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  Most popular articles (Since August 26, 2019)

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Oxygen delivery devices in Covid-19 patients: Review and recommendation
Avishek Roy, Abhishek Singh, Puneet Khanna
July 2020, 4(5):3-7
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has become a matter of concern all over the world. This virus caused acute respiratory distress syndrome(ARDS) in almost 67% of patients, with 71% of total patients requiring mechanical ventilation. Oxygen therapy is prudent for patients suffering fromSARS-CoV-2 at different stages of the disease. The choice of different oxygen delivery devices depends on the patient's status and its availability. In this review we will discuss the pros and cons of several oxygen delivery devices, as well as the safety precautions and personal protective equipments.
  5,708 350 -
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.
  2,444 172 -
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
  2,078 218 5
Covid-19: What we know so far
Christopher Ryalino
January-March 2020, 4(1):1-2
  1,479 272 5
Bilateral C5 palsy after posterior cervical spine decompression surgery: A case report and literature review
Yuen-Mei Chow
July-September 2020, 4(3):129-131
C5 palsy is a well-known complication following cervical spine surgery. We describe a case of a 68-year-old male who underwent C3 to C6 posterior instrumentation and fusion with laminectomy and C7 hemilaminectomy for severe multilevel cervical stenosis. This is complicated by severe bilateral C5 palsy and neuropathic symptoms postoperatively, which improved with conservative management and acupuncture. This is the first described case of acupuncture being used in the treatment of C5 palsy. Further studies are needed to determine the efficacy of acupuncture in the management of neuropathic symptoms in patients with C5 palsy.
  1,455 60 -
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.
  1,127 127 -
Effect of music on preoperative anxiety in patients undergoing laparoscopic cholecystectomy
Nidhi Yadav, Shubhi Singhal, Devang Bharti
July-September 2020, 4(3):90-94
Introduction: Anxiety is a common phenomenon among hospitalized patients awaiting any surgical procedure and causes acute psychological distress in the perioperative period. It activates the sympathetic nervous system, adversely affecting the induction and maintenance of anesthesia and postoperative recovery, leading to a lower level of satisfaction with the treatment. The current study aims to explore the effect of music on preoperative anxiety. Patients and Methods: In this randomized controlled study, 104 patients posted for laparoscopic cholecystectomy were randomly divided into two groups. Patients in both groups received oral alprazolam 0.25 mg on the night before surgery. In addition, patients in Group II were also exposed to 30 min of soft, soothing music, 1 h before the surgery. Vitals of patients, including heart rate (HR), blood pressure, and respiratory rate, in both the groups along with the general anxiety – visual analog scale (GA-VAS), were recorded and compared. Results: On comparing T30 vitals between the two groups, a statistically significant difference was seen in all the monitored parameters, with vitals in Group II being lower than in Group I. T60 vitals in Group II were found to be lower than Group I in all the monitored parameters, except for HR (P = 0.051). The GA-VAS scores in Group II were lower compared to Group I (P = 0.008). Conclusion: Exposure to music, as an addition to alprazolam 0.25 mg, in the preoperative period for patients who underwent laparoscopic cholecystectomy reduces the patient's anxiety compared to alprazolam alone.
  1,066 179 -
Perioperative management for cesarean section in COVID-19 patients
Tjokorda Gde Agung Senapathi, Christopher Ryalino, Anu Raju, I Gde Sastra Winata, I Nyoman Budi Hartawan, I Gusti Agung Utara Hartawan
July 2020, 4(5):13-16
Background: Pregnant women and neonates are susceptible populations in many infections. Health-care workers are facing a new challenge as only few data are available on the effect of coronavirus disease 2019 (COVID-19) on pregnancy. The aim of this review was to see the current recommendations regarding the perioperative management of the cesarean section in COVID-19 patients. Methods: We used the keywords of (((((coronavirus [Title/Abstract]) OR (covid-19 [Title/Abstract])) OR (ncov-19 [Title/Abstract])) OR (SARS-cov-2 [Title/Abstract]))) AND (Cesarean [Title/Abstract] or Pregnancy [Title/Abstract]) in the PubMed database to find eligible reports. We studied all titles and abstracts from the search results and removed irrelevant studies that did not comply with our research question. Two authors were assigned to assess the validity and reliability of the studies using the Joanna Briggs Institute's critical appraisal tool. The cutoff point for inclusion was 50% of the total checkmarks in each critical appraisal checklist. Results: We found 16 articles from the PubMed database based on keywords described earlier. After eligibility screening, we found seven eligible articles describing perioperative management of the cesarean section during the COVID-19 pandemic. Conclusion: There is no solid evidence that the cesarean section is protective against the transmission of COVID-19. The use of an appropriate biosafety level-3 protective suits is imperative in managing patients presenting for cesarean section with COVID-19 in an operating room. A negative-pressure environment, both in the operating room and incubator, should be prepared for such cases. Regional anesthesia is the recommended technique, but general anesthesia is preferable in specific maternity conditions.
  1,032 142 -
An out-of-plane approach for pericapsular nerve group block: A case series
Ashok Jadon, Neelam Sinha, Swastika Chakraborty, Asif Ahmad
0, 0(0):0-0
Pericapsular nerve group (PENG) block is a new ultrasound (US)-guided nerve block, which has been used successfully to manage fractured hip pain. As an alternative approach to give PENG block, we have investigated the out-of-plane (OOP) approach instead of the in-plane approach, which is conventionally used. Ten patients aged between 55 and 72 years scheduled for hip surgery under spinal anesthesia were given US-guided PENG block by the OOP approach. The success of block was assessed by reduction in rest pain and pain during 15° straight leg raising (SLR) (passive SLR test) on a numeric rating Score (NRS) after 30 min of block. Ease of positioning score was also assessed during spinal anesthesia. The procedural difficulty was assessed by the number of attempts (needle re-insertion at the skin). All patients had successful blocks and showed a significant pain relief in resting pain (6.5 ± 1.3 vs. 3.8 ± 0.78) as well as pain during 15° SLR (8.5 ± 1.1 vs. 5.1 ± 0.73). All blocks required single needle entry; however, in three patients, medial redirection of the needle was required before final positioning. No complication was observed in any case. PENG block provides effective analgesia during positioning for spinal anesthesia in patients with hip fracture. OOP approach can easily be used as an alternative to conventional in-plane technique.
  1,129 28 -
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.
  911 82 -
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.
  860 124 -
How indonesia copes with coronavirus disease 2019 so far (part two): Is the country ready for the new norm?
Christopher Ryalino
July-September 2020, 4(3):89-89
  875 96 -
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.
  855 110 -
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.
  843 117 -
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.
  841 115 -
Perioperative safety during Covid-19 pandemic: A review article
Tjokorda Gde Agung Senapathi, Christopher Ryalino, Made Wiryana, I Gusti Agung Gede Utara Hartawan, Adinda Putra Pradhana
July 2020, 4(5):8-12
Introduction: Coronavirus disease 2019 (Covid-19) has become a pandemic all over the world. Despite our familiarity with various protection devices, the high incidence among medical personnel is still worrisome. In this review, we provide several perioperative strategies regarding the management of daily cases in the Covid-19 pandemic setting. Methods: We used keywords (((((coronavirus[Title/Abstract]) OR (covid-19[Title/Abstract])) OR (ncov-19[Title/Abstract])) OR (SARS-cov-2[Title/Abstract]))) AND (perioperative[Title/Abstract]) in the National Library of Medicine (NLM) database to find eligible reports. Results: We found 32 articles from the NLM database. After eligibility screening, we found 25 eligible articles describing perioperative management during the Covid-19 pandemic that relates to the staff's safety. All eligible articles stress the importance of the negative-pressurized environment to deal with perioperative care of Covid-19 patients. In general, the use of personal protective equipment (PPE) and video laryngoscopy is also essential. Conclusion: The best protective suit to avoid health-care personnel from getting Covid-19 infection is proper training and self-discipline. This combined with cooperative, honest patients and proper PPE supply is vital in efforts to reduce the spread of the disease. Negative-pressure chambers, both in operating rooms and intensive care units, are essential in this pandemic. Unfortunately, they are not easily available in underdeveloped and developing countries.
  846 107 -
Comparison of glottis views with fixed-height pillow versus adjustable-pillow height by pressure infusion bag for successful intubation
Kinna Shah, Jayshree Thakkar, Dushyant Vaidya
April-June 2020, 4(2):35-38
Background: This study aimed to get optimal sniffing position for successful intubation rate and measuring intubation time. The classical rationale for the sniffing position is that the alignment of the mandibular axis, pharyngeal axis, and laryngeal axis is facilitated, permitting successful direct laryngoscopy. Patients and Methods: A total of 100 patients without any anticipated difficult airway were enrolled after informed consent is given. After induction of anesthesia, patients were randomly divided into two groups. In Group PB, a deflated pressure infusion bag was put under the nape of the neck and occiput. The anesthetist performed laryngoscopy with the left hand while inflating the bag with the right hand up to the best glottic view without external pressure is achieved. The height of the bag was measured. In Group PI, 10-cm fixed-height noncompressible pillow was placed behind the head up to the shoulder. The best glottic view of the entire glottis without external pressure was noticed. Grading of glottic opening grade, SPO2, intubation time, and intubation trials were also noted. Results: Failure to intubate was noted in one patient in Group PB and two in Group PI. Intubations successful in 45 (90%) patients in Group PB as compared to 38 (76%) patients in Group PI (P < 0.05). Laryngoscopic view in Group PB was superior to that with Group PI (P < 0.05), with mean pressure bag height of 4.86 cm. Conclusion: The use of pressure infusion bag for adjustable-pillow height provides more success in intubation condition by head elevated position than the fixed height of 10 cm.
  838 90 -
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.
  828 92 -
Adductor Canal block with 0.5% ropivacaine for postoperative pain relief in lower limb surgeries performed under spinal anesthesia
Manisha Agrawal
April-June 2020, 4(2):49-52
Background: Postoperative pain is an essential consequence of lower limb surgeries that can affect early ambulation, range of motion, and duration of stay in the hospital. This study aimed to evaluate the effect of the adductor canal block in the postoperative pain control and analgesic consumption in the lower limb surgeries done under spinal anesthesia. The adductor canal block is a compartment block of the saphenous nerve (branch of femoral nerve), which can provide adequate analgesia with the preservation of motor function. Patients and Methods: Sixty patients aged 18–70 years scheduled for lower limb surgeries under spinal anesthesia were included in this prospective, placebo-controlled randomized study. The patients were randomly divided into two equal groups of 30 each. At the end of the surgery, single-shot ultrasound-guided adductor canal blockade was given with 30 ml of 0.5% ropivacaine (Group A) or 30 ml of 0.9% saline (Group C). The pain was assessed for 24 h postoperatively by a visual analog scale (VAS). Postoperative analgesia consumption was also studied. Motor function was assessed with a straight leg raise test. Results: Analgesic consumption was lesser in the ropivacaine group as compared to the control group. VAS was favorable in the ropivacaine group. There was no prolonged loss of motor function in either group. Conclusions: The adductor canal block significantly reduces pain and analgesic consumption. It also does not affect motor function. Hence, it can be effectively used as an adjuvant to spinal anesthesia for lower limb surgeries.
  765 78 1
The predictive value of skin-to-epiglottis distance to assess difficult intubation in patients who undergo surgery under general anesthesia
Tjokorda Gde Agung Senapathi, Made Wiryana, I Wayan Aryabiantara, Christopher Ryalino, Rina Lizza Roostati
April-June 2020, 4(2):46-48
Background: Intubation is crucial in the management of anesthesia because it is related to the maintenance of oxygenation and ventilation during general anesthesia. Clinical markers for predicting difficult airway have limitations, including requiring coordination with patients. The use of ultrasonography (USG) to measure the distance of the skin to epiglottis is expected to estimate the difficulty level of intubation. Patients and Methods: This was a cross-sectional study of 128 patients who underwent surgery under general anesthesia. We examined the skin-to-epiglottis distance using US prior to surgery. We then assessed the Cormack–Lehane scores during direct laryngoscopy for intubation. The unpaired t-test was used to assess differences in the skin-to-epiglottis distance between patients with easy intubation (Cormack–Lehane I and IIa) and difficult intubation (Cormack–Lehane IIb, III, and IV). Results: The cutoff value of skin-to-epiglottis distance between easy and difficult intubation was 26.05 mm. The sensitivity and specificity of this method to predict difficult airway were 69.4% and 93.5%, respectively. The positive and negative predictive values were 80.6% and 88.7%, respectively. Conclusion: The skin-to-epiglottis distance of >26.05 is a risk factor for difficult intubation.
  743 96 1
The impact of case reports in medical science
Ankur Khandelwal
October-December 2020, 4(4):147-147
  747 78 -
Effectiveness of continuous adductor canal block versus continuous epidural analgesia in patients with total knee arthroplasty: A systematic review
Tjokorda Gde Agung Senapathi, I Putu Fajar Narakusuma, Aninda Tanggono, Christopher Ryalino, Adinda Putra Pradhana
October-December 2020, 4(4):148-151
Background: This systematic review aimed to summarize the evidence base on randomized controlled trials (RCTs) comparing the continuous adductor canal block (CACB) and continuous epidural analgesia (CEA) in total knee arthroplasty (TKA) surgery. Methods: We searched the Cochrane Library, PubMed, and EMBASE database from the beginning of 2016 until 2020 to find RCTs published in English language, which have investigated pain score, length of stay (LOS), ambulation distance, and total opioid consumption in TKA. Results: Three RCTs were included in the final analysis. All of them employed similar argument that CACB is better than CEA in pain score, but only two of three studies investigated the other parameters such as LOS, ambulation distance, and opioid consumption, with the result that CACB is better than CEA. Conclusion: It was found that CACB was better in pain control compared to CEA, but there are very few similar studies. Future research is required to establish the therapeutic efficiency of CACB than CEA in TKA surgery.
  713 97 -
Comparison of efficacy and safety of dexmedetomidine versus propofol infusion for maintaining depth of general anesthesia when muscle relaxants are not used
Pulak Tosh, Sunil Rajan, Naina Narayani, Karthik Chandra Babu, Niranjan Kumar, Jerry Paul
April-June 2020, 4(2):42-45
Background: In surgeries where direct nerve stimulation is required intraoperatively, the use of long-acting muscle relaxants should be avoided. The study aimed to assess the efficacy of dexmedetomidine versus propofol infusion in providing an adequate depth of general anesthesia where long-acting muscle relaxants were not used intraoperatively and to compare hemodynamics in both the groups. Patients and Methods: It was a prospective randomized controlled study done in forty patients undergoing total parotidectomy or brachial plexus surgeries. Group D received an intravenous (IV) bolus of dexmedetomidine 1 mcg/kg body weight before induction, followed by infusion at 0.7 mcg/kg/h intraoperatively. In Group B, the infusion of propofol was started at a rate of 1.5 mg/kg/h to a maximum of 100 mg/h after intubation. In both the groups, if the patient moved, bucked on the endotracheal tube, or if there were signs of inadequate depth of anesthesia, a bolus of propofol 0.5 mg/kg IV was given and repeated as required. Statistical analysis was performed using Mann–Whitney U-test and Fisher's exact test. Results: The number of times propofol bolus was required intraoperatively did not show any significant difference between groups. The mean heart rate was significantly lower in Group D before induction. At any other time points, the mean systolic blood pressure and mean arterial blood pressure were comparable in both the groups. Conclusion: Both dexmedetomidine and propofol infusions are equally effective and safe in providing an adequate depth of general anesthesia as reflected by patient immobility during surgeries where long-acting muscle relaxants were not used.
  697 109 -
Correlation of red cell distribution width and serum lactate levels in critically ill pediatric patients
Ni Made Sukewanti, I Nyoman Budi Hartawan, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, Christopher Ryalino
July-September 2020, 4(3):104-108
Background: Blood lactate concentration has been widely used as a marker of altered tissue perfusion. An increase in lactate concentration to >1.5 mEq/L is associated with a higher mortality rate. Red cell distribution width (RDW) measures variability in red blood cell size. The purpose of this research is to see the correlation between lactate levels and RDW. Patients and Methods: We performed a cross-sectional study to assess the correlation between blood lactate concentration and RDW in critically ill children admitted to the pediatric intensive care unit (PICU) from October 2018 until February 2019. Blood lactate and RDW were taken during the first 24 h of admission. Data were obtained from the medical report. The association between RDW and lactate was determined using Spearman's correlation test. Results: There were forty patients enrolled in this study with a median age of 27 months (ranged from 2 months to 17 years), with an equal proportion of male and female. The median PICU length of stay was 7.5 days, with a mortality rate of 42.5%. The most common underlying disease was pneumonia (35%), followed by sepsis (17.5%) and meningitis (10%). The median lactate level was significantly higher in the nonsurvivor group compared to the survivor group (P = 0.002). The median RDW was also higher in the nonsurvivor group (P = 0.001). There is a moderate correlation between RDW and lactate (r = 0.532, P < 0.001). Conclusion: There was a moderate and significant correlation between RDW and serum lactate level in critically ill pediatric patients.
  723 76 -
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.
  722 74 -