Bali Journal of Anesthesiology (BJOA)
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Factors associated with the need for intraoperative packed red cells transfusion in pediatric liver transplant patients
Get PDFBackground: Massive hemorrhage is one of the most common problems encountered during a liver transplantation procedure. Correction of the blood loss using packed red cells (PRC) is essential during the procedure to improve outcome. This retrospective study aims to investigate preoperative and intraoperative factors that may predict the PRC need.Materials and Methods: Thirty-four patients who underwent pediatric liver transplantation procedure within 2010-2018 were included in this study. Their medical record was examined and the data was analyzed using a comparison of mean and regression model.Results: The mean bleeding in this study was found to be 906.62±674.30 mL, while the mean PRC transfusion was 566.71±307.30 mL. Correction of blood loss was also compensated with other means such as a crystalloid or colloid fluid.Conclusion: This study statistically demonstrated that pre-operative weight, as well as bleeding volume, significantly affect the PRC transfusion requirement (p <0.05). However, other factors such as hemoglobin and surgical duration may also be clinically significant factors to predict PRC transfusion need
Comparison between lidocaine and NaCl 0.9% inhalation in heart rate and blood pressure changes during laryngoscopy and intubation
Get PDFIntroduction: Laryngoscopy and intubation is an invasive procedure routinely done during general anesthesia. The cardiovascular response to these procedures can be harmful in patients who are vulnerable, especially those who have cardiac or cerebrovascular problems. One method to attenuates the cardiovascular response was the use of anesthetics, including lidocaine. This study aimed to assess the effect of inhaled lidocaine on cardiovascular responses after laryngoscopy and intubation.Patients and Methods: This study was a randomized double-blind clinical trial on 50 subjects who underwent elective surgery, 24 subjects were given inhaled lidocaine 1.5 mg/kg and 25 subjects were given 0.9 % NaCl inhalation before laryngoscopy and intubation. Cardiovascular parameters being investigated were changes in systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate in a serial manner.Results: In the first minute after intubation, MAP and heart rate were higher in the NaCl group. The difference in MAP was 15.5 mmHg (p <0.001) while heart rate was 9.5 beats/min (p <0.001). In the 3rd minute after intubation, MAP and heart rate kept different in both groups: 16.6 mmHg (p <0.001) and 11.2 beats/minute (p <0.001), respectively. In the 5th minute after intubation, MAP and heart rate remained different between two groups: 16.7 mmHg (p <0.001) and 10.0 beats/min (p=0.03), respectively.Conclusion: Lidocaine inhalation was able to attenuate cardiovascular response due to pain stimuli and sympathetic stimulation after laryngoscopy and intubation
Characteristics of patients requiring non-invasive ventilation in pediatric intensive care unit
Get PDFBackground: Non-invasive ventilation (NIV) has become an essential tool in the treatment of both acute and chronic respiratory failure in children. This study aimed to determine the efficacy of NIV usage in pediatric patients who were admitted to the Pediatric Intensive Care Unit (PICU) with respiratory failure.Patients and Methods: This study is a retrospective, cross-sectional review. The data were collected from the medical record of PICU patients at our hospital from 2017 to 2018. Successful NIV was defined as patients who survived without intubation. Failure was defined as worsened patients and needed intubation for the rescue.Results: The total subjects of this study was 78 patients. The most common indication for NIV was ARDS (78.1%), and CPAP was the most common frequently used (78.68%). The data shows that the NIV was commonly used after extubation (52.56%) than for the first-time rescue (47.44%). The success rate of NIV after extubation were 65.85% and 34.15% failed and shifted to mechanical ventilation. The duration of NIV usage was less than three days (73.77%).Conclusion: NIV is a useful tool for the treatment of respiratory failure in pediatrics. The use of post-extubation NIV may be a valuable tool to prevent reintubation
Anesthesia management of carotid body tumour excision
No full textCarotid body tumour (CBT) is a rare tumour of chemoreceptor cells, which arises at the bifurcation of the carotid artery. These cells sense the partial pressure of oxygen and carbon dioxide from the blood. Hence, the carotid body plays an important role in the control of ventilation during hypoxia, hypercapnia and acidosis. The tumour arising from these cells is benign and tends to turn out malignant. This tumour is found in persons who live at high altitudes. Removal of tumour poses several anaesthetic challenges and perioperative morbidity or mortality. We report successful anaesthetic management of CBT excision.
The role of endothelial glycocalyx in sepsis
Get PDFABSTRACTThe surface of endothelial cells is filled with various membrane-bound molecules that form the glycocalyx. The endothelial glycocalyx is a surface layer mainly consisted of glycosaminoglycans that include heparan sulfate, chondroitin sulfate, and hyaluronic acid and its core proteins. Previous studies suggest that endothelial surface glycocalyx shedding could play a role in endothelial dysfunction and inflammation. This article will review the endothelial glycocalyx and its role in sepsis.
Combined morphine-clonidine adjuvant in epidural analgesia support role of supraspinal modulation in opioid tolerant patient
Get PDFABSTRACT Acute pain patients with complicated pain-related experiences would need more than just a pain reliever, especially those with behavioral opioid usage. Latest findings revolving supraspinal modulation are not only taking experts and pain physician into a different stage of understanding but also making theories and management revisited. A 41-years-old Australian male underwent plate and screw fixation of his right femur. He was overweight with a history of behavioral opioid usage. He was given epidural analgesia for postsurgical management with bupivacaine 0.1% with morphine 2 mg and clonidine 30 mcg every 12 hours as adjuvants. Hemodynamic curves were in normal limits, no paralysis, urinary difficulties, or pruritus. He was discharged on the fourth day. The combined morphine-clonidine adjuvant in epidural analgesia technique was an effective choice to alleviate pain response in this opioid-tolerant patient.
The Effect of Contralateral Head Rotation on Internal Jugular Vein to Carotid Artery Distance and Overlap Ratio
No full textIntroduction: Carotid artery puncture during central venous catheter (CVC) insertion could lead to serious complication if there was overlapping of internal jugular vein (IJV) and carotid artery (CA). IJV and CA overlap ratio and distance were determined by contralateral head rotation angle. Optimal angle of contralateral head rotation during CVC insertion can decrease the risk of CA puncture complication. This study was aimed to investigate the optimal angle of contralateral head rotation on IJV to CA distance and overlap ratio at the cricoid level by ultrasound guidance.Methods: This was a cross-sectional study of 34 patients undergoing elective surgery with CVC insertion. IJV to CA distance and overlap ratio at the cricoid level on each subject in supine position was measured by using two-dimensional ultrasound (Sonosite® M-Turbo, 6-13 MHz probe) at 0o, 30o, 45o, 60o contralateral head rotation of insertion site. Collected data were analyzed using SPSS 21.0.Results: There were significant differences on IJV to CA distance and overlap ratio at different contralateral rotation angles (0o, 30o, 45o, 60o, p<0.001). Overlapping of IJV and CA started to occur at contralateral head rotation 30o (11.72%) and increased in line with the increasing of contralateral head rotation angle (21.21% at 45o).Conclusion: There were significant effects of contralateral head rotation to distance and overlapping IJV to CA at cricoid level. Optimal contralateral head rotation angle for CVC was less than 30o to prevent IJV and CA overlapping
Addiction in Anesthesiology : Sometimes Sh*t Happens
No full textAnesthesiology demands a vigilant and controlled cautious person with a good tempered manner and professional character. Those virtues and values were built through thousands of trials, errors, failures, chances and breakdowns. When some individuals could resist and thrive, others may fall and surrender. Anesthesiologists are responsible of patients beneficiary with the utmost point should be considered in patient physical safety and survival. The aim to become a good anesthesiologist who keeps the safety and patient wellbeing sometimes had taken its toll by sacrificing the wellbeing of the anesthesiologists themselves
EGDT MODIFICATIONS USING IVC DIAMETER AND IVC COLLAPSIBILITY INDEX TO PROVIDE INTRAVASCULAR ADEQUACY FOR SEPSIS MANAGEMENT IN REMOTE AREA
Get PDFEarly Goal Directed Therapy (EGDT) protocols can still be considered to provide clear guidelines for bedside clinicians to treat sepsis. The use of EGDT protocol requires Central Venous Catheter (CVC) installation to calculate Central Venous Pressure (CVP). In the field, especially in the remote area, the installation of CVC often cannot be done because of the unavailability of tools or other reasons. Wiryana, et al. found that there was a strong negative correlation between CVP and collapsibility index of Inferior Vena Cava (IVC) and that IVC Collapsibility Index (IVC CI) could replace CVP(1), so it could be used to replace the role of CVP on modified EGDT protocol. Five patients were measured IVC diameter and IVC CI after initial fluid therapy and had an expiratory IVC diameter and a collapsibility index belonging to the CVP group of 11-15cmH2O according to Katja, et al(2)
PERIOPERATIVE ANESTHETIC MANAGEMENT IN LIPOSUCTION SURGERY
Get PDFLiposuction or lipoplasty is one of the most popular treatment modalities in aesthetic surgery which brings the certain unique anesthesia considerations. The patient should be assessed by the same standards as anyone else who is undergoing any surgery including a complete preoperative history and physical examination. The patients undergoing major liposuction procedure have a greater associated comorbid condition with the incidence of obesity. Moreover, intraoperative fluid management in liposuction procedure is also different from other surgeries where this procedure has the higher risk for fluid overload. Some complications related to liposuction are pulmonary thromboembolism, fat embolism syndrome, and anesthesia-related complications. This case report describes an obese class I (BMI >30.3 kg/m2) patient who was undergoing an elective tumescent liposuction surgery under general anesthesia. During surgery, this patient received total subcutaneous infiltration of 1,200 mL tumescent solution and the total lipoaspirate was 3,300 mL. The surgery was uneventful without any certain complication. The anesthetic management of liposuction includes the preoperative evaluation, with particular attention to anything that might predispose the patient to complications, being essential to avoid unwanted occurrences