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Journal of Anaesthesia and Pain
Number of Followers: 13  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2722-3167 - ISSN (Online) 2722-3205
Published by Universitas Brawijaya Homepage  [10 journals]
  • Perioperative Application of 2% Lidocaine

    • Authors: Fitri Hapsari Dewi, Andy Nugroho, Fandi Ahmad Muttaqin
      Pages: 26 - 30
      Abstract: Perioperative intravenous lidocaine (IVL) can help minimize opioid-related side effects that impede the postoperative recovery process. Neurological side effects were averaged at an 8 mg/kg dose, and cardiotoxicity side effects were reported at plasma values greater than 21 g/ml. Approximately 90% of lidocaine is converted to monoethylglycinexylidide (MEGX) in the liver via oxidative demethylation (dealkylation). Analysis of MEGX concentrations after lidocaine administration can be a method used to evaluate liver function. Perioperative intravenous lidocaine lowers discomfort, nausea, the duration of ileus, the need for opioids, and the length of time spent in the hospital after surgery. During injection, low blood concentrations can result in these symptoms, which may last for several hours or days after termination. Postoperative problems, such as pain and organ failure, can be caused by anti-inflammatory and pro-inflammatory components. Analgesic, anti-inflammatory, and anti-hyperalgesic are just some of the other effects of lidocaine. It also decreases the volume of the airways and the rate of breathing, prolongs the duration of exhalation, reduces the respiratory rate and tidal volume, also causes vasoconstriction at low concentrations and vasodilation at high concentrations. In clinical applications, lidocaine can prevent propofol injection pain, improve postoperative recovery, and play a role in various surgical procedures. Perioperative IVL application is proven to provide more benefits in various surgeries compared to other available anesthetic options. Very few studies have systematically analyzed the occurrence of side effects, and the quality of evidence is low. 
      PubDate: 2022-05-31
      DOI: 10.21776/ub.jap.2021.003.02.01
      Issue No: Vol. 3, No. 2 (2022)
       
  • C-Section in Uncorrected Ventricular Septal Defect and Pulmonary
           Hypertension Management in Anesthesia Perspective

    • Authors: Rizki Fitria Febrianti, Robertus Theodorus Supraptomo
      Pages: 31 - 33
      Abstract: Background: Pregnancy with cardiac defects and pulmonary hypertension happen 0.2% to 3% and is correlated with valuable hemodynamic burden due to cardiocirculatory changes which becomes a remarkable indirect cause of maternal mortality and poor fetal outcome. Ventricular septal defect (VSD) is one of the most common forms of heart disease among pregnant women, meanwhile the VSD-specific pregnancy data are insufficient. This case report addresses the anesthetics management for patient with uncorrected ventricular septal defect and pulmonary hypertension.Case: A 30-year-old multigravida with 37 weeks of gestation weighing 52 kg referred elective cesarean section and tubal ligation. She was compos mentis with arterial oxygen saturation was 87-88% room air. A grade IV/VI systolic murmur was heard at the second intercostal space of the left midclavicular line and the punctum maximum at the fourth intercostal spaces of the left sternal border. She had cyanotic in all of her extremities and clubbing fingers. Other examination is within normal limit. Titrated epidural was given at L1-2 level with parenteral levobupivacaine and fentanyl used as an adjuvant. The patient was stable during the surgery. Both maternal and fetal had a good outcome. The patient was discharged at the 7th day after surgery.Conclusion: To achieve a good outcome from management of the high-risk obstetric patients requires multidisciplinary approach involving anesthetist, obstetrician, and cardiologist in planning and managing the case. 
      PubDate: 2022-05-31
      DOI: 10.21776/ub.jap.2022.003.02.02
      Issue No: Vol. 3, No. 2 (2022)
       
  • High Spinal Anesthesia in Total Knee Replacement

    • Authors: Febri Ahmad Belinda, Hery Budi Sumaryono
      Pages: 34 - 36
      Abstract: Background: Osteoarthritis (OA) is the most common degenerative disease at people aged 63-70 years. Human ageing is associated with an increase in weakness around the joints, decreased joint flexibility, calcification of cartilage, and decreased chondrocyte function. Total knee replacement (TKR) is performed to treat pain and immobilisation in osteoarthritis patients. This procedure is done with spinal anaesthesia.Case: A 73 years old man diagnosed with bilateral OA and underwent TKR. The patient had left knee pain six months ago with a history of high blood pressure. If blood pressure <160/90 mmHg subarachnoid block was planed. The patient entered the operating room with an intravenous (IV) line of ringer lactate 10 dpm. Preoperatively, the patient was given ranitidine 50 mg IV and ondansetron 4 mg. The anaesthetic agent was hyperbaric bupivacaine 0.5% 15 mg + fentanyl 25 µg; the patient was hemodynamically monitored and maintained with O2 4 lpm. After 45 minutes of spinal anesthesia, the patient experienced respiratory distress, so we placed a masked and intubated the patient with endotracheal tube (ETT) 7.0. It is suspected that the patient had high spinal anesthesia.Conclusion: A 73-year-old man has been subjected to regional spinal anesthesia with total knee replacement surgery. However, spinal anesthesia failed and was converted to general anesthesia with ETT, with a duration of operation of 4 hours, hemodynamically stable, postoperatively the patient was admitted to the high care unit.
      PubDate: 2022-05-31
      DOI: 10.21776/ub.jap.2022.003.02.03
      Issue No: Vol. 3, No. 2 (2022)
       
  • Dexmedetomidine for Awake Intubation Procedure in Subtotal Thyroidectomy

    • Authors: Riandini Pramudita Riyanti, Paramita Putri Hapsari
      Pages: 37 - 40
      Abstract: Background: Giant struma makes airway management difficult for the anesthesiologist due to the risk of tracheal intubation failure. Awake fiberoptic intubation(AFOI) is the gold standard in the management of a predicted difficult airway. Giving analgesia and sedation can facilitate operator and patient comfort during the awake intubation procedure.Case: We report the case of a 63-year-old woman with a giant struma who was planned for a subtotal thyroidectomy. We provide ondansetron and dexamethasone premedication, analgesia and sedation using dexmedetomidine, propofol induction, muscle relaxant atracurium, with maintenance anesthetic sevoflurane. Dexmedetomidine was administered on loading dose 0.8 µg /kg/hour in the first 10 minutes then continue on analgesia dose 0.2 µg /kg. During the AFOI procedure, 100% oxygenation was given with the patient's hemodynamic range, namely systolic blood pressure of 110-131 mmHg, diastolic blood pressure of 75-93 mmHg, heart rate of 77-91 beats per minute, and SpO2 of 98-100%. Postoperatively the patient was transferred to the Intensive care unit (ICU) with an endotracheal tube intube. Monitoring of postoperative complications such as production of thyroid crisis drainage and extubation 24 hours after surgery was confirmed by the cuff leak test.Conclusion: Giving dexmedetomidine is better than opioids in the AFOI procedure because of its minimal respiratory depressant effect. Maintaining hemodynamic stability during the AFOI procedure is very important to avoid hemodynamic fluctuations so it can minimize the risk of perioperative complications.
      PubDate: 2022-05-31
      DOI: 10.21776/ub.jap.2022.003.02.04
      Issue No: Vol. 3, No. 2 (2022)
       
 
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