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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.

Acute Motor Axonal Neuropathy with Respiratory Failure: A Case Report on the Clinical Course Following a Single Session of Therapeutic Plasma Exchange Wirjapratama Putra; Septian Adi Permana; Ellen Josephine Handoko
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.v6i2.775

Introduction: Guillain-Barré syndrome (GBS) is a severe, immune-mediated peripheral neuropathy. The acute motor axonal neuropathy (AMAN) variant, characterized by a direct antibody attack on motor axons, often leads to rapid, severe paralysis. Standard immunotherapy for severe GBS involves a multi-session course of therapeutic plasma exchange (TPE) or Intravenous Immunoglobulin (IVIg). Case presentation: We present the case of a 68-year-old male with rapidly progressive GBS, confirmed as the AMAN subtype through clinical, cerebrospinal, and electrophysiological findings. The patient developed flaccid quadriparesis and acute respiratory failure, necessitating emergent intubation and mechanical ventilation in the intensive care unit (ICU). Following a single, large-volume session of TPE, a marked and rapid clinical improvement was observed. The patient was successfully weaned from mechanical ventilation and transferred from the ICU within three days of the intervention. Conclusion: This case documents a noteworthy temporal association between a single TPE session and rapid clinical recovery in a patient with ventilator-dependent AMAN-GBS. While a causal relationship cannot be definitively established due to the disease's natural history, the observation prompts a deep exploration of the underlying pathophysiology. The discussion theorizes how a single, well-timed intervention might profoundly disrupt the autoimmune cascade by affecting peak antibody titers, complement activation, and cytokine kinetics.

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.

Navigating High-Risk Obstetric Anesthesia: Successful Management of Cesarean Section with Graded Epidural Blockade in a Parturient with Atrial Septal Defect and Moderate Pulmonary Hypertension Viky Wicaksana; Septian Adi Permana; Bambang Novianto Putro
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.v6i2.796

Introduction: The convergence of a large, uncorrected atrial septal defect (ASD) with secondary pulmonary hypertension (PH) in pregnancy creates a high-risk hemodynamic environment. The physiological stresses of parturition can precipitate cardiovascular collapse. Anesthetic management for cesarean delivery must be meticulously planned to preserve the delicate balance between systemic and pulmonary vascular resistance, with the primary goal of maintaining systemic vascular resistance to prevent exacerbation of the intracardiac shunt. Case presentation: We present the case of a 28-year-old primigravida at 37+2 weeks' gestation with a known large secundum ASD and moderate PH (echocardiographically estimated sPAP of 50.2 mmHg), who required an emergency cesarean section. A comprehensive, multidisciplinary plan was formulated, prioritizing maternal hemodynamic stability. The patient was successfully managed with a carefully titrated, graded lumbar epidural anesthetic using 0.5% levobupivacaine. Advanced invasive monitoring, including arterial and central venous catheters, guided the slow induction of a T6 sensory block. This strategy resulted in hemodynamic parameters being maintained within a clinically acceptable range, obviating the need for vasopressor support. The postoperative course in the cardiovascular ICU was uneventful. Conclusion: This case provides compelling evidence that a graded epidural blockade, executed with vigilance and supported by a robust, team-based safety framework, is a highly effective anesthetic technique for cesarean delivery in parturients with ASD and moderate PH. The ability to exert temporal control over the onset of sympathetic blockade is paramount to preventing abrupt hemodynamic shifts, thereby protecting the vulnerable right ventricle and ensuring maternal safety.

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.

Strategic Avoidance of General Anesthesia in Obstetric Trauma: Ear Ring Block for Auricular Reconstruction in a Second-Trimester Pregnancy Purwoko; Septian Adi Permana; Fernando Feliz Christyan
Sriwijaya Journal of Otorhinolaryngology Vol. 3 No. 2 (2025): Sriwijaya Journal of Otorhinolaryngology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjorl.v3i2.241

Introduction: Surgical interventions during pregnancy present a complex clinical dichotomy requiring the balance of maternal physiological stability with fetal safety. Trauma necessitating ear reconstruction typically requires general anesthesia, which carries elevated risks of difficult airway management, aspiration, and potential neurotoxicity in the developing fetus. The "Ring Block" technique offers a regional alternative, yet evidence regarding its safety profile specifically in second-trimester trauma remains limited. Case presentation: We present the case of a 41-year-old multigravida at 14 weeks of gestation (ASA II) presenting with a complex traumatic laceration of the right auricle following a motor vehicle accident. Given the patient’s advanced maternal age and the risks associated with general anesthesia, including hemodynamic fluctuation and teratogenicity concerns, an awake ear reconstruction was planned. We utilized a landmark-based Ear Ring Block using 12 mL of 2% Lidocaine. The procedure achieved complete surgical anesthesia with a V-pattern and inverted V-pattern injection trajectory. Intraoperative monitoring revealed hemodynamic stability with no fluctuations in mean arterial pressure or fetal heart rate abnormalities. The patient reported a visual analog scale score of zero intraoperatively and was discharged 12 hours after surgery without complications. Conclusion: The Ear Ring Block represents a superior anesthetic modality for auricular trauma in pregnant patients. It effectively mitigates the physiological risks of general anesthesia while providing profound analgesia and hemodynamic stability. This technique should be considered a primary anesthetic strategy for auricular reconstruction in the obstetric population.

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