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Purwanto, Osmond
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Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

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Endotracheal Intubation without Neuromuscular Blocking Agent in Patient with Fracture Cervical Spine C1 and C4 Underwent Fusion C12 and C46 Suarjaya, I Putu Pramana; Purwanto, Osmond; Aldy, Aldy; J. Sutawan, Ida Bagus Krisna
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.584

Abstract

About 30% of cervical spine fractures involve injuries to the C1 and C2 vertebrae, which are considered unstable. Ensuring the stability of the injured cervical spine throughout perioperative period, including preoperative examinations, anesthesia induction, laryngoscopy, and intubation, is crucial for anesthesiologists. A 40-year-old woman suffered neck pain following a motorcycle accident, suffering a Spinal Cord Injury ASIA Impairment Scale (SCI AIS) E, a fracture of the C5 vertebral body (CV) classified as AO Spine Type A2, a Jefferson Type IV fracture, and mild head trauma. She underwent surgical fusion of the C1C2 and C4C6 vertebrae under general anesthesia, which included dexmedetomidine, propofol, sevoflurane, and fentanyl without any neuromuscular blocking agents (NMBA). The primary goal of perioperative airway management in cervical injury is a secured airway, while maintaining cervical stability without inflicting secondary injury. The cervical muscle group is essential for maintaining cervical stability, and the use of NMBA may jeopardize this stability, necessitating external cervical stabilization, especially during laryngoscopy and intubation. Induction agents in combination with opioid, widely used to facilitate laryngoscopy and intubation without using NMBA. Anesthesiologists must precisely arrange the management of cervical spine injuries patient to avoid secondary injury and improve surgical outcomes.
Anesthesia Management for Evacuation of Cerebral Abscess in Geriatric Patient with Myasthenia Gravis Suarjaya, I Putu Pramana; Purwanto, Osmond; Wundiawan, Kristian Felix; J. Sutawan, Ida Bagus Krisna
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.585

Abstract

A Cerebral abscess is an intracranial focal abscess which is a life-threatening emergency. Myasthenia gravis is an autoimmune disorder caused by antibodies targeting the neuromuscular junctions post-synaptic receptor. A seventy-three-year-old male, with an intra-axial tumor in the frontoparietal region underwent craniotomy for abscess evacuation. The Patient also has a history of hypertension and myasthenia gravis under treatment of dexamethasone and pyridostigmine. Anesthesia induction was performed with thiopental, opioid analgesics with fentanyl, neuromuscular blocking agent (NMBA) with rocuronium, and scalp block. The Patients depth of neuromuscular block was monitored with a Train-of-Four (TOF). Surgery was performed in a supine position, duration of surgery was 4.5 hours. The Patient was extubated in the operating theatre, monitored in the intensive care unit, and discharged home on the nineteenth day. Anesthetic management in geriatric patients with cerebral abscesses accompanied by myasthenia gravis has become complex due to the interaction of disease state, medical treatment, anesthetic drugs especially neuromuscular blocking agents, and surgical stress. The Patient was at risk for residual paralysis and had high sensitivity to nondepolarizing neuromuscular blocking agents, so the use of train-of-four (TOF) was very helpful for extubating this patient safely.
Co-Authors Aldy, Aldy J. Sutawan, Ida Bagus Krisna Putu Pramana Suarjaya Wundiawan, Kristian Felix