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  Most popular articles (Since August 26, 2019)

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Covid-19: What we know so far
Christopher Ryalino
January-March 2020, 4(1):1-2
  770 194 -
Comparison of combination of ketamine hydrochloride and propofol with fentanyl citrate and propofol for patients undergoing endoscopic retrograde cholangiopancreatography
Kashmira Prem, Jenish Patel, Damini Sanjay Makwana, Jupi Talukdar, JM Thakkar
September-December 2019, 3(3):155-160
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a lengthy diagnostic/therapeutic procedure performed for various pancreatic-biliary disorders often involving high-risk patients. The aim of our study is to compare the ketamine hydrochloride and fentanyl citrate with propofol for patients undergoing ERCP. Patients and Methods: In this prospective randomized study, 100 consenting patients undergoing ERCP were randomly allocated into two groups of 50 each: Group PK received ketamine 1 mg/kg and Group PF received fentanyl 1 mcg/kg. Sedation (based on the Ramsay Sedation Score), blood pressure (BP), heart rate (HR), peripheral oxygen saturation (SpO2), recovery time, total propofol consumed, quality of analgesia, endoscopist and patient's satisfaction score, and various complications were recorded. Results: The sedative and analgesic effects did not differ among both the groups. The mean HR in the PK Group was higher than Group PF. The decrease in the mean arterial BP was much more in the PF Group. SpO2did not differ in both the groups. Total propofol consumption was higher in PF Group than PK. Moreover, the recovery time was longer in the PK Group compared to Group PF. Patients' and endoscopists' satisfaction score showed no significant difference between the two groups. Conclusion: We concluded that ketamine and fentanyl are equally efficacious with propofol for sedation in patients undergoing ERCP. Recovery time was shorter in the propofol-fentanyl regimen compared to the propofol-ketamine regimen.
  383 69 -
Cost-effectiveness and efficacy of combined dexamethasone–metoclopramide versus ondansetron in the prevention of postoperative nausea and vomiting in women undergoing myomectomy under spinal anesthesia
TA Ogbo, IT Ekwere, Kingsley Ufuoma Tobi, NP Edomwonyi
September-December 2019, 3(3):161-165
Background: Postoperative nausea and vomiting (PONV) is a common complication following surgery under spinal anesthesia. The aim of this study was to compare the efficacy and cost-effectiveness of metoclopramide–dexamethasone combination with ondansetron as prophylaxis against PONV in the routine gynecological surgeries amenable to subarachnoid block (SAB). Materials and Methods: Following institutional ethical approval, patients were randomly assigned to receive either ondansetron 4 mg or metoclopramide 10 mg plus dexamethasone 8 mg. All patients had a SAB with 3 ml of 0.5% hyperbaric bupivacaine plus 25 μg of fentanyl. The primary outcome was proportion of patients in both groups with PONV within 24 h from institution of the SAB. Secondary outcome included comparison of severity of PONV between the two study groups, incidence of side effects related to the study drugs (i.e., sedation, headaches, and movement disorder), and cost implication of the study drugs in both groups. Results: One hundred patients were recruited in this study. The overall incidence of PONV for the 24-h period was 10% (n = 5) and 12% (n = 6) for the ondansetron group and the combination group, respectively. Side effects of the study drugs were minimal and comparable in both groups. The cost-effectiveness ratio, evaluated based on the number of women completely free of nausea and vomiting in each group, was higher at ₦ 177.78 for group ondansetron compared to ₦ 113.63 for metoclopramide and dexamethasone combination group. Conclusion: Combined dexamethasone–metoclopramide had comparable clinical effectiveness with lower cost-effectiveness compared to ondansetron for the prevention of PONV in women undergoing myomectomy under SAB.
  407 45 -
Effectiveness of high-flow inhalation anesthesia technique using isoflurane compared to low-flow inhalation anesthesia technique using sevoflurane and isoflurane in terms of cost and safety
Arinanda Lalita Hayu, Elizeus Hanindito, Hamzah Hamzah, Arie Utariani
September-December 2019, 3(3):170-173
Background: The low-flow technique could reduce the direct and indirect total cost as well as lower the pollution and glasshouse effects. This study aimed to compare the effectiveness of two inhalation anesthetic agents using low-flow techniques on the hemodynamic changes and cost needed. Subjects and Methods: This is an experimental study with posttest-only control group design and a cost minimization analysis on sixty patients, who had underwent surgery and met the inclusion and exclusion criteria. Patients were grouped into high-flow isoflurane (HIS), low-flow isoflurane (LIS), and low-flow sevoflurane (LSV) groups. The amount of anesthetic agent used was measured before and after the surgery. The cost needed was the main outcome of this research. Results: There was no significant difference in the hemodynamic changes between these three groups (P > 0.05). There was a significant cost difference between the three groups (P = 0.003). There was no significant cost difference between LIS and LSV groups (P = 0.353). There was a significant difference between the cost of high flow and low flow, but there was no significant difference between the cost of low-flow anesthetic agents. Conclusion: HIS resulted in a more expensive compared to the LIS and LSV. However, there was no significant cost difference between the use of low-flow techniques.
  375 58 -
Anesthesia management in mendelson's syndrome
Ornella Widyapuspita, Bambang Novianto Putro
September-December 2019, 3(3):181-183
In anesthetized patient, aspiration occurs because of insufficient airway protective reflex and subsequent aspiration of gastric contents. It is rare but potentially fatal, depending on its severity. Symptoms may vary from hypoxia to respiratory failure and acute respiratory distress syndrome, even collapsed lung and death. A 30-year-old woman who had a hysterectomy with intra-abdominal packing was scheduled for pack removal. She vomited during induction and ended up with aspiration pneumonitis (Mendelson's syndrome). She was admitted to the intensive care unit after surgery and was extubated on the 4th day. She was then moved to the ward 6 days after the surgery. Awareness and skills to minimize the risk of aspiration anesthetic practice are developing well, but it still causes more than 50% of deaths related to the airway during anesthesia. Recognizing risks and its management is essential to prevent morbidity and mortality.
  386 43 -
The effect of low-dose granisetron on shivering in subarachnoid block
Isngadi Isngadi, Wiwi Jaya, Dedy Fardian
September-December 2019, 3(3):166-169
Background: Shivering has many negative effects on the postanesthesia patient. Shivering is regulated by serotonin. The serotonin antagonists such as ondansetron and granisetron are widely used to prevent nausea and vomiting. Ondansetron is used in regional and general anesthesia, while granisetron is widely used in chemotherapy. This study aimed to determine the effect of low-dose granisetron on the incidence of shivering in postspinal anesthesia. Patients and Methods: The study conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia. Twenty-three patients divided into two groups: Group C (control) received no premedication and Group G (granisetron) received low-dose granisetron 10 μg/kg. The shivering grade and shivering intensity were recorded every 5 min in the first 1-h postanesthesia. The data were analyzed using t-test, regression test, and effective contribution test. Results: The shivering incidence in Group K was 71.9% and Group G was 9.4% (P = 0.018). The control group experienced shivering Grade I, II, III, and IV. Granisetron group only experienced shivering Grade I and II. Conclusion: The administration of low-dose granisetron before the spinal anesthesia significantly reduced the incidence of shivering in adult patients with no side effects.
  337 62 -
The effect of ketamine on the immature granulocyte and C-reactive protein concentration in rat models of sepsis
Aswoco Andyk Asmoro, Isngadi Isngadi, Ristiawan Muji Laksono, Ibnu Firdiansayah, Agus Supriyanto
September-December 2019, 3(3):174-177
Background: Sepsis directly affects the immune system, leads tissue damage, and forms system organ dysfunction. The immunological biomarker of sepsis has a possibility to become an immunotherapy target of sepsis. This study was conducted to determine the effect of ketamine on the number of immature granulocyte and C-reactive protein (CRP) concentration in rat models of sepsis. Materials and Methods: This study used thirty white mice (Rattus norvegicus) divided into six treatment groups. The negative control group received nothing, and the positive control (sepsis) group was fecal-induced peritonitis (FIP) by fecal administration (i. p). The treatment groups (A, B, C, and D) treat with ketamine 5 mg/kg body weight (i. p.) right after FIP, 3 h after FIP, 5 h after FIP, and intermittent every 2 h. The peripheral mononuclear blood cell was isolated 6 h after FIP. The immature granulocytes counted using a hematology analyzer while CRP concentration analyzed using kit enzyme-linked immunosorbent assay. Data were analyzed statistically using the one-way ANOVA test using SPSS version 20 software (P < 0.05). Results: Sepsis induction with FIP increases the number of immature granulocytes in animal models from 0.48% to 9.12% (P < 0.05) but did not affect CRP concentration (P > 0.05). The ketamine administration significantly decreases the immature granulocytes in Groups C (1.04%) and D (1.58%). Ketamine administration did not have a significant effect on CRP concentration. Conclusion: The ketamine administration at 5 h after FIP and intermittently every 2 h can be an alternative to be sepsis immunotherapy with immature granulocyte as the potential target.
  308 36 -
Analgesic efficacy and safety of oxycodone as an adjuvant epidural analgesia for patients undergoing laparotomy gynecology
Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, I Gusti Agung Gede Utara Hartawan, Christopher Ryalino, Cokorda Istri Arintha Devi
September-December 2019, 3(3):184-187
Postoperative pain, when poorly controlled, will cause chronic pain and prolong the healing process. The use of an epidural catheter is a safe and effective method for pain relief in the intraoperative and postoperative period. Opioid as an adjuvant can increase the potency and duration of epidural analgesia. Morphine has been used as an adjuvant in epidural analgesia, but with known side effects such as nausea, vomiting, and pruritus. Oxycodone is one of the opioids which can be given through epidural route as an adjuvant with fewer side effects than morphine. In this case series, we describe six patients with American Society of Anesthesiologists physical status I–II who underwent laparotomy gynecological surgery. All patients were managed by combined general and epidural anesthesia. The regimen for epidural anesthesia is bupivacaine with oxycodone as adjuvant. In this study, we described the hemodynamic profile, quality of analgesia, side effects, and anti-inflammatory effect of oxycodone as an adjuvant in epidural analgesia.
  273 40 -
Perioperative management in a malignant hyperthermia susceptible patient
Ratna Farida Soenarto, Aino Nindya Auerkari, Fildza Sasri Peddyandhari, Claudia Lunaesti, Ahmad Jabir Rahyussalim
September-December 2019, 3(3):178-180
Malignant hyperthermia (MH) is a rare genetic disorder. Susceptible one could suffer fatal condition if the patient is exposed to triggers. MH can be seen in many general anesthesia procedures using volatile anesthetics. In susceptible patients who will be undergoing surgery, the most important is to prevent intraoperative MH despite overcoming the crisis. This case will discuss an elective spine surgery performed in a patient with a family history of MH.
  261 44 -
The comparison of gastric ph after premedication using ranitidine, antacids, and ranitidine-antacids combination in cesarean section
Ristiawan Muji Laksono, Isngadi Isngadi, Agung Hidayatullah
January-March 2020, 4(1):8-10
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.
  212 47 -
Comparison the effect of preloading and coloading with crystalloid fluid on the incidence of hypotension after spinal anesthesia in cesarean section
I Made Artawan, Budi Yulianto Sarim, Sidarta Sagita, Maria Agnes Etty Dedi
January-March 2020, 4(1):3-7
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.
  196 48 -
Oxycodone intravenous for acute pain management in modified radical mastectomy
Tjokorda Gde Agung Senapathi, I Putu Pramana Suarjaya, I Wayan Aryabiantara, Adinda Putra Pradhana, Amalia Margaretha Berhimpon
January-March 2020, 4(1):11-13
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.
  174 36 -
How indonesia copes with coronavirus disease 2019 so far (part one): The country, the government, and the society
Christopher Ryalino
April-June 2020, 4(2):33-34
  157 45 -
The ultrasonic cardiac output monitor (USCOM) as a tool in evaluating fluid responsiveness in pediatric patients underwent emergency surgery
Putu Kurniyanta, Arie Utariani, Elizeus Hanindito, Christopher Ryalino
January-April 2019, 3(1):19-22
Background: Assessment fluid adequacy in pediatric patients underwent surgery is a challenge for anesthesiologists. Hemodynamic parameters used as fluid monitoring sometimes don't accurately provide valid information. Ultrasonic Cardiac Output Monitor (USCOM) is one of the non-invasive methods that are easy to operate and may provide various hemodynamic parameters monitoring information. Objective: Analyze the effectiveness of Stroke Volume Variation (SVV) and Stroke Volume Index (SVI) by using USCOM in assessing fluid responsiveness in preoperative pediatric patients who underwent emergency surgeries. Method: This study was conducted on 16 pediatric patients underwent emergency surgeries. Before general anesthesia is given, blood pressure, mean arterial pressure, heart rate, cardiac index, SVV, SVI were recorded before and after administration of 10 mL/kg of fluid given within 20 minutes Results: 10 subjects responded with SVV and SVI changes of more than 10% compared to 6 non-responders. SVV changes between responders and non-responders were 31.5±1.58 and 7.5±1.04, respectively. SVV percentage changes between responders and non-responders were 38.04±0.47 and 5.24±4.89, respectively. Conclusion: SVV and SVI recorded by USCOM showed significant fluid responsiveness changes in pediatric patients underwent emergency surgeries in 62.5% of the subjects.
[ABSTRACT]   Full text not available  [PDF]
  152 47 -
Co-administration of dexmedetomidine and levobupivacaine results in better onset and duration of epidural anesthesia in lower extremity orthopedic surgery
Rizal Zainal, H Zulkifli, Theodorus Parulian, Ihsan Affandi
January-April 2019, 3(1):1-4
Background: The goal of this study is to know the efficacy of the addition of 0.5 mcg/kg dexmedetomidine to 15 mL isobaric 0.5% levobupivacaine on the onset and duration of sensory and motor blockade of epidural anesthesia in lower extremity orthopedic surgery. Methods: Randomized clinical double-blind trials were conducted in Dr. Mohammad Hoesin Hospital Palembang. A total of 34 patients underwent lower extremity surgery met the inclusion and exclusion criteria. Data were analyzed by independent t-test and Mann-Whitney test using SPSS 22.0 software. Result: The onset of sensory block in group D was 5.41±1.84 minutes compared to 17.59± 2.65 in Group C (p <0.001), as seen in [Table 2]. The sensory block duration was 362.41±25.66 minutes in Group D compared to 215.82±15.69 in Group C (p <0.001). The onset of the motoric block in group D was 16.53±1.81 minutes compared to 26.12±2.78 in Group C (p <0.001), while the motoric block duration was 301.29±20.55 minutes in Group D compared to 167.35±17.24 in Group C (p <0.001). Conclusion: The addition of 0.5mcg/kg dexmedetomidine to 15 ml isobaric 0.5% levobupivacaine in epidural anesthesia provide faster onset and prolonged duration in both motoric and sensory block in patients undergoing lower extremity surgery.
[ABSTRACT]   Full text not available  [PDF]
  138 46 -
Estimation of surgical blood loss and transfusion requirements in orthopedic soft tissue tumor surgery
Aino Nindya Auerkari, Aida Rosita Tantri, Anas Alatas
May-August 2019, 3(2):93-97
Background: Over half of soft tissue tumor surgeries require intraoperative packed red cell (PRC) transfusion. Several factors that can be identified in the preoperative period have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion. Methods: A retrospective cohort was analyzed on 84 records of orthopedic soft tissue tumor surgery during 2014-2018. Data were analyzed by linear regression and multivariate analysis. Results: Most commonly found malignant tumor in this study was rhabdomyosarcoma (20 . 2 % ). Preop hemoglobin of 11.5 g/dL (p=0.013) and tumor size of =5 cm (p<0.001) are the two significant predictors for intraoperative transfusion. Conclusion: tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion.
[ABSTRACT]   Full text not available  [PDF]
  136 45 -
Differences in the suppression of immune response between general anesthesia and spinal anesthesia in femoral bone surgery
Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, I Gusti Agung Gede Utara Hartawan, Christopher Ryalino, Oscar Indra Kusuma
January-March 2020, 4(1):14-17
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.
  149 30 -
The relationship between nutritional status based on nutritional risk index (NRI) and length of stay of digestive surgery patients
Dian Reginalda Kusuma, Kadek Agus Heryana Putra, Putu Kurniyanta
January-April 2019, 3(1):14-18
Background: Malnutrition is a common concomitant illness that can be found in digestive surgery patients. The risk of malnutrition in digestive surgery patients is often overlooked even though malnutrition has been known to be associated with poor postoperative outcomes. The study aimed to analyze the relationship of nutritional status based on the Nutritional Risk Index (NRI) and length of stay of digestive surgery patients in Sanglah General Hospital. Patients and methods: The design of this study is an analytical cross-sectional using secondary data from the medical record of the digestive surgery patients in Sanglah General Hospital. Data on body weight and serum albumin level were used to identify the preoperative nutritional status of the patients based on NRI. Results: Of the 42 patients involved in this study, 54.8% of patients have poor nutritional status and the remainder 45.2% of patients have good nutritional status. The result of the statistical analysis showed a significant relationship between nutritional status and length of stay. The result of the logistic regression test showed that the prevalence of long hospitalizations (≥11 days) were 5.2 times greater in digestive surgery patients with poor preoperative nutritional status compared to patients with good nutritional status Conclusion: This study shows that poor nutritional status is a significant problem for digestive surgery patients and it is one of the factors that contribute to a longer hospital stay.
[ABSTRACT]   Full text not available  [PDF]
  136 40 -
The role of endothelial glycocalyx in sepsis
I Nyoman Budi Hartawan, Made Wiryana
January-April 2019, 3(1):27-32
The surface of endothelial cells is filled with various membrane-bound molecules that form the glycocalyx. The endothelial glycocalyx is a surface layer mainly consisted of glycosaminoglycans that include heparan sulfate, chondroitin sulfate, and hyaluronic acid and its core proteins. Previous studies suggest that endothelial surface glycocalyx shedding could play a role in endothelial dysfunction and inflammation. This article will review the endothelial glycocalyx and its role in sepsis.
[ABSTRACT]   Full text not available  [PDF]
  134 39 -
Characteristics of patients requiring non-invasive ventilation in pediatric intensive care unit
Vania Catleya Estina, Dyah Kanya Wati, Ida Bagus Suparyatha, I Nyoman Budi Hartawan
May-August 2019, 3(2):106-110
Background: Non-invasive ventilation (NIV) has become an essential tool in the treatment of both acute and chronic respiratory failure in children. This study aimed to determine the efficacy of NIV usage in pediatric patients who were admitted to the Pediatric Intensive Care Unit (PICU) with respiratory failure. Patients and Methods: This study is a retrospective, cross-sectional review. The data were collected from the medical record of PICU patients at our hospital from 2017 to 2018. Successful NIV was defined as patients who survived without intubation. Failure was defined as worsened patients and needed intubation for the rescue. Results: The total subjects of this study was 78 patients. The most common indication for NIV was ARDS (78.1%), and CPAP was the most common frequently used (78.68%). The data shows that the NIV was commonly used after extubation (52.56%) than for the first-time rescue (47.44%). The success rate of NIV after extubation were 65.85% and 34.15% failed and shifted to mechanical ventilation. The duration of NIV usage was less than three days (73.77%). Conclusion: NIV is a useful tool for the treatment of respiratory failure in pediatrics. The use of post-extubation NIV may be a valuable tool to prevent reintubation.
[ABSTRACT]   Full text not available  [PDF]
  131 38 -
Radiofrequency ablation of genicular nerve in a patient with knee pain associated with osteoarthritis
Erwin Mulyawan, Jokevin Prasetyadhi
January-April 2019, 3(1):8-11
Osteoarthritis is a leading cause of pain and disability in the elderly. In addition to the economic burden, the pain caused by knee osteoarthritis may also reduce the quality of life and affect the patient's psychological condition. Surgery is the best option for patients with severe osteoarthritis. However, a patient with severe osteoarthritis generally tend to be elderly and have multiple co-morbidities, and thus, may not be a suitable candidate for surgery. In regards to several interventional methods that have been investigated, radiofrequency ablation (RFA) neurotomy showed promising results. We report a case of 65-year-old woman with chronic knee osteoarthritis pain that underwent a conventional RFA procedure for right genicular nerve
[ABSTRACT]   Full text not available  [PDF]
  131 36 -
Clinical profile comparison of cisatracurium and rocuronium in elective surgery
Reema Meena, Priyanka Jain, Divya Rana, Indu Verma, Sunil Chauhan
May-August 2019, 3(2):89-92
Background: Most surgeries are carried out with ease using neuromuscular blocking agents. This study was aimed to compare the intubating dose of cisatracurium and rocuronium regarding the onset of action, clinical duration, recovery index, intubating conditions, efficacy, and safety in elective surgery. Method: 60 adult patients of American Society Anesthesiology (ASA) grade I & II, underwent elective laparoscopic surgery were randomized to receive either cisatracurium 0.1 mg/kg (Group C) or rocuronium 0.6 mg/kg (Group R). Neuromuscular monitoring was done using STIMPOD Xavant NMS450. Relaxogram interpretation was carried out for the onset of action, clinical duration, and recovery index. Results: Cisatracurium had significant longer onset (233.33±62.31 vs. 86.66±28.62 seconds, p <0.001) and significant longer clinical duration (40±3.56 vs. 27.46±2.14 minutes, p <0.001) than rocuronium. Recovery index was significantly longer in the cisatracurium group (12.23±1.54 vs. 8.30±1.80 minutes, p <0.001). Clinically acceptable intubating conditions were achieved in 180 seconds (C group) compared to 60 seconds in the R group. No untoward or adverse response and complications were distinguished in either group. Conclusion: Cisatracurium 0.1 mg/kg exhibited a slower onset of action than rocuronium 0.6 mg/kg and provided excellent intubating conditions in the majority of patients after 180 seconds. The clinical duration and recovery index were significantly longer in cisatracurium compared to rocuronium. Both are potent and safe agents with excellent cardiovascular stability.
[ABSTRACT]   Full text not available  [PDF]
  121 45 -
Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center
Pontisomaya Parami, I Wayan Suranadi, I Gusti Agung Gede Utara Hartawan, I Gusti Ngurah Mahaalit, Christopher Ryalino, Adinda Putra Pradhana
January-April 2019, 3(1):33-36
Pain is a common complaint found in the population. Inadequate knowledge about pain management is the most common reason that triggers the inadequate management of pain. Pharmacological pain management is also not without risk. Various risks from the use of pharmacological agents related to side effects that can arise may also cause new problems. Several medical intervention techniques with invasive procedures for pain have also been carried out, although they are still less popular, due to a lack of public knowledge of this technique. We conducted a cost-free, minimally invasive pain procedure in people with chronic musculoskeletal pain in a public health center in a rural area in Bali Island to alleviate their pain-associated symptoms and to introduce this minimally invasive pain management technique.
[ABSTRACT]   Full text not available  [PDF]
  129 34 -
The effectivity of earplug utilization to reduce emergence delirium incidence in pediatric patients undergoing inhalational general anesthesia
Aries Perdana, Christopher Kapuangan, Raihanita Zahra
May-August 2019, 3(2):102-105
Background: Emergence delirium (ED) also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors such as agitation, irritable, uncompromising, uncooperative, inconsolably crying following general anesthesia. A high noise level in the operating room can be reduced with an earplug application. This study aimed to see the effectiveness of earplug utilization in reducing the incidence of emergence delirium without extending the time of extubation compared to control patients. Methods: This is a double-blind, randomized clinical trial towards 1-5 years old patients underwent inhalational general anesthesia in Dr. Cipto Mangunkusumo hospital in 2018. They were assigned to either the Earplug (E) group with an application of an earplug at the end of the surgery or Control (C) group, without the use of an earplug. The incidence of ED was measured using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Data were analyzed using multivariate logistic regression and analysis of covariance tests. Results: Incidence of ED in earplug group was 16.7% while in control group was 32.1% (OR = 0.402, CI95%=0.152-1.062, p=0.066). The mean time-to-extubation in E vs. C groups were 5.76±3.23 vs. 6.54±3.67 minutes, respectively. Conclusion: The application of an earplug at the end of anesthesia was not statistically effective to reduce the incidence of ED in 1-5 years old patients underwent inhalational general anesthesia.
[ABSTRACT]   Full text not available  [PDF]
  129 29 -
Anesthesia management of a parturient with meningioma underwent elective Cesarean section
Susilo Chandra
January-April 2019, 3(1):78-81
The occurrence of primary intracranial tumors in pregnancy is an extremely rare event. Symptoms of a brain tumor include nausea, vomiting, headache, visual disturbances and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. It is a well-established fact today that the technique of choice for elective cesarean section is regional anesthesia. However, in patients with intracranial hypertension and central nervous system infection, this technique should be avoided. General anesthesia poses high risks for pregnant patients. These patients have potentially difficult airways with delayed gastric emptying, which are factors increasing the possibility of pulmonary aspiration after general anesthetic induction. This paper aimed at reporting the anesthetic management of a parturient with intracranial hypertension due to meningioma submitted to elective cesarean section. This kind of surgery needs special attention and specific skill of the anesthesiologist.
[ABSTRACT]   Full text not available  [PDF]
  126 30 -