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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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Controlled Hypotension During Functional Endoscopic Sinus Surgery (FESS) - A Comparative Evaluation Between Esmolol and Nitroglycerine Gowtham, Kotaru; Shankar, Mittapally; Sowjanya, Bhagothula
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.2023.004.03.02

Abstract

Background: Intraoperative bleeding is a frequent complication in functional endoscopic sinus surgery (FESS). Controlled hypotension is a useful technique for enhancing the surgical field and reducing operative blood loss. Nitrovasodilators and beta receptor antagonists are effective options for regulated hypotensive anaesthesia during FESS. We assessed the efficacy of esmolol and nitroglycerine for controlled hypotension in subjects undergoing FESS.Methods: A source of 64 participants undergoing elective FESS, were randomly allocated to group N (n=32), which got an intravenous Nitroglycerin infusion at 5–10 µg/kg/min, and group E (n=32), which received an initial bolus of 500 mcg/kg of intravenous esmolol over 30 seconds. Hemodynamic parameters were measured and the visibility of the surgical field was assessed using the average category scale (ACS).Result: In groups N and E, the mean surgical duration was 113.5 minutes and 102.34 minutes, respectively, and the mean operative blood loss was 188.5 ml and 173.7 ml. The esmolol group experienced a rapid decline in heart rate, and there was a statistically significant difference in mean SBP, DBP, and MAP across the study groups. At the 10-min, the majority of cases displayed scores of 3 in group E and 4 in group N. In the esmolol group, there was a significant difference between the hypotensive phase and the hemodynamic measures (p<0.05).Conclusion: Nitroglycerine and esmolol were effective in controlling hypotension. However, esmolol was superior in controlling the operative bleeding, surgical duration, enhanced surgical field visibility, and absence of reflex tachycardia compared to nitroglycerine
Assessment of Quality of Pain and Patient Satisfaction using ASSIST Questionnaire Following Intraperitoneal Instillation of Ropivacaine Compared with the Addition of Adjuncts Ketamine versus Dexmedetomidine in Laparoscopic Cholecystectomy patients Kapoor, Ruchi; Dua, Steffi; Saxena, Ashok Kumar
Journal of Anaesthesia and Pain Vol. 5 No. 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.01

Abstract

Background: Evaluation of patient satisfaction score and to assess quality of pain relief following intraperitoneal instillation of Ropivacaine with adjuncts Dexmedetomidine vs Ketamine using modified version of revised APS-POQ in patients undergoing laparoscopic cholecystectomy.Methods: Sixty patients undergoing laparoscopic cholecystectomy were randomised into three groups of  20 each and received Ropivacaine 0.2 % (group R), Ropivacaine 0.2 % with Dexmedetomidine 0.7µg/ kg (group RD) and Ropivacaine with Ketamine 0.5 mg/kg (group RK) in a total volume of 40 ml. Pain severity, subjective pain complaints, pain interference in physical activity, and patient's and caregiver's satisfaction were evaluated using a modified version of the revised APS-POQ at 24 hours postoperatively.Result: Mean pain scores for worst pain were observed to be least in Group RD, with mean values being 1.75±1.743, followed by 5.45±1.701 in Group R and mean value of 5.60±0.754 in Group RK. Mean patient satisfaction scores were found to be highest in Group RD (94.00±8.826), followed by Group R (80.00±15.218), and least in Group RK (78.50±12.258). This difference was observed to be statistically significant (p<0.05) in all groups. Primary care physicians caring for the RD group had higher satisfaction scores (9.40±0.883) compared to Group RK (7.85±1.226) and Group R (8.05±1.468)Conclusion: Quality of pain relief improved the best with Dexmedetomidine followed by Ketamine and least when Ropivacaine used alone for intraperitoneal instillation. The overall patients' satisfaction was found to be more with Ropivacaine with Dexmedetomidine when compared to Ropivacaine alone or with Ketamine
Thoracotomy: An Overview of Perioperative Anaesthetic Management Solanki, Nilesh Maganbhai; Engineer, Smita; Shah, Namrata; Mistry, Nirmal; Tamilanban, Soundarya
Journal of Anaesthesia and Pain Vol. 5 No. 2 (2024): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.02.02

Abstract

Background: The anesthesiologist's role during open thoracotomy includes using a double lumen tube (DLT) for lung isolation, maintaining oxygenation with one-lung ventilation (OLV), and providing postoperative analgesia. This study aims to describe patient demographics, comorbidities, perioperative anesthetic management, complications, and the effectiveness of epidural catheter analgesia.Methods: In this prospective, observational study, patients who underwent open thoracotomy for decortications were evaluated. Thoracotomy was done under general anaesthesia, OLV with DLT, and epidural analgesia. Postoperatively, all the patients were shifted to the intensive care unit. Collected data included patient demographics, associated co-morbidities, severity of lung diseases, complications, and postoperative recovery. Postoperative analgesia was assessed by the visual analogue scale (0-10).   Result: Of 20 patients, 16 were male, and 4 were female, with a mean age of 35 years (range 15-60) and a mean weight of 52 kg (range 36-66). History of hypertension (N=5), hypertension with diabetes (N=3), obstructive lung disease (N=6), restrictive lung disease (N=11), and both combined (N=3) were noted on pre-anesthetic check-ups. Intraoperative complications were hypotension (N=3), desaturation (N=3), respiratory acidosis (N =7), and metabolic acidosis (N=3). Postoperative analgesia was managed with an epidural catheter (N=18) & systemic analgesia (N=2). All patients had uneventful postoperative courses except one patient who had pulmonary edema and did not survive.Conclusion: Patients undergoing open thoracotomy had an increased risk for adverse perioperative outcomes. The incidences of perioperative morbidity are high in patients with associated comorbidities. Proper OLV strategy helps to correct intraoperative desaturation. Epidural analgesia plays a key role in postoperative recovery.
One Lung Ventilation (OLV) on Needle Evacuation Thoracotomy in Pediatric Patient Hariyanto, Achmad; Hadi Pratama, Muhamad Rizal; Alami, Eqiel Navadz Akhtar
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.2023.004.03.05

Abstract

Background: One lung ventilation (OLV) is a ventilation method that functions to facilitate surgery on one side of the lung to protect one of the lungs from exposure to fluids such as blood, secretions, or foreign bodies. Therefore, it is necessary to place the endrotracheal tube correctly so that complications do not occur. This case report aims to determine the success in surgery using OLV method with blind insertion in pediatric patient.Case: A 10 years old male patient came to the hospital with complaints of sore throat. Thorax X-Ray photo examination showed that there was a needle-shaped corpus alienum density in the right bronchus branch of the orificium of the right lung. The patient was planned for a needle evacuation thoracotomy using a Double lumen endotracheal-tube (DLT) size 26. The patient was induced using the total intravenous anaesthesia (TIVA) method, ventilation using OLV. The operation was carried out with an incision at the 8th posterolateral intercostal space (ICS) of the dextra deepened layer by layer, the pleura was bluntly penetrated. This surgery went success to extract needle and the patient's condition was stable (HR=104x/min, SpO2=95%). On a third day after surgery, the patient was stable and discharged.Conclusion: The OLV method using DLT in pediatric patient with blind insertion during thoracotomy showed good results with early mobilization on day 1 after surgery, 3 days of hospital stays, and did not show any serious complication after surgery.  
Factors Affecting Outcome of Patients with Upper Gastrointestinal Haemorrhage Presenting to Emergency Department: A Prospective observational cohort study Lal, Devakrishna Bhavan; Ekka, Meera; Yadav, Rupesh; Yadav, Amlendu; Kumar, Sandeep
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.2023.004.03.04

Abstract

Background: Upper gastrointestinal bleeding (UGIB) is one of the most common presentations in an emergency department (ED). UGI endoscopy is the definitive diagnostic and therapeutic modality for UGIB. Aim of the study were look into the outcomes of UGIB and outcomes based on the timing of endoscopy (early endoscopy mean before 24 hours and late endoscopy mean after 24 hours).Methods: 180 patients presented in ED with UGIB and undergo Upper gastrointestinal (UGI) endoscopy. Socio-demographic profiles, with presenting signs and symptoms, co-morbidities, vitals, lab parameters, endoscopic diagnosis with the treatment of the patient were collected. They were followed up to day 7 of presentation to determine all-cause mortality, re-bleed, development of hemorrhagic shock, admission rate and length of ED stay, early endoscopy and late endoscopy.Result: The mortality difference in the early endoscopy (3.2%) and late endoscopy (16.1%) group was significant with a p-value of 0. 012. Late endoscopy (18.6%) was associated with a higher risk of development of hemorrhagic shock compared to the early group (4.8%) with a p-value of 0.011. The factors that had a significant association with mortality on univariate analysis were, late endoscopy, systolic blood pressure on presentation less than 90, variceal bleeding, blood transfusion requirement, AIMS 65 score greater than 0. Multivariate analysis showed that late endoscopy (OR 5.35(1.12-25.3)) and AIMS 65 score (OR 11.76(1.48-93.3)) were independent risk factors for mortality.Conclusion: We concluded that early endoscopy was associated with decreased mortality, decreased length of ED stay and decreased risk of development of hemorrhagic shock.
Patients Perceptions of Opioid Use for Chronic Lower Back Pain in Rural Guatemala Ruan, Tiffany; Puga, Troy Brian; Onwenu, Jason; Amani, Tafadzwa; Tyler, Robert
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.2023.004.03.01

Abstract

Background: Chronic lower back pain is a common cause of disability. Opioids, although not first-line treatment, are often prescribed for chronic lower back pain. The purpose of this study is to understand the perceptions of opioids among the rural Guatemalan population for chronic low back pain to best optimize a shared decision-making process in pain management. Methods: Participants were given a survey regarding demographic information, whether they were offered an opioid prescription for chronic lower back pain, and whether they would take the medication if offered. Participants completed the Prescription Opioid Overdose Knowledge Score (Rx-OOKS) questionnaire, to evaluate knowledge of opioid overdose.Result: The survey results showed that 93.3% of participants were never offered an opioid prescription for chronic low back pain by a provider in Guatemala. However, a majority would have taken an opioid if given the opportunity. Scores on the Rx-OOKS revealed a statistically significant lower mean (p< 0.05) than the United States’ study baseline for the knowledge of signs of prescription opioid overdose construct, actions to take in the opioid overdose construct, and total score construct.Conclusion: This research study was able to show that although there is a low prevalence of opioid use in rural Guatemala and decreased knowledge of opioid overdose. Thus, physicians and other healthcare providers must do their due diligence to educate their communities about opioid use, opioid overdose, and naloxone use for a potential overdose. This process is essential in the development of a shared decision-making process for pain management.
Comparison of Hemodynamic Response to Endotracheal Intubation with Nebulized Lignocaine and Dexmedetomidine: a Prospective Randomized Controlled Trial Dash, Sulochana; Sree, Pasupala Subba Kavya; Panigrahy, Sasmita; Sahu, Alisha; Nath, Abinash Kumar; Rani, Pedireddy Sobha
Journal of Anaesthesia and Pain Vol. 5 No. 2 (2024): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.02.01

Abstract

Background: Though different studies have compared intravenous (IV) lignocaine with dexmedetomidine for blunting laryngoscopic and intubation response, there is hardly any study comparing nebulized Lignocaine and dexmedetomidine for the same. This study compared the effectiveness of nebulized dexmedetomidine and Lignocaine for blunting hemodynamic response to laryngoscopy and intubation.Methods: This prospective randomized double-blinded study among 60 patients was divided into two equal groups of 30 (groups D and L). Group D patients were nebulized with 1 µg/kg of dexmedetomidine diluted in 0.9% saline to a total volume of 4 ml, and Group L patients were nebulized with 4ml of 4% Lignocaine hydrochloride in the preoperative room over 5 min. After induction of general anesthesia, laryngoscopy and intubation were performed, and hemodynamic changes were recorded for statistical analysis. A two-sample t-test was applied to compare means in two groups with a confidence interval of 95%.Result The Dexmedetomidine group demonstrated a significant difference, with lower values of mean heart, systolic, diastolic, and mean arterial pressure rate immediately before laryngoscopy till 10 minutes postintubation (recorded at 2 mins intervals till 10mins) compared to the lignocaine group. The p-values for all the parameters were < 0.001, underlining the robustness of our findings.Conclusion: Nebulised Dexmedetomidine before laryngoscopy is not just an alternative technique, but a superior one for blunting the hemodynamic response to laryngoscopy and endotracheal intubation. It outperforms Nebulised Lignocaine without significant adverse effects, such as postoperative sore throat and sedation, making a compelling case for its adoption in clinical practice.
Succesful Continuous Renal Replacement Therapy (CRRT) for Acute Kidney Injury (AKI) with Septic Shock Underwent Long Coronary Artery Bypass Graft Procedure (CABG) Pertiwi, Previasari Zahra; Fatoni, Arie Zainul; Agustina, Ayu Yesi; Jaya, Wiwi
Journal of Anaesthesia and Pain Vol. 5 No. 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.05

Abstract

Background :AKI occurs in significant numbers of patients undergoing cardiopulmonary bypass surgery for coronary artery disease. Patient with AKI requiring renal replacement therapy (RRT) after cardiac surgery were at a higher risk of postoperative mortality. One of mode of RRT is CRRT. CRRT can keep hemodynamic of the patient stable, excellent control of azotemia, sypport beneficial immunomodulation,increase clearance of inflammatory mediators and potentially less ongoing or repeated renal ischaemia. As an alternative to traditional intermittent hemodialysis, CRRT has now emerged as the leading form of RRT for patients with AKI post CABG because the CRRT can keep hemodynamic still stable.Case: We report a case report of patient who had long aorta cross clamp in CABG procedure. He got AKI with shock condition during hospitalization in ICU, had been done with CRRT and had good response after the procedure.Discussion: The  incidence  of AKI  after  cardiac  surgery in this patient  may  increase  with several risk factors, such as surgical bleeding, diabetes mellitus, pre operative renal dysfunction, low  LVEF,  the use of CPB machine and infection. An  imbalance  between  renal oxygen  supply  and  oxygen demand will induce AKI. This patient had done CRRT and showed good clinical and laboratory condition after that. Conclusion : CRRT is a good choice for AKI patient post CABG procedure with shock condition.
Dexmedetomidine as an Ambulatory Sedation Agent for Abdominal MRI in Patients with Suspected Pheochromocytoma Iradat, Prataganta; Vitraludyono, Rudy; Yupono, Karmini
Journal of Anaesthesia and Pain Vol. 5 No. 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.04

Abstract

Background: Pheochromocytoma is a vascular tumor of chromaffin tissue, most commonly at the adrenal medulla, that produces and secretes norepinephrine and epinephrine and is a tumor that secretes catecholamines. Magnetic resonance imaging (MRI) is often used to provide clinical data and remains challenging in pediatrics. We present anesthesia management for abdominal MRI in pediatric patients with suspected pheochromocytoma.Case: A 12-year-old child weighing 25 kg with a diagnosis of suspected pheochromocytoma will have an abdominal MRI for diagnosis with sedation. Intravenous sedation technique using dexmedetomidine loading dose 50 μg for 10 minutes and continued maintenance of dexmedetomidine dose 17.5 μg/hour. Durante's MRI showed stable hemodynamics. Post-MRI of the abdomen, monitoring, and evaluation were carried out in the conscious recovery room and found no complications.Conclusion: The use of dexmedetomidine as a sedation agent in patients with suspected pheochromocytoma generally shows stable hemodynamics in the absence of signs of catecholamine spikes.
Neuroanesthesia Management in Transspenoidal Pituitary Cyst Surgery Subagyo, Houdini Pradanawan; Nofiyanto, Eko
Journal of Anaesthesia and Pain Vol. 5 No. 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.03

Abstract

Background: Neuroanesthesia management of patients with masses in the sella area undergoing transspenoidal surgery is a challenge for anesthesiologists. Good preoperative, intraoperative and postoperative management is shown to improve the patient’s quality of life.Case: A 45-year-old man with chief complaints of headache and visual disturbances, from the results of the vision examination obtained visus 1/60 (count fingers) and narrowed visual field area. From computerized tomography (CT) scan and Magnetic resonance imaging (MRI) images of the Head obtained a picture of cystic mass of the suprasellar sella pressing the optic chiasm. The patient was planned for surgical excision of pituitary cyst per transspenoidal. The patient underwent general anesthesia with endotracheal intubation with intravenous induction fentanyl, propofol, atracurium and lidocaine, followed by maintenance with sevoflurane inhalation agent with 60% oxygen. During the operation the hemodynamic condition was stable and postoperatively the patient was extubated in the operating room and then treated in the intensive care unit.Conclusion: In pituitary cyst patients undergoing transspenoidal surgery, the preoperative evaluation is mainly aimed at airway assessment, neurological disorders and hormonal disorders in patients. During intraoperative, the anesthesiologist is expected to optimize cerebral oxygenation, maintain hemodynamic stability, facilitate the surgical area, prevent and manage intraoperative complications and rapid recovery of consciousness. Postoperatively a good neuroendocrine evaluation is required

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