Pub Date : 2022-07-28DOI: 10.20473/ijar.v4i22022.80-86
S. Larasati, A. Setyaningtyas, Elizeus Hanindito, Mia Ratwita Andarsini
Introduction: Anemia often occurs in critically ill children and is associated with increased morbidity and mortality in women and children and impaired cognitive and behavioral development in children. Objective: This study aims to understand the profile and characteristics of anemia patients in the critical care population. Materials and Methods: This is a retrospective, descriptive study of the patient's medical records. Data were collected by the total sampling technique. Results: Among 203 patients, 52% were anemic at admission to the Pediatric Intensive Care Unit (PICU), while 45% were anemic at discharge. Anemia tends to be more common in older age and male individuals with their chief complaints being respiratory symptoms, higher mean Red Cell Distribution Width (RDW) levels, and poorer nutritional status. There were 84 patients (41%) who received Packed Red-Cells (PRC) transfusions, among them there were 54 patients (51%) who were anemic at PICU admission. Of the 84 patients who received PRC transfusions during their PICU stay and 43 patients (47%) were anemic on PICU discharge. Conclusion: Anemia is quite common in critically ill children and is dominated by male patients aged under 5 years. Anemia also mostly happens in patients with higher organ dysfunction scores and poorer nutritional status than nonanemic patients. Half of the patients with anemia at the PICU also received PRC blood transfusion.
{"title":"Anemia Profile in Pediatric Patients at Pediatric Intensive Care Unit (PICU) of Dr. Soetomo General Academic Hospital","authors":"S. Larasati, A. Setyaningtyas, Elizeus Hanindito, Mia Ratwita Andarsini","doi":"10.20473/ijar.v4i22022.80-86","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.80-86","url":null,"abstract":"Introduction: Anemia often occurs in critically ill children and is associated with increased morbidity and mortality in women and children and impaired cognitive and behavioral development in children. Objective: This study aims to understand the profile and characteristics of anemia patients in the critical care population. Materials and Methods: This is a retrospective, descriptive study of the patient's medical records. Data were collected by the total sampling technique. Results: Among 203 patients, 52% were anemic at admission to the Pediatric Intensive Care Unit (PICU), while 45% were anemic at discharge. Anemia tends to be more common in older age and male individuals with their chief complaints being respiratory symptoms, higher mean Red Cell Distribution Width (RDW) levels, and poorer nutritional status. There were 84 patients (41%) who received Packed Red-Cells (PRC) transfusions, among them there were 54 patients (51%) who were anemic at PICU admission. Of the 84 patients who received PRC transfusions during their PICU stay and 43 patients (47%) were anemic on PICU discharge. Conclusion: Anemia is quite common in critically ill children and is dominated by male patients aged under 5 years. Anemia also mostly happens in patients with higher organ dysfunction scores and poorer nutritional status than nonanemic patients. Half of the patients with anemia at the PICU also received PRC blood transfusion.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114361566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-28DOI: 10.20473/ijar.v4i22022.87-97
Y. Avidar, Agustina Salinding, Hamzah, Akhyar Nur Uhud, Maulydia
Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Materials and Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results and Discussion: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.
剖宫产是世界上最常见的外科手术，其术后疼痛在一些国家仍然是一个主要问题。在资源匮乏的环境下，这种管理对麻醉师提出了挑战。氯胺酮是世界上使用最多的麻醉药物，因为它容易获得和证明的好处。目的:分析低剂量氯胺酮在医疗物资紧缺地区剖宫产术中术后镇痛的效果。材料与方法:一项随机对照试验(RCT)于2020年8月至2021年1月在同意剖宫产的孕妇中进行。在蛛网膜下腔阻滞(SAB)之前，抽样人群随机接受氯胺酮静脉注射或安慰剂。低剂量氯胺酮分为0.15 mg/kg、0.25 mg/kg和0.5 mg/kg三组。结果分为主要结果(术后1小时、2小时、24小时、48小时疼痛评分)和次要结果(术后1分钟和5分钟Apgar评分、SAB后低血压、术中镇静效果、术后恶心呕吐、术后接受阿片类药物作为抢救镇痛的时间和阿片类药物总用量)。结果和讨论:本研究筛选了105名患者，并招募了90名患者，随机分为两组，每组45名患者接受低剂量氯胺酮或安慰剂治疗。氯胺酮组术后1 h (p值= 0.0037)和2 h (p值= 0.0037)疼痛评分较低。他们还表明，它可以延长芬太尼的给药时间(p值= 0.0003)，并降低芬太尼的总使用量(p值= 0.0008)。给予氯胺酮的组显示有镇静作用(p值= 0.0001)，这取决于使用的剂量。结论:小剂量氯胺酮静脉注射可降低术后1 ~ 2小时疼痛评分，显示需要减少阿片类药物的需求。
{"title":"Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies","authors":"Y. Avidar, Agustina Salinding, Hamzah, Akhyar Nur Uhud, Maulydia","doi":"10.20473/ijar.v4i22022.87-97","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.87-97","url":null,"abstract":"Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Materials and Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results and Discussion: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131050492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-28DOI: 10.20473/ijar.v4i22022.115-119
P. Ananda, Sony
Introduction: Early tracheostomy needs to be considered if the use of a ventilator is expected to be used for a long time. Early Tracheostomy is recommended because it can improve respiratory function, reduce the risk of Ventilator-Associated Pneumonia, improve patient comfort, cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization, and speech efforts, and allow treatment outside the Intensive Care Unit (ICU). Case Report: We report four cases of severe head injury with early tracheostomy which illustrates prevent of VAP. In these four cases, early tracheostomy was performed (£ 4 days) with consideration of the initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be used for a long period time. During treatment, there is no VAP which is evidenced by a sputum culture examination. Based on a meta-analysis study early tracheostomy can reduce mortality due to VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late tracheostomy (> 10 days) or prolonged intubation (> 14 days). Conclusion: VAP prevention efforts are carried out by applying VAP Bundle. An early tracheostomy provides more benefits than prolonged intubation or delayed/late tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by up to 25%.
{"title":"Early Tracheostomy in Prolonged Mechanical Ventilation Due to Severe Head Injury to Prevent Ventilator-Associated Pneumonia (VAP)","authors":"P. Ananda, Sony","doi":"10.20473/ijar.v4i22022.115-119","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.115-119","url":null,"abstract":"Introduction: Early tracheostomy needs to be considered if the use of a ventilator is expected to be used for a long time. Early Tracheostomy is recommended because it can improve respiratory function, reduce the risk of Ventilator-Associated Pneumonia, improve patient comfort, cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization, and speech efforts, and allow treatment outside the Intensive Care Unit (ICU). Case Report: We report four cases of severe head injury with early tracheostomy which illustrates prevent of VAP. In these four cases, early tracheostomy was performed (£ 4 days) with consideration of the initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be used for a long period time. During treatment, there is no VAP which is evidenced by a sputum culture examination. Based on a meta-analysis study early tracheostomy can reduce mortality due to VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late tracheostomy (> 10 days) or prolonged intubation (> 14 days). Conclusion: VAP prevention efforts are carried out by applying VAP Bundle. An early tracheostomy provides more benefits than prolonged intubation or delayed/late tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by up to 25%.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126916168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-28DOI: 10.20473/ijar.v4i22022.107-114
I. Wijaya
Introduction: Henoch-Schonlein Purpura or Immunoglobulin-A vasculitis is a systemic vasculitis caused by immune complexes that attack small blood vessels. The classic symptoms of Henoch-Schonlein Purpura include erythema purpura, arthralgia, gastrointestinal complaints, and renal involvement. Some cases show that pregnancy itself could be the trigger for its recurrence and lead to early delivery. Case report: A 33-year-old patient, G2P1A0 and 35 weeks and 4 days pregnant complained of diarrhea 8 days before hospital admission (8-15 times per day). The patient was diagnosed with Henoch-Schonlein Purpura 3 years ago. Upon monitoring in the ward, the fetus was found to be in a compromised condition and an emergency cesarean section was needed. The patient was assessed as having an ASA II physical status and was anesthetized with regional anesthesia epidural in the sitting position, with a median approach, puncture at L3-L4 level, and with 12 ml of Bupivacaine 0.5% isobaric. Postoperative care was continued in the ward. Discussion: As long as there are no contraindications, a neuraxial block could be performed on parturient patients with Henoch-Schonlein Purpura who would undergo a cesarean section. Neuraxial block, namely epidural block, has the added advantage of being a postoperative analgesic and helps to avoid the use of Non-Steroidal Anti Inflammatory Drugs (NSAIDs) in Henoch-Schonlein Purpura patients who often have renal complications. Conclusion: Caesarean Section with Henoch-Schonlein Purpura disease has been reported with Epidural Block Anesthesia without complications.
过敏性紫癜或免疫球蛋白a血管炎是一种由免疫复合物攻击小血管引起的全身性血管炎。过敏性紫癜的典型症状包括红斑性紫癜、关节痛、胃肠道不适和肾脏受累。一些病例表明，怀孕本身可能是其复发的触发因素，并导致早产。病例报告:患者33岁，G2P1A0，孕35周4天，入院前8天主诉腹泻(每天8-15次)。患者三年前被诊断为过敏性紫癜。在病房监测后，发现胎儿处于受损状态，需要紧急剖宫产。患者经评估为ASA II级身体状态，采用坐位硬膜外区域麻醉，中位入路，L3-L4位穿刺，12 ml 0.5%等压布比卡因。术后护理继续在病房进行。讨论:只要无禁忌症，可对剖宫产的过敏性紫癜患者行神经轴阻滞。神经轴阻滞，即硬膜外阻滞，具有术后镇痛的额外优势，有助于避免在经常有肾脏并发症的过敏性紫癜患者中使用非甾体抗炎药(NSAIDs)。结论:在硬膜外阻滞麻醉下剖宫产治疗紫癜无并发症。
{"title":"Anesthetic Management of A Patient with Henoch-Schonlein Purpura for Caesarean Section","authors":"I. Wijaya","doi":"10.20473/ijar.v4i22022.107-114","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.107-114","url":null,"abstract":"Introduction: Henoch-Schonlein Purpura or Immunoglobulin-A vasculitis is a systemic vasculitis caused by immune complexes that attack small blood vessels. The classic symptoms of Henoch-Schonlein Purpura include erythema purpura, arthralgia, gastrointestinal complaints, and renal involvement. Some cases show that pregnancy itself could be the trigger for its recurrence and lead to early delivery. Case report: A 33-year-old patient, G2P1A0 and 35 weeks and 4 days pregnant complained of diarrhea 8 days before hospital admission (8-15 times per day). The patient was diagnosed with Henoch-Schonlein Purpura 3 years ago. Upon monitoring in the ward, the fetus was found to be in a compromised condition and an emergency cesarean section was needed. The patient was assessed as having an ASA II physical status and was anesthetized with regional anesthesia epidural in the sitting position, with a median approach, puncture at L3-L4 level, and with 12 ml of Bupivacaine 0.5% isobaric. Postoperative care was continued in the ward. Discussion: As long as there are no contraindications, a neuraxial block could be performed on parturient patients with Henoch-Schonlein Purpura who would undergo a cesarean section. Neuraxial block, namely epidural block, has the added advantage of being a postoperative analgesic and helps to avoid the use of Non-Steroidal Anti Inflammatory Drugs (NSAIDs) in Henoch-Schonlein Purpura patients who often have renal complications. Conclusion: Caesarean Section with Henoch-Schonlein Purpura disease has been reported with Epidural Block Anesthesia without complications.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"44 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114302043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Ear, Nose, and Throat (ENT) surgeries are commonly performed and very often require the surgeon and anesthesiologist to share the same workspace. Over the years, ENT surgery techniques have evolved from conventional methods to computer-assisted intraoperative navigation. In contrast to the past, a minimally invasive approach to paranasal sinus and petrous bone surgery is now preferred. Bleeding, postoperative nausea, and vomiting are complications often encountered in ENT surgery. In addition, pain management during surgery and patient comfort after a surgical procedure is a challenge for anesthesiologists. Therefore, the choice of anesthetic drugs is important. Objective: This study aims to determine the action profile, anesthetic management, and pain management in ENT surgery at Dr. Soetomo General Academic Hospital Surabaya. Materials and Methods: This is a retrospective descriptive study. A total of 177 patients underwent airway surgery. Data were obtained from the Medical Records of the Integrated Surgery Center of Dr. Soetomo General Academic Hospital recorded from January to December 2021. Results and Discussion: Most of the patients were in the age group of 45 - 65 years (40.1%) and a majority were men (65.5%). Most patients who were ≥ 20 years old had a normal nutritional status (54.2%). The most frequent diagnosis was laryngeal cancer (23%), with micro laryngeal surgery being the most frequently performed (35.8%). Most surgeries also needed less than 60 minutes followed by 60 to 119 minutes (27.1%). The most frequently used induction agents were a combination of propofol, fentanyl, and rocuronium (39.5%), with isoflurane as the most frequent inhalation agent (91.3%). Metamizole (70.1%) was the most postoperative analgesic. Conclusion: In general, intravenous agents were used for anesthesia induction. A combination of different induction agents brings synergistic benefits.
{"title":"Anesthesia and Analgesia Management Profile for Airway Surgeries at Dr. Soetomo General Academic Hospital Surabaya","authors":"Agustina Salinding, Widiartha Wahyudi, Arya Pradipta","doi":"10.20473/ijar.v4i22022.98-106","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.98-106","url":null,"abstract":"Introduction: Ear, Nose, and Throat (ENT) surgeries are commonly performed and very often require the surgeon and anesthesiologist to share the same workspace. Over the years, ENT surgery techniques have evolved from conventional methods to computer-assisted intraoperative navigation. In contrast to the past, a minimally invasive approach to paranasal sinus and petrous bone surgery is now preferred. Bleeding, postoperative nausea, and vomiting are complications often encountered in ENT surgery. In addition, pain management during surgery and patient comfort after a surgical procedure is a challenge for anesthesiologists. Therefore, the choice of anesthetic drugs is important. Objective: This study aims to determine the action profile, anesthetic management, and pain management in ENT surgery at Dr. Soetomo General Academic Hospital Surabaya. Materials and Methods: This is a retrospective descriptive study. A total of 177 patients underwent airway surgery. Data were obtained from the Medical Records of the Integrated Surgery Center of Dr. Soetomo General Academic Hospital recorded from January to December 2021. Results and Discussion: Most of the patients were in the age group of 45 - 65 years (40.1%) and a majority were men (65.5%). Most patients who were ≥ 20 years old had a normal nutritional status (54.2%). The most frequent diagnosis was laryngeal cancer (23%), with micro laryngeal surgery being the most frequently performed (35.8%). Most surgeries also needed less than 60 minutes followed by 60 to 119 minutes (27.1%). The most frequently used induction agents were a combination of propofol, fentanyl, and rocuronium (39.5%), with isoflurane as the most frequent inhalation agent (91.3%). Metamizole (70.1%) was the most postoperative analgesic. Conclusion: In general, intravenous agents were used for anesthesia induction. A combination of different induction agents brings synergistic benefits.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134340860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-28DOI: 10.20473/ijar.v4i22022.72-79
Annisa Maya Sabrina, Maulydia, R. F. Perdana, Mariza Fitriati
Introduction: Airway foreign body (AFBs) is the most common emergency for ENT-HN (Ear, Nose, Throat-Head Neck) that requires immediate treatment. The gold standard management for AFBs is a bronchoscopy performed under general anesthesia (GA). Objective: This study aims to determine the profile of AFBs patients who underwent bronchoscopies with GA at Dr. Soetomo General Hospital Surabaya from January 2018 – December 2019. Methods and Materials: This is a descriptive, retrospective study that uses data from medical records. Microsoft Excel was used to analyze the data. 22 patients met the inclusion criteria. Results: The most common ages were 11 to 20-year-olds (73%), 55% were female, and 45% were male. The patients were from outside (73%) and inside (27%) Surabaya. As much as 67% of the sampled patients had coughs and 23% were symptomless. The foreign bodies found were pins (67%), clipboard nails (14%), and nuts (9%). These AFBs were located in the left main bronchus (45%), trachea (32%), and right main bronchus (18%), and in 5% of these cases, the AFBs could not be located. The duration between the event and the bronchoscopy was mostly less than 1 day (54%), 2 days (32%), and 3 days (14%). Most cases (90%) were without AFBs complications, but some had obstruction (5%), and hemoptysis (5%). Most patients also had an uncomplicated bronchoscopy (81%), however, some suffered lesions (14%) and bleeding (5%). A majority of the patients were also ASA I (68%), and the remainder were classified as ASA II (18%), and III (14%). The premedication drugs administered were fentanyl (41%), and a combination of fentanyl and midazolam (41%). Meanwhile, the most frequently maintained anesthetic agent was Isoflurane+O2 (27%). Most patients also did not have any comorbid factors (85%), but some had anemia (5%), obstruction (5%), as well as obesity followed by sputum retention and hypernatremia (5%). Conclusion: Most AFB patients who underwent bronchoscopy under GA were 11-20 years old, female, and had a cough as a clinical symptom. Most AFBs were pins at the left main bronchus. The duration between the incident and the bronchoscopy was less than 1 day. There were also mostly no complications of AFBs and bronchoscopies. The most common physical status in patients was ASA I, with fentanyl only or fentanyl and midazolam as a premedication drug. The most common agent used to maintain the anesthesia was a combination of isoflurane and O2. Most patients also had no comorbid factors for GA.
{"title":"Airway Foreign Bodies in Patients that Underwent Bronchoscopies with General Anesthesia in Dr. Soetomo General Academic Hospital Surabaya","authors":"Annisa Maya Sabrina, Maulydia, R. F. Perdana, Mariza Fitriati","doi":"10.20473/ijar.v4i22022.72-79","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.72-79","url":null,"abstract":"Introduction: Airway foreign body (AFBs) is the most common emergency for ENT-HN (Ear, Nose, Throat-Head Neck) that requires immediate treatment. The gold standard management for AFBs is a bronchoscopy performed under general anesthesia (GA). Objective: This study aims to determine the profile of AFBs patients who underwent bronchoscopies with GA at Dr. Soetomo General Hospital Surabaya from January 2018 – December 2019. Methods and Materials: This is a descriptive, retrospective study that uses data from medical records. Microsoft Excel was used to analyze the data. 22 patients met the inclusion criteria. Results: The most common ages were 11 to 20-year-olds (73%), 55% were female, and 45% were male. The patients were from outside (73%) and inside (27%) Surabaya. As much as 67% of the sampled patients had coughs and 23% were symptomless. The foreign bodies found were pins (67%), clipboard nails (14%), and nuts (9%). These AFBs were located in the left main bronchus (45%), trachea (32%), and right main bronchus (18%), and in 5% of these cases, the AFBs could not be located. The duration between the event and the bronchoscopy was mostly less than 1 day (54%), 2 days (32%), and 3 days (14%). Most cases (90%) were without AFBs complications, but some had obstruction (5%), and hemoptysis (5%). Most patients also had an uncomplicated bronchoscopy (81%), however, some suffered lesions (14%) and bleeding (5%). A majority of the patients were also ASA I (68%), and the remainder were classified as ASA II (18%), and III (14%). The premedication drugs administered were fentanyl (41%), and a combination of fentanyl and midazolam (41%). Meanwhile, the most frequently maintained anesthetic agent was Isoflurane+O2 (27%). Most patients also did not have any comorbid factors (85%), but some had anemia (5%), obstruction (5%), as well as obesity followed by sputum retention and hypernatremia (5%). Conclusion: Most AFB patients who underwent bronchoscopy under GA were 11-20 years old, female, and had a cough as a clinical symptom. Most AFBs were pins at the left main bronchus. The duration between the incident and the bronchoscopy was less than 1 day. There were also mostly no complications of AFBs and bronchoscopies. The most common physical status in patients was ASA I, with fentanyl only or fentanyl and midazolam as a premedication drug. The most common agent used to maintain the anesthesia was a combination of isoflurane and O2. Most patients also had no comorbid factors for GA.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126794491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Preeclampsia is the leading cause of maternal and fetal death. This is an urgency in maternal health, especially in developing countries such as Indonesia. Patients with severe preeclampsia who had critical conditions tend to be admitted to the resuscitation room for assistance from more skilled personnel and more sophisticated technology. Objective: This study aims to determine the complications, treatments, and outcomes of severe preeclampsia patients managed in the resuscitation room at Dr. Soetomo General Academic Hospital from January 1st, 2018 – December 31th 2019. Methods and Materials: The method used in this study was retrospective descriptive using medical records and analyzed using Microsoft Excel. Eighty-one samples met the inclusion criteria. Results: The majority of patients were aged 20-35 years (65.43%) and had completed senior high school (88.89%). Most patients were having stage 2 obesity (44.44%) and multigravida (41.97%). A history of preeclampsia and hypertension was not found in the majority of patients. Most patients are diagnosed with late-onset preeclampsia (69.14%). The majority of patients were referred from secondary health facilities (96.30%). The most common complication was pulmonary edema(53.09%). The majority of patients had 2 complications (43.17%) with the most common combinations being eclampsia and HELPP syndrome (13.58%). Intubation is given to the majority of patients (70.37%) and most often in patients with eclampsia (56.14%). Termination of pregnancy by cesarean section is carried out in the majority of patients (72.84%). There were no cases of maternal death in this study. Most of the fetal born had prematurity (70.11%), low birth weight (60%), and asphyxia as assessed by the first minute APGAR score (72.97%) and fifth minute APGAR score (54.05%). Conclusion: The majority of preeclampsia patients with complications in the resuscitation room at Dr. Soetomo General Academic Hospital Surabaya from January 1st 2018-December 31rd 2019 had good maternal outcomes but not the fetal outcome.
{"title":"Severe Preeclamptic Patients in The Resuscitation Room of Dr. Soetomo General Academic Hospital Surabaya: A Retrospective Study","authors":"Neissya Nastiti Firmanto, Maulydia, Pungky Mulawardhana, Mariza Fitriati","doi":"10.20473/ijar.v4i22022.62-71","DOIUrl":"https://doi.org/10.20473/ijar.v4i22022.62-71","url":null,"abstract":"Introduction: Preeclampsia is the leading cause of maternal and fetal death. This is an urgency in maternal health, especially in developing countries such as Indonesia. Patients with severe preeclampsia who had critical conditions tend to be admitted to the resuscitation room for assistance from more skilled personnel and more sophisticated technology. Objective: This study aims to determine the complications, treatments, and outcomes of severe preeclampsia patients managed in the resuscitation room at Dr. Soetomo General Academic Hospital from January 1st, 2018 – December 31th 2019. Methods and Materials: The method used in this study was retrospective descriptive using medical records and analyzed using Microsoft Excel. Eighty-one samples met the inclusion criteria. Results: The majority of patients were aged 20-35 years (65.43%) and had completed senior high school (88.89%). Most patients were having stage 2 obesity (44.44%) and multigravida (41.97%). A history of preeclampsia and hypertension was not found in the majority of patients. Most patients are diagnosed with late-onset preeclampsia (69.14%). The majority of patients were referred from secondary health facilities (96.30%). The most common complication was pulmonary edema(53.09%). The majority of patients had 2 complications (43.17%) with the most common combinations being eclampsia and HELPP syndrome (13.58%). Intubation is given to the majority of patients (70.37%) and most often in patients with eclampsia (56.14%). Termination of pregnancy by cesarean section is carried out in the majority of patients (72.84%). There were no cases of maternal death in this study. Most of the fetal born had prematurity (70.11%), low birth weight (60%), and asphyxia as assessed by the first minute APGAR score (72.97%) and fifth minute APGAR score (54.05%). Conclusion: The majority of preeclampsia patients with complications in the resuscitation room at Dr. Soetomo General Academic Hospital Surabaya from January 1st 2018-December 31rd 2019 had good maternal outcomes but not the fetal outcome.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126663777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.20473/ijar.v4i12022.1-5
Purwoko Purwoko, B. Putro, Arif Zuhal Amin Hananto
Introduction: Burn injury impairs almost every organ system, which causes significant morbidity and mortality. Meanwhile, the phases included in burn healing are inflammation, cell recruitment, matrix deposition, epithelialization, and tissue remodeling phase. Previous studies showed that snakehead fish and sea cucumber extract have these effects and are beneficial in burn and post-surgery wounds. Objective: This study aims to analyze the effect of snakehead fish and sea cucumber extract supplementation towards mast cell infiltration, IL-6, and albumin level in burn and post-surgery wounds. Materials and Methods: A double-blind randomized control trial was carried out at Dr. Moewardi Hospital Surakarta in November 2017 on 30 subjects, which were divided into 2 groups. Mast cell infiltration was observed on burn and post-surgery wounds colored with Toluidine Blue, while IL-6 and albumin were measured -blood, where both groups had comparable basic characteristics. Results and Discussion: There was a statistically insignificant (p=0.835) higher increase in albumin level in the treatment group, while an insignificant (p=0.056) greater decrease also occur in the IL-6 level. The decrease in cell mast infiltration after treatment was also higher and not statistically significant (p=0.526). Previous studies showed that amino acids from snakehead fish play an important role in wound healing. Meanwhile, high EPA content in sea cucumber is due to its ability as an Echinodermata to regenerate tissue. It was also discovered that the results available about sea cucumber and sea snake extract on wound healing are different based on the skin condition after the use of the extracts. Conclusion: Snakehead fish and sea cucumber extract supplementation can increase albumin level, decrease IL-6 level and mast cell infiltration in burn or post-surgery wounds.
{"title":"Effect of Snakehead Fish and Sea Cucumber Extract Administration on Mast Cell Infiltration, Interlukin-6 (IL-6), and Albumin Levels in Burns and Surgical Wounds","authors":"Purwoko Purwoko, B. Putro, Arif Zuhal Amin Hananto","doi":"10.20473/ijar.v4i12022.1-5","DOIUrl":"https://doi.org/10.20473/ijar.v4i12022.1-5","url":null,"abstract":"Introduction: Burn injury impairs almost every organ system, which causes significant morbidity and mortality. Meanwhile, the phases included in burn healing are inflammation, cell recruitment, matrix deposition, epithelialization, and tissue remodeling phase. Previous studies showed that snakehead fish and sea cucumber extract have these effects and are beneficial in burn and post-surgery wounds. Objective: This study aims to analyze the effect of snakehead fish and sea cucumber extract supplementation towards mast cell infiltration, IL-6, and albumin level in burn and post-surgery wounds. Materials and Methods: A double-blind randomized control trial was carried out at Dr. Moewardi Hospital Surakarta in November 2017 on 30 subjects, which were divided into 2 groups. Mast cell infiltration was observed on burn and post-surgery wounds colored with Toluidine Blue, while IL-6 and albumin were measured -blood, where both groups had comparable basic characteristics. Results and Discussion: There was a statistically insignificant (p=0.835) higher increase in albumin level in the treatment group, while an insignificant (p=0.056) greater decrease also occur in the IL-6 level. The decrease in cell mast infiltration after treatment was also higher and not statistically significant (p=0.526). Previous studies showed that amino acids from snakehead fish play an important role in wound healing. Meanwhile, high EPA content in sea cucumber is due to its ability as an Echinodermata to regenerate tissue. It was also discovered that the results available about sea cucumber and sea snake extract on wound healing are different based on the skin condition after the use of the extracts. Conclusion: Snakehead fish and sea cucumber extract supplementation can increase albumin level, decrease IL-6 level and mast cell infiltration in burn or post-surgery wounds.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123345432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.20473/ijar.v4i12022.37-46
M. Adhi, Arie Utariani, Lucky Andriyanto
Introduction: The management of conjoined twins requires multidisciplinary teamwork. The complex problems in conjoined twin separation surgery are challenging for anesthesiologists without experience in the management of conjoined twins. Objective: To describe anesthetic management and utilization of teleanesthesia in conjoined twin separation surgery. Case Report: Sixty days-old pygopagus type conjoined twins, with a total body weight of 7030 grams. Both babies looked healthy, moved actively, found no respiratory function disorders, were hemodynamically stable and had no congenital abnormalities. The sacral region's computerized tomography scan (CT-scan) reveals conjoined twins with skin unification and subcutaneous in the perianal region and no internal-vertebral-spinal fusion. Two anesthesia teams performed the management of anesthesia. After confirming there was no cross-circulation with the atropine test, we alternately induced anesthesia by inhalation technique while maintaining spontaneous breathing. Anesthesia was maintained with sevoflurane 2.0-3.0 vol%, in a mixture of oxygen and air with a flow of 4 L/min using Jackson Reese. Circulating volume, hemodynamic stability, and normothermia were maintained intraoperatively. The separation surgery lasted 20 minutes, and the total surgical time for each baby was two hours. Awake extubation was performed immediately after the surgery was complete. Both babies underwent postoperative care at the PICU and were discharged on day 11. During the pre-operative for surgery, the local team conducted telemedicine consultations with the pediatric anesthesia team at Dr. Soetomo hospital and performed intra-anesthesia telementoring. Conclusion: Careful preparation and pre-operative evaluation, proper intra-anesthesia maintenance and monitoring, as well as good communication and teamwork, are keys to successful anesthesia management in conjoined twin separation surgery. Consultation and assistance from an experienced team during surgery using teleanesthesia are significantly beneficial to the anesthesiologist without experience in conjoined twin separation surgery.
{"title":"Successful Anesthetic Management from Separation Surgery of Pygopagus Conjoined Twin; Lesson-Learning With A Teleanesthesia","authors":"M. Adhi, Arie Utariani, Lucky Andriyanto","doi":"10.20473/ijar.v4i12022.37-46","DOIUrl":"https://doi.org/10.20473/ijar.v4i12022.37-46","url":null,"abstract":"Introduction: The management of conjoined twins requires multidisciplinary teamwork. The complex problems in conjoined twin separation surgery are challenging for anesthesiologists without experience in the management of conjoined twins. Objective: To describe anesthetic management and utilization of teleanesthesia in conjoined twin separation surgery. Case Report: Sixty days-old pygopagus type conjoined twins, with a total body weight of 7030 grams. Both babies looked healthy, moved actively, found no respiratory function disorders, were hemodynamically stable and had no congenital abnormalities. The sacral region's computerized tomography scan (CT-scan) reveals conjoined twins with skin unification and subcutaneous in the perianal region and no internal-vertebral-spinal fusion. Two anesthesia teams performed the management of anesthesia. After confirming there was no cross-circulation with the atropine test, we alternately induced anesthesia by inhalation technique while maintaining spontaneous breathing. Anesthesia was maintained with sevoflurane 2.0-3.0 vol%, in a mixture of oxygen and air with a flow of 4 L/min using Jackson Reese. Circulating volume, hemodynamic stability, and normothermia were maintained intraoperatively. The separation surgery lasted 20 minutes, and the total surgical time for each baby was two hours. Awake extubation was performed immediately after the surgery was complete. Both babies underwent postoperative care at the PICU and were discharged on day 11. During the pre-operative for surgery, the local team conducted telemedicine consultations with the pediatric anesthesia team at Dr. Soetomo hospital and performed intra-anesthesia telementoring. Conclusion: Careful preparation and pre-operative evaluation, proper intra-anesthesia maintenance and monitoring, as well as good communication and teamwork, are keys to successful anesthesia management in conjoined twin separation surgery. Consultation and assistance from an experienced team during surgery using teleanesthesia are significantly beneficial to the anesthesiologist without experience in conjoined twin separation surgery.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133829564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-26DOI: 10.20473/ijar.v4i12022.14-21
Rama Azalix Rianda, B. Semedi, Agus Subagjo, Y. Avidar
Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a scoring system to predict mortality risk after cardiac surgery. EuroSCORE II was introduced to replace and show superiority over EuroSCORE I which tends to overestimate the risk of heart surgery procedures and have a low discrimination ability. Meanwhile, this is the first study to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Objective: This study aims to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Materials and Methods: This is a retrospective study using medical records of CABG patients in Dr. Soetomo General Academic Hospital from January 2016 to December 2017. Results and Discussion: Out of 39 Patients who have performed CABG surgery, most were male (89.7%) with the highest age range of 46-65 years (59%). Deceased patients had an average EuroSCORE II of 22.36% and SD±26.97%7%, while 27 patients who survived had an average EuroSCORE II of 6.78% and SD±6.4%. Based on morbidity assessment, EuroSCORE II only accurately predicted the risk of kidney failure and did not properly assess the length of inotropic use, vasopressors, hospitalization time, the risk of arrhythmias, low cardiac output syndrome, Durante-operative bleeding, and the need for blood transfusion. These inaccuracies occurred because the samples that were included varied based on their standard deviation and pattern-less graph. Conclusion: EuroSCORE II is inadequate to predict morbidity and mortality in postoperative patients, therefore, it is considered less effective.
{"title":"EuroSCORE II as Predictor of Mortality and Morbidity in Post-CABG Patient in Dr. Soetomo General Academic Hospital","authors":"Rama Azalix Rianda, B. Semedi, Agus Subagjo, Y. Avidar","doi":"10.20473/ijar.v4i12022.14-21","DOIUrl":"https://doi.org/10.20473/ijar.v4i12022.14-21","url":null,"abstract":"Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a scoring system to predict mortality risk after cardiac surgery. EuroSCORE II was introduced to replace and show superiority over EuroSCORE I which tends to overestimate the risk of heart surgery procedures and have a low discrimination ability. Meanwhile, this is the first study to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Objective: This study aims to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Materials and Methods: This is a retrospective study using medical records of CABG patients in Dr. Soetomo General Academic Hospital from January 2016 to December 2017. Results and Discussion: Out of 39 Patients who have performed CABG surgery, most were male (89.7%) with the highest age range of 46-65 years (59%). Deceased patients had an average EuroSCORE II of 22.36% and SD±26.97%7%, while 27 patients who survived had an average EuroSCORE II of 6.78% and SD±6.4%. Based on morbidity assessment, EuroSCORE II only accurately predicted the risk of kidney failure and did not properly assess the length of inotropic use, vasopressors, hospitalization time, the risk of arrhythmias, low cardiac output syndrome, Durante-operative bleeding, and the need for blood transfusion. These inaccuracies occurred because the samples that were included varied based on their standard deviation and pattern-less graph. Conclusion: EuroSCORE II is inadequate to predict morbidity and mortality in postoperative patients, therefore, it is considered less effective.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130269341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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