Bali Journal of Anesthesiology (BJOA)
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EFFECT OF CLONIDINE ADDED TO CAUDAL ROPIVACAINE IN PEDIATRIC INFRAUMBILICAL SURGERIES
No full text Background: Caudal epidural block is the most popular regional anesthesia technique in pediatrics. Several agents are required as an adjuvant with a local anesthetic to prolong the duration of caudal analgesia by single shot technique in children. The aim of this study was to compare the efficacy of clonidine with ropivacaine versus ropivacaine alone for caudal analgesia in children undergoing infraumbilical surgeries under general anesthesia.Methods: Sixty patients of ASA grade I – II between the ages of 1-12 years, of either sex, undergoing infraumbilical surgeries under general anesthesia were included randomly into two groups: Control group (Group A) ropivacaine 0.2% (1ml/kg) with maximum volume 12 ml and clonidine group (Group B) ropivacaine 0.2% (1ml/kg) with clonidine 1µg/kg with maximum volume 12 ml. The changes of hemodynamic parameters were recorded intraoperatively. The FLACC pain score, sedation score, duration of analgesia and requirement of analgesic were recorded in the recovery room.Results: The demographic characteristic were comparable in both the groups. The mean duration of analgesia was significantly prolonged (707.3 + 59.56 minutes) in group B compared to (411.83 + 14.82 minutes) in group A. The requirement of first rescue analgesic medication was significantly prolonged in group B compared to group A (P < 0.05). Total analgesic consumption was significantly higher in group A (180+70 mg) compared to group B (90+70 mg) (P < 0.05)Conclusion: Addition of clonidine 1µg/kg to ropivacaine 0.2 % in caudal analgesia significantly increases the duration of postoperative analgesia compared to plain ropivacaine 0.2% without any significant sedation
CASE REPORT ANESTHETIC MANAGEMENT OF ADRENAL TUMOR RESECTION
No full textABSTRACTThe adrenal glands are secretory organs that are located above each kidney and produce hormones that play a major role in the metabolic processes. Tumors of the adrenal gland can cause metabolic abnormalities associated with hormonal disorders such as Cushing's syndrome, pheochromocytoma, or Conn's syndrome. To be able to give a good anesthetic management on resection of the adrenal tumor, it requires adequate preoperative evaluation. However, this will take large resources. Management of anesthesia in adrenal tumor with an unknown hormonal disorder should consider a variety of hormonal abnormalities that may present in the patient so it can be anticipated effectively.Keywords: incidentaloma, adrenalectomy, hormonal disorder, perioperativ
ANAESTHETIC MANAGEMENT OF EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION
Get PDFExtrahepatic portal venous obstruction (EHPVO) is the commonest cause of portal hypertension and variceal bleeding in children. Major concerns are growth retardation, decrease lean body mass and loss of muscle that may lead to postoperative respiratory failure. Upper abdominal surgery with severe pain may compound the problem of pulmonary atelectasis. Poor preoperative nutritional status and anemia may lead to delayed wound healing, delayed ambulation, and respiratory complications. To avoid postoperative respiratory complications and surgical site infection we inserted epidural catheter despite the possibility of intraepidural space bleed due to low platelet counts. The patient had an excellent recovery profile in term of analgesia, decrease postoperative nausea and vomiting due to decrease consumption of opioids, increase sedation-free period, early ambulation and parent’s satisfaction. The intraoperative epidural also provides better abdominal muscle relaxation, wider surgical bloodless field and optimal pressure in anastomosis vessels. Regional techniques are avoided in thrombocytopenia, but risk and benefits must be assessed in each case
COMPARISON OF EPIDURAL CATHETER TIP PLACEMENT BETWEEN MEDIAN AND PARAMEDIAN TECHNIQUES WITH FLUOROSCOPY
Get PDFIntroduction: The installation of an epidural catheter can be perform by median or paramedian techniques with the aim of position the epidural catheter tip being posterior to the epidural space. The goal of this study was to compare the location and position of the epidural catheter tip placed by the median technique compared to the paramedian technique by using fluoroscopy method.Patients and Methods: Fifty patients aged 18- 65 years who underwent lower abdominal surgery and lower extremities surgery are classified into two groups by consecutive sampling. The first group consists of those who were inserted epidural catheter by median technique approach, and the second group by paramedian technique approach. From the fluoroscopy imaging, the catheter position was classified into one the the following: anterior, posterior, and lateral. Result: In median approach, the epidural catheter tip were placed 16% anteriorly, 20% posteriorly, and 64% laterally. In the paramedian approach, the epidural catheter tip were placed 4% anteriorly and 96% posteriorly. The paramedian approach is more superior to median technique in terms of expected epidural catheter tip position (p <0.001, RR 4.8, CI95%=2.183-10.556). Conclusion: Placement of the catheter tip in the epidural space using paramedian technique is a better option than the median technique
PAIN MANAGEMENT IN BURN INJURY
Get PDFBurn injury is one of the challenging cases in medical practice, which need comprehensive and multidiscipline management. Pain management is one of an important factors in caring for the burn patient. Pain management in burn injury is challenging and the patient may be at risk for undertreatment. Undertreated severe acute pain can lead to adverse consequences of many organ systems, delay recovery and discharge process, and potentially lead to chronic pain. Reports of inadequate pain relief persist, although there are advances in the acute pain management in recent years.An understanding of pain pathway can achieve effective burn injury pain management, types of pain in burn injury, analgesics selection, continuous and accurate assessment of the pain and the response to therapy, dose adjustment to achieve maximum effect and minimal side effect, and role of nonpharmacological treatment as a complement to medication. Acute pain service plays an important role in providing effective burn injury pain management for reducing morbidity and mortality
INCIDENCE AND RISK FACTOR OF ACUTE KIDNEY INJURY POST OPEN HEART SURGERY IN PAEDIATRIC PATIENTS
Get PDFIntroduction: Acute Kidney Injury (AKI) was a frequently complication after open heart surgery, especially in paediatric patients < 2 years old and had been related with increased mortality and adverse renal outcomes. This study aimed to know the incidence of AKI post open heart surgery in paediatric patients and its relation with duration of cardiopulmonary bypass (CPB) and patient’s age in Indonesia tertiary national hospital.Methods: This was a cohort retrospective study, using medical record and Cardiac ICU chart data, of 195 paediatric patients who underwent open heart surgery from June 2014 - June 2015 in Integrated Cardiovascular Center Cipto Mangunkusumo hospital. After ethical approval from Research Ethic Committee, data were collected and sorted by inclusion and exclusion criteria. AKI was diagnosed based on RIFLE criteria. Data were analyzed by chi-square and multivariate analysis (SPSS software 22.0 version).Results: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB > 60 min had a significant correlation with increased incidence of AKI (p 0.043; RR 1.248). Patient’s age ≤ 2 years old also had a significant correlation with increased incidence of AKI (p<0.001; RR 2.431). Multivariate analysis results showed that both duration of CPB > 60 min and patient’s age ≤ 2 years old were significant risk factors of AKI (OR 2.951, OR 5.371).Conclusion: Incidence of AKI post open heart surgery in paediatric patients was 36.4%. Duration of CPB duration > 60 min and patient’s age < 2 years old were significant risk factors of AKI
SURGEONS BEHAVIOR TOWARD PROPHYLAXIS ANTIBIOTICS IN SANGLAH HOSPITAL
No full text Background: The emergence of antibiotic resistance is a complicated problem due to many factors, especially its use and abuse. Inappropriate use of antibiotics is very common in both developed and developing countries. The goal of this study was to see the knowledge of the surgeons toward prophylaxis antibiotic at Sanglah Hospital.Methods: This is a descriptive study of 55 surgeons who performed elective surgery at Sanglah Hospital. A questionnaire was filled by the surgeons randomly without prior notice about the study. The information about their behavior toward prophylaxis antibiotics was gathered from medical record of the day.Result: Out of the 55 surgeons participated in this study, 85.5% have followed a training on rational antibiotic use. The level of knowledge about factors that can increase surgical wound infections is quite good (94.4%), while the knowledge regarding factors that can reduce surgical wound infections very low (16.4%). Almost all (92.7%) clean-surgery patients were given prophylactic antibiotics. The most given antibiotic was ceftriaxone (72.7%), the third generation of cephalosporins.Conclusion: The mean knowledge of the surgeons toward antibiotic prophylaxis was 59.8%. The most used antibiotic as pre-surgical prophylaxis was ceftriaxone. And the time of administration for prophylaxis antibiotic was 16-60 minutes prior to surgical incision
ANESTHESIA MANAGEMENT OF ESOPHAGEAL ATRESIA REPAIR SURGERY: A CASE REPORT
No full textABSTRACTEsophageal Atresia (EA)is a congenital anomaly commonly found with TracheoesophagealFistula (TEF) of neonates in the first week oflife. This anomaly can cause several complications includingaspiration, reduction in respiration, and other complication from other concomitant congenital anomaly, mostly from heart origin. The treatment for this anomaly is surgery.Intraoperatively, thepatient may develop hypoxia due to lung retraction and hemodynamic instability from bleeding or hypothermia. Anesthesiologists play important role in the management of EA during theperioperative period. Careful examination of the preoperative period must be done to discover any other concomitant anomaly and complication. Good anticipation of any complication during surgery and continuous monitoring post surgery can elevate the prognosis of the patient
LOW DOSE SPINAL ANESTHESIA FOR CESAREAN SECTION IN GRAVIDA WITH RHEUMATIC HEART DISEASE
No full textCardiac disease in pregnancy remains an important etiology of maternal and fetal morbidity and mortality.1 Mitral stenosis is the most commonly acquired valve lesion encountered in pregnant women and is almost invariably caused by Rheumatic Heart Disease (RHD).1 Pregnancy and peripartum period represent a physiologic burden that may worsen symptoms in even moderate degrees of cardiac disease.1 Consequently, many women are first diagnosed with cardiac disease during pregnancy.1 In this case report, we describe peripartum management of a 38 years old woman with Congestive Heart Failure functional class II, severe Mitral Stenosis, moderate Mitral Regurgitation, moderate Tricuspid Regurgitation because of Rheumatic Heart Disease. She successfully underwent cesarean section in low dose spinal anesthesia using 7 mg hyperbaric bupivacaine intrathecally. This report highlights that low dose spinal anesthesia remains a good option in anesthesia management for cesarean section in gravida with rheumatic heart disease, especially with severe mitral stenosis.
DEXMEDETOMIDINE PROVIDES BETTER HEMODYNAMIC STABILITY COMPARED TO CLONIDINE IN SPINE SURGERY
Get PDFIntroduction: Spine surgery presents a number of challenges to the anesthesiologist. The α2 adrenergic agonist drugs are commonly used in such cases to provide hemodynamic and sympathoadrenal stability. Dexmedetomidine (DEX) is one of the most potent and highly selective α2-adrenergic receptor agonists. Another α2 adrenergic agonist drug that is used widely is clonidine. The study aims to compare both drugs in terms of hemodynamic stability in spine surgeries.Patients and Methods: 30 patients underwent spinal surgery were classified into one of the following group: DEX group (received DEX 1 mcg/kg in 10 minutes followed by 0.5 mcg/kg/hour during the course of the surgery) or CLO group (received clonidine 1 mcg/kg in 10 minutes followed by 1 mcg/kg/hour during surgery), by consecutive sampling. All other treatments and medications were similar in both groups. The systolic and diastolic blood pressure, mean arterial pressure, and heart rate were recorded every 5 minutes. Data was then analyzed by SPSS.Result: The patients in the DEX group had a better mean arterial pressure (p=0.002) and heart rate (p=0.018) stability compared to those in the CLO group.Conclusion: The administration of dexmedetomidine provides a better hemodynamic stability compared to clonidine in patients underwent spinal surgery