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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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Dexmedetomidine for Awake Intubation Procedure in Subtotal Thyroidectomy Riyanti, Riandini Pramudita; Hapsari, Paramita Putri
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.2022.003.02.04

Abstract

Background: Giant struma makes airway management difficult for the anesthesiologist due to the risk of tracheal intubation failure. Awake fiberoptic intubation(AFOI) is the gold standard in the management of a predicted difficult airway. Giving analgesia and sedation can facilitate operator and patient comfort during the awake intubation procedure.Case: We report the case of a 63-year-old woman with a giant struma who was planned for a subtotal thyroidectomy. We provide ondansetron and dexamethasone premedication, analgesia and sedation using dexmedetomidine, propofol induction, muscle relaxant atracurium, with maintenance anesthetic sevoflurane. Dexmedetomidine was administered on loading dose 0.8 µg /kg/hour in the first 10 minutes then continue on analgesia dose 0.2 µg /kg. During the AFOI procedure, 100% oxygenation was given with the patient's hemodynamic range, namely systolic blood pressure of 110-131 mmHg, diastolic blood pressure of 75-93 mmHg, heart rate of 77-91 beats per minute, and SpO2 of 98-100%. Postoperatively the patient was transferred to the Intensive care unit (ICU) with an endotracheal tube intube. Monitoring of postoperative complications such as production of thyroid crisis drainage and extubation 24 hours after surgery was confirmed by the cuff leak test.Conclusion: Giving dexmedetomidine is better than opioids in the AFOI procedure because of its minimal respiratory depressant effect. Maintaining hemodynamic stability during the AFOI procedure is very important to avoid hemodynamic fluctuations so it can minimize the risk of perioperative complications.
High Spinal Anesthesia in Total Knee Replacement Belinda, Febri Ahmad; Sumaryono, Hery Budi
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.2022.003.02.03

Abstract

Background: Osteoarthritis (OA) is the most common degenerative disease at people aged 63-70 years. Human ageing is associated with an increase in weakness around the joints, decreased joint flexibility, calcification of cartilage, and decreased chondrocyte function. Total knee replacement (TKR) is performed to treat pain and immobilisation in osteoarthritis patients. This procedure is done with spinal anaesthesia.Case: A 73 years old man diagnosed with bilateral OA and underwent TKR. The patient had left knee pain six months ago with a history of high blood pressure. If blood pressure <160/90 mmHg subarachnoid block was planed. The patient entered the operating room with an intravenous (IV) line of ringer lactate 10 dpm. Preoperatively, the patient was given ranitidine 50 mg IV and ondansetron 4 mg. The anaesthetic agent was hyperbaric bupivacaine 0.5% 15 mg + fentanyl 25 µg; the patient was hemodynamically monitored and maintained with O2 4 lpm. After 45 minutes of spinal anesthesia, the patient experienced respiratory distress, so we placed a masked and intubated the patient with endotracheal tube (ETT) 7.0. It is suspected that the patient had high spinal anesthesia.Conclusion: A 73-year-old man has been subjected to regional spinal anesthesia with total knee replacement surgery. However, spinal anesthesia failed and was converted to general anesthesia with ETT, with a duration of operation of 4 hours, hemodynamically stable, postoperatively the patient was admitted to the high care unit.
Serratus Anterior Block as Analgesia in Post-Thoracotomy Patients: Serial Case Parathon, Nugroho Satya; Basuki, Djudjuk Rahmad
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

Abstract

Providing analgesia in postoperative period for those undergone thoracotomy is chalenging, because nessesity to relieve postoperative pain and to prevent pulmonary complication following thoracotomy. Analgesic options for thoracotomy are various with each having benefits and disadvantages. It is mentioned that thoracic epidural is the gold standard for management of thoracotomy pain. Other option include paravertebral block, interpleural block, intrathecal opioid. Serratus anterior plane block (SAPB) is a relatively new compartment block technique for thoracic wall pain first developed in 2013 by Blanco et al. SAPB is a sensory nerve block that provides analgesia to the ipsilateral hemithorax form second thoracic (T2) to T9 dermatomes. SAPB has ben used in several procedure such as breast surgery, thoracoscopy, rib fracture analgesia, and shoulder injury as a good alternative analgesic method after thoracoscopic surgeries.This case series found that SAPB was an effective as post-operative analgesia after thoracotomy with good efficacy. Further investigation is still needed to determine the role of SAPB in the management of a variety of patients with acutely painful conditions and to understand possible side effects that my arise. 
Comparison of Lignocaine with Ondansetron for Attenuation of Propofol Induced Pain in Adult Patient Undergoing Laparoscopic Cholecystectomy: A Comparative Randomized Study. Kanojia, Akash; Sood, Rajesh; Kumar, Sandeep; Yadav, Rupesh
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.02

Abstract

Background: Propofol is a non-opioid intravenous anesthetic agent and it is most commonly used for induction of anesthesia but it has a consistent side-effect of pain when it is injected intravenously. Aim of our study was to compare lignocaine and ondansetron for attenuation of pain on propofol injection in laparoscopic cholecystectomy.Methods: 100 patients planned for laparoscopic cholecystectomy were enrolled for this comparative randomized study. Group L (Lignocaine) – Patients received Inj. Lignocaine 0.5 mg/kg 1 minute before inducing with injection propofol. Group O (Ondansetron) – Patients received Inj. Ondansetron 0.1mg/kg 1 minute before inducing with injection propofol. The patient was evaluated for pain during injection using a four-point scale of 5 seconds and 15 seconds after the propofol injection. Chi-squared test, Fisher’s exact test, and Mann-Whitney test were used for data analysis.Result: Demographic data  in group L and group O were similar. The mean± SD pain score during the first 5 seconds in group O was 0.38 ± 0.57 while in group L was 0.02 ± 0.14  (p<0.001). The mean± SD post-operative nausea and vomiting (PONV) score during the first hour in group O was 0.08 ± 0.27 while in group L was 1.96 ± 1.160 (p<0.001).Conclusion: We concluded that lignocaine was found more effective than ondansetron for attenuation of propofol-induced pain and post-operative nausea vomiting was much lower than by ondansetron as compared to lignocaine.
Anaesthetic Management of a Case of Down Syndrome with Chronic Kidney Disease Undergoing Major Orthopaedic Surgery Naik, Sudarshan; Prahalad, Prahalad; Kate, Shreyas
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.04

Abstract

Background: Down syndrome is one of the common congenital chromosomal disorders. Renal complications in Down syndrome patients are rare but is increasing in number due to increased survival. Anaesthesia in such patients is challenging due to intellectual disability, anatomical complications and multiple comorbidities.Case: This case report describes the pre-operative evaluation and anaesthetic management of a 19 -year-old male patient with Down syndrome with hypothyroidism with Chronic Kidney Disease stage 4 who underwent open reduction internal fixation with plating for bilateral subtrochanteric fracture under general anaesthesia. It was a complicated surgery for both surgeon and anaesthetist because the patient was anaemic with significant anticipated blood loss along with fluid restriction during the  perioperative period. We had major challenges like patient positioning, significant blood loss, hypotension, and early fluid overload. But an extensive preoperative evaluation, optimization prior and proper coordination we overcame the challenges.Conclusion: Major orthopaedic surgeries in patients like Down syndrome with chronic kidney disease create a major anaesthetic challenge due to expected significant blood loss, chances of fluid overload, multiple comorbidities and intellectual disability. Thorough preoperative evaluation, intraoperative monitoring as well as postoperative period is important as several complications are envisaged. So a closed group management with orthopaedic surgeon, nephrologist, anaesthesiologist, endocrinologist, nursing team is required to handle such complicated cases.
Scorpion Envenomation: The Cause of Inadequate Subarachnoid Block - A Case Series Pakhare, Vandana Patilbuwa; Nanda, Ananya; Priyanka, Reddy Devi Sai; Gopinath, Ramchandran
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.05

Abstract

Background: Failure of neuraxial or regional anaesthesia can result from factors such as drug errors, technical inefficiencies, and poor patient positioning. While these causes are well-known, resistance to local anaesthetic action due to mutations in sodium channels or scorpion sting is a lesser-known contributor to block failure. In India, a tropical country with a significant number of patients presenting for surgical procedures, a history of scorpion bites is not uncommon.Case: We observed seven cases of failed regional anesthesia who had history of scorpion sting. All the patients received intrathecal bupivacaine by experienced anesthesiologists, of seven patients five patients did not develop sensory or motor block. One patient had delayed successful subarachnoid block after second attempt and one patient had successful block at first attempt.Conclusion: Our observations revealed instances of failed spinal blocks, despite adequate drug dosages and experienced anesthesiologists performing the procedures, in patients with a history of scorpion envenomation. Accordingly, our study concludes that obtaining a thorough scorpion sting history during pre-anesthesia check-ups, particularly in endemic areas, can effectively prevent unnecessary repeated pinpricks, escalating dosages, patient and surgeon discomfort, and skepticism towards the skills of anesthesiologists.
Continuous Ketamine Administration Decreases Monocyte Count in Sepsis Patients in Intensive Care Units Hartono, Ruddi; Jaya, Wiwi; Mayasari, Mayasari; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol. 4 No. 1 (2023): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.01.01

Abstract

Background: Cytokines storm becomes the most common cause of mortality in sepsis patients treated in the intensive care unit (ICU). Cytokines storm is characterized by an excessive elevation in the immunocompetent cells, including monocyte. Ketamine, as a sedating agent, has immunosuppressive properties. This study was conducted to determine the effect of ketamine on monocyte count in septic patients in the ICU.Methods: This is a quantitative case-control  study of 30 patients treated in the ICU. The study subjects were divided into control (n=15) and treatment (n=15) groups. The treatment group received ketamine HCl therapy at 0.3 mg/kg body weight/hour. The mean monocytes were counted at 0, 24, and 48 hours post-therapy. Data analysis used an independent sample t-test with α=5%.Result: Administration of ketamine therapy in septic patients treated in the ICU showed a decrease in the monocytes during observation from 0 to 48 hours post-therapy. Administration of ketamine at 48 hours had a significantly lower monocyte (5.21%) compared to control (7.67%) (p=0.012).Conclusion: Ketamine administration reduces the monocytes count in septic patients treated in the intensive care unit. Ketamine is expected to be a therapeutic option in sepsis patients.
Comparison of Blockbuster LMA with Air Q LMA for Success of Blind Tracheal Intubation in Patients Undergoing General Anesthesia Endigeri, Archana; Hulakund, Shivanand; Rajanna, Raghavendra; Ganeshnavar, Anilkumar; Kelageri, Satish; Teja, Palluri Sai
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.03

Abstract

Background: Blockbuster Laryngeal mask airway (LMA) is a device gaining popularity in airway management, and advantageous in ventilation and intubation. Air Q LMA is a supraglottic airway device with a shorter and wider breathing tube designed for ventilation as well as intubation in difficult airway. We aimed to evaluate the success of tracheal intubation using these devices.Methods: Overall 80 participants aged 18-60 years with ASA I and II were randomized into Group A (Air Q LMA) and Group B (Blockbuster LMA) using computer generated random numbers. The objectives of our study were to evaluate first pass successful intubation, ease, time and attempts taken for device insertion, oropharyngeal leak pressure, time for LMA removal and post operative complications. Association between variables were assessed with chi square test and unpaired t test.Result: There was a statistically significant difference in the first pass successful intubation between the groups which was higher in Group B (90%) than Group A (60%) (P<0.001), the overall successful intubation was more in Group B 97.5% compared to Group A 85%. The device insertion was easy in 85% patients in Group A and 95% patients in Group B. The time taken for introduction of Air Q was longer (38.15±4.92sec) when compared with blockbuster LMA (26.25±4.44sec), (P<0.001).  Mean Oropharyngeal leak pressure of blockbuster LMA (32.40±3.99cmH2O) was greater than Air Q LMA (29.10±2.61cmH2O), (P<0.001).Conclusion: Blockbuster LMA provides greater success of blind tracheal intubation when compared to air Q LMA.
Pain and Complications Assessment in Gynecological Cancer Brachytherapy Patients Under Spinal Anesthesia Setiawan, Alfredo Abrian Erlangga; Fitrisyah, Aidyl; Zainal, Rizal; Santoso, Budi; Laeto, Arwan Bin
Journal of Anaesthesia and Pain Vol. 4 No. 3 (2023): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.03.03

Abstract

Background: Brachytherapy is a radiation therapy that can deliver radiation to cancer by minimizing radiation exposure to adjacent organs or tissues. In its implementation, brachytherapy can cause pain so that adequate anesthesia is needed in order to get optimal results. This study was aimed to determine the adequacy of anesthesia and complications that occur in gynecological cancer patients undergoing brachytherapy with spinal anesthesia.Methods: A descriptive observational study using primary data that taken by interviewing the patients who underwent gynecological brachytherapy under spinal anesthesia at dr. Mohammad Hoesin Palembang. The number of samples in this study that met the inclusion criteria was 18 subjects. Pain was assessed using an 11-point numeric rating scale. Data were collected in 5 different times, before procedure, during applicator insertion, during radiation process, during applicator removal, and 4 hours after brachytherapy. in addition, all complications that occurred during the procedure were recorded. Data were analyzed to describe the mean, median, minimum, and maximum of pain scores.Result: The average pain score before brachytherapy was 0.78, at the time of applicator insertion was 0, 0.28 at irradiation, 0,11 at removal of the applicator and 1.33 after the brachytherapy procedure. The most common complications were back pain (27.8%) and urinary retention (27.8%).Conclusion: For most patients, high dose rate (HDR) brachytherapy under spinal anesthesia was well tolerated, in fact most patients experienced no pain and no significant life-threatening complications. The post-brachytherapy pain score had the highest average score. Then, back pain and urinary retention were the most common complications.
Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray Laksono, Buyung Hartiyo; Hartono, Ruddi; Tamam, Abdul Rasyid; Jaya, Wiwi
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.01

Abstract

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units.Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test.Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters.Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.

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