Jurnal Anestesi dan Terapi Intensif Udayana
JATI (Jurnal Anestesi dan Terapi Intensif) Udayana publishes original research articles, review articles, and case reports in the field of anesthesiology and intensive care. The journal aims to advance knowledge, research, and clinical practice in the following areas: General Anesthesia Advances, techniques, and innovations in general anesthesia practice for various age groups and surgical procedures, including: Thoracic, Cardiac, and Vascular Anesthesia Neuroanesthesia Pediatric Anesthesia Ophthalmic Anesthesia Ear, Nose, and Throat (ENT) Anesthesia Oncologic Anesthesia Orthopedic Anesthesia Obstetric Anesthesia Urologic Anesthesia Digestive Surgery Anesthesia Plastic Surgery Anesthesia Trauma Anesthesia Minimally Invasive Surgery Anesthesia Anesthesia Outside the Operating Room (Non-OR Anesthesia) One-Day Care Anesthesia Regional Anesthesia Research and clinical application of neuraxial and peripheral nerve blocks, including ultrasound-guided and nerve stimulator-assisted techniques. Intensive Care and Critical Medicine Topics related to the management of critically ill patients, including hemodynamic monitoring, sepsis, organ support, and intensive care protocols. Acute and Chronic Pain Management Perioperative pain control, chronic pain interventions, multimodal analgesia, and opioid-sparing techniques. Emergency and Resuscitation Clinical and experimental research on resuscitation, trauma management, cardiac arrest, and perioperative emergencies. Mechanical Ventilation and Monitoring Innovations in respiratory support, weaning strategies, and advancements in perioperative and critical care monitoring. Basic Anesthesia Sciences and Clinical Pharmacology Studies on pharmacokinetics, pharmacodynamics, anesthetic mechanisms, and physiology relevant to anesthesia practice. Ethics and Patient Safety Issues related to informed consent, safety culture, medical errors, ethical dilemmas, and risk mitigation in anesthesia and critical care practice. Medical Law Covers legal aspects of anesthesiology, intensive care, and perioperative medicine, including informed consent, medical confidentiality, patient–physician rights and responsibilities, medical litigation, and the application of bioethical principles in clinical decision-making and risk management. Anesthesia Medical Education Educational strategies, curriculum development, simulation-based training, and assessment methods for anesthesiology residents and professionals.
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<![CDATA[Single versus Double Injection Techniques in Supraclavicular Brachial Plexus Block and the Role of Perfusion Index: A Narrative Review ]]>
<![CDATA[Fransiscus Braveno Rapa]]>;
<![CDATA[I Made Gede Widnyana]]>;
<![CDATA[Made Agus Kresna Sucandra]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/eszj4f98
<![CDATA[Ultrasound-guided supraclavicular brachial plexus block (SCBPB) is a widely used regional anesthesia technique for upper extremity surgery; however, variability in block onset and success remains a clinical concern. Differences in injection strategies, particularly single versus double injection techniques, have been proposed to improve anesthetic spread and block reliability. In parallel, the perfusion index (PI), derived from pulse oximetry, has emerged as a potential objective and non-invasive indicator for early assessment of block success. This narrative review aims to synthesize current evidence comparing single and double injection techniques in supraclavicular brachial plexus block and to evaluate the clinical value of the perfusion index as an objective monitoring tool. A narrative literature search was conducted using PubMed, ScienceDirect, and Google Scholar with keywords related to supraclavicular brachial plexus block, injection techniques, and perfusion index, focusing on studies published between 2015 and 2025. The reviewed literature suggests that the double injection technique is generally associated with faster sensory and motor onset, longer block duration, and higher block success rates compared with the single injection approach, although it requires longer procedural time and may slightly increase the incidence of transient neurological symptoms. Studies assessing perfusion index consistently demonstrate a significant increase following successful blocks, often preceding conventional sensory and motor assessments, with reported threshold values showing high sensitivity and specificity despite variability among studies. Overall, double injection supraclavicular brachial plexus block appears to offer improved block characteristics, while perfusion index monitoring represents a promising, rapid, and objective adjunct for early block evaluation. Further studies integrating injection techniques with standardized perfusion index assessment are required to optimize clinical application.]]>
<![CDATA[Linea Semilunaris vs. Lateral Transversus Abdominis Plane (TAP) Block after Caesarean Section: A Narrative Review ]]>
<![CDATA[Luh Ratna Oka Rastini]]>;
<![CDATA[Putu Kurniyanta]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/qg4fmv98
<![CDATA[Cesarean section (CS) is a major obstetric surgery with a prevalence of moderate to severe postoperative pain exceeding 80% within the first 24 hours. Pain involves both somatic and visceral components, and inadequate pain management may impair early mobilization, hinder breastfeeding, increase the risk of postpartum depression, and contribute to chronic pain. The Transversus Abdominis Plane (TAP) block is an effective regional analgesia technique that can reduce somatic pain after CS and decrease opioid requirements. Two commonly used approaches are the linea semilunaris and lateral approaches; however, direct comparisons of their effectiveness in CS patients remain scarce in Indonesia. This narrative review was conducted through a literature search between 2015 and 2025 and included clinical studies evaluating pain intensity, analgesia duration, opioid requirements, and adverse effects in post-CS patients. The results show that linea semilunaris may offer broader analgesic coverage and longer duration of analgesia compared to the lateral approach in post-CS patients. Large-scale, well-designed RCTs are needed to confirm its clinical superiority and establish optimal dosing guidelines.]]>
<![CDATA[Ultrasound-Guided PENG Block for Analgesia in Early Pregnancy with Femoral Head Fracture and Hip Dislocation: A Case Report ]]>
<![CDATA[Made Agus Cahya Nugraha Koriawan]]>;
<![CDATA[I Gusti Agung Gede Utara Hartawan]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/3eb6hh34
<![CDATA[Femoral head fracture accompanied by hip dislocation during pregnancy is an uncommon clinical event that presents significant challenges in maternal analgesia and fetal safety. Traumatic hip dislocations account for a small proportion of joint dislocations, while their occurrence during pregnancy is rarely reported, particularly when associated with femoral head fractures. Management becomes more complex because timely reduction and defenitive orthopedic fixation must be achieved while ensuring adequate analgesia and minimizing systemic drug exposure. We describe the case of a 32-year-old woman in early pregnancy (11 weeks of gestation) who presented with a posterior dislocation of the left hip accompanied by a Pipkin type I femoral head fracture following a traffic accident. To provide effective analgesia and reduce fetal risk, a pericapsular nerve group (PENG) block was selected as part of the anesthetic strategy. This regional technique enabled optimal positioning for reduction, minimized the requirement for systemic opioids, and supported early mobilization. Maternal hemodynamics and fetal parameters remained stable throughout the perioperative period. This case highlights the potential role of the PENG block as a focused regional analgesic technique in pregnant trauma patients, particularly during early gestation, where minimizing systemic drug exposure is a critical priority.]]>
<![CDATA[Rotational Thromboelastometry-guided Transfusion in Major Obstetric Hemorrhage: A Case Series ]]>
<![CDATA[David]]>;
<![CDATA[Tjahya Aryasa EM]]>;
<![CDATA[Marilaeta Cindryani Ra Ratumasa]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/7nf7vg96
<![CDATA[Major obstetric hemorrhage remains a critical cause of maternal morbidity and mortality, requiring rapid yet precise transfusion management to prevent coagulopathy and adverse outcomes. We report a case series of seven obstetric patients with major perioperative hemorrhage managed using rotational thromboelastometry (ROTEM) guided transfusion at a tertiary referral center. The patients, predominantly with placenta accreta spectrum disorders, placenta previa, uterine atony, and one case of idiopathic thrombocytopenic purpura, experienced a wide range of estimated blood loss from 200 to 4500 mL. ROTEM assessment using EXTEM and FIBTEM parameters was performed during active bleeding to identify specific coagulation abnormalities and guide transfusion decisions. All patients received packed red cell transfusion, while fibrinogen replacement, fresh frozen plasma, platelet concentrates, and tranexamic acid were administered selectively based on viscoelastic findings rather than estimated blood loss alone. Four patients received tranexamic acid due to evidence of impaired clot stability, whereas others with preserved clot firmness were managed without empiric plasma or antifibrinolytic therapy despite significant hemorrhage. One patient with minimal bleeding required platelet transfusion after ROTEM detected qualitative platelet dysfunction. All patients achieved hemodynamic stabilization without major transfusion-related complications or need for reoperation. This case series highlights the clinical value of ROTEM in enabling goal-directed, individualized transfusion strategies in obstetric hemorrhage, emphasizing that viscoelastic-guided management may optimize hemostasis while limiting unnecessary blood product exposure.]]>
<![CDATA[Wound Infiltration for Enhanced Recovery After Cesarean Surgery in Rural Hospital: A Case Series ]]>
<![CDATA[Roy Sando]]>;
<![CDATA[Jimmy Wongkar]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/t9an4z51
<![CDATA[Cesarean section is a major surgical procedure frequently associated with significant postoperative pain, which may delay mobilization and prolong hospital stay, particularly in rural hospitals with limited healthcare resources. Wound infiltration with local anesthetic represents a simple and practical analgesic component within the multimodal pain management strategy of the Enhanced Recovery After Cesarean Surgery (ERACS) pathway. This case series describes ten parturients scheduled for elective cesarean section with American Society of Anesthesiologists (ASA) physical status II and body mass index (BMI) < 30 kg/m2. All patients received regional anesthesia using subarachnoid block without intrathecal adjuvants. Local wound infiltration was performed before skin closure using 0.2% isobaric bupivacaine with adrenaline (1:200,000) along the incision margins. Postoperative outcomes included pain intensity was assessed by the Visual Analog Scale (VAS) at 2, 4, and 6 hours, as well as postoperative nausea and vomiting, early ambulation, early initiation of breastfeeding and length of hospital stay. Across all cases, low early postoperative pain scores were observed, with VAS score ≤ 2 during the first 4 hours and decreasing to 1 at 6 hours postoperatively. Eight patients achieved early ambulation and successfully initiated breastfeeding within 24 hours. Two patients experienced postoperative nausea and vomiting, which delayed mobilization and prolonged hospital stay beyond 24 hours. No wound complications or signs of local anesthetic systemic toxicity were observed. In this rural hospital setting, wound infiltration with bupivacaine and adrenaline was associated with favorable early postoperative outcomes and appears to be feasible, low-resource adjunct within ERACS protocols to support early recovery after cesarean delivery.]]>
<![CDATA[Supraclavicular Block for ORIF of Distal Humerus Fracture in End-Stage Renal Disease: A Case Report ]]>
<![CDATA[Dessy Kusumadewi]]>;
<![CDATA[Taufiq Siswagama]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/vk6kyr32
<![CDATA[Supraclavicular block (SCB) is a well-established regional anesthesia technique for upper limb surgery; however, its application in patients with end-stage renal disease (ESRD) receiving antiplatelet therapy presents distinct clinical challenges. This case is noteworthy because of the coexistence of ESRD, ongoing clopidogrel therapy, anemia, and potential respiratory compromise, all of which complicate anesthetic decision-making. We report a 44-year-old female with ESRD on regular hemodialysis who sustained a comminuted intra-articular distal humerus fracture and underwent open reduction and internal fixation under ultrasound-guided SCB. The block was performed using 15 mL of 0.75% ropivacaine with dexamethasone as an adjuvant, following careful consideration of bleeding risk, local anesthetic dosing, and pneumothorax prevention. The procedure provided effective intraoperative anesthesia and prolonged postoperative analgesia without neurological, respiratory, or bleeding complications. Postoperative pain scores remained low, opioid consumption was minimal, and motor function recovered uneventfully. This case highlights that ultrasound-guided SCB can be safely and effectively performed in carefully selected ESRD patients receiving antiplatelet therapy when meticulous technique, dose justification, and risk mitigation strategies are applied. The key learning point is the importance of individualized anesthetic planning rather than a generalized preference for regional over general anesthesia.]]>
<![CDATA[Supportive Care for Severe Tetanus in the Intensive Care Unit: A Narrative Review ]]>
<![CDATA[Michael Jaya]]>;
<![CDATA[I Putu Fajar Narakusuma]]>;
<![CDATA[Cynthia Dewi Sinardja]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/v0ftgb42
<![CDATA[Tetanus is an acute infectious disease caused by Clostridium tetani and remains associated with high mortality, particularly in severe cases requiring intensive care unit (ICU) admission. The neurotoxin tetanospasmin induces persistent muscle spasms, autonomic dysfunction, and respiratory failure, rendering ICU management complex and resource-intensive. This narrative review aims to synthesize current evidence on multimodal supportive care strategies that improve clinical outcomes in patients with severe tetanus managed in the ICU. This literature review identifies several interrelated components as central to successful management, including early airway control and mechanical ventilation, optimized sedation and spasm control using benzodiazepines, magnesium sulfate, and selected adjuvant agents, targeted nutritional and metabolic support through early enteral feeding, prevention of ICU-related complications, and early rehabilitation to mitigate ICU-acquired weakness. Collectively, evidence indicates that a comprehensive, evidence-based supportive care approach improves hemodynamic stability, reduces complication rates, and facilitates functional recovery in patients with severe tetanus.]]>
<![CDATA[Scalp Nerve Block for External Ventricular Drain in a Geriatric Patient with Anticipated Difficult Airway: A Case Report ]]>
<![CDATA[Komang Ady Widayana]]>;
<![CDATA[Andika Metrisiawan]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/zfaszb91
<![CDATA[Emergency neurosurgical procedures in geriatric patients with an anticipated difficult airway pose major anesthetic challenges due to limited physiological reserve and the risk of hemodynamic instability during general anesthesia. We report the use of a scalp nerve block (SNB) as the primary anesthetic technique for urgent external ventricular drain (EVD) placement in a female patient in her mid-70s with intracerebral hemorrhage and obstructive hydrocephalus. She presented with decreased consciousness and a LEMON score of 6, indicating a high likelihood of difficult airway, and was classified as American Society of Anesthesiologists (ASA) physical status IIIE. Given the elevated intracranial pressure and anticipated difficulty in airway management, SNB with lidocaine and dexmedetomidine as an adjuvant was performed under standard monitoring. The procedure was completed uneventfully, with stable hemodynamics and adequate analgesia, without the need for airway manipulation or conversion to general anesthesia. This case highlights that SNB may be a feasible alternative anesthetic approach for selected high-risk geriatric patients undergoing EVD placement, particularly when airway intervention may be hazardous or when advanced airway and critical care resources are limited. Further reports and larger studies are required to determine safety and generalizability.]]>
<![CDATA[Diaphragm Thickening Fraction vs Rapid Shallow Breathing Index in Predicting Weaning Success: A Prospective Diagnostic Study ]]>
<![CDATA[Deif Tunggal]]>;
<![CDATA[I Gusti Ngurah Mahaalit Aribawa]]>;
<![CDATA[Dewa Ayu Mas Shintya Dewi]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/bnr74z53
<![CDATA[Introduction: Weaning from mechanical ventilation is a critical step in intensive care, and inaccurate assessment may increase the risk of complications. The rapid shallow breathing index (RSBI) is widely used to evaluate weaning readiness but does not directly assess diaphragmatic function. Diaphragm thickening fraction (DTF), measured by bedside ultrasound, has been proposed as an additional predictor of weaning success. This study aimed to compare the diagnostic performance of DTF and RSBI in mechanically ventilated ICU patients. Patients and Methods: This prospective diagnostic accuracy study was conducted in a tertiary hospital in Denpasar, Indonesia, from September to December 2022, in accordance with STARD 2015 guidelines. Adult patients aged 18–65 years who received invasive mechanical ventilation for >24 hours and were considered ready for weaning were included. RSBI and right-sided DTF were measured at the fifth minute of a spontaneous breathing trial. Weaning success was defined as extubation without reintubation, noninvasive ventilation, or death within 48 hours. Results: Fifty-six patients were included, of whom 73.2% achieved successful weaning. DTF demonstrated high sensitivity (95.4%) and moderate specificity (75.0%), with a positive predictive value of 93.3% and a negative predictive value of 81.8%. RSBI showed sensitivity of 97.5% and specificity of 80.0%, with higher discriminative performance (AUC 0.88 vs 0.79). Confidence intervals and statistical comparisons between AUCs were not performed. Conclusion: Both RSBI and DTF were associated with weaning success. RSBI demonstrated superior overall diagnostic performance and remains the primary assessment tool. DTF may provide additional physiological information on diaphragmatic function and serve as a complementary parameter during weaning assessment.]]>
<![CDATA[Pre-induction Stroke Volume Variation as a Predictor of Early Post-induction Hypotension in Non-Cardiac Surgery: A Cross-sectional Observational Study ]]>
<![CDATA[Marthen Luther King Elmas]]>;
<![CDATA[Putu Agus Surya Panji]]>;
<![CDATA[I Ketut Wibawa Nada]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/s6hn5y93
<![CDATA[Introduction: General anesthesia induction-related hypotension is common and is associated with postoperative organ injury. Dynamic indices derived from echocardiography may help identify patients at risk, although stroke volume variation (SVV) is conventionally more robust under controlled mechanical ventilation than during spontaneous breathing. We investigated whether pre-induction transthoracic echocardiography-derived SVV was associated with arterial pressure 10 min after induction in adult elective non-cardiac surgical patients. Patients and Methods: This single-centre cross-sectional observational study enrolled consecutive adult patients undergoing elective non-cardiac surgery with general anesthesia at a tertiary hospital (August–September 2022). Pre-induction SVV was measured in the supine position using the left ventricular outflow tract method during standardized spontaneous breathing. Anesthesia was induced with propofol 1.5 mg kg−1, fentanyl 2 µg kg−1, and atracurium 0.5 mg kg−1. Non-invasive arterial pressure was recorded for 10 min after induction. The prespecified primary outcomes were systolic blood pressure (SBP) and mean arterial pressure (MAP) at 10 min. Spearman’s rank correlation was used. Results: Sixty-four patients were analysed (mean age 48.4 yr; 57.8% male; 62.5% ASA physical status II). Mean pre-induction SVV was 13.4% (SD 4.3). Mean systolic blood pressure (SBP) decreased from 116.1 (7.9) mmHg pre-induction to 93.3 (6.3) mmHg at 10 min; mean arterial pressure (MAP) from 93.4 (12.3) to 76.8 (6.1) mmHg. Higher pre-induction SVV correlated with lower SBP at 10 min (Spearman r = −0.494; 95% CI −0.660 to −0.282; P < 0.001) and lower MAP at 10 min (r = −0.676; 95% CI −0.790 to −0.516; P < 0.001). Conclusion: Pre-induction transthoracic echocardiography-derived SVV was associated with lower arterial pressure 10 min after induction. Because the study was observational and measurements were obtained during spontaneous breathing, the findings should be interpreted as hypothesis-generating and warrant confirmation in prospective studies.]]>
