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All Journal SAINS MEDIKA : JURNAL KEDOKTERAN DAN KESEHATAN Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Medica Arteriana (Med-Art) Journal of Anaesthesia and Pain Asian Journal of Social and Humanities Jurnal Komplikasi Anestesi
Calcarina Fitriani Retno Wisudarti
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Gadjah Mada/RSUP Dr. Sardjito Yogyakarta
Decision Sciences, Operations Research & Management Earth & Planetary Sciences Education Environmental Science Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Public Health

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Perbandingan Pengukuran Cardiac Output, Cardiac Index, dan Systemic Vascular Resistance Antara Menggunakan Non-Invasive Cardiometry (Icon®) dan Pressure-Recording Analytic Method (MOST- CARE®) pada Pasien Pascaoperasi Mayor di RSUP Dr. Sardjito Yogyakarta Daniswara; Wisudarti, Calcarina Fitriani Retno; Kurniawaty, Juni
Jurnal Komplikasi Anestesi Vol 8 No 3 (2021): Volume 8 Number 3 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v8i3.8372

Abstract

Background: Pulmonary Artery Catheter (PAC) is the gold standard for examining cardiac output (CO), cardiac index (CI), and systemic vascular resistance (SVR), however, PAC insertion is very invasive, causing complications. A less invasive method is currently being developed in the form of Most-Care® (pressure recording analytical method (PRAM)) and non-invasive ICON® (electrical cardiometry (EC)). Methods: The study sample was adult patients who were treated in the ICU Dr. Sardjito with age ≥ 18 years,post major surgery with an arterial line and central venous catheter (CVC). CO, CI, and SVR values were measured at the first hour after the patient arrived at the ICU using ICON® and Most-Care®. Collected data were processed and analyzed to compare between two of them using paired ttest. Results: From a total population of 49 patients, 23 subjects met the inclusion criteria, and the remaining 26 subjects were eliminated due to CHF, obesity, atrial fibrillation, tachycardia, bradycardia, and thoracic surgery. CO and CI of ICON® and Most-Care® are not significantly different (p>0.05). High SVR of ICON® and Most-Care® are not significantly different (p=0.667), but showed a significant difference in normal SVRp=0.015. Conclusion: The measurement of CO and CI between ICON® and Most-Care® showed no significant difference (p>0.05), but showed a significant difference (p=0.015) in the normal SVR category
Hubungan Kadar Interleukin-6 terhadap Luaran Mortalitas dan Hari Rawat serta Hari Penggunaan Oksigenasi Tekanan Positif Pasien COVID-19 di RSUP Dr. Sardjito Kuncoro, Kusuma Edhi; Sudadi; Sari, Djayanti; Wisudarti, Calcarina Fitriani Retno
Jurnal Komplikasi Anestesi Vol 9 No 1 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v9i1.8518

Abstract

Background: COVID-19 is a disease caused by the SARS-CoV-2 virus with the main clinical manifestations of respiratory disorders. Patients with severe and critical symptoms require oxygenation therapy during treatment. Interleukin-6 (IL-6) plays a role in the course of the disease and is associated with the clinical severity of COVID-19. IL-6 has the potential as one of the test parameters to estimate the outcome of COVID-19 patients. Objective: To know the relationship between IL-6 levels and the outcome of mortality, length of stay (LOS) and positive pressure oxygenation days of COVID-19 patients during hospitalization at Dr. Sardjito hospital. Methods: The study design was a retrospective observational cohort by taking secondary data from the medical records of hospitalized COVID-19 confirmed patients who were examined for serum IL-6 during April 2020- March 2021 at dr.Sardjito Hospital. Data collection was carried out at the Medical Records Instalation of Dr. Sardjito Hospital. The relationship of the IL-6 variable to the outcome was tested by logistic regression method and further analyzed with Kaplan-Meier and Cox regression analysis of survival. Results: There were 302 research subjects with a mean age of 55.45 (+14.79) years, 183 male (60.6%) and 119 female (39.4%). Subjects with IL-6 >80 pg/mL had a higher risk of death than those with IL-6 <80 (p=0.000, HR=4.68). As many as 87.4% of the subject required oxygenation therapies during hospitalization. Group of subjects with an IL-6 value >80 was significantly required more positive pressure oxygenation therapy (p=0.000) and require longer (p=0.005) duration of positive pressure oxygenation (9.36(+5,9) days) compared to the group of subjects with IL-6 <80 (6(+2,98) days). The difference in LOS was significantly different between groups of subjects, with the median LOS for subjects with IL-6 >80 was 25 days, while for subjects with IL-6 <80 was 13 days (p= 0.000). Conclusion: There was a significant relationship of IL-6 levels >80 pg/mL with increased risk of mortality, LOS and the requirement of positive pressure oxygenation therapies in COVID-19 patients.
Hubungan Thoracic Fluid Content Cardiometry dengan Lung Ultrasound Score untuk Menilai Lung Water pada Pasien Pascaoperasi Mayor di ICU Pradana, Gilar Rizki Aji; Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno
Jurnal Komplikasi Anestesi Vol 9 No 1 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v9i1.8519

Abstract

Background: Perioperative fluid management in patients undergoing major surgery is important. Excessive administration of fluid can cause atrial natriuretic peptide release and iatrogenic glycocalyx/vascular endothelial junction dysfunction which can cause intravascular fluid shifting to the extravascular space. This fluid shifting can occur in the pulmonary interstitial space. Lung Ultrasound Score (LUS) score and Thoracic Fluid Content (TFC) examination with ICON is considered suitable to assess Extravascular Lung Water (EVLW). Objective: To determine the correlation between the LUS score with TFC using ICON in post-operative major patients in the ICU. Methods: A prospective observational research design with a cross-sectional study design. The sample size was 30 adult post-major surgery patients who were treated in the ICU of Dr. Sardjito. The LUS score was obtained from an ultrasound examination of the lungs and TFC was assessed with the ICON device. LUS examination was performed at 3-4 and 7-8 intercostal space between the parasternal-mid clavicular line, and on the lateral side at the level of the mid-axillary line. Correlation analysis was conducted to determine the degree of correlation between LUS score and TFC. Results: The sample of this study was 30 patients. Mean age 46.40±12.30 years, P/F ratio 411,21±77,64, AaDO2 121,20±53,4, LUS score 3.30±2.58, and TFC 24.56±10.30. Fluid balance during operation 194,2±756,65. The Spearman correlation test between LUS score and TFC showed a positive and significant correlation between LUS score and TFC, p<0.001 and r=0.703. The Spearman correlation test for LUS score and P/F ratios, LUS score and AaDO2, LUS score and fluid balance in the operating room showed no significant relationship (p>0.05). Conclusions: The correlation between LUS score and TFC values in postmajor surgery patients treated in the ICU was statistically significant (p<0.001) and the correlation was positive (r=0.703).
Manajemen Intensif Peripartum pada Pasien COVID-19 Apsari, Ratih Kumala Fajar; Wisudarti, Calcarina Fitriani Retno; Negara, Adista Yugadhyaksa Gupta
Jurnal Komplikasi Anestesi Vol 9 No 1 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v9i1.8521

Abstract

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Pregnant women in the third trimester and after delivery are at risk for severe COVID19. Intensive management of pregnant women with COVID-19 consists of a variety of steps. Key points of intensive management include fluid management, steroids, thromboprophylaxis, antibiotics, monoclonal antibodies, and ventilation management. Laboratory, radiological, and clinical examination monitoring should be carried out as needed. In pregnant women with severe COVID-19, there are critical targets that must be achieved. Patient management must be adjusted to achieve these targets. This case report discusses a 23-year-old woman who was 30 weeks pregnant who experienced severe COVID-19 and eventually died. There is much to be learned about the intensive management of pregnant women with COVID19 from this case.
Konsiderasi Anestesi pada Pasien Seksio Sesarea dengan COVID-19 Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun; Trijayanti, Christiana
Jurnal Komplikasi Anestesi Vol 9 No 1 (2021)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v9i1.8522

Abstract

COVID-19 infection in pregnant patients can lead to premature labor. The most common method of delivery is by caesarean section. There are many aspects that must be considered in carrying out anesthesia for COVID-19 patients, including physiological changes that occur due to pregnancy and the effects of COVID-19 infection which can aggravate the condition of pregnant patients. Maintaining adequate oxygenation in the blood, choosing the right anesthetic agent, considering its effect on the fetus, and mechanical ventilation management related to ARDS caused by COVID-19 infection are the main things that should be of concern in anesthesia management
A case series Percutaneus Dilatasional Tracheostomy (PDT) in Cerebrovascular Disease Helen Yudi Irianto, Helen Yudi; Wisudarti, Calcarina Fitriani Retno
Jurnal Komplikasi Anestesi Vol 10 No 3 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i3.8778

Abstract

ABSTRAK Penyakit jaringan otak sering kali membutuhkan manajemen proteksi jalan nafas. Intubasi dan PDT merupakan opsi dari prosedur guna mempertahankan patensi jalan nafas. PDT dapat menurunkan resiko pneumonia dan mempermudah penyapihan bentilator. PDT dilakukan di ruang ICU dan dilakukan anesthesiologist senior dan terdapat 12 kasus yang dikumpulkan serta dicatat kemudian dibagi menjadi 2 kelompok grup yakni dilakukan PDT awal (kurang dari 7 hari setelah intubasi ) dan PDT ahir ( lebih dari 7 hari setelah intubasi). Terdapat 3 set PDT yang dilakukan sterilisasi ulang oleh tim CSSD RSUD Ciawi yang kemudian di Analisa usap instrument oleh tim BLKK dari Jakarta. Semua manajemen PDT dilakukan secara berhasil tanpa adanya komplikasi, hasil lauran pasien pada kedua grup tidak berbeda jauh. Jumlah hari yang dibutuhkan untuk penyapihan ventilator, evaluasi kultur sputum dan instrumen PDT dicatat dan di tampilkan. Penelitian lebih lanjut dibutuhkan untuk melihat keuntungan PDT dan waktu terbaik prosedur dilakukan. Penggunaan set PDT berulang yang disterilisasi menggunakan cairan dekonek dan di suhu dingin dapat memnghindari dari infeksi bakteri. Kata kunci : VaskularisasI otak, penyakit, PDT, komplikasi, luaran
Hubungan Antara Tingkat Keparahan dan Jenis Terapi Oksigen Terhadap Kualitas Hidup Penyintas Covid-19 yang Pernah Dirawat Di ICU RSUP Dr Sardjito wandito, Gayuh Utomo; Wisudarti, Calcarina Fitriani Retno; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i1.12436

Abstract

Latar Belakang: Proses infeksi COVID-19 dapat meninggalkan gejala sisa, sehingga dapat mempengaruhi kualitas hidup penyintasnya, terutama pada penyintas COVID-19 dengan derajat sedang, berat dan kritis. Pasien yang pernah mendapatkan perawatan di ruangan ICU dengan terapi oksigen beragam, memiliki kualitas hidup yang lebih rendah. Tujuan: Mengetahui hubungan antara tingkat keparahan dan jenis terapi oksigen terhadap kualitas hidup penyintas COVID-19 yang pernah dirawat di ICU RSUP dr Sardjito. Metode Penelitian: Jenis dan rancangan penelitian ini adalah observasional kohort prospektif. Peneliti mengambil data sekunder dari rekam medis pada pasien yang terkonfirmasi COVID-19 derajat sedang, berat, kritis dan mendapatkan terapi oksigen yang pernah dirawat di RSUP Dr. Sardjito Yogyakarta dan kualitas hidup diukur dan menggunakan kuesioner EQ-5D-5L secara langsung pada saat penelitian. Subjek penelitian adalah seluruh penyintas COVID-19 yang pernah dirawat di ICU RSUP dr Sardjito bulan Januari 2020 sampai dengan Desember 2021. Analisis bivariat untuk menganalisis hubungan hubungan antara tingkat keparahan dan jenis terapi oksigen terhadap kualitas hidup adalah uji Kruskal Wallis. Variable yang memiliki p < 0,25 pada uji bivariat dilanjutkan analisis multivariat dengan uji regresi linier berganda. Hasil: Total subjek penelitian yang memenuhi kriteria adalah 56 subjek. Skor EQ-5D-5L pada pasien dengan suplementasi oksigen dengan , nasal kanul 0.82, non-rebreathing mask 0.96, High Flow Nasal Canule 0.53 dan ventilator 0.81 yakni (p=0,115). Skor EQ-5D-5L pada COVID-19 derajat sedang 0.92, derajat berat 0.92, sedangkan derajat kritis, yakni 0,75 (p=0,254). Kesimpulan: Tidak terdapat hubungan antara tingkat keparahan dan jenis terapi oksigen terhadap kualitas hidup penyintas COVID-19 yang pernah dirawat di ICU RSUP dr Sardjito. Kata Kunci: COVID-19, derajat keparahan, terapi oksigen, kualitas hidup
Opioid Intratekal pada Enhanced Recovery After Surgery (Eras) Loho, Irvan Revaldi; Wisudarti, Calcarina Fitriani Retno; Sudadi
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i1.12640

Abstract

Enhanced Recovery After Surgery (ERAS) is a multidisciplinary protocol introduced for a faster and more effective recovery from elective surgery. The target of ERAS is early mobilization, early oral intake and a faster length of stay. Preoperative ERAS recommends optimizing the patient's clinical condition, smoking cessation, minimizing fasting and drinking clear, carbohydrate-rich fluids up to 2 hours before surgery, reducing patient anxiety, and PONV prophylaxis. Intraoperatively, ERAS recommends the use of multimodal analgesia, maintenance of normothermia, and goal-directed fluid therapy. Postoperatively, ERAS recommends multimodal analgesia so that patients can mobilize early and eat early. Intrathecal opioid therapy can be an option in achieving the goals of ERAS. Optimal use of opioids is one of the factors that influence effectiveness in patients with the ERAS protocol.
Management of Diabetes Insipidus After Sublabial Transsphenoidal Hypophysectomy Surgery Prasamya, Erlangga; Wisudarti, Calcarina Fitriani Retno; Widodo, Untung; Jufan, Ahmad Yun
Jurnal Komplikasi Anestesi Vol 11 No 2 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i2.12773

Abstract

Summary A 36-year-old female patient was diagnosed with diabetes insipidus after sublabial transsphenoid hypophysectomy (SLTH) surgery. The patient had pituitary adenoma. The patient undergoes 14 days of care in the ICU with titrated intravenous vasopressin dose(0,01-0,3unit/hour) and later subcutaneous dose(6-13unit/8 hours). Subcutaneous vasopressin started on day 3 while intravenous was tapering down; at the early transition from the intravenous vasopressin route to the subcutaneous vasopressin route on day 7, there is a sharp surge of urine production as well at plasma sodium level. The intravenous vasopressin started again, along with the elevated dose of subcutaneous vasopressin. The patient shows a response to therapy after a watchfully titrated dose. Background Diabetes insipidus is a combination of signs and symptoms generating a plentiful volume of urine and causing elevated serum osmolality. There are two types of diabetes insipidus: central diabetes insipidus and nephrogenic diabetes insipidus. Central neurogenic diabetes insipidus occurs when the production of the hormone Arginine Vasopressin (AVP) is low. In contrast, nephrogenic diabetes insipidus occurs when the kidneys cannot respond to high levels of the hormone AVP. Postsurgical central insipidus can be categorized into transient, permanent, and triphasic. Transient courses of diabetes insipidus following surgery represent most of the cases. Temporary diabetes insipidus is thought to be caused by temporary dysfunction of AVP-producing neurons as a result of direct surgical trauma or indirect after-surgical edema. The incidence of diabetes insipidus in patients who underwent pituitary surgery is 5%, and 4.6% of these patients will have only transient diabetes insipidus, and only 0.4% became permanent. Transphenoidal surgery is considered a minimally invasive and effective procedure for pituitary adenomas. Diabetes Insipidus after this surgery is not an uncommon complication, even though the reported rate of postsurgical central diabetes insipidus varies widely from 1 to 67%. Postoperative temporary diabetes insipidus gradually resolves up to 6 months. Case Presentation A 36-year-old female patient presented chief complaints of headache and blurred vision, which gradually worsened one year ago. After undergoing several examinations, the patient was diagnosed with pituitary adenoma. The patient underwent a sublabial transsphenoidal hypophysectomy. The duration was three long hours and uneventful. On Day 0, the patient arrived at the intensive care unit (ICU) intubated, hemodynamically stable, and sedated. The patient is then monitored and weaned; a brain protection strategy and strict fluid balance urine collection and pain management are applied. On day 1, the patient was then extubated. The patient was examined for several parameters, such as electrolytes, kidney function, and blood glucose level. The patient began to significantly increase urine output (>5 milliliters/kilogram body weight/hour). Increased urine production is accompanied by a simultaneous decrease in urine-specific gravity (<1.005) and an increase in serum sodium level up to 151 mmol/liter. The patient was diagnosed with postsurgical diabetes insipidus. The patient started receiving intravenous vasopressin at a dose of 0.3 units/hour and titrated according to urine production until the target urine output was reached after the third day of care. After urine is reached, the dose of vasopressin slowly decreases, and the administration begins to transition to the subcutaneous route. On day 7 of treatment, when the intravenous vasopressin dose had been discontinued and the vasopressin dose at the 8u/h point, there was a significant urine production spike and an increase in the plasma sodium level to 156 mmol/liter. On the eighth day of treatment, the administration of vasopressin was again given intravenously and subcutaneously until a decrease in urine production towards the target was achieved. Finally, on days 11 to 14, vasopressin is administered only subcutaneously until the patient is discharged from the ICU. The patient was successfully discharged to the ward with a tapering-off subtotal dose. Discussion The patient developed polyuria within the initial hours of treatment. Polyuria is a hallmark sign of diabetes insipidus. The clinician should be aware of other polyuria causes, such as postoperative hypervolemia, hyperglycemia, and the use of diuresis drugs. This differential diagnosis must be excluded. In this case, the differential diagnosis was excluded through proper fluid balance calculations, monitoring serum electrolytes and glucose levels, and ensuring the absence of diuretic use. Confirmation of the postoperative central diabetes insipidus is made based on findings of high urine output (5 ml/kg BW/hour), urine specific gravity (<1.005), response to vasopressin, average blood glucose level, and absence of diuretic use. Diabetes Insipidus is the body's inability condition to concentrate urine due to defective production of the antidiuretic hormone (central diabetes insipidus) or nephrogenic diabetes insipidus (NDI), which corresponds to the insensitivity of the kidney to the antidiuretic effects of vasopressin. Diabetes insipidus (DI) is a syndrome characterized by polyuria (>30ml/kg/24H) of hypotonic urine, equivalent polydipsia, and hypernatremia. The patient shows elevated urine volume (108 cc/kg/24H) and blood sodium levels (144-151mmol/L). The primary therapy was the titrated vasopressin dose, in conjunction with electrolytes and fluid management. Vasopressin titration is based on patient clinical condition, urin output, fluid management, oral intake, and laboratory measures (natrium blood level and urin osmolarity). Transient Diabetes Insipidus must be closely monitored after neurosurgical operations, especially in regions adjacent to the pituitary DI. Transient Management with good monitoring is the key. The risk of morbidity comes from the risk of untreated dehydration, electrolyte imbalance Intravenous vasopressin provides a rapid effect with lower doses. At the same time, subcutaneous administration requires caution in critically ill patients because absorption is slow, resulting in a slow effect and the need for higher doses. The conversion of the administration route needs to consider the patient's pharmacology, route, and hemodynamics. References Leroy, C., Karrouz, W., Douillard, C., Do Cao, C., Cortet, C., Wémeau, J.-L., Vantyghem, M.-C., 2013. Diabetes insipidus. Ann. Endocrinol. 74, 496–507. https://doi.org/10.1016/j.ando.2013.10.002 Priya, G., Kalra, S., Dasgupta, A., Grewal, E., 2021. Diabetes Insipidus: A Pragmatic Approach to Management. Cureus. https://doi.org/10.7759/cureus.12498 Schreckinger, M., Szerlip, N., Mittal, S., 2013. Diabetes insipidus following resection of pituitary tumors. Clin. Neurol. Neurosurg. 115, 121–126. https://doi.org/10.1016/j.clineuro.2012.08.009 Sharman, A., Low, J., 2008. Vasopressin and its role in critical care. Contin. Educ. Anaesth. Crit. Care Pain 8, 134–137. https://doi.org/10.1093/bjaceaccp/mkn021
Serial Kasus Tatalaksana Sulit Jalan Napas pada Tumor Tiroid Bayu, Timor Krisna; Widodo, Untung; Sudadi; Wisudarti, Calcarina Fitriani Retno; Farid, Anisa Fadhila
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i1.12913

Abstract

This case report studies three patients with difficult airways managed according to the American Society of Anesthesiologists (ASA) algorithm. The first case is a 46-year-old woman with bilateral SNNT who underwent a subtotal thyroidectomy without prior hyperthyroid therapy. The patient, with an ASA physical status II, was intubated using a videolaryngoscope. Postoperatively, the patient was cared for in the ward. The second case is a 58-year-old woman with a retrosternal goiter and comorbid hyperthyroidism and hypertension, who underwent a total thyroidectomy. The patient, with an ASA physical status II, was intubated while conscious. Postoperatively, the patient was admitted to the ICU. The third case is a 60-year-old woman with bilateral SNNT planned for thyroidectomy and permanent tracheostomy. The patient, with an ASA physical status III and comorbid hyperthyroidism, had failed intubation attempts with a videolaryngoscope and fiber optics. The patient could not be intubated, and the family was educated about the condition. This study demonstrates the importance of individualized management in patients with difficult airways, following ASA guidelines for optimal results.
Co-Authors Agustina, Ayu Yesi Akhmad Yun Jufan Akhsaniati, Novi Dwi Andriani, Ika Jati Setya Anggraini, Diana Anindita, Triatma Anisa Fadhila Farid Atmanagara, Dikho Bambang Suryono, Bambang Baskoro, Windu Adi Bayu, Timor Krisna Bhirowo Yudo Pratomo Bowo Adiyanto Daniswara Dian Ayu Listiarini Djayanti Sari Ferdiansyah, David Gupta, Adista Yugadhyaksa Helen Yudi Irianto, Helen Yudi Ikhsan, Isroful Jufan, Ahmad Yun Juni Kurniawaty Muhdar Abubakar Djayanti Sari Krisdiyantoro, Nova Krisna Bayu, Timor Krispratama, Avian Kuncoro, Kusuma Edhi Kusumasari, Nur Hesti Loho, Irvan Revaldi Mahardieni, Karlina Maryani, Nova Meta Restu Synthana Mi’raj, Geza Getar Mochammad Imron Awalludin Mustikawati, Siti Rakhmah Naomi, Diah Anis Nasution, Rusdi Anwar Negara, Adista Yugadhyaksa Gupta Nova Maryani Nova Maryani Nugraha, Achmad Fauzani Nur, Muhammad Ikhwan Palupi, Isnafianing Pasmawati, Desti Pradana, Gilar Rizki Aji Prasamya, Erlangga Pratomo, Bhirowo Yudho Rahman, Farhan Ali Rakhmatjati, Pradana Bayu Ratih Kumala Fajar Apsari Ridha, Ihsanur Sadiyanto, Dewang Sari, Ayu Rosema Setiandari, Kristina Siti Helmyati Sri Rahardjo Sudadi Taneo, Desy Chery Marlyn Trijayanti, Christiana Untung Widodo Untung Widodo, Untung Utami, Vengky Utomo, F uad Cipto Utomo, Wandito Gayuh wandito, Gayuh Utomo Wibowo, Catur Prasetyo Yuliani, Irma Yunita Widyastuti Yusmein Yusmein Uyun Zulfakhri, Zulfakhri