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Effectiveness of Airway Management Strategies in Critically Ill Patients: A Meta-Analysis Putra, Ricko Yorinda; Novita Anggraeni; Johannas
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1113

Abstract

Background: Airway management is a cornerstone of critical care, but the optimal strategies for critically ill patients remain debated. This meta-analysis aimed to evaluate the effectiveness of various airway management techniques in critically ill patients. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted from January 2018 to December 2023. Studies comparing different airway management strategies (e.g., endotracheal intubation, laryngeal mask airway, video laryngoscopy) in critically ill adults were included. Primary outcomes were successful airway establishment, time to airway securement, and complications (e.g., hypoxia, aspiration). Meta-analyses were performed using random-effects models, and the risk of bias was assessed. Results: Twenty-three studies (n=5,894 patients) were included. Video laryngoscopy was associated with a higher success rate of first-pass intubation compared to direct laryngoscopy (OR 1.85, 95% CI 1.43-2.40, p<0.001). No significant differences were found in overall complications between video laryngoscopy and direct laryngoscopy (OR 0.92, 95% CI 0.68-1.24, p=0.59). In patients with difficult airways, video laryngoscopy demonstrated a reduced risk of complications compared to direct laryngoscopy (OR 0.63, 95% CI 0.41-0.97, p=0.04). Conclusion: Video laryngoscopy is a safe and effective alternative to direct laryngoscopy, particularly in critically ill patients with predicted difficult airways. Further research is needed to determine the optimal airway management strategy in specific subgroups of critically ill patients.
Successful Anesthetic Management for Mandibular Neoplasm Resection in a Patient with Osteogenesis Imperfecta: A Case Report Indriani, Andi Riza Mirda; T Addi Saputra; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i12.1140

Abstract

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and deformities. Patients with mandibular neoplasms and suspected OI require careful anesthetic management to avoid complications. This case report describes the successful anesthetic management of a patient with a mandibular neoplasm and suspected OI. Case presentation: A 33-year-old man presented with a large mandibular tumor causing airway obstruction and difficulty eating. He had physical features suggestive of OI, including short stature, bone deformities, and abnormal tooth growth. Preoperative evaluation revealed a difficult airway due to the tumor and potential cervical spine instability. Anesthesia was induced with propofol and atracurium after securing the airway via ultrasound-guided tracheostomy under local anesthesia. The tumor was resected successfully, and the patient recovered without complications. Conclusion: Anesthetic management in patients with suspected OI and mandibular neoplasms requires careful planning and execution. A multidisciplinary approach, including preoperative evaluation, airway management strategies, and close postoperative monitoring, is crucial for successful outcomes.
Hyponatremia After Intracranial Hemorrhage: Cerebral Salt Wasting Syndrome (CSWS) or The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)? Wan Novriza Wijaya; Novita Anggraeni; Sony; Andrea Valentino
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i1.1174

Abstract

Background: Hyponatremia is a common electrolyte disorder encountered in neurosurgical patients, often associated with significant morbidity and mortality. This case report highlights the importance of recognizing and appropriately managing cerebral salt wasting syndrome (CSWS), a rare but important cause of hyponatremia in neurosurgical patients, often following intracranial hemorrhage (ICH). Distinguishing CSWS from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is crucial for appropriate management. Case presentation: A 56-year-old male with a history of hypertension and diabetes mellitus presented with sudden-onset left-sided weakness and decreased consciousness following an ICH. He underwent a ventriculoperitoneal (VP) shunt placement for hydrocephalus. Post-operatively, he developed hyponatremia with elevated urine sodium levels and hypovolemia, suggestive of CSWS. The patient was treated with fluid replacement therapy, including hypertonic saline, and desmopressin, resulting in improvement in his hyponatremia. Conclusion: CSWS is an important cause of hyponatremia in neurosurgical patients. Prompt diagnosis and appropriate management, including fluid replacement and potentially desmopressin, can improve patient outcomes. This case underscores the need for a high index of suspicion for CSWS in neurosurgical patients presenting with hyponatremia and highlights the importance of careful monitoring and individualized treatment strategies.
Rare and Fatal Complication: A Case of Ketorolac-Induced Anaphylaxis Leading to Cardiac Arrest and Hypoxic-Ischemic Brain Injury in a Young Adult Yogi Ramadhan; Pratama Ananda; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1196

Abstract

Background: Anaphylaxis is a severe, life-threatening allergic reaction that can lead to cardiac arrest and hypoxic-ischemic brain injury (HIBI). Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) commonly used for postoperative pain management, has been rarely associated with anaphylaxis. Case presentation: We present the case of a 32-year-old woman who developed anaphylaxis and subsequent cardiac arrest following intravenous administration of ketorolac after an appendectomy. Despite successful resuscitation, the patient suffered from HIBI and remained in a persistent vegetative state. Conclusion: This report highlights the potential for fatal complications associated with ketorolac administration and emphasizes the importance of prompt recognition and management of anaphylaxis in the perioperative setting. This case underscores the need for heightened vigilance regarding potential anaphylactic reactions to ketorolac, even in patients with no prior history of drug allergies. Early recognition and aggressive management of anaphylaxis are crucial to minimize the risk of severe complications like cardiac arrest and HIBI.
Successful Epidural Anesthesia Management in Cesarean Section for a Patient with Eisenmenger Syndrome: A Case Report Abdi Kumala; Novita Anggraeni; Sony
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1197

Abstract

Background: Eisenmenger syndrome is a rare and complex condition that poses significant challenges for anesthesiologists during pregnancy, particularly during labor and delivery. The physiological changes associated with pregnancy, such as increased cardiac output and blood volume, can exacerbate the hemodynamic instability in these patients. Careful selection of anesthetic techniques and agents is crucial to maintain hemodynamic stability and ensure the safety of both mother and fetus. Case presentation: We present the case of a 34-35-week pregnant woman with Eisenmenger syndrome who underwent a successful cesarean section under epidural anesthesia. The patient's hemodynamic parameters were closely monitored throughout the procedure, and no significant complications were encountered. Conclusion: This case report demonstrates that epidural anesthesia can be a safe and effective option for cesarean section in patients with Eisenmenger syndrome. Meticulous planning, close monitoring, and prompt management of potential complications are essential for a successful outcome.
Anesthetic Management of a Pediatric Patient with Popliteal Pterygium Syndrome Undergoing Labiopalatoplasty: A Case Report Peter Leonardo; Novita Anggraeni; Vera Muharrami
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1200

Abstract

Background: Popliteal pterygium syndrome (PPS) is a rare congenital disorder characterized by multiple anomalies, including orofacial, musculoskeletal, and genitourinary defects. Airway management in PPS patients can be challenging due to associated craniofacial abnormalities. This case report describes the anesthetic management of a 5-month-old infant with PPS undergoing labiopalatoplasty. Case presentation: A 5-month-old male infant, weighing 5.9 kg, presented for labiopalatoplasty. He had a diagnosis of PPS with associated labiopalatoschisis, ankyloblepharon filiforme, pterygium in the popliteal fossa, cryptorchidism, and syndactyly. Airway assessment revealed a patent airway with a cleft lip and palate. Anesthesia was induced with sevoflurane and maintained with sevoflurane and nitrous oxide. Direct laryngoscopy was unsuccessful, and videolaryngoscopy was used to facilitate tracheal intubation. Conclusion: This case highlights the challenges of airway management in infants with PPS. A thorough preoperative airway assessment and the availability of alternative intubation techniques, such as videolaryngoscopy, are crucial for successful anesthetic management in these patients.
Successful Anesthetic Management of Pheochromocytoma in a Patient with Preoperative Hypertension: A Case Report Faisal Irwanda; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1222

Abstract

Background: Pheochromocytoma, a rare tumor arising from chromaffin cells in the adrenal medulla, poses significant anesthetic challenges due to its propensity to release catecholamines, potentially leading to life-threatening hypertensive crises. This case report describes the successful anesthetic management of a patient with pheochromocytoma presenting with preoperative hypertension. Case presentation: A 37-year-old female with a 12x5 cm right adrenal tumor diagnosed as pheochromocytoma was scheduled for adrenalectomy. She presented with a history of uncontrolled hypertension, episodic headaches, diaphoresis, and palpitations. Preoperative management focuses on blood pressure control using alpha and beta-adrenergic blockers. Anesthesia was induced with propofol, fentanyl, and atracurium, while nitroglycerin and sevoflurane were used to maintain hemodynamic stability. The patient's blood pressure was closely monitored throughout the procedure, with interventions made to manage fluctuations during tumor manipulation. Conclusion: Successful anesthetic management of pheochromocytoma requires meticulous preoperative preparation, vigilant intraoperative monitoring, and prompt pharmacological interventions. This case highlights the importance of a multidisciplinary approach, including endocrinologists, anesthesiologists, and surgeons, to optimize patient outcomes.
Successful Anesthetic Management of a Cesarean Section in a Patient with Cardiomyopathy and Cardiogenic Shock: A Case Report Alta Ikhsan Nur; Nopian Hidayat; Novita Anggraeni; Sony
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1230

Abstract

Background: Cardiomyopathy in pregnancy is a rare but serious condition that can lead to significant maternal and fetal morbidity and mortality. Anesthetic management of these patients is challenging due to the complex interplay of physiological changes and the potential for hemodynamic instability. This case report describes the successful anesthetic management of a cesarean section in a patient with cardiomyopathy and cardiogenic shock. Case presentation: A 29-year-old woman with cardiomyopathy and cardiogenic shock presented for emergency cesarean section at 36-37 weeks gestation. She had a history of global hypokinetic, left ventricular and atrial dilatation, and an ejection fraction (EF) of 32%. She was also in atrial fibrillation. Epidural anesthesia was selected due to its lower risk of complications compared to general anesthesia. The patient was carefully monitored throughout the procedure, and her hemodynamics were maintained with a combination of fluids and inotropes. The surgery was successful, and the patient delivered a healthy baby boy. Conclusion: This case report demonstrates that successful anesthetic management of cesarean section is possible in patients with cardiomyopathy and cardiogenic shock. Careful planning, close monitoring, and a multidisciplinary approach are essential for a positive outcome.
Spontaneous Respiration Intubation as a Cornerstone of Multidisciplinary Management for Delayed Tracheoesophageal Fistula Repair in a Critically Ill Neonate Sulthoni; Dino Irawan; Novita Anggraeni; Nopian Hidayat; T Addi Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1474

Abstract

Background: The perioperative management of neonates with esophageal atresia and Type C tracheoesophageal fistula (EA/TEF) is exceptionally challenging, particularly in cases of delayed diagnosis complicated by aspiration pneumonia and congenital heart disease. The primary anesthetic risk is catastrophic gastric insufflation and hemodynamic collapse from positive pressure ventilation (PPV) before fistula control. This report details a successful multidisciplinary strategy centered on an airway technique that preserves spontaneous ventilation. Case presentation: A 16-day-old, 2.5 kg female neonate with Type C EA/TEF presented for surgical repair following a delayed referral. The case was critically complicated by severe aspiration pneumonia (cultures positive for Klebsiella pneumoniae), which was managed with targeted antibiotic therapy, and hemodynamically significant congenital heart defects (2.5 mm patent ductus arteriosus, 3 mm patent foramen ovale). After 48 hours of intensive cardiorespiratory and nutritional optimization in the neonatal intensive care unit (NICU), the patient underwent surgery. To circumvent the life-threatening risks of PPV, an inhalational induction with sevoflurane was performed, maintaining spontaneous ventilation. The airway was secured via direct laryngoscopy without neuromuscular blockade. A right extrapleural thoracotomy, fistula ligation, and primary esophageal anastomosis were successfully performed. Intraoperative lung retraction-induced desaturation was managed with coordinated surgeon-anesthetist maneuvers. The postoperative course was uneventful. Conclusion: In a high-risk neonate with delayed TEF presentation and profound cardiorespiratory compromise, securing the airway while maintaining spontaneous ventilation is a cornerstone of safe anesthetic practice. This approach, integrated within a comprehensive, multidisciplinary management plan, directly mitigates the risk of gastric perforation and cardiovascular collapse, thereby enabling a successful surgical repair and favorable outcome.
PENGARUH KEBIJAKAN FISKAL TERHADAP PERTUMBUHAN EKONOMI INDONESIA Muhlis; Novita Anggraeni; Mujito
Indonesian Journal of Social Science and Education (IJOSSE) Vol. 1 No. 1 (2025): Vol. 1 No. 1 Edisi Januari 2025
Publisher : JCI Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62567/ijosse.v1i1.637

Abstract

Penelitian ini bertujuan untuk menganalisis pengaruh kebijakan fiskal terhadap pertumbuhan ekonomi Indonesia, dengan fokus pada penerimaan pajak, pengeluaran pemerintah, dan defisit anggaran selama periode 2014-2024. Kebijakan fiskal mempengaruhi berbagai aspek perekonomian, termasuk konsumsi dan investasi, yang berdampak pada pertumbuhan ekonomi. Data yang digunakan berasal dari Badan Pusat Statistik (BPS) dan Kementerian Keuangan Republik Indonesia, yang mencakup data PDB tahunan, penerimaan pajak, pengeluaran pemerintah, dan defisit anggaran. Metode analisis yang digunakan adalah regresi linier berganda, dengan uji asumsi klasik untuk memastikan kualitas data. Hasil penelitian menunjukkan bahwa penerimaan pajak memiliki pengaruh signifikan terhadap pertumbuhan PDB, dengan nilai signifikansi sebesar 0,046 yang lebih kecil dari 0,05. Peningkatan penerimaan pajak dapat memperkuat kapasitas fiskal pemerintah untuk mendanai pembangunan, yang pada gilirannya mendorong pertumbuhan ekonomi.