Papers by Christopher Ryalino
Bali Journal of Anesthesiology, 2022
Bali Journal of Anesthesiology, 2023
Bali Journal of Anesthesiology, 2020
Background: Postoperative cognitive dysfunction (POCD) causes an increase in social and economic ... more Background: Postoperative cognitive dysfunction (POCD) causes an increase in social and economic burdens because of the prolonged length of stay in the hospital, increased costs, and decreased quality of life. No data on POCD has ever been recorded in Indonesia. The goal of this study was to determine the incidence of POCD in elderly people at Sanglah General Hospital, Indonesia. Patients and Methods: This is a descriptive study conducted at Sanglah General Hospital in 2018. Inclusion criteria included patients of 60 years old or more who came to anesthesia preoperative clinic with the American Society of Anesthesiologists physical status 1 and 2. Cognitive functions were assessed three times: 1 day before the surgery, 2 days after the surgery, and 4 weeks after the surgery. POCD was defined as an at least 20% decreased result of two out of three instruments used. Results: The study included 84 participants consisting of 52 males and 32 females. The mean age was 66.0 ± 5.1 years. Most participants were elementary school graduates (34.5%) and high school graduates (27.4%). There were 7 (8.3%) patients who developed POCD within 48 h and 4 weeks postoperatively. Conclusion: The incidence of POCD at Sanglah General Hospital was 8.33% both at 48 h and 4 weeks postoperatively.
Social Science Research Network, 2022
Medicina : jurnal ilmiah kedokteran, Feb 5, 2020
Bali Journal of Anesthesiology, 2022
Bali Journal of Anesthesiology
Hypotension event in intraoperative settings may cause postoperative morbidity in surgical correc... more Hypotension event in intraoperative settings may cause postoperative morbidity in surgical correction of scoliosis. Most often complications of intraoperative hypotension are postoperative ischemic optic neuropathy and postoperative ischemic stroke due to global hypoperfusion. Hypovolemic shock due to bleeding or blood loss is the most common cause of intraoperative hypotension in surgical correction of scoliosis. However, bleeding is not only the main cause of hypotension. A young female underwent surgical correction of scoliosis, during the operation she had a sudden and rapid decrease of blood pressure (BP) but then rapidly improved after the surgeon stopped the surgery which was a de-rotational procedure. Neurogenic shock is one of the complications that may occur during the manipulation of the spinal cord which is marked by a sudden and rapid decrease of BP and usually accompanied by bradycardia due to sudden and rapid loss of autonomic tone. Hypotension in neurogenic shock usually is refractory hypotension which cannot be treated only with fluid resuscitation but also needs vasopressor, thus this neurogenic shock should get immediate and prompt treatment to avoid further complications.
International Journal of Critical Illness and Injury Science
The Lancet
Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.
Bali Journal of Anesthesiology
Bali Journal of Anesthesiology
International Journal of Critical Illness and Injury Science
Pulmonary embolism and thrombosis are two common postmortem findings in novel coronavirus disease... more Pulmonary embolism and thrombosis are two common postmortem findings in novel coronavirus disease 2019 (COVID-19), the fact which led experts to include anticoagulants in the standard management of COVID-19. However, at least until now, no guidelines stated the exact safe yet optimal dose of anticoagulants. We report a case of a 65-year-old man admitted to our hospital with severe acute respiratory distress syndrome due to COVID-19. He showed remarkable improvement during the first 10 days of treatment at our facility but subsequently developed spontaneous iliopsoas hemorrhage (IPH). We discontinued antithrombotic and anticoagulant agents as soon as we confirmed the IPH from the abdominal computed tomography scan. His condition worsened even after he received adequate blood transfusion sets and eventually developed disseminated intravascular coagulation. Due to the limitation of our hospital, we could not perform stent grafting and angiographic embolization. He finally died 6 days after the occurrence of IPH. To the best of our knowledge, this is the first case of COVID-19 with IPH in Indonesia. As a developing country, many hospitals in Indonesia do not have stent grafting and angiographic embolization. This condition urges the dose recommendation for anticoagulant therapy to provide safe and efficient management for COVID-19.
Research and Reports in Urology, 2020
Background Many factors could contribute to the cases of residual benign prostate hypertrophy (BP... more Background Many factors could contribute to the cases of residual benign prostate hypertrophy (BPH) volume after transurethral resection of the prostate (TURP), such as age, obesity, testosterone level, and inflammation. The goal of this study was to determine the risk of tumor necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β) in prostate tissue, serum prostate-specific antigen (PSA), serum testosterone, and age in promoting prostate volume progression after TURP. Patients and Methods This was a prospective cohort study on 83 BPH patients who underwent TURP at five hospitals in Bali, Indonesia. Trans-rectal ultrasonography (TRUS) was carried out to examine the prostate’s size. Three years after, we redo the TRUS examination to collect the data of the latest prostate size. TNF-α, TGF-β, serum PSA, testosterone, and age were registered for analysis. We used Pearson’s and Spearman’s correlation tests and multivariate analytic linear regression test (coefficient β) b...
Anaesthesia, 2021
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Anaesthesia, 2021
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
Bali Journal of Anesthesiology, 2020
Our aim studied to observe the effectivity of remifentanil on the hemodynamic response and condit... more Our aim studied to observe the effectivity of remifentanil on the hemodynamic response and condition of intubation on intubation without a muscle relaxant using a combination with propofol. A total of six patients aged 25–60 years with the American Society of Anesthesiology physical status I–II underwent elective oncologic surgery. Patients received premedication midazolam 0.05 mg/kg and induction with propofol 2 mg/kg and remifentanil 2 μg/kg intravenously over 60 s. Systolic blood pressure, diastolic blood pressure, and heart rate were observed before premedication, before intubation, and postintubation. Intubation condition was assessed using the Copenhagen Consensus Score based on the ease of laryngoscopy, the position and movement of the vocal cord, and reacting to intubation. All patients were intubated without problem, and the intubation condition was excellent. One patient had hypotension and could be treated by administering the fluids and vasoconstrictor. The other remaining patients were stable without significant hemodynamic changes. A combination of propofol with remifentanil could provide excellent intubation condition and maintaining hemodynamic stability.
Bali Journal of Anesthesiology, 2019
Postoperative pain, when poorly controlled, will cause chronic pain and prolong the healing proce... more Postoperative pain, when poorly controlled, will cause chronic pain and prolong the healing process. The use of an epidural catheter is a safe and effective method for pain relief in the intraoperative and postoperative period. Opioid as an adjuvant can increase the potency and duration of epidural analgesia. Morphine has been used as an adjuvant in epidural analgesia, but with known side effects such as nausea, vomiting, and pruritus. Oxycodone is one of the opioids which can be given through epidural route as an adjuvant with fewer side effects than morphine. In this case series, we describe six patients with American Society of Anesthesiologists physical status I–II who underwent laparotomy gynecological surgery. All patients were managed by combined general and epidural anesthesia. The regimen for epidural anesthesia is bupivacaine with oxycodone as adjuvant. In this study, we described the hemodynamic profile, quality of analgesia, side effects, and anti-inflammatory effect of oxycodone as an adjuvant in epidural analgesia.
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Papers by Christopher Ryalino