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All Journal Jurnal Kesehatan Andalas Journal of Agromedicine and Medical Sciences Buletin Ilmiah Nagari Membangun Oto Rhino Laryngologica Indonesiana Majalah Kedokteran Andalas Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Ilmu Kesehatan Indonesia (JIKSI) Jurnal Anestesi: Jurnal Ilmu Kesehatan dan Kedokteran Jurnal Otorinolaringologi Kepala dan Leher Indonesia (JOKLI) Jurnal Riset Ilmiah Seroja Husada: Jurnal Kesehatan Masyarakat
Ade Asyari
Bagian Telinga, Hidung, Tenggorok, Kepala, Dan Leher FK Unand/RSUP Dr. M. Djamil Padang
Agriculture, Biological Sciences & Forestry Humanities Biochemistry, Genetics & Molecular Biology Dentistry Economics, Econometrics & Finance Education Engineering Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Veterinary Other

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Intraoperative Vagal Excitation During Rigid Esophagoscopy for an Esophageal Earring in a 4-Month-Old Infant: A Case Report Ilham Daryl Fathurozzi Alamsjah; Ade Asyari; Rio Rusman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 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.v10i3.1533

Abstract

Background: Esophageal foreign body ingestion is a prevalent otorhinolaryngologic emergency in the pediatric population but is epidemiologically rare in infants under six months of age. While rigid esophagoscopy remains the gold standard for extraction, it involves stimulating the highly innervated aerodigestive tract. This case highlights a life-threatening vagal reflex—an underreported complication in infants—during foreign body removal. Case presentation: A 4-month-old female infant presented with a history of accidental earring ingestion three days prior, manifesting as hypersalivation and feeding refusal. Radiographic imaging confirmed a radiopaque foreign body at the T1 vertebral level or thoracic inlet. The patient underwent rigid esophagoscopy under general anesthesia. During the extraction phase, mechanical manipulation of the esophageal mucosa triggered profound vagal excitation, resulting in severe bradycardia and oxygen desaturation. The procedure was immediately paused, and the patient was successfully resuscitated using vagolytic agents and hyperoxygenation by the anesthesiology team. A second attempt was successful without recurrence of the reflex. Post-operative recovery was uneventful. Conclusion: Foreign body ingestion in early infancy requires a high index of suspicion and meticulous perioperative planning. The manipulation of the esophageal inlet can trigger potent vagovagal reflexes, particularly in infants with high vagal tone. This case underscores the necessity of deep anesthetic planes, prophylactic vagolytic preparation, and seamless communication between the surgeon and anesthesiologist to manage hemodynamic instability.
NILAI AMBANG PROKALSITONIN DAN RISIKO KEMATIAN DINI PADA ABSES LEHER DALAM: PERSPEKTIF KLINIS: procalciton pada abses leher dalam Asyari, Ade; Tri Novriansyah, Wahyu; Novialdi, Novialdi; Dia Rofinda, Zelly; Rasyid, Rosfita; Utami, Refi Amalia
Oto Rhino Laryngologica Indonesiana Vol. 55 No. 2 (2025): VOLUME 55, NO. 2 JULY - DECEMBER 2025
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v55i2.744

Abstract

Background: Procalcitonin (PCT) is widely used as an inflammatory marker in sepsis, but still controversial in deep neck abscesses. Purpose: To evaluate the usefulness of PCT as outcome predictor in deep neck abscess. Method: A prospective observational cohort study was conducted at Dr. M. Djamil Hospital, Padang, Indonesia (March 2022–May 2023). Patients with confirmed deep neck abscess by pus aspiration in the Emergency Department were included. Baseline laboratory and serum PCT tests were performed before surgical drainage. All patients received broad-spectrum antibiotics and standard postoperative care. Assessed outcomes were mortality, septic shock, organ failure, mediastinitis, empyema/ pleural effusion, necrotizing fasciitis, tracheostomy, pharyngocutaneous fistula, Intensive Care Unit >24 hours, and hospital stay. Result: Thirty-five patients met inclusion criteria. Multiple neck space involvement was found in 74.3%, and 93.4% underwent surgery. Mortality occurred in 28.6%, septic shock in 20%, mediastinitis in 14.3%, empyema/pleural effusion in 11.4%, necrotizing fasciitis in 8.6%, tracheostomy in 5.7%, fistula in 8.6%, and ICU stay >24 hours in 20%. Mean hospital stay was 9.03±7.90 days. Mean admission PCT was 0.313±0.677 ng/mL, with 17.1% having elevated PCT>0.5 ng/mL. No significant correlation was found between PCT and overall outcome. However, Receiver Operating Characteristic (ROC) analysis showed PCT≥0.14 ng/mL, predicted <5-day mortality (sensitivity 85.7%, specificity 78.4%), Area Under Curve (AUC) 0.773, p=0.027). Conclusion: Procalcitonin showed potential as an adjunctive marker in deep neck abscess. Although low initial levels are frequent, they do not exclude severe complications, highlighting its role in early risk stratification and clinical decisions.
Co-Authors Abdiana Abdiana, Abdiana Aci Mayang Sari Adha, Muhammad Rofid Adrial Adrial, Adrial Afdal Afdal, Afdal Afrainin Syah, Nur Al Hafiz Al Hafiz Al Hafiz Ali Djamhuri Amany, Esmaralda Nurul Amri, Siti Salsabilla Andani Eka Putra Arif Fahmi Arni Amir ASRAWATI Asrining Tyas Bestari J Budiman Bestari Jaka Budiman Bestari Jaka Budiman Bonny Murizky Cimi Ilmiawati, Cimi Deni Amri Dia Rofinda, Zelly Dia Diflayzer, Diflayzer Dolly Irfandy Dwininta Alfathika Effy Huriati Effy Huriyati Efrida Efrida Efrida Elniza Morina Elniza Morina Embun Dini Erly Indrama Erwi Saswita Esmaralda Nurul Amany Esmaralda Nurul Amany Eti Yerizal Eti Yerizel Faathira, Ken Rabbani Fachzi Fitri Fasya, Haidar Haikal Fika Tri Anggraini Fikri Akbar Firdawati, Firdawati Gestina Aliska Hafni Bachtiar Hafni Bachtiar Hafni Bachtiar Hafni Bachtiar Hafni Bachtiar Harun Harnavi Hendra Permana Ilham Daryl Fathurozzi Alamsjah Jacky Munilson Jacky Munilson Julianda, Wahyu Khairil Faiz Amir Lestari, Rahmi Masnadi, Nice Rachmawati Mizwar, Mizwar Monica, Febrina Nadhirah binti Sa'an Nasman Puar Naura Aqila Netti Suharti Netti Suharti, Netti Nirza Warto Novialdi . Nur Azizah Nur Azizah Octavia, Tri Aryanti Putri Rizki Fitriani Rachmawati, Elvie Zulka Kautzia Rafly, Alifyar Rahmadona Rahmadona Rimelda Aquinas Rio Rusman Rita Risandi Rosfita Rasyid Rossy Rosalinda Salim, Aurelia Agantha Saptino Miro Saptino Miro, Saptino Sariwati, Siska Septiany, Dwi Tika Sri Rahma Liza Sukri Rahman Sutas, Bima Ferdana Syandrez Prima Putra Tri Novriansyah, Wahyu Tuti Handayani Tuti Handayani Utami, Refi Amalia Wahyu Julianda Wahyu Julianda Yan Edward Yolazenia Yolazenia Yuniar Lestari