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   Table of Contents - Current issue
January-March 2020
Volume 4 | Issue 1
Page Nos. 1-31

Online since Monday, March 16, 2020

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Covid-19: What we know so far Highly accessed article p. 1
Christopher Ryalino
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Comparison the effect of preloading and coloading with crystalloid fluid on the incidence of hypotension after spinal anesthesia in cesarean section p. 3
I Made Artawan, Budi Yulianto Sarim, Sidarta Sagita, Maria Agnes Etty Dedi
Introduction: Hypotension after spinal anesthesia is a frequent complication in patients undergoing cesarean section; the incidence of maternal hypotension is 60%–70%. One way to overcome or prevent hypotension due to spinal anesthesia is by administering intravenous fluid boluses. This study was conducted with the aim of comparing the effectiveness of crystalloid fluid preloading and coloading against the incidence of hypotension after spinal anesthesia in cesarean section. Methods: This research is a single-blind clinical trial. The number of subjects who participated in this study were 51 subjects. Subjects selected by consecutive sampling with inclusion criteria gravida patients aged 16 years to 40 years with ASA 1 or ASA 2 physical status who would undergo elective cesarean section with spinal anesthesia and there were no contraindications for spinal anesthesia. Participants were divided into three groups, namely preloading group, coloading group, and control group. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and pulse rates are measured in basal conditions and 1, 2, 4, 6, 8, 10, 15, 20, 25, and 30 min after spinal anesthesia. Statistical analysis for the differences in hemodynamic parameters among the three groups of subjects were analyzed by the Repeated Measured Multivariate Analysis of Variance (MANOVA) test. Whereas Bonferonni post hoc test was used to compare the differences in hemodynamic parameters between each group. Results: Bonferroni post hoc test results showed that there were significant differences in the decrease of systolic, diastolic, and MAP blood pressure differences between the coloading group with the preloading group and the control group (P < 0.001); the lowest decrease was in the coloading group. Conclusion: Crystalloid fluid coloading was significantly better in reducing hypotension incidence after spinal anesthesia in cesarean section compared with the preloading and control groups.
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The comparison of gastric ph after premedication using ranitidine, antacids, and ranitidine-antacids combination in cesarean section p. 8
Ristiawan Muji Laksono, Isngadi Isngadi, Agung Hidayatullah
Background: Pregnant women are at high risk of experiencing gastric fluid aspiration, which is known as Mendelson's syndrome. The possibility of aspiration increases in an emergency condition. Low pH and high volume of aspirate increase the severity of aspiration. Ranitidine and antacids can increase gastric pH. This study aimed to compare gastric pH after receiving ranitidine, antacids, and ranitidine-antacids combination as premedication in patients undergoing an emergency cesarean section (C-section). Patients and Methods: This study is a true-experimental design on 27 participants who underwent a C-section at Dr. Saiful Anwar Hospital. The R group received ranitidine 50 mg, the A group received 10 ml of antacids, and the C group received the combination of both. The measurement of gastric pH was carried out on 0, 5, 15, 30, 45, and 60 min after premedication. The data were analyzed using the one-way ANOVA test. Results: The average change in gastric pH is better seen in the antacids group. The gastric pH increases from 3.19 ± 1.04 to 4.64 ± 1.20 at 60 min after premedication (P > 0.05). Ranitidine administration showed better results at 5, 15, and 30 min after premedication (P > 0.05). The combination of ranitidine and antacids showed better results at 45 and 60 min after premedication (P > 0.05). Conclusion: There is no significant difference in gastric pH after receiving premedication in patients undergoing a C-section. However, all groups show an increase in gastric pH after receiving premedication. The administration of ranitidine and antacids combination is not better than a single dose of ranitidine or antacids.
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Oxycodone intravenous for acute pain management in modified radical mastectomy p. 11
Tjokorda Gde Agung Senapathi, I Putu Pramana Suarjaya, I Wayan Aryabiantara, Adinda Putra Pradhana, Amalia Margaretha Berhimpon
Oxycodone hydrochloride is a semisynthetic opioid which extracted from the baine plant, with a similar analgesic potency compared with morphine. Although oxycodone was introduced in 1917, the global use of oxycodone in acute postoperative management became popular in the past decades. Oxycodone has a bioavailability up to twice from the bioavailability of morphine in the enteral route and shows more potency in visceral pain. Furthermore, oxycodone has better pharmacokinetics in the central nervous system than morphine and has less adverse effects. In this case series, we report the effects of analgesia, inflammatory markers, and adverse effects of continued intravenous oxycodone as acute pain management in patients who underwent a modified radical mastectomy.
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Differences in the suppression of immune response between general anesthesia and spinal anesthesia in femoral bone surgery p. 14
Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, I Gusti Agung Gede Utara Hartawan, Christopher Ryalino, Oscar Indra Kusuma
Anesthesia is an effective way to control stress response. Surgical injury, different anesthesia techniques, and related drugs can directly or indirectly affect the immune system. The perioperative immunosuppression observed in surgical patients is associated with the neuroendocrine stress exerted through the activation of the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. Dysregulation of this inflammatory process may increase susceptibility to infections and result in postoperative complications, such as wound-healing disturbances and infections leading to sepsis. In this case report which enrolled six patients who underwent femoral bone surgery, three patients were under general anesthesia and three patients were under regional anesthesia. We found that increased neutrophil count and serum C-reactive protein (CRP) concentration were lower in patients under spinal anesthesia compared to those under general anesthesia. In conclusion, the inflammatory response to surgery, which could be seen in the neutrophil count and CRP level, was suppressed during spinal anesthesia to a greater extent than during general anesthesia.
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Comparative effects of remifentanil and fentanyl on inflammatory stress response in mastectomy surgery with general anesthesia: A case series p. 18
Tjokorda Gde Agung Senapathi, I Made Subagiartha, I Gusti Agung Gede Utara Hartawan, Adi Dharma Thius
Malignancy associated with chronic inflammation and stress response events by the surgical procedure. The use of an opioid such as remifentanil can decrease stress response that may be measured by leukocyte, neutrophil-to-lymphocyte ratio (NLR), platelet-to -lymphocyte ratio (PLR), mean platelet volume, blood sugar, and C-reactive protein (CRP). This was a randomized, single-blind study, with a total sample of ten patients, and they were divided into two groups: 1.remifentanil group (0.1–0.3 mcg/kg body weight [BW]/min) and fentanyl group (intermittent 0.5–1 mcg/kg BW every 60 min). The patients' blood were collected two times before and 24 h after surgery. Inflammation markers such as total leukocyte value, NLR, PLR, and dan CRP were increased in two groups.Even PLR postoperative remains high in both group, but in remifentanil group was lower than fentanyl group. There were no differences between the two groups, but remifentanil was found better to suppress the postoperative PLR rather than in the fentanyl group.
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The use of remifentanil without muscle relaxant for intubation in short-timed, elective surgeries p. 22
Tjokorda Gde Agung Senapathi, I Gede Budiarta, I Putu Pramana Suarjaya, I Gusti Ngurah Mahaalit Aribawa, Christopher Ryalino, Frangky Hamsyah
Our aim studied to observe the effectivity of remifentanil on the hemodynamic response and condition of intubation on intubation without a muscle relaxant using a combination with propofol. A total of six patients aged 25–60 years with the American Society of Anesthesiology physical status I–II underwent elective oncologic surgery. Patients received premedication midazolam 0.05 mg/kg and induction with propofol 2 mg/kg and remifentanil 2 μg/kg intravenously over 60 s. Systolic blood pressure, diastolic blood pressure, and heart rate were observed before premedication, before intubation, and postintubation. Intubation condition was assessed using the Copenhagen Consensus Score based on the ease of laryngoscopy, the position and movement of the vocal cord, and reacting to intubation. All patients were intubated without problem, and the intubation condition was excellent. One patient had hypotension and could be treated by administering the fluids and vasoconstrictor. The other remaining patients were stable without significant hemodynamic changes. A combination of propofol with remifentanil could provide excellent intubation condition and maintaining hemodynamic stability.
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Anesthetic management of large tongue swelling in neonate and children: A series of four cases p. 25
Nilesh M Solanki, Jahnavi B Shah, Rashmita H Jasoliya
Management of neonatal airway is difficult due to its anatomical and physiological changes. The presence of intraoral pathology causes anticipated difficult intubation during the management of infant and children airway. Bleeding, difficult in visualizing the airway, and enlarged upper respiratory structures make airway management challenging for anesthesiologist. There is a risk in the postoperative period also for airway patency. In these case series, we described the management of difficult airway with large intraoral swelling.
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Transesophageal echo: The time-saver in complications of balloon mitral valvuloplasty p. 29
Aseem Gargava, S Surendhar, Sanjeeta Umbarkar, Renu Upadhyay
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