Bali Journal of Anesthesiology (BJOA)
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COMBINE MIDAZOLAM-FENTANYL-KETAMIN FOR EVISERATION SURGERY IN PATIENT WITH MULTIDRUG ALERGY IN ACUTE ON CHRONIC EXCACERBATION OF HIPERSENSITIVITY REACTION
No full textABSTRACTMultidrug Alergy is a relatively rare imunology abnormality. Generally, it caused by congenital genotype and influence with environment. After treated the acute on chronic exacerbation of hypersensivity tipe 1, and the inflamation can alleviate, the patient schedule of eviseration oculi dextra with general anesthesia. And the opthamologist curious about the proceddure because eviseration need antibiotic to wash the oculi, but there are no antibiotic saved for the patient. For general anesthesia, the patient has no history so we can’t predicted about the anesthetic drug’s allergy. We choose combine ketamine-midazolamadn fentanyl to facilitate the anesthesia. Ketamine significantly reduces the production of inflammatory cytokines without affecting the production of anti-inflammatory cytokines. Fentanyl is the opioid which is the most rarely caused allergy and have strong potential. Midazolam can help the sedatio
Low Flow Practice for Laparoscopic Colorectal Surgery in Pediatric Patients
No full textLow flow anesthesia and laparoscopic technique in pediatric patients are kinds many kind of modern medical field development. Both technique were made to support environment friendly, safety, and comfortable anesthesia practice for patients. In three cases presented in this case series, laparoscopy was done in all three cases (two digestive cases, and one urology case). All three cases performed with general anesthesia by low flow anesthesia technique with volatile sevoflurane combined with caudal block regional anesthesia. In all those cases, no morbidity was found after anesthesia or operation that influence in patient’s outcome. Improvement in outcome of pediatric patients was seen with low flow anesthesia technique, which are significant reduction of volatile used, faster wake up time, and reduction of agitation condition after anesthesia
Leadership in anesthesiology: not just a one man show
Get PDFAnesthesiology had been one of highly skilled professional specialty with diversity of training but with a structured model of leadership culture. The culture which could be drawn back since medical training to become a medical doctor. School of medicine had already established a standard model of teaching and training. The tutoring method is implemented mostly based on classroom meetings in traditional basic lesson, bedside teaching for clerkship and internship and lately adopted method of case-based discussio
SPONTANEOUS RUPTURE OF ARTERIOVENOUS MALFORMATION: ICU BASED BRAIN RESUSCITATION
Get PDFArteriovenous 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
Programmed intermittent epidural bolus improves efficacy of patient controlled epidural analgesia in postoperative pain management
Get PDFBackground: Postoperative acute pain will have negative impacts if not handled properly so it must be treated effectively. Patient Controlled Epidural Analgesia (PCEA) allows the patient to have an active role in determining the need of analgesia personally. Programmed Intermittent Epidural Bolus (PIEB) is a new method which proven better than Continuous Epidural Infusion. Ropivacaine has similar characteristic to Bupivacaine but with minimal cardiotoxic effect. Fentanyl as an adjuvant can accelerate the onset of action of local anesthetics in epidural analgesia. The purpose of this study was to compare the efficacy of PCEA+PIEB with PCEA as a modality of postoperative analgesia. Methods: Total 54 patients undergoing major surgery of the abdomen and lower extremities were divided into 2 groups randomly: PIEB+PCEA and PCEA. Then we did an evaluation of VAS, PCA demand, and total consumption of solution Ropivacaine 0.1% + Fentanyl 2 mcg/mL at 4 hours, 8 hours, and 24 hours postoperative. Results: VAS at resting and at moving in both groups were found clinically comparable, although statistically, VAS at moving at 4 hours and 24 hours postoperative were lower in PCEA+PIEB group (p < 0.01). PCA attempted and PCA given were lower in PCEA+PIEB group (p ≤ 0.05). Total consumption of solution until 8 hours postoperative was comparable in both groups but at 24 hours postoperative it was much greater in PCEA+PIEB group (p < 0.01). Conclusions: PCEA+PIEB have greater efficacy than PCEA. VAS (at resting and at moving), PCA attempted, and PCA given were lower in PCEA+PIEB group. Total consumption of solution RopivacaineFentanyl until 8 hours postoperative was comparable, but at 24 hours postoperative it was much greater in PCEA+PIEB group. In orthopedic surgery, VAS at resting was obtained below 30 mm in PCEA+PIEB group but VAS at moving was obtained in the category of moderate pain in both groups
Establishing good rapport in anesthesiarelated doctor-patient communication: bridging the triangular communication between anesthesiologist-surgeon-patient
No full textDoctor-patient communication is central in clinical practice. Communication skill has been an essential component of clinical competence to become a five-star doctor. In the other hand, there are major problems in doctor-patient communication that would lead to medical disputes even malpractice suspicions. With effective communication, a definitive theory would turn into high-quality medical practice and improve patient safety and satisfaction to a whole new level. Based on the Calgary-Cambridge observation guide, there is five point plan of tasks that embrace doctor and patient in daily interviews starting from initiating the session, gathering information, building the relationship, explanation, and planning, and closing. Those tasks would have been easily introduced when you are dealing with a good healthy patient. But in anesthesia-related, wide range of patients are met in different settings and condition
Anesthesia on Pediatric Laproscopy
No full textLaparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patient's age, cardiovascular function, and anesthetic agents are used. Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by insufflation gas or penetration laparoscopic and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery
Safety Timeout for Local Anesthetics and Regional Anesthesia
No full textOur anesthesia practices are always based on patient safety in WHO surgical and anesthesia guidelines. Those guidelines are interpreted in checklists and protocols that could be applied in daily routine in every standard operating theaters. A surgical patient would be notified and identified during the surgery by all member of the operating room including the anesthesiologist through a specialized checklists which was called a safety surgical checklist usually done in the preparation room, signing in, 5 minutes for timeout before the incision, and the last sign out before closure stitching. Anesthesia conduct and monitoring is viewed as a part of the whole surgery practice.The safety timeout that has been elaborated in ASRA Regional Block Pre-Procedural Checklist is one important thing that needs to be encouraged and confirmed every time an anesthesiologist is getting ready to do a regional anesthesia. The safety timeout is useful as a quick reminder for operating theater personnel especially anesthesiologist and the nurse anesthetists to do a double check and reassessment on patient condition, drug and adjuvant choice, labels, and other implicating factors. There are many contributing factors that could induced emergency and crisis situations in regional anesthesia conduct, and the safety timeout is an alternative way to eliminate and trace those factors in an appropriate way
Central Venous Pressure Correlates with Inferior Vena Cava Collapsibility Index in Patient Treated in Intensive Care Unit
No full textBackground: Intravascular volume status is an important parameter in monitoring the patients treated at intensive care unit (ICU), so accuracy and strict monitoring of fluid volume is one factor that influence patient’s health status. Amongst others, two ways to monitor body fluid volume status is central venous pressure (CVP) and collapsibility index of inferior vena cava (IVC) diameter. The purpose of this study is to determine the correlation between CVP with the IVC collapsibility index in patients treated in ICU Sanglah Hospital in Denpasar. Method: Seventy patients treated at Sanglah Hospital ICU with already inserted CVC for appropriate indication, were measured for CVP, then followed by examination the diameter of IVC with ultrasound to measure the maximum and minimum collapsibility index. Spearman’s correlation coefficients was used to assess the correlation between CVP and collapsibility index of the IVC. Results: In 70 patients, we found a very strong negative correlation between CVP and IVC’s collapsibility index (Spearman's rho = -0.854; p <0.001). Conclusion: This study found that there is a very strong negative correlation between CVP and collapsibility index of IVC. This finding indicates that the collapsibility index of the IVC may substitute CVP in determining the status of the intravascular volume
REGIONAL ANESTHESIA IN MOLAR PREGNANCY WITH THYROTOXICOSIS IN A REMOTE HOSPITAL
Get PDFHydatidiform 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.