Bali Journal of Anesthesiology

Background: Certain laboratory markers can be used as predictors of COVID-19 prognosis. Elevated levels of cardiac D-dimer, C-reactive protein (CRP), lactate dehydrogenase, and Troponin-I are thought to be associated with poor outcomes, although this must be proven again. The aim of this research is to determine the correlation between CRP and D-dimer levels and severity and mortality in patients. Materials and Methods: This research is a retrospective cohort study conducted between January 2021 and December 2021. A total of 51 patient medical records that met the inclusion and exclusion criteria were analyzed. The binomial logistic regression test was used to analyze the correlation between CRP levels and D-dimer levels, respectively, on the severity and mortality of COVID-19. Results: In this study, the mean CRP level was 12.6 ± 3.2 mg/dL in nonsevere COVID-19 cases and 21.5 ± 1.9 mg/dL in severe cases (P = 0.008). In nonsevere COVID-19, the mean D-dimer level was 334.7 ± 68.5 ng/mL compared to the severe cases of 2156.8 ± 431 ng/mL. The Mann–Whitney test showed a significant difference between nonsevere and severe COVID-19 (P < 0.001). There was a significant difference between CRP (P = 0.016) and D-dimer (P < 0.001) levels between survivors and nonsurvivors. Multivariate regression analysis found that increased D-dimer levels were associated with an increased degree of severity of COVID-19 (P = 0.001) and increased CRP levels were associated with increased mortality from COVID-19. Conclusion: An increase in D-dimer levels is significant as a predictor of COVID-19 severity and increase in CRP levels is significant as a predictor of COVID-19 mortality.

IMade Artawan

Sidarta Sagita

MariaAgnes Etty Dedi

C-reactive Protein and D-dimer levels correlates with covid-19 severity and mortality: a retrospective study

C反应蛋白和D-二聚体水平与COVID-19严重程度及死亡率的相关性：一项回顾性研究

Background: The diagnostic effectiveness of magnetic resonance imaging (MRI) resulted in its growing usage among cases of all ages. Nevertheless, children having MRIs are frequently sedated due to the magnetic field's extremely loud decibel level and to avoid motion artefacts. This research aimed to compare the efficacy and safety of intranasal dexmedetomidine and midazolam in pediatric MRI patients. Materials and Methods: This double-blind, randomized clinical trial involved 60 cases aged 2–8 years, both sexes getting elective MRI. Sixty children were randomly allocated into two equal groups, subjects in group D were sedated with 2 μg/kg intranasal dexmedetomidine, whereas group M were sedated with 0.3 mg/kg intranasal midazolam. Successful sedation was considered when the Modified Observer Assessment of Alertness/Sedation Scale < 4. Results: The 1st and 2nd dose success rates were significantly higher in group D (80% and 90%) as opposed to group M (46.67% and 63.33%) (P = 0.015 and 0.032, respectively). Sedation onset was significantly faster in group D compared to group M (P = 0.037). Sedation time was significantly prolonged in group D than group M (P = 0.044). MRI satisfaction of operator was significantly higher in group D compared to group M (P = 0.022). Conclusion: Intranasal dexmedetomidine provided higher incidence of successful sedation and operator satisfaction with quicker onset and prolonged period of sedation and less adverse events than intranasal midazolam in pediatrics undergoing pelviabdominal MRI.

TaysserM Abdelraheem

HamdyA Hendawy

AmiraM Elkeblawy

Intranasal dexmedetomidine versus intranasal midazolam as sole sedative agents for pelviabdominal magnetic resonance imaging in pediatrics: A randomized double-blind trial

鼻内右美托咪定与鼻内咪达唑仑作为唯一镇静剂用于小儿盆腹磁共振成像的随机双盲试验

Background: The coronavirus disease-2019 (COVID-19) pandemic has significantly impacted global health, resulting in millions of reported cases and deaths worldwide. The Acute Physiologic and Chronic Health Evaluation (APACHE) II is a commonly used assessment system for determining the severity of illness in critically unwell patients. This study investigates the feasibility of using the APACHE II scoring system as a mortality predictor for COVID-19. Materials and Methods: In this cross-sectional study, we evaluated 499 confirmed patients with COVID-19 before COVID-19 vaccination, all of whom received standard treatment. Patients with confirmed COVID-19 by polymerase chain reaction (PCR) test were enrolled in this study, and their demographic data, chest computed tomographic (CT) findings, APACHE II score, need for mechanical ventilation, length of in-hospital stay, and outcome (discharge or death) were collected in a checklist. Results: The mean age of the patients was 62.24 ± 18.48 years, composed of 52.5% male and 47.5% female. Respiratory complaints, such as cough, dyspnea, and chest pain, were observed in 56.9% of patients, and 8.8% presented with palpitations, decreased blood pressure (BP), and cardiac arrest. Among these patients, 96.3% were discharged, and 3.6% died. Non-survived patients had significantly higher APACHE II scores than survived patients (12.3 vs. 17.7, P = 0.007). The ROC curve analysis revealed an APACHE II cutoff of 18.5 for predicting mortality in patients with COVID-19, with sensitivity and specificity values of 63% and 84%, respectively. Conclusion: The APACHE II scoring system can be valuable in the emergency department for prioritizing patients based on their severity of illness.

SeyedReza Ahmadi Koupaei

Hosein Zakeri

ElnazVafadar Moradi

Arezoo Arianmanesh

BehrangRezvani Kakhki

Shima Yazdanparase

APACHE II scoring system to predict mortality of covid-19 patients: a cross-sectional study

APACHE II评分系统预测COVID-19患者死亡率的横断面研究

Some mild-to-severe complications can occur following central venous catheter (CVC) insertion. Hemothorax is a rare complication. Controlling the bleeding is key to managing this condition. The use of triple antithrombotic therapy may become a challenge in controlling the bleeding. We report the case of a patient with hemothorax following CVC placement at the right subclavian vein. The patient was on triple antithrombotic therapy (aspirin, ticagrelor, and warfarin) following primary percutaneous coronary intervention procedure as he presented with ST-segment elevation myocardial infarction and new-onset atrial fibrillation during hospitalization. After CVC insertion, a chest X-ray confirmed a hemothorax that filled up to half of the right hemithorax. A thorax drain was then inserted with an initial blood drain of 140cc. Ticagrelor, as one of the dual antiplatelet therapies, was switched to clopidogrel, and warfarin as anticoagulant thromboembolic prophylactic at atrial fibrillation was stopped. Thorax drain was pulled out on day 8 of admission with a total production of 460cc blood with good clinical signs. Chest X-ray evaluation revealed a clear lung without residual hemothorax. Thorax drain insertion and triple antithrombotic therapy adjustment successfully managed this bleeding complication. Hemothorax, as one of the bleeding complications secondary to CVC insertion, could be associated with significant morbidity and mortality, especially in patients with triple antithrombotic therapy. Prompt treatment is mandatory to save a patient’s life, including immediate identification and treatment such as thorax drain insertion and triple antithrombotic adjustment.

Andrianto Andrianto

AlamancoKardinov Kamardikan

HanestyaOky Hermawan

Hemothorax after central venous catheter insertion in patient with triple antithrombotic therapy: A case report

三重抗血栓治疗患者中心静脉导管插入后发生血胸: 病例报告

Introduction: Continuous femoral–sciatic block and continuous epidural block have antinociceptive and anti-inflammatory effects through Na-K channel block at the peripheral level and spinal nerve. The anti-inflammatory effect in the continuous femoral–sciatic block is better than in continuous epidural block due to the block density, which could limit neurogenic inflammation to reduce cytokine production and postoperative pain severity. Materials and Methods: This study was a clinical trial with randomized sampling in pre and post-test design. A total of 60 samples were used in this study and were divided into two groups: continuous anesthesia femoral–sciatic block and continuous anesthesia epidural block. Result: There was a decrease in the prostaglandin E2 (PGE2) level in group I, which was statistically significant than the control group (P < 0.05). However, there was an increased level of high-sensitivity C-reactive protein in both groups in which the gap was found lesser in the control group (P < 0.05). Meanwhile, the interleukin-6 (IL-6) level was only decreased on the third day postoperative in group I but was not statistically significant (P > 0.05) than the control group. Visual analog scale (VAS) score at rest was decreased on the third day postoperative, and VAS at movement in the first hour and on the third day of postoperative was much better in group I than group II in a statistically significant manner (P < 0.05). Conclusion: The continuous femoral–sciatic block could reduce the level of PGE2 than the control group and attenuate the increased level of IL-6. However, the VAS score decreased at rest and on movement and was purely the effect of the continuous femoral–sciatic block.

MadeGde Widnyana

TjokordaGde Agung Senapathi

AdindaPutra Pradhana

Comparison between continuous femoral–sciatic block with continuous epidural block on reduced level of high-sensitivity C-reactive protein, prostaglandin E2, interleukine-6, and visual analog scale in lower limb surgery: Randomized, pre, and post-test trials

下肢手术中连续股神经-坐骨神经阻滞与连续硬膜外阻滞对高敏C反应蛋白、前列腺素E2、白细胞介素-6及视觉模拟评分水平的影响比较：随机前测与后测试验

Divya Gupta

Deepak Gupta

Should ASA physical status classification consider geriatric age?

ASA身体状况分类是否应考虑老年年龄？

Abstract Background: Several studies have been conducted to assess the accuracy of predictors of difficult intubation, but the results are still very variable. This study aims to discover the incidence of difficult intubation in our cohort. We also compared the accuracy of the Mallampati score, thyromental distance, and thyrohyoid distance in predicting intubation difficulties in patients who will undergo surgery under general anesthesia. Materials and Methods: This prospective, observational study was conducted on 100 subjects who met the inclusion and exclusion criteria and had their Mallampati score, thyromental distance, and thyrohyoid distance measured preoperatively. After inducing anesthesia, the degree of difficulty in intubation was assessed using the Cormack-Lehane grading. The Mallampati score, thyromental distance, and thyrohyoid distance were then tested for accuracy as predictors of the occurrence of difficult intubation using the binomial logistic regression. Results: The incidence of difficult intubation was 21%. We found a significant difference ( P &lt; 0.001) between the Mallampati score and the degree of intubation difficulty, where subjects with a Mallampati score of 1–2 experienced fewer intubation difficulties. The mean thyromental distance differed significantly between subjects with and without difficulty intubating (6.3 ± 0.6 vs. 4.6 ± 0.6 cm, P &lt; 0.001). There was also a significant difference in the mean thyrohyoid distance between subjects with and without difficulty intubating (3.6 ± 0.4 vs. 2.0 ± 0.2, P &lt; 0.001). Conclusion: Mallampati score, thyromental distance, and thyrohyoid distance were not significant as single predictors of difficult intubation, but they were significant when combined.

I Made Artawan

Su Djie To Rante

Comparison of the Thyromental Distance, Thyrohyoid Distance, and Mallampati Scores in Prediction of Difficult Intubation in Patients Undergoing General Anaesthesia: An Observational Study

甲状腺颏下距离、甲状舌骨距离和Mallampati评分在预测接受全身麻醉患者困难插管中的比较：一项观察性研究

Abstract Application of cardiopulmonary bypass (CPB) in cardiac surgery may cause systemic inflammatory reactions, possibly causing clinical sequelae and multiple organ failures such as systolic or diastolic dysfunction, regional or global left ventricle or right ventricle low contractility, and the function of vascular tone. The use of drugs (i.e., corticosteroids) and the ultrafiltration method during the CPB application has been known to prevent or minimize the complication of CPB in cardiac surgery. One of the non-pharmacological approaches to minimize those inflammatory responses is the modified ultrafiltration (MUF) technique. Theoretically, this is due to ultrafiltration which may reduce the interstitial fluid and inflammatory mediator. MUF can be used to counteract inflammatory responses in pediatric cardiac surgery. This ultrafiltration method became a recommended procedure in minimally invasive surgery and conventional open-heart surgery. However, studies about effectiveness in adults are limited. In this case series, the MUF technique was used in three patients who underwent valvular heart surgery with a CPB machine. Following the application of the CPB, the MUF technique is performed for 10 min at a speed of no more than 10% full flow. Hemodynamic measurements and interleukin-6 (IL-6) levels were taken during surgery and 24 h post-CPB. At 24 h post-CPB, the vasoactive inotropic score and duration of mechanical support use were less than 20 and 18–24 h, respectively, and the IL-6 level ranged from 7.22 to 14.22 pg/mL. The cardiac index increased, ranging from 2.43 to 3.47 L/min/m 2 , and pulmonary vascular resistance decreased, ranging from 78 to 146 dyne s/cm 5 .

Made Ryan Kharmayani

Ratna Farida Soenarto

Anas Alatas

Muhammad Arza Putra

Modified Ultrafiltration Technique in Valvular Heart Surgery: A Case Series

瓣膜性心脏病手术中的改良超滤技术：病例系列研究

Abstract Landau–Kleffner syndrome (LKS), also known as acquired epileptic aphasia, is a childhood disease associated with acquired aphasia and epileptiform abnormalities on the electroencephalographic. We report the uneventful anesthesia management of a 17-year-old female patient with LKS syndrome. Her vital signs and laboratory results were normal, and plasma levels of valproic acid (73.6 µg/mL) were within therapeutic limits. She had mild micrognathia, short thyromental distance, and normal neck movements and mouth opening. An intravenous induction was performed with 100 mg lidocaine, 100 µg fentanyl, 200 mg propofol, and 60 mg rocuronium intravenously. After preoxygenation with 80% O 2 for 3 min, she was intubated without complications with a number 7.5 mm endotracheal tube connected to a ventilator. Anesthesia maintenance was provided with 2.2% sevoflurane and 50% oxygen–50% air mixture, 0.01–0.05 μg/kg/min infusion of remifentanil. The target partial pressure of carbon dioxide was 30–35 mm Hg. Care was taken to ensure that intra-abdominal pressure did not exceed 14 mm Hg. Spontaneous breathing returned in 5 min after discontinuation of sevoflurane. She was extubated after following commands and transferred to the post-anesthesia care unit. It is unknown whether general anesthesia has a short- or long-term effect on patients with LKS. Since epileptic seizures are essential in patients with LKS, the correct selection of anesthetic agents is significant. In addition, hypoxemia, hypercarbia, hypocapnia, high positive end-expiratory pressure, and acidosis should all be avoided as they may trigger seizure activity.

Ahmed Uslu

Nedim Çekmen

Successful Anesthesia Management in Landau–Kleffner Syndrome Undergoing Laparoscopic Surgery: A Case Report

兰道-克莱夫纳综合征腹腔镜手术麻醉管理成功案例报告

Abstract Background: Lung-protective ventilation strategies, one of which is to limit peak inspiratory pressure (PIP), are recommended in the management of acute respiratory distress syndrome (ARDS). The purpose of this study was to determine whether dynamic pressure gradient, defined as the difference between PIP and positive end-expiratory pressure (PEEP), is associated with pediatric ARDS mortality in the pediatric intensive care unit (PICU). Materials and Methods: This was a retrospective, single-center cohort study with consecutive sampling. Children aged 1 month to 18 years with ARDS who were admitted to PICU and used invasive mechanical ventilator between January and December 2023 were included. Patient’s demographic data, pediatric logistic organ dysfunction 2 (PELOD-2) score, oxygenation index (OI), oxygen saturation index (OSI), PEEP, and dynamic pressure gradient were collected from the patient’s medical record. The outcome is mortality, which is measured upon discharge. Results: The subjects’ median age was 6 months, predominantly male (64.06%). The etiology of ARDS was pneumonia (90.63%) and sepsis (9.37%). Bivariate analysis showed that dynamic pressure gradient (OR = 4.77, 95% CI=1.47–15.5, P = 0.003), PEEP (OR = 3.21, 95% CI = 1.07–9.52, P = 0.033), and PELOD-2 score at 24–72 h (OR = 3.68, 95% CI = 1.146–11.83, P = 0.024) had a significant association with mortality of ARDS patients at PICU. The results of multivariate analysis showed that dynamic pressure gradient had a significant relationship with the mortality of ARDS patients at PICU (OR = 5.22, 95% CI = 1.47–18.56, P = 0.015). Conclusion: Dynamic pressure gradient was associated with mortality in pediatric patients with ARDS who were treated in PICU.

Magdalena Rusady Goey

I Nyoman Budi Hartawan

Dyah Kanya Wati

Ida Bagus Gede Suparyatha

Siska Sinardja

The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort

儿科重症监护病房急性呼吸窘迫综合征患儿动态压力梯度与死亡率的相关性：一项单中心回顾性队列研究

Publication Information	Publisher: Wolters Kluwer Medknow Publications，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2017，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%
Average review cycle	18 weeks

Bali Journal of Anesthesiology

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