Pemberian Magnesium Sulfat Intravena Meningkatkan Efek Analgesia Pascaoperasi pada Bedah Mayor Menggunakan Anestesi Umum

Penatalaksanaan nyeri akut pascaoperasi merupakan tugas penting dokter anestesi. Morfin banyak digunakan untuk mengontrol nyeri pascaoperasi. Tujuan penelitian ini untuk mengetahui pengaruh pemberian MgSO4 intravena selama operasi terhadap efek analgesia dan kebutuhan morfin pascaoperasi. Penelitian ini adalah uji klinik blok tersamar ganda. Tiga puluh enam subjek usia 21–55 tahun dialokasikan ke dalam kelompok A yang diberikan MgSO4 30 mg/kgBB intravena 15 menit dilanjutkan 15 mg/kgBB/jam sampai akhir operasi dan kelompok B diberikan NaCl 0,9% dengan volume sama yang menjalani operasi bedah mayor di RSUP Sanglah Denpasar pada Juni–Agustus 2014. Data hasil penelitian dianalisis dengan Uji Mann-Whitney. Nilai visual analog scale (VAS) diam dan bergerak pada jam ke-4 dan ke-8 pada kelompok Mg berbeda bermakna (p<0,05). Perbedaan konsumsi morfin pascaoperasi pada jam ke-4, ke-8, dan ke-24 berbeda bermakna (p<0,05). Simpulan penelitian ini adalah pemberian MgSO4 intravena selama operasi meningkatkan efek analgesia dan menurunkan kebutuhan morfin pascaoperasi.Kata kunci: Analgesia pascaoperasi, anestesi umum, bedah mayor, magnesium sulfatIntravenous Magnesium Sulphate Administration to Improve Post-operative Analgesia Effect in Major Surgery with General AnesthesiaAbstractRelieving acute post-operative pain is an important role of anesthesiologist. Morphine is frequently used to control moderate to severe post operative pain. The objective of this study is to understand the effect of intravenous MgSO4 administration in improving post-operative analgesia effect. This study was a double-blind randomized block clinical trial. The subjects of this study were patients who underwent major surgeries in Sanglah Hospital during the period of June to August 2014. Thirty six subjects age 21–55 years allocated to group A received intravenous MgSO4 30 mg/kgBW intravenous bolus in 15 minutes followed by 15 mg/kgBW/hour until the surgery is finished and group B received NaCl 0.9% with the same volume. Data were then analyzed using  the Mann-Whitney Test. The stationary and mobile VAS scores in the  4th and 8th hour in Mg group were significantly different (p<0.05). Post-operative morphine consumptions in the 4th, 8th, and 24th hour were significantly different between the Mg and NaCl 0.9% groups (p<0.05). It is concluded that the administration of  intravenous MgSO4 during operation increases analgesia effect and reduces post-operative morphine needKey words: General anesthesia, magnesium sulfate, major surgery, post-operative analgesia DOI: 10.15851/jap.v2n3.33

Pemberian Magnesium Sulfat Intravena Meningkatkan Efek Analgesia Pascaoperasi pada Bedah Mayor Menggunakan Anestesi Umum

Penatalaksanaan nyeri akut pascaoperasi merupakan tugas penting dokter anestesi. Morfin banyak digunakan untuk mengontrol nyeri pascaoperasi. Tujuan penelitian ini untuk mengetahui pengaruh pemberian MgSO4 intravena selama operasi terhadap efek analgesia dan kebutuhan morfin pascaoperasi. Penelitian ini adalah uji klinik blok tersamar ganda. Tiga puluh enam subjek usia 21–55 tahun dialokasikan ke dalam kelompok A yang diberikan MgSO4 30 mg/kgBB intravena 15 menit dilanjutkan 15 mg/kgBB/jam sampai akhir operasi dan kelompok B diberikan NaCl 0,9% dengan volume sama yang menjalani operasi bedah mayor di RSUP Sanglah Denpasar pada Juni–Agustus 2014. Data hasil penelitian dianalisis dengan Uji Mann-Whitney. Nilai visual analog scale (VAS) diam dan bergerak pada jam ke-4 dan ke-8 pada kelompok Mg berbeda bermakna (p<0,05). Perbedaan konsumsi morfin pascaoperasi pada jam ke-4, ke-8, dan ke-24 berbeda bermakna (p<0,05). Simpulan penelitian ini adalah pemberian MgSO4 intravena selama operasi meningkatkan efek analgesia dan menurunkan kebutuhan morfin pascaoperasi.Kata kunci: Analgesia pascaoperasi, anestesi umum, bedah mayor, magnesium sulfatIntravenous Magnesium Sulphate Administration to Improve Post-operative Analgesia Effect in Major Surgery with General AnesthesiaAbstractRelieving acute post-operative pain is an important role of anesthesiologist. Morphine is frequently used to control moderate to severe post operative pain. The objective of this study is to understand the effect of intravenous MgSO4 administration in improving post-operative analgesia effect. This study was a double-blind randomized block clinical trial. The subjects of this study were patients who underwent major surgeries in Sanglah Hospital during the period of June to August 2014. Thirty six subjects age 21–55 years allocated to group A received intravenous MgSO4 30 mg/kgBW intravenous bolus in 15 minutes followed by 15 mg/kgBW/hour until the surgery is finished and group B received NaCl 0.9% with the same volume. Data were then analyzed using  the Mann-Whitney Test. The stationary and mobile VAS scores in the  4th and 8th hour in Mg group were significantly different (p<0.05). Post-operative morphine consumptions in the 4th, 8th, and 24th hour were significantly different between the Mg and NaCl 0.9% groups (p<0.05). It is concluded that the administration of  intravenous MgSO4 during operation increases analgesia effect and reduces post-operative morphine needKey words: General anesthesia, magnesium sulfate, major surgery, post-operative analgesia DOI: 10.15851/jap.v2n3.33

Combined morphine-clonidine adjuvant in epidural analgesia support role of supraspinal modulation in opioid tolerant patient

ABSTRACT Acute pain patients with complicated pain-related experiences would need more than just a pain reliever, especially those with behavioral opioid usage. Latest findings revolving supraspinal modulation are not only taking experts and pain physician into a different stage of understanding but also making theories and management revisited. A 41-years-old Australian male underwent plate and screw fixation of his right femur. He was overweight with a history of behavioral opioid usage. He was given epidural analgesia for postsurgical management with bupivacaine 0.1% with morphine 2 mg and clonidine 30 mcg every 12 hours as adjuvants. Hemodynamic curves were in normal limits, no paralysis, urinary difficulties, or pruritus. He was discharged on the fourth day. The combined morphine-clonidine adjuvant in epidural analgesia technique was an effective choice to alleviate pain response in this opioid-tolerant patient.

Pseudomonas alcaligenes, Potential Antagonist Against Fusarium oxysporum f.sp.lycopersicum the Cause of Fusarium Wilt Disease on Tomato

The research is financed by the Directorate General of Higher Education, Ministry of Education and Culture the Republic of Indonesia in fiscal year 2012. Abstract Fusarium wilt disease caused by Fusarium oxysporum f.sp. lycopersici is one of important diseases that potentially cause significant yield losses on tomato. There is no measure available to control the disease effectively.  This study was done to isolate the antagonistic Pseudomonas sp.  from rhizospeheres of plants of Leguminosae and Solanaceae and to determine their antagonistic activity against F.oxysporum f.sp.lycopersicum. Biochemical test and molecular analysis of the 16S rRNA gene were done  to determine the species of Pseudomonas sp. There are three isolates of Pseudomonas sp. were obtained in this study namely  isolates KtS1, TrN2, and TmA1. Results of 16S rRNA gene analysis showed that all three isolates had  more than 99% similarity to P. alcaligenes. These isolates showed strong antagonistic activity against F. oxysporum f.sp. lycopersici with inhibitory activity more than 80%.  Application of bacterial suspension of P. alcaligeneseffectively suppressed the disease incidence of Fusarium wilt on tomato. Keywords : antagonistic activity,  Pseudomonas alcaligenes, Fusarium wilt disease

Isobaric levobupivacaine for intrathecal anesthesia as an effective and safe option in transurethral resection of the prostate surgery

The search for safer anesthetic solutions has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, emerged as a safer alternative for intrathecal anesthesia than its racemic parent (bupivacaine). Levobupivacaine shows a lower risk of the central nervous system and cardiovascular toxicity.However, in many countries, levobupivacaine is only available in isobaric solution, where the isobaric solution for intrathecal anesthesia is still often be questioned its effectiveness because of the fear that the block spreading is unpredictable. In this case series, we describe sensory and motor block characteristics, hemodynamics profile and adverse effects of isobaric levobupivacaine in intrathecal anesthesia for six patients with American Society of Anesthesiology physical status II-III whose undergo transurethral endoscopic surgery

Continuous caudal analgesia as a safe and effective method for pediatric post - chordectomy analgesia

ABSTRACTIt brings great satisfaction for medical officers to be able to see children smiling, laughing, and playing without pain after surgery, yet many children still experience inadequate postoperative pain management. This phenomenon could lead to serious immediate and long term effects in the pediatric patient. Disruption of the healing process caused by pain could become the source of morbidity and mortality in the early postoperative period. Opioid side effects and transformation from acute to chronic pain due to inadequate analgesia are other problems met when dealing with postoperative pain management. This is where regional analgesia takes advantage. Caudal analgesia is an old yet very popular method in pediatric anesthesia and has gained widespread use. It can be delivered as a single injection or continuous infusion. The continuous technique provides a longer duration of analgesia than single injection does. We report a satisfying result from using continuous caudal analgesia for post chordectomy pain management in a 5-year-old boy.

Perioperative management of patient with hemophilia a underwent orthopedic surgery

Hemophilia presents challenging consideration for anesthesiologists. In non emergency cases it is essential that factor VIII is raised to its optimal activity prior to surgery. Intra operative bleeding is a fatal complication in hemophilia. Certain measurements must be taken under considerations to manage this case for anesthesia. Peripheral lines should be secured with utmost care. Intramuscular injections and arterial punctures must be avoided. Intubation and airway positioning should be done gently in deep plane anesthesia. Small vessels hemostatis must be taken care of by the surgeon. A multidisciplinary team has to be involved when patients with hemophilia are planned for surgery. The knowledge related to replacement therapy should be mastered not only by hematologist, but also by the whole team involved in patient management

Non-Convulsive Status Epilepticus (NCSE) in ICU

Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long,  associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes of. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended asthe first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis.  This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response

The effectiveness of Patient Controlled Analgesia (PCA) morphine-ketamine compared to Patient Controlled Analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery

Background: Laparotomy may cause moderate to severe after surgery pain, thus adequate pain management is needed. The addition of ketamine in patient controlled analgesia (PCA) morphine after surgery can be the option. This study aims to evaluate the effectiveness of PCA morphine-ketamine compared to PCA morphine in patient postoperative laparotomy surgery to reduce total dose of morphine requirement and pain intensity evaluated with visual analog scale (VAS). Methods: This study was a double-blind RCT in 58 patients of ASA I and II, age 18-64 years, underwent an elective laparotomy at Sanglah General Hospital. Patients were divided into 2 groups. Group A, got addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) and patients in group B received morphine (1mg/ml) by PCA. Prior to surgical incision both group were given a bolus ketamine 0,15mg/ kg and ketorolac 0,5mg/kg. The total dose of morphine and VAS were measured at 6, 12, and 24 hours postoperatively. Result: Total dose of morphine in the first 24 hours postoperatively at morphine-ketamine group (5,1±0,8mg) is lower than morphine only group (6,5±0,9mg) p&lt;0,001. VAS (resting) 6 and 12 hour postoperative in morphine-ketamine group (13,4±4,8 mm) and (10,7±2,6 mm) are lower than morphine (17,9±4,1mm) p≤0,05 and (12,8±5,3mm) p≤0,05. VAS (moving) 6, 12, and 24 hour postoperative morphineketamine group (24,8±5,1mm), (18±5,6mm) and (9±5,6mm) are lower than morphine (28,7±5,2mm) p≤0,05, (23,1±6,0mm) p≤0,05, and (12,8±5,3mm) p≤0,05. Conclusions: Addition of ketamine in PCA morphine for postoperative laparotomy surgery reduces total morphine requirements in 24 hours compared to PCA morphine alone

Low Dose Ketamin

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Low-dose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psikomimetik like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression