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Solo Journal of Anesthesi, Pain and Critical Care
Published by Universitas Sebelas Maret
ISSN : 27761770     EISSN : 27970035     DOI : https://doi.org/10.20961
Core Subject : Health, Engineering,
Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health
Case Report, Original Research and Review Article in the scope of : Life Support Emergency and Trauma Cardiovascular Anesthesia Pediatric Anesthesia Neuro Anesthesia Pain Management Intensive Care Obstetry Anesthesia Geriatric and Oncology Anesthesia Regional Anesthesia Ambulatory Anesthesia
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 5 Documents
 1 
Search results for , issue "Vol 3, No 2 (2023): October 2023" : 5 Documents clear
Anesthetic Management for Urgent Caesarean Section in Patient with Uncontrolled Hyperthyroidism and Severe Mitral Regurgitation Reyfal Khaidar; Andri Subiantoro; Wahyu Sugiharto; Tomy Oky Prasiska
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.64451

Abstract

Background :The prevalence of hyperthyroidism in pregnancy approximately 0.05% to 3% and mostly caused by Graves’ Disease (GD). The prevalence of Hyperthyroid Heart Disease (HHD) in pregnancy is 3.87%. Uncontrolled hyperthyroidism during pregnancy can increase maternal and fetal mortality. We report a case of a pregnant woman with uncontrolled hyperthyroidism and severe mitral regurgitation that underwent cesarean section with spinal anesthesia for delivery.Case Illustration :A 33 years-old patient G4P1A2 visited the Obstetric-Gynecology outpatient clinic at our hospital at 23 weeks of gestation (WoG) due to uncontrolled hyperthyroidism caused by GD that diagnosed 3 years ago and shortness of breath. The echocardiography test obtained severe mitral regurgitation and left atrial dilatation with 58% LVEF. It was decided to maintain the pregnancy till the fetus is viable while still monitoring the patient’s condition. At 32 WoG, the patient came to the ED due to shortness of breath, chest pain, and nausea. Fetal movement and fetal heart rate (FHR) were within normal limits. The patient was given a nasal cannula at 3 liters/minute, extra furosemide 20 mg, and fetal lung maturation with dexamethasone injection. The patient was prepared for termination by cesarean section. Spinal anesthesia was performed in a sitting position using a 27 G spinal needle. Inserted at L 3-4, using a low dose of heavy bupivacaine 0.5% 7.5 mg combined with 25 g fentanyl and 0.1 mg morphine intrathecally. C-section was successfully performed and hemodynamics during surgery was stable, resulting the delivery of a preterm baby who weighed 1.9 kg at birth and the baby was transferred to the NICU for further treatment.Conclusion : Spinal anesthesia with low dose bupivacaine combined with opioids for cesarean section was revealed maternal and neonate safe.
Effectiveness of Low-Dose Intermittent Epidural Bolus of 1 mg Morphine as Postoperative Analgesia Gusti Ayu Pitria Septiani
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.67251

Abstract

Background: Patients who have undergone major surgery typically experience postoperative pain that persists for seven days following surgery. The challenge for the anesthesiologist is to provide adequate postoperative pain control which is not always achievable. In contrast to systemic administration, epidural administration of opioids places the medications close to the site of action, allowing for relatively small doses to be effective with a low incidence of side effects. Morphine is a long-established analgesia drug that characteristically slows diffusion and long duration in epidural analgesia, making it widely used in postoperative pain management. However, giving morphine is not without any complications.Case Illustration: Nine patients who underwent major surgeries either under combined epidural-general anesthesia or epidural anesthesia received a low-dose intermittent epidural bolus of 1 mg morphine in 10 mL normal saline every 12 hours after surgery. Postoperative pain scores were recorded at the 1st,12th,24th, 36th, and 48th hours after surgery, data of additional rescue analgesia, and the incidence of nausea, vomiting, pruritus, sedation, and respiratory depression were also collected. Only one patient needed rescue analgesia with 30 mg Ketorolac IV, and one patient needed anti-emetic with 4 mg ondansetron IV an hour after the completion of surgery. The rest of the patients have mild pain (NRS≤3/10) within 48 hours after surgery. Furthermore, there is no other adverse effects of morphine were foundConclusion: low dose intermittent epidural bolus of 1 mg morphine can be used as effective postoperative analgesia and has fewer adverse effects.
Relationship Between Simple Oxygen Extraction Ratio to Cardiac Index and Mean Arterial Pressure in Septic Shock Patient Treated in ICU Dr. Sardjito Hospital Yogyakarta helen yudi irianto; Akhmad Yun Jufan; Untung Widodo
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.76067

Abstract

Background : Oxygen extraction ratio (O2ER)  having any relationship with  cardiac index and mean arterial pressure in septic shock patient.Objective: Discover any relation between simplified oxygen extraction ratio with cardiac index and mean arterial pressure in shock septic condition at ICU of RSUP Dr Sardjito YogyakartaMethod : 32 subject with crossectional study was performed by inclution criteria such as : patient in ICU diagnosed as shock septic, more than 18 years old, inerted cvc in right atrium, inserted arterial line in  arterial radialis or brachialis which connected mostcare. BGA (arterial and venous ) sampel was taken by I-STAT® together with recording mean arterial pressure (MAP) and cardiac index value.Result :  Correlation between O2ER and cardiac index p=0,009 (p<0,05) with r -0,456. Correlation between O2ER and MAP p=0,006 (p<0,05) with r-0,474.Conclusion :Anesthesia management of TGA TGA cases is to avoid reducing cardiac output and SVR and keep the PVR lower than the SVR.
Anaesthetic Management during Balloon Atrial Septostomy in Transposition of Great Arteries Devina Ravelia Tiffany Subroto; Ulya A&#039;malia; Ardian Wibowo
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.62221

Abstract

Background: Transposition of the great arteries (TGA) is a congenital heart defect that can cause death in 30% of the first week of birth, 50% in the first month, 70% in 6 months, and 90% in the first year, thus requiring immediate corrective action in neonates with rapid early detection. The purpose of this case study is to highlight management considerations in TGA cases in the Balloon Atrial septostomy (BAS) procedure.Discussion: A 1-day-old newborn girl was brought to               Dr. Moewardi General Hospital in February 2022. The patient had a history of cyanosis when she cried and was born with an APGAR score of 6.7.8. The lips were cyanotic on physical examination, with a SpO2 of 77% with a nasal O2 of 2 lpm. The echocardiography results obtained TGA, ASD II, PFO, and PDA. The patient then underwent a BAS procedure. Anesthesia management was performed using ketamine for induction, air bar, O2, and sevoflurane for maintenance of anesthesia. The operation was successful, and postoperative care was carried out. Anesthesia management aims to keep SVR and PVR to a minimum, with a PVR lower than SVR, to prevent desaturation in the patient. A decrease in PVR also can increase pulmonary blood flow, allowing more blood to be mixed and higher oxygen saturation in the blood for the patient.Conclusion: The principle of anesthesia management in TGA cases is to avoid a reduction in cardiac output and SVR and keep the PVR lower than the SVR.
Meta-Analysis of Higher PEEP Strategies' Effects on Mortality Rates and Inflammatory Mediators in Patients with ARDS: A Perspective Review on Patients with Severe COVID-19-Associated ARDS Yehuda Tri Nugroho Supranoto; I Made Putra Wira Negara
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.62253

Abstract

Background: Different strategies of positive end-expiratory pressure (PEEP) in mechanical ventilation are crucial for patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). PEEP acts as a “double-edged sword” for ARDS patients. PEEP could recover pulmonary atelectasis but can induce alveolar hyperinflation.Objective: This review aimed to evaluate the effect of higher PEEP in patients with severe COVID-19-associated ARDS.Method: This meta-analysis included randomized controlled trial (RCT) studies to assess the mortality rates, barotrauma events, and inflammatory mediators modulation due to higher PEEP strategies. The pooled effect of the mortality rates and barotrauma events were presented as risk ratios (RR) with 95% confidence of interval (CI) using random-effects model (REM) or fixed-effects model (FEM).Results: We identified twelve RCTs comparing higher versus lower PEEP in ARDS patients. There was unsignificant result in overall mortality rates group [RR=0.94,95%CI(85,1.03),p=0.21] but not in mortality after positive response of oxygenation group [RR=0.88,95%CI(0.81,0.95),p=0.002] in higher PEEP group. In terms of patients without positive response of oxygenation, higher PEEP group had significantly higher mortality rates [RR=1.07,95%CI(1.00,1.15),p=0.06]. Higher PEEP significantly reduced the mortality rates in ARDS patients with PaO2/FiO2<150 mmHg [RR=0.867,95%CI(0.74,1.00),p=0.04] instead of patients with moderate ARDS (PaO2/FiO2 ≥150 mmHg) [RR=1.12, 95%CI(0.85,1.47), p=0.44]. There were no differences in overall barotrauma events [RR=1.03,95%CI(0.78,1.36),p=0.85] between higher and lower PEEP group. The use of higher and lower PEEP also contribute to the modulation of inflammatory mediators including TNF-α, IL-6, IL-1RA, and IL-8.Conclusion: Higher PEEP could reduce the mortality of patients with ARDS who responded to the oxygenation. Higher PEEP does not increase the risk of overall barotrauma events. Higher PEEP can modulate the inflammatory mediators.

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