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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
I Putu Fajar Narakusuma
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Physics

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Successful Post-Resuscitation Care in End-Stage Renal Disease Patients: A Case Report Merry; Made Septyana Parama Adi; I Gusti Agung Gede Utara Hartawan; I Gusti Ngurah Mahaalit Aribawa; I Putu Fajar Narakusuma; I Gusti Agung Made Wibisana Kurniajaya
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.v6i1.673

Abstract

Introduction: Cardiac arrest in end-stage renal disease (ESRD) patients presents unique challenges due to their complex medical conditions. Post-resuscitation care for these patients requires careful management of various factors, including hemodynamic instability, electrolyte imbalances, and fluid overload. This case report describes the successful post-resuscitation care of an ESRD patient who experienced cardiac arrest and achieved a return of spontaneous circulation (ROSC). Case presentation: A 50-year-old female with ESRD on hemodialysis (HD) presented with acute dyspnea and cardiac arrest. After 8 minutes of cardiopulmonary resuscitation (CPR), ROSC was achieved. The patient was managed with a comprehensive post-resuscitation care protocol, including brain resuscitation (targeted temperature management, ventilation optimization, and hemodynamic control) and sustained low-efficiency dialysis for fluid balance. Despite the severity of her condition, the patient showed significant neurological recovery and was successfully extubated after 7 days of mechanical ventilation. She was discharged after 12 days with follow-up for her chronic conditions. Conclusion: This case highlights the importance of individualized management strategies for ESRD patients post-cardiac arrest, including the need for prolonged resuscitation and careful monitoring to improve patient outcomes.
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.
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report Parama Adi, Made Septyana; I Gusti Ngurah Mahaalit Aribawa; I Gusti Agung Gede Utara Hartawan; I Putu Fajar Narakusuma; Gusti Agung Made Wibisana Kurniajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (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.v8i4.977

Abstract

Background: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space. Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10. Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions.
Spinal Anesthesia with Ultrasonography (USG) Marker in Morbidly Obese Pregnant Women Undergoing Cesarean Section Surgery: A Case Report Parama Adi, Made Septyana; I Gusti Ngurah Mahaalit Aribawa; I Gusti Agung Gede Utara Hartawan; I Putu Fajar Narakusuma; Gusti Agung Made Wibisana Kurniajaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (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.v8i4.977

Abstract

Background: Spinal anesthesia is a regional anesthesia technique used to provide analgesia or numbness in the lower part of the body. This technique has long been employed in childbirth and cesarean section surgeries due to its numerous advantages for pregnant women. Obese pregnant patients often have increased adipose tissue in the back area, making it challenging to identify the appropriate interspinous space. Case presentation: A 26-year-old primigravida at 38 weeks of gestation with morbid obesity, standing at 158 cm tall and weighing 140 kg, with a body mass index (BMI) of 56.1 kg/m², underwent cesarean section surgery under spinal anesthesia. The identification of the spinal needle insertion site was performed using pre-procedural ultrasound (USG) marker at the L3-L4 level, with heavy bupivacaine 0.5% 12.5 mg used as the anesthetic agent. The surgery lasted for 1 hour and 20 minutes, with stable hemodynamics and a blood loss of 450 ml. A female infant was delivered, weighing 3080 grams, with a length of 50 cm and an APGAR score of 8-9-10. Conclusion: The use of USG markers can assist in determining the precise location for spinal anesthesia injection, thereby reducing complications from repeated needle insertions.
Efektivitas dan Keamanan Deksmedetomidine Nebulisasi Dibandingkan Rute Intravena sebagai Premedikasi Anestesi: Tinjauan Naratif Katarina, Ida; I Putu Fajar Narakusuma; Made Septyana Parama Adi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/93296c76

Abstract

Laringoskopi dan intubasi trakea merupakan prosedur rutin anestesi yang sering memicu respons hemodinamik berupa peningkatan tekanan darah dan denyut jantung, yang dapat berisiko pada pasien dengan komorbiditas kardiovaskular atau serebrovaskular. Deksmedetomidine, agonis reseptor α2 adrenergik selektif, terbukti efektif dalam menekan respon tersebut melalui efek simpatolitik dan sedatif. Namun, pemberian intravena sering menyebabkan efek samping berupa hipotensi dan bradikardia. Tinjauan naratif ini bertujuan membandingkan efektivitas dan profil keamanan deksmedetomidine nebulisasi dengan rute intravena sebagai agen premedikasi untuk mengontrol respon hemodinamik selama laringoskopi dan intubasi. Berdasarkan hasil sintesis, deksmedetomidine nebulisasi mampu menurunkan lonjakan tekanan darah dan denyut jantung secara efektif dengan insidensi hipotensi dan bradikardi yang lebih rendah dibandingkan pemberian intravena, serta mengurangi kebutuhan obat induksi anestesi tanpa menimbulkan komplikasi serius. Dengan demikian, deksmedetomidine nebulisasi berpotensi menjadi alternatif premedikasi yang efektif dan lebih aman untuk stabilisasi hemodinamik selama anestesi, meskipun masih diperlukan uji klinis multisenter berskala besar untuk memperkuat bukti dan menentukan dosis optimal.
Efektivitas dan Keamanan Deksmedetomidine Nebulisasi Dibandingkan Rute Intravena sebagai Premedikasi Anestesi: Tinjauan Naratif Katarina, Ida; I Putu Fajar Narakusuma; Made Septyana Parama Adi
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/93296c76

Abstract

Laringoskopi dan intubasi trakea merupakan prosedur rutin anestesi yang sering memicu respons hemodinamik berupa peningkatan tekanan darah dan denyut jantung, yang dapat berisiko pada pasien dengan komorbiditas kardiovaskular atau serebrovaskular. Deksmedetomidine, agonis reseptor α2 adrenergik selektif, terbukti efektif dalam menekan respon tersebut melalui efek simpatolitik dan sedatif. Namun, pemberian intravena sering menyebabkan efek samping berupa hipotensi dan bradikardia. Tinjauan naratif ini bertujuan membandingkan efektivitas dan profil keamanan deksmedetomidine nebulisasi dengan rute intravena sebagai agen premedikasi untuk mengontrol respon hemodinamik selama laringoskopi dan intubasi. Berdasarkan hasil sintesis, deksmedetomidine nebulisasi mampu menurunkan lonjakan tekanan darah dan denyut jantung secara efektif dengan insidensi hipotensi dan bradikardi yang lebih rendah dibandingkan pemberian intravena, serta mengurangi kebutuhan obat induksi anestesi tanpa menimbulkan komplikasi serius. Dengan demikian, deksmedetomidine nebulisasi berpotensi menjadi alternatif premedikasi yang efektif dan lebih aman untuk stabilisasi hemodinamik selama anestesi, meskipun masih diperlukan uji klinis multisenter berskala besar untuk memperkuat bukti dan menentukan dosis optimal.
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 Ery Oktadiputra Gusti Agung Made Wibisana Kurniajaya I Gusti Agung Gede Utara Hartawan I Gusti Agung Made Wibisana Kurniajaya I Gusti Ngurah Mahaalit Aribawa Katarina, Ida Made Septyana Parama Adi Merry Parama Adi, Made Septyana Tjokorda Gde Agung Senapathi