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Journal of Anaesthesia and Pain
Published by Universitas Brawijaya
ISSN : 27223167     EISSN : 27223205     DOI : http://dx.doi.org/10.21776/ub.jap
Core Subject : Health,
Health Professions Medicine & Pharmacology
Journal of Anaesthesia and Pain is a peer-reviewed and open-access journal that focuses on anesthesia and pain. Journal of Anaesthesia and Pain, published by Anesthesiology and Intensive Therapy Specialist Program of Medicine Faculty, Brawijaya University. This journal publishes original articles, case reports, and reviews. The Journal s mission is to offer the latest scientific information on anesthesiology and pain management by providing a forum for clinical researchers, scientists, clinicians, and other health professionals. This journal publishes three times a year. Subjects suitable for the Journal of Anaesthesia and Pain are all subjects related to anesthesiology and pain management.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 125 Documents
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Multidisciplinary Management of Severe Hemorrhagic Stroke with Triple Challenge: Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Hydrocephalus-A Case Report Wijaya, Andryadi; Jufan, Akhmad Yun
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2025.006.03.05

Abstract

Background: Hemorrhagic stroke, particularly subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), is a neurological emergency associated with high morbidity and mortality, especially when complicated by increased intracranial pressure (ICP). This report aims to describe the comprehensive management of a patient with severe hemorrhagic stroke complicated by SAH, ICH, and hydrocephalus Case: This case report describes the management of a 69-year-old female with extensive SAH, ICH, ruptured anterior communicating artery aneurysm, and obstructive hydrocephalus. The patient presented with decreased consciousness post-seizure. Initial management included emergency external ventricular drain (EVD) placement and subsequent surgical clipping of the aneurysm. Non-invasive ICP monitoring using optic nerve sheath diameter (ONSD) demonstrated a reduction from 0.68 cm to 0.49 cm over seven days, reflecting successful ICP control. Complications included vasospasm managed with nimodipine, hypernatremia and polyuria suggestive of central diabetes insipidus treated with desmopressin, and nosocomial pneumonia due to serratia marcescens. Antibiotic therapy was escalated from ceftriaxone to meropenem and de-escalated to cefepime based on culture results. Despite optimal intensive care, the patient showed no significant neurological improvement (persistently low Glasgow Coma Scale [GCS]) and failed ventilator weaning. Given a poor prognosis (WFNS grade 4, Hunt & Hess grade 4, ICH score 3), the patient was transitioned to palliative care.  Conclusion: This case highlights the importance of multidisciplinary management, non-invasive ICP monitoring, and timely transition to palliative care in severe hemorrhagic stroke.
The Role of Intravenous Immunoglobulin in Myasthenic Crisis: A Case Report of Successful Management in an Elderly Patient with Thymoma Hanafia, Mochamad Fauzi; Adiyanto, Bowo
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2025.006.03.04

Abstract

Background: Myasthenic crisis represents the most severe and life-threatening manifestation of myasthenia gravis, affecting approximately 15-20% of patients, with mortality rates ranging from 2-16% globally. Intravenous immunoglobulin (IVIG) is emerging as a primary therapeutic modality alongside plasmapheresis for crisis management. The optimal treatment approach in elderly patients with concurrent thymoma remains challenging due to increased perioperative risks and complex clinical presentations. The present case report describes the successful management of myasthenic crisis in an elderly patient with thymoma using intensive IVIG therapy in conjunction with timely surgical interventionCase: A 71-year-old male with established myasthenia gravis presented with myasthenic crisis two days prior to scheduled thymectomy. Clinical manifestations included respiratory distress, bilateral ptosis, drooping head, and dysphonia requiring immediate intensive care management. The patient received three cycles of IVIG therapy (0.4 g/kg/day for 5 days each cycle) in the intensive care unit in conjunction with mechanical ventilation, corticosteroids, pyridostigmine, and urgent thymectomy. Treatment resulted in successful weaning from mechanical ventilation after 8 days, with complete clinical recovery and transfer to the general ward without complications.Conclusion: This case demonstrates the efficacy and safety of intensive IVIG therapy in managing myasthenic crisis in elderly patients with thymoma. The systematic administration of multiple IVIG cycles proved effective in stabilizing respiratory function and facilitating successful surgical intervention, supporting IVIG as a cornerstone therapy in critical care management of severe myasthenia gravis.
Characteristic Outline of Head Trauma Patients at Dr. Saiful Anwar General Hospital Laksono, Buyung Hartiyo; Pertiwi, Previasari Zahra; Siswagama, Taufiq Agus; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Traumatic brain injury is defined as a decline in brain function characterized by a decreased level of consciousness, seizures, and focal sensory and motor neurologic deficits caused by blunt force or penetration by a sharp object into the intracranial space. This reseracrh aims to determine the characteristics of head trauma patients at Dr. Saiful Anwar General Hospital, Malang.Methods: This descriptive observational study sampled all head trauma patients at Dr. Saiful Anwar General Hospital, Malang, from March to August 2023. The study variables included patient demographics, cause of trauma, clinical data, pre-and postoperative procedures, outcomes of trauma patients undergoing treatment, and length of stay. Data were analyzed using Microsoft Excel.Results: A total of 227 head trauma patients were identified, most of whom were men aged 20-39 (71). Students (72) were the most common victims of head trauma, most often due to accidents. There were 156 patients with mild head injuries. 208 patients had normal oxygen saturation. 157 patients had normal hemoglobin, 181 patients had normal sodium, and 196 patients had normal blood glucose levels. 102 patients experienced hypocarbia. A normal CT scan of 141 patients was performed. 206 patients underwent surgery, while 214 patients did not undergo tracheostomy. 149 patients underwent surgery with early emergence. The highest number of patients were patients with a hospital stay of more than 14 days (140 patients). The most common outcome was mild disability (84 patients).Conclusion: Most patients were male, aged 20-39. The most common cause was accidents involving students. Most patients with mild head injuries had normal oxygen saturation, hemoglobin,sodium, and blood glucose levels. Most patients with hypocarbia had no bleeding, and CT scans showed no bleeding. Most patients underwent surgery and early emergence, with a hospital stay of more than 14 days, and the most common outcome was mild disability.
A Retrospective Case Series of Anaesthetic Management of Children with Temporomandibular Joint Ankylosis from a Tertiary Level Referral Paediatric Hospital Ganigara, Anuradha; Ravishankar, Chandrakala Kunigal; Ashwathanarayanashett, Bhavana Dalasanura; Mariam, Mahdiyyah; Vakoda, Chandrika Yabagodu Rama
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.05

Abstract

Background: Children with temporomandibular joint ankylosis (TMJA) are associated with a difficult airway and require special anesthesia management. No clear guidelines have been issued for managing difficult airways in children, especially for TMJA.  Therefore, the aim of this retrospective case study was to understand the difficulties in airway access faced in children with TMJA and to describe the various techniques for successful airway management.Case: We conducted a retrospective review from 2017 to 2022 of 14 children aged 2-14 years who presented for surgical correction of unilateral or bilateral TMJ ankylosis (TMJA) at a pediatric tertiary referral center.  The maximal interincisor distance (MID) and Colorado pediatric airway score (COPUR) were used to plan airway management in these children. Unilateral TMJA was seen in 11 children; the remaining 3 had bilateral TMJA with MID < 1 cm. Flexible fiberoptic intubation was used as an aid to facilitate intubation in a total of five children with MID ≤ 1 cm. Video laryngoscopy and direct laryngoscopy were suitable for visualizing the glottic opening in the remaining children with a midline deviation (MID) greater than 1 cm. Conclusion: Flexible fiberoptic intubation is beneficial for airway management in children with bilateral and/or unilateral TMJA and MID ≤ 1 cm. Children with lesser degrees of mouth opening restriction were successfully managed with video laryngoscopy and direct laryngoscopy for airway control. This preliminary report provides vital information about the decision-making and referral process for children with TMJA, taking into consideration the varying infrastructural resources available in low- and middle-income settings.   
Comparison of Efficacy of Bolus Dosages of Norepinephrine, Phenylephrine, and Ephedrine in Treating Post-Spinal Hypotension During Elective Cesarean Section: A Randomized Double-Blinded Controlled Trial Ganeshnavar, Anilkumar Sangappa; Endigeri, Archana; Chitti, Prashant Kumar Reddy; Nair, Vinduja; Konappanavar, Chaitra
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.04

Abstract

Background: Phenylephrine and ephedrine are widely used to manage spinal-induced hypotension after cesarean section. Norepinephrine is an alternative vasopressor that maintains the heart rate. This study compared the efficacy and safety of bolus administration of norepinephrine, phenylephrine, and ephedrine for treating post-spinal hypotension during elective cesarean section.Methods: This prospective, randomized, double-blind controlled trial included patients between 20–45 years of age undergoing elective cesarean section; they were randomized into three groups receive norepinephrine 6 µg (Group A, n = 45), phenylephrine 100 µg (Group B, n = 45), or ephedrine 6 mg (Group C, n = 45) boluses after a 20% drop in blood pressure. The primary objective was to compare the efficacy (total doses required) and safety (maternal complications) of treating post-spinal hypotension. Secondary objectives assessed neonatal outcomes using fetal arterial blood gas and Apgar scores. Mean differences were analyzed using one-way analysis of variance at a 95% confidence level (α = 0.05).Result: The total number of drug boluses required to treat maternal hypotension was significantly lower in group A (1.78 ± 0.74) than in groups B (1.93 ± 0.69) and C (2.38 ± 0.81) (F = 7.89; p < 0.001). Tachycardia occurred more frequently in group C (37.8%) than in groups A (15.6%) and B (26.7%) (p = 0.001). The incidence of bradycardia was higher in group B (24.4%) than in groups A (20%) and C (6.7%) (p = 0.001). Maternal complications were comparable between the groups, with no significant differences in neonatal outcomes.Conclusion: Norepinephrine is a potent drug with a better hemodynamic profile than phenylephrine and ephedrine.
Comparative Study of Epidural Block with Combined Femoral and Sciatic Nerve Block in Adults for Lower Limb Surgery using Bupivacaine with Fentanyl Gulia, Abhity; Kohli, Pramod; Pandey, Maitree
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.03

Abstract

Background: Combined femoral and sciatic nerve blocks for lower limb surgery have been shown to be as effective as epidural blocks for intraoperative anesthesia and postoperative analgesia. This study compared the analgesic effect of epidural and the combined femoral and sciatic nerve block for lower limb surgeries in adults.Methods: This randomized controlled study included 60 patients who underwent lower limb surgery, divided into two groups to receive epidural (Group E, n = 30) or combined femoral and sciatic nerve block (Group PNB, n = 30). The duration of sensory and motor block, intraoperative hemodynamics, duration of postoperative analgesia, and adverse effects were assessed. Data was analyzed using McNemar’s test with α = 0.05.Result: There are no intraoperative hemodynamic changes in group PNB. The sensory block lasted 18.81 ± 1.78 hours, and postoperative analgesia for 17 ± 1.87 hours in group PNB. Whereas in group E, the sensory blockade lasted for 6.54 ± 0.87 hours and postoperative analgesia for 5.13 ± 1.13 hours (p = 0.000). The duration of the motor blockade in group E was 4.48 ± 1.02 hours. No motor blockade was seen in group PNB. No nausea, vomiting, hypotension, numbness, or urine retention were noted in group PNB. In group E, hypotension was noted at 15, 30, and 45 minutes, with 33.3% having nausea and 13.3% postoperative vomiting.Conclusion: Femoral and sciatic nerve block provide similar surgical conditions for lower limb surgeries with better hemodynamic stability, earlier ambulation, and longer duration of postoperative analgesia than epidural.
Comparison of Intermittent Epidural Bolus and Continuous Epidural Infusion for Postoperative Pain Management in Abdominal Surgery Patients Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk; Subagyo, Houdini Pradanawan; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.02

Abstract

Background: Abdominal surgery often leads to high postoperative pain scores, which are commonly managed using epidural analgesia through either continuous infusion or intermittent bolus administration. This study aimed to compare the effectiveness of intermittent epidural bolus and continuous epidural infusion in managing postoperative pain among patients who underwent abdominal surgery.Methods: This cross-sectional study included 90 patients who underwent abdominal surgery and were randomly assigned to two groups. Group one received intermittent epidural bolus analgesia with ropivacaine 0.1875% and fentanyl 50 µg, administered as 10 cm³ every 8 hours (n=45). Group two received continuous epidural infusion analgesia with ropivacaine 0.1875% and fentanyl 100 µg, in a total volume of 50 cm³ at a rate of 3 cm³/hour (n=45). Pain levels were assessed using the numerical rating scale (NRS) at rest and during movement, measured every 12 hours for 84 hours. Statistical analysis was conducted using the independent t-test with a significance level of α=0.05 and a 95% confidence interval.Result: At 24 hours postoperatively, the NRS at rest was significantly lower in the continuous infusion epidural (0.15 ± 0.36) compared to the intermittent bolus (0.91 ± 0.35) (p=0.000), and this trend persisted at subsequent time points (36, 48, 60, 72, and 80 hours postoperatively). For movement, the NRS at 36 hours was also lower in the continuous infusion epidural (1.00 ± 0.00) compared to the intermittent bolus (1.29 ± 0.45) (p=0.000), with similar differences observed at other time points.Conclusion: Continuous epidural infusion provides superior analgesia to intermittent epidural bolus administration in abdominal surgery patients. This method is associated with faster and sustained reductions in pain intensity at rest and during movement.
Efficacy and Outcomes of Interventional Procedures in Cancer Pain Management: A Retrospective Cohort Study Steele, Patrick; Young, Jamie; Koh, Angelina; Ungar, Rafael; Shahzad, Eeman
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.01

Abstract

Background: Interventional procedures used for opioid-resistant cancer pain lack evidence. This study aimed to determine the effects of interventional procedures on pain, function, distress, and opioid consumption to improve the understanding of their role in cancer pain.Methods: This retrospective cohort study included 74 patients who received interventional procedures as inpatients or outpatients for cancer pain between 2021 and 2022; the primary outcomes included pain and oral morphine equivalent daily dose (oMEDD). For inpatients receiving palliative care management, the secondary outcomes were function and distress associated with pain. These were measured pre-intervention, on the day of intervention, and 3 months post-intervention. The outcomes were compared using the Wilcoxon signed-rank test with α = 0.05.Result: Most patients underwent palliative management (67.6%) and had pancreatic cancer (23.0%). In total, 94.5% of patients received temporary peripheral, neuraxial, or sympathetic blocks. Pain was most commonly experienced in the lower limbs (43.2%) and abdomen (33.8%). For the inpatients, there was a reduction in pain scores, distress, and post-intervention maintenance of function; however, these results were insignificant. Overall, the extension of oMEDD was greater in this group (p < 0.05). There was insufficient data for outpatients to assess pain, function, and distress; however, there was a decrease in regular oMEDD post-intervention (p > 0.05).Conclusion: Although interventions reduced pain, maintained function, and reduced the distress associated with pain in palliative patients, most of these results were statistically insignificant. A significant increase in inpatient oMEDD may be consistent with disease progression. Conversely, a decrease in outpatient oMEDD may suggest a more stable disease course, potentially benefiting from earlier interventions for opioid-sparing reasons.
C-Section in Uncorrected Ventricular Septal Defect and Pulmonary Hypertension Management in Anesthesia Perspective Febrianti, Rizki Fitria; Supraptomo, Robertus Theodorus
Journal of Anaesthesia and Pain Vol. 3 No. 2 (2022): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2022.003.02.02

Abstract

Background: Pregnancy with cardiac defects and pulmonary hypertension happen 0.2% to 3% and is correlated with valuable hemodynamic burden due to cardiocirculatory changes which becomes a remarkable indirect cause of maternal mortality and poor fetal outcome. Ventricular septal defect (VSD) is one of the most common forms of heart disease among pregnant women, meanwhile the VSD-specific pregnancy data are insufficient. This case report addresses the anesthetics management for patient with uncorrected ventricular septal defect and pulmonary hypertension.Case: A 30-year-old multigravida with 37 weeks of gestation weighing 52 kg referred elective cesarean section and tubal ligation. She was compos mentis with arterial oxygen saturation was 87-88% room air. A grade IV/VI systolic murmur was heard at the second intercostal space of the left midclavicular line and the punctum maximum at the fourth intercostal spaces of the left sternal border. She had cyanotic in all of her extremities and clubbing fingers. Other examination is within normal limit. Titrated epidural was given at L1-2 level with parenteral levobupivacaine and fentanyl used as an adjuvant. The patient was stable during the surgery. Both maternal and fetal had a good outcome. The patient was discharged at the 7th day after surgery.Conclusion: To achieve a good outcome from management of the high-risk obstetric patients requires multidisciplinary approach involving anesthetist, obstetrician, and cardiologist in planning and managing the case. 
Perioperative Application of 2% Lidocaine Dewi, Fitri Hapsari; Nugroho, Andy; Muttaqin, Fandi Ahmad
Journal of Anaesthesia and Pain Vol. 3 No. 2 (2022): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.003.02.01

Abstract

Perioperative intravenous lidocaine (IVL) can help minimize opioid-related side effects that impede the postoperative recovery process. Neurological side effects were averaged at an 8 mg/kg dose, and cardiotoxicity side effects were reported at plasma values greater than 21 g/ml. Approximately 90% of lidocaine is converted to monoethylglycinexylidide (MEGX) in the liver via oxidative demethylation (dealkylation). Analysis of MEGX concentrations after lidocaine administration can be a method used to evaluate liver function. Perioperative intravenous lidocaine lowers discomfort, nausea, the duration of ileus, the need for opioids, and the length of time spent in the hospital after surgery. During injection, low blood concentrations can result in these symptoms, which may last for several hours or days after termination. Postoperative problems, such as pain and organ failure, can be caused by anti-inflammatory and pro-inflammatory components. Analgesic, anti-inflammatory, and anti-hyperalgesic are just some of the other effects of lidocaine. It also decreases the volume of the airways and the rate of breathing, prolongs the duration of exhalation, reduces the respiratory rate and tidal volume, also causes vasoconstriction at low concentrations and vasodilation at high concentrations. In clinical applications, lidocaine can prevent propofol injection pain, improve postoperative recovery, and play a role in various surgical procedures. Perioperative IVL application is proven to provide more benefits in various surgeries compared to other available anesthetic options. Very few studies have systematically analyzed the occurrence of side effects, and the quality of evidence is low. 

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