Pub Date : 2023-07-01DOI: 10.4103/bjoa.bjoa_118_23
Ji Kwon, Ki Lee, Sang Lee, Yong Kim, Sung Shin
Background: Choosing an appropriate endotracheal tube size during the first attempt is crucial for avoiding unnecessary reintubation. Previous studies on endotracheal tube size in children focused on uncuffed tubes. Following recent studies on pediatric airway anatomy, cuffed endotracheal tubes are increasingly utilized in children. The objective of our study was to develop a new formula for selecting the correctly sized cuffed endotracheal tube for pediatric patients. Materials and Methods: We examined the electronic anesthetic records of 465 pediatric patients who received elective ophthalmic surgery between January 2011 and December 2018. Multiple linear regression was used to identify potential predictors of cuffed endotracheal size among age, weight, height, body mass index, and the presence of underweight, overweight, and obesity. We used repeated-measures ANOVA to assess the difference between the actual and calculated sizes of the endotracheal tube. Results: The derived formula is as follows: Predicted endotracheal tube size (mm) = 3.7 + 0.1 × age (years) + 0.02 × weight (kg) + 0.1 × presence of overweight (0: negative, 1: positive). The coefficient of determination (R2) for the total population was 0.685 and was higher in the overweight group (R2 = 0.763). When compared with the three conventional age-based formulas (Cole’s, Khine’s, and Duracher’s formula), the difference between the actual endotracheal tube size and the endotracheal tube size calculated using Duracher’s formula was the smallest. Conclusions: In choosing the appropriate size of a cuffed endotracheal tube in children, age and body size should be considered.
{"title":"A new formula for selecting the size of cuffed endotracheal tubes in pediatric patients","authors":"Ji Kwon, Ki Lee, Sang Lee, Yong Kim, Sung Shin","doi":"10.4103/bjoa.bjoa_118_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_118_23","url":null,"abstract":"Background: Choosing an appropriate endotracheal tube size during the first attempt is crucial for avoiding unnecessary reintubation. Previous studies on endotracheal tube size in children focused on uncuffed tubes. Following recent studies on pediatric airway anatomy, cuffed endotracheal tubes are increasingly utilized in children. The objective of our study was to develop a new formula for selecting the correctly sized cuffed endotracheal tube for pediatric patients. Materials and Methods: We examined the electronic anesthetic records of 465 pediatric patients who received elective ophthalmic surgery between January 2011 and December 2018. Multiple linear regression was used to identify potential predictors of cuffed endotracheal size among age, weight, height, body mass index, and the presence of underweight, overweight, and obesity. We used repeated-measures ANOVA to assess the difference between the actual and calculated sizes of the endotracheal tube. Results: The derived formula is as follows: Predicted endotracheal tube size (mm) = 3.7 + 0.1 × age (years) + 0.02 × weight (kg) + 0.1 × presence of overweight (0: negative, 1: positive). The coefficient of determination (R2) for the total population was 0.685 and was higher in the overweight group (R2 = 0.763). When compared with the three conventional age-based formulas (Cole’s, Khine’s, and Duracher’s formula), the difference between the actual endotracheal tube size and the endotracheal tube size calculated using Duracher’s formula was the smallest. Conclusions: In choosing the appropriate size of a cuffed endotracheal tube in children, age and body size should be considered.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"114 1","pages":"141 - 144"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365877","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 : 2023-07-01DOI: 10.4103/bjoa.bjoa_149_23
Arie Fatoni, Maghfira Azizah, Ratri Istiqomah
Background: On a regional and global level, the prevalence of coronavirus disease (COVID-19) cases is rising daily, splitting intensive care units (ICUs) into COVID-19 ICUs and regular ICUs during the COVID-19 pandemic. Numerous studies have revealed that COVID-19 ICU health personnel had higher levels of anxiety than those in the regular ICU. This study aimed to compare the levels of anxiety among medical personnel in the regular ICU and the COVID-19 ICU. Materials and Methods: This is a population-based observational study. All healthcare workers working in COVID-19 and regular ICU at our institution were included in this study. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to measure the level of anxiety. Mann–Whitney test was used to compare the anxiety level of participants in both groups. Results: Of the 108 participants who filled out the questionnaire, there were 99 eligible subjects for further analysis. The mean GAD-7 score for COVID-19 ICU health professionals was higher (3.87 ± 4.18) than for regular ICU (1.87 ± 2.38), causing significant differences between the two groups (P = 0.005). Among all observed variables, a significant difference of anxiety levels between groups were found in age (P = 0.032) and education (P = 0.036) variables.. Conclusion: The anxiety levels among health workers in the COVID-19 ICU were significantly higher compared to those in the regular ICU setting.
{"title":"Comparison of health workers’ anxiety levels in coronavirus disease and regular intensive care unit Saiful Anwar Hospital Malang: A cross-sectional study","authors":"Arie Fatoni, Maghfira Azizah, Ratri Istiqomah","doi":"10.4103/bjoa.bjoa_149_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_149_23","url":null,"abstract":"Background: On a regional and global level, the prevalence of coronavirus disease (COVID-19) cases is rising daily, splitting intensive care units (ICUs) into COVID-19 ICUs and regular ICUs during the COVID-19 pandemic. Numerous studies have revealed that COVID-19 ICU health personnel had higher levels of anxiety than those in the regular ICU. This study aimed to compare the levels of anxiety among medical personnel in the regular ICU and the COVID-19 ICU. Materials and Methods: This is a population-based observational study. All healthcare workers working in COVID-19 and regular ICU at our institution were included in this study. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to measure the level of anxiety. Mann–Whitney test was used to compare the anxiety level of participants in both groups. Results: Of the 108 participants who filled out the questionnaire, there were 99 eligible subjects for further analysis. The mean GAD-7 score for COVID-19 ICU health professionals was higher (3.87 ± 4.18) than for regular ICU (1.87 ± 2.38), causing significant differences between the two groups (P = 0.005). Among all observed variables, a significant difference of anxiety levels between groups were found in age (P = 0.032) and education (P = 0.036) variables.. Conclusion: The anxiety levels among health workers in the COVID-19 ICU were significantly higher compared to those in the regular ICU setting.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"28 1","pages":"154 - 159"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366189","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}
Background: Perfusion index (PI) can be used to assess peripheral perfusion dynamics as it depicts the changes in peripheral vascular tone. Increased risk of fall in blood pressure following subarachnoid block (SAB) has been reported in pregnant patients with raised PI value due to their decreased peripheral vascular resistance. This study aimed to evaluate PI as a noninvasive tool for predicting incidence and severity of maternal hypotension following SAB in parturients undergoing lower segment cesarean section (LSCS). Materials and Methods: A prospective, observational study was conducted on 120 American Society of Anesthesiologists-II parturients undergoing LSCS under SAB. Noninvasive blood pressure, heart rate (HR), and PI were recorded at baseline and at 1-min interval till delivery of baby. Episodes of hypotension, bradycardia, total amount of vasopressor consumption, intraoperative nausea, vomiting (IONV), and APGAR scores were observed. Results: Receiver operator characteristics curve determined the optimal cutoff point for PI to predict intraoperative hypotension and IONV was 3.82 with a sensitivity of 79.07% and specificity of 72.73%. Incidence of hypotension in subjects with a higher baseline PI (≥3.82) was 79.1% compared with 20.9% with low baseline PI (<3.82). Amount of vasopressor used and incidence of IONV was significantly higher in subjects with high baseline PI (P < 0.001). Conclusions: There is a significant correlation between PI and SAB-induced hypotension in parturients undergoing LSCS. Pregnant patients with higher baseline PI (>3.82) are at a greater risk of developing hypotension.
背景：灌注指数（PI）可用于评估外周灌注动态，因为它描述了外周血管张力的变化。有报道称，蛛网膜下腔阻滞（SAB）后，由于外周血管阻力下降，PI 值升高的孕妇血压下降的风险增加。本研究旨在评估 PI，将其作为一种无创工具，用于预测接受下段剖宫产术（LSCS）的孕妇在蛛网膜下腔阻滞术（SAB）后产妇低血压的发生率和严重程度。材料和方法：对 120 名在 SAB 下接受 LSCS 的美国麻醉医师协会 II 级产妇进行了前瞻性观察研究。无创血压、心率（HR）和 PI 均在基线和婴儿娩出前每隔 1 分钟记录一次。观察低血压发作、心动过缓、血管加压素消耗总量、术中恶心、呕吐（IONV）和 APGAR 评分。结果受体运算特性曲线确定了预测术中低血压和 IONV 的最佳 PI 临界点为 3.82，灵敏度为 79.07%，特异度为 72.73%。基线 PI 较高（≥3.82）的受试者发生低血压的几率为 79.1%，而基线 PI 较低（3.82）的受试者发生低血压的几率为 20.9%，后者发生低血压的风险更大。
{"title":"Perfusion index as predictor of intraoperative hypotension following subarachnoid block in cesarean section: A prospective, observational study","authors":"Sandeep Singh, Gurpreeti Kaur, Richa Jain, Neeru Luthra, Namrata Sharma, Anju Grewal","doi":"10.4103/bjoa.bjoa_161_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_161_23","url":null,"abstract":"Background: Perfusion index (PI) can be used to assess peripheral perfusion dynamics as it depicts the changes in peripheral vascular tone. Increased risk of fall in blood pressure following subarachnoid block (SAB) has been reported in pregnant patients with raised PI value due to their decreased peripheral vascular resistance. This study aimed to evaluate PI as a noninvasive tool for predicting incidence and severity of maternal hypotension following SAB in parturients undergoing lower segment cesarean section (LSCS). Materials and Methods: A prospective, observational study was conducted on 120 American Society of Anesthesiologists-II parturients undergoing LSCS under SAB. Noninvasive blood pressure, heart rate (HR), and PI were recorded at baseline and at 1-min interval till delivery of baby. Episodes of hypotension, bradycardia, total amount of vasopressor consumption, intraoperative nausea, vomiting (IONV), and APGAR scores were observed. Results: Receiver operator characteristics curve determined the optimal cutoff point for PI to predict intraoperative hypotension and IONV was 3.82 with a sensitivity of 79.07% and specificity of 72.73%. Incidence of hypotension in subjects with a higher baseline PI (≥3.82) was 79.1% compared with 20.9% with low baseline PI (<3.82). Amount of vasopressor used and incidence of IONV was significantly higher in subjects with high baseline PI (P < 0.001). Conclusions: There is a significant correlation between PI and SAB-induced hypotension in parturients undergoing LSCS. Pregnant patients with higher baseline PI (>3.82) are at a greater risk of developing hypotension.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"28 1","pages":"160 - 164"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365561","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 : 2023-07-01DOI: 10.4103/bjoa.bjoa_189_23
Marilaeta Cindryani
{"title":"Artificial intelligence in anesthesia and critical care (part 1): Current perspective in critical care setting","authors":"Marilaeta Cindryani","doi":"10.4103/bjoa.bjoa_189_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_189_23","url":null,"abstract":"","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"9 1","pages":"125 - 125"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364780","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}
D. Purwaamidjaja, Mayang Lestari, Asep Hendradiana, Bastian Lubis, Muhammad Thamrin
To reduce the risk of critically ill patients becoming unstable and needing readmission to the intensive care unit (ICU), patients are typically treated in the ward first following discharge from ICU. However, managing patients with advanced or terminal comorbidities or those requiring palliative care differs from general patients. Patients in this category can be discharged immediately to their homes with tracheostomy care and family education. This case series describes the cases and outcomes of patients with direct from ICU sent home (DISH) protocol. Twelve patients were immediately discharged from the ICU upon completion of treatment. Following the established standard operating procedure, they underwent DISH from the ICU. Early tracheostomy was performed in every patient (from day 1 to day 12th postintubation). All patients were safely discharged following the DISH procedure. According to the findings of this case series, DISH of critically ill patients with tracheostomy cannulas can be executed securely if the patient management method is firmly established. This technique must involve a good education process involving the ICU team, doctors, and family/companions.
{"title":"Selective Critically ill patients with tracheostomy are eligible for direct from intensive care unit sent home: Case series","authors":"D. Purwaamidjaja, Mayang Lestari, Asep Hendradiana, Bastian Lubis, Muhammad Thamrin","doi":"10.4103/bjoa.bjoa_90_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_90_23","url":null,"abstract":"To reduce the risk of critically ill patients becoming unstable and needing readmission to the intensive care unit (ICU), patients are typically treated in the ward first following discharge from ICU. However, managing patients with advanced or terminal comorbidities or those requiring palliative care differs from general patients. Patients in this category can be discharged immediately to their homes with tracheostomy care and family education. This case series describes the cases and outcomes of patients with direct from ICU sent home (DISH) protocol. Twelve patients were immediately discharged from the ICU upon completion of treatment. Following the established standard operating procedure, they underwent DISH from the ICU. Early tracheostomy was performed in every patient (from day 1 to day 12th postintubation). All patients were safely discharged following the DISH procedure. According to the findings of this case series, DISH of critically ill patients with tracheostomy cannulas can be executed securely if the patient management method is firmly established. This technique must involve a good education process involving the ICU team, doctors, and family/companions.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"4 1","pages":"183 - 187"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364408","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}
Background: Intraoperative nausea and vomiting (IONV) are common complications in patients undergoing lower segment cesarean section (LSCS) under subarachnoid block. This study aimed to compare the combination of phenylephrine and ondansetron with ondansetron and phenylephrine alone in preventing IONV in patients undergoing LSCS under subarachnoid block. Materials and Methods: This prospective, double-blind, randomized, comparative study included 195 patients posted for elective LSCS under subarachnoid block. They were randomly allocated into three groups of 65 each. Group A received phenylephrine (25 mcg/min) and ondansetron 4 mg, group B received phenylephrine (25 mcg/min), and group C received only ondansetron 4 mg. Primary outcome measured was the incidence of IONV. Secondary outcomes measured were hemodynamic parameters, incidence of intraoperative hypotension, and vasopressor requirement. Categorical data were presented as numbers (proportion) and compared using the Chi-square test. Results: The proportion of subjects who experienced IONV was highest in group C (24.6%) compared with groups A (9.2%) and B (10.7%) (P = 0.025). The mean number of episodes of IONV was significantly lower in patients who received a combination of phenylephrine and ondansetron compared with phenylephrine or ondansetron (0.126 ± 0.42 vs. 0.107 ± 0.312 vs. 0.307 ± 0.58; P = 0.0233). The number of episodes of intraoperative hypotension was significantly high in group C (0.23 ± 0.49) compared with other groups (P = 0.041). Conclusion: Infusion of 25 mcg/min of phenylephrine with 4 mg ondansetron and infusion of 25 mcg/min of phenylephrine alone reduce the incidence of IONV in patients undergoing elective LSCS under subarachnoid block when compared with ondansetron alone.
{"title":"Phenylephrine, ondansetron, or combination of both for prevention of intraoperative nausea and vomiting in patients undergoing lower segment cesarean section: A prospective, double-blind randomized control trial","authors":"Vikram Bedi, Pratibha Yadav, B. Bairwa, Santosh Choudhary, Naveen Kumar, Gayatri Deshpande","doi":"10.4103/bjoa.bjoa_105_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_105_23","url":null,"abstract":"Background: Intraoperative nausea and vomiting (IONV) are common complications in patients undergoing lower segment cesarean section (LSCS) under subarachnoid block. This study aimed to compare the combination of phenylephrine and ondansetron with ondansetron and phenylephrine alone in preventing IONV in patients undergoing LSCS under subarachnoid block. Materials and Methods: This prospective, double-blind, randomized, comparative study included 195 patients posted for elective LSCS under subarachnoid block. They were randomly allocated into three groups of 65 each. Group A received phenylephrine (25 mcg/min) and ondansetron 4 mg, group B received phenylephrine (25 mcg/min), and group C received only ondansetron 4 mg. Primary outcome measured was the incidence of IONV. Secondary outcomes measured were hemodynamic parameters, incidence of intraoperative hypotension, and vasopressor requirement. Categorical data were presented as numbers (proportion) and compared using the Chi-square test. Results: The proportion of subjects who experienced IONV was highest in group C (24.6%) compared with groups A (9.2%) and B (10.7%) (P = 0.025). The mean number of episodes of IONV was significantly lower in patients who received a combination of phenylephrine and ondansetron compared with phenylephrine or ondansetron (0.126 ± 0.42 vs. 0.107 ± 0.312 vs. 0.307 ± 0.58; P = 0.0233). The number of episodes of intraoperative hypotension was significantly high in group C (0.23 ± 0.49) compared with other groups (P = 0.041). Conclusion: Infusion of 25 mcg/min of phenylephrine with 4 mg ondansetron and infusion of 25 mcg/min of phenylephrine alone reduce the incidence of IONV in patients undergoing elective LSCS under subarachnoid block when compared with ondansetron alone.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"2 1","pages":"145 - 149"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364616","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 : 2023-07-01DOI: 10.4103/bjoa.bjoa_156_23
Ari Andayani, Luh Putu Dewi, Ariesanti Handayani, I. Widiana, I. Jayanegara, I. Widnyana
Introduction: Specific guidelines regarding the safest and most effective anesthetic procedure for patients undergoing pars plana vitrectomy have not been established. Regional anesthetic use has increased in recent years. Regional anesthetic techniques can be needle-based (retrobulbar and peribulbar) and cannula-based (sub-Thenon’s block). This research aimed to compare the efficacy of sub-Thenon’s anesthesia and peribulbar block in vitrectomy surgery. Materials and Methods: This study was a prospective randomized controlled single-blind pilot. Thirty subjects were divided equally into sub-Thenon’s and peribulbar groups. Subjects were randomized by permuted block randomization with a single-blind method. Eye drops of 1% tropicamide and 5% phenylephrine were used to achieve pupil dilation. Local anesthetic used was 0.5% propacaine hydrochloride. Sub-Thenon anesthesia was achieved by 2.5 mL llidocaine 2% and 2.5 mL bupivacaine, whereas peribulbar block by 4 mL lidocaine 2% and 4 mL of bupivacaine 0.5% injection. The observed outcome variables included the numerical rating scale (NRS) at trocar insertion, anesthetic onset, and anesthesia duration. Results: The NRS during trocar insertion under sub-Thenon’s compared with peribulbar was comparable (P = 0.28). The onset of sub-Thenon’s versus peribulbar anesthesia is 6 versus 10 min (P = 0.74). Duration of anesthesia under sub-Thenon’s versus peribulbar anesthesia was 73.3 ± 30 versus 68 ± 26 min (P = 0.32). The results of multivariate analysis showed there were no differences in pain scale on trocar insertion, the onset of anesthesia, and duration of anesthesia between sub-Thenon’s and peribulbar anesthesia after controlling for confounding variables. Conclusion: There are no differences in trocar insertion pain scale, onset, and duration of anesthesia between sub-Thenon’s anesthesia and peribulbar anesthesia.
{"title":"Comparable pain scale, onset, and duration of anesthesia in sub-Thenon’s and peribulbar anesthesia in vitrectomy: A pilot study","authors":"Ari Andayani, Luh Putu Dewi, Ariesanti Handayani, I. Widiana, I. Jayanegara, I. Widnyana","doi":"10.4103/bjoa.bjoa_156_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_156_23","url":null,"abstract":"Introduction: Specific guidelines regarding the safest and most effective anesthetic procedure for patients undergoing pars plana vitrectomy have not been established. Regional anesthetic use has increased in recent years. Regional anesthetic techniques can be needle-based (retrobulbar and peribulbar) and cannula-based (sub-Thenon’s block). This research aimed to compare the efficacy of sub-Thenon’s anesthesia and peribulbar block in vitrectomy surgery. Materials and Methods: This study was a prospective randomized controlled single-blind pilot. Thirty subjects were divided equally into sub-Thenon’s and peribulbar groups. Subjects were randomized by permuted block randomization with a single-blind method. Eye drops of 1% tropicamide and 5% phenylephrine were used to achieve pupil dilation. Local anesthetic used was 0.5% propacaine hydrochloride. Sub-Thenon anesthesia was achieved by 2.5 mL llidocaine 2% and 2.5 mL bupivacaine, whereas peribulbar block by 4 mL lidocaine 2% and 4 mL of bupivacaine 0.5% injection. The observed outcome variables included the numerical rating scale (NRS) at trocar insertion, anesthetic onset, and anesthesia duration. Results: The NRS during trocar insertion under sub-Thenon’s compared with peribulbar was comparable (P = 0.28). The onset of sub-Thenon’s versus peribulbar anesthesia is 6 versus 10 min (P = 0.74). Duration of anesthesia under sub-Thenon’s versus peribulbar anesthesia was 73.3 ± 30 versus 68 ± 26 min (P = 0.32). The results of multivariate analysis showed there were no differences in pain scale on trocar insertion, the onset of anesthesia, and duration of anesthesia between sub-Thenon’s and peribulbar anesthesia after controlling for confounding variables. Conclusion: There are no differences in trocar insertion pain scale, onset, and duration of anesthesia between sub-Thenon’s anesthesia and peribulbar anesthesia.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"59 1","pages":"165 - 169"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366044","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}
Background: Augmented reality (AR) has gained importance, complementing teaching and learning in medicine. However, there is limited use of AR in anesthesia. We aimed to explore the usefulness of AR in learning spinal anatomy relevant to neuraxial needle insertion training in labor epidural analgesia with feedback from trainers and learners. Materials and Methods: A pilot study was conducted from January to March 2022 at a local specialist maternity hospital. Computer tomography images were obtained from an epidural mannequin trainer, reconstructed, and uploaded to an AR program loaded onto an AR device. Anesthetists with varying experiences utilized the AR program to evaluate the AR experience, with pre- and postuser surveys conducted. Results: Thirty-one participants were recruited with a mean (standard deviation) of 7.9 (6.2) years of anesthesia experience. Twenty-five (80.6%) were aware of AR applications, but most (80.6%) had no prior experience with AR-based learning. Using the Likert scale (1 being strongly disagree and 5 being strongly agree), the postuser survey showed median scores of ≥4 in all questions on AR-based learning. The majority (92%) agreed that the AR software should include functions for obtaining clear visualization of anatomy, rotating 3D structures, changing magnification, and selecting specific parts to focus on. Feedback also highlighted the need for familiarization and flexibility with manipulating holographic images and haptic device links for task training. Conclusions: Our study showed potential for AR in facilitating anatomy learning related to training in labor epidural insertion. Improvements through program flexibility and haptic device link could enhance task training.
背景：增强现实技术（AR）在医学教学中发挥着重要作用。然而，AR 在麻醉领域的应用还很有限。我们旨在根据培训师和学员的反馈，探索 AR 在学习分娩硬膜外镇痛中神经针插入培训相关的脊柱解剖学方面的实用性。材料和方法：2022 年 1 月至 3 月，在当地一家专科妇产医院开展了一项试点研究。计算机断层扫描图像从硬膜外人体模型训练器中获取、重建并上传到 AR 设备上的 AR 程序中。具有不同经验的麻醉师利用AR程序对AR体验进行了评估，并进行了使用前和使用后调查。结果：共招募了 31 名参与者，平均（标准差）麻醉经验为 7.9（6.2）年。25人（80.6%）知道AR应用，但大多数人（80.6%）以前没有基于AR的学习经验。使用李克特量表（1 表示非常不同意，5 表示非常同意）进行的用户后期调查显示，在有关基于 AR 的学习的所有问题中，得分中位数均≥4。大多数人（92%）同意，AR 软件应包括获得清晰的可视化解剖结构、旋转三维结构、改变放大倍率和选择要关注的特定部位等功能。反馈意见还强调，需要熟悉并灵活操作全息图像和触觉设备链接，以便进行任务培训。结论：我们的研究显示了 AR 在促进与分娩硬膜外插入培训相关的解剖学习方面的潜力。通过程序灵活性和触觉设备链接进行改进，可加强任务培训。
{"title":"Use of augmented reality in learning lumbar spinal anatomy for training in labor epidural insertion: A pilot study","authors":"Wei Lau, J. Chan, C. Chan, Chin Tan, B. Sng","doi":"10.4103/bjoa.bjoa_75_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_75_23","url":null,"abstract":"Background: Augmented reality (AR) has gained importance, complementing teaching and learning in medicine. However, there is limited use of AR in anesthesia. We aimed to explore the usefulness of AR in learning spinal anatomy relevant to neuraxial needle insertion training in labor epidural analgesia with feedback from trainers and learners. Materials and Methods: A pilot study was conducted from January to March 2022 at a local specialist maternity hospital. Computer tomography images were obtained from an epidural mannequin trainer, reconstructed, and uploaded to an AR program loaded onto an AR device. Anesthetists with varying experiences utilized the AR program to evaluate the AR experience, with pre- and postuser surveys conducted. Results: Thirty-one participants were recruited with a mean (standard deviation) of 7.9 (6.2) years of anesthesia experience. Twenty-five (80.6%) were aware of AR applications, but most (80.6%) had no prior experience with AR-based learning. Using the Likert scale (1 being strongly disagree and 5 being strongly agree), the postuser survey showed median scores of ≥4 in all questions on AR-based learning. The majority (92%) agreed that the AR software should include functions for obtaining clear visualization of anatomy, rotating 3D structures, changing magnification, and selecting specific parts to focus on. Feedback also highlighted the need for familiarization and flexibility with manipulating holographic images and haptic device links for task training. Conclusions: Our study showed potential for AR in facilitating anatomy learning related to training in labor epidural insertion. Improvements through program flexibility and haptic device link could enhance task training.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"546 1","pages":"135 - 140"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366185","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}
Background: Sepsis is a clinical syndrome with a high mortality rate which shows a direct relationship with the severity of the disease. Changes in procalcitonin levels in several studies are considered indicators of bacterial infection. The goal of this study was to prove that low procalcitonin clearance is a mortality predictor in sepsis patients who are given antibiotics in the intensive care unit. Materials and Methods: This was an analytic, observational, retrospective study, with a cross-sectional design. The study was conducted by taking medical record data of sepsis patients who were treated with culture-specific antibiotics and then collecting data on changes in procalcitonin levels on the first day and 72 h antibiotics administration per antibiotic-sensitivity results. Patients were grouped with procalcitonin clearance <70% and ≥70% and were associated with survive and mortality groups. Data were analyzed by chi-square test. Results: There were 116 sepsis patients with an average age of 48.92 years. Most of the patients were aged 18–65 years (86.2%), with male predominance (72.4%). In this study, we found 68 patients (58.6%) with procalcitonin clearance ≥70%, whereas 48 patients (41.4%) had procalcitonin clearance <70%. The 28-day mortality in patients with procalcitonin clearance <70% (66.7%) was higher than in patients with procalcitonin clearance ≥70% (47.1%). There was a significant relationship between procalcitonin clearance <70% and the 28-day mortality outcome in septic patients who were given antibiotics according to culture (P = 0.036). Conclusion: Low procalcitonin clearance was significantly associated with 28-day mortality outcome in septic patients. Further studies are needed to gain a better understanding of this matter.
{"title":"Low procalcitonin clearance correlates with mortality treated with culture-matched antibiotics in intensive care unit: A retrospective, observational study","authors":"Fradita Yunus Guzasiah, Haizah Nurdin, Faisal Muchtar, Hisbullah Rum, A. Palinrungi","doi":"10.4103/bjoa.bjoa_157_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_157_23","url":null,"abstract":"Background: Sepsis is a clinical syndrome with a high mortality rate which shows a direct relationship with the severity of the disease. Changes in procalcitonin levels in several studies are considered indicators of bacterial infection. The goal of this study was to prove that low procalcitonin clearance is a mortality predictor in sepsis patients who are given antibiotics in the intensive care unit. Materials and Methods: This was an analytic, observational, retrospective study, with a cross-sectional design. The study was conducted by taking medical record data of sepsis patients who were treated with culture-specific antibiotics and then collecting data on changes in procalcitonin levels on the first day and 72 h antibiotics administration per antibiotic-sensitivity results. Patients were grouped with procalcitonin clearance <70% and ≥70% and were associated with survive and mortality groups. Data were analyzed by chi-square test. Results: There were 116 sepsis patients with an average age of 48.92 years. Most of the patients were aged 18–65 years (86.2%), with male predominance (72.4%). In this study, we found 68 patients (58.6%) with procalcitonin clearance ≥70%, whereas 48 patients (41.4%) had procalcitonin clearance <70%. The 28-day mortality in patients with procalcitonin clearance <70% (66.7%) was higher than in patients with procalcitonin clearance ≥70% (47.1%). There was a significant relationship between procalcitonin clearance <70% and the 28-day mortality outcome in septic patients who were given antibiotics according to culture (P = 0.036). Conclusion: Low procalcitonin clearance was significantly associated with 28-day mortality outcome in septic patients. Further studies are needed to gain a better understanding of this matter.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"11 1","pages":"150 - 153"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364586","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}
S. Mallikarjuna, Priyanka Gupta, Siddharth Chakraborty, Alok Padhee
Hyponatremia is the most common electrolyte abnormality encountered in neurosurgical practice. The pathophysiology for hyponatremia among neurosurgical patients is most commonly due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is the most common cause of euvolemic hyponatremia. There are various causes of SIADH ranging from drugs to malignancies. Among neurosurgical patients, it is described in subarachnoid hemorrhage, traumatic brain injury, pituitary surgeries, postoperatively after intracranial insult, and rarely in association with other intracerebral pathologies. The diagnostic criteria for SIADH include hypoosmolality, elevated urinary osmolality, euvolemia, and elevated urinary sodium which was present in our case. Our patient was diagnosed with trigeminal neuralgia due to CP angle epidermoid and was on T. Oxcarbazepine 300 mg daily since 6 months for the neuropathic pain. History and physical examination were unremarkable except for serum sodium of 118 mEq/L. Though the possibility of intracranial tumor may be the cause of SIADH, which is very rare due to the tumor location; hence, the possible explanation for the asymptomatic hyponatremia in this patient may be due to oxcarbazepine-induced SIADH. Here is a case report of SIADH due to oxcarbazepine and its perioperative management in a 24-year-old woman diagnosed with trigeminal neuralgia.
{"title":"Oxcarbazepine-induced syndrome of inappropriate antidiuretic hormone secretion in a trigeminal neuralgia: A case report","authors":"S. Mallikarjuna, Priyanka Gupta, Siddharth Chakraborty, Alok Padhee","doi":"10.4103/bjoa.bjoa_40_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_40_23","url":null,"abstract":"Hyponatremia is the most common electrolyte abnormality encountered in neurosurgical practice. The pathophysiology for hyponatremia among neurosurgical patients is most commonly due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is the most common cause of euvolemic hyponatremia. There are various causes of SIADH ranging from drugs to malignancies. Among neurosurgical patients, it is described in subarachnoid hemorrhage, traumatic brain injury, pituitary surgeries, postoperatively after intracranial insult, and rarely in association with other intracerebral pathologies. The diagnostic criteria for SIADH include hypoosmolality, elevated urinary osmolality, euvolemia, and elevated urinary sodium which was present in our case. Our patient was diagnosed with trigeminal neuralgia due to CP angle epidermoid and was on T. Oxcarbazepine 300 mg daily since 6 months for the neuropathic pain. History and physical examination were unremarkable except for serum sodium of 118 mEq/L. Though the possibility of intracranial tumor may be the cause of SIADH, which is very rare due to the tumor location; hence, the possible explanation for the asymptomatic hyponatremia in this patient may be due to oxcarbazepine-induced SIADH. Here is a case report of SIADH due to oxcarbazepine and its perioperative management in a 24-year-old woman diagnosed with trigeminal neuralgia.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"2 1","pages":"170 - 172"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365635","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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