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All Journal Archives of The Medicine and Case Reports Journal of Anesthesiology and Clinical Research
Ruddi Hartono
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Perioperative Considerations for ASD Device Closure in the First Trimester: A Case of Secundum ASD with Bidirectional Shunt Nugroho, Yusuf Agung; Isngadi; Ruddi Hartono
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.v5i3.640

Abstract

Introduction: Atrial septal defect (ASD) closure during pregnancy is a complex procedure requiring careful consideration of maternal and fetal risks. This case report highlights the perioperative management of a secundum ASD with a bidirectional shunt in a patient during her first trimester. Case presentation: A 31-year-old woman, G3P2A0, presented at approximately 10-11 weeks gestation with a recently diagnosed large secundum ASD and pulmonary hypertension. She was on Sildenafil and Bisoprolol. Due to the potential risks associated with an unrepaired ASD during pregnancy, the decision was made to proceed with percutaneous ASD closure. General anesthesia was administered with meticulous hemodynamic monitoring. The procedure was successful, and the patient recovered without complications. Conclusion: ASD closure during the first trimester can be safely performed with careful planning and execution. Multidisciplinary collaboration and vigilant monitoring are crucial for optimal maternal and fetal outcomes.
Anesthesia Management of Cesarean Section in Women with Peripartum Cardiomyopathy: A Case Series Praskita Pande; Ruddi Hartono
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.v5i3.652

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a rare but serious heart condition that occurs during late pregnancy or within the first few months after delivery. It can lead to significant maternal and fetal morbidity and mortality. Anesthetic management of PPCM patients undergoing cesarean section (C-section) is challenging due to the hemodynamic instability and potential for complications. Case presentation: This case series describes the anesthetic management of four women with PPCM undergoing C-section. Various anesthetic techniques were employed, including combined spinal-epidural (CSE) and epidural anesthesia, with careful monitoring and individualized management strategies. Case 1 present a 34-year-old female with mild mitral regurgitation, mild tricuspid regurgitation, mild pulmonary regurgitation, intermediate probability pulmonary hypertension, hypertensive heart failure, and obesity underwent C-section under CSE anesthesia with ropivacaine and bupivacaine. Case 2 present a 26-year-old female with PPCM and mild mitral regurgitation underwent C-section under CSE anesthesia with ropivacaine and bupivacaine. Case 3 present a 26-year-old female with PPCM, thrombocytosis, and hypoalbuminemia underwent C-section under epidural anesthesia with ropivacaine and fentanyl. Case 4 present a 30-year-old female with PPCM, marginal placenta previa, uterine myoma, and severe myopia underwent C-section under epidural anesthesia with ropivacaine and fentanyl. Conclusion: Regional anesthesia, particularly CSE and epidural techniques, appears to be a safe and effective anesthetic approach for C-sections in women with PPCM. Meticulous hemodynamic monitoring and individualized management are crucial for successful outcomes.
Perioperative Anesthetic Management of Brain Abscess Evacuation in a Child with Double Outlet Right Ventricle: A Case Report Rio Kharisma Putra; Buyung Hartiyo Laksono; Eko Nofiyanto; Fanniyah; Ruddi Hartono
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.v6i1.668

Abstract

Introduction: Double outlet right ventricle (DORV) is a rare congenital heart defect where both the aorta and pulmonary artery arise from the right ventricle. This anomaly poses unique challenges for anesthetic management, especially during intracranial surgeries. Case presentation: We present the case of a 7-year-old female child diagnosed with a brain abscess and DORV, who underwent open evacuation and cranioplasty. Anesthetic management focuses on maintaining hemodynamic stability and ensuring adequate oxygenation. The patient was successfully extubated postoperatively and transferred to the intensive care unit (ICU) for close monitoring. Conclusion: Surgical interventions in patients with DORV require careful preoperative evaluation and close perioperative monitoring to minimize morbidity and mortality. This case highlights the importance of a multidisciplinary approach and meticulous anesthetic management in ensuring a successful outcome.
Comparative Efficacy of Prophylactic Bolus Phenylephrine versus Ephedrine on Maternal Hemodynamics and Neonatal APGAR Scores in Elective Cesarean Section: A Randomized Controlled Trial Pande Made Praskita Putra Soma; Ruddi Hartono; Isngadi
Journal of Anesthesiology and Clinical Research Vol. 7 No. 1 (2026): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v7i1.838

Abstract

Introduction: Spinal anesthesia-induced hypotension is a pervasive physiological challenge during cesarean delivery, precipitating maternal hemodynamic instability and compromising uteroplacental perfusion. While phenylephrine and ephedrine are the mainstay vasopressors for prophylaxis, their comparative impact on immediate neonatal vitality in the context of bolus administration remains a critical subject of investigation, particularly in resource-limited settings where infusion pumps are not universally available. This study aimed to rigorously compare the efficacy of prophylactic intravenous bolus phenylephrine versus ephedrine regarding maternal blood pressure control and neonatal APGAR scores. Methods: We conducted a prospective, randomized, double-blind experimental study at Dr. Saiful Anwar Regional General Hospital, Malang. Forty-two parturients classified as ASA I or II undergoing elective cesarean section were randomized into two groups. Immediately following subarachnoid block, Group P received a bolus of Phenylephrine (125 µg), and Group E received Ephedrine (10 mg). Hemodynamic parameters were recorded at baseline and at 1, 3, 6, 9, 12, 15, and 18 minutes post-anesthesia. The primary outcome was the neonatal APGAR score at the first minute. Results: Both vasopressor regimens successfully mitigated severe spinal-induced hypotension. There were no statistically significant differences in the magnitude of systolic or diastolic blood pressure reduction between the Phenylephrine and Ephedrine groups at any observed time point (p>0.05). However, a significant divergence was observed in neonatal outcomes. The mean first-minute APGAR score in the Phenylephrine group was significantly higher (7.62 ± 0.97) compared to the Ephedrine group (7.05 ± 0.74) with a p-value of 0.038. Conclusion: Phenylephrine and ephedrine demonstrated equipotent efficacy in maintaining maternal hemodynamic stability when administered as prophylactic boluses. However, phenylephrine prophylaxis resulted in superior immediate neonatal vitality as evidenced by significantly higher first-minute APGAR scores. Phenylephrine should be prioritized as the vasopressor of choice to optimize neonatal safety during cesarean delivery.
Preserving Spontaneous Ventilation in ASA III Patients: Transtracheal Block as a Primary Anesthetic Strategy for Complex Bronchoscopy Yoga Indrawan Pratama; Ruddi Hartono; Muhammad Farlyzhar Yusuf
Journal of Anesthesiology and Clinical Research Vol. 7 No. 1 (2026): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v7i1.854

Abstract

Introduction: Fiberoptic bronchoscopy (FOB) in patients with American Society of Anesthesiologists (ASA) physical status III presents a significant anesthetic challenge. General anesthesia carries risks of hemodynamic instability and respiratory compromise, while conventional topical anesthesia is often insufficient for cough suppression. This study evaluates the efficacy of transtracheal block (TTB) combined with dexmedetomidine as a primary anesthetic strategy to preserve spontaneous ventilation in high-risk patients. Case presentation: We present a serial case report of four adult males (aged 43-66 years) with severe pulmonary comorbidities, including advanced lung malignancies, atelectasis, and massive pleural effusion. All patients were classified as ASA III. The anesthetic protocol utilized a multimodal approach: intravenous dexmedetomidine sedation (loading dose 1 mcg/kg, maintenance 0.2-0.7 mcg/kg/hr) combined with a TTB using 20 mg of 2% lidocaine. All procedures were successfully completed without conversion to general anesthesia. Hemodynamic monitoring revealed that mean arterial pressure (MAP) and heart rate variability remained within 15% of baseline. No episodes of desaturation (SpO2 < 90%) or significant periprocedural respiratory distress were observed. Patients demonstrated rapid recovery with minimal coughing (Visual Analog Scale for Cough < 2/10) and were discharged from the ICU within 24 hours. Conclusion: Transtracheal block combined with dexmedetomidine provides profound airway anesthesia while maintaining spontaneous ventilation and hemodynamic stability. This technique represents a superior safety profile compared to general anesthesia for complex bronchoscopy in patients with compromised respiratory reserve.
Navigating the Perfect Storm: Ultrasound-Guided Peripheral Nerve Block for Emergency Amputation in a Patient with Acute STEMI and Failed PCI Ella Priliandini; Ruddi Hartono; Ahmad Feza Fadhlurrahman; Muhammad Farlyzhar Yusuf
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.829

Abstract

Acute limb ischemia presenting concurrently with acute coronary syndrome creates a precarious clinical dilemma, often termed the "cardiac cripple" scenario. The mortality risk is compounded when patients have a history of failed percutaneous coronary intervention, severe left ventricular dysfunction, and require emergency major amputation while on active dual antiplatelet therapy. In these patients, general anesthesia poses a risk of hemodynamic collapse, while neuraxial anesthesia is contraindicated due to bleeding risks. A 75-year-old male presented with a Rutherford Grade III-IV "dead limb" of the right lower extremity and concurrent Acute Anterior STEMI (Killip II, TIMI 7/14, GRACE 137). His history included a failed percutaneous coronary intervention two months prior and three-vessel disease, resulting in a left ventricular ejection fraction of 32%. General anesthesia posed an unacceptable risk of exacerbating myocardial pump failure, while spinal anesthesia was contraindicated due to recent clopidogrel ingestion. A decision was made to perform a below-knee amputation using an ultrasound-guided femoral nerve block and a popliteal sciatic nerve block via the crosswise approach. The procedure utilized 0.5% ropivacaine with 2 mg dexamethasone. The patient remained hemodynamically stable without vasopressor support, reported a Visual Analogue Scale score of 0 intraoperatively, and avoided adverse cardiac events. In conclusion, peripheral nerve blockade, specifically the combined femoral and crosswise popliteal sciatic approach, serves as a superior anesthetic alternative in high-risk cardiac patients. It bypasses the sympatholytic risks of general anesthesia and the coagulation constraints of neuraxial techniques, offering a safe corridor for life-saving surgery.
Co-Authors Ahmad Feza Fadhlurrahman Buyung Hartiyo Laksono Eko Nofiyanto Ella Priliandini Fanniyah Isngadi Muhammad Farlyzhar Yusuf Nugroho, Yusuf Agung Pande Made Praskita Putra Soma Praskita Pande Rio Kharisma Putra Yoga Indrawan Pratama