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The Relationship Between the Time Elapsed from the Incident to Medical Management and the Outcome of Traumatic Brain Injury Patients Undergoing Craniotomy Agung Nugroho, Fauzi; Adiyanto, Bowo; Sudadi, Sudadi
Jurnal Komplikasi Anestesi Vol 12 No 3 (2025)
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.v12i3.27389

Backgrround: Traumatic brain injury (TBI) is one of the leading causes of global morbidity and mortality, with treatment outcomes influenced by several factors, including treatment timing. Objective: This study aims to analyze the relationship between the duration from injury to initial medical management and the duration from injury to craniotomy surgery on the outcomes of TBI patients at RSUP Dr. Sardjito Yogyakarta, using the Glasgow Outcome Scale Extended (GOSE) as an assessment tool and Length of Stay (LOS).Subject and Method: This is a prospective observational study conducted on TBI patients treated at RSUP Dr. Sardjito from May to October 2024. Data were collected from the patients' electronic medical records who underwent craniotomy procedures. The analysis was performed using regression tests to evaluate the impact of the duration between the incident and initial medical management, as well as the duration until craniotomy, on patient outcomes.Result: Among 71 included patients, the median age was 19 years (Q1: 7; Q3: 57), and 71.8% were male. Most patients (52.1%) presented with a GCS score of 13–15. GOSE outcomes showed good recovery in 28.2%, mild disability in 26.8%, slight disability in 9.9%, moderate disability in 21.1%, severe disability in 5.6%, and death in 8.4%, with a median length of stay of 10 days.

Case Series: Lumbar Cerebrospinal Fluid Drainage in Aneurysm Clipping Bayu, Timor Krisna; Prandani, Muhammad Yogi; Farid, Anisa Fadhila; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 12 No 3 (2025)
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.v12i3.14679

Intracranial aneurysm rupture is a medical emergency often accompanied by subarachnoid hemorrhage (SAH), which requires immediate medical intervention to reduce the risk of morbidity and mortality. This case report provides an overview of lumbar cerebrospinal fluid drainage (LCFD) as a method to reduce increased intracranial pressure and prevent or treat hydrocephalus that can occur after SAH. It is done by inserting an epidural catheter in the subarachnoid lumbar. The effectiveness of LCFD is more significant in patients with MFS 3-4. This finding supports the use of LCFD in managing SAH aneurysm to improve patients’ prognosis. Management of this case involved meticulous preoperative evaluation, appropriate intraoperative intervention, and strict postoperative monitoring, including treatment of cerebral vasospasm that may arise as a complication of SAH. The results suggest that LCFD can successfully reduce complications and improve clinical outcomes in patients with ruptured aneurysms who have undergone aneurysm clipping. The success of this method emphasizes the importance of a multidisciplinary approach in the management of SAH to achieve optimal patient outcomes.

The Relationship Between the Time Elapsed from the Incident to Medical Management and the Outcome of Traumatic Brain Injury Patients Undergoing Craniotomy Agung Nugroho, Fauzi; Adiyanto, Bowo; Sudadi, Sudadi
Jurnal Komplikasi Anestesi Vol 12 No 3 (2025)
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.v12i3.27389

Backgrround: Traumatic brain injury (TBI) is one of the leading causes of global morbidity and mortality, with treatment outcomes influenced by several factors, including treatment timing. Objective: This study aims to analyze the relationship between the duration from injury to initial medical management and the duration from injury to craniotomy surgery on the outcomes of TBI patients at RSUP Dr. Sardjito Yogyakarta, using the Glasgow Outcome Scale Extended (GOSE) as an assessment tool and Length of Stay (LOS).Subject and Method: This is a prospective observational study conducted on TBI patients treated at RSUP Dr. Sardjito from May to October 2024. Data were collected from the patients' electronic medical records who underwent craniotomy procedures. The analysis was performed using regression tests to evaluate the impact of the duration between the incident and initial medical management, as well as the duration until craniotomy, on patient outcomes.Result: Among 71 included patients, the median age was 19 years (Q1: 7; Q3: 57), and 71.8% were male. Most patients (52.1%) presented with a GCS score of 13–15. GOSE outcomes showed good recovery in 28.2%, mild disability in 26.8%, slight disability in 9.9%, moderate disability in 21.1%, severe disability in 5.6%, and death in 8.4%, with a median length of stay of 10 days.

Comparing Sniffing Position Between Inflatable Vs Fixed Pillow for Glottic Visualization during Laryngoscopy Adiyanto, Bowo; Ikhwandi, Arif
Jurnal Komplikasi Anestesi Vol 13 No 1 (2025)
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.v13i1.28464

Background: Effective glottic visualization is crucial for successful tracheal intubation and reducing complications during airway management. The sniffing position is commonly used, with various pillow types employed to optimize the alignment of the airway axes. We performed a study to evaluate the effectiveness of an inflatable intubation pillow for glottic visualization, intubation time, and first-attempt intubation success.Objective: We performed a study to evaluate the effectiveness of an inflatable intubation pillow for glottic visualization, intubation time, and first-attempt intubation success.Methods: A randomized controlled trial was conducted with 222 patients undergoing general anesthesia and endotracheal intubation at Dr. Sardjito General Hospital, Yogyakarta. Patients were randomly assigned to two groups: Group I (inflatable pillow) and Group S (fixed pillow). The primary outcome was glottic visualization, assessed using the Cormack–Lehane score, while secondary outcomes included intubation time and the number of intubation attempts. Multivariate analyses adjusted for potential confounders such as BMI, sex, and age.Results: The inflatable pillow group showed a higher proportion of grade 1 glottic visualization (64%) compared to the fixed pillow group (55%), but this difference was not statistically significant after adjusting for confounders. The inflatable pillow group demonstrated a significantly shorter intubation time (35 seconds) compared to the fixed pillowConclusion: The use of an inflatable pillow in the sniffing position significantly reduced intubation time, improving procedural efficiency. However, it did not show a significant improvement in glottic visualization or first-attempt intubation success after adjusting for confounding factors. BMI was the primary determinant of glottic visualization

english English Pasmawati, Desti; Fitriani R.W, Calcarina; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 13 No 2 (2026)
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.v13i2.28917

Background : Sepsis is one of the causes of morbidity and mortality patients hospitalized in the intensive care unit (ICU) which requires early detection and management to predict outcomes. Lactate-albumin ratio has a predictive value of mortality in patient with sepsis that is similar to APACHE II and SOFA scores. Objective : To determine the relationship between the lactate-albumin ratio and mortality and length of stay patient with sepsis in ICU of Dr. Sardjito Hospital. Method : Research design using a retrospective cohort observational study by collecting data from the medical records of sepsis patients at ICU of Dr. Sardjito Hospital. Data were calculate the optimal cutoff using the ROC curve. The relationship between lactate-albumin ratio levels and mortality was analyzed using the chi-square test method followed by logistic regression. Results : The total study subjects were 136 patients. The cut-off value for the Lactate-Albumin ratio in predicting mortality 0,878, sensitivity 73.0 % and specificity 57.1% (AUC = 0,687; 95% CI 0,56-0,81; p=0,007). The cut-off value for the Lactate-Albumin ratio in predicting ICU length of stay 0,878, sensitivity 71,2% and specificity 63,6% (AUC = 0,684; 95% CI 0,53-0,84; p=0,043). Multivariate analysis showed that an increase in the Lactate-Albumin ratio was independent and significant factor as a predictor of mortality (OR=3,43; 95% CI 1,29-9,16; p=0,013) and ICU length of stay (OR=4,33; 95% CI 1,19-15,68; p=0,036). Conclusion : An increase in the Lactate-Albumin ratio is independently and significantly associated with an increased risk of mortality and length of stay in sepsis patients.

Penatalaksanaan Status Epileptikus dengan Infeksi Sistem Saraf Pusat di Unit Perawatan Intensif: Laporan Kasus: Laporan Kasus Akhsaniati, Novi Dwi; Adiyanto, Bowo
Cermin Dunia Kedokteran Vol 53 No 05 (2026): Mei 2026
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i05.1548

Introduction: Status epilepticus (SE) is a critical neurological emergency characterized by prolonged seizure activity that poses significant neurological risks and death, requiring immediate and effective management to prevent morbidity and mortality. SE can result from a variety of causes, including primary neurological disorders, metabolic disturbances, and iatrogenic factors. In the ICU, drug toxicity and electrolyte imbalances are common triggers, accounting for over 30%−35% of seizures. Understanding the underlying causes, such as central nervous system infections or autoimmune encephalitis, is crucial for targeted treatment and improving patient outcomes. Case: A 21-yearold male with SE complicated by a central nervous system (CNS) infection was managed in the intensive care unit (ICU). Seizure control was achieved using continuous infusions of midazolam and phenytoin. The treatment strategy also included supportive care, including mechanical ventilation and hemodynamic stabilization with norepinephrine. The patient's condition improved significantly. Discussion: This case demonstrates that favorable clinical outcomes in SE complicated by a CNS infection rely heavily on continuous sedation, the selection of antibiotics with adequate CNS penetration (such as linezolid), and meticulous hemodynamic monitoring in the intensive care setting. Conclusion: This case highlights the importance of early diagnosis, targeted treatment, and interdisciplinary collaboration.

Pendekatan dan Pengelolaan Delirium pada Pasien ICU: Deteksi, Intervensi Nonfarmakologi, dan Pencegahan Multikomponen Ratno Samodro; Bowo Adiyanto; Erlangga Prasamya
Jurnal Ilmiah Kedokteran dan Kesehatan Vol. 5 No. 1 (2026): Januari: Jurnal Ilmiah Kedokteran dan Kesehatan
Publisher : Lembaga Pengembangan Kinerja Dosen

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/klinik.v5i1.5700

Delirium is an acute neuropsychiatric syndrome characterized by fluctuating disturbances in attention, consciousness, and cognition, frequently observed in critically ill patients in the intensive care unit (ICU). This review aims to summarize current evidence on early detection methods, nonpharmacological interventions, and multicomponent prevention strategies for ICU delirium. The methodology involved a narrative literature review of studies published between 2012 and 2024, focusing on validated screening tools such as the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC), their diagnostic performance, and implementation protocols. Findings indicate that daily screening with CAM-ICU (sensitivity ~80%, specificity ~96%) and ICDSC (sensitivity ~74%, specificity ~82%) facilitates timely identification. Nonpharmacological measures, including the ABCDEF bundle—encompassing pain management, spontaneous awakening and breathing trials, choice of sedation, delirium monitoring, early mobilization, and family engagement—have demonstrated efficacy in reducing delirium incidence and duration. Multicomponent prevention protocols such as the Hospital Elder Life Program (HELP) further decrease delirium risk through cognitive orientation, sleep promotion, and sensory support. Implications for practice include adopting standardized screening, embedding bundles into ICU workflows, and prioritizing environmental design modifications. Future research should explore optimized pharmacological adjuncts and cost-effectiveness analyses of bundle implementation.

Successful Management of Life-Threatening Adrenal Crisis in an Elderly Patient with Secondary Adrenal Insufficiency: A Case Report of Comprehensive Multidisciplinary Care Setiadi, Teguh; Adiyanto, Bowo
Journal of Anaesthesia and Pain Vol. 7 No. 2 (2026): May
Publisher : Faculty of Medicine, Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2026.007.02.03

Background: Adrenal crisis is an acute, life-threatening manifestation of cortisol deficiency that requires prompt recognition and treatment. Infection and sepsis are important precipitating factors, particularly in patients with underlying adrenal insufficiency. We report the successful multidisciplinary management of adrenal crisis complicated by septic shock and metabolic disturbances in an older patient.Case: A 64-year-old female patient with a diagnosis of adrenal crisis, septic shock, hyponatremia, recurrent hypoglycemia, and hospital-acquired pneumonia (HAP) is reported. Initial management included hydrocortisone administration as an exogenous glucocorticoid to address cortisol deficiency. Associated shock was managed with fluid resuscitation and vasopressors. Additionally, management of complications such as treating hypoglycemia with dextrose administration, correcting hyponatremia, and culture and antibiotic sensitivity testing were performed. Antibiotic therapy was administered in stages, starting with Ceftriaxone (empirical), escalation to Meropenem and Vancomycin, then de-escalation according to culture and sensitivity results. After 8 days of intensive care unit (ICU) treatment, the patient's condition improved, followed by 5 days of step-down care in the high care unit (HCU). The patient was then transferred to the general ward for 4 days. The patient was discharged with the tracheostomy still in place.Conclusion: Adrenal crisis in critically ill patients requires rapid glucocorticoid replacement together with simultaneous treatment of precipitating infection, shock, electrolyte abnormalities, and hypoglycemia. This case highlights the importance of coordinated multidisciplinary care, close physiologic monitoring, and culture-guided antimicrobial therapy in achieving clinical stabilization and recovery.

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