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All Journal Journal of Anaesthesia and Pain Jurnal Kesehatan Tambusai The International Journal of Medical Science and Health Research
Hanafia, Mochamad Fauzi
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Management of Tetanus Patients in the Intensive Care Unit : A Case Report Hanafia, Mochamad Fauzi; Adiyanto, Bowo
The International Journal of Medical Science and Health Research Vol. 4 No. 3 (2024): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/afhb4p29

Abstract

We report a case of a 41-year-old male patient with a history of a nail puncture wound who presented to the Emergency Department (ED) with complaints of generalized body stiffness. The patient experienced worsening stiffness, particularly in the neck, jaw, back, and abdomen. He was diagnosed with tetanus and received initial treatment with human tetanus immunoglobulin (HTIG) and antibiotics. The patient was admitted to the intensive care unit (ICU) due to the risk of recurrent seizures and airway obstruction. During the treatment, he developed several complications, including pneumonia and hematemesis. Supportive care was provided, including adequate nutrition, prevention of pressure sores, and physiotherapy. The patient showed improvement after the administration of magnesium sulfate (MgSO4) to control spasms and autonomic dysfunction. He was successfully weaned off the ventilator and discharged after 40 days of intensive care.
MANAJEMEN ARDS PADA PASIEN SINDROM MEIGS DI ICU hanafia, mochamad fauzi; Jufan, Akhmad Yun; Prasamya, Erlangga
Jurnal Kesehatan Tambusai Vol. 6 No. 2 (2025): JUNI 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i2.45875

Abstract

Sindrom Meigs merupakan tumor jinak ovarium disertai asites dan efusi pleura yang dapat memicu komplikasi sistemik, termasuk Acute Respiratory Distress Syndrome (ARDS). Laporan ini membahas tantangan tatalaksana ARDS pada pasien sindrom Meigs dengan kontraindikasi operasi akibat instabilitas hemodinamik. Pasien dirujuk dengan rencana operasi pengangkatan tumor ovarium, namun mengalami perburukan kondisi akibat efusi pleura masif, hipoalbuminemia (2,53 g/dL), dan syok septik. Kriteria ARDS berat (rasio PaO₂/FiO₂ 85,71) ditegakkan berdasarkan analisis gas darah dan pencitraan toraks. Tatalaksana meliputi ventilasi mekanik mode Synchronized Intermittent Mandatory Ventilation (SIMV) dengan Positive End-Expiratory Pressure (PEEP) 5-8 cmH₂O dan tidal volume 4-6 mL/kgBB ideal (191-287 mL), terapi antibiotik meropenem, koreksi hipoalbuminemia dengan albumin 20%, serta nutrisi enteral dan parenteral. Manajemen ARDS pada sindrom Meigs memerlukan pendekatan multidisiplin dengan fokus pada optimasi ventilasi protektif, koreksi gangguan onkotik, dan kontrol infeksi. Meskipun protokol tatalaksana sesuai pedoman, prognosis tetap ditentukan oleh respons individu terhadap terapi dan komorbiditas penyerta.
The Role of Intravenous Immunoglobulin in Myasthenic Crisis: A Case Report of Successful Management in an Elderly Patient with Thymoma Hanafia, Mochamad Fauzi; Adiyanto, Bowo
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2025.006.03.04

Abstract

Background: Myasthenic crisis represents the most severe and life-threatening manifestation of myasthenia gravis, affecting approximately 15-20% of patients, with mortality rates ranging from 2-16% globally. Intravenous immunoglobulin (IVIG) is emerging as a primary therapeutic modality alongside plasmapheresis for crisis management. The optimal treatment approach in elderly patients with concurrent thymoma remains challenging due to increased perioperative risks and complex clinical presentations. The present case report describes the successful management of myasthenic crisis in an elderly patient with thymoma using intensive IVIG therapy in conjunction with timely surgical interventionCase: A 71-year-old male with established myasthenia gravis presented with myasthenic crisis two days prior to scheduled thymectomy. Clinical manifestations included respiratory distress, bilateral ptosis, drooping head, and dysphonia requiring immediate intensive care management. The patient received three cycles of IVIG therapy (0.4 g/kg/day for 5 days each cycle) in the intensive care unit in conjunction with mechanical ventilation, corticosteroids, pyridostigmine, and urgent thymectomy. Treatment resulted in successful weaning from mechanical ventilation after 8 days, with complete clinical recovery and transfer to the general ward without complications.Conclusion: This case demonstrates the efficacy and safety of intensive IVIG therapy in managing myasthenic crisis in elderly patients with thymoma. The systematic administration of multiple IVIG cycles proved effective in stabilizing respiratory function and facilitating successful surgical intervention, supporting IVIG as a cornerstone therapy in critical care management of severe myasthenia gravis.
Co-Authors Akhmad Yun Jufan Bowo Adiyanto Prasamya, Erlangga