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The Role of Invasive Hemodynamic Monitoring in Patients with Severe Mitral Regurgitation Undergoing Herniorrhaphy Operation Kapitan, Titin Agustin; Adinda Putra Pradhana; Cynthia Dewi Sinardja
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.v8i2.920

Background: Mitral regurgitation (MR) indeed presents challenges during noncardiac surgeries, especially as the severity of MR tends to increase with age and poses a higher risk of perioperative complications. Accurate hemodynamic monitoring becomes crucial in these cases to manage potential complications effectively. However, the standard monitoring in MR conditions during operation, such as TEE, is not always available, but there are other options for invasive monitoring, such as arterial lines, which provide accurate hemodynamic monitoring. Case presentation: A 64-year-old, male, presented with Reponible Lateral Inguinal Hernia with comorbid of severe mitral and tricuspid regurgitation alongside congestive heart failure. The patient was premedicated with fentanyl 25 mcg intravenously, followed by oxygen supplementation with 3 lpm nasal cannula and insertion of the arterial line. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, Reponible Lateral Inguinal Hernia. The local anesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 8 ml. The onset of action of epidural anesthesia is achieved within 20 minutes as long as the operation reaches a total blockade as high as T8. The patient is monitored with standard monitors and an artery line during surgery. There were no complaints of shortness of breath, chest heaviness, or chest pain felt by the patient during the operation. Conclusion: Epidural anesthesia technique can provide stable hemodynamics in patients with severe mitral-tricuspid regurgitation and congestive heart failure and hemodynamic monitoring plays an important role postoperatively to prevent further deterioration and maintain stability.

Difficult Airway Management of Reconstructive Surgery for Noma (Cancrum oris): A Rare Neglected Disease Supono, Benny; Adinda Putra Pradhana; I Gusti Putu Sukrana Sidemen; Putu Kurniyanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (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.v8i3.937

Background: Noma is a rare necrotizing gangrenous stomatitis that occurs due to poor oral hygiene and chronic malnutrition. Noma’s survivors usually had significant facial deformities that needed reconstructive surgery as its definitive treatment. However, this facial deformity can result in a difficult airway that is very challenging for anesthesiologists. Case presentation: A 22-year-old male patient had a significant deformity on his left face due to Noma. Preoperative evaluation revealed a potentially difficult airway due to deformity of the maxilla and mandible, malocclusion, inadequate mask seal, and incomplete dentition. Nasal fiberoptic intubation was chosen as the management of a difficult airway in this patient. A tracheostomy was prepared as the emergency invasive airway in the event of failed intubation attempts. Intubation attempts were limited to three times, and the nasal fiberoptic intubation in this patient was successful on the third attempt. The patient was stable, and the airway was safely maintained during the surgery. Conclusion: Detailed and careful perioperative evaluation had vital role assessing potential difficult airway and planning the optimal airway management for patient with facial deformity. Nasal fiberoptic intubation is still the safest choice with high success rate for Noma patient with significant facial deformity.

Opioid Free Anesthesia During Sectio Caesarea Surgery in Pregnant Patients with Dengue Hemorrhagic Fever (A Case Report) Dwipayana, I Made Agus Yudha; Pradhana, Adinda Putra
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v9i11.16915

This study aims to evaluate the effectiveness of Opioid-Free Anesthesia (OFA) in maintaining hemodynamic stability and reducing side effects in emergency cesarean section patients. The background of this research lies in the high risk of opioid addiction and the rising death toll from opioid overdoses in the United States, along with common opioid-related side effects such as respiratory depression, ileus, and postoperative nausea and vomiting (PONV). The patient in this study is a 22-year-old woman at 38 weeks of pregnancy, in the latent phase of labor, with a history of fever due to Dengue infection without warning signs. The method used was general anesthesia without opioids, employing a multimodal pain management approach with non-opioid analgesics aimed at preemptively inhibiting pain receptors along the complex pain pathway, both centrally and peripherally. Results showed that OFA provided consistent hemodynamic stability from induction through to post-operation without any pain complaints, use of additional analgesics, or PONV. OFA effectively provides stable anesthesia and reduces the common side effects of opioids in patients, while supporting safe and efficient pain control without the risk of addiction. The study suggest that OFA with a multimodal approach is a viable option for perioperative anesthesia, reducing opioid dependency and associated side effects, and promoting patient safety in surgical procedures.

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

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.

The Role of Invasive Hemodynamic Monitoring in Patients with Severe Mitral Regurgitation Undergoing Herniorrhaphy Operation Kapitan, Titin Agustin; Adinda Putra Pradhana; Cynthia Dewi Sinardja
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.v8i2.920

Background: Mitral regurgitation (MR) indeed presents challenges during noncardiac surgeries, especially as the severity of MR tends to increase with age and poses a higher risk of perioperative complications. Accurate hemodynamic monitoring becomes crucial in these cases to manage potential complications effectively. However, the standard monitoring in MR conditions during operation, such as TEE, is not always available, but there are other options for invasive monitoring, such as arterial lines, which provide accurate hemodynamic monitoring. Case presentation: A 64-year-old, male, presented with Reponible Lateral Inguinal Hernia with comorbid of severe mitral and tricuspid regurgitation alongside congestive heart failure. The patient was premedicated with fentanyl 25 mcg intravenously, followed by oxygen supplementation with 3 lpm nasal cannula and insertion of the arterial line. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, Reponible Lateral Inguinal Hernia. The local anesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 8 ml. The onset of action of epidural anesthesia is achieved within 20 minutes as long as the operation reaches a total blockade as high as T8. The patient is monitored with standard monitors and an artery line during surgery. There were no complaints of shortness of breath, chest heaviness, or chest pain felt by the patient during the operation. Conclusion: Epidural anesthesia technique can provide stable hemodynamics in patients with severe mitral-tricuspid regurgitation and congestive heart failure and hemodynamic monitoring plays an important role postoperatively to prevent further deterioration and maintain stability.

Difficult Airway Management of Reconstructive Surgery for Noma (Cancrum oris): A Rare Neglected Disease Supono, Benny; Adinda Putra Pradhana; I Gusti Putu Sukrana Sidemen; Putu Kurniyanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 3 (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.v8i3.937

Background: Noma is a rare necrotizing gangrenous stomatitis that occurs due to poor oral hygiene and chronic malnutrition. Noma’s survivors usually had significant facial deformities that needed reconstructive surgery as its definitive treatment. However, this facial deformity can result in a difficult airway that is very challenging for anesthesiologists. Case presentation: A 22-year-old male patient had a significant deformity on his left face due to Noma. Preoperative evaluation revealed a potentially difficult airway due to deformity of the maxilla and mandible, malocclusion, inadequate mask seal, and incomplete dentition. Nasal fiberoptic intubation was chosen as the management of a difficult airway in this patient. A tracheostomy was prepared as the emergency invasive airway in the event of failed intubation attempts. Intubation attempts were limited to three times, and the nasal fiberoptic intubation in this patient was successful on the third attempt. The patient was stable, and the airway was safely maintained during the surgery. Conclusion: Detailed and careful perioperative evaluation had vital role assessing potential difficult airway and planning the optimal airway management for patient with facial deformity. Nasal fiberoptic intubation is still the safest choice with high success rate for Noma patient with significant facial deformity.

Managemen Anestesi pada Congenital Diapragmatic Hernia dengan Ventrikel Septal Defek dan Atrium Septal Defek pada Pasien Pediatrik : Laporan Kasus Mauritius Septa; Adinda Putra Pradhana; I Putu Kurniyanta; Ketut Wibawa Nada; Novandi Kurniawan; 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.p06

Congenital diaphragmatic hernia (CDH) merupakan kelainan kongenital pada diafragma yang terjadi pada pediatri. Insiden terjadinya hernia tipe Borchdalek lebih sering terjadi pada sisi kiri dari pada sisi kanan. Penyulit lain pada CDH adalah hipoplasia paru, hipertensi paru dan kelainan pada jantung. Pada kasus ini kami mendiskusikan bayi 12 hari dengan kelainan CDH sisi kanan dengan kelainan jantung berupa ventrikel septal defek (VSD) dan atrium septal defek (ASD) yang dilakukan operasi laparotomi hernia. Manajemen anestesi pada pasien ini menggunakan inhalasi sevoflurane, fentanil, volume tidal rendah, obat inotropik dengan kondisi hemodinamik yang stabil selama pembedahan. Kami melaporkan management anestesi dengan sevoflurane yang dikombinasi dengan volume tidal rendah dan inotropik dobutamine pada operasi congenital diaphragmatic herdia dengan VSD dan ASD membantu dalam keberhasilan intraoperatif. Setelah operasi, pasien dilakukan perawatan di NICU untuk perawatan secara ketat.

Combined Lumbar Plexus and Sciatic Nerve Blocks Improve Postoperative Recovery in Lower Extremity Surgery: A Randomized Controlled Trial Wiranata, Jeremia Alvian; Aribawa, I Gusti Ngurah Mahaalit; Parami, Pontisomaya; Senapathi, Tjokorda Gde Agung; Hartawan, I Gusti Agung Gede Utara; Adi, Made Septyana Parama; Kurniajaya, I Gusti Agung Made Wibisana; Pradhana, Adinda Putra
Journal of Anaesthesia and Pain Vol. 7 No. 1 (2026): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Background: Patients undergoing lower extremity orthopedic surgery often experience moderate to severe postoperative pain, commonly managed with opioids. Regional anesthesia techniques, such as peripheral nerve blocks, offer promising alternatives. This study evaluates the efficacy of combined lumbar plexus block (LPB) and sciatic nerve block (SNB) versus intravenous opioid analgesia in enhancing postoperative recovery and pain control. Methods: In a single-blind, randomized controlled trial, 42 patients scheduled for lower extremity orthopedic surgery under spinal anesthesia were allocated to two groups. Group P1 received postoperative LPB and SNB using 20 mL of 0.25% bupivacaine, while group P2 received intravenous opioids. Outcomes at 24 hours included quality of recovery (QoR-40) scores, total morphine consumption, duration of analgesia, and monitored adverse events. Result: Group P1 showed significantly better recovery scores [QoR-40: 183 (178–188) vs. 152 (136–161.5), p < 0.001], reduced morphine consumption [4 (4–6.5) mg vs. 18 (16–22) mg, p < 0.001], and longer analgesia duration [480 (340–600) min vs. 75 (60–110) min, p < 0.001]. No adverse events were observed. Conclusion: Combined LPB and SNB significantly improve postoperative recovery quality and analgesia in patients undergoing lower extremity orthopedic surgery, reducing opioid requirements and extending pain-free duration compared to intravenous opioids.

Dynamic Fluid Responsiveness Assessment Using Pulse Pressure Variation in Intraoperative Spine Surgery Settings: A Case Report Agus Aryanda Putra; Adinda Putra Pradhana
Sehat Rakyat: Jurnal Kesehatan Masyarakat Vol. 4 No. 4 (2025): November 2025
Publisher : Yayasan Pendidikan Penelitian Pengabdian Algero

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54259/sehatrakyat.v4i4.5908

Vertebral metastases are a frequent complication in advanced malignancies, often presenting with severe pain and neurological impairment. This case report describes the perioperative anesthetic management of a 52yearold woman with breast cancer metastasis to the thoracic spine, scheduled for spinal decompression in the prone position. The patient presented with significant pleural effusion, thoracic vertebral compression, and decreased cardiorespiratory reserve. General anesthesia was induced and maintained using targetcontrolled infusions of propofol and remifentanil, with invasive monitoring through an arterial line and a central venous catheter. Intraoperative fluid responsiveness was evaluated using pulse pressure variation (PPV). Monitoring with PPV provides dynamic, realtime indicators that are highly reliable for predicting fluid responsiveness and help maintain hemodynamic stability without worsening pulmonary congestion or edema. PPV serves as a dynamic paramete influenced by the respiratory cycle and is particularly beneficial in mechanically ventilated patients. However, its accuracy may be affected by low tidalvolume ventilation, prone positioning, and pleural effusion. In this case, vigilant monitoring and prone positioning with a freehanging abdomen helped minimize confounding factors. The combination of PPV with clinical assessment and central venous pressure monitoring offered effective guidance for fluid therapy, enhancing intraoperative hemodynamic stability. Despite its limitations, PPV remains a valuable tool in perioperative fluid management, especially when integrated with other dynamic indices and a minifluid challenge. This case emphasizes the utility of PPV in complex oncologic spine surgery, where assessing fluid responsiveness is critical due to major bleeding, prone positioning, and mechanical ventilation.

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