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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 40 Documents
 1   2   3   4 
Effectiveness of Atropine Sulfate and Diazepam in Organophosphate Poisoning in Remote Area: A Case Report Junapati, I Kadek Ludi; Pratama, Fabianus Anugrah
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.77914

Abstract

Background: Organophosphate poisoning is a significant public health concern in developing countries, including Indonesia, largely due to the widespread use of pesticides and insecticides. These chemicals, while effective for agricultural purposes, have been linked to severe health issues, including acute poisoning. One of the major health risks associated with organophosphate exposure is its potential link to suicide attempts. The toxic effects of organophosphates primarily stem from their inhibition of acetylcholinesterase, an enzyme crucial for the proper functioning of the nervous system. This inhibition leads to the accumulation of acetylcholine, resulting in overstimulation of the nervous system. Managing organophosphate poisoning poses a considerable challenge, particularly in remote areas where access to specific antidotes is limited. Case Illustration: A 17-year-old female high school student presented to the emergency room of the Boawae Primary Health Care Center with a major complaint of decreased consciousness, as evidenced by a Glasgow Coma Scale (GCS) score of 9/15. The patient had no prior history of neurological or psychiatric disorders. It was suspected that the patient had attempted suicide by ingesting pesticides approximately 60 minutes prior to admission. At the time of admission, she exhibited symptoms including nausea and vomiting, which had progressively worsened. Upon examination in the emergency room, the patient displayed increased saliva production and pinpoint pupils. In response to these symptoms, the medical team administered intravenous Diazepam and Atropine Sulfate, continuing treatment until atropinization was achieved. Conclusion:  In managing organophosphate poisoning, particularly in remote regions with limited access to specific antidotes, Atropine Sulfate and Diazepam represent viable alternative treatment modalities. These treatments can effectively counteract the toxic effects of organophosphates and achieve necessary atropinized conditions to stabilize the patient’s condition.
Resolution of Complete AV block to Normal Sinus Rhythm without Cardiac Pacemaker in a Patient with Severe Acidosis: A Case Report Filiana, Rari Dewinda Sudarmaji; Kusuma, Taufik Ridwan Hadi; Noviar, Vira Khairunisa
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.62234

Abstract

Background : Complete atrioventricular block (CAVB) is a life-threatening medical emergency and requires an immediate cardiac pacemaker to reduce mortality by up to 87%.Case Illustration : A 55-year-old woman with an unknown medical history was brought to the emergency room with a Glasgow Coma Scale (GCS) of E2V1M1 (sopor comatose) and Kussmaul breathing. The patient, who was in septic shock, had Multiple Organ Dysfunction Syndrome (MODS) and severe acidosis. The patient was hemodynamically unstable, requiring vasopressor to maintain a Mean Arterial Pressure (MAP) ≥ 65 mm Hg. The analysis of the arterial blood gas revealed a pH of 7.19, pCO2 of 16 mm Hg, pO2 of 204 mm Hg, and bicarbonate of 5.9 mmol/L. Hyperkalemia (5.33mmol/L) was discovered during the electrolyte analysis. Conclusion : An electrocardiogram (ECG) examination showed CAVB with non-malignant ventricular extrasystoles. Without the use of a cardiac pacemaker, the ECG becomes normal sinus rhythm after corrections for severe acidosis and hyperkalemia. This case demonstrates that severe acidosis and hyperkalemia can induce reversible CAVB without the use of a pacemaker. Hence, it should be evaluated as part of the initial assessment and therapy of CAVB before a cardiac pacemaker is implanted.
Thoracal Paravertebral vs. Serratus Anterior Plane Block in Combination with COMBIPECS for Modified Radical Mastectomy Utomo, Wandito Gayuh; Fitriani, Calcarina; Sudadi, Sudadi; Ali, Farhan
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.93110

Abstract

Background: Breast cancer is one of the most common malignancies in women worldwide. Surgical options for breast cancer include modified radical mastectomy (MRM), in which the entire breast is removed but the pectoralis major muscle is spared. Routine anesthesia modalities for MRM include general anesthesia (GA), epidural blockade combined GA, and nerve blockade combined GA . Thoracic paravertebral block (TPVB) is still recognized as the gold standard analgesic procedure for breast surgery. However, TPVB is more difficult to perform with possible complications such as hypotension, pneumothorax, and unintentional spread of anesthetic agent to epidural space. Serratus anterior plane block (SAPB) is a promising new procedure that is relatively easier to perform and safer. Previous studies have reported its benefit in reducing the need of postoperative opioids and postoperative pain.Case illustration: We describe the case of 2 females with left breast cancer undergoing unilateral MRM, both with ASA class II. First patient was given TPVB, PEC 1, and PEC 2 (COMBIPECS). Second patient was given nerve block and guided ultrasonography using SAPB, PEC1, and PEC 2 (COMBIPECS). Each patient was sedated with a dexmedetomidine loading dose of 1mcg/kg/10 minutes, titration 0.2-0.4mcg/kg/hour. Both types of blocks provide adequate anesthesia. Ketorolac 30mg/8 hour was given post-operative. Both patients showed normal vital signs, and the same post-operative NRS of 0. No block related complication was found in both cases.Conclusions: TVPB and SAP combined with COMBIPECS have similar results in terms of post-operative pain score and minimal complication.
A PECS II Block as Post Operative Analgesia After Modified Radical Mastectomy Rosyadi, Imron -; Anam, Khairul; Mochamat, Mochamat
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.67195

Abstract

Background: In Indonesia, breast cancer is the most common cancers in 2018, with a mortality rate of 11%. Postoperative pain is a complication that can occur after MRM surgery. The implementation of Enhanced Recovery After Surgery (ERAS) is currently increasingly being applied to breast surgery, one of which is by reducing the use of opioids. Selection of regional anesthetic technique as an alternative used in the form of neuraxial and peripheral nerve blocks. The use of regional anesthetic techniques also reduces the side effects of opioids that are often found, namely Post Operative Nausea and Vomiting (PONV) and pruritus. Analgesic technique with pectoral nerve block (PECS block) is an effective alternative postoperative MRM pain treatment in addition to opioid analgesia.Methods: An analytical experimental study with double-blind randomized controlled trial (RCT) design. The study population was all patients who underwent MRM surgery at Dr. Kariadi General Hospital in May 2021 - August 2021. The study sample consisted of 46 subjects that obtained using the random allocation method, and randomly divided into two groups (PECS II block and control group). Postoperative pain scores, time to first request of rescue analgesic, total dose of rescue analgesic, incidence of PONV, and pruritus within 24 hours postoperative were analyzed in both groups.Results: Based on the results of the analysis, the mean pain scores at 4, 12 and 24 hours postoperative were significantly lower in the PECS II block group compared to the control group (p=0.001, p=0.013, and p=0.003). The mean time to first use of rescue analgesics was longer and the total dose of rescue analgesics was lower in the PECS II block group (p=0.00, p=0.00). The incidence of PONV ((69,5 %) and postoperative pruritus (17,4 %) were more common in the control group (p=0.001, p=0.346)Conclusion: PECS II block is effective as postoperative analgesic after modified radical mastectomy.
Thromboprophylaxis in Intensive Care Unit Patients Rikardi, Fachrizal; Fitriani R.W, Calcarina
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.93687

Abstract

Background: Intensive Care Unit (ICU) patients are at twice the risk of experiencing thrombosis compared to patients in regular wards. This risk is associated with prolonged immobility, sedation, and neuromuscular blockade to facilitate ventilation. The incidence ranges from 8-40%. This undoubtedly leads to poorer patient outcomes, including increased patient mortality. ICU patients require prophylaxis to prevent thrombotic events. The use of thromboprophylaxis has been shown to reduce mortality rates in these patients.Content: Intensive Care Unit (ICU) patients are at risk of developing thrombosis, which is closely related to Virchow's triad, which consists of venous stasis, endothelial dysfunction, and hypercoagulability. Considering the high morbidity associated with thrombotic events and the low side effects of carefully administered anticoagulants, pharmacological prophylaxis should be provided to all critically ill patients without contraindications to anticoagulants. Regular monitoring is necessary when administering pharmacological prophylaxis. Compared with UFH and mechanical compression, LMWH is the preferred thromboprophylaxis for ICU patients. Generally, patients weighing 50-100 kg can be given LMWH, such as enoxaparin, at a subcutaneous dose of 40 mg per day. The discontinuation of thromboprophylaxis should consider the patient's clinical condition and drug side effects.Summary: Thromboprophylaxis is highly necessary for Intensive Care Unit (ICU) patients. The preferred thromboprophylaxis for ICU patients is LMWH. In certain circumstances, UFH or mechanical thromboprophylaxis may be considered.
Relationship Between Spinal Anesthesia Injection Speed and the Incidence of Hypotension in Patients Undergoing Cesarean Section Mafazi, Fikri Alim; Novrinta, Donatila; Sasongko, Himawan
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.67198

Abstract

Background : The incidence of post-spinal hypotension in pregnancy is very high 50-85%. There have been many studies preventing hypotension but still considered unsatisfactory. Reducing the speed of injection of spinal anesthetic drugs can prevent hypotension, but still controversial.Objective : to determine the incidence of hypotension, onset of achieving sensory blocks, and the association of injection rate with the occurrence of post-spinal anesthetic hypotension.Methods: A Randomised Control Trial Study, including 48 patients underwent caesarean delivery who fulfil inclusion criteria. Samples were divided into fast and slow groups. Spinal anesthesia was given using hyperbaric bupivacain 0.5% of 10mg, Fentanyl 25mcg, and 100mcg morphine total volume of 3 cc. Group A received fast injection for 10 seconds, while group B for 30 seconds. The incidence of hypotension, onset of block and incidence of side effects after spinal anesthesia were recorded.Result : The incidence of hypotension in the fast group was 70.4%, while in slow group was 23.8%. There was a significant association between injection rate with post-spinal anesthetic hypotension (p = 0.004). Onset of Block T6 post-spinal anesthesia is faster in the fast group. Furthermore, there was no significant difference in nausea, vomiting, and chills between two groups.Conclusion: Slow injection rate may reduce the incidence of post-spinal anesthetic hypotension. However, the onset of sensory block was faster achieved with fast rate injection, with no difference in other side effects.
Prophylactic Use of Continuous Norepinephrine at a Dose of 0.05 mcg/kg BW/min in Spinal Anaesthesia for Cesarean Section Patients in Ketapang Rachman, Abdul
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.67175

Abstract

Background: Norepinephrine infusion decreases hypotension after spinal anesthesia during a cesarean section. There is an increasing attitude toward using norepinephrine to prevent spinal hypotension. There hasn't been much investigation on the use of norepinephrine in spinal anesthesia in Indonesia, particularly for cesarean sections in rural areas.Methods: In this single-blinded norepinephrine group. Randomized clinical trial: The norepinephrine group was given continuous norepinephrine before spinal anesthesia. Parturients for elective and emergency cesarean section were allocated to receive norepinephrine infusion (0.05 mcg/kg BW/mnt. Our primary outcome was the incidence of hypotension within 36 min of spinal anesthesia administration. Secondary outcomes included side effects such as nausea, vomiting, and chills during surgery.Result: In total, 92 patients were enrolled. Of these patients included in the final analysis. Patients who suffered hypotension showed hypotension at minute zero and minute twelve (14.13 %), minute twenty-four (13.04 %), and minute thirty-six (18.47 % )—the frequency of chills and nausea/vomiting. Three (3.26 %) and eight (8.89 %) participants in the norepinephrine group reported feeling chills and nausea/vomiting.Conclusion: prophylactic norepinephrine infusion may reduce HR without increasing the risk of post-spinal hypotension following cesarean delivery.
Local Anesthetic Systemic Toxicity After Thoracal Paravertebral, Pectoralis I, and Serratus Anterior Plane Block in Modified Radical Mastectomy Pranuri, Gesit Entra; Sudadi, Sudadi; Rachman, Farhan Ali; Wisudarti, Calcarina Retno; Prasamya, Erlangga
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.67753

Abstract

Background: Breast cancer is the most common cancer in woman worldwide. Local Anaesthetic Systemic Toxicity (LAST) is one of the complication in Anesthetic block technique for modified radical mastectomy. Local anesthetic systemic toxicity is rare, but once a LAST occurs, it can be fatal, even if the patient is left untreated. Because of the potential dangers that occur as a result of LAST, an anesthesiologist must understand the mechanism of LAST and good management in handling LAST. Thoracal Paravertebral, Pectoralis I, and Serratus Anterior Plane Block offers complete unilateral block and has long term analgesic effect can be used as an anesthetic technique in Modified Radical Mastectomy. Case Illustration: A 39-year old woman with invasive ductal carcinoma underwent modified radical mastectomy with multiple injection Thoracic paravertebral block (TPVB), Pectoralis 1 (PECS 1), and Serratus Anterior Plane (SAP) Block as a sole anesthesia regiment for this surgery. First anesthetic Peripheral Nerve Block (PNB) is TPVB followed by SAP Block than PECS 1 block. LAST symptom was shown suddenly after the PECS 1 Local Anesthetic (LA) block injection. Previously, repeated aspiration was performed before administering the drug with no blood results. We give Lipid solution to treat the symptom of LAST and the seizure stops within 30 seconds. During surgery, the patient was sedated with titrated dexmedetomidine. Hemodynamic was stable during intraoperative phase. The postoperative pain level is low and there was no complication such as pulmonary and neurological complications.Conclusion: LAST can be performed after Anesthesia block technique. Thoracic paravertebral block, Pectoralis I, and Serratus Anterior Plane Block are enough to covered anestetic and pain management in modified radical mastectomy.
Dexmedetomidine Adjuvant in Awake Intubation as Difficult Airway Management for Submandibular Abscess with Mediastinum Infiltration Arianto, Ardana Tri; Utama, Sigit Prastya; Faras, Asaduddien
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.67811

Abstract

Background: Maintaining a secure airway in difficult airway settings is important due to morbidity and mortality. Conventional intubation relies on benzodiazepines, opioids, and propofol which have a respiratory depression effect. Dexmedetomidine has a minimal to no central respiratory depression effect. A submandibular abscess can result in laryngeal edema which narrows or occludes the airway.Case Ilustration: A 65-year-old male complained of difficulty breathing and shortness of breath accompanied by neck and right jaw pain that radiated to the right cheek. The patient also complained of a salty taste every time the patient swallows. Obtained blood pressure 112/73 mmHg on norepinephrine support syringe pump 0.1 mcg/kg/minute (5.4 cc/hour), pulse rate 120 bpm, respiratory rate 32 times per minute with the help of respiratory muscles. The patient’s temperature was 36.7oC. The patient’s initial Glasgow Coma Scale was E3V5M6. Difficult airway was observed due to submandibular mass, 1-2 finger mouth opening, trismus, mallampati was difficult to evaluate, limited neck motion due to pain, and missing teeth. Imaging showed a soft tissue mass in the neck region. The patient underwent awake intubation using a video laryngoscope and Nasoendotracheal tube number 6.5 was installed with 70 mcg of dexmedetomidine syringe pump in 10 minutes (with pump rate of 105 ml per hour) and lidocaine mouth rinse. The intubation process went smoothly and the patient was admitted to the Intensive Care Unit for further monitoring.Conclusion: Management of difficult airway settings is important due to morbidity and mortality. The use of dexmedetomidine is considered safe and effective in securing the airway in patients with difficult airway.
The Role of Erector Spinae Plane Block in Percutaneous Nephrolithotomy Pain Management Septian, Muhammad Raditia; Giani, Maia Thalia
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.62133

Abstract

Background: The erector spine plane block (ESPB) is a novel peripheral nerve block approach between the erector spinal muscle and the thoracic transverse processes. It blocks multiple dermatomal sensory nerves in the thoracic and abdominal walls. ESPB is widely used in thoracoabdominal surgery, including percutaneous nephrolithotomy (PCNL). This review aims to assess the role of ESPB in PCNL.Methods: A Literature search was performed systematically with the medical terms “erector spinae plane block” and “nephrolithotomy” in PubMed, ScienceDirect, Cochrane Library, and Google Scholar until April 30, 2022. Two independent reviewers screened the articles for inclusion based on relevancy to the subject and outcomes. Data extraction was conducted for the included studies. The result from these studies demonstrates the efficacy of ESPB in PCNL.Results: A total of 267 literatures according to the search strategy. Nineteen studies were included in this review after excluding the duplicated, non-English, and irrelevant studies based on the title or abstract. From the full article review, 11 studies were with 644 patients. ESPB group had a significantly superior outcome of decreasing pain score compared to the conventional analgesia, tramadol intravenously, and placebo. ESPB had no significantdifferences with intrathecal morphine on the pain scale and first analgesic request. The timing of the first rescue analgesia in the ESPB group was longer and the procedure also reduced opioid requirement in PCNL patients. Conclusion: ESPB is a potentially effective technique to provide post-PCNL analgesia. ESPB provides pain relief after surgery, prolongs time to take additional analgesic drugs including postoperative opioid consumption.

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