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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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Bilateral Diaphragm Paralysis in Deep Neck Infection: Mimicking Respiratory Distress in Sepsis Yakushiji, Tatsumi; Hakozaki, Takahiro; Iseki, Yuzo; Inoue, Satoki
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.2024.005.02.03

Abstract

Background: This case report highlights an occurrence of bilateral diaphragm paralysis following surgical drainage for deep neck infection.Case: A 56-year-old male underwent surgical drainage and tracheostomy for a deep neck infection. Before the second surgical drainage, he exhibited tachypnea (>30 bpm), although his general condition was not significantly compromised. Following a successful drainage procedure, he was transferred to the intensive care unit and placed on mechanical ventilation. Despite attempts at spontaneous breathing trials (SBT), he failed each trial, leading to a deterioration in his general condition. Subsequently, he was diagnosed with diaphragm paralysis.Conclusion: The clinical manifestations of bilateral diaphragm paralysis closely resemble the common symptoms of sepsis. Therefore, it is crucial to recognize that surgical interventions for deep neck infections may pose a risk of developing diaphragm paralysis, likely associated with phrenic nerve palsy.
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.
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.
Perioperative Management of Neuroanesthesia in Patients with Supratentorial Tumors Who Have Excised Tumors Using Neuroprotection Technique and Total Intravenous Anesthesia Aditiarso, Candra; Laksono, Buyung Hartiyo
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.2024.005.02.04

Abstract

Background: Neuroanesthesia management presents a unique challenge for anesthesiologists. They must provide an optimal surgical condition without worsening the patient's neurological deficits. Therefore, we need drugs with neuroprotective abilities. This case report explains the perioperative management of neuroanesthesia in patients with supratentorial tumors who have excised tumors using a neuroprotection technique and total intravenous anesthesia (TIVA).Case: A 43-year-old female patient with space-occupying process cerebri with the differential diagnosis of meningioma frontotemporal dextra, post trepanation frontal sinistra tumor excision, edema cerebri, and hydrocephalus on ventriculoperitoneal shunt. On physical examination, Glasgow coma scale E3M6Vaphasia, aphasia and left hemiparesis were found. She underwent a tumor excision procedure with total intravenous anesthesia modified with neuroprotection techniques and total intravenous anesthesia techniques using 300 mg thiopental, 2 mg midazolam, 150 µg fentanyl, 80 mg lidocaine, and 50 mg rocuronium. Intraoperative anesthesia management was carried out by administering propofol 50 mg/hour, fentanyl 50 µg/hour, and atracurium 15 mg/hour.Conclusion: Total intravenous anesthesia is a complete general anesthesia method used in all intravenous agents, where the benefits of this method are used in neurosurgery, including accelerating the patient's return from the effects of anesthesia, faster recovery of cognitive function, as well as reducing intracranial pressure and the risk of ischemia.
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.  
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.
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.
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
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.
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.   

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