Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.
Currently, continuous epidural anesthesia was one of the regional anesthesia technique used on daily anesthesia practice. It could be used for single anesthesia on surgery, adjuvant of general anesthesia, pain management of post surgery and chronic pain management of malignancy. One of the problems faced on continuous epidural procedure was migration of epidural catheter out from epidural space. In the beginning catheter was placed on epidural space and confirmed by Loss of Resistance (LOR) technique, hanging drop, or by ultrasonography. Due to many factors, epidural catheter could migrate from the place that should be. This surely affected the effectivity of anesthesia from epidural technique itself, and became fatal if a certain amount of local anesthesia regiment entered to other spaces through the catheter which previously moved to subarachnoidea space, intravascular, or subdural space. Migration of catheter could be caused by malposition on placement or patient's movement, and increased of epidural space pressure. Thus, it's important for anesthesiologist to know what factors that would increase the risk of epidural catheter migration and how to prevent and manage the complication that could happen. ABSTRAKEpidural kontinyu saat ini merupakan salah satu satu tekhnik regional anestesia yang mulai sering digunakan dalam praktek anesthesia sehari-hari. Dapat digunakan untuk anestesia tunggal dalam pembedahan, adjuvan anestesia umum, manajemen nyeri paska operasi serta menajemen nyeri kronis pada pasien keganasan. Salah satu permasalahan yang banyak dihadapi pada prosedur epidural kontinyu adalah kejadian migrasi kateter epidural keluar dari ruang epidural. Kateter pada awalnya telah berada di rongga epidural dan telah dikonfirmasi dengan teknik Loss of
Background: An aneurysm may be a true aneurysm or a pseudoaneurysm. Pseudoaneurysm is defined as a defect in the arterial wall, making a connection between the lumen and the extraluminal space. The main etiology of brachial artery pseudoaneurysm is incidental arterial puncture during venous cannulation for hemodialysis. Case:: Anesthetic management was performed on a female patient 56 years old, body weight 45 kg, height 150 cm. The patient had other comorbidities such as hypertension, diabetes mellitus, chronic renal kidney with a diagnosis of left brachial pseudoanuerysm. Pro Pseudoanurysm repair surgery. The anesthetic technique uses axillary peripheral nerve block with ultrasound guiding. The duration of surgery is ± 120 minutes. After the operation, the patient was treated in the hospital ward. Conclusion: Choosing the most appropriate anesthetic technique for patients with renal impairment is necessary to maintain normovolemia and normotension in order to avoid unexpected complications. Using regional anesthetic technique for sympathetic nerve block may be favorable in these patients. With ultrasound guiding, the incidence of failure is lower, the time required is shorter, the latency is shorter, the blockade is longer, and the risk of accidental vascular puncture is lower so that vascular lesions are less likely.
Nyeri pada saat penyuntikan jarum epidural menjadi kekurangan terhadap aplikasi tindakan epidural. Tujuan penelitian ini adalah mengetahui perbedaan efektivitas pemberian EMLA 5% dibanding dengan etil klorida spray untuk mengurangi nyeri pada suntikan jarum epidural dengan skor visual analoge scale (VAS). Penelitian ini merupakan jenis penelitian eksperimental dengan pendekatan uji klinis dengan teknik single blind. Terdapat 30 subjek penelitian menjalani tindakan epidural di RSUD Dr. Moewardi Surakarta dengan status fisik ASA I dan II berusia 20–65 tahun. Sampel meliputi 10 subjek dengan pemberian EMLA 5%, 10 subjek etil klorida spray dan 10 subjek lidokain 2%. Setelah dilakukan randomisasi dilakukan pengukuran intensitas nyeri dengan skor VAS pada kedalaman jarum epidural 0,5–1 cm dan 1–4 cm. Hasil pemberian EMLA 5% memberikan hasil yang lebih baik terhadap nilai VAS saat penyuntikan jarum epidural dibanding dengan etil klorida spray, perbedaan tingkat nyeri ditunjukkan pada kedalaman jarum epidural 0,5–1 cm (p=0,006) dan 1–4 cm p=0,000 (p<0,05). Simpulan, pemberian EMLA 5% efektif mengurangi rasa nyeri pada suntikan epidural.
Background: The Transversus Abdominis Plane (TAP) block technique is one method for inhibiting abdominal pain stimuli by blocking afferent nerves in the abdominal wall via the Petit triangle. TAP block action is frequently performed as a postoperative procedure, such as in the case of hernia repair. The goal of using ultrasound in TAP blocks is to distribute the anesthetic agent accurately in the appropriate neurovascular plane. Case: A 66-year-old male geriatric patient with an incarcerated right inguinal hernia and a history of Hypertensive Heart Disease (HHD) was seen. The patient complained of right groin pain that spread to the right side of the abdomen. Based on the Electrocardiogram (ECG), atrial fibrillation was identified as slow ventricular response and Left Ventricular Hypertrophy (LVH). Chest X-ray revealed cardiomegaly with LVH configuration. ASA III E was assigned to the patient. Regional Anesthesia Subarachnoid Block (RASAB) was used to perform an emergency hernia repair using a regimen of Bupivacaine heavy 0.5% 7.5 mg with adjuvant Fentanyl 50 g. Bilateral TAP block administration using Ropivacaine regimen 0.25% of the total volume of 30 ml was given as postoperative analgesia management. Hemodynamic monitoring, complications and postoperative pain scale were carried out in the High Care Unit (HCU). Hemodynamically stable, pain scale was 1-2 at 24 hours postoperative and no complications. Conclusion: TAP block is provide an effective and safe anti-pain effect in patients undergoing hernia repair with geriatric comorbidities and a history of HHD, as well as to prevent cardiovascular complications and to speed up postoperative patient mobilization.
Background: Local anesthetics have been widely used over the past 50 years in many clinical practices, ranging from emergency departments to operating rooms. Local anesthetics systemic toxicity (LAST) is a life-threatening condition when the effects of local anesthetics reach the systemic circulation with an incidence of 0.03% or 0.27 incidence of 1000 episodes of Peripheral nerve block (PNB). Case: We report a 78-year-old male who underwent of remove of inplate (ROI) and open reduction internal fixation (ORIF) reconstruction. Preoperative physical examination revealed GCS E4V5M6, blood pressure 195/76, other vital signs within normal limits, SpO2 99% in the supine position. On examination of the lungs, there were increased bronchial breath sounds and rough crackles, especially in the 2-5 left intercostal space. Other physical and laboratory examinations were within normal limits. The patient was hemodynamically stable after infusion lipid emulsion. The main principle of LAST management is to ensure adequate ventilation and organ perfusion with sufficient oxygen-rich blood to reach the brain, heart, and kidneys to prevent acidosis until lipid emulsion therapy. Conclusion: LAST management requires prompt and precise diagnosis and treatment to get a good outcome.
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