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All Journal Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Majalah Kesehatan FKUB Jurnal Respirologi Indonesia Journal of Anaesthesia and Pain Journal of Anesthesiology and Clinical Research Majalah Anestesia & Critical Care (MACC)
Arie Zainul Fatoni
Universitas Brawijaya- RSUD Dr. Saiful Anwar, Malang
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Successful Management of Myasthenia Gravis Crisis with Septic Shock and Arrhythmia using Plasmapheresis: A Case Report Viandini, Riska Yulinta; Arie Zainul Fatoni
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.638

Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune disorder that causes muscle weakness. In severe cases, it can lead to myasthenic crisis, a life-threatening condition characterized by respiratory failure. Sepsis, a systemic inflammatory response to infection, can further complicate MG and increase the risk of mortality. This case report describes the successful management of a patient with MG crisis complicated by septic shock and arrhythmia using plasmapheresis. Case presentation: A 52-year-old male with a history of MG presented with progressive dyspnea, decreased consciousness, and oxygen desaturation. He was diagnosed with MG crisis, septic shock, and arrhythmia. The patient was treated with plasmapheresis, antibiotics, and supportive care. Following plasmapheresis, the patient showed significant improvement in muscle strength, respiratory function, and hemodynamic stability. The arrhythmia resolved, and the patient was eventually weaned off mechanical ventilation. Conclusion: This case report highlights the potential benefits of plasmapheresis in managing MG crisis complicated by septic shock and arrhythmia. Plasmapheresis may be considered as a therapeutic option in such cases to improve patient outcomes.
Successful Application of Non-Invasive Ventilation in Acute Respiratory Failure Complicating Thyroid Storm-Induced Pulmonary Edema: A Case Report Muhammad Priangga Akbar; Arie Zainul Fatoni
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.752

Abstract

Introduction: Thyroid storm is a rare, life-threatening exacerbation of thyrotoxicosis characterized by severe multisystem organ dysfunction, including cardiovascular collapse and respiratory failure. Acute pulmonary edema is a recognized but challenging complication, often stemming from high-output cardiac failure or tachyarrhythmia-induced cardiomyopathy. Non-invasive ventilation (NIV) offers a crucial therapeutic modality for acute respiratory failure by improving oxygenation, reducing the work of breathing, and providing beneficial hemodynamic effects, potentially obviating the need for endotracheal intubation. Case presentation: We present the case of a 23-year-old female who developed acute hypoxemic respiratory failure secondary to acute pulmonary edema precipitated by a thyroid storm, occurring post-operatively after a ureterorenoscopy. She presented with severe dyspnea, tachycardia (atrial fibrillation with rapid ventricular response), tachypnea, and significant hypoxemia (PaO₂/FiO₂ ratio of 106.4). Diagnosis of thyroid storm was confirmed by elevated free thyroxine (FT4), suppressed thyroid-stimulating hormone (TSH), and a Burch-Wartofsky Point Scale (BWPS) score of 80. The patient was managed with NIV, alongside standard medical therapy for thyroid storm, including antithyroid drugs, beta-blockers, iodine solution, and corticosteroids. Conclusion: NIV was successfully utilized as primary respiratory support, leading to rapid clinical and radiological improvement, resolution of respiratory failure, and avoidance of invasive mechanical ventilation. The PaO₂/FiO₂ ratio improved to 260 within four days. This case highlights the efficacy and safety of early NIV initiation in patients with acute respiratory failure due to pulmonary edema in the complex setting of thyroid storm.
Co-Authors Ahmad Feza Fadhlurrahman Alwi Shahab Anugrah Onie Ardianto Ardianto Ariady, Randika Rea Aswoco Andyk Asmoro Aswoco Andyk Asmoro Aulia Martyana Achsar Christian Ambrosius Soeiono Della Fitricana Devi Ariani Dewi Arum Sawitri Dewi Arum Sawitri Harri Kurnia Chandra Isngadi Isngadi Isngadi Karmini Yupono Kinanti Narulita Dewi Laksono, Buyung Hartiyo Maya sari Muhammad Priangga Akbar Nasywa Florean Dzakiyyah Ramacandra Rakhmatullah Ratna Maila Dewi Razi Ageng Pratama Resa Putra Adipurna Ristiawan Muji Laksono Ruddi Hartono Rudy Vitraludyono Slamet Hadi Santoso Taufiq Agus Siswagama Trianna Mailawati Ulil Abshor Viandini, Riska Yulinta Vilda Prasastri Yuwono Wiwi Jaya Wiwi Jaya Yana Agung Satriasa Yoan Levia Magdi Yuliato Kusnadi