardiopulmonary bypass (CPB). Objective: This observational study aims to investigates cerebral oxygenation changes during CABG and correlations with hematocrit, mean arterial pressure (MAP), blood oxygen levels, CPB flows, and temperature. Methods: Seventy-two elective CABG patients underwent CPB with parameters including rSO2, hematocrit, MAP, PaO2, temperature, and pump flows assessed at specific time points: T1: Baseline pre-anesthesia; T2: Post-anesthesia induction (FiO2 100%); T3: Post-anesthesia induction (FiO2 50%); T4: CPB initiation; T5: CPB at 35°C; T6: CPB at 32°C; T7: CPB rewarming (36°C); T8: Post-CPB weaning (FiO2 100%); T9: Post-CPB weaning (FiO2 50%). Results: The mean baseline values for rSO2 were 72.14 for the right side and 71.90 for the left side. Upon initiating CPB at 35°C, a significant maximum reduction in rSO2 of 10.5% was observed, which remained below baseline during the hypothermia phase. The rSO2 values began to increase during the rewarming phase, nearly reaching baseline levels after CPB. A post hoc analysis indicated that changes in rSO2 were correlated with variations in hematocrit (correlation coefficient = 0.518), MAP (correlation coefficient = 0.399), and PaO2 (correlation coefficient = 0.001). Conclusion: This study explored the fluctuations in rSO2 during CABG with CPB and examined its correlations with hematocrit, MAP, PaO2, CPB flows, and temperature. The findings highlight significant correlations among these variables, providing insights into factors influencing cerebral oxygenation during cardiac surgery.
Bispectral Index Versus Minimum Alveolar Concentration Guided Anesthesia for Assessment of Intraoperative Awareness in Patients Undegoing Laparascopic Abdominal Surgery Shreya Garg; Vinod Bala Dhir; Jyoti Gupta; Yadav, Rupesh; Deepak Verma
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.12-21

Abstract

Introduction: Intraoperative awareness with explicit recall (AWR) occurs when an individual retains memory of intraoperative events after completion of anesthesia. It is an unpleasant feeling feared by both the patients and the anesthetists. Objective: This research aims to compare Bispectral Index (BIS) versus Minimum Alveolar Concentration (MAC) guided anesthesia for assessment of intra-operative awareness in patients undergoing laparoscopic abdominal surgery. Methods: This research is a prospective comparison involving 100 patients divided into two groups of 50 patients each. Group M (MAC): Desflurane concentration was maintained at a MAC value of 1. The BIS monitor was not to be applied to this group of patients at the time of induction, but in Group B (BIS), the BIS electrode was applied on the forehead immediately before induction. Hemodynamic parameters including heart rate and mean arterial blood pressure were recorded.  After the surgery, the patients were interviewed using the Modified Brice Awareness Questionnaire and Michigan Awareness Classification score for assessment of intra-operative awareness or consciousness at two intervals: in the post-anesthesia care unit and 48 hours after surgery. Results: Demographic data were comparable between groups M and B. No significant differences in the hemodynamic parameters, which include heart rate and mean arterial blood pressure (MAP) between the M group and the B group (p value>0.05). The patient’s awareness was compared based on a modified Brice awareness questionnaire. The distribution of awareness was comparable between groups M and B (0% vs. 4% respectively) (p value=0.495). The distribution of Michigan awareness classification scores was comparable between groups M and B. Class 0 (no awareness) was 98% vs. 96% respectively, and Class 1(isolated auditory perception) of 2% vs. 4% respectively with (p value=1). Conclusion: This research found that BIS-guided anesthesia works just as well as MAC-guided anesthesia at keeping patients from waking up and keeping an eye on changes in their blood pressure while they are under general anesthesia for laparoscopic abdominal surgery.
Acute Lung Oedema in Severe Pre-eclampsia: Advanced Management and Anesthetic Interventions Hotabilardus, Nusi Andreas; Anggraeni, Novita
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.45-52

Abstract

Introduction: Acute Lung Oedema (ALO) during pregnancy is an uncommon but potentially life-threatening condition, particularly when associated with severe pre-eclampsia. This critical obstetric emergency requires prompt recognition and comprehensive management to prevent adverse maternal and fetal outcomes. Objective: This report aims to highlights the management of a complex case of ALO in a pregnant patient with severe pre-eclampsia, underscoring the essential role of multidisciplinary collaboration, evidence-based protocols, and individualized care in achieving favorable outcomes. Case Report: A 30-year-old woman at 29–30 weeks gestation presented with significantly reduced consciousness and severe shortness of breath. Clinical examination revealed hypertension, tachycardia, and profound hypoxemia, with radiological evidence of pulmonary oedema. The diagnosis included severe-feature pre-eclampsia complicated by acute respiratory distress syndrome (ARDS) secondary to ALO. Endotracheal intubation was used to protect the mother's airway, mechanical ventilation was used to help her get enough oxygen, and her blood pressure and heart rate were stabilized right away. Fluid therapy was carefully monitored to avoid exacerbating pulmonary oedema. Obstetric management prioritized delaying delivery until maternal stabilization was achieved. A surgical intervention under general anesthesia resulted in the delivery of a moderately distressed neonate. Postoperative care in the intensive care unit included continued mechanical ventilation, sedation, and meticulous fluid management. Gradual stabilization allowed for successful weaning off ventilatory support, extubation, and transfer to a general hospital ward. Discussion: Management strategies were guided by the ABCDE principle, targeting reductions in left ventricular preload and afterload, adequate oxygenation, and infection prevention. The case emphasizes the value of early diagnosis, prompt intervention, and interdisciplinary collaboration involving obstetricians, intensivists, and anesthetists. Conclusion: This case illustrates the importance of early recognition, swift intervention, and tailored care in managing ALO associated with severe pre-eclampsia. Comprehensive, team-based approaches are critical for optimizing maternal and neonatal outcomes in such high-risk scenarios.
A Comparison of Postoperative Analgesic Effect of Intravenous Tramadol versus Transdermal Buprenorphine Patch in Patients Undergoing Aortofemoral Graft Surgery Meena, Reema; Sharma, Ashish; Garg, Namita; Yadav, Ramgopal
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.22-29

Abstract

Introduction: The popularity of the transdermal buprenorphine patch (TDB) is currently increasing for chronic pain management because of its ease of use, non-invasive nature, sustained drug delivery, and avoidance of side effects associated with oral or parenteral routes. However, its role in postoperative pain management for aortofemoral bypass surgery is poorly established. The study was designed to compare the postoperative analgesic effect of intravenous tramadol versus transdermal buprenorphine patch in patients undergoing aortofemoral graft surgery. Objective: To compare the efficacy between a buprenorphine patch versus intravenous tramadol for postoperative analgesia in patients undergoing aortofemoral bypass surgeries.  Methods: This is a hospital-based, prospective, randomized, and interventional study. This study was conducted in the cardiac surgery Operation Theatre (OT). A total of 60 patients of either sex belonging to ASA 2 or 3 in the age group of 30-60 years and BMI ≤ 40 kg/m2 scheduled for aortofemoral bypass surgery were enrolled in this study. These 60 patients were divided into two groups; the intravenous tramadol and the transdermal buprenorphine patch group using a randomization table. Results: The two groups were comparable in terms of demographical data, duration of surgery, and time for extubation. The analysis of variance showed that the VAS score was higher in the buprenorphine group as compared to the tramadol group for the first 3 hours post operatively but after that, the VAS score was significantly less in the buprenorphine group at various study intervals. A greater number of patients complained of pain for the first 3 hours postoperatively, but after that the patients had better pain relief for the rest of the study period. Conclusion: Transdermal buprenorphine applied preoperatively is a safe and effective option for postoperative pain management as it offers superior pain control and reduces the need for rescue analgesia, thereby decreasing potential side effects as compared to intravenous tramadol.
The Differentiating of Sepsis-Associated and Sepsis-Induced Acute Kidney Injury in Intensive Care Unit Patients Hotabilardus, Nusi; Anggraeni, Novita
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): 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.V7I12025.53-65

Abstract

Introduction: Acute kidney injury (AKI) is a severe and common complication in Intensive Care Unit (ICU) patients, commonly resulting from sepsis. It is associated with elevated mortality, chronic renal failure, and other long-term consequences. Sepsis-associated AKI (SA-AKI) and Sepsis-induced AKI (SI-AKI), a specific sub-phenotype, differ in their underlying pathophysiology. Objective: To examine the distinctions between SA-AKI and SI-AKI, focusing on their pathophysiology, biomarkers for detection, and associated prognoses in critically ill patients. This literature review examines the findings of randomized control trials (RCTs) or meta-analysis studies that learn about biochemical mediators and biomarkers for SA-AKI and SI-AKI, including NGAL, Kim-1, and others, as well as the prognostic impact of these conditions. The literature was gathered from Google Scholar and PubMed using the keywords Sepsis-Associated Acute Kidney Injury, Sepsis-Induced Acute Kidney Injury, Intensive Care Unit, and Sepsis and published within the last ten years (2018–2023). Articles unavailable in the full text were excluded. Review: SA-AKI and SI-AKI are distinct entities within the broader spectrum of sepsis and AKI. SI-AKI involves sepsis-induced direct kidney damage, which differentiates it from other forms of SA-AKI. Various biomarkers such as NGAL, Kim-1, and others are crucial for early detection and differentiation between these conditions. Patients with SA-AKI and SI-AKI usually have a bad outlook. They are more likely to die, be disabled for a long time, and need longer stays in the ICU and hospital than patients with sepsis or AKI alone. Figuring out the underlying pathophysiology and using the right biomarkers can help with early diagnosis and could lead to better outcomes for patients through targeted therapies. Summary: SA-AKI and SI-AKI represent critical complications in ICU patients with sepsis, leading to high mortality and long-term adverse outcomes. Differentiating between these conditions using biomarkers is essential for early detection and management. These patients have a worse prognosis than those with sepsis or AKI alone. This shows how important it is to keep researching and finding better ways to treat these serious complications in critically ill patients.
Management of Anesthesia in Pediatric Patients with Bronchoscopy Late Onset Foreign Body Aspiration Sintani, Rinni; Vitraludyono, Rudy
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 2 (2025): 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.V7I22025.116-127

Abstract

Introduction: Aspiration of foreign bodies in the airways is a severe and fatal condition if it occurs in children, because the risk of life-threatening obstruction is higher. Bronchoscopy is the main choice of procedure for treating foreign body aspiration, either with rigid bronchoscopy or flexible bronchoscopy. Anesthesia techniques are used with comprehensive anesthesia considerations, such as premedication, induction of anesthesia, maintenance of anesthesia, and monitoring. Objective: To evaluate the management of anesthesia in a pediatric patient with foreign body aspiration in late-onset settings. Case report: We report a case of anesthesia management in a child who aspirated a foreign body (peanuts) three days before being delivered to the hospital and undergoing a rigid bronchoscopy procedure. The patient experienced respiratory failure, and atelectasis was found in the right lower lobe of the lung upon arrival at the Emergency Unit (ER) due to the late onset of the case, so a secure airway must be performed before rigid bronchoscopy. Post-treatment care is carried out by observation and monitoring in the Intensive Care Unit (ICU) with complications of pneumonia. After three days of ICU treatment, the patient was transferred to the High Care Unit (HCU) in improved condition. The patient was discharged after three days of treatment in the low care Unit. Conclusion: Rigid bronchoscopy is the best modality for extracting foreign bodies in the pediatric airway. Delayed onset effects from foreign body aspiration in the respiratory tract cause greater complications after bronchoscopy. Pneumonia is the most common complication. Comprehensive anesthesia evaluation and preparation are the keys to the success of this procedure.
Anesthesia and Surgical Considerations in Awake Craniotomy for Eloquent Area Tumor Masoudifar, Mehrdad; Mirhosseini, Maryam; Najafabadipour, Amirhossein
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 2 (2025): 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.V7I22025.128-131

Abstract

Introduction: Awake craniotomy is a specialized neurosurgical technique in which the patient remains conscious during surgery, enabling real-time functional mapping of the cerebral cortex. This procedure is primarily employed when a brain tumor or lesion is situated near critical areas responsible for motor, visual, or language functions. Its application minimizes the risk of postoperative neurological deficits, ensuring the preservation of vital brain functions. Objective: The objective of this case report is to highlight the use of the awake craniotomy technique for a patient with a brain tumor located in the left parietal lobe, emphasizing the surgical and anesthetic considerations necessary for successful outcomes. Case Report: The patient, diagnosed with a brain tumor in the left parietal lobe, presented unique surgical challenges due to the tumor's proximity to the cortical centers governing movement and speech. To mitigate the risk of neurological impairment, an awake craniotomy was performed. Bilateral scalp nerve blocks were administered for effective pain management, alongside dexmedetomidine to provide conscious sedation. The "awake-wake-wake" protocol was followed, ensuring the patient remained alert throughout critical phases of the surgery. This allowed the surgical team to conduct real-time assessments of motor and language functions, optimizing tumor resection while preserving neurological integrity. Conclusion: This case underscores the importance of the awake craniotomy technique in neurosurgical interventions involving eloquent brain regions. The use of dexmedetomidine and precise nerve blocks provided effective sedation and analgesia, enabling active patient participation during functional mapping. The procedure highlights the value of interdisciplinary collaboration between neurosurgeons and anesthesiologists to achieve optimal patient outcomes while minimizing neurological risks.
Comparing Hemodynamic Responses to Intubation in Hypertensive Patients: Clearvue® Video Laryngoscope Versus Macintosh Direct Laryngoscope Vyas, Ram Kishan; Meena, Sunita; Sharma, Jai; Sompura, Ritesh Kumar
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 2 (2025): 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.V7I22025.76-84

Abstract

Introduction: The ClearVue® video-laryngoscope (CVL) is believed to alleviate the stress response associated with intubation by providing superior laryngeal views, minimizing oropharyngo-laryngeal stimulation, and potentially reducing the pressor response. Objective: This study aims to assess and compare how effective and safe intubation is when using a CVL versus a Macintosh direct laryngoscope (MDL) in patients with high blood pressure who are having surgery. Methods: This prospective, randomized, interventional study was conducted on 140 hypertensive patients on antihypertensive medication undergoing elective surgery under general anesthesia (GA), who were allocated into two groups, CVL group (n = 70) and MDL group (n = 70). Hemodynamic parameters, including mean arterial pressure (MAP), mean heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), were monitored at baseline, induction, and at various intervals post-intubation (1, 2, 3, 4, 5, and 10 minutes). Other metrics, such as intubation time, intubation attempts, ease of intubation, and associated complications, were documented. Results: Significant differences in heart rate were observed between the groups, right at intubation and at 1, 2, and 3 minutes post-intubation (p-values: 0.011; 0.028; 0.002; 0.003). SBP showed significant differences at intubation and during the first four minutes post-intubation (p-values < 0.001 except for the fourth minute, p = 0.001). DBP and MBP also showed significant differences at various intervals post-intubation (p-values < 0.001 to 0.025 and < 0.001 to 0.020, respectively). No significant difference in airway complications was noted. Conclusion: The CVL offers advantages over MDL in patients with controlled hypertension, specifically in reducing hemodynamic changes during intubation without increasing airway complications. At the same time, MDL offered less intubation time overall than CVL.

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