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Jurnal Anestesiologi dan Terapi Intensif
Published by Universitas Udayana
ISSN : 30903580     EISSN : 30903580     DOI : https://doi.org/10.24843
Core Subject : Health,
Health Professions Medicine & Pharmacology
Jurnal Anestesiologi dan Terapi Intensif (JATI) is the official publication of the Department of Anesthesiology and Intensive Care, Udayana University, Indonesia. The journal is dedicated to advancing knowledge, research, and clinical practice in the fields of anesthesiology, intensive care, pain medicine, and perioperative medicine. Aims The primary aim of JATI is to serve as a platform for disseminating high-quality, peer-reviewed scientific work that contributes to the improvement of patient care, education, and research in anesthesiology and intensive care. The journal seeks to: - Promote the integration of clinical practice, research, and education in perioperative and critical care medicine. - Encourage the publication of innovative research, case-based learning, and evidence-based reviews. - Provide opportunities for academic exchange among clinicians, researchers, and educators at the national and international levels. - Uphold ethical publishing standards and support the development of early-career researchers and clinicians. Scope JATI publishes original articles, review articles, case reports, study protocols, editorials, and commentaries covering a broad range of topics, including but not limited to: - General anesthesia and regional anesthesia - Perioperative medicine and patient safety - Critical care and intensive care medicine - Pain medicine, pain management, and interventional procedures - Resuscitation, trauma, and emergency medicine - Basic and translational anesthesia sciences - Clinical pharmacology and therapeutics - Ethics, professionalism, and medical law in anesthesiology - Simulation, education, and training in anesthesiology and critical care The journal operates on an open access model under the Creative Commons Attribution (CC BY 4.0) license, ensuring that all published articles are freely available to readers worldwide. Manuscripts are subject to rigorous double-blind peer review to ensure scientific quality and integrity.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 44 Documents
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Wound Infiltration for Enhanced Recovery After Cesarean Surgery in Rural Hospital: A Case Series Roy Sando; Jimmy Wongkar
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/t9an4z51

Abstract

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.
Supraclavicular Block for ORIF of Distal Humerus Fracture in End-Stage Renal Disease: A Case Report Dessy Kusumadewi; Taufiq Siswagama
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/vk6kyr32

Abstract

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.
Supportive Care for Severe Tetanus in the Intensive Care Unit: A Narrative Review Michael Jaya; I Putu Fajar Narakusuma; Cynthia Dewi Sinardja
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/v0ftgb42

Abstract

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.
Scalp Nerve Block for External Ventricular Drain in a Geriatric Patient with Anticipated Difficult Airway: A Case Report Komang Ady Widayana; Andika Metrisiawan
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/zfaszb91

Abstract

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.
Diaphragm Thickening Fraction vs Rapid Shallow Breathing Index in Predicting Weaning Success: A Prospective Diagnostic Study Deif Tunggal; I Gusti Ngurah Mahaalit Aribawa; Dewa Ayu Mas Shintya Dewi
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/bnr74z53

Abstract

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.
Pre-induction Stroke Volume Variation as a Predictor of Early Post-induction Hypotension in Non-Cardiac Surgery: A Cross-sectional Observational Study Marthen Luther King Elmas; Putu Agus Surya Panji; I Ketut Wibawa Nada
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/s6hn5y93

Abstract

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.
Regional Anesthesia and Ultrasound-Guided Peripheral Nerve Blocks in Current Practice Tjokorda Gde Agung Senapathi
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/8p9ktj40

Abstract

This editorial underscores the increasing centrality of regional anesthesia in contemporary anesthesiology, as reflected in the current issue. Peripheral nerve blocks and ultrasound-guided techniques are highlighted as key drivers of a broader shift toward precision, safety, and patient-centered perioperative care. Regional anesthesia has evolved beyond its traditional role, contributing to improved postoperative outcomes through optimized analgesia, reduced opioid use, and enhanced recovery. The integration of ultrasound has further strengthened accuracy, reproducibility, and educational value in clinical practice. However, the expansion of these techniques must be supported by adequate training, standardization, and vigilant attention to patient safety. Overall, this issue illustrates an evolving discipline in which innovation must remain aligned with evidence-based practice and clinically meaningful outcomes.
Epidural Anesthesia for Cesarean Section in a Parturient with Chiari I Malformation: a Case Report I Wayan Ade Punarbawa; Nyoman Bendhesa Wirananggala
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/kr9sdk52

Abstract

Chiari I malformation is a congenital neurological condition characterized by caudal herniation of the cerebellar tonsils, which may alter cerebrospinal fluid dynamics and complicate anesthetic management during pregnancy. The optimal anesthetic approach for parturients with this condition remains controversial, particularly regarding the safety of neuraxial anesthesia. We report the case of a 28-year-old woman with a known Chiari I malformation who presented at term gestation and underwent an urgent cesarean section after the onset of regular uterine contractions. Preoperative neurological evaluation and imaging demonstrated stable cerebellar tonsillar herniation without syringomyelia or signs of increased intracranial pressure. Following multidisciplinary consultation, epidural anesthesia was selected to minimize abrupt cerebrospinal fluid pressure changes and maintain hemodynamic stability. Epidural anesthesia was performed using 15 mL of 0.5% plain bupivacaine, achieving a T6 sensory block level. A healthy neonate was delivered with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. The procedure was performed uneventfully, with stable intraoperative parameters and no neurological complications. Postoperative recovery was smooth, and no neurological deterioration was observed during follow-up. This case highlights that carefully planned and titrated epidural anesthesia may be a feasible anesthetic option for cesarean section in selected parturients with Chiari I malformation following thorough multidisciplinary assessment.
Bougie-First Versus Stylet-First Technique for Tracheal Intubation in Adults: A Systematic Review and Meta-analysis Oktavio Jalu Kuncoro Jati; I Putu Fajar Narakusuma; Gde Bagus Susila Pradnyana Nurcahyo Oka; Regina Florean Napitupulu; Jeseline Felicia Liem; Tirza Faithania Amaris; Elmer Sebastian Cruz
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/8hqnbs41

Abstract

Introduction: Bougie-first and stylet-first techniques are widely used to facilitate adult tracheal intubation, but randomized evidence remains inconsistent across emergency, intensive care, and operating room settings. This systematic review and meta-analysis aimed to compare bougie-first versus stylet-first intubation in adults, focusing on first-attempt intubation success and key procedural and airway-related safety outcomes. Material and Methods: We conducted a PRISMA 2020–compliant systematic review registered in PROSPERO (CRD420261298317). PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched from database inception to 31 January 2026. Records were screened in duplicate, and randomized controlled trials enrolling adults (≥18 years) undergoing oral tracheal intubation comparing a planned bougie-first strategy versus a planned stylet-first strategy were included. Random-effects meta-analyses pooled dichotomous outcomes as odds ratios (ORs) and continuous outcomes as mean differences (MDs). Results: From 1,158 records, eight randomized controlled trials involving 2,578 participants were included. First-attempt intubation success did not differ significantly between bougie-first and stylet-first techniques (OR 0.99, 95% CI 0.37–2.65; p = 0.980), with substantial heterogeneity (I² = 89.05%; p < 0.001). Bougie-first was associated with longer time to successful intubation (MD 21.84 seconds, 95% CI 5.55–38.14; p = 0.010), although heterogeneity was very high (I² = 97.37%; p < 0.001). There were no significant differences in more than one attempt (OR 0.91, 95% CI 0.21–3.91; p = 0.900), esophageal intubation (OR 0.48, 95% CI 0.17–1.40; p = 0.180), pulmonary aspiration (OR 1.47, 95% CI 0.57–3.75; p = 0.420), or postoperative sore throat (OR 1.10, 95% CI 0.48–2.52; p = 0.830).  Conclusion: Current randomized evidence did not demonstrate a consistent difference in first-attempt intubation success between bougie-first and styletfirst tracheal intubation in adults. Bougie-first was associated with longer intubation time, but this finding should be interpreted cautiously because of very high heterogeneity and variable timing definitions. 
Phenylephrine Infusion for Preventing Hypotension in Obese Parturients Undergoing Caesarean Delivery: A Systematic Review Angelo Alexander; Felix Kurniawan Adithia; Guwivanda Helga Firjatullah; Sianty Dewi
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/ga6yy358

Abstract

Background: Spinal anaesthesia-induced hypotension is common during caesarean delivery, and the optimal phenylephrine dosing strategy for obese parturients remains uncertain. This systematic review evaluated the efficacy and dosing regimens of prophylactic phenylephrine infusion in this population. Methods: PubMed, ScienceDirect, the Cochrane Library, and Scopus were searched for randomised controlled trials published from 2010 through 2025. Eligible studies included parturients with singleton pregnancies at ≥36 weeks of gestation, a body mass index ≥30 kg/m², and no major comorbidities. Phenylephrine infusion was compared with bolus regimens or alternative infusion doses. The primary outcome was maternal hypotension; secondary outcomes included reactive hypertension, maternal adverse effects, and neonatal outcomes. Risk of bias was assessed using Cochrane RoB 2, and findings were synthesised narratively because of clinical and methodological heterogeneity. Results: Three randomised controlled trials involving 334 parturients were included. Phenylephrine infusion was associated with fewer hypotensive episodes than bolus administration, although the certainty of evidence was low. One dose-response trial reported preliminary ED₅₀ and ED₉₀ estimates of 0.42 and 0.68 µg/kg/min, respectively. Higher infusion doses were associated with more reactive hypertension, whereas bradycardia did not differ significantly across groups. Nausea, vomiting, and neonatal outcomes showed no consistent between-group differences. Conclusion: The certainty of evidence was low for most outcomes, precluding firm conclusions about the efficacy and optimal dosing of phenylephrine infusion in obese parturients without major comorbidities. Reactive hypertension increased with higher infusion doses, whereas evidence for bradycardia and neonatal safety remained limited. Larger, standardised trials are needed, particularly in parturients with severe obesity or comorbidities.

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