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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.

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.

Optimizing Critical Care for the Obese Population: From Physiology to Practice Argoseto, Argoseto; Adiyanto, Bowo; Prasamya, Erlangga
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.108499

Obesity poses distinct issues in the Intensive Care Unit (ICU) owing to its related physiological changes, comorbidities, and the intricacies of management. Obese individuals face heightened risks for respiratory problems, cardiovascular issues, and metabolic dysregulation.Effective management necessitates customized strategies: Respiratory Support: Elevated positive end-expiratory pressure (PEEP), prone positioning, as well as tailored ventilatory modifications are crucial for managing impaired breathing mechanics and averting lung injury. Hemodynamic Management: Careful fluid management and non-invasive monitoring are needed to address altered cardiovascular dynamics and optimize perfusion. Pharmacologic Adjustments: Dosage modifications for sedatives, analgesics, and vasoactive agents accommodate altered drug metabolism and distribution. Nutritional Support: Hypocaloric, high-protein feeding is advised to meet energy needs while avoiding overfeeding, ideally guided by indirect calorimetry. Thromboprophylaxis and Mobility: Heightened risk for venous thromboembolism (VTE) requires higher anticoagulant doses and early mobilization using bariatric equipment. Furthermore, obesity can also caused obesity paradox, an unexpected survival benefit in septic patients with obesity, likely due to enhanced energy reserves, RAAS activation, and anti-inflammatory effects.A multidisciplinary and individualized approach is critical to improving outcomes in obese ICU patients, highlighting the need for updated clinical guidelines and further research tailored to this population.

Acute Fatty Liver of Pregnancy Management in Intensive Care Atsari, Nadhila; Apsari, Ratih Kumala Fajar; Adiyanto, Bowo; Widodo, Untung
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.78517

Background: Acute fatty liver of pregnancy (AFLP) is an obstetric emergency with high mortality that usually requires treatment in the intensive care unit (ICU). The cause of AFLP is not known with certainty, but it is suspected due to a deficiency of long chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) in the fetus which causes accumulation of fatty acid metabolites from the fetus and placenta which are hepatotoxic. The clinical manifestations of AFLP are acute liver failure and progression to multiple organ dysfunction syndrome (MODS). This reported case was the only one successful case out of 3 incidences of AFLP recorded in RSUP Dr. Sardjito Yogykarta within a year of 2022. Case Illustration: A 24-years-old postpartum woman at 38 weeks' gestation admitted to resuscitation room with hypovolemic shock due to early postpartum hemorrhage. Patient was resuscitated and then taken to emergency operating room for uterine exploration under general anesthesia. Patient was subsequently admitted to the intensive care unit (ICU). The patient's initial condition was intubated, requiring vasopressor support with epinephrine and norepinephrine, and the patient showed symptoms of encephalopathy, liver failure and kidney failure. AFLP diagnosis was then made with patient showing score 10 of Swansea criteria. Resuscitation, stabilization, and intensive care treatment was continued for up to eight days in the ICU. The patient's final condition was stable, there were no sequelae of AFLP and the patient was discharged from the hospital at the 14th day in good condition.Conclusion: AFLP is a serious complication during pregnancy and postpartum period that is reversible with a chance of complete recovery but has a high mortality associated with delayed treatment. Adequate early intensive care treatment with multidisciplinary approach essential for successful treatment of AFLP.

SEIZURE CONTROL IN PATIENTS WITH ANTI-NMDAR ENCEPHALITIS : CASE SERIES Wijaya, Indriyani; Wisudarti, Calcarina Fitriani; Adiyanto, Bowo
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 1 (2024): April 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i1.69732

Background: Anti N-methyl-D-aspartate Receptor (anti-NMDAR) encephalitis is a rare, yet has had increasing number of cases. Patients often require airway protection, mechanical ventilation and intensive care because the patients’ complex symptoms accompanied by seizures that are difficult to control. Here, we present two related case reports that discuss intensive care management and focus on the administered sedation/anesthesia methods and their outcomes.Case illustration: Male patients, 19 and 21 years old, presented with neuropsychiatric symptoms, seizures, dyskinesia. Both require airway protection and mechanical ventilation as well as Intensive Care Unit (ICU) care. Radiodiagnostic head Computed Tomography (CT) scan and head Magnetic Resonance Imagng (MRI) showed no cerebral abnormalities. Cerebrospinal Fluid (CSF) examination showed positive NMDAR antibodies. First patient had failed to improve clinically even with multiple anti-convulsants, ketamine, dexmedetomidine, immunotherapy, and chemotherapy. Second patient clinically improved with benzodiazepine (midazolam) and propofol as anti-convulsants followed by plasma exchange immunotherapy. The two cases had different outcomes. The first case deceased from septic shock, while the second case was treated by outpatient procedure.Conclusion : Our presented cases suggest that midazolam, propofol, dextemedetomidine, ketamine do not provide satisfying results for seizure control in patients with anti-NMDAR encephalitis, unless immunotherapy is carried out as early as possible and optimally.

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