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Anesthetic Management of a Single Ventricle in Pediatric Patient Undergoing Open Duodeno–Duodenostomy Surgery: A Case Report Lesmana, Pita Mora; I Putu Kurniyanta; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1045

Abstract

Background: Duodenal atresia is a rare congenital disorder characterized by blockage of the small intestine. Open duodeno-duodenostomy is the surgery of choice to correct this condition. Case presentation: We report the case of a three-day-old baby girl with duodenal atresia and a functional single ventricle who underwent open duodeno-duodenostomy. The patient was born via caesarean section due to indications for a previous caesarean section in the mother and congenital abnormalities in the fetus. At birth, the patient showed signs of intestinal obstruction and cyanosis. Preoperative physical and laboratory examinations confirmed duodenal atresia and cardiac abnormalities. The patient underwent an open duodeno-duodenostomy without complications. The patent ductus arteriosus must be kept open to maintain systemic perfusion by maintaining PaO2 at 40 to 45 mmHg and SaO2 at 70% to 80%, along with the administration of prostaglandin agents. Good perioperative management and improvements in surgical procedures will increase the life expectancy of patients with single ventricle problems, especially hypoplastic left heart syndrome. The use of low-dose fentanyl induction agent, 1 MAC sevoflurane, and atracurium has been proven to produce favorable outcomes in these patients. Conclusion: Open duodeno-duodenostomy is a safe and effective operation for duodenal atresia. The patient in this case recovered well after surgery. Open duodeno-duodenostomy should be considered as the primary treatment option for duodenal atresia.
Translasi Kondilus Mandibula Sebagai Prediktor Sulit Laringoskopi Tanuwijaya, Tommy M; Suarjaya, I PP; Sucandra, I MK; Senapathi, Tjokorda GA; Wiryana, Made; Widnyana, I MG; Panji, I PAS; Kurniyanta, I P
Journal of Medicine and Health Vol 6 No 2 (2024)
Publisher : Universitas Kristen Maranatha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.28932/jmh.v6i2.8475

Abstract

Kegagalan mengelola patensi jalan napas yang disebabkan oleh sulitnya laringoskopi dan intubasi dapat menyebabkan gangguan ventilasi, desaturasi, aritmia, kerusakan otak permanen hingga kematian. Salah satu anatomi yang berperan selama proses laringoskopi adalah sendi temporomandibular. Penilaian ultrasonografi sendi temporomandibular terutama fungsi translasi kondilus mandibula memberikan hasil yang dapat diandalkan. Tujuan penelitian ini adalah membuktikan korelasi antara jarak translasi kondilus mandibula dengan skor Cormack Lehane. Populasi penelitian observasional analitik prospektif ini adalah pasien berumur 18-65 tahun yang menjalani operasi dengan anestesi umum pipa orotrakeal di RSUP Prof IGNG. Ngoerah pada periode Februari 2024 dengan jumlah perhitungan 114 subjek. Kriteria inklusi meliputi pasien usia 18-65 tahun, status fisik ASA I - III dan IMT kurang dari 30 kg/m2. Analisis data menggunakan bantuan SPSS versi 26 yang meliputi analisis korelasi dan perhitungan titik potong jarak translasi kondilus mandibula dengan kurva ROC. Hasil didapatkan korelasi negatif kuat r=0,631 dan nilai p<0,001 dengan titik potong jarak translasi kondilus mandibula dengan skor Cormack-Lehane ≥2b adalah 11,25 mm dengan sensitivitas 94,6%, spesifisitas 95,5%. Simpulan penelitian ini adalah translasi kondilus mandibula yang diukur ultrasonografi berkorelasi negatif kuat terhadap skor Cormack-Lehane sebagai prediktor tingkat kesulitan visualisasi laringoskopi.
Anaesthesia Management in Parturient with Peripartum Cardiomyopathy: A Case Report Leo, Joseph Nelson; Aryasa, Tjahya; Senapathi, Tjokorda Gde Agung
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v9i11.16917

Abstract

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months following delivery. Generally, the clinical presentation and anaesthetic management principle are similar to heart failure due to other causes. We report a case of a 27-year-old woman with a diagnosis of first pregnancy, 34 weeks, single and viable fetus, with preeclampsia with severe presentation and lung oedema et causa PPCM planned to have an emergency cesarean section. Pre-anesthesia evaluation revealed physical status ASA III E with lung edema (SpO2 96% with NRM 10 lpm) and EF 38% from echocardiography. The surgery was done with a regional anaesthesia epidural on L1-L2 using bupivacaine 0.25% with lidocaine 1% volume 10 ml caudally and bupivacaine 0.25% volume 10 ml via the epidural catheter. During surgery, blood pressure drops and is manageable with vasopressor. After surgery, the mother and baby were stable. The patient was treated in intensive care for three days and then transferred to a general ward. PPCM is relatively rare. This case could be used as a reference in managing future PPCM cases.
Anesthesia Management of Space-Occupying Lesion in the Pontine Region due to Brainstem Glioma in a Pediatric Patient: a Case Report Yustisia, Putu Ngurah Krisna Denta; Sutawan, Ida Bagus Krisna Jaya; Senapathi, Tjokorda Gde Agung; Kurniyanta, I Putu
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v9i11.16937

Abstract

A space-occupying lesion (SOL) in the pontine region of the medulla oblongata, often suspected as a brainstem glioma, poses a complex diagnostic challenge. Brainstem gliomas, primarily diffuse intrinsic, afflict all age groups with a median survival of about 12 months, influenced by tumor characteristics. Comprehensive preoperative evaluation is essential to assess the patient's health status and identify potential complications, guiding optimal anesthesia management. This case report aimed to describe the author's anesthesia technique for managing patients with SOL in the pontine region of the medulla oblongata, focusing on those with suspected brainstem gliomas. A four-year-old girl weighing 20 kilograms presented with sudden left-sided weakness, difficulty swallowing, headaches, and speech difficulties. Examination revealed right cranial nerve paresis and decreased left extremity strength. MRI showed a pontine glioma. Surgery preparation included fasting, fluid calculation, and medication readiness. Anesthesia induction involved midazolam premedication, propofol induction, and remifentanil for intubation. Monitoring included EtCO2 and oxygen saturation maintenance. Intraoperatively, target-controlled infusion (TCI) propofol and compressed air sustained oxygenation. Paracetamol and tranexamic acid were administered. The surgery lasted five hours in the left lateral decubitus position. Postoperative analgesia included fentanyl and oral paracetamol. The patient spent seven days in the PICU on a ventilator before discharge on the eighth day. In summary, the case of the four-year-old girl with left-sided weakness and difficulty swallowing, diagnosed with pontine glioma, showcases the intricate multidisciplinary approach essential in pediatric neurosurgery.
Manajemen Anestesi pada Pasien Pediatri yang Menjalani Operasi Reseksi Tumor dengan Posisi Pronasi: Sebuah Laporan Kasus Kamaswari, Ida Ayu Dwi; Pradhana, Adinda Putra; Senapathi, Tjokorda Gde Agung
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v9i12.17001

Abstract

Posisi pronasi dapat menimbulkan tantangan dalam manajemen anestesi, khususnya pada pasien pediatri. Sacrococcygeal teratoma (SCT) adalah tumor pediatrik langka dan menimbulkan tantangan anestesi yang signifikan karena lokasi anatomi dan komplikasi yang terkait. Laporan kasus ini membahas manajemen anestesi pada seorang anak perempuan berusia tiga tahun dengan massa pada regio sacrococcygeal yang semakin membesar sejak lahir, menyebabkan nyeri intermiten tanpa gejala fungsional atau sistemik. Pemeriksaan fisik menunjukkan refleks normal dan anemia normositik normokromik ringan dengan trombositosis. Temuan magnetic resonance imaging (MRI) menunjukkan adanya massa heterogen dengan komponen kistik dan lemak yang menginfiltrasi otot di sekitarnya dan menekan rektum, menunjukkan adanya massa jaringan lunak ganas yang memerlukan reseksi bedah dan rekonstruksi. Evaluasi pra operasi mengikuti protokol standar, termasuk puasa dan pemantauan terperinci. Induksi anestesi melibatkan midazolam, ketamine, dan sevoflurane, dengan manajemen intraoperatif memastikan oksigenasi yang memadai dan stabilitas hemodinamik. Nyeri pasca operasi ditangani dengan fentanil, parasetamol, dan ibuprofen. Laporan ini menggarisbawahi pentingnya pelaporan protokol anestesi dalam posisi pronasi pada pasien pediatri secara rinci untuk perbandingan dan evaluasi langsung. Perbedaan fisiologis terkait usia secara signifikan berdampak pada stabilitas dan hasil hemodinamik, seperti terlihat pada kondisi intraoperatif yang berbeda antara pasien ini dan kasus neonatal yang dilaporkan. Selain itu, temuan MRI dapat bervariasi berdasarkan waktu diagnosis dan pertumbuhan tumor, sehingga memengaruhi presentasi klinis dan perencanaan pembedahan. Penanganan dan pemeriksaan diagnostik yang lebih komprehensif diperlukan untuk meningkatkan penanganan dan manajemen anestesi pada kasus SCT.
Intraoperative Fluid Management Correlates with Intraoperative Complications in Cesarean Section: A Prospective Clinical Trial Humianto, Michael; Marilaeta Cindryani; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (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.v8i2.923

Abstract

Background: This study focused on perioperative fluid administration in pregnant women undergoing a caesarean section (CS) by comparing liberal and non-liberal fluid administration in a multicentre setting across various Hospitals in the Bali province and its surrounding areas. Methods: Sampling was conducted using a total sampling method. All patients meeting the inclusion criteria were included in this study. A total of 310 samples of pregnant patients undergoing CS surgery in various operating rooms across hospitals in the Bali province and surrounding areas were obtained during the period of January to December 2022. The fluid administration strategy was divided into two types: liberal and non-liberal. Data analysis was performed using the Chi-square test with the correlation test of the contingency coefficient. Results: The results showed that liberal fluid administration significantly increased complications in the operating room for pregnant patients undergoing cesarean section (p<0.001; r=0.305; OR 6.22) but not in the recovery room or postoperative hospital ward. Conclusion: Liberal fluid administration could significantly increase complications in the operating room for pregnant patients undergoing cesarean section but not in the postoperative period.
Epidural Anesthesia in Management of Pregnant Eissenmenger’s Syndrome Patient Undergoing Caesarean Section Jayantha Ananda, I Gusti Ngurah Bagus; Tjahya Aryasa; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (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.v8i2.932

Abstract

Background: Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population, and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Managing anesthesia in maternal patients with a cardiac abnormality might be particularly difficult because these individuals have inadequate circulatory reserves and altered maternal cardiovascular physiology. Case presentation: We present a 26-year-old 34 weeks pregnant woman with Eisenmenger’s syndrome (ES) scheduled for an elective caesarean section. The clinical findings reveal slight tachypnea with peripheral oxygen saturation of 82% with oxygen supplementation using a cannula at 3 lpm. The patient's baseline hemodynamics are stable, but a third-degree murmur is heard in the 3rd and 4th left intercostal space. The patient was managed with epidural anesthesia using bupivacaine 0.5% 20 ml without adjuvant. The epidural catheter was inserted in an interspinous process between L3-L4. The surgery was done in 90 minutes with stable hemodynamics, and postoperatively, the patient was monitored in the intensive cardiac care unit (ICCU). Conclusion: Epidural anesthesia has been shown to provide favorable outcomes due to its slow onset and reducing the likelihood of abrupt hemodynamic changes.
Anesthetic Management of a Single Ventricle in Pediatric Patient Undergoing Open Duodeno–Duodenostomy Surgery: A Case Report Lesmana, Pita Mora; I Putu Kurniyanta; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1045

Abstract

Background: Duodenal atresia is a rare congenital disorder characterized by blockage of the small intestine. Open duodeno-duodenostomy is the surgery of choice to correct this condition. Case presentation: We report the case of a three-day-old baby girl with duodenal atresia and a functional single ventricle who underwent open duodeno-duodenostomy. The patient was born via caesarean section due to indications for a previous caesarean section in the mother and congenital abnormalities in the fetus. At birth, the patient showed signs of intestinal obstruction and cyanosis. Preoperative physical and laboratory examinations confirmed duodenal atresia and cardiac abnormalities. The patient underwent an open duodeno-duodenostomy without complications. The patent ductus arteriosus must be kept open to maintain systemic perfusion by maintaining PaO2 at 40 to 45 mmHg and SaO2 at 70% to 80%, along with the administration of prostaglandin agents. Good perioperative management and improvements in surgical procedures will increase the life expectancy of patients with single ventricle problems, especially hypoplastic left heart syndrome. The use of low-dose fentanyl induction agent, 1 MAC sevoflurane, and atracurium has been proven to produce favorable outcomes in these patients. Conclusion: Open duodeno-duodenostomy is a safe and effective operation for duodenal atresia. The patient in this case recovered well after surgery. Open duodeno-duodenostomy should be considered as the primary treatment option for duodenal atresia.
Ultrasound-Guided Neuraxial Precision in a High-Risk Adolescent Parturient: Navigating Anesthetic Management in the Confluence of Nephrotic Syndrome, Diastolic Heart Failure, and Anasarca Made Bagus Cahya Maha Putra; Tjokorda Gde Agung Senapathi; I Gusti Ngurah Mahaalit Aribawa
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.v10i1.1480

Abstract

Background: Anesthetic management for cesarean delivery in parturients with concurrent nephrotic syndrome and decompensated heart failure presents a profound clinical challenge. Severe anasarca can obliterate anatomical landmarks, while complex cardiorenal pathophysiology creates a state of extreme hemodynamic fragility. This case report describes a systematic, ultrasound-guided approach to overcome these obstacles. Case presentation: A 15-year-old primigravida at 33 weeks gestation, with new-onset nephrotic syndrome and decompensated heart failure (NYHA Class III), required an emergency cesarean section. Clinical examination revealed severe anasarca, rendering lumbar spinal landmarks impalpable. A systematic pre-procedural lumbar ultrasound examination was performed using a low-frequency curvilinear transducer. This allowed for precise identification of the L3-L4 interspace and an accurate skin-to-dura depth measurement of 4.6 cm. A single-attempt subarachnoid block was successfully performed with a reduced dose (10 mg) of hyperbaric bupivacaine. An adequate T4 sensory block was achieved for surgery. The patient remained remarkably hemodynamically stable throughout the procedure, with no episodes of hypotension requiring vasopressor support. A healthy infant was delivered, and both maternal and neonatal outcomes were excellent. Conclusion: This case demonstrates that a systematic pre-procedural ultrasound protocol is an indispensable tool for enhancing the safety and success of neuraxial anesthesia in high-risk obstetric patients. By enabling precise anatomical localization and informed dose reduction, it mitigates procedural risk and supports hemodynamic stability in the face of distorted anatomy and severe cardiorenal comorbidities.
Awake Intubation in Patient with Superoanterior Mediastinal Mass and Superior Vena Cava Syndrome (SVCS): A Case Report Ery Oktadiputra; I Putu Fajar Narakusuma; Tjokorda Gde Agung Senapathi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 2 (2025): JATI Agustus 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/JATI.2025.v01.i02.p05

Abstract

Superior vena cava syndrome (SVCS) with airway compression is challenging in anesthesia management. We report the case of a 69-year-old man with a superoanterior mediastinal mass and grade 3 SVCS who underwent Video-Assisted Thoracoscopic Surgery (VATS) with awake intubation using a double lumen tube (DLT) and videolaryngoscope. Awake intubation was chosen as the safest anesthesia technique where patients still breathe spontaneously without experiencing the effects of deep sedation. The combination of 4% lidocaine nebulization, oropharyngeal lidocaine spray, and dexmedetomidine infusion (0.5 μg/kg bolus over 10 minutes followed by 0.3-0.6 μg/kg/hour during surgery) in this patient, successfully maintained spontaneous ventilation without hemodynamic complications. The use of nebulized lidocaine, lidocaine spray, and dexmedetomidine as intubation facilities showed excellent effectiveness by maintaining the patient's spontaneous breathing, increasing the pain threshold, suppressing the nausea-vomiting reflex, and providing comfort in the form of mild sedation during awake intubation. This approach emphasizes the importance of topical anesthesia and selective sedation in high-risk patients with airway difficulties.
Co-Authors A A Gde Putra Semara Jaya Adinda Putra Pradhana Albert Albert Anak Agung Gde Agung Adistaya Andi Irawan Andi Kusuma Wijaya, Andi Anggreni, Anak Agung Ayu Aprilnita, Aida Aryasa EM, Tjahya Astawa N. M., Astawa N. Astawa P., Astawa Astuti, Mira Kusuma Astuti, Mira Kusuma Bayu Saputra, Ida Bagus Prema Satia Brillyan Jehosua Toar Budiadnyana, I Made Pasek Budiarta, Gede Cahyono, Ardy Wibowo Christopher Ryalino Christopher, Michael Cindryani Ra Ratumasa, Marilaeta Cung Flavyanto, Eugenius Silvester Cynthia Dewi Sinardja D.H., Asterina David Rendra Mahardika Dewa Ayu Mas Shintya Dewi Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Doddy Setiawan Ekaputra Ekaputra, Ekaputra Elisma Nainggolan, Elisma EM, Tjahya Aryasa Emkel Perangin Angin, Emkel Eric Makmur, Eric Ery Oktadiputra Estrada, Ronald Eugenia, Michelle Ferry, Ferdinand Gede Semarawima, Gede Gede Wirya Kusuma Duarsa Giovanni, Malvin Hadiwijono, Vanessa Juventia Hartanto, Wijaya Hartawan , I.G.A.G. Utara Hartawan, IGAG Utara Hengky Hengky, Hengky Humianto, Michael I Dewa Made Sukrama I Gede Budiarta I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ayu Putri Purwanthi I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Wibawa Nada I Made Agus Kresna Sucandra I Made Bakta I Made Darma Junaedi, I Made I Made Gede Widnyana I Made Prema Putra I Made Subagiartha I Made Wiryana, I Made I Putu Agus Surya Panji I Putu Fajar Narakusuma I Wayan Aryabiantara, I Wayan I Wayan Suranadi Ida Bagus Krisna Jaya Sutawan IGNA Putra Arimbawa, IGNA Putra Jayantha Ananda, I Gusti Ngurah Bagus Jeanne, Bianca Jhoni Pardomuan Pasaribu Jimmy Wongkar Johanes, Kevin Paul Junaedi, I Made Darma Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Kamaswari, Ida Ayu Dwi Kenzi, Ignatio Armando Ketut Semara Jaya, Ketut Semara Ketut Wibawa Nada Ketut Yudi Arparitna, Ketut Yudi Komang Ady Widayana Komang Alit Artha Wiguna Komang Alit Artha Wiguna Kurnia, Prajnaariayi Prawira Kurniyanta, I P Kurniyanta, I Putu Kusuma, Oscar Indra Labobar, Otniel Adrians Leo, Joseph Nelson Lesmana, Pita Mora Leton, Yohanes PT Made Agus Kresna Sucandra Made Agus Kresna Sucandra, Made Agus Kresna Made Bagus Cahya Maha Putra Made Widnyana Made Wiryana Marilaeta Cindryani Marilaeta Cindryani Lolobali, Marilaeta Cindryani Marilaeta Cindryani, Marilaeta Marting, Millenia Mauritius Septa Murti, Dede Taruna Kreisnna Nada, I Ketut Wibawa Nandaswari, Ni Made Nilam Narakusuma, I Putu Fajar Ni Nyoman Sri Budayanti Ni Putu Novita Pradnyani, Ni Putu Novandi Kurniawan Pande Nyoman Kurniasari, Pande Panji, I PAS Patricia, Yoshie Pontisomaya Parami Pramana, Putu Bagus Gin Gin Pranoto, Theodorus Pascalis Yullie Pratana, Yolanda Jenny Putu Agus Surya Panji Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Ra Ratumasa, Marilaeta Cindryani Raka-Sudewi A. A. Ratumasa, Marilaeta Cindryani Ra Reynaldi Reiky Hadiwijaya Riko Riko Santo, Budi Saputra, Darmawan Jaya Satoto D., Satoto Satria Pinanditas S Sidabutar, Beny Pratama Sidemen, I Gusti Ayu Eka Para Santi Sidemen, I.G.P.Sukrana Sidemen, IGP Sukrana Sonni Soetjipto, Sonni Sri Maliawan Stefanus Taofik stefanus taofik, stefanus Suarjaya, I PP Suastika, I Gede Juli Sucandra, I Made Agus Kresna Sucandra, I MK Sumanti, Alan F. A. Sunanda Naibaho Suranadi , I Wayan Suryadi N. T., Suryadi N. Suryana, I Ketut Syamsuddin, Johanis Bosco Troy Tanuwijaya, Tommy M Tirta, Ian Tjahya Aryasa Tjahya Aryasa Tjahya Aryasa E M Tjokorda Gde Bagus Mahadewa Togi Stanislaus Patrick Virayanti, Luh Putu Diah W. A., W. Wardani, Dinar Kusuma Welly, Julian Widnyana, I MG Widyana, I Made Gede Wiryana M., Wiryana Yadikusumo, Andrian Yustisia, Putu Ngurah Krisna Denta