Garuda - Garba Rujukan Digital

Anesthesia Management of Patients with Esophageal Atresia/Traceoesophageal Fistula undergoing Thoracostomy and Esophagostomy Procedures Marthendro, Triade; Irawan, Dino; Muharrami, Vera; Hidayat, Nopian; Ananda, Pratama
Journal La Medihealtico Vol. 5 No. 5 (2024): Journal La Medihealtico
Publisher : Newinera Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37899/journallamedihealtico.v5i5.1597

Esophageal atresia is a congenital disorder characterized by a disruption in the continuity of the esophageal lumen. Esophageal atresia may be accompanied by tracheoesophageal fistula, which is a lumen connection between the proximal and or distal part of the esophagus and the airway (trachea). Type C atresia is the most prevalent, which is approximately 88.5% to 90% of cases, where there is proximal esophageal atresia with distal tracheoesophageal fistula. In this case, a 9-day-old infant was admitted to Arifin Ahmad Hospital for thoracostomy and esophagostomy surgery due to continuous mucus discharge. The patient underwent awake intubation and was positioned intraoperatively, with a tilt to the right when an orogastric tube was placed. During surgery, the patient maintained stable hemodynamic and was subsequently admitted to the NICU using a ventilator. Infants with esophageal atresia often show symptoms of hypersalivation and shortness of breath caused by aspiration pneumonia. When the nasogastric tube cannot pass through the esophagus, atresia can be suspected. Radiology studies play an important role in diagnosing esophageal atresia, confirming esophageal atresia with or without fistula and diagnosing other anomalies associated with VACTERL.

Total Intravenous Anaesthesia (TIVA) in Supratentorial Meningioma Undergoing Craniotomy Tumour Removal : A Case Report Herman, Awanda; Hidayat, Nopian; Anggraeni, Novita; Ananda, Pratama
Biomedika Vol 16, No 2 (2024): Biomedika Agustus 2024
Publisher : Universitas Muhammadiyah Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23917/biomedika.v16i2.6390

Meningiomas are tumours that grow inside the head cavity or intra-cranial tumours, The incidence of intra-cranial tumours in patients of all ages is approximately 4.2 - 5.4 /100,000. The brain uses 20% of the body's total oxygen. The brain uses most of its oxygen consumption (60%) to generate adenosine triphosphate (ATP), which supports the electrical activity of neurons. In cranitomy tumour removal, it is expected that good oxygen supply and oxygen consumption by the brain are reduced by reducing electrical activity in the brain with the aim of relaxing the brain, Selection of 4 intravenous anaesthetic agents in craniotomy tumour removal in this patient in the form of Tiopental, Fentanyl, Rocuronium and Dexmedetomidine because the use of these agents is the best in reducing cerebral metabolic rate (CMR) and cerebral blood flow (CBF) so as to reduce intracranial pressure (ICP) which appears in this case stable hemodynamics and adequate depth of anaesthesia during surgery.

Adverse Event : Myocardial Injury after Non-Cardiac Surgery (MINS) Post Craniectomy in Critical Care Fajri, Doni; Anggraeni, Novita; Hidayat, Nopian; Ananda, Pratama
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.664

Intracerebral hemorrhage (ICH) describes the non-traumatic parenchymal hemorrhage caused by the rupture of cerebral vessels, accounting for 2030% of all strokes. ICH will cause compression on the surrounding brain tissues, eventually giving rise to increased intracranial pressure. Decompressive craniectomy (DC) effectively reduce intracranial pressure. Myocardial injury is defined as an elevation of cardiac troponin levels with or without associated ischemic symptoms. Case a male, 66 years old patient was admitted to the ICU after undergoing Emergency Craniectomy Hematoma Evacuation due to Spontaneous ICH. After 52 hours of treatment, the patient was found to have ventricular tachycardia (VT) on the monitor and restlessness. The patient was also found to have comorbid hypertension. On a 12-Lead ECG we found NSTEMI, and Troponin I level was measured at 453.0 ng/L (positive). This patient was treated with anticoagulants, antiplatelet and statin, with monitoring of the ECG daily. On The 6th day patient was moved to High Care Unit (HCU). Myocardial Injury after Noncardiac Surgery is defined by elevated postoperative cardiac troponin concentrations, with or without accompanying symptoms or signs. It typically occurs within 30 days after surgery. The management of MINS involves the use of anticoagulants and antiplatelet therapy. Anticoagulant therapy should be considered between benefit and risk of re-bleeding post operative. MINS is a rare condition but is associated with an increased risk of 30-day mortality. A multidisciplinary treatment approach and a coordinated team effort are essential for improving the outcomes of patients with this condition.

Myasthenia Gravis with Thymoma Complication: Dilemmas and Prospective Anesthesiology Approach Jaya, Pelinggo; Ananda, Pratama; Anggraeni, Novita
Jurnal Ilmu Kedokteran Vol 19, No 1 (2025): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26891/JIK.v19i1.2025.96-99

Myasthenia gravis (MG) is an autoimmune disease affecting the postsynaptic neuromuscular junction. Myasthenia Gravis occurs in 1:7500 individuals, mostly female and or Asian. Myasthenia gravis can later be complicated with thymoma, and by several indications might need an operative approach. The need for thymectomy while there is a preexisting neuromuscular anomaly in Myasthenia gravis becomes a dilemma when choosing the right anesthetic regimens. This case report aims to discuss findings and offer a possible anesthetic approach that can be considered for cases of Myasthenia gravis with thymoma complications. We received a referred female patient with main complaints of dyspnoea, which was suspected as lung cancer. After further investigation, we found that the patient has previously been diagnosed with Myasthenia gravis, but did not follow through with her treatment plan. We performed a CT scan and confirmed a suspected thymoma as a complication of her Myasthenia gravis. Tymectomy was performed afterwards under general anesthesia. Post-operative extubation was successful, and maintenance of Myasthenia gravis treatment was followed by a neurologist. MG with thymoma is a rare finding in our hospital. Myasthenia gravis causes neurologic anomalies in which patients require special consideration on choosing a proper anesthesia regimen, as general anesthesia and muscle relaxants can worsen respiratory depression. Developing A proper scoring and suitable management plan will enhance the outcome and quality of life. Currently, there are several known anesthetic and supportive medicine approaches to thymectomy in Myasthenia gravis patients, including alternative regimens with similar efficacy.

Efficacy of Opioid-Free Anesthesia vs Opioid Anesthesia in Postoperative Outcome of Patients Underwent General Anesthesia Ananda, Pratama; Anggraeni, Novita; Sari, Valencia Ayu
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Background: Opioids are widely used narcotic analgesics in perioperative settings. However, it has a series of postoperative side effects. Opioid-free anesthesia (OFA) is an anesthetic technique that avoids the use of opioids intraoperatively to minimize their side effects. This study aimed to compare the postoperative outcome and side effects between OFA and opioid anesthesia. Methods: This is a randomized comparative experimental study in adults undergoing elective surgery under general anesthesia. We enrolled 30 patients and divided them into Group A (treatment) (n = 15), who were given ketamine at 0.25-0.5 mg/kg repeated every 30 minutes and 2% lidocaine at 1-1.5 mg/kg followed by maintenance doses. Group B (control) (n = 15) received fentanyl at 1-5 µg/kg/hour. Postoperative outcome (pain intensity) using the Wong-Baker FACES® Pain Rating Scale and side effects of opioids, including postoperative hypoxia, ileus, delirium, and postoperative nausea and vomiting (PONV), were observed. The data between groups were analyzed using the Wilcoxon, chi-square, unpaired t-test, Fisher’s exact, and Mann-Whitney test with α = 0.05. Result: Moderate to severe postoperative pain was observed to be higher in the control group than in the treatment group (88.9% vs 11.1%) (p = 0.020). Incidence of hypoxia, ileus, delirium, nausea, and vomiting in group A (p = 0.003; p = 0.030; p = 0.042; p = 0.001, respectively) was higher compared to group B. Conclusion: The use of OFA results in better postoperative pain control and a lower incidence of postoperative opioid-related side effects, i.e., postoperative hypoxia, ileus, delirium, and PONV.

PNEUMONIA NOSOKOMIAL AKIBAT KLEBSIELLA PNEUMONIAE POSITIF ESBL PADA PASIEN DENGAN MENINGIOMA FRONTALIS BESAR : LAPORAN KASUS Rahmadhani, Nadia Putri; Ananda, Pratama; Wijaya, Dewi
Jurnal Kesehatan Tambusai Vol. 6 No. 3 (2025): SEPTEMBER 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i3.49967

Pneumonia nosokomial (Hospital Acquired Pneumonia/HAP) adalah infeksi saluran pernapasan bawah yang terjadi ≥48 jam setelah pasien dirawat di rumah sakit dan tidak dalam keadaan inkubasi saat masuk. Klebsiella pneumoniae positif extended-spectrum beta-lactamase (ESBL) merupakan agen etiologi utama yang berhubungan dengan peningkatan morbiditas, mortalitas, serta lama hari rawat pada kasus HAP. Meningioma adalah tumor intrakranial primer yang berasal dari sel meningotelial pada meningen, khususnya lapisan arakhnoid. Tumor ini merupakan neoplasma jinak paling sering pada sistem saraf pusat, meskipun sebagian kecil dapat bersifat atipikal atau ganas. Pasien dengan meningioma, terutama yang menjalani perawatan jangka panjang, memiliki risiko lebih tinggi mengalami komplikasi seperti HAP. Laporan kasus ini menyoroti interaksi antara kondisi neurologis dasar dan infeksi nosokomial. Pemberian antibiotik empiris dapat memperbaiki prognosis. Seorang pasien perempuan berusia 44 tahun datang dengan keluhan sakit kepala disertai muntah. Pemeriksaan MRI menunjukkan adanya meningioma pada konveksitas frontal posterior kiri dengan ukuran 6x6x6 cm. Pada hari ke-5 perawatan di rumah sakit, pasien mengalami penurunan kesadaran yang disertai sesak napas. Pasien dirawat di ICU, dilakukan intubasi, dan diberikan antibiotik empiris meropenem sambil menunggu hasil kultur sputum. Hasil kultur menunjukkan Klebsiella pneumoniae positif ESBL. Setelah 3 hari terapi antibiotik, kesadaran pasien membaik, serta hasil pemeriksaan laboratorium dan radiografi toraks menunjukkan perbaikan. Pasien dengan keganasan memiliki risiko tinggi untuk mengalami pneumonia nosokomial selama perawatan rumah sakit yang berkepanjangan. Terapi antibiotik empiris sebagai penatalaksanaan awal memberikan prognosis yang baik dalam mencegah perburukan infeksi.

Navigating Airway Dilemmas in Massive Lung Abscess: A Case Report of Risking Rupture to Save Ventilation Putri, Nurul Hazi; Fauzi, Zarfiardy Aska; Ananda, Pratama
Respiratory Science Vol. 6 No. 1 (2025): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v6i1.185

Background: Lung abscess is a necrotizing infection with cavitary lesions and air fluid levels, most often from aspiration, hematogenous spread, or bronchial obstruction. Despite better antibiotics, large abscesses remain difficult to manage, especially with respiratory failure and altered consciousness. Case: A 49-year-old woman with uncontrolled hypertension who presented with progressive shortness of breath, cough, and fever. On admission to the Respiratory Intensive Care Unit (RICU), the patient appeared acutely ill, with a Glasgow Coma Scale of E4M6V4 and signs of systemic inflammation, hypoalbuminemia, and elevated D-dimer. Chest imaging revealed a large cavitary lesion in the left lower lobe (9.4 × 12.5 × 12.4 cm) with segmental atelectasis. PaO₂/FiO₂ ratio was 210, indicating mild oxygenation impairment. Blood cultures yielded Staphylococcus haemolyticus. Due to declining consciousness and respiratory effort, the patient underwent endotracheal intubation with lung-protective ventilation. A chest tube was placed, draining 300 mL of purulent fluid. The patient improved clinically and radiographically and was discharged, with successful extubation and recovery over ten days. Discussion: This case shows that managing a massive lung abscess in a critically ill patient demands individualized, multidisciplinary decisions that balance airway protection, infection control, and procedural safety, using head-up RSI with minimal-pressure ventilation and early cuff inflation, strict lung-protective settings, and timely chest-tube drainage. Stabilization was achieved despite a negative sputum culture and Staphylococcus haemolyticus bacteremia, in the context of complicating comorbidities. Conclusion: Timely intubation and individualized drainage strategies using a multidisciplinary approach are essential in managing large pulmonary abscesses in critically ill patients.

Early Tracheostomy in Prolonged Mechanical Ventilation Due to Severe Head Injury to Prevent Ventilator-Associated Pneumonia (VAP) Ananda, Pratama; Sony
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.115-119

Introduction: Early tracheostomy needs to be considered if a ventilator is expected to be used for an extended period of time. Early tracheostomy is recommended since it improves respiratory function, reduces the risk of ventilator-associated pneumonia (VAP), improves patients' comfort level, cleanses secretions in the throat, reduces laryngeal ulceration, improves mobilization, and speech efforts, and allows treatment outside the intensive care unit (ICU). Case Series: Four cases of severe head injury with an early tracheostomy, which illustrate the prevention of VAP, were reported. In these four cases, early tracheostomy was performed (£ 4 days) considering the initial critical GCS, the location of the lesion, and that mechanical ventilation was expected to be used for an extended period of time. During treatment, no VAP signs were detected, evidenced by Clinical Pulmonary Infection Score (CPIS), Rontgen thorax, and sputum culture examinations. Based on a meta-analysis study, early tracheostomy reduces mortality due to VAP by up to 50% and reduces the length of stay in ICU compared to delayed/late tracheostomy (> 10 days) or prolonged intubation (> 14 days). Conclusion: In the study cases, early tracheostomy (<4 days) was found to be associated with reduced ventilation time and shortened ICU and hospital stays without an increased risk of VAP. VAP prevention efforts are carried out by applying early tracheostomy and VAP bundle as well. Early tracheostomy offers more benefits than prolonged intubation or delayed/late tracheostomy.

Perioperative Anesthetic Management in Repair Diaphragmatic Hernia with Atrial Septal Defect and Pulmonary Hypertension Noorrahman, M Irvan; Ananda, Pratama; Anggraeni, Novita
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 2 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I22024.106-115

Introduction: Patients who had suffered disease of atrial septal defect (ASD) coming by pulmonary hypertension (PH) often present a clinical dilemma. Both of these disorders are congenital anomalies that often appear in pediatrics. Anaesthetic management in diaphragmatic hernia repair with this comorbidity requires precision and accuracy to avoid morbidity and mortality during surgery. The right management and care of anesthetic procedures is needed for patients who will be operated on with these two disorders. Objective: To describe the anesthetic management of a diaphragmatic hernia repair patient with comorbid ASD and pulmonary hypertension. Case report: The patient, a 1.5-month-old female baby born, has presented with shortness of breath complaints since the birth. Those were born spontaneously at the midwife's office and did not cry immediately, and a history of blueing and decreased consciousness was admitted for 20 days. Based on the examination, the diagnosis of diaphragmatic hernia from echocardiography found ASD and PH with a left ventricular ejection fraction of 64%. The patient was planned for diaphragmatic hernia repair under general anesthesia. Induction of anesthesia was performed with 5 mcg of fentanyl and inhalation anesthetic 3.5 vol% sevoflurane. After the endotracheal tube (ETT) was attached, the patient was desaturated to 50%, then the hyperventilated oxygenation was performed and positioned with knee chest position, and then milrinone at a dose of 1 mcg/min was given, saturation rose to 100%. During intraoperative ventilation control with manual bagging and maintenance anesthesia with inhalation ansethetic sevoflurane of 3.2 vol%. After surgery, the patient was admitted and observed in the pediatric intensive care unit for 2 days before extubation. Conclusion: Appropriate perioperative management in ASD patients with PH can reduce perioperative morbidity and mortality.

Title

Found 9 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 9 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 9 Documents
Search