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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 75 Documents
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Acute Fatty Liver of Pregnancy Management in Intensive Care Atsari, Nadhila; Apsari, Ratih Kumala Fajar; Adiyanto, Bowo; Widodo, Untung
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.78517

Abstract

Background: Acute fatty liver of pregnancy (AFLP) is an obstetric emergency with high mortality that usually requires treatment in the intensive care unit (ICU). The cause of AFLP is not known with certainty, but it is suspected due to a deficiency of long chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) in the fetus which causes accumulation of fatty acid metabolites from the fetus and placenta which are hepatotoxic. The clinical manifestations of AFLP are acute liver failure and progression to multiple organ dysfunction syndrome (MODS). This reported case was the only one successful case out of 3 incidences of AFLP recorded in RSUP Dr. Sardjito Yogykarta within a year of 2022. Case Illustration: A 24-years-old postpartum woman at 38 weeks' gestation admitted to resuscitation room with hypovolemic shock due to early postpartum hemorrhage. Patient was resuscitated and then taken to emergency operating room for uterine exploration under general anesthesia. Patient was subsequently admitted to the intensive care unit (ICU).  The patient's initial condition was intubated, requiring vasopressor support with epinephrine and norepinephrine, and the patient showed symptoms of encephalopathy, liver failure and kidney failure. AFLP diagnosis was then made with patient showing score 10 of Swansea criteria. Resuscitation, stabilization, and intensive care treatment was continued for up to eight days in the ICU. The patient's final condition was stable, there were no sequelae of AFLP and the patient was discharged from the hospital at the 14th day in good condition.Conclusion: AFLP is a serious complication during pregnancy and postpartum period that is reversible with a chance of complete recovery but has a high mortality associated with delayed treatment. Adequate early intensive care treatment with multidisciplinary approach essential for successful treatment of AFLP. 
Effectiveness of Intraperitoneal Bupivacaine in General Anesthesia for Laparoscopic Appendectomy Caverina, Sarah Lorenza; Rindiati, Fanda Ayyu; Respati, F.X. Andhi Haris
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 1 (2024): April 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i1.67397

Abstract

Introduction: Appendicitis is an inflammation of vermiform appendix organ. It is a medical emergency case and one of the most common acute abdominal cases. The removal of acute appendix with minimally invasive surgery, laparoscopic procedure, is associated with shortened recovery time and length of stay in hospital, reduced risk of postoperative wound infections, also improved cosmetic outcomes. Anesthesia procedure for laparoscopic in Indonesia is usually performed under general anesthesia (GA) which has effective and safe form of sedation. One local anesthesia agent that often used in laparoscopic procedure is bupivacaine. Studies have shown that intraperitoneal bupivacaine as analgesia after laparoscopy can reduce postoperative pain, such as visceral pain associated with tissue injury and the stretching of nerve endings in the peritoneal cavity, parietal pain related to the incisional trauma at the port sites, and shoulder pain referred by stretching of the diaphragm.Case report: Mr. TA, 27 years old, his lower right abdomen hurt and he was diagnosed with acute appendicitis ASA II. Patients performed with laparoscopic procedure under general anesthesia. Fentanyl 2 mcg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg, and sevoflurane 1 MAC, 50% FiO2 : 50% water, 4 lpm flow were administered. After 90 minutes of surgery, 40 cc of 0.5% intraperitoneal bupivacaine was administered. Patient was assessed for the NRS score within 30 minutes after laparoscopic procedure. The NRS score was 0.Conclusion: It has been reported a patient underwent laparoscopic appendicitis procedure received intraperitoneal bupivacaine as a postoperative analgesia which provided quicker recovery and good improvement of pain control without any significant negative consequences.
Respiratory Failure and Hypercoagulable State in Creutzfeldt-Jakob Disease: A Rare Case Report Kurniawan, Celine; Manggala, Sidharta Kusuma
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.91846

Abstract

Background:Creutzfeldt-Jakob Disease (CJD) is a rare, rapidly progressive neurodegenerative disorder caused by prion proteins. It is characterized by a variety of neurological symptoms that lead to severe cognitive decline and death. The uniqueness of this case lies in the severe complications of respiratory failure and a hypercoagulable state, which are not commonly highlighted in the literature. Reporting this case underscores the critical need for awareness and management strategies for such complications in CJD patients, which can significantly impact their clinical outcomes and quality of life.Case Illustration:A 69-year-old female presented with progressively worsening neurological symptoms over a short period. Initially, she experienced visual disturbances and hallucinations, followed by a rapid decline in consciousness, the onset of seizures, and myoclonus. Diagnostic investigations, including an electroencephalogram (EEG) and Magnetic Resonance Imaging (MRI), confirmed the diagnosis of Creutzfeldt-Jakob Disease (CJD).As her condition deteriorated, the patient developed pneumonia and septic shock. Excessive salivary secretion, a symptom often overlooked in CJD, led to significant respiratory compromise and failure. She was admitted to the intensive care unit (ICU) and required mechanical ventilation. Due to the prolonged need for ventilation and to manage airway secretions better, a tracheostomy was performed.Management of her respiratory failure involved meticulous care to reduce hypersalivation and prevent micro-aspiration. Regular suctioning of secretions was crucial. Additionally, given her immobility and increased risk of thromboembolism, she received prophylactic heparin to prevent venous thromboembolism. Physiotherapy was initiated to maintain limb mobility, and elastic stockings were used to reduce the risk of deep vein thrombosis.Conclusion:This case report highlights the complex clinical challenges in managing a patient with CJD, particularly the severe respiratory and thromboembolic complications. The comprehensive approach to managing respiratory failure through tracheostomy and proactive measures to prevent thromboembolism was essential in stabilizing the patient. However, the incurable nature of CJD meant that the focus ultimately shifted to palliative care. This case underscores the importance of recognizing and managing secondary complications in CJD to improve patient outcomes and the need for ongoing research into effective treatments for this devastating disease.
Spinal Anesthesia in a Patient with Complete Placenta Previa and Suspected Placenta Accreta Undergoing Cesarean Hysterectomy: Is it Possible? Irwanda, Awang Dody; Handrawan, Stevanus Eliansyah; Lestari, Mayang Indah
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.61448

Abstract

Background : Placenta accreta spectrum (PAS) is a major contributor to peripartum hemorrhage and an important cause of maternal morbidity and mortality. Anesthetic management in such cases requires planning to minimize complications. Case Illustration : This report describes the perioperative management of a 39-year-old woman, gravida 4 para 2 at 35 weeks' gestation, who was diagnosed with complete placenta previa and suspected placenta accreta based on ultrasonography and clinical presentation. She underwent cesarean section followed by hysterectomy under spinal anesthesia using 0.5% hyperbaric bupivacaine (12 mg) and clonidine (30 mcg) at the L4-L5 interspace. Intraoperative monitoring included non-invasive blood pressure, ECG, SpO₂, EtCO₂, body temperature, urine output, and serial blood glucose. The operation lasted approximately 2.5 hours with an estimated blood loss of 2000 ml. Fluid resuscitation consisted of crystalloids, albumin, and packed red cells, achieving a calculated fluid replacement of 11.1 mL/kg/h. The baby was delivered in good condition with an APGAR score of 7 and 9 at 1 and 5 minutes, respectively. Postoperative recovery within 24 hours was stable, with minimal pain and no complications. Conclusion : This case demonstrates that with appropriate preparation, spinal anesthesia can be safely and effectively used in selected patients with PAS.
The Effectiveness of PECS II Block on PONV and Rescue Opioid Dose in Post–Modified Radical Mastectomy Patients Siahaan, Waldemar P; Kambey, Barry Imanuel; Kumaat, Garry Dietmar Chrysogonus; Ngantung, Venesa Laurent
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.112962

Abstract

Background: Modified radical mastectomy (MRM) remains a mainstay for breast cancer but is associated with significant postoperative pain and postoperative nausea and vomiting (PONV). Pectoralis II (PECS II) block offers targeted chest wall analgesia with potential opioid‐sparing and antiemetic benefits. This study aimed to assess the effectiveness of PECS II block on PONV and rescue opioid dose in post-modified radical mastectomy patients.Methods: This single‐blind randomized trial included 32 women (30–65 years) undergoing MRM were allocated to general anesthesia (GA; n=16) or GA combined with ultrasound‐guided PECS II block (GA+PECS; n=16). Primary outcome was the mean numeric rating scale (NRS) score in the first 24 hours. Secondary outcomes included incidence of postoperative nausea and vomiting (PONV) and need for rescue opioid. Sample size was calculated to detect a 2‐point NRS difference (SD 2, α=0.05, β=0.20). The data were analysed using independent t‐tests for continuous data and χ² or Fisher’s exact test for categoric data.Results: Mean NRS was significantly lower in GA+PECS (1.38 ± 0.50) versus GA alone (3.44 ± 1.37, p< 0.001). PONV occurred in 5/16 (31.3%) of GA patients and 0/16 (0%) of GA+PECS patients (p-value = 0.02). Rescue opioid was required in 1/16 (6.3%) of GA patients versus none in GA+PECS (p-value = 0.31).Conclusion: Adding PECS II block to GA in MRM substantially improves postoperative pain control and eliminates PONV, with minimal opioid rescue. Larger multicenter studies are warranted to confirm these findings.
Transnasal Sphenopalatine Ganglion Block as Management Pain for PDPH (Post Dural Puncture Headache) Ashlihati, Diena; Mahmud, Mahmud; Kurniawati, Juni; Sudadi, Sudadi
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 2 (2025): October 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i2.78449

Abstract

Background : Post dural puncture headache (PDPH) is a complication of the neuroaxial block anesthesia technique that cause leakage of cerebrospinal fluid (CSF) from a dural defect and intracranial hypotension. Typical symptoms, PDPH is bilateral, frontal, retroorbital or occipital headaches and extends into the neck constanly or slowly, and associated with photophobia and nausea.  Management treatment of PDPH starting from conventional therapy (non-pharmacological and pharmacological) and invasive therapy including transnasal sphenopalatine ganglion block and as a gold standar is epidural blood patch that more invasive. Transnasal sphenopalatine ganglion block is a minimally invasive procedure on sphenopalatine ganglion which is an extracranial parasympathetic ganglion at fossa pterygopalatine. Various research state that efficacy of sphenopalatine ganglion block better than epidural blood patch.Case Illustration : Reported a female, 37 years old came with headache extend to neck dan was diagnosed with PDPH post caesarean section with subarachnoid block anesthesia. Conservative therapy has been done but there is no improvement. As the next step, the patient transnasal sphenopalatine ganglion block using lidocaine 2% 3cc. The day after therapy, there is no complaint, VAS was 0-1 without complications and patient was allowed dismiss from hospital.Conclusion : Transnasal sphenopalatine ganglion block is an invasive procedure as PDPH therapy that is very rarely performed. This action can be performed if the patient has undergone conventional therapy and there has been no improvement. With this case report, we can see that the efficacy of this procedure is very good and it is recommended before an epidural blood patch is performed.
Bradycardic Episodes of Trigeminocardiac Reflex During Fluoroscopy-Guided Ganglion Gasseri Radiofrequency Ablation in a Trigeminal Neuralgia Patient: A Case Report Nurdianto, Muhammad Syarif; Mahmud, Mahmud; Sari, Djayanti; Sari, Dhanty Dwita
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.91702

Abstract

Background: Trigeminocardiac reflex (TCR) is a known but infrequently reported complication of Ganglion Gasseri interventions, manifesting as profound bradycardia and hemodynamic instability.Case Illustration: A 55-year-old woman with left-sided trigeminal neuralgia, hypertension, and type 2 diabetes underwent fluoroscopy-guided Ganglion Gasseri block with radiofrequency ablation. At the 25th minute of needle manipulation, her heart rate dropped acutely to <30 bpm, followed by a second episode to 30–35 bpm ten minutes later. Both episodes were successfully managed by immediate cessation of manipulation and deepening of sedation using intravenous midazolam (2 mg) and propofol (20 mg), without the need for atropine. Post-procedural pain scores decreased from 7–8 to 2–3 on the Numeric Rating Scale.Conclusion: This case highlights the necessity of vigilant hemodynamic monitoring and the potential role of adequate sedation depth in mitigating vagal responses during trigeminal procedures, particularly in patients with pharmacologically altered autonomic tone
Anesthetic Management in Cardiac Sympathetic Denervation Kurniawan, Adhe; Sudjud, Reza Widianto
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.78404

Abstract

Background : This case report discusses anesthetic management of cardiac sympathetic denervation (CSD), with a particular focus on strategies for maintaining optimal perioperative hemodynamic stability.Case Illustration : A 59-year-old woman diagnosed with dilated cardiomyopathy accompanied by impaired ejection fraction was treated for refractory ventricular tachycardia. She experienced recurrent ventricular tachycardia despite having undergone radiofrequency CA and receiving pharmacologic agents such as beta-blockers and antiarrhythmic drugs. She underwent CSD procedure through video‑assisted thoracoscopic surgery (VATS) approach under general anesthesia. In addition to standard monitoring and invasive blood pressure monitoring, the preparation of an external defibrillator, vasopressors, and inotropic agents were necessary prior to the induction of anesthesia. Intravenous induction agents were administered in small initial doses and increased gradually according to the response of the patient. CSD was performed through a left side sympathetic ganglionectomy using VATS approach. During CSD procedure, patient was placed in supine position to reduce the risk of hemodynamic instability associated with position change to right lateral decubitus and to facilitate cardiopulmonary resuscitation and defibrillation if ventricular tachycardia and/or ventricular fibrillation occur perioperatively. The patient was extubated in the operating room and transferred to ICU safely.Conclusion: Anesthesiologists must determine the hemodynamic targets to be achieved before inducing patients with dilated cardiomyopathy, so that several things must be appointed including the patient clinical status and the degree of cardiac function, the appropriate monitoring devices and anesthetic agents, and other resources which required to activate the ACLS protocol to maximize perioperative survival.
The Effect of Melatonin on Platelet Levels in Wistar Rat After Burns in Two Days Qusairi, Velya Lizhariany Hafidha; Purwoko, Purwoko; Purnomo, Heri Dwi
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 1 (2024): April 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i1.67051

Abstract

Background : Burns can caused by high temperatures. Burns have an impact on platelet levels and hemostatic regulation. Melatonin is a therapeutic agent that can increase platelet levels on burns by neutralizing Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) so it can suppress tissue damage due to burns. This study aims to determine the effect of giving melatonin on the platelet levels of burnt wistar rats in two daysMethods : This is experimental study with a sample of 12 Wistar rats that matched the inclusion and exclusion criteria. Rats were divided into two groups, namely K1 as control and K2 as a group that was given melatonin at a dose of 10 mg/kg. Platelet levels were measured at T1 (0th hour post burn), T2 (24th hour post burn), and T3 (48th hour post burn). The data were analyzed by the Shapiro-Wilk normality test, followed by Parametric Paired t-Test and the Independent t-Test.Result : This experimental results there was a significant increase in the number of platelets between T2 and T3 and between T1 and T3 in control group. And in K2, there was a significant decrease in the number of platelets between T1 and T2 and between T2 and  T3. Meanwhile, between T1 and T3 there was a significant increase in platelet levels.Conclusion: Melatonin can significantly increase the platelet levels of burn Wistar rats at 48 hours post-burn.
Considerations Regarding Anesthesia for Renal Transplantation Kurniawaty, Juni; Ancilla, Cornelia; Arovah, Novita Intan
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.66326

Abstract

Background : Transplantation provides near-normal life and excellent rehabilitation compared to dialysis and is the preferred method of treating end-stage renal disease (ESRD) patients.Methods: We conducted a retrospective analysis of anesthesia management from 20 cases of live renal transplants carried out between August 2017 and April 2019 at Dr. Sardjito Central General Hospital, Yogyakarta. Preoperative patient status, anesthesia management, and postoperative care of the subjects were assessed.Result : Most patients had preoperative anemia, normal serum potassium, normal serum creatinine, and normal ejection fraction. Anesthesia management began since 24 hours before surgery, in which the patients were hospitalized, had peripheral IV access and fluid maintenance, and hemodialysis, followed by premedication 1 hour before surgery. Prior surgery, anesthesia induction and intubation were done, followed by maintenance of anesthesia and intaoperative monitoring. Postoperative care consisted of administration of analgesia and management of complications.Conclusion: Optimization of preoperative status, proper anesthesia management, and good postoperative care are keys for a successful renal transplant program.

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