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Prihatma Kriswidyatomo
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Departemen Anestesiologi dan Reanimasi Fakultas Kedokteran Universitas Airlangga-RSUD Dr Soetomo Surabaya Gedung Anestesi Baru-RSUD Dr Soetomo Surabaya Jl. Mayjen Prof. Dr. Moestopo No 6-8, Airlangga, Gubeng, Surabaya, 60286, Indonesia
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Jawa timur
INDONESIA
Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Published by Universitas Airlangga
ISSN : 27224554     EISSN : 2686021X     DOI : 10.20473/ijar.V2I12020.1-7
Core Subject : Health,
Medicine & Pharmacology
IJAR is a scientific journal published by Department of Anesthesiology and Reanimation, Faculty of Medicine Universitas Airlangga. IJAR is an English language journal. IJAR FOCUSES original research, review article, case report, and correspondence, on anesthesiology; pain management; intensive care; emergency medicine; disaster management; pharmacology; physiology; clinical practice research; and palliative medicine. This journal is a peer-reviewed journal established to improve the understanding of factors involved in anesthesiology and emergency medicine.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 7 Documents
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Search results for , issue "Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)" : 7 Documents clear
Anesthetic Considerations in Patients with Mitochondrial Disorders Ziske Maritska; Nita Parisa; Mathius Karina; Marco Manza Putra; Noviyanti Eliska; Muhammad Irga; Maya Rina Santara Manurung; Andre Saputra
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.102-111

Abstract

Introduction: Mitochondrial Disorders (1/4,000 patients) are rare and caused by dysfunctional mitochondria. Anesthetic consideration in patients with Mitochondrial Disorders involves careful preoperative and perioperative observations. Objective: To provide a brief insight into how general anesthetics interfere with mitochondrial energy formation pathways and help form precautions for anesthesiologists when managing patients with Mitochondrial Disorder. Review: Mitochondrial Disorder patients would experience various health problems, such as damaged cardiac functions, neurology systems, and musculoskeletal functions due to energy production disruptions by dysfunctional mitochondrial processes. Moreover, patients with Mitochondrial Disorders exhibit hyperreactivity to volatile anesthetics. Summary: No anesthetic strategies are found to be safe in patients with Mitochondrial Disorder yet. Therefore, anesthesiologists should remain alert when monitoring fluid choices and managing patient temperature with Mitochondrial Disorders.
The Difference in Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), and Lactate Levels Between Sepsis and Septic Shock Patients Who Died in The ICU Dwi Rachmawati; Arie Utariani; Paulus Budiono Notopuro; Bambang Pujo Semedi
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.64-71

Abstract

Introduction: Sepsis and septic shock are organ dysfunctions caused by the dysregulation of the body's response to infection and are the most common causes of death. Objective: This study aims to describe the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lactate levels in patients with sepsis and septic shock who died in the Intensive Care Unit (ICU). Materials and Methods: An observational retrospective study was conducted by examining the medical record data of sepsis and sepsis shock patients who were hospitalized in the ICU of Dr. Soetomo General Academic Hospital Surabaya from January to December 2019. Results: The study sample was 28 patients: 16 with sepsis and 12 with septic shock. Fifteen patients (53.6%) were women. The patients’ mean age was 53.18 ± 13.61 years, and most patients (8 patients, 28.6%) belonged to the late adult age group (36-45 years). The most common comorbidities were diabetes mellitus and hypertension (30.8%). The highest incidence of infection in both groups occurred in the lungs (42.9%). Most of the patients had high SOFA scores, in the moderate (7-9) to severe (≥ 10) category (39.3%). Almost all patients (82.1%) were treated for less than one week. The hematological examination within the first 24 hours showed a leukocyte value of 16,995 (Leukocytosis) and a platelet value of 279,500 (Normal). The NLR of septic shock patients (31.38±55.61) was higher than the NLR of sepsis patients (23.75±22.87). The PLR of septic shock patients (534.02±1000.67) was lower than the PLR of patients (802.93±1509.89). Lastly, the lactate levels in septic shock patients (3.84±1.99) were higher than in sepsis patients (1.97±1.06). Conclusion: There were no significant differences in the NLR and PLR values ​​between sepsis and septic shock patients, but there were significant differences in their initial lactate levels.
Opioid-Free Anesthesia in Ophthalmic Surgeries Aida Rosita Tantri; Hansen Angkasa; Riyadh Firdaus; Tasya Claudia; Ignatia Novianti Tantri
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.81-87

Abstract

Introduction: Opioid-free anesthesia (OFA) is an alternative to Opioid based anesthesia (OBA) which uses multimodal analgesia to replace opioids. However, its feasibility, safety, and exact recommended combination remain debatable. Case Series: We administered OFA in 5 types of elective ophthalmic surgeries under general anesthesia in ASA 1-2 adult patients (evisceration, ocular exenteration, periosteal graft, scleral buckling, vitrectomy, and dacryocystorhinostomy) to assess the feasibility of OFA. We gave preoperative Paracetamol and Pregabalin with Dexmedetomidine as a loading dose (1 mcg/kg in 10 minutes) and maintenance at 0.7 mcg kg-1 per hour. Induction was performed using Propofol 1-2 mg kg-1, Lidocaine 1-1.5 mg kg-1 IV, and Rocuronium. Before the incision, Dexamethasone and Ranitidine were given. Maintenance was done using Dexmedetomidine and Sevoflurane. Fentanyl was used as rescue analgesia if required. Dexmedetomidine was stopped 15-30 minutes before the procedure ended. Metoclopramide and Ketorolac were given as postoperative management. Throughout the procedure, our patients had stable hemodynamics, did not experience life-threatening bradycardia, and did not require rescue analgesia. All patients regained full consciousness and did not experience postoperative nausea and vomiting, emergency delirium, or coughing. Conclusion: Multimodal analgesia was an excellent intraoperative OFA regimen as an alternative to OBA and provided controlled hypotension in ocular surgery. Safe OFA is possible with combined analgesia regimens, strict intraoperative monitoring, and adequate anesthesia depth.
Acute Respiratory Distress Syndrome (ARDS) Management Severe COVID-19 Helen Yudi Irianto; Akhmad Yun Jufan
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.96-101

Abstract

Introduction: The Coronavirus disease 2019 (COVID-19) caused a global pandemic and many management challenges. Acute Respiratory Distress Syndrome (ARDS) is one of the most common pneumonia complications in COVID-19 cases. ARDS in COVID-19 have worse outcomes and increased risk of intensive care unit (ICU) admission. Objective: This case report aims to recognize and understand ARDS management in a severe COVID-19 case. Case Report: A 68-year-old man with diabetes mellitus and hypertension arrived at the Emergency Room (ER) after experiencing five days of fever, cough, diarrhea with frequency of four times a day, weakness, and a positive antigen result for COVID-19 at admission. Anosmia was absent. The patient had been vaccinated for COVID-19 twice. The main problem was his desaturation of 88%, blood pressure of 156/73 mmHg, heart rate of 80x/minute, and respiratory rate of 20x/minute. However, the patient was alert and admitted to the isolation ward. After 21 days of hospitalization, the patient's condition worsened. The patient developed ARDS and was referred to the COVID ICU for 25 days and 20 days to the non-COVID ICU, where he was intubated, and a tracheostomy was performed. After 45 days of admission to the ICU, the patient's condition improved. Discussion: COVID-19 patients with ARDS should be immediately intubated when conditions such as dyspnea, RR>30x/min, SpO2<92% (for patients with no comorbidities) or <95% (for patients with comorbidities), unconsciousness, or shock appears. Furthermore, other conditions, such as an HR> of 120x/min and a ROX index of <3.851, should be considered an indication for intubation. Conclusion: Timely intubation improves the outcome of COVID-19 patients with ARDS.
A Systematic Review and Meta-Analysis of Paracervical Blocks as A Perioperative Strategy in Reducing Postoperative Pain in Patients Undergoing Laparoscopic Hysterectomy Rifaldy Nabiel; Daniel Alexander Suseno; Yonas Hadisubroto; Taufiq Gemawan; Aurellia Nuraini Anindito Putri; Syadza Salsabila; Eprila Darma Sari
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.112-121

Abstract

Introduction: Perioperative strategies to reduce postoperative pain are important for enhancing patient satisfaction. However, further research and trials has sparked ongoing debates of various strategies regarding efficacy and safety. Objective: This study aims to improve evidence-based strategies regarding the effect of paracervical anaesthetic blocks in patients undergoing laparoscopic hysterectomy. Materials and Method: A systematic literature search was conducted through PubMed, Google Scholar, and ScienceDirect for RCTs in laparoscopic hysterectomy patients administered paracervical blocks and those given placebos. The quantitative analysis of pooled relative risk and mean difference with a 95% confidence interval were performed using the Review Manager 5.4 software in the random-effects model or fixed-effects model forest plot. Results: Based on four RCTs included in the analysis, there were significant differences in overall postoperative pain scores assessed by VAS (Visual Analogue Scale) [MD = -0.82, 95%CI (-1.47 to -1.06), p = 0.01]. The subgroup analysis also showed significant differences in VAS pain scores at 30 min and 1 hour post-operation [MD = -2.13, 95% CI (-3.09 to -1.16), p = 0.0001] and [MD = -2.55, 95% CI (-4.29 to -0.81), p = 0.004]. However, there were insignificant results in adequate pain control [RR = 7.90, 95%CI (0.39 to 158.67), p = 0.18], length of hospital stay [MD = 0.01, 95%CI (-0.52 to 0.54), p = 0.96], additional analgesics requirement at 24 hours [RR = 0.88, 95%CI (0.55 to 1.39), p=0.58], and perioperative complications [RR = 0.90, 95%CI (0.56 to 1.47), p = 0.68].Conclusion: This meta-analysis provides evidence that the administration of paracervical block in patients undergoing laparoscopic hysterectomy is associated with a reduction of postoperative VAS pain score but not associated with the length of hospital stay, adequate pain control, additional analgesics requirement at 24 hours, and perioperative complications.
Validation of the APACHE IV Score for ICU Mortality Prediction in Dr. Sardjito Hospital During the Pandemic Era Rayhandika; Akhmad Yun Jufan; Yunita Widyastuti; Juni Kurniawaty
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.72-80

Abstract

Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objectives: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Materials and Method: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient’s observed ICU Mortality was used. The model’s predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.
Prilocaine 2% for Spinal Anesthesia in Incarcerated Inguinal Hernia Surgery with Congestive Heart Failure Mirza Koeshardiandi; Pandhu Mahendra Bisama; Dian Muhammad Gibran
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): 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.V5I22023.88-95

Abstract

Introduction: Congestive heart failure (CHF) is a disease caused by abnormalities in the myocardium. This abnormality reduces the heart's ability to pump blood throughout the body. Anesthetic drugs have a major cardiovascular effect under general and regional anesthesia. Objective: This study aims to examine the effect of prilocaine as a subarachnoid block regional anesthetic drug in patients undergoing non-cardiac surgery with comorbid heart failure. Case Report: A 59-year-old man came complained of a lump in his left upper groin that had been present since a day before his admission to the hospital. The lump could not be inserted. The patient felt pain in the lump area with a visual analog score (VAS) of 7-8. His blood pressure was 138/84 mmHg, pulse rate was 104 times per minute, respiration rate was 22 times per minute, temperature was 36oC for axillary measurement, oxygen saturation was 92% based on room oxygen, and VAS was 7-8. The abdominal examination revealed a lump in the patient's left upper groin that could not be reinserted, hyperemic, and painful when pressed. With an EF Teich of 17.1%, the echocardiographic examination revealed that the dimensions of the patient’s heart chambers (RV and LV dilatation) and LV systolic function had decreased. Conclusion: Stable hemodynamics in non-cardiac surgery with a relatively short duration is the main choice for HF patients. Spinal anesthesia with a regimen of 2% prilocaine at a dose of 80 mg plus 0.1 mg morphine resulted in stable hemodynamics and low pain scores in patients with comorbid congestive heart failure undergoing non-cardiac surgery.

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