Indonesian Journal of Anesthesiology and Reanimation

Journal Information
ISSN / EISSN : 2722-4554 / 2686-021X
Published by: Universitas Airlangga (10.20473)
Total articles ≅ 44
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Purwoko Purwoko, Bambang Novianto Putro, Arif Zuhal Amin Hananto
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 1-5; https://doi.org/10.20473/ijar.v4i12022.1-5

Abstract:
Introduction: Burn injury impairs almost every organ system, which causes significant morbidity and mortality. Meanwhile, the phases included in burn healing are inflammation, cell recruitment, matrix deposition, epithelialization, and tissue remodeling phase. Previous studies showed that snakehead fish and sea cucumber extract have these effects and are beneficial in burn and post-surgery wounds. Objective: This study aims to analyze the effect of snakehead fish and sea cucumber extract supplementation towards mast cell infiltration, IL-6, and albumin level in burn and post-surgery wounds. Materials and Methods: A double-blind randomized control trial was carried out at Dr. Moewardi Hospital Surakarta in November 2017 on 30 subjects, which were divided into 2 groups. Mast cell infiltration was observed on burn and post-surgery wounds colored with Toluidine Blue, while IL-6 and albumin were measured -blood, where both groups had comparable basic characteristics. Results and Discussion: There was a statistically insignificant (p=0.835) higher increase in albumin level in the treatment group, while an insignificant (p=0.056) greater decrease also occur in the IL-6 level. The decrease in cell mast infiltration after treatment was also higher and not statistically significant (p=0.526). Previous studies showed that amino acids from snakehead fish play an important role in wound healing. Meanwhile, high EPA content in sea cucumber is due to its ability as an Echinodermata to regenerate tissue. It was also discovered that the results available about sea cucumber and sea snake extract on wound healing are different based on the skin condition after the use of the extracts. Conclusion: Snakehead fish and sea cucumber extract supplementation can increase albumin level, decrease IL-6 level and mast cell infiltration in burn or post-surgery wounds.
Rama Azalix Rianda, Bambang Pujo Semedi, Agus Subagjo, Yoppie Prim Avidar
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 14-21; https://doi.org/10.20473/ijar.v4i12022.14-21

Abstract:
Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a scoring system to predict mortality risk after cardiac surgery. EuroSCORE II was introduced to replace and show superiority over EuroSCORE I which tends to overestimate the risk of heart surgery procedures and have a low discrimination ability. Meanwhile, this is the first study to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Objective: This study aims to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Materials and Methods: This is a retrospective study using medical records of CABG patients in Dr. Soetomo General Academic Hospital from January 2016 to December 2017. Results and Discussion: Out of 39 Patients who have performed CABG surgery, most were male (89.7%) with the highest age range of 46-65 years (59%). Deceased patients had an average EuroSCORE II of 22.36% and SD±26.97%7%, while 27 patients who survived had an average EuroSCORE II of 6.78% and SD±6.4%. Based on morbidity assessment, EuroSCORE II only accurately predicted the risk of kidney failure and did not properly assess the length of inotropic use, vasopressors, hospitalization time, the risk of arrhythmias, low cardiac output syndrome, Durante-operative bleeding, and the need for blood transfusion. These inaccuracies occurred because the samples that were included varied based on their standard deviation and pattern-less graph. Conclusion: EuroSCORE II is inadequate to predict morbidity and mortality in postoperative patients, therefore, it is considered less effective.
Mahendratama Purnama Adhi, Arie Utariani, Lucky Andriyanto
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 37-46; https://doi.org/10.20473/ijar.v4i12022.37-46

Abstract:
Introduction: The management of conjoined twins requires multidisciplinary teamwork. The complex problems in conjoined twin separation surgery are challenging for anesthesiologists without experience in the management of conjoined twins. Objective: To describe anesthetic management and utilization of teleanesthesia in conjoined twin separation surgery. Case Report: Sixty days-old pygopagus type conjoined twins, with a total body weight of 7030 grams. Both babies looked healthy, moved actively, found no respiratory function disorders, were hemodynamically stable and had no congenital abnormalities. The sacral region's computerized tomography scan (CT-scan) reveals conjoined twins with skin unification and subcutaneous in the perianal region and no internal-vertebral-spinal fusion. Two anesthesia teams performed the management of anesthesia. After confirming there was no cross-circulation with the atropine test, we alternately induced anesthesia by inhalation technique while maintaining spontaneous breathing. Anesthesia was maintained with sevoflurane 2.0-3.0 vol%, in a mixture of oxygen and air with a flow of 4 L/min using Jackson Reese. Circulating volume, hemodynamic stability, and normothermia were maintained intraoperatively. The separation surgery lasted 20 minutes, and the total surgical time for each baby was two hours. Awake extubation was performed immediately after the surgery was complete. Both babies underwent postoperative care at the PICU and were discharged on day 11. During the pre-operative for surgery, the local team conducted telemedicine consultations with the pediatric anesthesia team at Dr. Soetomo hospital and performed intra-anesthesia telementoring. Conclusion: Careful preparation and pre-operative evaluation, proper intra-anesthesia maintenance and monitoring, as well as good communication and teamwork, are keys to successful anesthesia management in conjoined twin separation surgery. Consultation and assistance from an experienced team during surgery using teleanesthesia are significantly beneficial to the anesthesiologist without experience in conjoined twin separation surgery.
Inge Andriani, Arie Utariani, Hamzah Hamzah
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 22-36; https://doi.org/10.20473/ijar.v4i12022.22-36

Abstract:
Introduction: IL-1β and IL-6 are cytokines that have major roles in cytokine storms and endogenous pyrogens. Several studies have also displayed the effectiveness of IL-1β inhibitors in COVID-19 patients in minimizing severity and mortality. Objective: This study aims to analyze the correlation between IL-1β and body temperature with ARDS severity and mortality in COVID-19 patients. Materials and Methods: This is an analytical observational study with a prospective cohort design. A total of 54 patients have met the inclusion criteria from July to September 2020. This study mainly applied the Spearman-Rho, Mann Whitney, free sample T2 test, and Chi-Square test. Results and Discussion: The correlation between body temperature and IL-1β levels in COVID-19 patients with ARDS did not show a statistically significant difference towards mortality and ARDS severity, as shown by the p-value > 0.05 in the analysis tests of each of the variables studied. Nonetheless, the occurrence of ARDS (p = 0.022), the severity of ARDS (p = 0.001), application of mechanical ventilation (p = 0.00), secondary infection (p = 0.00), and length of stay (p = 0.042) were found to be statistically significant towards COVID-19 patients’ mortality. Conclusion: Body temperature does not correlate with the occurrence of ARDS, the severity of ARDS, mortality, and IL-1β levels. IL-1β levels and transformation in IL-1β levels also do not correlate with mortality as well as the occurrence and severity of ARDS, but the use of mechanical ventilation, secondary infection, and length of stay were correlated with mortality in COVID-19 patients.
Mirza Koeshardiandi, Zulfikar Loka Wicaksana, Bambang Pujo Semedi, Yoppie Prim Avidar
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 47-54; https://doi.org/10.20473/ijar.v4i12022.47-54

Abstract:
Introduction: Coronavirus disease-19 (COVID-19) has become a pandemic that is still ongoing today. This is a new challenge for health workers in handling emergency cases. Several COVID-19 patients arrived at the hospital with severe respiratory problems. Meanwhile, other pathological conditions causing respiratory failure must also be considered, such as pneumothorax. Objective: This study aimed to examine the effective emergency procedures to treat COVID-19 cases with tension pneumothorax. Case report: A 45-year-old male patient arrived with a referral letter from a pulmonologist with a diagnosis of simple pneumothorax and pneumonia. The patient also presented a positive SARS COV-2 PCR test result. The patient complained about a worsening of shortness of breath. A symptom of dry cough for 14 days was also reported. Chest radiograph examination subsequently indicated right tension pneumothorax. In the emergency ward, needle decompression procedure connected to the vial containing sterile intravenous fluids was performed. Re-examination of the chest x-ray demonstrated right pulmonary re-expansion. The patient was monitored and after four days, needle decompression was removed and no chest tube was inserted because complete resolution of the lungs had occurred. Discussion: This case illustrates that tension pneumothorax causes worsening of the patient's condition with COVID-19 diagnosis. In another case of tension pneumothorax in a COVID-19 patient, needle decompression of the 2nd intercostal space and the mid-clavicular line was performed as initial treatment followed by chest tube insertion as definitive treatment. However, in this case, chest tube approach was not carried out because the patient had demonstrated clinical and radiological improvement and a worsening condition had not occurred. Conclusion: Prolonged needle decompression connected to a vial containing sterile intravenous fluids as deep as 2 cm from the water surface is an effective procedure in the management of tension pneumothorax even without the installation of a chest tube.
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 55-61; https://doi.org/10.20473/ijar.v4i12022.55-61

Abstract:
Introduction: General anesthesia in experimental animals is not limited in the field of anesthesia research. In Indonesia, ventilators and breathing circuit systems utilized in research involving anesthesia in rats are not widely available. The limitations in using ventilators and breathing circuit systems in research are one of the reasons why Indonesia is lacking complex and advanced animal experimental studies. Objective: This study aimed to examine a general anesthesia procedure for intubation in rats using tools and materials commonly discovered in clinical settings. Method: A search on the PubMed database using keywords consisting of animal study, rats, anesthesia, breathing circuit was performed. Review and Discussion: An endotracheal tube insertion procedure may utilize a Miller size 0 laryngoscope, while the endotracheal tube may use a 16 G intravenous cannula in which the needle is replaced by a small wire. The 3-way stopcock system may be considered as a replacement for the Mapleson E system for the breathing circuit system. The Fresh Gas Flow (FGF) source needs to be connected to the angled port, while the other two ports are connected to the reservoir and the intravenous cannula which would be delivered to the experimental animals. FGF three to five times as much as the minute ventilation may be used and the use of a reservoir capacity is similar to the tidal volume of spontaneous ventilation. Therefore, the oxygen flow rate is set to approximately 1-1.5 L per minute. A reservoir is not required for controlled ventilation. Conclusion: The use of a 3-way stopcock as a non-rebreathing circuit system is effective because it utilizes the similar principle as Mapleson E. The ability to use common tools and materials for general anesthesia procedures would significantly boost research of animal models in Indonesia to a further level.
Ghuraba Adi Surya, Kun Arifi Abbas
Indonesian Journal of Anesthesiology and Reanimation, Volume 4, pp 6-13; https://doi.org/10.20473/ijar.v4i12022.6-13

Abstract:
Introduction: Acute Kidney Injury (AKI) is a significant cause of morbidity and mortality following common cardiac surgery. The most common cardiac surgery performed at Dr Soetomo General Academic Hospital Surabaya is coronary artery bypass grafting (CABG). Along with the increasing number of these procedures performed on subjects, Cardiopulmonary Bypass (CPB) has also grown in popularity, which is frequently associated with postoperative AKI. Objective: To investigate the incidence of postoperative AKI in subjects who had undergone a CABG procedure using the CPB technique. Materials and Methods: A retrospective study was conducted at Dr. Soetomo General Academic Hospital in Surabaya. All subjects who had CABG with CPB in 2019 were included in the study. The incidence of AKI was determined by comparing the creatinine serum level before and after surgery on days 0, 1, 2, 3, and >3 according to the AKIN criteria. Results and Discussion: The 68 subjects who underwent the CABG with CPB procedure were made up of 53 males (77.9%) and 15 females (22.1%). The average age of the subjects was 58.209.07. This study included 63 subjects (five subjects could not be evaluated due to incomplete data), and AKI was diagnosed in 44 of them using the AKIN criteria (69.8%). Postoperative AKI was reported in 14 subjects (22.2%) on day 0, 18 subjects (28.6%) on day 1 post-operation, and the same number of 6 subjects (9.5%) on day 2 and day 3 post-operation. None of them had AKI after the third post-operative day. Conclusion: More than 50 % of cases of post-CABG Acute Kidney Injury (AKI) occur at Dr. Soetomo General Academic Hospital, with the majority occurring on the first day after surgery.
Akhyar Nur Uhud, , Lucky Andriyanto
Indonesian Journal of Anesthesiology and Reanimation, Volume 3, pp 81-90; https://doi.org/10.20473/ijar.v3i22021.81-90

Abstract:
Introduction: NRSD (Neonatal Respiratory Distress Syndrome) is one of the most frequent causes of newborns in intensive care (NICU). Several NICU centers are now using the High Flow Nasal Cannula (HFNC) in recent years. With the use of HFNC as a breath aid in preterm infants, HFNC had the same efficacy ratio as nasal Continuous Positive Airway Pressure (CPAP) (continuous or intermittent). Case Report: A three-day-old baby boy was admitted to anesthesia with respiratory failure due to grade II HMD with suspicion of congenital heart failure. The initial condition showed that a respiratory rate of 70-80x / minute, breathing of the nostrils and retractions in the intercostals and abdomen with 85% post ductal SpO2 with the help of a CPAP mask (Pinsp 10, Fio2 70%). There was a Ronchi sound in the right and left basal lungs, and hemodynamics obtained a pulse of 180-195x / minute, non-invasive blood pressure 95/34 mmHg (54), heart murmurs were not found. During day 1 - day three, the patient uses a CPAP mask until the patient vomits and being consulted to an Anesthesiologist. On day 3 - day seven, the patient uses HFNC; after day seven until day 10, the patient uses neonatal nasal canularis oxygen. Until day 10, the patient is still being treated at the NICU by administering oxygen 0.5 liters/minute with SpO2 ranging from 93-96% with stable conditions but still needing oxygen. Conclusion: The use of Modified High Flow Nasal Cannula (HFNC) in preterm infants with Neonatal Respiratory Distress Syndrome (NRSD) is more effective and efficient than CPAP. The use of HFNC was associated with a lower incidence of nasal trauma and pneumothorax than nasal CPAP.
Christya Lorena, Hamzah Hamzah, Maulydia Maulydia
Indonesian Journal of Anesthesiology and Reanimation, Volume 3, pp 54-61; https://doi.org/10.20473/ijar.v3i22021.54-61

Abstract:
Introduction: Intubation mistakes, such as ETT malposition, will result in serious complications. Endobronchial intubation can cause pneumothorax and contralateral lung collapse (atelectasis). On the contrary, superficial ETT could increase the risk of being released easily, leading to desaturation or even cardiac arrest. A shallow ETT position could cause the compression of the vocal cord and laryngeal nerve by ETT's cuff. An optimal position can be reached if the cuff position is 1.5-2.5 cm under the vocal cord and the tip is 3-5 cm above the carina. Several methods of ETT depth measurement based on airway length data can be an alternative, especially during the COVID-19 era, where the use of a stethoscope to check ETT depth is limited. Objectives: To analyze the accuracy of ETT depth placement using Chula and MSJ formula. Methods and Material: We conducted the prospective comparative analytic research on 50 patients who had elective surgery in GBPT operating room at Dr. Soetomo Hospital Surabaya. The research data during the intubation and FOL (Fyber Optic Laryngoscope) from each patient were height, MSJ length, initial ETT length, the distance of carina-ETT tip, the distance of cuff-vocal cord, and final ETT length. Result and Discussion: In the Chula formula group, the average patients' height was 160.60cm ± 9.738 for men and 157.76 cm ± 8.604 for women. The average MSJ length was 20.28 cm. The application of the Chula formula is more accurate because ETT revision was carried out in only 8.0% of the samples, with an average revision is 0.04. On the other hand, the ETT revision with an average of 0.868 on the MSJ formula group was conducted in 84% of the samples. This research also found a linear correlation between increasing ETT depth and body height. Conclusion: Applying the Chula formula to measure the ETT depth for Indonesian (Javanese) people is more appropriate than the MSJ formula.
Cindy Aprilia Eka Prasanty, Arina Setyaningtyas, Arie Utariani
Indonesian Journal of Anesthesiology and Reanimation, Volume 3, pp 39-45; https://doi.org/10.20473/ijar.v3i22021.39-45

Abstract:
Introduction: Respiratory failure is the respiratory system’s inability to maintain its gas exchange functions, oxygenation, and carbon dioxide elimination. Infant and children are more susceptible to develop respiratory failure. Respiratory failure can also be caused by several diseases/conditions, which is a common reason for pediatrics to be admitted to the intensive care unit. Objective: This study aims to describe patients’ demographic and clinical profile with respiratory failure at the PICU of Dr. Soetomo General Hospital, Surabaya. Materials and Methods: This is a prospective study with the descriptive method using the medical records of patients with respiratory failure who were admitted to the PICU from September 2019 to February 2020 and had arterial BGA data (PaCO2, PaO2), which were examined in the PICU or resuscitation room before the patients were admitted to the PICU. Results: This study showed that out of 35 patients, 24 (68.6%) were female, 19 (54.3%) were <1 year old, and 20 (57.1%) had normal nutritional status. Type I (hypoxemic) and type II (hypercapnic) respiratory failures were found in 13 patients (37.1%), respectively. The most common clinical signs were fever in 26 patients (74.3%), shortness of breath in 24 patients (68.6%), and chest retraction in 24 patients (68.6%). The primary diagnosis that commonly occurred was respiratory system disorders in 15 patients (42.9%). The other diagnosis that mainly occurred was nutrition and metabolic disorders of 19 patients (54.3%). The patients' outcome was that 24 patients were survived (68.6%), and ten patients died (28.6%). Conclusions: Various clinical signs and diagnoses can be found in patients with respiratory failure at PICU. The most common respiratory failure types are type I (hypoxemic) and type II (hypercapnic) respiratory failure.
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