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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 129 Documents
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Epidural Anesthesia Management in Cesarean Section with Placenta Accreta Aura Ihsaniar; Pandu Anggoro
Journal of Anaesthesia and Pain Vol 3, No 3 (2022): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2022.003.03.05

Abstract

Background: In pregnant women, the spectrum of placenta accreta is considered a high risk syndrome. Placenta accreta is responsible for 7-10% of all maternal deaths worldwide. This study reports on a patient with placenta accreta who underwent a cesarean section using epidural anesthesia.Case: A 30-year-old woman (Gravida: 3, Abortus: 1, Partus: 1) with a gestational age of 8 months came to the hospital.  with 8 months of gestation was diagnosed with antepartum hemorrhage et causa placenta previa totalis morbidly adherent placenta high risk with planned elective cesarean section with bilateral tubectomy to hysterectomy, Double J (DJ) stent, Ballooning using epidural anesthesia with physical American Society of Anesthesiologists (ASA) II status. Local anesthetic with 2% lidocaine 2 ml, 12 ml of 0.5% bupivacaine given in incremental doses of 4 ml every 5 minutes while monitoring the patient's hemodynamics. Intraoperative drugs consist of intravenous (IV) dexamethasone 5 mg IV, ondansetron 8 mg IV, tranexamic acid 1 gram, paracetamol 1 gram IV, bupivacaine 0.5% 3ml every 1 hour via an epidural catheter. Maintenance using O2 3 lpm. The operation lasted 450 minutes, with stable outcome both maternal and fetal.Conclusion: Anesthesia management in patients with bleeding during labor is very important. In this case, epidural anesthesia provide a good outcome in maternal and fetal after cesarean section in placenta accreta patient. 
Difficult Airway Management in Pediatric Patient with Neck Contracture Pradipta Arief Pramono; Fitri Hapsari Dewi
Journal of Anaesthesia and Pain Vol 3, No 3 (2022): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2022.003.03.04

Abstract

Background: A specific airway evaluation and physical examination should be performed in all pediatric patients undergoing anesthesia. Pediatric difficult airway problems can occur due to congenital, inflammation, trauma, or malignant disorders. Laryngeal mask airway (LMA) is an alternative breathing device for difficult airway cases.Case: We reported a 5-year-old girl, 12 kg of weight, with a diagnosis of Colli region contracture planned for contracture release. Physical examination revealed glasgow coma scale score 15, with a pulse of 98 beats per minute, a breath rate of 22 times per minute and SpO2 of 98% on the room air. In the airway evaluation, it was found that the lower mouth was pulled down by the contracture tissue, 2-fingers-wide of mouth opening, the mallampati score was difficult to evaluate, there was no obstruction and neck motion was limited due to contractures. In this report, intubation via video laryngoscope was failed due to the severely restricted neck motion caused by the contracture. The use of LMA became an alternative difficult airway management in this patient after failed intubation with a video laryngoscope.Conclusion: Preoperative evaluation for assessing and evaluating difficult airway in pediatric patients greatly determines the success of airway management. The use of airway devices such as LMA is still very helpful in cases of pediatric difficult airway. 
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.
Combination of Femoral and Parasacral Sciatic Nerve Block as Multimodal Pain Management in Post Hemiarthroplasty Surgery Patient Faundra Arieza Firdaus; Ristiawan Muji Laksono
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.2023.004.01.03

Abstract

Background: The prevalence of femoral neck fractures is high in geriatric patients with a high mortality rate. Many geriatric patients have comorbidities and find it difficult to tolerate general or neuraxial anesthesia during hip hemiarthroplasty. A more safe technique in lower extremities using peripheral nerve blocks is preferred. The combination of sciatic nerve blocks and psoas compartments can supply adequate anesthesia for hip surgery thus reducing mortality. Femoral nerve blocks decrease the incidence of complications than psoas compartment blocks.Case: A 88-year-old female patient, 70 kg, with distal femoral subtrochanteric fracture accompanied by dislocation, hypertension emergency, hyperplasia heart disease (HHD), and heart failure stage B Fc II were undergoing hemiarthroplasty with regional anesthesia sciatic nerve block and femoral block. After surgery, a block was performed using regional anesthesia sub-arachnoid block bupivacaine 0,5% 7mg + fentanyl 25 µg + Morphin 0,1 µg, post-operative pain with ultrasound, the patient received 0.375% naropin and 50 mg trilac total volume 20 cm3. Then femoral block was done with 0.375% and 50 mg trilac total volume 20 cm3.  Patients were observed for pain scale during hospitalization, time of mobilization, and length of stay. Post-operative hemodynamic was stable, the pain scale using VAS assessment was 0-1 during hospitalization without additional opioid analgesia, active mobilization began on the 2nd day, and the length of stay was 3 days.Conclusion: The combination of a femoral and sciatic nerve block to the proximal part of the skin incision can supply adequate pain compliance for hip hemiarthroplasty.
Intravenous Immunoglobulin (IVIG) Therapy for COVID-19 Omicron (B.1.1.529) Variant with Acute Respiratory Distress Syndrome Dewi Arum Sawitri; Arie Zainul Fatoni
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.2023.004.01.04

Abstract

Background: COVID-19 become the pandemic and infect more than million people. The World health organization and other clinical institutions have not yet established a definitive therapy to treat this disease due to a rapid virus mutation and anomaly.Case: A 78-year-old man who had previously confirmed COVID-19 was referred to the COVID-19 intensive care unit (ICU), the patient had geriatrics comorbid, cerebrovascular accident (CVA) infarction, and hypertension. The patient came with unresponsive awareness, and complaints of right hemiparesis and dysarthria. Other symptoms included cough, shortness of breath, and fever. Shortness of breath aggravates, blood pressure increases, and SpO2 was 86%. We decide intubated the patient because have a sign of respiratory distress. Patients receive standard therapy for COVID-19. On the second day, patient receive intravenous immunoglobulin (IVIG) gamaras 20 g. IVIG therapy perform for five days. On the fifth day of treatment in the ICU, the patient’s complaints had decreased and the patient breathed spontaneously with high flow nasal cannula (HFNC).Conclusion: Intravenous immunoglobulin (IVIG) therapy on the COVID-19 Omicron variant patient with ARDS produce a positive outcome. Patients treat with IVIG for 5 days show an improvement in breathing, laboratory result and chest x-ray. 
Ultrasound-guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patient Undergoing Inguinal Hernia Repair Heri Dwi Purnomo; Dimas Yuliar Sevanto
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: 10.21776/10.21776/ub.jap.2023.004.01.05

Abstract

Background: The Transversus Abdominis Plane (TAP) block technique is one method for inhibiting abdominal pain stimuli by blocking afferent nerves in the abdominal wall via the Petit triangle. TAP block action is frequently performed as a postoperative procedure, such as in the case of hernia repair. The goal of using ultrasound in TAP blocks is to distribute the anesthetic agent accurately in the appropriate neurovascular plane.Case: A 66-year-old male geriatric patient with an incarcerated right inguinal hernia and a history of Hypertensive Heart Disease (HHD) was seen. The patient complained of right groin pain that spread to the right side of the abdomen. Based on the Electrocardiogram (ECG), atrial fibrillation was identified as slow ventricular response and Left Ventricular Hypertrophy (LVH). Chest X-ray revealed cardiomegaly with LVH configuration. ASA III E was assigned to the patient. Regional Anesthesia Subarachnoid Block (RASAB) was used to perform an emergency hernia repair using a regimen of Bupivacaine heavy 0.5% 7.5 mg with adjuvant Fentanyl 50 g. Bilateral TAP block administration using Ropivacaine regimen 0.25% of the total volume of 30 ml was given as postoperative analgesia management. Hemodynamic monitoring, complications and postoperative pain scale were carried out in the High Care Unit (HCU). Hemodynamically stable, pain scale was 1-2 at 24 hours postoperative and no complications. Conclusion: TAP block is provide an effective and safe anti-pain effect in patients undergoing hernia repair with geriatric comorbidities and a history of HHD, as well as to prevent cardiovascular complications and to speed up postoperative patient mobilization.
Comparison Between Hydrocortisone and Dexamethasone Given Intraperitoneally for Postoperative Pain Relief in Patients After Laparoscopic Hysterectomy – an Observational Study Reshma Sugathan; Shari Sasikumar; Muhammed Alif
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.2023.004.01.02

Abstract

Background: Pain after laparoscopic surgeries is a common complaint which can prolong hospital stay and delay recovery. Different methods have been developed to manage pain after laparoscopic hysterectomy. One such technique is intraperitoneal instillation of local anaesthetics with adjuvants like hydrocortisone, dexmeditomedine, magnesium sulphate. Various studies have confirmed the efficacy of local anaesthetics with hydrocortisone for analgesia. Studies comparing sole use of steroids are few. We thus devised to conduct a study to compare how effective hydrocortisone or dexamethasone administered intraperitoneally is in causing relief from pain after laparoscopic hysterectomy.Methods: We conducted an observational study, 60 patients planned for laparoscopic hysterectomy were classified into two groups. Group A (n=30) who received 100 mg hydrocortisone in 50 ml normal saline intraperitoneally and Group B (n=30) who received 8 mg dexamethasone in 50 ml normal saline intraperitoneally. Abdominal and shoulder pain was assessed using visual analogue scale (VAS) at 1, 6, 12 and 24 hour after surgery.Results: Both Group A and B had similar efficacy in providing both abdominal pain and shoulder pain relief post operatively. Both groups had no rescue analgesic requirement after 12 hour. Both drugs were has low incidence of postoperative nausea and vomiting (PONV).Conclusion: Intraperitoneal dexamethasone is as equally effective as hydrocortisone in providing postoperative analgesia and antiemesis after laparoscopic hysterectomy
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.
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.
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.

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