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Successful Anesthetic Management for Mandibular Neoplasm Resection in a Patient with Osteogenesis Imperfecta: A Case Report Indriani, Andi Riza Mirda; T Addi Saputra; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (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.v8i12.1140

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and deformities. Patients with mandibular neoplasms and suspected OI require careful anesthetic management to avoid complications. This case report describes the successful anesthetic management of a patient with a mandibular neoplasm and suspected OI. Case presentation: A 33-year-old man presented with a large mandibular tumor causing airway obstruction and difficulty eating. He had physical features suggestive of OI, including short stature, bone deformities, and abnormal tooth growth. Preoperative evaluation revealed a difficult airway due to the tumor and potential cervical spine instability. Anesthesia was induced with propofol and atracurium after securing the airway via ultrasound-guided tracheostomy under local anesthesia. The tumor was resected successfully, and the patient recovered without complications. Conclusion: Anesthetic management in patients with suspected OI and mandibular neoplasms requires careful planning and execution. A multidisciplinary approach, including preoperative evaluation, airway management strategies, and close postoperative monitoring, is crucial for successful outcomes.

Awake Intubation for a Predicted Difficult Airway in a Patient with Giant Goiter-Induced Tracheomalacia: A Case Report Indriani, Andi Riza Mirda; Diana Masjkur; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1359

Background: The management of a predicted difficult airway in patients with giant goiters presents a significant anesthetic challenge. Chronic tracheal compression can lead to secondary tracheomalacia, a condition characterized by tracheal weakness that can precipitate catastrophic airway collapse upon induction of general anesthesia. We present a case where a high index of suspicion for tracheomalacia guided the decision to perform awake tracheal intubation. Case presentation: A 22-year-old female presented with a massive, non-toxic nodular goiter that had been growing for eight years, causing significant positional dyspnea. Airway assessment revealed a 10x10 cm neck mass with tracheal deviation, indicating a high risk for difficult intubation and ventilation. Preoperative suspicion of tracheomalasia was high due to symptoms and chronicity. The airway was secured using awake intubation with topical and intravenous lidocaine prior to the induction of general anesthesia. The patient underwent a total thyroidectomy. Intraoperative palpation confirmed flaccid tracheal rings, supporting the diagnosis. The endotracheal tube was retained postoperatively, and the patient was monitored in the intensive care unit. She was successfully extubated on the third postoperative day without complications. Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for tracheomalacia in patients with long-standing, giant goiters. Awake tracheal intubation is a cornerstone technique, providing a safe and effective method to secure the airway while preserving spontaneous ventilation, thereby mitigating the risk of life-threatening airway obstruction. A meticulous, multidisciplinary perioperative plan is paramount for optimal patient outcomes.

Awake Intubation for a Predicted Difficult Airway in a Patient with Giant Goiter-Induced Tracheomalacia: A Case Report Indriani, Andi Riza Mirda; Diana Masjkur; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1359

Background: The management of a predicted difficult airway in patients with giant goiters presents a significant anesthetic challenge. Chronic tracheal compression can lead to secondary tracheomalacia, a condition characterized by tracheal weakness that can precipitate catastrophic airway collapse upon induction of general anesthesia. We present a case where a high index of suspicion for tracheomalacia guided the decision to perform awake tracheal intubation. Case presentation: A 22-year-old female presented with a massive, non-toxic nodular goiter that had been growing for eight years, causing significant positional dyspnea. Airway assessment revealed a 10x10 cm neck mass with tracheal deviation, indicating a high risk for difficult intubation and ventilation. Preoperative suspicion of tracheomalasia was high due to symptoms and chronicity. The airway was secured using awake intubation with topical and intravenous lidocaine prior to the induction of general anesthesia. The patient underwent a total thyroidectomy. Intraoperative palpation confirmed flaccid tracheal rings, supporting the diagnosis. The endotracheal tube was retained postoperatively, and the patient was monitored in the intensive care unit. She was successfully extubated on the third postoperative day without complications. Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for tracheomalacia in patients with long-standing, giant goiters. Awake tracheal intubation is a cornerstone technique, providing a safe and effective method to secure the airway while preserving spontaneous ventilation, thereby mitigating the risk of life-threatening airway obstruction. A meticulous, multidisciplinary perioperative plan is paramount for optimal patient outcomes.

Successful Anesthetic Management for Mandibular Neoplasm Resection in a Patient with Osteogenesis Imperfecta: A Case Report Indriani, Andi Riza Mirda; T Addi Saputra; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (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.v8i12.1140

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and deformities. Patients with mandibular neoplasms and suspected OI require careful anesthetic management to avoid complications. This case report describes the successful anesthetic management of a patient with a mandibular neoplasm and suspected OI. Case presentation: A 33-year-old man presented with a large mandibular tumor causing airway obstruction and difficulty eating. He had physical features suggestive of OI, including short stature, bone deformities, and abnormal tooth growth. Preoperative evaluation revealed a difficult airway due to the tumor and potential cervical spine instability. Anesthesia was induced with propofol and atracurium after securing the airway via ultrasound-guided tracheostomy under local anesthesia. The tumor was resected successfully, and the patient recovered without complications. Conclusion: Anesthetic management in patients with suspected OI and mandibular neoplasms requires careful planning and execution. A multidisciplinary approach, including preoperative evaluation, airway management strategies, and close postoperative monitoring, is crucial for successful outcomes.

Anesthetic Management of a Giant Ovarian Cyst: A Case Report Indriani, Andi Riza Mirda; Saputra, T. Addi; Anggraeni, Novita
Journal of Health and Nutrition Research Vol. 4 No. 3 (2025)
Publisher : Media Publikasi Cendekia Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56303/jhnresearch.v4i3.507

Ovarian cysts are highly prevalent among women, particularly those of reproductive age. However, giant ovarian cysts are rare, as most cases are detected early during routine gynecological or ultrasound examinations. A giant ovarian cyst is defined as an ovarian cyst that is more than 10 cm in diameter. Cases with giant size pose significant clinical challenges. We report a case of an 18-year-old female patient with symptoms of an enlarged abdomen for six months causing shortness of breath, difficulty in activities and supine position. Initial examination revealed an abdominal circumference of 120 cm and a large cystic mass that required laparotomy. Challenges in anesthetic management are related to increased abdominal pressure by the mass, including aspiration risk, hemodynamic disorders, supine hypotensive syndrome, and re-expansion pulmonary edema. Consideration of anesthetic agent selection and perioperative monitoring strategies is key to minimizing complications and ensuring patient safety. In this case, anesthetic agents were carefully selected due to the presence of a giant ovarian cyst that significantly increased intra-abdominal pressure. A balanced general anesthesia approach was employed, prioritizing agents with minimal cardiovascular effects to maintain hemodynamic stability. Propofol was chosen for induction because of its rapid onset and ease of titration, while sevoflurane was used for maintenance due to its favorable cardiovascular profile and rapid recovery characteristics. Rocuronium was administered to facilitate muscle relaxation, and fentanyl was selected for analgesia owing to its potency and minimal impact on hemodynamics. To mitigate the risk of aspiration, rapid sequence induction was performed with endotracheal intubation in a semi-recumbent position. This anesthetic strategy was specifically tailored to address the risks associated with large intra-abdominal masses, such as aspiration, cardiovascular instability, and respiratory compromise.

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