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All Journal Journal of Anaesthesia and Pain Jurnal Komplikasi Anestesi
Hapsari, Paramita Putri
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Health Professions Medicine & Pharmacology

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Dexmedetomidine for Awake Intubation Procedure in Subtotal Thyroidectomy Riyanti, Riandini Pramudita; Hapsari, Paramita Putri
Journal of Anaesthesia and Pain Vol 3, No 2 (2022): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2022.003.02.04

Abstract

Background: Giant struma makes airway management difficult for the anesthesiologist due to the risk of tracheal intubation failure. Awake fiberoptic intubation(AFOI) is the gold standard in the management of a predicted difficult airway. Giving analgesia and sedation can facilitate operator and patient comfort during the awake intubation procedure.Case: We report the case of a 63-year-old woman with a giant struma who was planned for a subtotal thyroidectomy. We provide ondansetron and dexamethasone premedication, analgesia and sedation using dexmedetomidine, propofol induction, muscle relaxant atracurium, with maintenance anesthetic sevoflurane. Dexmedetomidine was administered on loading dose 0.8 µg /kg/hour in the first 10 minutes then continue on analgesia dose 0.2 µg /kg. During the AFOI procedure, 100% oxygenation was given with the patient's hemodynamic range, namely systolic blood pressure of 110-131 mmHg, diastolic blood pressure of 75-93 mmHg, heart rate of 77-91 beats per minute, and SpO2 of 98-100%. Postoperatively the patient was transferred to the Intensive care unit (ICU) with an endotracheal tube intube. Monitoring of postoperative complications such as production of thyroid crisis drainage and extubation 24 hours after surgery was confirmed by the cuff leak test.Conclusion: Giving dexmedetomidine is better than opioids in the AFOI procedure because of its minimal respiratory depressant effect. Maintaining hemodynamic stability during the AFOI procedure is very important to avoid hemodynamic fluctuations so it can minimize the risk of perioperative complications.
SERIAL KASUS EKSTUBASI FAST-TRACK PADA BEDAH JANTUNG TERBUKA Hapsari, Paramita Putri; Pratomo, Bhirowo Yudo; Putro, Bambang Novianto
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i1.14651

Abstract

Fast-track extubation (FTE) has been shown to reduce the incidence of prolonged mechanical ventilation, resulting in shorter hospitalization, lower morbidity, mortality, and hospital costs. We present a case series of fast-track extubation involving two females aged 31 and 33 with Atrial Septal Defect (ASD) and a 33-year-old male with Ventricular Septal Defect (VSD) scheduled for defect closure. These patients were in good clinical condition with normal biventricular function and a low probability of pulmonary hypertension. The anesthesia and surgery procedures proceeded smoothly, with cardiopulmonary bypass time < 90 minutes, aortic cross-clamp time < 60 minutes, no residual shunt, acceptable lactate and blood gas analysis, stable hemodynamic with low doses of vasoactive agents, and adequate analgesia. Following the successful execution of the fast-track extubation protocol in the operating theatre, the patients were transferred to the intensive care unit (ICU) where they received postoperative management. The total ICU length of stay was < 24 hours, demonstrating the safety and efficacy of FTE for simple cardiac procedures and favourable outcomes. This approach is aimed at accelerating patient recovery, reducing complications, and enhancing overall surgical outcomes.
Dexmedetomidine for Awake Intubation Procedure in Subtotal Thyroidectomy Riyanti, Riandini Pramudita; Hapsari, Paramita Putri
Journal of Anaesthesia and Pain Vol. 3 No. 2 (2022): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2022.003.02.04

Abstract

Background: Giant struma makes airway management difficult for the anesthesiologist due to the risk of tracheal intubation failure. Awake fiberoptic intubation(AFOI) is the gold standard in the management of a predicted difficult airway. Giving analgesia and sedation can facilitate operator and patient comfort during the awake intubation procedure.Case: We report the case of a 63-year-old woman with a giant struma who was planned for a subtotal thyroidectomy. We provide ondansetron and dexamethasone premedication, analgesia and sedation using dexmedetomidine, propofol induction, muscle relaxant atracurium, with maintenance anesthetic sevoflurane. Dexmedetomidine was administered on loading dose 0.8 µg /kg/hour in the first 10 minutes then continue on analgesia dose 0.2 µg /kg. During the AFOI procedure, 100% oxygenation was given with the patient's hemodynamic range, namely systolic blood pressure of 110-131 mmHg, diastolic blood pressure of 75-93 mmHg, heart rate of 77-91 beats per minute, and SpO2 of 98-100%. Postoperatively the patient was transferred to the Intensive care unit (ICU) with an endotracheal tube intube. Monitoring of postoperative complications such as production of thyroid crisis drainage and extubation 24 hours after surgery was confirmed by the cuff leak test.Conclusion: Giving dexmedetomidine is better than opioids in the AFOI procedure because of its minimal respiratory depressant effect. Maintaining hemodynamic stability during the AFOI procedure is very important to avoid hemodynamic fluctuations so it can minimize the risk of perioperative complications.
Co-Authors Bhirowo Yudo Pratomo Putro, Bambang Novianto Riyanti, Riandini Pramudita