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
26 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.]]>
