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Journal of Anesthesiology and Clinical Research

JACR
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Published by HM Publisher

ISSN : - EISSN : 27459497 DOI : https://doi.org/10.37275/jacr

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

Journal of Anesthesiology and Clinical Research/JACR that focuses on anesthesiology; pain management; intensive care; emergency medicine; disaster management; pharmacology; physiology; clinical practice research; and palliative medicine.

Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine

Articles 59 Documents

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Anesthesia Management in Intramural Uterine Myoma and Obesity Morbid Patients Who Underwent Myomectomy Perlaparatomy RZ Harahap; Rose Mafiana
Journal of Anesthesiology and Clinical Research Vol. 1 No. 1 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity. Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable. Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Anesthesia Management in Caesarean Section with Preeclampsia and Partial HELLP Syndrome Tiara Wima; Agustina Br. Haloho
Journal of Anesthesiology and Clinical Research Vol. 1 No. 1 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. Pre-eclampsia is a significant cause of maternal and fetal mortality and morbidity. Pre-eclampsia is characterized by hypertension (blood pressure ≥ 140/90 mmHg), oedema and amount of protein in urine 300 mg in the 24-hour, which appears after 20 weeks of gestation. Pre-eclampsia can cause complications, one of which is HELLP syndrome. This case report discusses the use of anaesthesia in a patient who underwent a cesarean section with indications for pre-eclampsia and partial HELLP syndrome. Case Presentation. A woman, 41 years old, G4P3A0 34 weeks pregnant with pre-eclampsia + syndrome HELLP will undergo emergency cesarean section with ASA IIE physical statusLabouror pain management was carried out using regional spinal anaesthesia technique, using bupivacaine 0.5% hyperbaric agent 12.5 mg. The operation lasted for 1 hour 30 minutes, with 300 ml bleeding, hemodynamically stable. Conclusion. Difficult intubation in emergency cases can be avoided by choosing of neuraxial anaesthesia technique is recommended. It will lead to better uteroplacental perfusion, good analgesia/anaesthesia quality, reducing surgical stress, reducing drugs that enter the uteroplacental circulation, and maternal psychological to be able to see the baby at birth.

Waste Anesthetic Gase: A Forgotten Problems Andi Miarta; Mayang Indah Lestari; Zulkifli
Journal of Anesthesiology and Clinical Research Vol. 1 No. 1 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Waste anesthetic gas (WAG) is a small amount of inhaled anesthetic gas that comes out of the patient’s anesthesia breathing circuit into the envorinment air while the patient is under anesthesia. According to American Occupation Safety and HealthAdministration (OSHA) more than 200.000 healthcare workers especially aneaesthesiologist, surgery nurse, obstetrician and surgeons are at risk of developing work-related disease due to chronic exposure to WAG. Exposure to WAG in short time associated with multiple problems such as headaches, irritability, fatigue, nausea, drowsiness, decrease work efficiency and difficulty with judgment and coordination. While chronic exposure of WAG is associated with genotoxicity, mutagenicity, oxidative stress, fatigue, headache, irritability, nausea, nephrotoxic, neurotoxic, hepatotoxic, immunosuppressive and reproductive toxicological effect. Waste anesthetic gases are known as environmental pollutants and will be released from the OR to the outside environment then the substance will reach the atmosphere damaging ozone layer. Exposure to trace WAG in the perioperative environment cannot be eliminated completely,but it can be controlled. Controlling WAG can be achieve by using scavenging system, proper ventilation, airway management, ideal anesthetic choice, maintaining anesthesia machine and equipment, hospital regulation and routine healthcare workers health status examination.

A Case Report: Diabetic Ketoacidosis in Patient with type 1 Diabetes Mellitus with Complication Septic Shock and AKI Stage III on HD Triggered by Perianal Abscess Muhammad Ikhsan Kartawinata; Yusni Puspita
Journal of Anesthesiology and Clinical Research Vol. 1 No. 1 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. Diabetic ketoacidosis (DKA) is an acute, life-threatening complication in diabetes mellitus. Infection is a common precipitating cause of diabetic ketoacidosis (DKA) in known diabetic patient, and diabetic ketoacidosis (DKA) often presents as the first symptom of an undiagnosed diabetes. diabetic ketoacidosis (DKA) is diagnosed with combination of hyperglicaemia, acidosis metabolic and ketonuria. Case Presentation. A 27 years old male patient, admitted to Intensive Care Unit with decrease level of consciousness (GCS 3), he was intubated and present with respiratory distress, metabolic acidosis, high glucose level, ketonuria with renal failure as a target organ. Patient known has perianal abscess as a triggered of diabetic ketoacidosis (DKA), turn into septic shock and underwent debridement surgery to source control the infection. The patient was treated in intensive care unit for 9 days, and sent to ward with GCS 15 an no sequelae of organ failure. The treatment of diabetic ketoacidosis (DKA) should include correcting the often substantial hypovolemia, the hyperglycemia, electrolyte imbalance and the triggering factor of diabetic ketoacidosis (DKA). Conclusion. Prompt surgical intervention, antibacterial therapy, rapid restoration of glycemic control are crucial to prevent mortality in diabetes mellitus patients complicated with abscess.

Herbicide Intoxication: Still A Threat in Developing Countries Stevanus Eliansyah Handrawan; Mayang Indah Lestari; Zulkifli
Journal of Anesthesiology and Clinical Research Vol. 1 No. 1 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

The critically ill patient has severe respiratory, cardiovascular or neurological disorder often in combination. The critically ill patient needs intensive care unit (ICU) admission and strict monitoring. Intoxication commonly experienced in a critically ill patient in ICU and can complicate management. In developing countries, poisoning of herbicide still common and used for suicide attempts. Herbicides such as paraquat and glyphosate are often used because of their availability. Paraquat and glyphosate have high mortality rate primarily as a suicide attempt agent in developing countries. The primary target for paraquat toxicity is in the lung and can cause lung fibrosis. Severe glyphosate intoxication can cause dehydration, hypotension, pneumonitis, oliguria, loss of consciousness, liver dysfunction, acidosis, hyperkalemia and dysrhythmia. Diagnosis for herbicide intoxication needs a history of herbicide ingestion, physical examination and laboratory examination. Stabilisation and supportive therapy is the only choice, and there is still no specific treatment for herbicide intoxication. The intoxication of herbicide particular critically ill patient because there is still no such specific treatment for these.

Correlation of Platelet-Lymphocyte Ratio (PLR) as 28-Days Sepsis Mortality Predictor in Intensive Care Unit of RSMH Palembang Tiara Santi Rizal; Fredi Heru Irwanto; Rizal Zainal; Mgs Irsan Saleh
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. Inflammatory and anti-inflammatory response are important in pathophysiology and mortality of sepsis. Platelet as first line inflammatory marker was found increasing during early phase of infection. Decrease in lymphocyte was caused by disrupted balance between inflammatory and anti-inflammatory response. Platelet-to- lymphocyte ratio (PLR) is a cheap and accessible biomarker of sepsis mortality. This study aims to find the sensitivity and specificity of PLR as mortality predictor of sepsis in 28 days. Methods. This observational analytic study with retrospective cohort design was conducted to 91 sepsis patients in intensive care unit of Dr. Mohammad Hoesin Palembang Central Hospital between January and December 2019. Samples were secondarily collected from medical record during June-July 2020. Data was analyzed using chi-square test, cog regression test, and ROC curve analysis. Results. The result found 50 patients (54,9%) died in 28 days. Morbidity score (Charlson) was the only statistically significant mortality parameter (p=0,009). The study reported PLR cut-off point of >272,22. The sensitivity and specificity of PLR as 28-days sepsis mortality predictor are 84% and 80,49% respectively. Conclusion. PLR is alternatively reliable mortality predictor in sepsis patient, accounted to its relatively high sensitivity and specificity.

Continuous Renal Replacement Therapy: A Review Mujahidin; Yasir Teuku; Dzaky. A. N
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Kidney is an important organ to maintain hemodynamic stability inside the human body. In patient with acute kidney injury (AKI) there was a decreased kidney function that could interfere hemodynamic stability which can lead to multi organ failure even death. Around 5-10% patients with AKI required renal replacement therapy (RRT) to support their decreased renal function. Continuous renal replacement therapy (CRRT) is one of RRT modality that commonly used for patients with AKI who are hemodynamically unstable or in critically ill conditions.CRRT could divided into 4 mode, slow continuous ultrafiltration (SCUF), continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodialfiltration (CVVHDF). CRRT used based on renal and nonrenal indication. Several studies are still trying to prove nonrenal indication of RRT, to ascertain whether CRRT could be used as therapy effectively. Therefore the indication, the mechanism and the comparison of renal replacement therapy are very important to be understood.

Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position Raden Theodorus Soepraptomo; Fitri Hapsari; Teddy Wijaya
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Suitability of CPOT and BPS to Assess Pain Response in Intubated Mohammad Hoesin Hospital Intensive Care Patients Dwi Darmanto; Agustina Br Haloho; Rizal Zainal; Erial Bahar
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Background. Assessing pain in mechanically ventilated patients is an important thing for leads to improved outcome and better quality life of patients in the ICU. CPOT and BPS has been developed for measuring nonverbal patients. Aims. To validate suitability the use of CPOT and BPS in ICU RSMH. Methods. Observational analytic with cross sectional design was chosen for 50 samples conducted on July 2020 in ICU RSMH. Data was collected before and after pain procedure. Result. From 50 patients mostly 27(54%) male with age majority > 30 years old 39 (78%). The lowest GCS 2 and the highest 10. Length of treatment in ICU was 1 – 20 days. Bleeding variations was 0 - 1200 cc. BPS average before painful procedure was 2 – 5 and after panful procedure was 5 – 7. CPOT average before painful procedure was 1 – 6 and after painful procedure was 3 - 8. Kappa before painful procedure are moderate (kappa=0,435) and after painful procedure are fair (kappa=0,248) with strongly correlated in Pearson correlation (r = 0,644, r = 0,610) (p < 0,05). Conclusion. This study demonstrated that CPOT more detail than BPS for measuring pain in intubated patients.

Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report Anugerah Ade Periambudi; Rizal Zainal; Mayang Indah Lestari
Journal of Anesthesiology and Clinical Research Vol. 1 No. 2 (2020): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH). Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care. Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

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Contact Name
RACHMAT HIDAYAT

Contact Email
hanifmedisiana@gmail.com

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+6287837160809

Journal Mail Official
journalanesthesiology@gmail.com

Editorial Address
Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang, Sumatera Selatan, Indonesia

Location
Kota palembang,

Sumatera selatan

INDONESIA

Abstract

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Abstract

Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name RACHMAT HIDAYAT

Contact Email hanifmedisiana@gmail.com

Phone +6287837160809

Journal Mail Official journalanesthesiology@gmail.com

Editorial Address Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang, Sumatera Selatan, Indonesia

Location Kota palembang, Sumatera selatan INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
RACHMAT HIDAYAT

Contact Email
hanifmedisiana@gmail.com

Phone
+6287837160809

Journal Mail Official
journalanesthesiology@gmail.com

Editorial Address
Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang, Sumatera Selatan, Indonesia

Location
Kota palembang,

Sumatera selatan

INDONESIA