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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Pratama Ananda
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Rare and Fatal Complication: A Case of Ketorolac-Induced Anaphylaxis Leading to Cardiac Arrest and Hypoxic-Ischemic Brain Injury in a Young Adult Yogi Ramadhan; Pratama Ananda; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1196

Abstract

Background: Anaphylaxis is a severe, life-threatening allergic reaction that can lead to cardiac arrest and hypoxic-ischemic brain injury (HIBI). Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) commonly used for postoperative pain management, has been rarely associated with anaphylaxis. Case presentation: We present the case of a 32-year-old woman who developed anaphylaxis and subsequent cardiac arrest following intravenous administration of ketorolac after an appendectomy. Despite successful resuscitation, the patient suffered from HIBI and remained in a persistent vegetative state. Conclusion: This report highlights the potential for fatal complications associated with ketorolac administration and emphasizes the importance of prompt recognition and management of anaphylaxis in the perioperative setting. This case underscores the need for heightened vigilance regarding potential anaphylactic reactions to ketorolac, even in patients with no prior history of drug allergies. Early recognition and aggressive management of anaphylaxis are crucial to minimize the risk of severe complications like cardiac arrest and HIBI.
The Eye as a Window to Systemic Hemodynamics: A Novel Approach to Estimating Central Venous Pressure via Tonometry in Sepsis M. Irvan Noorrahman; Nopian Hidayat; Riki Sukiandra; Pratama Ananda
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1473

Abstract

Background: Effective hemodynamic management in sepsis is critical, yet current practices are constrained by the risks and interpretive challenges of invasive central venous pressure (CVP) monitoring. The clinical utility of CVP is debated, fueling the search for safer alternatives. This study investigates a novel approach, exploring intraocular pressure (IOP) as a non-invasive surrogate for CVP, predicated on the direct anatomical link between the ocular venous drainage system and the central circulation. Methods: We conducted a prospective, single-center observational study in a tertiary intensive care unit, enrolling 20 adult patients with sepsis and indwelling central venous catheters. High-fidelity measurements of CVP via a pressure transducer and IOP via Perkins applanation tonometry were performed simultaneously. Data were collected at a baseline steady-state and again 15 minutes after a standardized fluid challenge (median volume 300 mL) to assess the dynamic relationship. The association was quantified using Pearson correlation and modeled with simple linear regression. Results: A strong, statistically significant positive correlation was observed between CVP and IOP at baseline (r=0.756, p=0.001). This physiological coherence was profoundly amplified following the fluid challenge, strengthening to a very strong correlation (r=0.947, p<0.001). The post-challenge data yielded a robust, preliminary predictive model, defined by the equation: CVP (mmHg) = -0.619 + (0.522 x IOP (mmHg)). The slope of this relationship was precisely estimated (95% CI: 0.435 to 0.609). The model demonstrated high predictive power, with post-challenge IOP accounting for 89% of the variance in CVP (R²=0.89). Conclusion: This pilot investigation provides compelling evidence for a strong and dynamic correlation between IOP and CVP in critically ill patients with sepsis. The findings suggest that ocular tonometry shows significant promise as a non-invasive method for assessing right-sided filling pressures and, more importantly, for tracking the dynamic response to fluid therapy, thereby offering a potential window into venous congestion. While intriguing, these results are from a small cohort. The derived formula is strictly hypothesis-generating and requires extensive validation in larger, more diverse clinical trials before any potential for clinical application can be considered.
Rare and Fatal Complication: A Case of Ketorolac-Induced Anaphylaxis Leading to Cardiac Arrest and Hypoxic-Ischemic Brain Injury in a Young Adult Yogi Ramadhan; Pratama Ananda; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1196

Abstract

Background: Anaphylaxis is a severe, life-threatening allergic reaction that can lead to cardiac arrest and hypoxic-ischemic brain injury (HIBI). Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) commonly used for postoperative pain management, has been rarely associated with anaphylaxis. Case presentation: We present the case of a 32-year-old woman who developed anaphylaxis and subsequent cardiac arrest following intravenous administration of ketorolac after an appendectomy. Despite successful resuscitation, the patient suffered from HIBI and remained in a persistent vegetative state. Conclusion: This report highlights the potential for fatal complications associated with ketorolac administration and emphasizes the importance of prompt recognition and management of anaphylaxis in the perioperative setting. This case underscores the need for heightened vigilance regarding potential anaphylactic reactions to ketorolac, even in patients with no prior history of drug allergies. Early recognition and aggressive management of anaphylaxis are crucial to minimize the risk of severe complications like cardiac arrest and HIBI.
The Eye as a Window to Systemic Hemodynamics: A Novel Approach to Estimating Central Venous Pressure via Tonometry in Sepsis M. Irvan Noorrahman; Nopian Hidayat; Riki Sukiandra; Pratama Ananda
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1473

Abstract

Background: Effective hemodynamic management in sepsis is critical, yet current practices are constrained by the risks and interpretive challenges of invasive central venous pressure (CVP) monitoring. The clinical utility of CVP is debated, fueling the search for safer alternatives. This study investigates a novel approach, exploring intraocular pressure (IOP) as a non-invasive surrogate for CVP, predicated on the direct anatomical link between the ocular venous drainage system and the central circulation. Methods: We conducted a prospective, single-center observational study in a tertiary intensive care unit, enrolling 20 adult patients with sepsis and indwelling central venous catheters. High-fidelity measurements of CVP via a pressure transducer and IOP via Perkins applanation tonometry were performed simultaneously. Data were collected at a baseline steady-state and again 15 minutes after a standardized fluid challenge (median volume 300 mL) to assess the dynamic relationship. The association was quantified using Pearson correlation and modeled with simple linear regression. Results: A strong, statistically significant positive correlation was observed between CVP and IOP at baseline (r=0.756, p=0.001). This physiological coherence was profoundly amplified following the fluid challenge, strengthening to a very strong correlation (r=0.947, p<0.001). The post-challenge data yielded a robust, preliminary predictive model, defined by the equation: CVP (mmHg) = -0.619 + (0.522 x IOP (mmHg)). The slope of this relationship was precisely estimated (95% CI: 0.435 to 0.609). The model demonstrated high predictive power, with post-challenge IOP accounting for 89% of the variance in CVP (R²=0.89). Conclusion: This pilot investigation provides compelling evidence for a strong and dynamic correlation between IOP and CVP in critically ill patients with sepsis. The findings suggest that ocular tonometry shows significant promise as a non-invasive method for assessing right-sided filling pressures and, more importantly, for tracking the dynamic response to fluid therapy, thereby offering a potential window into venous congestion. While intriguing, these results are from a small cohort. The derived formula is strictly hypothesis-generating and requires extensive validation in larger, more diverse clinical trials before any potential for clinical application can be considered.
Co-Authors M. Irvan Noorrahman Nopian Hidayat Novita Anggraeni Riki Sukiandra Yogi Ramadhan