Background: The addition of adjuvants to local anesthetics in the peribulbar block might be a method to elevate block quality. This study aimed to determine the effectiveness of peribulbar local anesthesia adjuvants using dexmedetomidine 20 mcg and dexamethasone 5 mg. Patients and Methods: This study was a single-blind randomized clinical trial. Patients were divided into three groups who received peribulbar group: Group C (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of normal saline), Group D (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexamethasone 5 mg), and Group M (received 4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexmedetomidine 20 mcg). Sensory and motor block onsets and durations were assessed. Results: There were 42 patients included. The sensory block onset was 70.7 s in Group M and the slowest in Group C (152.1 s). The longest sensory block duration was found in Group D (259.3 min) and the shortest in Group C (143.2 min). Conclusion: Dexamethasone 5 mg adjuvant affected sensory block onset, sensory, and motor block duration but did not affect motor block onset, while dexmedetomidine 20 mcg adjuvant affected sensory and motor block onsets as well as sensory and motor block durations.

Background: Laryngoscopy intubation can cause complications in the form of increased blood pressure and heart rate. This can be detrimental to patients with cardiovascular complications, increased intracranial pressure, and vascular anomalies. Various procedures are performed to stabilize hemodynamic fluctuations during laryngoscopy intubation, one of which is the administration of beta-blocking agents (Bisoprolol). In some studies, the administration of Bisoprolol can cause side effects such as hypotension and bradycardia. One drug considered to maintain hemodynamic stability in laryngoscopy intubation with minimal effects is the administration of Ivabradine, which works by regulating diastolic depolarization. Objective: To compare the effectiveness of Ivabradine 5 mg and Bisoprolol 5 mg in maintaining hemodynamic stability in laryngoscopy intubation. Methods: This double-blind randomized clinical trial was conducted at RSUP Dr. Wahidin Sudirohusodo Makassar in July-August 2022 with ethical qualifications from the Ethics Committee for Biomedical Research in Humans from the Faculty of Medicine, Hasanuddin University. The sample was the entire population that met the inclusion and exclusion criteria. The data were processed using SPSS 25. The analysis used paired T-test, Mann-Whitney, and Wilcoxon with a 95% confidence level (p<0.005). Result: There was a significant decrease in the mean arterial pressure and decrease in heart rate after induction (T2-T0) in the Bisoprolol group (p<0.05). The mean arterial pressure at T1-T0, T3-T0, T3-T2 did not statistically significant. Conclusion: Ivabradine 5 mg was more effective than Bisoprolol 5 mg in maintaining the stability of mean arterial pressure and heart rate in laryngoscopy intubation.

AIM: This single-blind study aimed to compare the combination of paracetamol with various doses of ibuprofen as multimodal analgesia in C-section surgery patients under spinal anesthesia. Levels of interleukin (IL)-6 and C-reactive protein (CRP) were analyzed as markers of inflammation. METHODS: Treatment groups (20 patients each) were: Group A, 750 mg paracetamol and 400 mg ibuprofen; Group B, 750 mg paracetamol and 600 mg ibuprofen; and Group C, 750 mg paracetamol and 800 mg ibuprofen. Degree of pain (movement and rest), scored using the numeric rating scale (NRS) and levels of IL-6 and CRP were assessed at various time points within 24 h of surgery. Side effects and numbers of subjects requiring rescue fentanyl administration were also recorded. RESULTS: Group C showed a rest NRS score of 1.00 ± 0.00 6 h postoperatively, compared with 2.00 ± 0.00 in Group B and 2.35 ± 0.87 in Group A. 4 h postoperatively, movement NRS scores were 1.00 ± 0.00 for Group C, compared to 3.00 ± 1.77 for Group B, and 4.85 ± 1.81 for Group A. At 12 h, IL-6 levels hours were 2.66 ± 0.04 pg/mL for Group A, 2.39 ± 0.02 pg/mL for Group B, and 2.05 ± 0.01 pg/mL for Group C. At 6 h, CRP levels were 1.18 ± 0.04 mg/L for Group A, 0.95 ± 0.01 mg/L for Group B, and 0.70 ± 0.02 mg/L for Group C. Overall, Group C showed the lowest values for all parameters analyzed, compared with other groups, and the differences were significant (p < 0.05). In addition, none of the patients in Group C required rescue fentanyl (p < 0.05), and no patients in any of the groups showed any side effects. CONCLUSION: For pain management after C-section surgery, the combination of 750 mg paracetamol and 800 mg ibuprofen yielded the best results as assessed by NRS scores, levels of IL-6 and CRP, and fentanyl rescue.

Pasien COVID-19 related Acute Respiratory Distress Syndrome (CARDS) dengan gejala ARDS sedang hingga berat memerlukan Invasive mechanical ventilation (IMV) dan memiliki prognosis yang buruk dengan angka ARDS sekitar 75% serta 63% menerima Invasive mechanical ventilation (IMV) dengan tingkat kematian 59% . Tingginya angka kematian pasien CARDS mendapat terapi invasive mechanical ventilation (IMV) menyebabkan para praktisi kesehatan berusaha untuk menunda intubasi dan ventilasi mekanik secara dini sehingga Non Invasive Ventilation Mechanic (NIV), CPAP dan HFNC menjadi alternatif terapi dalam penanganan CARDS. Kasus: Perempuan usia 49 tahun, masuk ICU dengan diagnosa POH-4 Craniectomy evakuasi tumor sphenoid, Sepsis Syok dan Covid-19 terkonfirmasi. Pada pemeriksaan didapatkan hipoksemia dengan ARDS berat P/F ratio 112.1 mmHg dan gambaran pneumonia dextra dan efusi pleura dextra.  Sebelum pindah ke ICU Covid, pasien mendapatkan terapi HFNC FiO2 40% dengan flow 35 L/menit, RR 25, Saturasi 95%, ROX index 9,5. Pemeriksaan laboratorium didapatkan Wbc : 7.800/L, Hb: 8,1mg/dl, Plt : 131.000/mm3, Bilirubin total 1,3 mg/dl, bilirubin direct 0,83 mg/dl, Na/K/cl : 143/2,9/111, Procalcitonin : 11.2. Kesimpulan: Terapi oksigen dengan HFNC pada CARDS sedang sampai berat menjadi pilihan bijaksana dimana terapi HFNC dapat menunda intubasi dan IMV dengan outcome yang baik. Sebagaimana Surviving Sepsis/Society of Critical Care Medicine merekomendasikan HFNC sebagai pendekatan lini pertama.

Abstrak Fraktur klavikula diperkirakan berkontribusi sekitar 15% dari fraktur ekstremitas atas. Fiksasi pembedahan dianjurkan untuk meningkatkan fungsi yang lebih baik. Multimodal analgesia adalah salah satu komponen kunci yang dianjurkan Procedure Specific Postoperative Pain Management (PROSPECT) untuk mendukung program Enhanced Recovery After Surgery (ERAS). Operasi regio klavikula umumnya dilakukan dalam anestesi umum atau dengan blok pleksus brachialis, namun blok seperti interscalene memiliki beberapa komplikasi berat seperti hemiparalisis diafragma, sindrom Horner, dan pneumothoraks. Blok pleksus servikalis superfisialis (PSS) terhindar dari komplikasi tersebut dan diharapkan dapat menjadi blok yang rutin dipakai untuk operasi daerah klavikula yang dikombinasi dengan anestesi umum. Tujuan penelitian ini adalah untuk mengetahui efek blok PSS terhadap hemodinamik, kebutuhan obat opioid, dan intensitas nyeri pada pasien operasi regio klavikula. Penelitian ini merupakan penelitian prospective randomized controlled trial dengan desain eksperimental. Sampel terdiri dari 2 kelompok, yaitu kelompok K (kelompok kontrol) dan B (kelompok dengan intervensi blok PSS) dengan jumlah sampel masing-masing 15 orang yang memenuhi kriteria inklusi. Dilakukan penilaian hemodinamik, penggunaan opioid, isofluran, NRS paska bedah, waktu rescue analgesia (WRA), dan rescue opioid paska bedah. Data dianalisis menggunakan uji statistik Mann-Whitney dan Wilcoxon, serta uji korelasi dengan uji Spearman. Hasil dari penelitian ini adalah hemodinamik yang lebih stabil, kebutuhan fentanil (p=0,001) dan isofluran (p<0,001) intraoperatif yang lebih rendah, NRS yang lebih rendah (p<0,001), dan tidak terdapat rescue pada kelompok blok (B). Blok PSS dapat mengurangi penggunaan obat anestesi, menurunkan intensitas nyeri, dan rescue opioid paska bedah pada pasien operasi regio klavikula. Kata kunci: BPSS, fentanil, isofluran, NRS, rescue