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  Citation statistics : Table of Contents
   2017| September-December  | Volume 1 | Issue 3  
    Online since November 12, 2019

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Spontaneous rupture of arteriovenous malformation: ICU based brain resuscitation
Putu Agus Surya Panji, I Wayan Aryabiantara, I Wayan Suranadi, Pontisomaya Parami, I Gusti Agung Made Wibisana Kurniajaya
September-December 2017, 1(3):48-50
Arteriovenous malformations (AVM) is a relatively rare intracranial abnormality. Generally, it caused by congenital abnormalities that recognized after the bleeding started. Spontaneous intracranial bleeding after AVM rupture is an emergency condition and require immediate treatment to reduce mortality rate. After stabilization of intracranial bleeding due to AVM rupture, secondary injury may occur hours or even days after the inciting traumatic event. The injury may result from impairment or local declines in cerebral blood flow (CBF) after brain injury. The decrease in CBF is the result of local edema, hemorrhage, or increased intracranial pressure (ICP). An adequate brain resuscitation is needed to decrease brain edema and intracranial pressure by achieving several targets and avoid things that can interfere with CBF. A recovery phase should be given to the patient with rupture of AVM before going to definitive therapy.
[ABSTRACT]   Full text not available  [PDF]
  - 864 110
Low flow anesthesia will gain eras (enhanced recovery after surgery)
Tjokorda Gde Agung Senapathi, I Putu Pramana Suarjaya, Adinda Putra Pradhana, Eric Makmur
September-December 2017, 1(3):51-54
As we know, the volatile agent needs fresh gas flow to be carried out to the patient. It is very common in anesthesia practice, we use the fresh gas flow more than 2 liters per minute. In recent practice, the more flow we gave, the more volatile agent blew out to the patient. The present of APL (adjustable pressure limit) also leaks out of the circuit, we spend more gases, volatile agent, hence gave more pollutant to the operating theater. The consequences of those are an increase of anesthesia expenses and change the way of health care being delivered. ERAS (Enhanced Recovery After Surgery) is popular with its quick recovery after surgery, include quick emergence post anesthesia, that will reduce the time in the operating theater, recovery room, and as results, reduce the cost of anesthesia and surgery.
[ABSTRACT]   Full text not available  [PDF]
  - 903 183
Venous Air Embolism (VAE) during craniotomy of supratentorial meningioma in supine position
Ida Bagus Krisna Jaya Sutawan, Tatang Bisri, Sri Rahardjo, Diana Lalenoh
September-December 2017, 1(3):60-63
Venous Air Embolism (VAE) is one of the most serious complications in neuroanesthesia case. The highest number of VAE incident is during neurosurgery procedure with sitting position, even tough VAE may occur during craniotomy of supratentorial tumor in the supine position. VAE occurs due to the pressure differential between open vein in the surgical field and right atrium. A 46 years old woman underwent craniotomy for supratentorial meningioma in the supine position. Intraoperative, the patient was experiencing a decrease in end-tidal CO2 pressure about 6 mmHg in 5 minutes. Therefore, management of acute VAE was proceed to the patient, such as informed the surgeon immediately, discontinued N2O and increased flow of O2, modified the anesthesia technique, asked the surgeon to irrigate the surgical field with fluids, gave compression on jugular vein, aspirated the right atrial catheter, prepared drugs to support the hemodynamic, and changed the patient's position if possible.
[ABSTRACT]   Full text not available  [PDF]
  - 825 102
Regional anesthesia in molar pregnancy with thyrotoxicosis in a remote hospital
Christopher Ryalino, Tjahya Ariasa, Gede Budiarta, Tjokorda Gde Agung Senapathi
September-December 2017, 1(3):64-66
Hydatidiform mole or molar pregnancy is a benign Gestational Trophoblastic Disease (GTD) that originates from the placenta. Treatment consists of vacuum evacuation but rarely hysterectomy may be required. One common complication of molar pregnancy is hyperthyroid. Anesthetic management is often complicated by the associated systemic complications. These complications cannot be prevented, but with a better understanding of the disease, some measurements to avoid maternal mortality can be performed.
[ABSTRACT]   Full text not available  [PDF]
  - 1,300 169
Case series: deep sedation for paedatric patients with pericardial effusion
Ratna Farida Soenarto, Jefferson Hidayat, Hendy Armanda Zaintama
September-December 2017, 1(3):70-72
Background: Pericardial effusion is an abnormal fluid accumulation in the pericardial space that potentially compromises cardiovascular function, thus it needs a prompt treatment. Pericardial effusion evacuation in paediatrics can be done by subxyphoid pericardiotomy, which requires patient's cooperation. General anaesthesia for paediatrics with pericardial effusion has been reported unfavourable. This case series reports safe anaesthesia procedures done for pericardiocentesis through both sedation and general anaesthesia. Case Presentations: Cases were taken from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 6 patients underwent sedation and 3 patients underwent general anaesthesia. Both groups used ketamine, midazolam and fentanyl. Sevoflurane was used as inhalation agent for maintenance. Blood pressure, heart rate, and SpO2 were recorded before and after pericardiocentesis. In both groups, there were no significant different between systolic and diastolic blood pressure, heart rate, and SpO2 before and after the procedure (p=0.05). Immobilization through sedation or general anaesthesia is required to perform an optimal pericardiotomy. Anaesthetic agents were chosen based on their minimal effects toward myocardial depression. Fluids balance before and after the procedure was crucial to prevent hemodynamic instability during effusion evacuation. Conclusion: Both sedation and general anaesthesia were safe for pericardiocentesis, with concern toward anaesthetic agents that were minimally depressive to myocardium, combined with opioid analgesics and other sedative agents, with balanced anaesthesia principle. Optimal intravenous fluid therapy with echocardiography monitoring is crucial. Sedation is more advantageous for patients requiring pericardiocentesis without preoperative preparation for general anaesthesia.
[ABSTRACT]   Full text not available  [PDF]
  - 672 89
Efficacy of subcutaneous morphine patient controlled analgesia compared to intravenous morphine patient controlled analgesia in cesarean section
Made Wiryana, I Ketut Sinardja, I Gede Budiarta, Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, I Gusti Ngurah Mahaalit Aribawa, Elisma Nainggolan
September-December 2017, 1(3):67-69
Background: Cesarean section causes moderate to severe pain in the first 48 hours postoperatively, thus requiring an adequate perioperative pain management, as of the mother can be quickly discharged and immediately can perform daily activities after surgery such as breastfeeding and nurse the baby. Objective: To determine the efficacy of subcutaneous morphine patient controlled analgesia (SC-PCA) in lowering VAS (visual analogue score), total morphine consumption and postoperative side effect of cesarean section compared with intravenous morphine patient controlled analgesia (IV- PCA). Methods: This study is an experimental clinical trial using consecutive sampling technique. Sixty-four subjects were allocated into two groups of PCA morphine subcutaneously (SC-PCA) and the group PCA morphine intravenously (IV-PCA), each consisting of 32 subjects using permuted block randomization. Morphine concentration was 5 mg/ml (group SC-PCA) or the concentration of 1mg/ml (group IV-PCA). Both groups were then analyzed for VAS ratings, total morphine consumption, and adverse effects, postoperatively at 4th, 8th, and 24th hour. Statistic analysis using repeated ANOVA test and t-test with p <0.05 considered significant. Result: Morphine consumption in IV-PCA group showed lower than SC-PCA (9.41 mg vs 4,9mg) p <0.001 24 at 24 hours postoperatively. The resting VAS at 4th hours significantly lower in IV-PCA group (1.06 ± 0.71 vs 0.81 ± 1.40, p=0.029) and at 8th hours (1.03 ± 0.59 vs 0.94 ± 0,9, p=0.048). The moving VAS at 4th hours significant lower in IV-PCA group (2.31 ± 0.47 vs 1.45 ± 2.06, p=0.019) but the resting or moving VAS are not different clinically. Side effects of nausea and vomiting are more common in IV-PCA group. We conclude that SC-PCA provides analgesia more effective and decreases side effects in patients undergo cesarean section with spinal anesthesia.
[ABSTRACT]   Full text not available  [PDF]
  - 895 115
Extended glasgow outcome scale and correlation with bispectral index
Tjokorda Gde Agung Senapathi, I Putu Pramana Suarjaya, Ida Bagus Krisna Jaya Sutawan, Ketut Yudi Arparitna
September-December 2017, 1(3):55-59
Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long-term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their caregivers and society as a whole. Clinicians and researchers require reliable and valid measures of long-term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high-quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we will describe the measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe) in correlation with bispectral index (BIS).
[ABSTRACT]   Full text not available  [PDF]
  - 711 97
Safety timeout for local and regional anesthesia
Cynthia Sinardja, IMG Widnyana, Marilaeta Cindryani
September-December 2017, 1(3):73-76
Full text not available  [PDF]
  - 663 96
Anaesthesia for ECT in neuroleptic malignant syndrome - what is ideal?
Priyaneka Baskaran, Jaishree Santhirasegaran, Norhuzaimah Bt Julai @ Julaihi
September-December 2017, 1(3):77-82
We report a case involving a 46 year old male with schizophrenia who presented with fever, inability to speak, sialorrhoea, limb stiffness, profuse sweating, tremors and rigidity of bilateral upper and lower limbsfollowing an increase in dosage of his antipsychotics. A provisional diagnosis of neuroleptic malignant syndrome (NMS) was made based on the Levensen criteria. His antipsychotics were promptly discontinued and he was transferred to ICU for critical care support. We utilised lorazepam and prescribed bromocriptine and his NMS symptoms improved. However, in view of residual catatonic symptoms, decision was made to commence ECT. A combination of rocuronium sugammadex was used successfully in all his ECT procedures and found to be an excellent alternative to succinycholine in this patient.
[ABSTRACT]   Full text not available  [PDF]
  - 731 106