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Wardhana, Anggia Rarasati
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Social Sciences

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UNCONTROLLED TYPE 1 DIABETES MELLITUS WITH TUBERCULOMA IN INFERIOR LOBE LEFT LUNG AND BILATERAL HYDRONEPHROSIS IN CHILD Wardhana, Anggia Rarasati; Sukartini, Sukartini; Muhyi, Annisa
Jurnal Ilmu Kesehatan dan Kesehatan Vol 3 No 2 (2019): AUGUST
Publisher : UNUSA Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33086/mhsj.v3i2.1155

Abstract

Diabetes Mellitus (DM) is an important risk factor for the development of active tuberculosis (TB). It is chronic and will weaken the immune system causing the patient have increased risk of tuberculosis by three-fold.We present a case of 13-year-old girl with chest pain and cough. She has a previous history of type 1 DM. Laboratory findings showed hyperglycemic state. Thoracic CT showed tuberculoma of inferoposterior lobe left lung, while abdominal CT showed bilateral hydronephrosis. He was then administered TB treatment of 2HRZE/10RH, corticosteroid, and insulin regiments with strict monitoring of blood glucoses. Clinical symptoms and blood glucose level were significantly improved after treatment.
UNCONTROLLED TYPE 1 DIABETES MELLITUS WITH TUBERCULOMA IN INFERIOR LOBE LEFT LUNG AND BILATERAL HYDRONEPHROSIS IN CHILD Wardhana, Anggia Rarasati; Sukartini, Sukartini; Muhyi, Annisa
Jurnal Ilmu Kesehatan dan Kesehatan Vol 3 No 2 (2019): AUGUST
Publisher : UNUSA Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33086/mhsj.v3i2.1155

Abstract

Diabetes Mellitus (DM) is an important risk factor for the development of active tuberculosis (TB). It is chronic and will weaken the immune system causing the patient have increased risk of tuberculosis by three-fold.We present a case of 13-year-old girl with chest pain and cough. She has a previous history of type 1 DM. Laboratory findings showed hyperglycemic state. Thoracic CT showed tuberculoma of inferoposterior lobe left lung, while abdominal CT showed bilateral hydronephrosis. He was then administered TB treatment of 2HRZE/10RH, corticosteroid, and insulin regiments with strict monitoring of blood glucoses. Clinical symptoms and blood glucose level were significantly improved after treatment.
Fast-Track Anesthesia for Cito Craniotomy Evacuation Hematoma Due to Temporoparietal Subdural Hemorrhagic Hematoma in a Pediatric Patient: A Case Report Wardhana, Anggia Rarasati; Ardana Tri Arianto
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.569

Abstract

Introduction: Subdural hematoma (SDH) in early childhood is a serious condition that requires immediate surgical intervention. Fast-track anesthesia is an approach that aims to speed up the patient's recovery after surgery. This case report presents the experience of fast-track anesthesia in a 4-month-old pediatric patient with SDH who underwent a cito craniotomy. Case presentation: A 4-month-old child with a history of head trauma due to shaking experienced recurrent seizures. CT scan examination showed left temporoparietal SDH with intraparenchymal hemorrhage. The patient was classified as ASA IIIE and underwent a cito craniotomy. A fast-track anesthesia strategy was implemented using rapid induction, multimodal analgesia, and strict fluid management. Conclusion: Fast-track anesthesia was successfully applied to pediatric patients with SDH undergoing cito craniotomy. This approach allows for a quicker recovery, reduces postoperative complications, and shortens the length of hospital stay.
Hemodynamic-Focused Anesthetic Strategy for Duodenal Atresia with Annular Pancreas in a Low-Birth-Weight Neonate: A Case Report and Pathophysiological Review Wardhana, Anggia Rarasati; Ardana Tri Arianto; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.802

Abstract

Introduction: The anesthetic management of low-birth-weight (LBW) neonates with complex congenital anomalies like duodenal atresia presents a profound physiological challenge. These patients exhibit immature organ systems, precarious fluid balance, and heightened sensitivity to anesthetic agents. This case report describes a successful hemodynamically-focused anesthetic strategy in a particularly high-risk neonate with the combined pathology of duodenal atresia and a constricting annular pancreas. Case presentation: A 4-day-old, 1800-gram male infant, born at 37 weeks with intrauterine growth restriction, presented with prenatally diagnosed duodenal atresia. Preoperative stabilization focused on correcting a severe hypochloremic, hypokalemic metabolic alkalosis. A hemodynamically stable anesthetic induction was achieved using intravenous fentanyl (2.8 mcg/kg) and ketamine (2.8 mg/kg), avoiding myocardial depressant volatile agents. Anesthesia was maintained with 60% oxygen in air and intermittent opioid boluses. Intraoperative management was centered on meticulous, goal-directed fluid therapy, rigorous maintenance of normothermia, and lung-protective ventilation. The surgery, a duodenojejunostomy, was completed successfully with remarkable hemodynamic stability. The infant was transferred to the NICU for planned postoperative ventilation and was extubated on the second postoperative day. Postoperative analgesia was achieved with a continuous sub-anesthetic ketamine infusion, later transitioned to intermittent metamizole. Conclusion: The successful outcome in this fragile neonate underscores the value of a tailored anesthetic approach grounded in neonatal pathophysiology. A strategy utilizing hemodynamically stable induction agents, proactive correction of metabolic derangements, goal-directed fluid therapy, and a planned, staged recovery can effectively mitigate the significant perioperative risks associated with major abdominal surgery in LBW infants with complex congenital anomalies.
Co-Authors Annisa Muhyi Ardana Tri Arianto Heri Dwi Purnomo