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Journal of Anesthesiology and Clinical Research
Published by HM Publisher
ISSN : -     EISSN : 27459497     DOI : https://doi.org/10.37275/jacr
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience
Journal of Anesthesiology and Clinical Research/JACR that focuses on anesthesiology; pain management; intensive care; emergency medicine; disaster management; pharmacology; physiology; clinical practice research; and palliative medicine.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 119 Documents
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Hemodynamic Response and Patient Comfort in Conscious Intubation with Recurrent Laryngeal Nerve Block Rapa, Fransiscus Braveno; Adinda Putra Pradhana
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.326

Abstract

Introduction: Anesthetic management of conscious intubation in difficult airway cases can be done with topical anesthetics, airway nerve blocks, or a combination of both. Inadequate quality of anesthesia can cause hemodynamic turmoil, pain, gag reflex, and patient discomfort. This study presents a case report on the use of recurrent laryngeal nerve blocks in patients who were consciously intubated. Case presentation: This man was premedicated in the reception room using 10 mg IV dexamethasone, 10 mg IV diphenhydramine, 2 drops of 0.05% oxymetazoline right nose, 4 ml of 4% lidocaine nebulization, 10% lidocaine spray on the uvula and 2 puffs of pharyngopalatine fauces. Once in the operating room, this man was given midazolam 1.5 mg IV, fentanyl 25 mcg IV, followed by ultrasound-guided recurrent laryngeal nerve block. The local anesthetic used was 2 ml of 2% lidocaine. After that, right intranasal conscious intubation was performed. During intubation, this man began to show discomfort in the form of frowning when the flexible scope (FIS) was in the larynx and briefly passed the vocal cords. In addition, a gag reflex and cough are seen when the FIS and airways pass over the larynx and vocal cords. Intubation is done in about 4 minutes with 1 attempt. Conclusion: Awake intubation can be performed with topical anesthesia, airway block, or a combination of the two. Awake intubation with a combination of laryngeal recurrent nerve blocks and topical anesthesia, in this case, was inadequate because there was coughing, gag reflex, and increased heart rate during intubation.
Perioperative Management of Intradural Extramedullary Tumor Patients Undergoing Hemilaminectomy and Tumor Resection: A Case Report Oka Rastini, Luh Ratna; Made Septyana Parama Adi
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.329

Abstract

Introduction: Intradural extramedullary (IDEM) tumor is a benign neoplasm originating in the spinal canal and accounts for approximately two-thirds of cases of primary spinal tumors. This case report aimed to further discuss the anesthetic management of IDEM tumor patients who underwent hemilaminectomy and tumor resection. Case presentation: A 25-year-old woman came with complaints of right hemiparesis, hypoesthesia as high as L3-L4, and unable to hold back urination since 4 months ago. Magnetic resonance imaging (MRI) examination showed a heterogeneous intradural extramedullary solid mass in the central spinal cord as high as Th 10-11 posterior, which narrowed the spinal canal. Dextra hemilaminectomy, tumor resection, and unilateral stabilization of dextra Th10-12 fusion were performed under general anesthesia and thoracolumbar interfascial plane blocks (TLIP). General anesthesia with non-kinking endotracheal intubation, controlled ventilation, and prone position is required for spinal thoracic surgery in adult patients. Propofol is a good induction agent, especially in maintaining the depth of anesthesia, because it can prevent side effects that arise from inhalation anesthetics. Conclusion: Bilateral modified TLIP block was performed in patients after induction of anesthesia with a median approach and ultrasonography (USG) guidance. TLIP block can reduce cumulative opioid consumption, acute pain intensity, the need for rescue analgesia, and the incidence of nausea and vomiting.
Anesthetic Management in Preeclampsia Patients with Thalassemia Minor B: A Case Report Dyatmika, Kadek Dwipa; Tjahya Aryasa; Otniel Adrians Labobar
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.330

Abstract

Introduction: One of the complications of anesthesia that can be encountered in thalassemia patients is cardiovascular instability caused by chronic anemia, cardiomyopathy, and endocrinopathy. In addition, patients with preeclampsia may also experience postoperative risks such as sustained hypertension, stroke, venous thromboembolism, and seizures. This case report will discuss the anesthetic management of pregnant women with preeclampsia and β thalassemia minor. Case presentation: The patient is a pregnant woman G6P0141, 34 weeks gestation, with preeclampsia and a history of minor β thalassemia without therapy. Patients with thalassemia minor are often asymptomatic before pregnancy, but physiological changes during pregnancy can contribute to anemia during pregnancy. Beta thalassemia minor is also associated with an increased incidence of hypertension in pregnancy. Neuraxial anesthesia is recommended in preeclamptic patients to avoid severe hypertension and has a protective effect against postoperative apnea in premature infants. Conclusion: Anesthetic management in asymptomatic patients with minor thalassemia is not much different from normal pregnant women. The risk of bleeding needs special attention, especially in thalassemia patients who have anemia. In patients with preeclampsia, neuraxial anesthesia is preferred over general anesthesia. Postoperative patient care is carried out in an obstetric high dependency unit (OHDU). The patient went home after being treated for 3 days without complications at the hospital.
Perioperative Management and Anesthesia in Patients with Hemifacial Spasm Undergoing Microvascular Decompression: A Case Report Agustyawan Pemayun, Tjok Dwi; IGAMW Kurniajaya
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.332

Abstract

Introduction: Microvascular decompression (MVD) is an operation performed to treat a symptom of hemifacial spasm. Hemifacial spasm is described as a disorder of neuromuscular movement characterized by repeated to persistent involuntary contractions affecting the muscles innervated by the facial nerve. Case presentation: A 33-year-old woman came to consciousness with complaints of twitching on the right side of her face since 1 year ago. Initially, the complaint was felt for the first time 3 years ago, only on the upper right eyelid, but it has been getting worse over the past year. Magnetic resonance imaging (MRI) was obtained vascular loop on the right anterior inferior cerebellar artery (AICA) in level cerebellar pontine angle (CPA). MVD is a unilateral neurosurgical procedure in the axial section of the posterior fossa. Positions that can be used are supine and modified lateral decubitus or park bench. The management of anesthesia-related to posterior fossa surgery includes, first, the effect of the drug on the ability of the lungs to hold air from entering the venous circulation. Intravenous administration of anesthetics, for example, fentanyl, can maintain a higher threshold for retaining air bubbles in the pulmonary circulation compared with inhalational anesthetics. Conclusion: Optimal hemodynamic monitoring, good analgesia, and adequate muscle relaxation are the principles of anesthesia monitoring that aim to facilitate the operator in finding access to the disturbed nerve complex.
Fluid Overload Management in HELLP Syndrome with Pulmonary Edema Underwent Caesarean Section Agustina, Mona; Christopher Ryalino
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.341

Abstract

Introduction: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a multisystemic disorder. HELLP syndrome is a life-threatening condition with high maternal and infant mortality rates. This study aimed to present an unexpected case of HELLP syndrome complicated by pulmonary edema. Case presentation: A 40-year-old woman, 80 kg, who was 26-27 weeks into her pregnancy, came to the obstetric department due to fever and nausea in the past three days. She was then referred to the internal medicine department and diagnosed with dengue fever by the symptom of fever and thrombocytopenia. After two days of in-patient treatment, the obstetrician diagnosed her with HELLP syndrome, followed by elevated liver enzymes. She was then posted for an urgent caesarean section, and we managed this case under general anaesthesia. Postoperatively, we aimed for -500 to -1,000 mL cumulative fluid balance to avoid further hypovolemia. Conclusion: The patient showed improvement, as evidenced by chest X-ray and oxygen saturation. Management of fluid overload in this patient with HELLP syndrome was challenging. On the second day in ICU, the antibiotic was changed from meropenem combined with levofloxacin to meropenem combined with amikacin because the leucocyte level increased and procalcitonin level increased in 48-72 hours.
Perioperative Management of Patients with Extra Axial Tumors in the Region Suprasella et causa Suspected Pituitary Macroadenoma Undergoing Tumor Resection Craniotomy Procedures Endonasal Transphenoid with Postoperative Diabetes Insipidus Complications Tjokorda Gde Agung Senapathi; Cung Flavyanto, Eugenius Silvester
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.343

Abstract

Introduction: Perioperative management of a patient with a pituitary macroadenoma involves a complex set of procedures, including careful clinical evaluation, decision making regarding the surgical strategy, preparation of the patient before surgery, execution of the operation with the correct technique, and care.post operation effective. Case presentation: A 52-year-old female patient with the diagnosis of extra axial tumor R. Suprasella ec susp pituitary macroadenoma, the plan is to perform craniotomy for transphenoid endonasal tumor resection. Induction with TCI propofol and preoxygenation. For analgesia can be given fentanyl 2-5 g/kg during induction, but before intubation. Ensure adequate neuromuscular blockade prior to intubation to avoid coughing/straining. Intubation with a videolaryngoscope is the technique we use to secure the airway. The position of the patient will depend on the location of the tumor. Maintain anesthesia with TCI propofol target effect 2-3 µg/kg/min, dexmedetomidine 0.2-0.7 mcg/kg/hour, and intermittent fentanyl 0.5-1 mg/kg/hour. Use light hyperventilation (PaCO2 30-35 mm Hg). Maintain euvolemia (Ringer Fundin/iso osmolar fluid) and neuromuscular relaxation. Conclusion: In these cases the anesthetic technique must be targeted towards hemodynamic stability, maintenance of adequate cerebral oxygenation and normal intracranial pressure. Postoperative care must also be considered considering the bleeding complications due to large blood vessel trauma and diabetes insipidus which often occurs post operation.
Age as Consumption Factor in Morphine Patient-Controlled Analgesia (PCA) for Knee Ligamentoplasty Laouamri, Okba
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.382

Abstract

Introduction: The consumption of morphine, or any other opioid analgesic, can be influenced by various factors, including age and sex. These factors play important roles in how individuals respond to and metabolize opioids, which can have implications for their pain management and potential risks associated with opioid use. The study was to investigate the relationship between age and total morphine consumption during knee ligamentoplasty with the use of three analgesic techniques. Methods: The study included 165 patients undergoing primary reconstruction of the anterior cruciate ligament of the knee. All patients underwent spinal anaesthesia. The first group, systemic analgesia (SA), received balanced systemic analgesia postoperatively for a minimum of five days, based on Paracetamol, Diclofenac and a morphine PCA. In addition to the systemic analgesia already described, the second group, femoral analgesia (FA), will benefit from a femoral peri-nervous catheter in the crural position. 20 ml of bupivacaine at 0.125% concentration is injected; maintenance is set up immediately with a continuous flow of 8 ml/h for 36 h. The third intra-articular analgesia (IAA) group received, in addition to the same systemic analgesia, an infusion through an epidural catheter of 20 ml of 0.125% bupivacaine, followed by maintenance with 8 ml/h of the same local anesthetic via an electric syringe pump for 36 h. Results: Cumulative morphine consumption was assessed, as was pain at rest using a numerical scale (EN) from 1 to 10. Data were collected from H0 to H36. Overall consumption was 15.13 ± 12.35 mg. The difference in consumption was not significant according to gender and ASA, but it was significant according to mean age. There was a negative correlation between age and morphine consumption, with Pearson's R at -0.19 p 0.016. Conclusion: Morphine consumption kinetics follow those of post-operative pain and its intensity, but also of other factors, including the patient's age. Young age is one of the criteria for over-consumption of morphine.
Mechanical Ventilation Management for Aneurysmal Subarachnoid Hemorrhage in ICU Settings: A Literature Review Jacoeb, Joseph Ivan; Bernadus Realino Harjanto; Tommy Nugroho Tanumihardja; Joshua Kurniawan; William Gilbert Satyanegara
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.394

Abstract

Aneurysmal Subarachnoid Hemorrhage (aSAH) is one of the challenging neurologic emergencies with a high mortality rate along with various permanent disabilities. In order to provide the patient with the most appropriate and accurate treatment, as well as to prevent further complications, a multidiscipline approach is required. This study aimed to review the various mechanisms, indications, management, and sedation of mechanical ventilation in aSAH, along with a review of prone positioning and acute respiratory distress management in aSAH. Although the main injured organ is the brain, aSAH also affects the respiratory system through various mechanisms. The usage of mechanical ventilation plays an important part in brain oxygenation and perfusion and helps prevent related complications. Levels of oxygen and carbon dioxide in the blood might play some roles in aSAH patients. No significant difference was found in using various sedative regimens. Prone positioning is indeed beneficial for the oxygenation of aSAH patients, provided that continuous monitoring is done. Blood glucose and calcium levels might be able to help predict the outcome of aSAH patients. Mechanical ventilation plays an important part in aSAH management. Clinicians must be aware of the impact of mechanical ventilation on neurological organs and the cardiopulmonary system. Balancing between oxygenation, ventilation, and sedation must be in line with aSAH condition. Several prognostic factors and tools can help predict aSAH mortality that might be able to help the clinician tailor aSAH management to their patient's needs.
The Use of Inferior Vena Cava Ultrasonography to Assess Fluid Overload in Acute Lung Oedema in Severe Preeclampsia Patient Pamrikso, Eko Setyo; Muhammad Husni Thamrin
Journal of Anesthesiology and Clinical Research Vol. 5 No. 1 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i1.410

Abstract

Introduction: Accurate evaluation of volume status is essential for appropriate therapy because inadequate assessment of volume status can result in unnecessary administration of therapy, which can increase mortality. This study aimed to describe the use of inferior vena cava ultrasound in assessing fluid overload in severe preeclampsia patients. Case presentation: We report a 23-year-old female patient with a diagnosis of acute pulmonary oedema, and severe preeclampsia at G1P0A0 40 weeks gestation with complaints of shortness of breath. On physical examination, the patient appeared short of breath with RR 32 x/minute, fine wet crackles in both lung fields, SpO2 92% with NRM 15 L/m, HR 160 x/minute, lifting strength, CRT < 2 seconds, blood pressure 160/120 mmHg. This patient underwent emergency termination of pregnancy by C-section under general anesthesia rapid sequence induction followed by intensive care in the ICU. Management in the ICU this patient was given mechanical ventilation, midazolam sedation 0.05 mg/kg, analgesic morphine 10 mcg/kg, fluid restriction with a fluid balance target of (-)1000 ml/24 hours and given furosemide 10 mg/hour to reduce fluid overload so that fluid in the lungs can be reduced. Evaluation of fluid overload by IVC ultrasound. Conclusion: Acute pulmonary edema requires proper management to get a good outcome. Measurement of the diameter of the inferior vena cava (IVC) can also be used to assess fluid volume status. Lack of volume is assessed with an IVC diameter of <1.5 cm, while an IVC diameter of >2.5 cm indicates volume overload.
Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl DM, Rica; Mafiana R; Zainal R; Bahar E
Journal of Anesthesiology and Clinical Research Vol. 5 No. 1 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i1.443

Abstract

Introduction: Regional anesthetic techniques and local anesthesia have proven to be more effective than general anesthesia in the practice of ambulatory anesthesia. Spinal anesthesia is the technique of choice for ambulatory anesthesia in cervical cancer brachytherapy patients. Low-dose local anesthetics can speed up the ambulation time. This study aims to compare the ambulation time of low-dose spinal anesthesia with conventional doses. Fast ambulation time can speed up recovery time for patients, thereby reducing the patient's length of stay. Methods: This study was a double-blind, randomized controlled trial conducted in August – September 2022 at the Radiotherapy Installation of Dr. Mohammad Hoesin General Hospital (RSMH) Palembang. All cervical cancer patients undergoing brachytherapy in adults with ASA I-II physical status were included in the study sample. Samples will be randomized into two groups, namely a combination of hyperbaric bupivacaine 5 mg and fentanyl 25 mcg and a group of bupivacaine 2.5 mg and fentanyl 25 mcg. Patients with allergies, impaired motor function, spinal failure, block level not achieved, shock, apnea, respiratory depression, and experiencing pain during the procedure were excluded from the study. Results: Ambulation time in the hyperbaric bupivacaine 5 mg and 25 mcg fentanyl group was longer than the hyperbaric bupivacaine 2.5 mg and 25 mcg fentanyl (155.22 + 10.68 minutes versus 98.69 + 7.13 minutes) with a significance level of p<0.001. Spinal anesthetic drugs work in a dose-dependent manner. Increasing the dose will increase the duration of action of the spinal anesthetic. The only side effects found were hypotension and pruritus. Conclusion: Spinal anesthesia with hyperbaric bupivacaine 2.5 mg and fentanyl 25 mcg can accelerate the ambulation time of cervical cancer patients undergoing brachytherapy.

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