Background: Prolonged motor and sensory block following epidural anesthesia has been associated with patient dissatisfaction. Administration of epidural crystalloids in patient who had received bupivacaine 0.75% and lidocaine 2% epidural anesthesia. However, bupivacaine 0.5% is commonly used in our institutional and the effectiveness of bolus of NS in non-obstetrical patients undergoing 0.5% bupivacaine epidural anesthesia has not been investigated. The objective of this study was to determine the relationship of normal saline (NS) epidural flush volume to the recovery of motor and sensory block and its hemodynamic stability (blood pressure and heart rate) in non-obstetrical patients undergoing epidural anesthesia using 0.5% bupivacaine. Methods: Following surgery, subjects with T6 dermatome level of sensory, were randomized to 2 treatment groups. Group 1 (control, n = 11) received 1-mL epidural normal saline (NS). Group 2 (experimental, n = 11) received an epidural bolus of 30-mL NS. Assesment of motor and sensory block was performed at 15-minute intervals until complete motor and sensory recovery. Hemodynamic stability (blood pressure and heart rate) between two groups were also monitor every 15-minutes and determined. Results: Times to full motor recovery were significantly faster in the epidural bolus of 30-mL groups than in the control group (69 ± 19.66 vs 95 ± 11.83; p = 0.0017).). Conclusions: A more rapid recovery of motor block in patients undergoing 0.5% bupivacaine epidural anesthesia can be achieved with the use of 30-mL NS epidural washout, with hemodynamic stability.

Background Coronavirus disease 2019 is a highly transmissible and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2, a novel coronavirus that was identified in early January 2020 in Wuhan, China, and has become a pandemic disease worldwide. The symptoms of coronavirus disease 2019 range from asymptomatic to severe respiratory failure. In moderate and severe cases, oxygen therapy is needed. In severe cases, high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation are needed. Many ventilation methods in mechanical ventilation can be used, but not all are suitable for coronavirus disease 2019 patients. Airway pressure release ventilation, which is one of the mechanical ventilation methods, can be considered for patients with moderate-to-severe acute respiratory distress syndrome. It was found that oxygenation in the airway pressure release ventilation method was better than in the conventional method. How about airway pressure release ventilation in coronavirus disease 2019 patients? We report a case of confirmed coronavirus disease 2019 in which airway pressure release ventilation mode was used. Case presentation In this case study, we report a 74-year-old Chinese with a history of hypertension and uncontrolled diabetes mellitus type 2. He came to our hospital with the chief complaint of difficulty in breathing. He was fully awake with an oxygen saturation of 82% on room air. The patient was admitted and diagnosed with severe coronavirus disease 2019, and he was given a nonrebreathing mask at 15 L per minute, and oxygen saturation went back to 95%. After a few hours with a nonrebreathing mask, his condition worsened. On the third day after admission, saturation went down despite using noninvasive ventilation. We decided to intubate the patient and used airway pressure release ventilation mode. Finally, after 14 days of being intubated, the patient could be extubated and discharged after 45 days of hospitalization. Conclusion Early use of airway pressure release ventilation may be considered as one of the ventilation strategies to treat severe coronavirus disease 2019 acute respiratory distress syndrome. Although reports on airway pressure release ventilation and protocols on its initiation and titration methods are limited, it may be worthwhile to consider, given its known ability to maximize alveolar recruitment, preserve alveolar epithelial integrity, and surfactant, all of which are crucial for handling the “fragile” lungs of coronavirus disease 2019 patients.

Community Service (PkM) is carried out by the Faculty of Medicine Universitas Methodist Indonesia by providing counselling the effect of HIV Infections and AIDS. PkM was held on 8-11 June 2022 at Lumban Pea Timur, Balige,Toba District, North Sumatera. The method used is to provide counselling/lectures and provide motivation, then followed by question and answer to obtain results and solutions as a form of problem’s solving and obstacles faced. The results of PkM with counselling are very effective considering that there are still many people who do not get information about HIV infections and AIDS. With this counselling, the public becomes aware of the HIV_AIDS Infections problem. Thus, it is hoped that the people of Lumban Pea Timur will aware and know how to prevent their community from HIV-AIDS Infections.