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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Agustina Salinding
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya
Medicine & Pharmacology

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Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies Yoppie Prim Avidar; Agustina Salinding; Hamzah; Akhyar Nur Uhud; Maulydia
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.87-97

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.
Anesthesia and Analgesia Management Profile for Airway Surgeries at Dr. Soetomo General Academic Hospital Surabaya Agustina Salinding; Widiartha Wahyudi; Arya Pradipta
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.98-106

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.
Co-Authors Akhyar Nur Uhud Arya Pradipta Hamzah Maulydia Widiartha Wahyudi Yoppie Prim Avidar