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Acute Respiratory Distress Syndrome in a Patient with Myasthenia Gravis and Septic Shock: A Case Report Nur Amin, Taufiqurrochman; Septian Adi Permana
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.v5i3.613

Introduction: Myasthenia gravis (MG) is an autoimmune disorder characterized by muscle weakness, often affecting respiratory and oropharyngeal muscles. This predisposition to respiratory compromise, coupled with impaired swallowing and the potential need for immunosuppressive therapies, increases the risk of pneumonia and subsequent sepsis in MG patients. Sepsis, in turn, is a significant risk factor for acute respiratory distress syndrome (ARDS), a severe lung condition with high mortality. Case presentation: We present the case of a 47-year-old male with a 4-year history of MG who was admitted to our hospital with progressive dyspnea and dysphagia. His condition deteriorated rapidly, leading to septic shock and respiratory failure necessitating invasive mechanical ventilation. Blood cultures identified Klebsiella pneumoniae with extended-spectrum beta-lactamase (ESBL) production. Despite aggressive treatment, including therapeutic plasma exchange (TPE), the patient's hospital course was complicated. Conclusion: This case underscores the critical importance of vigilant monitoring and early intervention in MG patients presenting with respiratory symptoms or signs of infection. Prompt recognition and aggressive management of sepsis are crucial to mitigate the risk of ARDS and improve outcomes in this vulnerable patient population.

Successful Management of Grade III Tetanus with Therapeutic Plasma Exchange: A Case Report Listyono Putro, Jati Febriyanto Adi; Andy Nugroho; Septian Adi Permana; Andi Hermawan
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.v5i3.644

Introduction: Tetanus, a severe neurologic disorder caused by Clostridium tetani neurotoxin, presents with progressive muscle rigidity and spasms. Grade III tetanus, characterized by generalized tetanus with severe spasms, carries a high mortality risk. Therapeutic plasma exchange (TPE) has emerged as an adjunctive therapy to remove circulating toxins and inflammatory mediators. Case presentation: We report a 50-year-old male with grade III tetanus following a minor injury. Despite standard treatment with tetanus immunoglobulin, antibiotics, and muscle relaxants, his condition deteriorated, necessitating intensive care unit (ICU) admission and mechanical ventilation. The patient underwent two sessions of TPE, demonstrating significant clinical improvement with reduced muscle spasms and successful ventilator weaning. Conclusion: This case highlights the potential benefit of TPE in managing severe tetanus, particularly in cases refractory to conventional therapy. Early recognition and aggressive management, including TPE, can improve outcomes in this life-threatening condition.

Navigating the Triad of Trauma: A Case Report on Managing Concurrent Pulmonary Contusion, Traumatic Brain Injury, and Cervical Fracture in a Geriatric Patient Yasyfie Asykari; Septian Adi Permana; Eko Setijanto
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.771

The management of geriatric patients with multiple severe injuries presents a formidable clinical challenge due to reduced physiological reserve and the complex interplay of competing therapeutic goals. This report details the case of a geriatric patient suffering from the triad of pulmonary contusion (PC), moderate traumatic brain injury (TBI), and an unstable cervical spine fracture, highlighting the intricate balance required in neuroprotective and lung-protective ventilatory strategies. A 68-year-old male was admitted following a 10-meter fall, sustaining a moderate TBI with a temporoparietal subdural hemorrhage, a complete C3 vertebral fracture, and significant bilateral pulmonary contusions. His hospital course was marked by acute respiratory distress and neurological deterioration, with a Glasgow Coma Scale (GCS) score of E3V4M5 and hypoxemia requiring intubation and mechanical ventilation in the intensive care unit (ICU). Management focused on the cautious application of positive end-expiratory pressure (PEEP) to improve oxygenation without exacerbating intracranial pressure (ICP), alongside strict cervical spine immobilization and neuro-monitoring. After eight days of complex critical care, the patient’s prolonged need for mechanical ventilation and significant sputum retention necessitated a percutaneous dilational tracheostomy (PDT) to facilitate respiratory weaning and improve pulmonary toilet. In conclusion, this case underscores the profound difficulty of managing concurrent lung and brain injuries in the context of cervical instability. The successful navigation of this trauma triad hinged on a highly individualized, multidisciplinary approach, with judicious ventilator management and timely procedural intervention like PDT being pivotal. It affirms the need for integrated care protocols that can dynamically balance competing organ-system priorities in complex geriatric trauma.

Point-of-Care Ultrasound in the Sequential Diagnosis of Postoperative Cardiac, Pulmonary, and Vascular Complications Following Thoracoabdominal Aortic Aneurysm Repair: A Case Report and Pathophysiological Review Agil Tri Hutomo; Septian Adi Permana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1387

Background: Open repair of a thoracoabdominal aortic aneurysm (TAAA) is a formidable surgical undertaking associated with profound physiological stress and a high risk of life-threatening postoperative complications. We present a case where a sequential, multi-system point-of-care ultrasound (POCUS) protocol was instrumental in unraveling a cascade of distinct but interconnected postoperative complications. Case presentation: A 67-year-old male with a Crawford Type II TAA underwent an elective open repair. His postoperative course in the Intensive Care Unit (ICU) was complicated by a cascade of events. On postoperative day one, he developed hypotensive shock. Bedside cardiac ultrasound revealed new-onset, severe left ventricular systolic dysfunction (ejection fraction ~20-25%), indicative of profound myocardial stunning. By day three, this was followed by progressive hypoxemic respiratory failure. Lung ultrasound identified a large, compressive left-sided pleural effusion, which was contributing to his respiratory decline. On day four, the patient developed signs of acute left lower limb ischemia. Vascular ultrasound confirmed a complete occlusive thrombus in the popliteal artery. This rapid series of diagnoses, all made at the bedside with POCUS, facilitated targeted interventions including the initiation of inotropic support, goal-directed diuretic therapy, and emergency surgical thrombectomy, leading to a successful patient outcome. Conclusion: This case highlights the unique diagnostic power of a structured, serial POCUS examination in the complex post-TAAA patient. It demonstrates how this non-invasive modality can effectively diagnose a "triple threat" of interconnected cardiac, pulmonary, and vascular complications, guiding real-time clinical decision-making and facilitating timely, life-saving interventions in the critical care setting.

Point-of-Care Ultrasound in the Sequential Diagnosis of Postoperative Cardiac, Pulmonary, and Vascular Complications Following Thoracoabdominal Aortic Aneurysm Repair: A Case Report and Pathophysiological Review Agil Tri Hutomo; Septian Adi Permana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (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.v9i9.1387

Background: Open repair of a thoracoabdominal aortic aneurysm (TAAA) is a formidable surgical undertaking associated with profound physiological stress and a high risk of life-threatening postoperative complications. We present a case where a sequential, multi-system point-of-care ultrasound (POCUS) protocol was instrumental in unraveling a cascade of distinct but interconnected postoperative complications. Case presentation: A 67-year-old male with a Crawford Type II TAA underwent an elective open repair. His postoperative course in the Intensive Care Unit (ICU) was complicated by a cascade of events. On postoperative day one, he developed hypotensive shock. Bedside cardiac ultrasound revealed new-onset, severe left ventricular systolic dysfunction (ejection fraction ~20-25%), indicative of profound myocardial stunning. By day three, this was followed by progressive hypoxemic respiratory failure. Lung ultrasound identified a large, compressive left-sided pleural effusion, which was contributing to his respiratory decline. On day four, the patient developed signs of acute left lower limb ischemia. Vascular ultrasound confirmed a complete occlusive thrombus in the popliteal artery. This rapid series of diagnoses, all made at the bedside with POCUS, facilitated targeted interventions including the initiation of inotropic support, goal-directed diuretic therapy, and emergency surgical thrombectomy, leading to a successful patient outcome. Conclusion: This case highlights the unique diagnostic power of a structured, serial POCUS examination in the complex post-TAAA patient. It demonstrates how this non-invasive modality can effectively diagnose a "triple threat" of interconnected cardiac, pulmonary, and vascular complications, guiding real-time clinical decision-making and facilitating timely, life-saving interventions in the critical care setting.

Trigeminal Block for Submandibular Abscess in Pediatric with Difficult Intubation: A Case Report Septian Adi Permana; Cipta, Juan
Indonesian Basic and Experimental Health Sciences Vol. 12 No. 2 (2024): April
Publisher : Rumah Sakit Umum Daerah Dr. Moewardi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/ibehs.vol12iss2pp55-58

Background: The use of trigeminal block with/without ultrasonography guidance as a pain management in outpatient settings are common, mainly for neuralgic pain. Whereas, the use of trigeminal block are not widely performed intraoperatively especially for oral-maxillofacial surgery. Case: We present a case of 16 year old boy diagnose with mandibular abscess prior to Open Reduction Internal Fixation (ORIF) due to mandibular fracture 1 months prior. Patient admitted with complaints of pain and swelling on right jaw, difficult opening his mouth and experienced a salty taste in mouth which we suspect the abscess penetrate into the oral cavity. Patient was in a limp condition, shortness of breath in supine position, with oxygen saturation of 96% room air. We use LEMON method to assess the intubation difficulties, we found swelling on the right jaw, Incisor distance less than 2 cm, make it impossible to evaluate mallampati score, and limited neck mobility due to pain. We decided to avoid general anesthesia since preoperative airway assessment indicates difficult intubation. We sedate the patient with midazolam and administered trigeminal block using 22-G needle with local anesthetic solution of levobupivacaine 0,375% and dexamethasone 2,5mg as an adjuvant with classic landmark trigeminal technique. The patient tolerated the procedure well and return to the ward after the procedure. Conclusion: The use of trigeminal block can be as an alternative general anesthesia oral-maxillofacial surgery area that may have predisposing difficult airway intubation and may be valuable in contributing better patients outcomes.

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