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.
Articles
37 Documents
<![CDATA[Peran Gabapentinoid dalam Strategi Analgesia Preemptif pada Mastektomi Radikal Termodifikasi: Tinjauan Naratif ]]>
<![CDATA[Pratana, Yolanda Jenny]]>;
<![CDATA[Kurniajaya, I Gusti Agung Made Wibisana]]>;
<![CDATA[Wirananggala, Nyoman Bendhesa]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025 ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/ztnjkq21
<![CDATA[Nyeri pascaoperasi tetap menjadi tantangan utama pada pasien kanker payudara yang menjalani prosedur Modified Radical Mastectomy (MRM), dengan prevalensi nyeri sedang hingga berat mencapai hampir 70%. Salah satu pendekatan yang menjanjikan adalah penggunaan analgesia preemptif dengan agen gabapentinoid, seperti pregabalin dan gabapentin, yang bekerja menghambat sensitisasi sentral serta menurunkan konsumsi opioid. Tinjauan naratif ini bertujuan mengevaluasi efektivitas kedua agen tersebut dalam mengurangi nyeri pasca-MRM, memperpanjang durasi bebas nyeri, dan menekan kebutuhan analgesik tambahan. Penelusuran literatur dilakukan melalui basis data PubMed, Scopus, ScienceDirect, dan Google Scholar dengan kata kunci “pregabalin”, “gabapentin”, “preemptive analgesia”, “modified radical mastectomy”, dan “postoperative pain”, mencakup publikasi berbahasa Inggris dan Indonesia periode 2013–2024. Hasil sintesis menunjukkan bahwa pregabalin dan gabapentin secara konsisten menurunkan skor nyeri Visual Analog Scale (VAS), memperpanjang waktu hingga permintaan analgesik pertama, dan mengurangi total konsumsi opioid pascaoperasi. Pregabalin dosis 150 mg menunjukkan efektivitas yang setara atau lebih baik dibandingkan gabapentin 900 mg, dengan onset kerja lebih cepat dan profil efek samping yang lebih ringan. Secara keseluruhan, gabapentinoid terbukti efektif dan aman sebagai bagian dari strategi analgesia multimodal pasca MRM, dengan pregabalin menunjukkan keunggulan farmakokinetik dan tolerabilitas yang lebih baik. Penelitian berskala besar dengan populasi homogen masih diperlukan untuk memperkuat rekomendasi klinis berbasis bukti.]]>
<![CDATA[Effectiveness of Dexmedetomidine Compared to Midazolam for Sedation in Mechanically Ventilated Patients: A Narrative Review ]]>
<![CDATA[Haithami, Guntur Mu Ammar]]>;
<![CDATA[Putu Agus Surya Panji]]>;
<![CDATA[Ida Bagus Krisna Jaya Sutawan]]>;
<![CDATA[Christopher Ryalino]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025 ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/359b8m36
<![CDATA[Delirium is a common and clinically significant neuropsychiatric complication in mechanically ventilated adult ICU patients, contributing to prolonged hospitalization, increased morbidity, and long-term cognitive impairment. The choice of sedative agent plays a pivotal role in preventing delirium, with dexmedetomidine and midazolam representing the most commonly used drugs with contrasting mechanisms. This narrative review evaluates the clinical efficacy, safety profile, neurocognitive outcomes, and cost-effectiveness of dexmedetomidine compared with midazolam in mechanically ventilated ICU patients. Literature was searched through PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar for studies published between 2020 and 2025 using the keywords dexmedetomidine, midazolam, sedation, mechanical ventilation, delirium, and intensive care units. Seventeen peer-reviewed publications were included and analyzed narratively. Dexmedetomidine consistently reduced the incidence and duration of delirium (RR 0.55–0.65; 95% CI 0.4–0.8), shortened mechanical ventilation by 0.7–1.5 days, and facilitated earlier extubation compared to midazolam. Its α₂-adrenergic agonism at the locus coeruleus produces a sleep-like, cooperative sedation, with mild, dose-dependent bradycardia as the most frequent adverse effect. Despite higher acquisition cost, economic analyses reported average savings of US$ 450–700 (≈ IDR 7–10 million) per patient through reduced ICU stay and delirium-related complications. Overall, dexmedetomidine demonstrates superior efficacy and safety compared with midazolam for ICU sedation, providing both clinical and economic advantages. Integration into light-sedation and delirium-prevention bundles may improve ICU outcomes, particularly in resource-limited settings.]]>
<![CDATA[Renal Resistive Index in Early Detection of AKI after Neurosurgery: A Case Series ]]>
<![CDATA[Sethiono, Aldy]]>;
<![CDATA[Parami, Pontisomaya]]>;
<![CDATA[Wirgunatha, I Made Wirga]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025 ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/t6eqx794
<![CDATA[Postoperative acute kidney injury (AKI) is a frequent yet underrecognized complication in neurosurgical patients, often contributing to increased morbidity and mortality. Brain injury can trigger systemic effects, including sympathetic overactivation, inflammatory responses, and hemodynamic instability, all of which predispose patients to renal dysfunction. The Renal Resistive Index (RRI), obtained by Doppler ultrasonography, reflects intrarenal vascular resistance and has emerged as a promising early marker of AKI. This case series describes three patients undergoing decompressive craniectomy for intracranial hemorrhage who had normal preoperative renal function and subsequently developed stage 1 AKI according to Kidney Disease; Improving Global Outcome (KDIGO) guideline within 24 hours postoperatively. In each case, an elevated RRI (>0.7) measured during the early postoperative period preceded the rise in serum creatinine and the reduction in urine output. The consistent pattern across these patients highlights the potential utility of RRI as a noninvasive, bedside predictor of postoperative AKI in neurosurgical populations. The findings support the clinical relevance of integrating RRI into perioperative monitoring, particularly in high-risk patients where early detection of renal dysfunction may guide timely interventions to optimize hemodynamic stability and prevent further injury. Further prospective studies with larger cohorts are warranted to validate these observations and establish standardized thresholds for practice.]]>
<![CDATA[Anesthetic Approach to Placenta Previa with Associated Bladder Rupture: A Case Report ]]>
<![CDATA[Putra, Made Bagus Cahya Maha]]>;
<![CDATA[IGAG Utara Hartawan]]>;
<![CDATA[Dewa Ayu Mas Shintya Dewi]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025 ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/nqk01d22
<![CDATA[This case report outlines the anesthetic management of total placenta previa with high-risk features of placenta accreta spectrum (PAS) complicated by bladder rupture, representing a rare but clinically significant form of invasive placentation. A 29-year-old G2P1001 at 35+3 weeks’ gestation presented with recurrent antepartum bleeding and ultrasonographic features consistent with PAS, including grade III lacunae, bridging vessels, severe myometrial thinning, and a Placenta Accreta Indeks (PAI) score of 6. Spinal anesthesia was initiated for delivery, followed by a controlled conversion to general anesthesia to facilitate hysterectomy, two-layer bladder repair, ureteral reconstruction, and Double-J stent placement. Hemodynamic stability was maintaned using tranexamic acid, colloid co-loading, invasive arterial monitoring, and norepinephrine titration. An estimated blood loss of 2,300 mL was managed with targeted transfusion, resulting in favourable maternal recovery and neonatal outcomes (Apgar 7 and 9). This case underscores the importance of early PAS recognition, structured anesthetic planning, and coordinated multidisciplinary care, supporting the benefit of a staged neuraxial-to-general anesthesia strategy in complex PAS with urologic involvement.]]>
<![CDATA[Dexmedetomidine as Adjuvant in Scalp Nerve Block for Craniotomy: A Double-Blind Randomized Clinical Trial ]]>
<![CDATA[Eka Nantha Kusuma, Putu]]>;
<![CDATA[I Putu Pramana Suarjaya]]>;
<![CDATA[Parami, Pontisomaya]]>;
<![CDATA[IGAG Utara Hartawan]]>;
<![CDATA[I Gusti Ngurah Mahaalit]]>;
<![CDATA[I Putu Kurniyanta]]>;
<![CDATA[Ida Bagus Krisna Jaya Sutawan]]>;
<![CDATA[Sudiantara, Putu Herdita]]>;
<![CDATA[I Made Gede Widnyana]]>;
<![CDATA[Gde Agung Senapathi, Tjokorda]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025 ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/q23wyc88
<![CDATA[Introduction: Scalp nerve block (SNB) is an effective adjunct for attenuating hemodynamic responses and reducing postoperative pain in craniotomy. Dexmedetomidine (DEX), with its analgesic and anti-inflammatory properties, may enhance the quality of SNB. This study evaluated the effects of adding DEX to SNB on hemodynamic stability, postoperative pain, inflammatory response, and analgesic duration in craniotomy patients. Methods: A double-blind, parallel-group randomized clinical trial was conducted on 36 adult patients undergoing elective craniotomy (July–September 2025) at a tertiary hospital Denpasar. Participants received SNB using 0.375% ropivacaine (20 mL) with or without DEX 1 µg/kg under standardized general anesthesia. Outcomes included mean arterial pressure (MAP), Visual Analog Scale (VAS) scores at 12 and 24 hours, neutrophil-to-lymphocyte ratio (ΔNLR), and time to first rescue analgesic (TTFAR). Statistical analyses used mixed ANOVA and Mann–Whitney U tests. Ethical approval number was 2159/UN14.2.2.VII.14/LT/2025. Results: MAP was significantly lower in the DEX group at 10 minutes (Δ = 4.89 mmHg; 95% CI 1.62–8.16), 20 minutes (Δ = 4.83; 95% CI 1.57–8.10), 30 minutes (Δ = 3.67; 95% CI 0.40–6.94), and upon PACU arrival (Δ = 3.72; 95% CI 0.45–6.99) (all p < 0.05). Median VAS scores were significantly lower with DEX at 12 hours (1.50 vs 3.00; p < 0.001) and 24 hours (1.00 vs 2.00; p < 0.001). ΔNLR was reduced in the DEX group (−0.56 vs 3.08; p = 0.004). TTFAR was markedly prolonged (554 vs 257 minutes; p < 0.001). No adverse events were reported. Conclusion: Dexmedetomidine added to scalp nerve block enhances hemodynamic stability, reduces postoperative pain for up to 24 hours, suppresses early systemic inflammation, and prolongs analgesic duration in craniotomy without observed complications. DEX–SNB represents a beneficial component of multimodal analgesia in neuroanesthesia and may support enhanced recovery pathways]]>
<![CDATA[Integrasi Pendekatan Multimodal dalam Praktik Anestesiologi dan Terapi Intensif ]]>
<![CDATA[Anak Agung Ngurah, Aryawangsa]]>
<![CDATA[ Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025 ]]>
Publisher : <![CDATA[Udayana University and Indonesian Society of Anesthesiologists (PERDATIN) ]]>
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DOI: 10.24843/087fc824
<![CDATA[Praktik anestesiologi dan terapi intensif mengalami pergeseran paradigma dari penggunaan terapi tunggal menuju strategi multimodal yang terstruktur dan saling melengkapi. Bukti ilmiah menunjukkan bahwa multimodal analgesia pada pembedahan mayor meningkatkan kontrol nyeri, menurunkan konsumsi opioid, serta mempercepat pemulihan pascaoperasi. Temuan ini menegaskan bahwa pendekatan multimodal merupakan elemen utama dalam manajemen perioperatif modern yang berfokus pada luaran klinis yang lebih baik. Pendekatan ini sejalan dengan konsep personalized anesthesia, di mana pilihan obat, teknik anestesi, dan strategi analgesia disesuaikan dengan karakteristik, komorbiditas, serta risiko individual pasien. Pada populasi berisiko tinggi, personalisasi multimodal menjadi faktor kritis dalam menjaga stabilitas perioperatif. Pemahaman baru mengenai respons stres perioperatif semakin menguatkan urgensi pendekatan multimodal. Peningkatan sitokin proinflamasi dan biomarker stres telah dikaitkan dengan komplikasi neurologis pascaoperasi, sehingga mengatur respons biologis berlebihan menjadi bagian penting dari keberhasilan terapi. Agen farmakologis seperti dexmedetomidine, dengan efek sedasi, analgesia, dan stabilitas hemodinamik, memberikan nilai tambah melalui penurunan kebutuhan opioid dan anestetik volatil, serta peningkatan kualitas pemulihan. Teknik anestesi regional berbasis ultrasonografi juga berperan sentral dalam multimodal perioperatif karena meningkatkan presisi tindakan, mengurangi risiko komplikasi, dan memberikan analgesia superior. Meskipun terdapat kekhawatiran mengenai kompleksitas protokol dan ketersediaan sumber daya, bukti menunjukkan bahwa strategi multimodal dan personalisasi terapi memberikan hasil klinis yang lebih baik serta efisiensi sistem yang lebih tinggi. Dengan komitmen terhadap praktik berbasis bukti dan pelayanan yang berpusat pada pasien, integrasi multimodal akan menjadi fondasi penting bagi peningkatan mutu dan keselamatan dalam anestesiologi dan terapi intensif.]]>
<![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.]]>
