Kidneys play an essential role in the regulation of water homeostasis, electrolyte balance, and acid–base balance. Anesthesiologists are frequently involved in the perioperative care of patients with kidney disease in elective and emergency scenarios. Fluid therapy is a main component of resuscitation to improve cardiac output, blood pressure, and perfusion pressure. This sometimes comes at a cost of increased risk of tissue edema due to fluid overload. Both during the transplant and nontransplant surgeries, the use or choice of fluid may influence the biochemical environment or homeostasis of human body and clinical outcomes. In this narrative review, we address the electrolyte and acid–base changes in renal disease, pharmacology of fluids, hemodynamic monitoring, and their applications.

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Congenital diaphragmatic hernia (CDH) is an emergency case in neonates. The prevalence of CDH is 1 in 2500 births and occurs 4–8 times more commonly on left side than right side. CDH is usually worsened by pulmonary hypoplasia and pulmonary hypertension. It is characterized by respiratory failure and bowel sound in the chest area and mostly requires surgical procedure. This case report discusses a neonate with congenital left diaphragmatic hernia who underwent surgical procedure to close the defect. Patients present with cyanosis and shortness of breath, are early intubated, and are mechanically ventilated in neonatal intensive care unit (NICU). In the present case, the surgical procedure lasted approximately 2 h with general anesthesia, with hemodynamic stability during the surgery. The patient was thereafter intubated and treated at the NICU for close monitoring.

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Background: Acute decline of renal function following cardiac surgery is a common and complex problem with an incidence of up to 30% in Europe and leading to increased mortality rate in immediate and long term. The aim of this study is to analyze risk factors regarding acute kidney injury (AKI) incidence following cardiac surgery. Patients and Methods: This was a descriptive cross-sectional study conducted at Dr. Wahidin Sudirohusodo Central General Hospital, Makassar, Indonesia. Serum creatinine level was measured to diagnose AKI. Hemoglobin level, blood transfusion, vasopressor, and inotropic needs before surgery were recorded. Hemodynamic parameters that included mean arterial pressure and heart rate were also recorded. Results: Of all 33 subjects who underwent adult cardiac surgery that included coronary artery bypass graft, heart valve, and congenital disease surgery, 21 (63.6%) patients had AKI and 12 (36.4%) patients did not. Several perioperative factor analyses between AKI and non-AKI group revealed that only age showed a significant difference between the two groups (P = 0.047). Conclusion: Age is the most significant factor in AKI incidence following cardiac surgery. Further studies are required to analyze other perioperative factors that might induce AKI.

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Background: The need for intra-operative dextrose supplementation in pediatrics remains a debate. Surgical stress responses lead to hyperglycemia, while regional anesthesia obtunds the stress response and thereby, hyperglycemia. We aimed to compare the effects of supplemental caudal analgesia on intraoperative blood glucose in children undergoing urological surgery under general anesthesia (GA). Intraoperative hemodynamics and opioid consumption were also compared. Patients and Methods: This was a cross-sectional, observational study conducted in children aged 5 months–6 years undergoing urological surgery, categorized as Group R (GA with caudal analgesia) or Group G (GA only). Blood sugars were measured until 2 h following intubation. Statistical analysis was performed using the Student's t-test and Chi-square tests. Results: Age in Group R was lesser than Group G (P = 0.044), but weights were comparable. Random blood sugar (RBS) at 60 min (P = 0.008) and 90 min (P = 0.007) were significantly lower in Group R. The difference in RBS from the baseline was significantly higher in Group G at all time points. Heart rate (HR) and mean arterial pressure (MAP) were comparable except at HR 60 (P = 0.046) and MAP 60 (P = 0.014) with significantly higher values in Group G. Group R had significantly lower intraoperative fentanyl consumption with less frequent need for additional bolus. Conclusions: Supplemental caudal analgesia blunts intraoperative increases in blood glucose levels and hemodynamics with a reduced analgesic requirement, compared to GA alone in children undergoing urological surgery.

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Background: Postoperative sore throat (POST), postextubation cough (PEC), and hoarseness of voice (HOV) are some of the common postoperative morbidities due to airway instrumentation. This study is aimed to compare the efficacy of 0.05% betamethasone gel to 2% lignocaine gel applied over the oro-endotracheal tube to reduce the incidence of POST, PEC, and HOV. Patients and Methods: This was a prospective, randomized, double-blinded clinical study in patients scheduled for elective surgeries under general anesthesia. They were randomized into two groups of 30. In Group B (betamethasone), the endotracheal tube was lubricated from the distal end of the cuff using 2.5 ml of betamethasone gel, and in Group L, the endotracheal tube was lubricated with lignocaine jelly in the same way. Patients were examined for POST, PEC, and HOV at intervals of 1, 3, 8, and 24 h after extubation. Results: Significant differences were found at 8 and 24 h postextubation. The incidence of PEC were 30% versus 6.7 % (P=0.02) and 26.7% versus 3.3% (P=0.01) in favour to group B. The incidence of POST were 30% vs 3.3% (P=0.005) and 23.3% vs 0% (P=0.004) in group L vs group B, respectively. Similarly, the incidence of HOV were 20% vs 3.3% (P=0.04) and 13.3% vs 0% (P=0.03) in group B's favour. Conclusion: Patients who underwent general anesthesia using betamethasone gel 0.05% applied to endotracheal tube reported a lower incidence of POST, PEC, and HOV in comparison to those with the application of lignocaine 2% on the endotracheal tube.

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Increased life expectancy will result in an increased number of elderlies scheduled for surgery. The vitreous undergoes the irreversible process of aging. Anesthesiologists must provide optimal perioperative care for patients posted for vitrectomy. Peribulbar block is one of the safest alternatives. Ropivacaine has a vasoconstriction effect that useful to minimize the increasing of intraocular pressure (IOP) after peribulbar injection. In this case report, we managed an 86-year-old patient who underwent vitrectomy procedure by peribulbar block. Peribulbar block provides blocks for ciliary, oculomotor, and abducens nerves. The needle is introduced into the extraconal space. The first injection is inferior and temporal, and the second injection is superior and nasal, between the medial third and lateral two-thirds of the orbital roof. The block provided adequate analgesia, akinesia, and decreased IOP.

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Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. If the management of acute postoperative pain is not done properly, it can lead to the complication such as chronic pain. Epidural anesthesia reduces perioperative stress response in surgery, increasing the surgery outcome. Epidural analgesia is one of the potential acute postoperative pain treatments. The administration of α-2 agonists has analgesic and sedative effect when used as adjuvant in epidural analgesia. The administration of α-2 adrenergic agonists' adjuvant can increase the potential duration of analgesia and reduce the local anesthetic dose needed 30%–40% and can reduce the occurrence of the side effects. Dexmedetomidine is one of the most potent and high selective alpha-2 adrenergic receptor agonists. The use of dexmedetomidine during epidural anesthesia has faster onset and longer motor sensory blockade duration with hemodynamic stability that can be accepted. While clonidine acts as selective partial alpha-2 receptor agonists that cause the analgesic action of alpha-2 receptor in the dorsal of spinal cord. Clonidine has been shown its ability to reduce the local anesthesia needed and improve the pain scores when is combined with bupivacaine 0.125% with or without fentanyl opioid 1–2 μg/mL.

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General anesthesia works centrally, causing loss of consciousness and blocking the pain response. Some of the general anesthesia techniques are using laryngoscopy and intubation. The side effects of endotracheal intubation, for instance, are stimulating cough reflex, laryngospasm, and sympathetic nervous system response that increases catecholamine levels. The side effects are increases in blood pressure and heart rate. Hereby, a big consent for anesthesiologists thus intravenous, topical, and regional drugs are usually needed to facilitate this action. Using a muscle relaxant to facilitate intubation is often performed but does not suppress the hemodynamic responses. Intubation with superior laryngeal nerve block technique has an equivalent quality compare with muscle relaxant uses. This technique can prevent hemodynamic responses from laryngoscopy endotracheal intubation.

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Background: Septoplasty is often performed under sedation with local anesthesia. Midazolam is one of the commonly used sedative but it lacks analgesic effect. Dexmedetomidine is now preferred, owing to the side effects of midazolam. However, there seems to be addressable literature void in this regard. This study was aimed to evaluate and compare the effectiveness of sedation between midazolam and dexmedetomidine infusions for procedural sedation during septoplasty under local anesthesia Patients and Methods: This was a randomized clinical trial involving sixty patients undertaking elective septoplasty under local anesthesia randomized into Group A that received intravenous dexmedetomidine 1 μg/kg over 10 min, followed by continuous infusion 0.5 μg/kg/h and Group B receiving intravenous midazolam 50 μg/kg (over 10 min), followed by continuous infusion 50 μg/kg/h. The Ramsay sedation score (RSS) and patient and surgeon satisfaction scores were documented. The analysis was done using the Chi-square test and Student t-test. Results: A significant change in the heart rate from 10 to 60 min was observed between the two groups (P < 0.05). The midazolam group showed a significant increase in mean arterial pressure (MAP) from baseline to 40 min time interval (P < 0.05). The respiratory rate remained constant in both groups. Patients attaining target RSS of 3–4 were significantly higher in the dexmedetomidine group (P < 0.05). Patient satisfaction score and surgeon satisfaction score were higher in the dexmedetomidine group (P < 0.05). Conclusion: Dexmedetomidine for septoplasty under local anesthesia is more effective than midazolam infusion in providing adequate sedation and provides stable hemodynamics and well-preserved respiratory functions.

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Transversus abdominis plane (TAP) block was developed as part of multimodal postoperative analgesia for cesarean section (CS) parturient. While continuous TAP block could provide satisfactory analgesia, the cost of the standard perineural catheters may limit its routine application. We present case reports of novel utilization of intravenous (IV) cannula as an alternative to the standard perineural catheters for postoperative intermittent TAP block. The results showed the feasibility and beneficial effect of IV cannula-facilitated TAP block in providing opioid-sparing postoperative acute pain management in CS parturient with minimal complication regarding its off-label application.

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The COVID-19 pandemic is a challenge for health practitioners, where there are many suspected and confirmed patients with COVID-19, including obstetric patients. Perioperative treatment of COVID-19 patients must be under applicable standards, for both patients and the medical personnel. Personal protective equipment is essential for health workers who treat patients with COVID-19 to prevent the transmission of the virus. The method of delivery ideally should be adapted to the clinical condition of the patient. At the same time, the management of anesthesia for patients with cesarean sections should also be adjusted to the patient's clinical condition by taking into consideration the availability of facilities and infrastructure that we have. Through this report, we want to show how we manage COVID-19 in obstetric cases using the available resources in a third-world country.

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Background: Spinal anesthesia is widely used regional anesthesia technique; however, postoperative analgesia is a major problem. The duration of analgesia can be prolonged by the addition of intrathecal adjuvants. Hence, this study is aimed to assess the characteristics of spinal block between the groups. Patients and Methods: One hundred and twenty-six adult patients were enrolled in this study. Patients were randomized into three groups of 42 in each group by the computer-generated numbers. Group A received 12.5 mg of 0.5% bupivacaine (2.5 ml) + 25 mcg fentanyl (0.5 ml), Group B received 12.5 mg of 0.5% bupivacaine (2.5 ml) + 5 mcg dexmedetomidine (0.1 ml) + 0.4 ml normal saline (NS), and Group C received 12.5 mg of 0.5% bupivacaine (2.5 ml) + 0.5 ml NS. Block characteristics and hemodynamic changes were recorded between the groups. Results: Time to achieve sensory block (T10) and motor block (M1) were faster in Group B when compared to Group A and C (P < 0.001). Duration of sensory block and motor block was longer with Group B (450.12 ± 22.295 min and 390.12 ± 22.551 min) when compared to Group A (380.71 ± 13.331 min and 320.71 ± 13.403 min) and Group C (220.10 ± 14.635 min and 180.10 ± 14.355 min). Time for first rescue analgesia was also longer in Group B when compared to Groups A and C (P < 0.001). Conclusion: Intrathecal dexmedetomidine provides effective prolongation of sensory and motor block as adjuvant to hyperbaric bupivacaine in spinal anesthesia.

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