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Anesthesiology and Intensive Therapy Program, Medicine FacultyBrawijaya University, Malang Indonesia Jl. Jaksa Agung Suprapto no.2, Malang, Indonesia
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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 139 Documents
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Evaluation of The Clinical Performance of LMA Proseal versus Blockbuster LMA in Adult Patients Undergoing General Anesthesia: a Randomized Interventional Comparative Study Ryavanaki, Basavaraj; Gupta, Arushi; Sahni, Ameeta; Mehta, Khushboo
Journal of Anaesthesia and Pain Vol. 6 No. 2 (2025): May
Publisher : Faculty of Medicine, Brawijaya University

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

Abstract

Background: The oropharyngeal Leak pressure (OLP) and the minimum effective cuff volume are the two most important determinants of the clinical performance of any supraglottic airway (SGA) device. This study aims to evaluate the clinical performance of the Blockbuster LMA compared with the LMA ProSeal. Methods: One-Hundred patients (18-65 years) posted for elective surgeries under general anesthesia were prospectively randomized into group P (LMA ProSeal) and Group B (Blockbuster LMA). The primary outcome was to measure the OLP at 5 and 30 min after device insertion, and, secondarily, to compare the minimum effective cuff volume to prevent leak, ease and time of insertion, number of attempts, leak fraction, anatomical position of the devices, and adverse respiratory events, if any. Result: The OLP of LMA ProSeal was lower than Blockbuster LMA (28.14 ± 2.79 cmH2O versus 32.62 ± 2.66 cmH2O at 5 minutes and 29.28 ± 3.1 cmH2O versus 33.82 ± 2.55 cmH2O at 30 minutes). The cuff pressure exerted by the Blockbuster LMA at the minimum effective volume to prevent leak was higher than that of the LMA ProSeal. The first attempt success rate and Brimacombe score were higher in Blockbuster LMA. The airway-sealing quality and the incidence of postoperative adverse respiratory events were similar between the two groups. Conclusion: Blockbuster LMA has a higher OLP, a better first-attempt success rate, and an anatomical position than LMA ProSeal, with higher pressure at the minimum effective volume of cuff inflation to prevent leaks, along with the added advantage of acting as a conduit for intubation.
Comparison of C-Reactive Protein Level and Pain Score in 2% Lidocaine Premedication with Tourniquet Handling and 2% Lidocaine Mixture in Propofol Injection Thamrin, Muhammad Husni; Novianto, Bambang; Leofirsta, Hendra
Journal of Anaesthesia and Pain Vol. 6 No. 2 (2025): May
Publisher : Faculty of Medicine, Brawijaya University

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

Abstract

Background: Propofol is a widely used anesthetic induction agent, yet post-injection pain is a frequent adverse effect. Common strategies to reduce this pain include venous occlusion following lidocaine administration and the admixture of lidocaine with propofol. This study investigates whether lidocaine pretreatment with tourniquet application provides superior pain relief compared to the admixture method. Method: We conducted a single-center, randomized controlled, single-blind trial involving patients scheduled for elective surgery. Participants were randomly assigned to receive either lidocaine pretreatment with tourniquet application (n=15) or a lidocaine-propofol admixture (n=15). The primary outcomes were pain scores and C-reactive protein (CRP) levels, while secondary outcomes included heart rate and blood pressure measurements. Result: 30 patients underwent elective surgery in Dr. Moewardi General Hospital between October and November 2023. Post propofol injection, increments in pain severity were observed in both treatment groups. However, lower pain severity was observed in the tourniquet handling group.  After injection, moderate and severe CRP levels were recorded in the lidocaine-propofol admixture (33.3% and 6.7%, respectively), whereas no moderate or severe CRP levels were discovered in the tourniquet handling group. The tourniquet handling group experienced less discomfort after propofol injection (3.139 ± 0.743 vs. 4.27±0.704, p=0.001). Lower CRP levels were evaluated in the experimental group (0.279 ± 0.121 to 1.68 ± 2.49, p=0.002). Conclusion: Lidocaine pretreatment with tourniquet occlusion or one minute before delivering propofol as an anesthetic induction agent was more effective than the lidocaine-propofol admixture in relieving pain after propofol injections.
Are Obstetric Anesthesia Services at District Hospitals Safe in Low-to Middle-Income Countries: A Scoping Review Pillay, Camira; Pillay, Shaylin
Journal of Anaesthesia and Pain Vol. 6 No. 2 (2025): May
Publisher : Faculty of Medicine, Brawijaya University

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

Abstract

Background: Currently, the global maternal mortality rate stands at 152 deaths per 100,000 live births, with many low to middle-income countries (LMICs) not on track to meet this goal. Inadequate obstetric anesthesia is a significant contributor to preventable maternal and newborn deaths. The inability of district hospitals to provide safe anesthesia may lead to poor outcomes. This paper reviews existing data to assess the safety of obstetric anesthesia in district hospitals in LMICs and identify challenges. Methods: A scoping review of grey and peer-reviewed literature was conducted using terms such as “obstetrics,” “anesthesia,” “low to middle-income countries,” and “first-level hospitals.” Of the 3780 citations screened, 22 studies met the inclusion criteria. Result: A narrative synthesis was employed to report the findings, with quality assessed using the Mixed Methods Appraisal Tool. Common issues in LMICs included a shortage of skilled anesthetic providers, lack of funding, poor infrastructure, and limited access to essential equipment, drugs, and blood products. Conclusion: Obstetric anesthesia provision in LMICs, especially at district hospitals, is inadequate. None of the hospitals assessed could provide safe anesthesia. Investments in basic infrastructure, including reliable water and electricity, are needed. Promoting anesthesia appointments and training programs in district hospitals can have a significant, lasting impact on mothers, infants, and the community, helping achieve the Sustainable Development Goals (SDGs).
Unanticipated Laryngeal Neoplasm: A Case of Intraoperative Airway Obstruction Requiring Emergency Tracheostomy Putera, Dewa Gede Agung Sasmara; Sarim, Budi Yulianto
Journal of Anaesthesia and Pain Vol. 6 No. 2 (2025): May
Publisher : Faculty of Medicine, Brawijaya University

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

Abstract

Background: Effective airway management is crucial in anesthesiology, especially when dealing with unexpected complications such as undiagnosed laryngeal tumors. These tumors often present with subtle symptoms that can be easily misattributed to more common conditions, posing significant challenges during intubation.Case : A 19-year-old male with neck lumps, hoarseness, and dysphagia faced severe airway obstruction during anesthesia induction, leading to failed intubation attempts and necessitating an emergency tracheostomy. Postoperative care included ICU admission and multidisciplinary management.Conclusion: This case underscores the importance of comprehensive preoperative evaluations and the use of advanced imaging techniques to identify hidden airway pathologies. Preparedness for emergency airway procedures like tracheostomy is essential for patient safety. Vigilance and thorough preoperative assessments are crucial in anesthesiology to prevent and manage unexpected airway complications effectively.
Perioperative Management of a Post-Cesarean Patient with Severe Preeclampsia, Obstructive Ileus, Sepsis, Acute Kidney Injury, and Decreased Consciousness: A Case Report Novara, Tendi; Cahyono, Iwan Dwi; Yuniar, Maulana Rizqi
Journal of Anaesthesia and Pain Vol. 7 No. 1 (2026): January
Publisher : Faculty of Medicine, Brawijaya University

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

Abstract

Background: Postoperative ileus following cesarean section is a rare but potentially life-threatening complication in obstetric patients, with an estimated global incidence of 0.1–0.3% and approximately 0.2–0.5% in Indonesia. This condition is primarily caused by reduced bowel motility after surgery and may be precipitated by intra-abdominal manipulation, hemorrhage, electrolyte imbalance, anesthetic effects, or systemic inflammation. In patients with severe preeclampsia, the risk of ileus is further increased due to impaired tissue perfusion, endothelial dysfunction, and postoperative bleeding, which may accelerate progression to multi-organ dysfunction. This case report aims to describe the clinical course, diagnostic challenges, and multidisciplinary management of postoperative ileus complicated by intra-abdominal bleeding, sepsis, and acute kidney injury following cesarean section in a patient with severe preeclampsia. Case: We report a 45-year-old woman (body weight 75 kg, height 155 cm, body mass index 31.2 kg/m²) who developed progressive abdominal distension, decreased level of consciousness, and acute kidney injury one day after undergoing cesarean section for severe preeclampsia. Clinical and radiological evaluations suggested obstructive ileus with suspected intra-abdominal bleeding, accompanied by sepsis and severe metabolic acidosis. Management included mechanical ventilation, blood transfusion, metabolic correction, and emergent hemodialysis under controlled sedation.Conclusion: This case illustrates a continuum of pregnancy-related complications beginning with severe preeclampsia and progressing to postoperative ileus and multi-organ dysfunction. Early recognition and prompt, integrated multidisciplinary perioperative management are essential to reduce morbidity and improve clinical outcomes.
Successful Management of Life-Threatening Adrenal Crisis in an Elderly Patient with Secondary Adrenal Insufficiency: A Case Report of Comprehensive Multidisciplinary Care Setiadi, Teguh; Adiyanto, Bowo
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): In Press
Publisher : Faculty of Medicine, Universitas Brawijaya

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

Abstract

Background: Adrenal crisis is an acute, life-threatening manifestation of cortisol deficiency that requires prompt recognition and treatment. Infection and sepsis are important precipitating factors, particularly in patients with underlying adrenal insufficiency. We report the successful multidisciplinary management of adrenal crisis complicated by septic shock and metabolic disturbances in an older patient.Case: A 64-year-old female patient with a diagnosis of adrenal crisis, septic shock, hyponatremia, recurrent hypoglycemia, and hospital-acquired pneumonia (HAP) is reported. Initial management included hydrocortisone administration as an exogenous glucocorticoid to address cortisol deficiency. Associated shock was managed with fluid resuscitation and vasopressors. Additionally, management of complications such as treating hypoglycemia with dextrose administration, correcting hyponatremia, and culture and antibiotic sensitivity testing were performed. Antibiotic therapy was administered in stages, starting with Ceftriaxone (empirical), escalation to Meropenem and Vancomycin, then de-escalation according to culture and sensitivity results. After 8 days of intensive care unit (ICU) treatment, the patient's condition improved, followed by 5 days of step-down care in the high care unit (HCU). The patient was then transferred to the general ward for 4 days. The patient was discharged with the tracheostomy still in place.Conclusion: Adrenal crisis in critically ill patients requires rapid glucocorticoid replacement together with simultaneous treatment of precipitating infection, shock, electrolyte abnormalities, and hypoglycemia. This case highlights the importance of coordinated multidisciplinary care, close physiologic monitoring, and culture-guided antimicrobial therapy in achieving clinical stabilization and recovery.
Ultrasound-Guided Axillary Block for Distal Radius Fracture Surgery during Second-Trimester Pregnancy: a Case Report Putra, I Made Prema; Sudiantara, Putu Herdita; Aryawangsa, Anak Agung Ngurah
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): In Press
Publisher : Faculty of Medicine, Universitas Brawijaya

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

Abstract

Background: Non-obstetric surgery during pregnancy requires an anesthetic strategy that preserves maternal safety while minimizing fetal risk. Regional anesthesia is an attractive option for upper-extremity surgery because it avoids airway manipulation and reduces systemic drug exposure. We describe the use of ultrasound-guided axillary block for distal radius fracture surgery during second-trimester pregnancy.Case: A 33-year-old woman (gravida 2, para 1, living 1) at 18–19 weeks’ gestation, American Society of Anesthesiologists physical status II, presented with a closed distal-third right radius fracture requiring open reduction and internal fixation. Obstetric assessment and fetal heart rate were normal. Mild sedation was achieved with intravenous midazolam 1 mg and fentanyl 50 µg, with supplemental oxygen and continuous respiratory monitoring. Ultrasound-guided axillary block was performed using 10 mL 0.5% levobupivacaine, 6 mL 2% lidocaine, and dexamethasone 5 mg; total local anesthetic doses remained within accepted safety limits. Complete sensory and motor block developed within 15 minutes. The 1-hour procedure was completed uneventfully without conversion to general anesthesia, with stable maternal hemodynamics and normal fetal heart rate throughout. Postoperative analgesia was satisfactory, requiring one fentanyl patient-controlled analgesia activation. She was discharged on postoperative day 2. At 37 weeks, elective cesarean delivery resulted in a healthy mother and neonate, with no obstetric complications.Conclusion: Ultrasound-guided axillary block provided effective surgical anesthesia and prolonged postoperative analgesia for distal radius fracture surgery in this second-trimester pregnant patient, with favorable maternal and fetal outcomes. pregnancy, non-obstetric surgery, axillary block, brachial plexus block, distal radius fracture, regional anesthesia.
Dexmedetomidine versus Propofol or Midazolam for Sedation in Neurocritical Care: A Systematic Review and Meta-analysis Indrawan, Khadafi; Sedono, Rudyanto; Wulung, Navy Gerard H. M. Lolong
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): In Press
Publisher : Faculty of Medicine, Universitas Brawijaya

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

Abstract

Background: Sedation in neurocritical care must provide adequate comfort and ventilator tolerance while preserving neurological assessment and minimizing hemodynamic instability. Dexmedetomidine, propofol, and midazolam are widely used, but their comparative effects on clinically important outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate whether dexmedetomidine improves hemodynamic outcomes, intensive care unit (ICU) length of stay, and duration of mechanical ventilation.Methods: This systematic review and meta-analysis included randomized controlled trials and observational studies involving adult neurocritical care patients that compared dexmedetomidine with propofol or midazolam, reported hemodynamic outcomes, ICU length of stay, or duration of mechanical ventilation.  We pooled continuous outcomes as mean differences (MDs) and categorical outcomes as odds ratios (ORs), with 95% confidence intervals (CIs).Results: Of 2,113 records identified, nine studies met the eligibility criteria. Compared with propofol, dexmedetomidine showed no significant difference in bradycardia (OR 2.72; 95% CI 0.62–11.93; p=0.18), hypotension (OR 0.89; 95% CI 0.64–1.25; p=0.51), or mean arterial pressure change (MD 1.12; 95% CI −5.11 to 7.35; p=0.72). ICU length of stay was similar versus propofol (MD −3.21 days; p=0.40) and midazolam (MD −5.97 days; p=0.09). Mechanical ventilation duration was also not significantly reduced versus propofol (MD −1.36 days; p=0.08) or midazolam (MD −2.00 days; p=0.22).Conclusion: Dexmedetomidine showed no significant superiority over propofol or midazolam in neurocritical care. Sedative selection should therefore be individualized according to neurological status, hemodynamic profile, ventilation requirements, and patient-specific risks.
Persistent Post-Dural Puncture Headache in an Autoimmune Patient: Diagnostic Challenges and Successful Management with Epidural Blood Patch Mangkuwerdojo, Liliana; Pryambodho; Sukmono, Raden Besthadi
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): In Press
Publisher : Faculty of Medicine, Universitas Brawijaya

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

Abstract

Background: Epidural blood patch (EBP) remains the gold-standard intervention for post-dural puncture headache (PDPH), offering rapid and substantial symptom relief. Case: A female in her 20s underwent diagnostic lumbar puncture for evaluation of suspected autoimmune disease. Approximately three days following the procedure, she developed a progressively worsening orthostatic headache (Visual Analogue Scale [VAS] 3–4 at baseline, escalating to 8–9 with positional changes), accompanied by photophobia, nausea, and pain with eye movement. Conservative management and transnasal sphenopalatine ganglion (SPG) block provided only partial and transient relief. An EBP was subsequently performed using 10 mL of autologous blood, resulting in complete bilateral resolution of headache at 24-hour follow-up without significant adverse effects. Conclusion: This case highlights the effectiveness of EBP in managing refractory PDPH unresponsive to conservative treatments and SPG block, even in patients with complex autoimmune backgrounds. EBP remains the definitive treatment for refractory PDPH as a safe and effective option, including in selected patients with underlying autoimmune disease.

Page 14 of 14 | Total Record : 139

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