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All Journal International Journal of Public Health Science (IJPHS) Jurnal Anestesiologi Indonesia Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Majalah Anestesia & Critical Care (MACC) Neurona Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute
Andi Ade Wijaya Ramlan
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo, Jakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Anesthetic Considerations in a Neonate Undergoing Thoracoscopic Removal of a Thoraco-Amniotic Shunt Following Prenatal Management of Fetal Pleural Effusion: A Case Report Nugroho, Nugroho; Andi Ade Wijaya Ramlan
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 9 No. - (2025): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v9i-.325

Abstract

Fetal pleural effusion is a condition characterized by the accumulation of fluid in the chest cavity of a developing fetus. It may be primary, often caused by lymphatic leakage such as chylothorax, or secondary to immune causes like Rh or ABO incompatibility, as well as nonimmune factors including chromosomal abnormalities, genetic disorders, infections, and congenital heart defects. These effusions may be associated with hydrops fetalis. The preferred prenatal treatment is thoraco-amniotic shunt (TAS), which drains pleural fluid into the amniotic sac. TAS improves lung development and has a survival rate of up to 85% in nonhydropic fetuses. A 34-week pregnant woman (gravida 2, para 1) was referred with suspected fetal lung fluid and diagnosed with fetal pleural effusion by ultrasound. After multidisciplinary evaluation, an ultrasound-guided thoraco-amniotic shunt (TAS) was performed under maternal spinal anesthesia, with fetal analgesia and paralysis achieved using fentanyl and vecuronium. The procedure was successful without complications. The patient delivered by cesarean section at 38 weeks. Postnatal imaging showed the shunt in place without residual effusion. On day six of life, the neonate underwent successful thoracoscopic shunt removal under general anesthesia, with stable intraoperative and postoperative outcomes. Conclusion, Thoraco-amniotic shunt placement and postnatal thoracoscopic removal require careful anesthetic planning and multidisciplinary coordination. Understanding maternal-fetal physiology and neonatal immaturity is essential. With thorough assessment and precise anesthetic management, both intrauterine and neonatal procedures can be performed safely with favorable outcomes.
Rapid Response Systems as Secondary Responders to In-Hospital Clinical Deterioration: A Four-Year Observational Study Sidharta Kusuma Manggala; Andi Ade Wijaya Ramlan; Dita Aditianingsih; Riyadh Firdaus; Arief Cahyadi; Aino Nindya Auerkari; Noor Hafidz; Luther Holan Parasian; Adhrie Sugiarto; Yoan Devina; Aivi Mujono; Avisa Cetta Cresma
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.80762

Abstract

Background: In-hospital cardiac arrest (IHCA) is a major cause of preventable inpatient mortality, especially in low- and middle-income countries (LMICs) where rapid response systems (RRS) are still developing. Evidence regarding RRS performance in Indonesia is limited. This study evaluated the performance and operational challenges of an institutional RRS over four years at a large tertiary referral hospital in Jakarta.Objective: This study aimed to determine the proportion of immediate survival following RRS activation and to investigate secondary outcomes, including the association between activation indications and mortality, and system-level barriers.Methods: This retrospective observational cohort study included all inpatient RRS activations at Cipto Mangunkusumo National General Hospital (RSCM), Jakarta, Indonesia, from January 1, 2021, to December 31, 2024. Data from the hospital’s RRS registry were analyzed for activation triggers, interventions, immediate outcomes, and operational issues.Results: Among 246,367 inpatient admissions, there were 5,900 eligible inpatient RRS activations, yielding an activation rate of 23.9 per 1,000 admissions. Immediate survival occurred in 4,763 (80.7%) events, while 1,137 (19.3%) patients did not survive. Cardiac arrest (8.0%) and respiratory arrest (6.5%) were the strongest predictors of non-survival odds ratio (OR) 48.17 and 27.13 vs. red early warning score (EWS) reference, both p<0.001). Most activations occurred out of hours (63.0%), and mortality was significantly higher (71.3% vs. 61.1%; p < 0.001). The most frequent single-parameter triggers were oxygen saturation ≤90% (38.5%) and sudden deterioration of consciousness (15.8%). Mismatched activations, where the patient’s condition upon team arrival differed from the activation indicationwere strongly associated with higher mortality (OR 17.3, 95% confidence interval (CI) 14.3–20.2, p<0.001).Conclusion: The institutional RRS demonstrated a moderate activation rate and favorable immediate survival compared with similar LMIC settings. However, outcomes were influenced by delayed recognition, out-of-hours activation, and limited critical-care capacity. Strengthening early-escalation culture, monitoring afferent-limb failure (ALF), expanding nighttime coverage, and increasing intensive care unit (ICU) capacity are essential to enhance RRS effectiveness and reduce preventable in-hospital mortality in resource-limited settings.
Co-Authors Agung Bintartho Aivi Mujono Al Rasyid Alatas, Anas Aldy Heriwardito Alexandra, Arky Kurniati Anggara Gilang Dwiputra Arief Cahyadi Auerkari, Aino Nindya Avisa Cetta Cresma Dinda Diafiri Dita Aditianingsih Fadhila, Fulki Ferdiana, Komang Ayu Gunawan, Ferriansyah Hafidz, Noor Hirari Fattah Yasfi Kadek Yogi Mahendra Kapuangan, Christopher Kurniawan, Mohammad Lasanudin, Joshua Eldad Frederich Luther Holan Parasian Manggala, Sidharta Kusuma Martira, Amelia Noor Hafidz Nugroho Nugroho Perdana, Aries Pramodana, Bintang Raden B Sukmono Rahendra, Rahendra Rahendra, Rahendra Raihanita Zahra Rakhmad Hidayat Ratna Farida Soenarto Reyhan Eddy Yunus Riyadh Firdaus Salim Harris Setiadi, Bakti Sugiarto, Adhrie Sukmono, Raden Besthadi Taufik Mesiano Yasir Mustafa Banadji Yoan Devina Zahra, Raihanita