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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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From Scene to Emergency Department: Is Delta Shock Index a Reliable Predictor in Trauma Care? A Meta-Analysis Aurelia, Cherryl; Alverina, Clara; Melbiarta, Rezy Ramawan; Edwar, Pesta Parulian Maurid
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.v5i2.106534

Abstract

Background: Trauma is a leading global cause of morbidity and mortality, with hemorrhage being a highly preventable cause of death. Delta SI (dSI), reflecting time-dependent hemodynamic changes, shows promise, though conflicting data necessitate comprehensive evaluation of its predictive superiority. This study, therefore, aims to assess the diagnostic accuracy of dSI in predicting clinical outcomes among trauma patients.Methods: This systematic review and meta-analysis included eight studies (Jan 2015–Jul 2025) on adult trauma patients evaluating dSI (Emergency Department SI – prehospital SI) for mortality, blood transfusion needs, or Intensive Care Unit (ICU) admission. Searches were conducted across ScienceDirect, PubMed, Scopus, and Taylor & Francis. The risk of bias was assessed using the QUADAS-2.Results: Eight studies (931,954 patients) were included. DSI consistently showed low sensitivity but high specificity. For blood transfusion, sensitivity was 0.411 (0.313–0.517) and specificity was 0.873 (0.802–0.921). For mortality, sensitivity was 0.350 (0.259–0.454) and specificity was 0.821 (0.763–0.867). ICU admission had a sensitivity of 0.21 (0.144–0.298) and a specificity of 0.887 (0.843–0.919). Subgroup analysis of massive transfusion and in-hospital mortality analyses also showed similar trends.Conclusion: Our findings highlight that while DSI demonstrates consistently high specificity across key clinical outcomes—including mortality, transfusion needs, and ICU admission—it suffers from limited sensitivity. However, its optimal utility lies in its integration with comprehensive clinical assessment rather than standalone use.
Omega-3 Fatty Acid Supplementation and ICU Length of Stay: A Critical Review of Current Evidence Oktaviningsih, Diah Annisa
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.v6i1.115774

Abstract

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) derived from fish oil, have been investigated for their role in modulating inflammation and immune function in critically ill patients in the intensive care unit (ICU). An exaggerated systemic inflammatory response in critical illness often leads to multiple organ dysfunction, nosocomial infections, and prolonged hospitalization. Omega-3 supplementation has been shown to suppress proinflammatory cytokine production, increase inflammatory resolution mediators, and support cellular energy metabolism. Evidence from controlled clinical trials and meta-analyses suggests that omega-3 supplementation, particularly via parenteral administration, may reduce ICU length of stay by an average of 2–3.5 days, reduce mechanical ventilation duration, and decrease infection rates. However, results are heterogeneous and vary with dose, route of administration, and patient characteristics. Notably, several trials in unselected ICU populations have yielded neutral or negative results, particularly with high-dose enteral omega-3 formulas. This review critically synthesizes the current evidence on omega-3 supplementation and ICU outcomes, discusses both supportive and non-supportive findings, and identifies gaps requiring further investigation.
Feasibility of Using iTIVA™ Mobile Application as Intraoperative Infusion Guide in Pediatric Olivia, Wilhemina; Pramodana, Bintang
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.v5i2.78489

Abstract

Background: Total intravenous anaesthesia (TIVA) is increasingly popular in pediatric anaesthesia. TIVA can be given with manual or target-controlled infusion (TCI). TCI pumps with specialized pediatric pharmacokinetic (PK) models are not widely available. iTIVA is a mobile application that simulates TCI infusion regiments with many available PK models, including pediatric. The app is available for download for iOS and Android devices. We report our experience using iTIVA as an intraoperative infusion guide. Case illustration: A 12-year-old boy with body weight of 53 kg and 153 cm tall, physical status ASA II, presented with tethered cord syndrome due to lipomyelomeningocele planned for untethering surgery. Anaesthesia was induced and maintained with TIVA using propofol with Eleveld model using Mindray TCI pump and remifentanil using Eleveld model simulated with iTIVA apps. The initial target, desired plasma or effect concentration were selected, and the application determined the required infusion rates for remifentanil. The Bispectral Index System (BIS) was used to monitor the depth of anaesthesia. There were no adverse events observed during the surgery. The patient was then transferred to the recovery room and discharged from the hospital on the second postoperative day. Conclusion: iTIVA can be useful to simulate TCI infusion regiments if specialized TCI pumps are unavailable.  
Effectiveness Comparison: Saddle Block vs. Low Dose Spinal Anesthesia in Cervical Cancer Brachytherapy Hariyanto, Andy Hafiz Dimas; Tunggal Putera, Try Buana; Sutiyono, Doso; Sasongko, Himawan; Nawangsih Priharsanti, Christina Hari
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.v6i1.91749

Abstract

Background: Brachytherapy plays a role in the management of cervical cancer by delivering radiation to large tumors at the end or in conjunction with chemoradiotherapy. Regional anesthesia is the dominant technique used for brachytherapy. Low Dose Spinal Anesthesia involves injecting local anesthetic into the subarachnoid space. Saddle block anesthesia is a type of low spinal block that provides anesthesia to the saddle area. Low Dose Spinal Anesthesia has the disadvantage of longer motor recovery in the extremities compared to saddle block. This study aims to compare the sensory and motor effectiveness between saddle block anesthesia and Low Dose Spinal Anesthesia in cervical cancer patients undergoing intracavitary brachytherapy.Methods: A non-paired double-blind consecutive clinical trial with cervical cancer patients undergoing elective brachytherapy at Dr. Kariadi Hospital, Semarang. Patients were divided into two groups: Saddle block anesthesia and Low dose spinal anesthesia. Vital signs, NRS pain scale, Bromage motor activity score, side effects including hemodynamics, patient satisfaction level (EVAN-LR), and operator satisfaction level were recorded. The collected data were analyzed using independent t-tests and Mann-Whitney tests, with results considered significant if p < 0.05.Results: Bromage scores at 30 minutes and 60 minutes in the saddle block anesthesia group were significantly higher than those in the low dose spinal group (p=0.000). The numerical rating scale during applicator placement, after moving rooms, and after removing the indicator in the saddle block anesthesia group was better than the low dose spinal group but not significant (p=0.054).Conclusion: Sensory and motor effectiveness in patients using Saddle Block Anesthesia is better compared to Low Dose Spinal Anesthesia.
Intra-Anesthetic Anaphylactic Shock Due to Rocuronium: Diagnosis and Treatment Peddyandhari, Fildza Sasri; Lengkong, Anthonio Barswot
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.v5i1.78500

Abstract

Introduction: Intraoperative anaphylactic events are rare, but are important to pay attention to as they are associated with morbidity and mortality rates. Intraoperative anaphylactic events can be caused by anesthetic drugs including muscle paralysis, rocuronium, succinylcholine and attracurium are the most common causes of intraoperative anaphylaxis.Case Illustration: An 11-year-old girl diagnosed with 3rd degree microtia with severe conductive hearing loss in the right ear. It is planned to undergo stage 1 auriculoplasty measures accompanied by rib harvesting. After induction of anesthesia with the administration of rocuronium as a muscle relaxant. Patients are suspected of anaphylaxis due to a decrease in blood pressure, increased pulse and low EtCO2 levels. Anaphylactic management is done quickly so that the patient experiences good resolution.Conclusion: The cause of anaphylaxis during intraoperative occurrence is caused by muscle relaxant, one of which is rocuronium where most likely the cause of anaphylaxis that occurs in patients due to rocuronium administration. In addition to observing the patient's blood pressure and pulse, a decrease in EtCO2 can be a sign of anaphylactic activity. The initial goals of anaphylactic treatment are improving cardiovascular homeostasis, intravenous epinephrine administration and intravascular volume replenishment. Proper recognition and management of intraoperative anaphylactic events will provide a good prognosis.
SEIZURE CONTROL IN PATIENTS WITH ANTI-NMDAR ENCEPHALITIS : CASE SERIES Wijaya, Indriyani; Wisudarti, Calcarina Fitriani; Adiyanto, Bowo
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.v4i1.69732

Abstract

Background: Anti N-methyl-D-aspartate Receptor (anti-NMDAR)  encephalitis is a rare, yet has had increasing number of cases. Patients often require airway protection, mechanical ventilation and intensive care because the patients’ complex symptoms accompanied by seizures that are difficult to control. Here, we present two related case reports that discuss intensive care management and focus on the administered sedation/anesthesia methods and their outcomes.Case illustration: Male patients, 19 and 21 years old, presented with neuropsychiatric symptoms, seizures, dyskinesia. Both require airway protection and mechanical ventilation as well as Intensive Care Unit (ICU) care. Radiodiagnostic head Computed Tomography (CT) scan and head Magnetic Resonance Imagng (MRI) showed no cerebral abnormalities. Cerebrospinal Fluid (CSF) examination showed positive NMDAR antibodies. First patient had failed to improve clinically even with multiple anti-convulsants, ketamine, dexmedetomidine, immunotherapy, and chemotherapy. Second patient clinically improved with benzodiazepine (midazolam) and propofol as anti-convulsants followed by plasma exchange immunotherapy. The two cases had different outcomes. The first case deceased from septic shock, while the second case was treated by outpatient procedure.Conclusion : Our presented cases suggest that midazolam, propofol, dextemedetomidine, ketamine do not provide satisfying results for seizure control in patients with anti-NMDAR encephalitis, unless immunotherapy is carried out as early as possible and optimally.  
Therapeutic Plasma Exchange in High Care Unit for Patient with a Snake bite : a Case Report Setijanto, Eko; Pambayun, Isma Angger; Utama, Sigit Prasetya; P, Septian Adi
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.v5i1.77939

Abstract

Background : Snake bites are one of the commonest occupational hazards in tropical countries and viperine bites are potential to cause systemic toxicity. Hemolitik anemia, coagulopathies, and acute kidney injury (AKI) have been documented, main therapy on snake bite with antivenom, when it combine with plasmapheresis it shown promising result. This case reports highlight the effective use of plasmapheresis for snake bite therapy.Case Illustration : A 40-year old presented following 7-days at HCU Dr Moewardi Hospital of snake bite with the right hand is swollen, blistered, painful, weakness, nausea, the yellowish body, icteric conjunctiva, and dark brown colored urin. A patient has anemia, leukocytosis, thrombocytopenia, increased total bilirubin, direct bilirubin, indirect bilirubin, elevate liver enzyme, and uremia. The patient was treated for 7 days in the HCU. Patient received 10 cc of antivenom in 500 cc 0,9% normal saline every 8 hours for 3 days. Patient also received one times therapeutic plasma exchange (TPE) on 2nd of admission, TPE with 2.500 ml output of plasma. The patient had received 8 flash 5% albumin therapy, with each flash contains 250 cc of 5% albumin and 1 flash 0,9% normal saline, with each flash contains 500 cc of 0,9% normal saline, with total liquid intake is 2500 cc. Patient with GCS E4V5M6.Conclusion : Most patients with snake bite present with hemolitik anemia, coagulopathies, and acute kidney injury (AKI). The management of snake bite is mainly with antivenom. In addition plasmapheresis not only eliminate the venom circulating in the blood, would also eliminate the toxins diffused into extravascular spaces and target organs after redistribution phenomenon. Therefore, therapeutic plasma exchange should be utilized as part of a tailored treatment plan that considers the patient's overall clinical condition and needs. This case report a 40-year-old as show evidence for the effectiveness of plasmapheresis treatment.
Protein First: Whey Protein Administration Strategy in Critically ill Patients Suharsoyo, Tomy; Prasamya, Erlangga
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.v6i1.116549

Abstract

Background: Critically ill patients in the intensive care unit (ICU) frequently develop hypercatabolic states associated with progressive muscle wasting and immune dysfunction. Meeting adequate protein targets remains a persistent challenge in standard ICU nutrition practice.Methods: A narrative review of the literature was conducted by searching PubMed, MEDLINE, and Google Scholar using the keywords “whey protein,” “critically ill,” “ICU nutrition,” “protein-first strategy,” “enteral nutrition,” and related terms. Articles published between 2015 and 2025 were prioritized, and foundational earlier studies were included where relevant. Randomized controlled trials, systematic reviews, meta-analyses, observational studies, consensus guidelines, and mechanistic studies were included. Articles without full-text availability or not relevant to critical care nutrition were excluded.Results: Whey protein is biologically characterized by rapid absorption, a rich essential amino acid profile, and a high leucine content that may activate the mTORC1 pathway to stimulate muscle protein synthesis. Whey protein–based enteral formulas have been shown in selected studies to facilitate achievement of recommended protein targets (1.2–2.5 g/kg/day) with acceptable gastrointestinal tolerance. Some evidence suggests potential benefits in nitrogen balance and inflammatory markers; however, evidence for consistent improvement in hard clinical outcomes—including mortality, ventilator duration, and ICU length of stay—across the general critically ill population remains limited. Most supportive studies are small, single-center, or focused on specific subpopulations, and several are feasibility assessments rather than outcome trials.Conclusion: Whey protein is a biologically plausible and practically useful component of individualized ICU nutrition. A “Protein First” approach using whey-based formulas may assist in meeting recommended protein targets; however, current evidence does not support claims of universal outcome benefit. Individualized dosing—with particular caution in patients with renal or hepatic impairment—remains essential.  
Integrating Quadratus Lumborum and Transabdominal Plane Blocks for Effective Pain Management in Colon Cancer: A Case Report Shallahudin, Shallahudin; Laksono, Ristiawan Mudji; Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk
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.v5i2.78834

Abstract

Background: The Quadratus Lumborum Block (QLB) is an ultrasound-guided posterior abdominal wall block that targets the interfascial plane. This case report investigates the concurrent application of QLB and transabdominal plane block for pain management in a patient with colon cancer-related pain.Case Illustration: A 53-year-old male patient presented with abdominal pain at the site of an abdominal stoma and his back over the past 3 months. The pain was characterized as sharp and exacerbated by movement. Laboratory tests revealed leukocytosis and a prolonged activated partial thromboplastin time. A 2022 CT scan indicated a residual mass in the transverse colon with associated fat stranding involving the adjacent ileal wall. The patient was diagnosed with cancer-related pain due to colon cancer, and a comprehensive pain management plan involving the combination of QLB, transabdominal plane block, and a Durogesic patch (12.5 mcg/3 days) was devised. The abdominal pain significantly diminished, with an initial resting Numerical Rating Scale (NRS) score of 5-6 and an initial exacerbated NRS score of 7-9, reducing to a final resting NRS score of 1-2 and a final exacerbated NRS score of 2-3 after administering the pain management regimen: QLB with Ropivacaine 0.375% + Methylprednisolone injection 62.5 mg, totaling 20 cc, along with transabdominal plane block using Ropivacaine 0.375% with a total volume of 10 cc. No occurrences of nausea or vomiting were reported.Conclusion: Employing a combined approach of QLB and transabdominal plane block for pain management holds the potential to alleviate acute and chronic pain while facilitating a robust post-operative recovery. Further research involving a larger patient population is warranted to explore the full efficacy and effectiveness of the QLB technique.
The Effectiveness of Basic Life Support Training on the Level of Knowledge of Teachers in Islamic Boarding Schools Yusuf, Muhammad Farlyzhar; Jaya, Wiwi; Isngadi, Isngadi; Asmoro, Aswoco Andyk; Laksono, Ristiawan Muji; Laksono, Buyung Hartiyo; Hartono, Ruddi; Siswagama, Taufiq Agus; Fatoni, Arie Zainul; Vitraludyono, Rudy; Fadhlurrahman, Ahmad Feza; Agustina, Ayu Yesi; Nofiyanto, Eko; Sidiq, Muhamad Akbar; Fanniyah, Fanniyah; Sawitri, Dewi Arum
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.v6i1.98730

Abstract

Background: Teachers in Islamic boarding schools (pesantren) must be prepared for emergencies. Basic Life Support (BLS) training is essential for improving their knowledge. This study evaluated the effectiveness of BLS training in enhancing teachers' knowledge.Methods: A pre-experimental study with a pretest-posttest design involving 15 teachers. Respondent receive BLS training by anesthesiologist team. Respondent's knowlegde were assesed before and after BLS training using questionnair. Data were analyzed using Shapiro-Wilk and paired T-tests.Result: This study enroll 15 respondent (teacher) from boarding school. The average score increased from 56.67 to 66.00 (p = 0.048), indicating a significant improvement.Conclusion: BLS training is effective in increasing teachers' knowledge and is recommended for regular implementation

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