Bali Journal of Anesthesiology (BJOA)
Not a member yet
82 research outputs found
Sort by
Vecuronium in tuberculosis: a rare case report of reversible quadriparesis
No full text ABSTRACTTuberculosis is a major health burden worldwide. The National treatment regimens for tuberculosis (TB) patients recommend the use of the five first lines anti TB drugs: isoniazid (INH), rifampicin (R), ethambutol (E), pyrazinamide (P) and streptomycin (S). Maintaining of oxygenation are very much challenging in tuberculosis patients associated with Acute Respiratory Distress Syndrome (ARDS). Often we need muscle relaxation with adequate sedation for maintaining oxygen saturation and lung recruitment. Skeletal muscle weakness has a confusing list of names and syndromes, including Acute Quadriplegic Myopathy Syndrome (AQMS), floppy man syndrome, critical illness polyneuropathy (CIP), and acute myopathy of intensive care. In disseminated tuberculosis with ARDS, we recommend the use of short-acting muscle relaxant drugs like cisatracurium whose metabolism not depends upon the liver. Interrupting the vecuronium infusion (vecuronium holiday) as its action was potentiated by streptomycin and corticosteroid which may result in the development of Critical Illness Polyneuro Myopathy (CIPM). Targeting Train of Four (TOF) of two rather than zero of four has been shown to be beneficial for a period of fewer than 48 hours
The interaction of neuroimmunology, neuromodulator, and neurotransmitter with nociceptor and MAPK signaling
Get PDFABSTRACTPhysiological pain is a protection mechanism against tissue damage or potential tissue damage. Inflammation pain is followed by tissue damage due to temperature, mechanical and chemical stimuli which increase crosstalk between neuron nociceptor, immune system, neuromodulator and neurotransmitter, and MAPK (Mitogen Activating Protein Kinase) signal. Initially, immune cell is produced at the primary afferent nerve endings and spinal cord, modulate thermal sensitivity and mechanic through MAPK signaling, then neuromodulator and neurotransmitter at the afferent nerve endings will regulate the innate immune response, adaptive and vascula
Aerosol propellants leading to factitious reading by gas monitoring
Get PDFA well-equipped Anaesthesia workstation is boon for safe anaesthesia practice. Anaesthesia agent gas monitoring has become an integral part of intraoperative monitoring. The infrared analyzers are commonly used for measuring anaesthetic agents. These advanced gas monitoring devices help in accurate titration of delivery of anaesthetics to patients particularly at low flows. However as with any technology, gas monitoring is also associated with inherent errors. Newer aerosol propellants like hydro-flouro- alkanes (HFA) are known to cause erroneous detection of inhalational anaesthetic agents during general anaesthesia
Ketamine: old drug, a new option
Get PDFUnique properties and recent development in the areas of clinical properties of ketamine make this agent to be popular for a long time. This anesthetic agent has wide range of indications. Many areas of clinical application of ketamine are explored in many studies. However, not many clinicians are familiar with the wide range of clinical applications of ketamine. As time passes there are many new alternative use of ketamine, a well-established anesthetic agent. The analgesic profile of ketamine is explored to have more benefits, such as postoperative pain control and as preemptive analgesia. The other aspect, which has been studied extensively, is the neuroprotective profile of ketamine. The administration of ketamine is not associated with increased intracranial pressure if normocapnia is achieved, making it possible anesthetic for neurosurgery. The other areas to explore include the role of ketamine to prevent opioid-induced acute tolerance and treat major depressive disorder
Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center
Get PDFABSTRACTPain is a common complaint found in the population. Inadequate knowledge about pain management is the most common reason that triggers the inadequate management of pain. Pharmacological pain management is also not without risk. Various risks from the use of pharmacological agents related to side effects that can arise may also cause new problems. Several medical intervention techniques with invasive procedures for pain have also been carried out, although they are still less popular, due to a lack of public knowledge of this technique. We conducted a cost-free, minimally invasive pain procedure in people with chronic musculoskeletal pain in a public health center in a rural area in Bali Island to alleviate their pain-associated symptoms and to introduce this minimally invasive pain management technique
A comparative study between supraclavicular brachial plexus block and Infraclavicular brachial plexus block for upper limb orthopedic surgeries: A prospective, randomized, double-blind study
Get PDFIntroduction: Supraclavicular brachial plexus block is a common approach as it provides faster and dense blockade. In the past few years, infraclavicular brachial plexus block has become a method of increased interest as it has a lower complication rate and near to equal efficacy. The goal of this study was to compare block performance time, block characteristics, quality of block, patient’s satisfaction, and complications between infraclavicular and supraclavicular techniques for brachial plexus block.Patients and Methods: 100 subjects were randomized in a double-blind fashion, to receive either an infraclavicular block (Group I, n=50) or supraclavicular block (Group S, n=50) using nerve locator apparatus. Block performance time, onset, peak, duration of sensory and motor blockade, any change in hemodynamics, complications were recorded at scheduled intervals intra-operatively and post-operatively as per study protocol. Data were analyzed using GraphPad INSTAT version 3.06 software by Chi-square test or Mann-Whitney U test to compare categorical variables.Results: The block performance time was faster in the Group S compared to the Group I (4.8±4.4 minutes vs. 6.3±1.39 minutes, p <0.001). The sensory block onset time was faster in Group S compared to the Group I (6.9±1.58 minutes vs. 7.6±1.34 minutes, p=0.019). Other observed variables were considered statistically not significant.Conclusion: From our study, it is inferred that nerve locator guided Infraclavicular block by a vertical coracoid approach using multineurostimulation method is less rapidly executed as nerve locator guided supraclavicular block with a similar degree of surgical anesthesia and lesser complication rate
Clinical profile comparison of cisatracurium and rocuronium in elective surgery
Get PDFBackground: Most surgeries are carried out with ease using neuromuscular blocking agents. This study was aimed to compare the intubating dose of cisatracurium and rocuronium regarding the onset of action, clinical duration, recovery index, intubating conditions, efficacy, and safety in elective surgery.Method: 60 adult patients of American Society Anesthesiology (ASA) grade I & II, underwent elective laparoscopic surgery were randomized to receive either cisatracurium 0.1 mg/kg (Group C) or rocuronium 0.6 mg/kg (Group R). Neuromuscular monitoring was done using STIMPOD Xavant NMS450. Relaxogram interpretation was carried out for the onset of action, clinical duration, and recovery index.Results: Cisatracurium had significant longer onset (233.33±62.31 vs. 86.66±28.62 seconds, p <0.001) and significant longer clinical duration (40±3.56 vs. 27.46±2.14 minutes, p <0.001) than rocuronium. Recovery index was significantly longer in the cisatracurium group (12.23±1.54 vs. 8.30±1.80 minutes, p <0.001). Clinically acceptable intubating conditions were achieved in 180 seconds (C group) compared to 60 seconds in the R group. No untoward or adverse response and complications were distinguished in either group.Conclusion: Cisatracurium 0.1 mg/kg exhibited a slower onset of action than rocuronium 0.6 mg/kg and provided excellent intubating conditions in the majority of patients after 180 seconds. The clinical duration and recovery index were significantly longer in cisatracurium compared to rocuronium. Both are potent and safe agents with excellent cardiovascular stability
The effectivity of ear plug utilization on emergence delirium incidence in pediatric patient undergoing general inhalated anesthesia
No full textBackground. Emergence Delirium (ED) also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors such as agitation, irritable, uncompromising, uncooperative, inconsolably crying following general anesthesia. The incidence of ED in pediatric patients in Dr. Cipto Mangunkusumo hospital was 39,7%. During emergence state, auditory stimulation induces thalamic synapse in lateral amygdala which leads to over response of fear (one of the risk factor of ED). A high noise level in operating room can be reduced with ear plug application to the patient. Design and Method. A double blind randomized clinical trial towards 1-5 years old pediatrics who underwent inhalation general anesthesia in Dr. Cipto Mangunkusumo hospital from September-December 2018. One hundred and seven subjects were randomized after a consecutive sampling into two groups. Earplug group (n=53) with application of ear plug at the end of surgery, while in control group (n=54) without application of ear plug. The incidence of ED and time to extubation were recorded. ED was measured using Pediatric Anesthesia Emergence Delirium (PAED) scale. All the data was analyzed using multivariate logistic regression and ANCOVA. Result. Incidence of ED in ear plug group was 16.7% while in control group was 32.1% (OR = 0.402; CI 95% 0.152-1.062; p=0.066). Mean value of time to extubation in ear plug vs control group (5.76+3.23 minutes) vs (6.54+ 3.67 minutes) with mean difference of 0.825(0.530-2.180); p=0.230. Conclusion. Ear plug application at the end of anesthesia was not statistically effective. However, it was clinically effective in reducing the incidence of ED in pediatric patient underwent inhalation anesthesia.
Isobaric levobupivacaine for intrathecal anesthesia as an effective and safe option in transurethral resection of the prostate surgery
Get PDFThe search for safer anesthetic solutions has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, emerged as a safer alternative for intrathecal anesthesia than its racemic parent (bupivacaine). Levobupivacaine shows a lower risk of the central nervous system and cardiovascular toxicity.However, in many countries, levobupivacaine is only available in isobaric solution, where the isobaric solution for intrathecal anesthesia is still often be questioned its effectiveness because of the fear that the block spreading is unpredictable. In this case series, we describe sensory and motor block characteristics, hemodynamics profile and adverse effects of isobaric levobupivacaine in intrathecal anesthesia for six patients with American Society of Anesthesiology physical status II-III whose undergo transurethral endoscopic surgery
Awake Intubation Fiberoptic Bronchoscope on Pregnancy Patient Undergo Decompression Laminectomy and Cervical Fusion Stabilization
Get PDFThe traumatic and ankylosing cervical spine being rare in pregnancy can cause serious problems continuing pregnancy. Extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression. We present a case of a patient in the 19th weeks with diagnosis C5 compression fracture and paracervical abscess C5 et causa suspect TB spondylosis, complaints with paralysis in all four limbs. Surgical intervention was deemed necessary and was performed in the prone position. The early operative treatment and appropriate anaesthetic procedure resulted in good clinical outcome with improvement of neurological recovery