Bali Journal of Anesthesiology (BJOA)
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The use of echocardiography as a routine perioperative monitoring standard: The perspective of a cardiothoracic anesthesiologist
No full textINTRODUCTIONIn the era of medicine that has been very advanced as it is today, we as anesthesiologists are required to be able to provide anesthetic services that are comfortable but still safe. Throughout the world, there are more than 300 million major surgery each year, and major cardiovascular adverse events are a significant cause of perioperative morbidity and mortality.1 This certainly relates to the nature of anesthetic agents that are mostly cardiovascular-depressant. Anesthetic agents such as propofol, ketamine, opioids, inhalation anesthetic agents, and many others, can directly affect the cardiovascular system.2While the major cardiac event occurred during perioperative events is also quite high. Especially for the patients in the perioperative period who will undergo non-cardiac surgery. This frequently reduces the alertness of an anesthesiologist, especially when performing perioperative monitoring. A study from Smilowitz et al.,1 showed that out of 10,581,621 patients admitted to hospital for major non-cardiac surgery plans, 317,479 (3%) patients had experienced major cardiac events. Which can be illustrated that major cardiac events occur in 1 in 33 patients treated for major non-cardiac surgery. Echocardiography is a safe, relatively inexpensive and well-tolerated action for patients.3Regular use of echocardiography in the perioperative period can certainly help to predict and even reduce major events adverse cardiac events. It is good to be used as a guide for making decisions in carrying out actions, as well as for monitoring the patient's condition regularly during the perioperative period. The use of echocardiography so far has been used for both diagnosis and management in the field of cardiology and is used by another specialist as well, although anesthesiologists do not use it in the perioperative period as a routine manner. Meanwhile, the role of an anesthesiologist as a perioperative doctor has become something that other specialties have begun to rely on.
Udayana One Health Collaborating Center (OHCC) initiated Bali’s first mass, integrated basic life support training
Get PDFABSTRACTBasic Life Support (BLS) is a first-aid training that can be utilized in case of emergency until the victims are retained by medical professionals. Mastering BLS skills can be the difference between life and death. A cardiopulmonary resuscitation (CPR) performed by a passer-by is important to ensure a successful resuscitation in out-of-hospital cardiac arrest. Yet, improving the survival rate for out-of-hospital cardiac arrest is still a major problem. Starting in 2019, Udayana One Health Collaborating Center (Udayana OHCC) will implement the first mass and integrated BLS training in Bali. The goals are to introduce BLS to more people and to produce BLS-friendly environment in Bali
Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors
No full textOver half of soft tissue tumor surgeries require intraoperative Packed Red Cell (PRC) transfusion. Transfusion should be sufficient, as inadequacy will increase risk of tissue ischemia, morbidity and mortality. On the other hand, liberal transfusion is related to infection, tumor recurrence, and immunosuppression. Therefore, good PRC planning measures in preoperative period are essential. Several factors that can be identified in the preoperative period, have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. These factors are ASA score, preoperative hemoglobin (Hb) value, malignancy, size, and location of tumor. By acknowledging influencing factors, a system for predicting blood requirement can be established to promote patient safety and avoid waste. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion.A retrospective cohort was analyzed on 84 records of orthopaedic soft tissue tumor surgery during 2014-2018. In all subjects, the aforementioned factors, amount of intraoperative bleeding and intraoperative PRC transfusion was recorded. Data was analyzed by linear regression to see the relationship of factors to the amount of bleeding and by logistic regression to assess the probability of receiving intraoperative PRC transfusions. A multivariate analysis identified tumor size as an independent determining factor of bleeding. In further analysis, it was found that tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion.
Characteristics of cervical myofascial pain in medical students
Get PDFBackground: Cervical myofascial pain or neck pain is in the fourth most disease that causes disability after back pain, depression, and other musculoskeletal diseases. Cervical myofascial pain is characterized by pain originating from a trigger point located in the skeletal muscle, commonly referred as myofascial trigger points (MTrPs).Methods: An observational study with a cross-sectional design, conducted on 3 to 9 of December 2018 with research subjects were medical students at Udayana University who undergoing 5th and 6th year in clinical clerkship at Sanglah General Hospital Denpasar. The data was taken using Google Form which was filled in online by the subject and then analyzed using SPSS version 21.Results: From 307 respondents, 62.2% stated experiencing neck pain (196 respondents) with the majority of women 65.4%, the duration of neck pain occurred for <24 hours with the most frequent frequency at least once per month (46.1%), and appeared most often at night (39.8%) and occurs after night shift in 106 subjects (55.5%). The pain was said getting worse by activity in 102 subjects (52.4%) and getting better when resting in 185 subjects (96.9%). Most of the subjects did not use pain relievers to treat neck pain experienced (84.3%). In subjects who use painkillers, Paracetamol is the most often drug of choice to relieve pain (11%). For non-pharmacological treatment, 53.4% of respondents chose to rest or sleep.Conclusion: Most of the respondents who were clerkship reported experiencing neck pain at least once a month and often felt after a night shift. Respondents who reported neck pain were mostly women
Radiofrequency ablation of genicular nerve in a patient with knee pain associated with osteoarthritis
No full textABSTRACTOsteoarthritis is a leading cause of pain and disability in the elderly. In addition to the economic burden, the pain caused by knee osteoarthritis may also reduce the quality of life and affect the patient's psychological condition. Surgery is the best option for patients with severe osteoarthritis. However, a patient with severe osteoarthritis generally tend to be elderly and have multiple co-morbidities, and thus, may not be a suitable candidate for surgery. In regards to several interventional methods that have been investigated, radiofrequency ablation (RFA) neurotomy showed promising results. We report a case of 65-year-old woman with chronic knee osteoarthritis pain that underwent a conventional RFA procedure for right genicular nerve
The correlation between the depth extent of Tuohy epidural needle with body mass index (BMI) to achieve loss of resistance in patients undergoing epidural anesthesia
Get PDFABSTRACTBackground: Anesthesia management in obesity is quite challenging. Epidural anesthesia become one of the choices. The attention should be addressed in order to prevent the misidentification of epidural space. The estimation of the depth extent of epidural space becomes crucial, especially in obese patients due to an accumulation of subcutaneous and epidural adipose tissue, which consequently complicate the epidural catheter insertion. This study aimed to analyze the correlation of the depth extent of Tuohy epidural needle to achieve loss of resistance between normal-weighted and obese patients.Method: This study was conducted with 56 adult patients aged 17 to 65 years who underwent elective surgery by epidural anesthesia inserted at level L2-L3 or L3-L4 interspace. Subjects are divided into normal and obese groups. Shapiro-Wilk and chi-square tests were used in the normality test. For normally distributed data, an independent t-test was used to test the hypothesis, otherwise, we used Mann-Whitney test Results: The results showed that the loss of resistance in epidural needle insertion procedures was 60 mm in a patient with BMI more than 30 kg/m2 and 50 mm in those with BMI <30 kg/m2 (p<0.001).Conclusion: The loss of resistance depth in epidural Tuohy needle insertion is significantly determined by BMI.
The ultrasonic cardiac output monitor (USCOM) as a tool in evaluating fluid responsiveness in pediatric patients underwent emergency surgery
Get PDFABSTRACTBackground: Assessment fluid adequacy in pediatric patients underwent surgery is a challenge for anesthesiologists. Hemodynamic parameters used as fluid monitoring sometimes don’t accurately provide valid information. Ultrasonic Cardiac Output Monitor (USCOM) is one of the non-invasive methods that are easy to operate and may provide various hemodynamic parameters monitoring information.Objective: Analyze the effectiveness of Stroke Volume Variation (SVV) and Stroke Volume Index (SVI) by using USCOM in assessing fluid responsiveness in preoperative pediatric patients who underwent emergency surgeries. Method: This study was conducted on 16 pediatric patients underwent emergency surgeries. Before general anesthesia is given, blood pressure, mean arterial pressure, heart rate, cardiac index, SVV, SVI were recorded before and after administration of 10 mL/kg of fluid given within 20 minutes.Results: 10 subjects responded with SVV and SVI changes of more than 10% compared to 6 non-responders. SVV changes between responders and non-responders were 31.5±1.58 and 7.5±1.04, respectively. SVV percentage changes between responders and non-responders were 38.04±0.47 and 5.24±4.89, respectively.Conclusion: SVV and SVI recorded by USCOM showed significant fluid responsiveness changes in pediatric patients underwent emergency surgeries in 62.5% of the subjects
Perioperative anesthetic management in pediatric with pheochromocytoma tumor resection
Get PDFPheochromocytomas (PCC) is rare neuroendocrine tumors which present as the malignant and familial features. These catecholamine-secreting tumors have triad classical symptoms of headache, sweating, and palpitation primarily due to the release of catecholamines and their metabolites in the body with hypertensive crisis become its predominant clinical symptoms. The excessive release of catecholamines may produce a life-threatening hemodynamic surge during the intraoperativeperiod, therefore preoperative preparation and intraoperative monitoring become an essential point. Nevertheless, postoperative care is also a critical issue in order to further curtail its morbidity and mortality rates
Co-administration of dexmedetomidine and levobupivacaine results in better onset and duration of epidural anesthesia in lower extremity orthopedic surgery
Get PDFABSTRACTBackground: The goal of this study is to know the efficacy of the addition of 0.5 mcg/kg dexmedetomidine to 15 mL isobaric 0.5% levobupivacaine on the onset and duration of sensory and motor blockade of epidural anesthesia in lower extremity orthopedic surgery.Methods: Randomized clinical double-blind trials were conducted in Dr. Mohammad Hoesin Hospital Palembang. A total of 34 patients underwent lower extremity surgery met the inclusion and exclusion criteria. Data were analyzed by independent t-test and Mann-Whitney test using SPSS 22.0 software.Result: The onset of sensory block in group D was 5.41±1.84 minutes compared to 17.59± 2.65 in Group C (p <0.001), as seen in Table 2. The sensory block duration was 362.41±25.66 minutes in Group D compared to 215.82±15.69 in Group C (p <0.001). The onset of the motoric block in group D was 16.53±1.81 minutes compared to 26.12±2.78 in Group C (p <0.001), while the motoric block duration was 301.29±20.55 minutes in Group D compared to 167.35±17.24 in Group C (p <0.001).Conclusion: The addition of 0.5mcg/kg dexmedetomidine to 15 ml isobaric 0.5% levobupivacaine in epidural anesthesia provide faster onset and prolonged duration in both motoric and sensory block in patients undergoing lower extremity surger
Anesthesia management of a parturient with meningioma underwent elective Cesarean section
Get PDFoai:ojs.bjoa.ejournals.ca:article/152ABSTRACTThe occurrence of primary intracranial tumors in pregnancy is an extremely rare event. Symptoms of a brain tumor include nausea, vomiting, headache, visual disturbances and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. It is a well-established fact today that the technique of choice for elective cesarean section is regional anesthesia. However, in patients with intracranial hypertension and central nervous system infection, this technique should be avoided. General anesthesia poses high risks for pregnant patients. These patients have potentially difficult airways with delayed gastric emptying, which are factors increasing the possibility of pulmonary aspiration after general anesthetic induction. This paper aimed at reporting the anesthetic management of a parturient with intracranial hypertension due to meningioma submitted to elective cesarean section. This kind of surgery needs special attention and specific skill of the anesthesiologist