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A Technical Approach to Anesthesia in the Case of Tonsillectomy Febrian Dwi Cahyo; Bambang Sutanto; Iin Novita Nurhidayati Mahmuda
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 1 (2023): April 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i1.60444

Background: Tonsillectomy is the most common surgical procedure performed by an ENT doctor (Throat Nose Ear) in children. This surgery can cause pain, bleeding and swelling in the injured throat. Patient may complain of pain, difficulty swallowing, eating, drinking disorders, nausea and vomiting and fall into a dehydrated state. This can reduce patient satisfaction.Discussion: Postoperative pain management of tonsillectomy is a concern both by the ENT doctor and by the anesthesiologist. The high incidence of post-tonsillectomy pain or anxiety increases the risk of secondary post-tonsillectomy bleeding. It is necessary to know the mechanism of post operative pain and the negative impact of pain.Conclusion: Doctors should give attention to reduce postoperative pain and choose a rational analgesic to overcome post operative tonsillectomy pain.

Comparison Between Norepinephrine-Epinephrine and Norepinephrine-Vasopressin Effectiveness in Reducing Mortality in Septic Shock: A Systematic Review Kenneth Tan; Benedictus Benedictus; Christopher William Purnomo
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 1 (2023): April 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i1.62121

Background: Sepsis is a state of organ dysfunction caused by the immune system’s abnormal response to an infection. Septic shock is sepsis complicated by circulatory and metabolic abnormalities, oftentimes resulting in death. Prompt identification and treatment of septic shock is crucial for the survival of patients. The latest international guideline recommends the administration of norepinephrine as the first line vasopressor, with the addition of epinephrine or vasopressin as an aid in achieving the target MAP (Mean Arterial Pressure).Methods: This study is a systematic review of literatures from the databases Pubmed PMC, Science Direct, and Proquest. Systematic reviews on septic shock, norepinephrine, and epinephrine or vasopressin were among the inclusion criterias. This resulted in a total of five systematic reviews to be included in the qualitative synthesis.Results: The five included studies were not in sync as to which vasopressor is best used for the treatment of septic shock patients. One of which did not compare the two combinations within the same category, two of which favored the use of norepinephrine-epinephrine, and the other two favored the use of norepinephrine-vasopressin for the treatment of septic shock patients.Conclusion: The existing evidence were insufficient to give a conclusion of the best combination of vasopressors for septic shock patients. More research, specifically randomized controlled trials, needs to be conducted on this topic with well defined administration of combinations of vasopressors as an advancement of this systematic review. The writers also recommend the delay of anymore systematic reviews until the former recommendation has been met.

Permissive Hypotension Strategy in Open-surgery of Abdominal Aortic Aneurysm Alvian Chandra Budiman; Handayu Ganitafuri; Bambang Novianto Putro
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 1 (2023): April 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i1.62208

Background: Open-surgery in patients with aortic aneurysms has always been a challenge for every anesthesiologist. The risk of massive bleeding, hemodynamic instability, and peripheral perfusion insufficiency are some of the reasons for the need of appropriate perioperative management. The purpose of this case report is to describe the permissive hypotension strategy in open-surgery of abdominal aortic aneurysm. Case Ilustration: A 65-year-old man with radiologic findings of an aneurysm in the abdominal aorta at 3rd-4th lumbar vertebrae level was planned for open-surgery aneurysmectomy and aortic graft. Pre-operative assessment concluded the physical status of ASA III. Patient was planned to receive general anesthesia. Invasive hemodynamic monitoring was performed by placing an arterial line and a central venous catheter. Just before the aortic clamp procedure, permissive hypotension strategy was started by lowering systolic blood pressure using titrated doses of nitroglycerin with target MAP of >60 mmHg. Bleeding management was carried out with intravascular fluid resuscitation until the CVP target of 7-8 mmHg was achieved. When the aortic clamp was released, titrated dose of norepinephrine was administered with target MAP of 65-75 mmHg. Post-operatively, the patient was admitted to the ICU. The patient was discharged on the seventh post-operative day. Conclusion: This case demonstrated the successful perioperative management of an open surgery aneurysmectomy by maintaining the hemodynamic stability of the patient using permissive hypotension strategy. The successful stabilization of patient’s hemodynamic state during surgery resulted in a good and fast post-operative outcome and recovery.

A Meta-Analysis of 80% Fraction of Inspired Oxygen on Surgical Site Infection in Patients Undergoing Surgery Rifaldy Nabiel Erisadana; Achmad Ilham Tohari; Yehuda Tri Nugroho Supranoto; Wiwien Sugih Utami; Laksmi Indreswari
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 1 (2023): April 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i1.62251

Background: WHO recommended the use of 80% FiO2 in patients undergoing general anesthesia with endotracheal intubation (ETI) to prevent surgical site infection (SSI). However, the ongoing debate regarding efficacy and safety raises because further trials have been published. We conducted a review based on recommendations in terms of SSI as the primary outcome and adverse events as the secondary outcome in both patients with or without ETI.Method: A literature search was carried out by PubMed, ScienceDirect, and Google Scholar for RCTs in all-type surgical patients who administrated 80% FiO2 compared with 30–35% FiO2. Pooled relative risks with a 95% confidence interval were conducted for meta-analysis. Result: Based on 23 RCTs included in the analysis, there were no significant differences in terms of SSI (RR,0.85; 95%CI, 0.72 to 1.01; p=0.07), sepsis (RR,1.47; 95%CI, 0.78 to 2.76; p=0.23), postoperative hospitalization days (PHD) (RR,0.16; 95%CI, -0.67 to 0.98; p=0.71), ICU admission (RR,0.94; 95%CI, 0.78 to 1.13; p=0.50), reoperation required (RR,0.78; 95%CI, 0.30 to 2.06; p=0.62), and 30-days mortality (RR,1.18; 95%CI, 0.76 to 1.84; p=0.45). In contrast, even though the subgroup analysis showed association that PHD longer in high FiO2 group for colorectal surgery (RR,0.80; 95%CI, 0.24 to 1.35; p=0.005), the high FiO2 significantly reduced SSI and anastomotic leakage in abdominal surgery (RR,0.78; 95%CI, 0.62 to 0.99; p=0.04 and RR,0.55; 95%CI, 0.36 to 0.85; p=0.008).Conclusion: This meta-analysis provides evidence that administration of 80% FiO2 even though association with longer of PHD in colorectal surgery, it is associated with a reduction in SSI and anastomotic leakage in patients who underwent abdominal surgery. It contrasts for sepsis, ICU admission, reoperation required, 30-day mortality, SSI, and PHD in all-type surgery.

Outcome Comparison Between Insulin-Dependent and Non Insulin-Dependent Patients after Open Adult Cardiac Surgery Juni Kurniawaty; Budi Yuli Setianto; Supomo Supomo; Yunita Widyastuti; Cornelia Ancilla; Cindy Elfira Boom
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 1 (2023): April 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i1.66306

Background: Insulin-dependent diabetic patients usually have poor glycemic control and higher risk of complications than non-insulin-dependent diabetic patients. However, the difference in clinical outcomes between these two groups of patients who underwent open cardiac surgery was not established. Therefore, this study compares the short-term outcome of insulin vs non-insulin-dependent diabetic patients after open cardiac surgery in a large-scale study.Methods: The study design was a retrospective cohort. All adults who underwent open cardiac surgery between January 1st 2016-December 31st 2020 in 4 tertiary hospitals in Indonesia were included in the study. From a total of 4.931 samples included in the study, 3.753 patients were non-diabetic (Group I) and 1.178 were diabetic (Group II). Group II was divided into subgroup IIA (930 non-insulin-dependent) and subgroup IIB (248 insulin-dependent). The main outcome was in-hospital mortality of open cardiac surgery patients.Result: In-hospital mortality between group I and II had no significant difference (6.8% vs 5.7%; p = 0.188), as well as IIA and IIB (5.6% vs 6%; p = 0.782). Multivariate analysis demonstrated that diabetes did not increase mortality of open cardiac surgery (OR 0.665; p = 0.021). In-hospital mortality of subgroup IIB was higher than subgroup IIA, but insulin therapy did not increase the risk of in-hospital mortality (OR 1.259; p = 0.464).Conclusion: Both insulin-dependent and non-insulin-dependent diabetes mellitus were not the predictors of poor short-term outcomes for open adult cardiac surgery patients.

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

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

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

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'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

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

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.

Home Page

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Contact Name
Septian Adi Permana

Contact Email
septian.adi03@gmail.com

Phone
+6282134489403

Journal Mail Official
sojafkuns@unit.uns.ac.id

Editorial Address
Jl. Kolonel Sutarto No.132, Jebres, Kec. Jebres, Kota Surakarta, Jawa Tengah 57126

Location
Kota surakarta,

Jawa tengah

INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name Septian Adi Permana

Contact Email septian.adi03@gmail.com

Phone +6282134489403

Journal Mail Official sojafkuns@unit.uns.ac.id

Editorial Address Jl. Kolonel Sutarto No.132, Jebres, Kec. Jebres, Kota Surakarta, Jawa Tengah 57126

Location Kota surakarta, Jawa tengah INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
Septian Adi Permana

Contact Email
septian.adi03@gmail.com

Phone
+6282134489403

Journal Mail Official
sojafkuns@unit.uns.ac.id

Editorial Address
Jl. Kolonel Sutarto No.132, Jebres, Kec. Jebres, Kota Surakarta, Jawa Tengah 57126

Location
Kota surakarta,

Jawa tengah

INDONESIA