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Fast-Track Anesthesia for Cito Craniotomy Evacuation Hematoma Due to Temporoparietal Subdural Hemorrhagic Hematoma in a Pediatric Patient: A Case Report Wardhana, Anggia Rarasati; Ardana Tri Arianto
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.v5i3.569

Introduction: Subdural hematoma (SDH) in early childhood is a serious condition that requires immediate surgical intervention. Fast-track anesthesia is an approach that aims to speed up the patient's recovery after surgery. This case report presents the experience of fast-track anesthesia in a 4-month-old pediatric patient with SDH who underwent a cito craniotomy. Case presentation: A 4-month-old child with a history of head trauma due to shaking experienced recurrent seizures. CT scan examination showed left temporoparietal SDH with intraparenchymal hemorrhage. The patient was classified as ASA IIIE and underwent a cito craniotomy. A fast-track anesthesia strategy was implemented using rapid induction, multimodal analgesia, and strict fluid management. Conclusion: Fast-track anesthesia was successfully applied to pediatric patients with SDH undergoing cito craniotomy. This approach allows for a quicker recovery, reduces postoperative complications, and shortens the length of hospital stay.

Beyond the Block: Sequential Spinal Anesthesia and Dexmedetomidine-Ketamine TIVA for a Four-Hour Cesarean Section in a 157-kg Parturient Agung Nugroho; Ardana Tri Arianto; Paramita Putri Hapsari
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.801

Introduction: Cesarean delivery in super-obese parturients (BMI ≥ 50 kg/m²) presents a complex combination of anesthetic challenges, amplified by comorbidities like preeclampsia. The strong imperative to avoid airway instrumentation makes regional anesthesia the preferred technique. However, the finite duration of a single-shot spinal block poses a significant risk in unexpectedly prolonged procedures, requiring a pre-planned strategy for anesthetic extension. Case presentation: A 38-year-old G2P1 parturient with a BMI of 63.7 kg/m² presented for an emergency cesarean section for fetal hypoxia and preeclampsia. After a rapid multidisciplinary consultation, a deliberate decision was made to proceed with spinal anesthesia to mitigate profound airway risks. The surgery became unexpectedly complex, lasting four hours. As the spinal block regressed, a planned transition to an opioid-sparing total intravenous anesthesia (TIVA) with dexmedetomidine and ketamine was initiated. This technique preserved spontaneous respiration and provided excellent hemodynamic stability, even during a 2000 mL hemorrhage. Conclusion: This case highlights the value of anesthetic adaptability in high-risk obstetrics. A sequential spinal-TIVA technique offers a safe and effective alternative to a high-risk conversion to general anesthesia, emphasizing the importance of having a pre-planned contingency for insufficient neuraxial blockade in super-obese parturients. This approach underscores the necessity of multidisciplinary communication and patient-centered care in navigating complex obstetric emergencies.

Hemodynamic-Focused Anesthetic Strategy for Duodenal Atresia with Annular Pancreas in a Low-Birth-Weight Neonate: A Case Report and Pathophysiological Review Wardhana, Anggia Rarasati; Ardana Tri Arianto; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.802

Introduction: The anesthetic management of low-birth-weight (LBW) neonates with complex congenital anomalies like duodenal atresia presents a profound physiological challenge. These patients exhibit immature organ systems, precarious fluid balance, and heightened sensitivity to anesthetic agents. This case report describes a successful hemodynamically-focused anesthetic strategy in a particularly high-risk neonate with the combined pathology of duodenal atresia and a constricting annular pancreas. Case presentation: A 4-day-old, 1800-gram male infant, born at 37 weeks with intrauterine growth restriction, presented with prenatally diagnosed duodenal atresia. Preoperative stabilization focused on correcting a severe hypochloremic, hypokalemic metabolic alkalosis. A hemodynamically stable anesthetic induction was achieved using intravenous fentanyl (2.8 mcg/kg) and ketamine (2.8 mg/kg), avoiding myocardial depressant volatile agents. Anesthesia was maintained with 60% oxygen in air and intermittent opioid boluses. Intraoperative management was centered on meticulous, goal-directed fluid therapy, rigorous maintenance of normothermia, and lung-protective ventilation. The surgery, a duodenojejunostomy, was completed successfully with remarkable hemodynamic stability. The infant was transferred to the NICU for planned postoperative ventilation and was extubated on the second postoperative day. Postoperative analgesia was achieved with a continuous sub-anesthetic ketamine infusion, later transitioned to intermittent metamizole. Conclusion: The successful outcome in this fragile neonate underscores the value of a tailored anesthetic approach grounded in neonatal pathophysiology. A strategy utilizing hemodynamically stable induction agents, proactive correction of metabolic derangements, goal-directed fluid therapy, and a planned, staged recovery can effectively mitigate the significant perioperative risks associated with major abdominal surgery in LBW infants with complex congenital anomalies.

Opioid-Sparing Anesthesia: The Dual Efficacy of Ketamine on Postoperative Pain and Systemic Inflammation Following Spinal Surgery Elanda Rahmat Arifyanto; Ardana Tri Arianto; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.804

Introduction: Postoperative pain and inflammation after major spinal surgery, such as laminectomy, pose significant challenges to patient recovery and contribute to opioid consumption. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is proposed to have both analgesic and anti-inflammatory properties, positioning it as a key component of an opioid-sparing strategy. This study aimed to evaluate the clinical efficacy of a specific intraoperative ketamine infusion regimen compared to a continuous micro-dose morphine regimen on early postoperative pain and systemic inflammation. Methods: This prospective, double-blind, randomized controlled trial included 24 adult patients (ASA I-II) undergoing thoracolumbar laminectomy. Patients were randomly assigned to receive either a continuous intraoperative infusion of ketamine at 10 mcg/kg/minute (n=12) or morphine at 10 mcg/kg/hour (n=12). The primary outcomes were postoperative pain intensity, measured by the Visual Analog Scale (VAS) at 6 and 12 hours, and the systemic inflammatory response, assessed via high-sensitivity C-reactive protein (hs-CRP) levels measured preoperatively and 6 hours postoperatively. Results: The study groups were comparable regarding baseline demographic and surgical characteristics (p>0.05). At 6 hours postoperatively, the ketamine group reported significantly lower VAS pain scores than the morphine group (mean score of 2.33 ± 0.78 versus 3.83 ± 1.03, respectively; p=0.001). This difference was not maintained at 12 hours (p=0.646). Critically, the surgically-induced increase in hs-CRP was significantly attenuated in the ketamine group, which showed a mean increase of only 1.43 ± 1.04 mg/L from baseline, compared to a much larger increase of 2.88 ± 1.06 mg/L in the morphine group (p=0.003). Conclusion: An intraoperative ketamine regimen of 10 mcg/kg/minute is more effective at reducing pain in the immediate 6-hour postoperative period and mitigating the systemic inflammatory response than a continuous micro-dose morphine regimen. These findings underscore ketamine's potent dual-mechanism action, targeting both nociceptive and inflammatory pathways, and strongly support its use in multimodal, opioid-sparing protocols for spinal surgery.

Therapeutic Plasma Exchange as Adjuvant Rescue Therapy for Weil’s Disease-Associated Acute Liver Failure in a Hemodialysis-Dependent Patient: A Case Report Ardana Tri Arianto; Aura Ihsaniar; Lichte Christian Purbono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1502

Background: Weil’s disease, the severe form of leptospirosis, manifests as a triad of jaundice, renal failure, and hemorrhage. In patients with pre-existing end-stage renal disease (ESRD), the management of superimposed acute liver failure (ALF) is exceptionally challenging due to altered pharmacokinetics, fluid intolerance, and the inability of standard hemodialysis to clear protein-bound hepatic toxins. Case presentation: We present a 32-year-old anuric male with ESRD on maintenance hemodialysis who presented with fever, jaundice, and altered mental status following floodwater exposure. He developed severe metabolic encephalopathy (GCS E2V2M4), profound coagulopathy (INR 6.04), and hyperbilirubinemia (Total Bilirubin 18.31 mg/dL). Following the failure of broad-spectrum antibiotics and sustained low-efficiency dialysis (SLED) to halt clinical deterioration, two sessions of therapeutic plasma exchange (TPE) were initiated as salvage therapy. The intervention utilized 100% fresh frozen plasma (FFP) replacement to address hemostatic failure. TPE resulted in rapid biochemical clearance and clinical stabilization. Post-intervention, the INR decreased from 6.04 to 1.57 (74% reduction), Total bilirubin declined from 18.31 to 5.57 mg/dL (69.5% reduction), and platelet counts recovered from 45,000 to 142,000/µL. Neurological status normalized (GCS 15) within 48 hours of the second session. Conclusion: TPE served as an effective bridge to recovery by clearing albumin-bound toxins and restoring coagulation factors in a high-risk patient where standard renal replacement was insufficient.

Therapeutic Plasma Exchange as Adjuvant Rescue Therapy for Weil’s Disease-Associated Acute Liver Failure in a Hemodialysis-Dependent Patient: A Case Report Ardana Tri Arianto; Aura Ihsaniar; Lichte Christian Purbono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1502

Background: Weil’s disease, the severe form of leptospirosis, manifests as a triad of jaundice, renal failure, and hemorrhage. In patients with pre-existing end-stage renal disease (ESRD), the management of superimposed acute liver failure (ALF) is exceptionally challenging due to altered pharmacokinetics, fluid intolerance, and the inability of standard hemodialysis to clear protein-bound hepatic toxins. Case presentation: We present a 32-year-old anuric male with ESRD on maintenance hemodialysis who presented with fever, jaundice, and altered mental status following floodwater exposure. He developed severe metabolic encephalopathy (GCS E2V2M4), profound coagulopathy (INR 6.04), and hyperbilirubinemia (Total Bilirubin 18.31 mg/dL). Following the failure of broad-spectrum antibiotics and sustained low-efficiency dialysis (SLED) to halt clinical deterioration, two sessions of therapeutic plasma exchange (TPE) were initiated as salvage therapy. The intervention utilized 100% fresh frozen plasma (FFP) replacement to address hemostatic failure. TPE resulted in rapid biochemical clearance and clinical stabilization. Post-intervention, the INR decreased from 6.04 to 1.57 (74% reduction), Total bilirubin declined from 18.31 to 5.57 mg/dL (69.5% reduction), and platelet counts recovered from 45,000 to 142,000/µL. Neurological status normalized (GCS 15) within 48 hours of the second session. Conclusion: TPE served as an effective bridge to recovery by clearing albumin-bound toxins and restoring coagulation factors in a high-risk patient where standard renal replacement was insufficient.

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