Pub Date : 2023-01-01DOI: 10.4103/bjoa.bjoa_254_22
Sukriti Chowdhury, Asim Maiti, S. Chattopadhyay, Debasish Bhar
Introduction: Pressure-controlled volume-guaranteed (PCV-VG) mode has the advantage of both volume-controlled (VCV) and pressure-controlled ventilation (PCV). Our objective is to compare gaseous exchange and lung dynamic compliance (Cdyn) after pneumoperitoneum and just before desufflation in VCV, PCV, and PCV-VG mode in laparoscopic cholecystectomy (LC). Materials and Methods: A total of 105 patients undergoing LC under general anesthesia were randomly distributed to group V (received VCV), group P (PCV), and group PV (PCV-VG) as mode of ventilation. Two arterial blood samples were taken for blood gas analysis: after the pneumoperitoneum (T1) and right before abdominal desufflation (T2). Arterial partial oxygen pressure (PaO2) and carbon dioxide (PaCO2) levels, oxygen saturation (SpO2) and end-tidal carbon dioxide were compared at these two points of time between the groups. Results: Cdyn was higher in group P (43.21 ± 4.4 mL/cmH2O) compared with group V (39.18 ± 3.2 mL/cmH2O) and PV (40.37 ± 2.45 mL/cmH2O) at T2 (P < 0.001). PaO2 was significantly higher (P < 0.001) in group P (197.50 ± 17.29 mm Hg) at T2 compared with group V (178.90 ± 23.7 mm Hg) and PV (183.47 ± 22.99 mm Hg). Furthermore, PaCO2 was also significantly higher in Group P (40.19 ± 2.92 mm Hg) compared with group V (32.57 ± 2.09 mm Hg) and group PV (34.14 ± 3.27 mm Hg). Conclusion: PaO2 and dynamic compliance are higher in pressure-controlled mode but, high PaCO2 in pressure-controlled mode indicates inadequate ventilation. Therefore, pressure controlled volume guaranteed mode can be considered as a favorable ventilation strategy during LC because dynamic compliance and PaO2 are higher than volume controlled ventilation and PaCO2 is significantly less than pressure controlled mode.
{"title":"Volume-controlled, pressure-controlled vs. pressure-controlled volume-guaranteed ventilations in improving respiratory dynamics during laparoscopic cholecystectomy: A prospective, randomized, comparative study","authors":"Sukriti Chowdhury, Asim Maiti, S. Chattopadhyay, Debasish Bhar","doi":"10.4103/bjoa.bjoa_254_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_254_22","url":null,"abstract":"Introduction: Pressure-controlled volume-guaranteed (PCV-VG) mode has the advantage of both volume-controlled (VCV) and pressure-controlled ventilation (PCV). Our objective is to compare gaseous exchange and lung dynamic compliance (Cdyn) after pneumoperitoneum and just before desufflation in VCV, PCV, and PCV-VG mode in laparoscopic cholecystectomy (LC). Materials and Methods: A total of 105 patients undergoing LC under general anesthesia were randomly distributed to group V (received VCV), group P (PCV), and group PV (PCV-VG) as mode of ventilation. Two arterial blood samples were taken for blood gas analysis: after the pneumoperitoneum (T1) and right before abdominal desufflation (T2). Arterial partial oxygen pressure (PaO2) and carbon dioxide (PaCO2) levels, oxygen saturation (SpO2) and end-tidal carbon dioxide were compared at these two points of time between the groups. Results: Cdyn was higher in group P (43.21 ± 4.4 mL/cmH2O) compared with group V (39.18 ± 3.2 mL/cmH2O) and PV (40.37 ± 2.45 mL/cmH2O) at T2 (P < 0.001). PaO2 was significantly higher (P < 0.001) in group P (197.50 ± 17.29 mm Hg) at T2 compared with group V (178.90 ± 23.7 mm Hg) and PV (183.47 ± 22.99 mm Hg). Furthermore, PaCO2 was also significantly higher in Group P (40.19 ± 2.92 mm Hg) compared with group V (32.57 ± 2.09 mm Hg) and group PV (34.14 ± 3.27 mm Hg). Conclusion: PaO2 and dynamic compliance are higher in pressure-controlled mode but, high PaCO2 in pressure-controlled mode indicates inadequate ventilation. Therefore, pressure controlled volume guaranteed mode can be considered as a favorable ventilation strategy during LC because dynamic compliance and PaO2 are higher than volume controlled ventilation and PaCO2 is significantly less than pressure controlled mode.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"13 - 18"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48185756","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_244_22
A. Uslu, N. Çekmen
Rothmund-Thomson Syndrome (RTS) is a rare, multisystem disease accompanied by many anomalies that require careful attention from preoperative evaluation to discharge regarding anesthesia preparation and management. Due to craniofacial deformities accompanying facial abnormalities, maintaining the airway becomes a complete struggle with a race against time for survival. This case report presents the preoperative preparation and perioperative management, the risks that may be encountered, and the detailed preparation for a 7-year-old patient diagnosed with RTS and multiple system involvement. General anesthesia was administered to this patient, who had intrauterine growth retardation, nail streaking, redness of the bullae and legs, and a history of somatotropin treatment and antinuclear antibody (ANA) positivity under optimum conditions. Thanks to successful and detailed preoperative preparation and perioperative management, the patient was followed up and discharged without any complications. Although RTS is rare, the need for general anesthesia often arises due to juvenile cataracts, dental anomalies, syndactyly and other extremity anomalies in these patients whose airway management is complex. Furthermore, this increases the current risk in the population of these patients. Managing these patients with a multidisciplinary approach will reduce complications, morbidity, mortality, and length of stay.
{"title":"Perioperative management in Rothmund–Thomson syndrome: A case report","authors":"A. Uslu, N. Çekmen","doi":"10.4103/bjoa.bjoa_244_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_244_22","url":null,"abstract":"Rothmund-Thomson Syndrome (RTS) is a rare, multisystem disease accompanied by many anomalies that require careful attention from preoperative evaluation to discharge regarding anesthesia preparation and management. Due to craniofacial deformities accompanying facial abnormalities, maintaining the airway becomes a complete struggle with a race against time for survival. This case report presents the preoperative preparation and perioperative management, the risks that may be encountered, and the detailed preparation for a 7-year-old patient diagnosed with RTS and multiple system involvement. General anesthesia was administered to this patient, who had intrauterine growth retardation, nail streaking, redness of the bullae and legs, and a history of somatotropin treatment and antinuclear antibody (ANA) positivity under optimum conditions. Thanks to successful and detailed preoperative preparation and perioperative management, the patient was followed up and discharged without any complications. Although RTS is rare, the need for general anesthesia often arises due to juvenile cataracts, dental anomalies, syndactyly and other extremity anomalies in these patients whose airway management is complex. Furthermore, this increases the current risk in the population of these patients. Managing these patients with a multidisciplinary approach will reduce complications, morbidity, mortality, and length of stay.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"43 - 46"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44489672","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_271_22
Taysser M. Abdelraheem, T. Naguib, A. Elkeblawy
Background: Gynecomastia is a benign proliferative condition affecting the glandular tissue of the male breast. This study compared the efficacy of ultrasound-guided thoracic interfacial plane block (TIPB) with ultrasound-guided thoracic paravertebral block (TPVB) in providing anesthesia for gynecomastia surgery. Materials and Methods: This prospective randomized open label clinical trial included 90 patients scheduled for elective surgery for idiopathic gynecomastia. Patients were randomly allocated into three equal groups: group C (control group) received bilateral tumescent local anesthesia, group TPVB received bilateral ultrasound guided TPVB, and group TIPB received bilateral ultrasound guided TIPB. We evaluated postoperative analgesic requirements, pain score, and patient’s satisfaction. Results: Intraoperative fentanyl requirement and total diclofenac in the first 24 hours postoperative were significantly lower in both TPVB and TIPB groups compared to control group (P = 0.002 and P < 0.001, respectively). Patient satisfaction was significantly better (P = 0.004) in both TPVB and TIPB groups when compared to control group. In postoperative evaluation, we found both TPVB and TIPB produced significantly lower pain score compared to control group in 2-hours (P < 0.001) and 4-hours (P = 0.001) after the surgery. Mean arterial blood pressure, heart rate, and peripheral oxygen saturation were comparable in all groups, as well as the occurrence of complications. Conclusion: Either TIPB and TPVB may provide effective analgesic property for anesthesia in gynecomastia surgery. This is shown by lower intraoperative analgesic requirements, lower postoperative pain score, and better patient’s satisfaction.
{"title":"Thoracic interfacial plane block versus thoracic paravertebral block for anesthesia in gynecomastia surgery: A randomized controlled trial","authors":"Taysser M. Abdelraheem, T. Naguib, A. Elkeblawy","doi":"10.4103/bjoa.bjoa_271_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_271_22","url":null,"abstract":"Background: Gynecomastia is a benign proliferative condition affecting the glandular tissue of the male breast. This study compared the efficacy of ultrasound-guided thoracic interfacial plane block (TIPB) with ultrasound-guided thoracic paravertebral block (TPVB) in providing anesthesia for gynecomastia surgery. Materials and Methods: This prospective randomized open label clinical trial included 90 patients scheduled for elective surgery for idiopathic gynecomastia. Patients were randomly allocated into three equal groups: group C (control group) received bilateral tumescent local anesthesia, group TPVB received bilateral ultrasound guided TPVB, and group TIPB received bilateral ultrasound guided TIPB. We evaluated postoperative analgesic requirements, pain score, and patient’s satisfaction. Results: Intraoperative fentanyl requirement and total diclofenac in the first 24 hours postoperative were significantly lower in both TPVB and TIPB groups compared to control group (P = 0.002 and P < 0.001, respectively). Patient satisfaction was significantly better (P = 0.004) in both TPVB and TIPB groups when compared to control group. In postoperative evaluation, we found both TPVB and TIPB produced significantly lower pain score compared to control group in 2-hours (P < 0.001) and 4-hours (P = 0.001) after the surgery. Mean arterial blood pressure, heart rate, and peripheral oxygen saturation were comparable in all groups, as well as the occurrence of complications. Conclusion: Either TIPB and TPVB may provide effective analgesic property for anesthesia in gynecomastia surgery. This is shown by lower intraoperative analgesic requirements, lower postoperative pain score, and better patient’s satisfaction.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"32 - 38"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45885645","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_255_22
R. Sedono, A. Adisasmita, R. Djuwita, A. Sjaaf, M. Nadjib, S. Syarif, B. Alisjahbana, A. Karuniawati, R. Wahyuningsih
Background: Majority of invasive candidiasis in critically ill patients was developed after admission to intensive care unit. The aim of this study was to identify risk factors for development of invasive candidiasis among patients admitted to intensive care unit, especially considering the timing of laboratory, microscopic, and culture examinations. Materials and Methods: This was a prospective observational study in which critically ill patients were assessed on the first, fifth, and ninth day since admission to intensive care unit. Potential risk factors were demographic and clinical characteristic, clinical managements profile proportions, laboratory profile (leukocyte, platelet, erythrocyte sedimentation rate, C-reactive protein and procalcitonin), morphological change (from yeast to hypae or pseudohyphae in microscopic examination) and colonization increase (from serial culture examination). Results: A total of 115 subjects enrolled in this study. Multivariate analysis identified older age (HR 2.8, 95% CI 0.8–8.9), parenteral nutrition (HR 3.1, 95% CI 0.77–12.3), central venous catheter (HR 1.7, 95% CI 0.43–6.67), corticosteroid (HR 2.8, 95% CI 0.53–14.8), procalcitonin day-5 (HR 3.1, 95% CI 0.89–10.8), morphology change in the axilla and rectal swab (HR 5.1, 95% CI 1.6–18.51), and morphology change and colonization increase in rectal swab day-9 (HR 4.3, 95% CI 1.0–18.02) as independent risk factors of invasive candidiasis. Conclusion: In addition to several typical risk factors, procalcitonin test on day-5 as well as serial microscopic and culture examinations were associated with the development of invasive candidiasis, therefore potentially help in the diagnosis and treatment of critically ill patients in intensive care unit.
背景:大多数危重患者侵袭性念珠菌病是在重症监护病房入院后发生的。本研究的目的是确定入住重症监护病房的患者中侵袭性念珠菌病发展的危险因素，特别是考虑到实验室、显微镜和培养检查的时间。材料和方法:这是一项前瞻性观察性研究，在重症监护病房入院后的第1天、第5天和第9天对危重患者进行评估。潜在的危险因素包括人口统计学和临床特征、临床管理情况、实验室情况(白细胞、血小板、红细胞沉降率、c反应蛋白和降钙素原)、形态变化(显微镜检查从酵母菌到菌丝或假菌丝)和定植增加(从连续培养检查)。结果:本研究共纳入115名受试者。多因素分析发现，年龄较大(HR 2.8, 95% CI 0.8-8.9)、肠外营养(HR 3.1, 95% CI 0.77-12.3)、中心静脉导管(HR 1.7, 95% CI 0.43-6.67)、皮质类固醇(HR 2.8, 95% CI 0.53-14.8)、降钙素原第5天(HR 3.1, 95% CI 0.89-10.8)、腋下和直肠棉签形态改变(HR 5.1, 95% CI 1.6-18.51)以及第9天直肠棉签形态改变和定植增加(HR 4.3, 95% CI 1.0-18.02)是浸润性念珠菌病的独立危险因素。结论:除几个典型的危险因素外，第5天降钙素原试验以及一系列的显微镜和培养检查与侵袭性念珠菌病的发生有关，因此可能有助于重症监护室危重患者的诊断和治疗。
{"title":"Risk Factors for development of invasive candidiasis in critically ill patients: A prospective observational study in intensive care unit of a tertiary hospital","authors":"R. Sedono, A. Adisasmita, R. Djuwita, A. Sjaaf, M. Nadjib, S. Syarif, B. Alisjahbana, A. Karuniawati, R. Wahyuningsih","doi":"10.4103/bjoa.bjoa_255_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_255_22","url":null,"abstract":"Background: Majority of invasive candidiasis in critically ill patients was developed after admission to intensive care unit. The aim of this study was to identify risk factors for development of invasive candidiasis among patients admitted to intensive care unit, especially considering the timing of laboratory, microscopic, and culture examinations. Materials and Methods: This was a prospective observational study in which critically ill patients were assessed on the first, fifth, and ninth day since admission to intensive care unit. Potential risk factors were demographic and clinical characteristic, clinical managements profile proportions, laboratory profile (leukocyte, platelet, erythrocyte sedimentation rate, C-reactive protein and procalcitonin), morphological change (from yeast to hypae or pseudohyphae in microscopic examination) and colonization increase (from serial culture examination). Results: A total of 115 subjects enrolled in this study. Multivariate analysis identified older age (HR 2.8, 95% CI 0.8–8.9), parenteral nutrition (HR 3.1, 95% CI 0.77–12.3), central venous catheter (HR 1.7, 95% CI 0.43–6.67), corticosteroid (HR 2.8, 95% CI 0.53–14.8), procalcitonin day-5 (HR 3.1, 95% CI 0.89–10.8), morphology change in the axilla and rectal swab (HR 5.1, 95% CI 1.6–18.51), and morphology change and colonization increase in rectal swab day-9 (HR 4.3, 95% CI 1.0–18.02) as independent risk factors of invasive candidiasis. Conclusion: In addition to several typical risk factors, procalcitonin test on day-5 as well as serial microscopic and culture examinations were associated with the development of invasive candidiasis, therefore potentially help in the diagnosis and treatment of critically ill patients in intensive care unit.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"24 - 31"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42832732","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_268_22
C. Purnamasidhi, P. Januraga, N. M. Sukmawati, Anak Agung Ayu Yuli Gayatri, I. Utama, I. Somia, K. Merati, R. Suteja, G. Purnama
Background: SARS-CoV-2 was discovered in December 2019 and later become global pandemic. Preliminary studies stated that broad vaccine coverage will suppress mortality and incidence of COVID-19. Therefore, we conduct a cross-sectional study to assess the efficacy of COVID-19 vaccination. Materials and Methods: We collected secondary data from electronic medical records of 343 COVID-19 positive patients confirmed via reverse transcription polymerase chain reaction from July 2021 to December 2021. We analyzed epidemiologic data, vaccination history, baseline symptoms, comorbidity, baseline vital signs, and outcome using hypothesis testing χ2 and logistic regression. Results: Sex had an χ2 of 9.34 (P < 0.001) while type of vaccine had an χ2 of 1.49 (P = 0.22) to clinical severity. Age, pulse rate, respiration rate, body temperature, and Glasgow coma scale were found to be significant risk factors to clinical severity. Number of vaccines previously received was found to be a protective factor to clinical severity (odds ratio (OR) = 0.49, 95% CI = 0.32–0.74, P < 0.001). We also found that sex (χ2 = 10.42, P < 0.001) was a predictor to discharge condition. Moreover, age was also found to be a significant predictor (OR = 1.03, 95% CI = 1.03–1.05, P < 0.001), as well as number of symptoms (OR = 0.66, P < 0.001), comorbidities (OR = 1.64, P < 0.001), pulse rate (OR = 1.04, P < 0.001), respiration rate (OR = 1.17, P < 0.001), and Glasgow coma scale (OR = 0.72, P = 0.03). Conclusion: Age, sex, number of vaccines received, number of symptoms, number of comorbidities, pulse rate, and respiration rate were significant predictors of clinical severity and outcome in COVID-19 patients. In addition, body temperature was also a predictor for clinical severity, while Glasgow coma scale was a predictor for outcome.
背景:SARS-CoV-2于2019年12月被发现，后来成为全球大流行。初步研究表明，广泛的疫苗覆盖率将抑制COVID-19的死亡率和发病率。因此，我们进行了一项横断面研究来评估COVID-19疫苗接种的效果。材料与方法:从2021年7月至2021年12月通过逆转录聚合酶链反应确诊的343例COVID-19阳性患者的电子病历中收集二次资料。我们使用假设检验χ2和logistic回归分析流行病学资料、疫苗接种史、基线症状、合并症、基线生命体征和结局。结果:性别与临床严重程度的χ2为9.34 (P < 0.001)，疫苗类型与临床严重程度的χ2为1.49 (P = 0.22)。年龄、脉搏率、呼吸率、体温和格拉斯哥昏迷评分是影响临床严重程度的重要危险因素。先前接种的疫苗数量被发现是临床严重程度的保护因素(优势比(OR) = 0.49, 95% CI = 0.32-0.74, P < 0.001)。我们还发现性别(χ2 = 10.42, P < 0.001)是出院状况的预测因子。此外，年龄也是一个重要的预测因子(OR = 1.03, 95% CI = 1.03 - 1.05, P < 0.001)，以及症状数量(OR = 0.66, P < 0.001)、合并症(OR = 1.64, P < 0.001)、脉搏率(OR = 1.04, P < 0.001)、呼吸率(OR = 1.17, P < 0.001)和格拉斯哥昏迷量表(OR = 0.72, P = 0.03)。结论:年龄、性别、接种疫苗次数、症状次数、合并症次数、脉搏率和呼吸率是影响COVID-19患者临床严重程度和预后的重要预测因素。此外，体温也是临床严重程度的预测指标，而格拉斯哥昏迷量表是预后的预测指标。
{"title":"The impact of vaccination to clinical severity and mortality of COVID-19 patients","authors":"C. Purnamasidhi, P. Januraga, N. M. Sukmawati, Anak Agung Ayu Yuli Gayatri, I. Utama, I. Somia, K. Merati, R. Suteja, G. Purnama","doi":"10.4103/bjoa.bjoa_268_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_268_22","url":null,"abstract":"Background: SARS-CoV-2 was discovered in December 2019 and later become global pandemic. Preliminary studies stated that broad vaccine coverage will suppress mortality and incidence of COVID-19. Therefore, we conduct a cross-sectional study to assess the efficacy of COVID-19 vaccination. Materials and Methods: We collected secondary data from electronic medical records of 343 COVID-19 positive patients confirmed via reverse transcription polymerase chain reaction from July 2021 to December 2021. We analyzed epidemiologic data, vaccination history, baseline symptoms, comorbidity, baseline vital signs, and outcome using hypothesis testing χ2 and logistic regression. Results: Sex had an χ2 of 9.34 (P < 0.001) while type of vaccine had an χ2 of 1.49 (P = 0.22) to clinical severity. Age, pulse rate, respiration rate, body temperature, and Glasgow coma scale were found to be significant risk factors to clinical severity. Number of vaccines previously received was found to be a protective factor to clinical severity (odds ratio (OR) = 0.49, 95% CI = 0.32–0.74, P < 0.001). We also found that sex (χ2 = 10.42, P < 0.001) was a predictor to discharge condition. Moreover, age was also found to be a significant predictor (OR = 1.03, 95% CI = 1.03–1.05, P < 0.001), as well as number of symptoms (OR = 0.66, P < 0.001), comorbidities (OR = 1.64, P < 0.001), pulse rate (OR = 1.04, P < 0.001), respiration rate (OR = 1.17, P < 0.001), and Glasgow coma scale (OR = 0.72, P = 0.03). Conclusion: Age, sex, number of vaccines received, number of symptoms, number of comorbidities, pulse rate, and respiration rate were significant predictors of clinical severity and outcome in COVID-19 patients. In addition, body temperature was also a predictor for clinical severity, while Glasgow coma scale was a predictor for outcome.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"3 - 7"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47614310","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_236_22
K. Lee, S. Lee
It is important for clinicians to perform a continuous comprehensive assessment of the depth of sedation, including the use of processed electroencephalographic monitors and the review of clinical signs. Ketamine is a safe anesthetic and sedative traditionally used in the clinical practice. It possesses analgesic, anti-inflammatory, and antidepressant activities and is used as a therapeutic agent in intractable pain. In this case series, we present a comparison between patient state index (PSI) and bispectral index (BIS) in a sample of eight patients with complex regional pain syndrome undergoing ketamine infusion therapy. Blood pressure, heart rate, respiratory rate, end-tidal carbon dioxide, and oxygen saturation were all noted, as well as the PSI and BIS values. The PSI and BIS readings were not recorded when the artifact was larger than 50%. Four patients (50%) received intravenous midazolam 5 mg when their agitation or movement could not be managed by the clinicians’ verbal instructions. In five patients (62%), 20 min after the ketamine infusion began, deep drowsiness was attained. There are fewer research studies on PSI than there are on BIS. We found that PSI values did not match BIS values. This case series could help clinicians select an appropriate course of action for ketamine sedation in individual patients.
{"title":"Comparison of the patient state index and bispectral index in patients with complex regional pain syndrome undergoing ketamine infusion therapy: Case series","authors":"K. Lee, S. Lee","doi":"10.4103/bjoa.bjoa_236_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_236_22","url":null,"abstract":"It is important for clinicians to perform a continuous comprehensive assessment of the depth of sedation, including the use of processed electroencephalographic monitors and the review of clinical signs. Ketamine is a safe anesthetic and sedative traditionally used in the clinical practice. It possesses analgesic, anti-inflammatory, and antidepressant activities and is used as a therapeutic agent in intractable pain. In this case series, we present a comparison between patient state index (PSI) and bispectral index (BIS) in a sample of eight patients with complex regional pain syndrome undergoing ketamine infusion therapy. Blood pressure, heart rate, respiratory rate, end-tidal carbon dioxide, and oxygen saturation were all noted, as well as the PSI and BIS values. The PSI and BIS readings were not recorded when the artifact was larger than 50%. Four patients (50%) received intravenous midazolam 5 mg when their agitation or movement could not be managed by the clinicians’ verbal instructions. In five patients (62%), 20 min after the ketamine infusion began, deep drowsiness was attained. There are fewer research studies on PSI than there are on BIS. We found that PSI values did not match BIS values. This case series could help clinicians select an appropriate course of action for ketamine sedation in individual patients.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"39 - 42"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47692313","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}
{"title":"Enhanced recovery after surgery in geriatric patients: A need to fly in the face of convention","authors":"N. Govil","doi":"10.4103/bjoa.bjoa_3_23","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_3_23","url":null,"abstract":"","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48460860","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_248_22
A. Uslu, N. Çekmen
Epidural anesthesia (EA) can be applied in the perioperative period (PP) in addition to general anesthesia (GA) or as a stand-alone anesthesia technique. EA provides better hemodynamic stability in high-risk patients, reduced neurohormonal surgical stress response, and preserved airway reflexes with spontaneous breathing. In addition, EA prevents pulmonary dysfunction through decreasing multifactorial mediators, improves pulmonary functions by reducing the decrease in functional residual capacity, and protects spontaneous respiratory and airway reflexes. Herein, we wanted to emphasize the importance of the perioperative approach, the choice of anesthesia technique, and the effects of this choice on the postoperative period in a high-risk patient with incidental stage four lung adenocarcinoma, right parietal brain, lumbar vertebral, liver, and adrenal metastasis, as well as hydropneumothorax. With a successful epidural catheterization and anesthesia, the patient was follow-up without any problems. As in our patient, we should adopt a multimodal approach in the perioperative period, perform a detailed examination before the operation, and evaluate all risks and benefits comparatively when choosing the most appropriate anesthesia technique. Thus, it should be kept in mind that the chosen technique will significantly affect perioperative complications, morbidity and mortality, drug use, length of hospital stay, and cost.
{"title":"Lumbar epidural anesthesia in a high-risk patient with advanced lung cancer, multi-organ metastasis and hydropneumothorax: A case report","authors":"A. Uslu, N. Çekmen","doi":"10.4103/bjoa.bjoa_248_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_248_22","url":null,"abstract":"Epidural anesthesia (EA) can be applied in the perioperative period (PP) in addition to general anesthesia (GA) or as a stand-alone anesthesia technique. EA provides better hemodynamic stability in high-risk patients, reduced neurohormonal surgical stress response, and preserved airway reflexes with spontaneous breathing. In addition, EA prevents pulmonary dysfunction through decreasing multifactorial mediators, improves pulmonary functions by reducing the decrease in functional residual capacity, and protects spontaneous respiratory and airway reflexes. Herein, we wanted to emphasize the importance of the perioperative approach, the choice of anesthesia technique, and the effects of this choice on the postoperative period in a high-risk patient with incidental stage four lung adenocarcinoma, right parietal brain, lumbar vertebral, liver, and adrenal metastasis, as well as hydropneumothorax. With a successful epidural catheterization and anesthesia, the patient was follow-up without any problems. As in our patient, we should adopt a multimodal approach in the perioperative period, perform a detailed examination before the operation, and evaluate all risks and benefits comparatively when choosing the most appropriate anesthesia technique. Thus, it should be kept in mind that the chosen technique will significantly affect perioperative complications, morbidity and mortality, drug use, length of hospital stay, and cost.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"47 - 50"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47776658","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_229_22
Ahmed H Bakeer, W. Hamimy, A. Zaghloul, A. Shaban, M. Magdy, Mahmoud Ahmed
Background: Pain has a wide spectrum of effects on the body and inadequate management of postoperative pain outcomes in multiple physiological and psychological consequences; and increases morbidity. The use of opioid-based analgesia in high doses can have multiple adverse effects including respiratory depression, nausea, and vomiting. Objectives: Our aim was to evaluate the efficacy of analgesic and safety of both techniques (transversus abdominis plane block [TAPB] and erector spinae plane block [ESPB]) in cases having lower abdominal surgery through laparotomy. Materials and Methods: This randomized trial was performed on 62 cases who underwent laparotomy for lower abdominal surgery under general anesthesia were recruited. Subjects were equally distributed into either TAPB or ESPB. The primary outcome was total morphine intake postoperatively for 24 h. Other variables were intraoperative fentanyl consumption, delay to first morphine demand, and intraoperative morphine consumption, the number of patients who needed rescue analgesia by morphine, perioperative heart rate and mean blood pressure, numerical rating score (NRS), postoperative nausea and vomiting, and block-related complications. Results: ESPB patients consumed less total postoperative morphine than the TAPB group (5.35 ± 2.65 vs. 8.52 ± 3.35 mg; P < 0.001). Patients who received ESPB showed less postoperative pain scores and, thus, needed rescue medication after a longer period than the TAPB group (12.50 ± 7.31 h vs. 7.72 ± 5.69 h; P = 0.008). In addition, ESPB patients needed less intraoperative fentanyl doses than TAPB (138.71 ± 35.85 vs. 203.23 ± 34.00 mcg; P < 0.001). ESPB group demonstrated statistically significant lower scores of NRS at rest and at movement. Conclusions: Ultrasound (US)-guided ESPB provides more safe and effective analgesia in lower abdominal surgeries compared with US-guided TAPB.
{"title":"Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block in laparotomies for cancer surgeries: A randomized blinded control study","authors":"Ahmed H Bakeer, W. Hamimy, A. Zaghloul, A. Shaban, M. Magdy, Mahmoud Ahmed","doi":"10.4103/bjoa.bjoa_229_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_229_22","url":null,"abstract":"Background: Pain has a wide spectrum of effects on the body and inadequate management of postoperative pain outcomes in multiple physiological and psychological consequences; and increases morbidity. The use of opioid-based analgesia in high doses can have multiple adverse effects including respiratory depression, nausea, and vomiting. Objectives: Our aim was to evaluate the efficacy of analgesic and safety of both techniques (transversus abdominis plane block [TAPB] and erector spinae plane block [ESPB]) in cases having lower abdominal surgery through laparotomy. Materials and Methods: This randomized trial was performed on 62 cases who underwent laparotomy for lower abdominal surgery under general anesthesia were recruited. Subjects were equally distributed into either TAPB or ESPB. The primary outcome was total morphine intake postoperatively for 24 h. Other variables were intraoperative fentanyl consumption, delay to first morphine demand, and intraoperative morphine consumption, the number of patients who needed rescue analgesia by morphine, perioperative heart rate and mean blood pressure, numerical rating score (NRS), postoperative nausea and vomiting, and block-related complications. Results: ESPB patients consumed less total postoperative morphine than the TAPB group (5.35 ± 2.65 vs. 8.52 ± 3.35 mg; P < 0.001). Patients who received ESPB showed less postoperative pain scores and, thus, needed rescue medication after a longer period than the TAPB group (12.50 ± 7.31 h vs. 7.72 ± 5.69 h; P = 0.008). In addition, ESPB patients needed less intraoperative fentanyl doses than TAPB (138.71 ± 35.85 vs. 203.23 ± 34.00 mcg; P < 0.001). ESPB group demonstrated statistically significant lower scores of NRS at rest and at movement. Conclusions: Ultrasound (US)-guided ESPB provides more safe and effective analgesia in lower abdominal surgeries compared with US-guided TAPB.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"19 - 23"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43313380","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 : 2023-01-01DOI: 10.4103/bjoa.bjoa_250_22
I. Isngadi, R. Hartono, Andreas Willianto
Brain tumors and intracranial bleeding are rare cases in pregnancy. Anesthesia management for a C-section with comorbidity remains challenging. We presented a 33-year-old woman (34–36 weeks pregnant) with the complaint of weakness in her right extremities, blurred vision, and ptosis of her left eye from a month before hospitalization. The brain computed tomography (CT) revealed a mass at the left parasellar region with a bleeding component and cerebral edema accompanied by subfalcine herniation. We conducted general anesthesia for cesarean delivery in a patient with a brain-protective technique. Brain CT revealed a decrease in the mass size and neither intracranial bleeding nor cerebral edema. In conclusion, general anesthesia management provided a good outcome in a parturient with a brain tumor and intracranial bleeding that underwent C-section. The mechanism of clinical improvement and tumor regression is unclear and requires further research, but it is believed that it is related to pregnancy hormones.
{"title":"Clinical improvement and tumor regression in parturient with a brain tumor and intracranial bleeding after C-section with general anesthesia: A case report","authors":"I. Isngadi, R. Hartono, Andreas Willianto","doi":"10.4103/bjoa.bjoa_250_22","DOIUrl":"https://doi.org/10.4103/bjoa.bjoa_250_22","url":null,"abstract":"Brain tumors and intracranial bleeding are rare cases in pregnancy. Anesthesia management for a C-section with comorbidity remains challenging. We presented a 33-year-old woman (34–36 weeks pregnant) with the complaint of weakness in her right extremities, blurred vision, and ptosis of her left eye from a month before hospitalization. The brain computed tomography (CT) revealed a mass at the left parasellar region with a bleeding component and cerebral edema accompanied by subfalcine herniation. We conducted general anesthesia for cesarean delivery in a patient with a brain-protective technique. Brain CT revealed a decrease in the mass size and neither intracranial bleeding nor cerebral edema. In conclusion, general anesthesia management provided a good outcome in a parturient with a brain tumor and intracranial bleeding that underwent C-section. The mechanism of clinical improvement and tumor regression is unclear and requires further research, but it is believed that it is related to pregnancy hormones.","PeriodicalId":8691,"journal":{"name":"Bali Journal of Anesthesiology","volume":"7 1","pages":"51 - 55"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45414385","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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