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Awake Fiberoptic Intubation in a Patient with T4N2M1 Buccal Tumor and Pulmonary Metastasis: A Case Report and Anesthetic Challenges Numbi Akhmadi Teguh; Jeffri Prasetyo Utomo; Taufiq Agus Siswagama
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (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.v9i3.1208

Background: Advanced buccal cancer with pulmonary metastasis presents significant challenges for airway management due to potential anatomical distortions and respiratory compromise. Awake fiberoptic intubation (AFOI) is often the preferred technique in these cases. This report describes the successful anesthetic management of a patient with a T4N2M1 buccal tumor and lung metastasis using AFOI. Case presentation: A 64-year-old male with a T4N2M1 buccal tumor and pulmonary metastasis presented for an open biopsy and biopsy of the oral cavity. He had limited mouth opening (Mallampati 2), anemia, and hypoalbuminemia. AFOI was performed using dexmedetomidine and topical lidocaine. General anesthesia was induced with propofol and atracurium and maintained with sevoflurane. Postoperative pain was managed with paracetamol and ketorolac. The patient's recovery was uneventful. Conclusion: This case highlights the importance of AFOI in securing the airway for patients with advanced buccal cancer and pulmonary metastasis. Meticulous preoperative planning, including optimization of comorbidities and vigilant perioperative monitoring, is essential for successful outcomes in these complex cases.

Effective Pain Management in a Patient with Colon Cancer: A Case Report of Combined Quadratus Lumborum and Transabdominal Plane Blocks Shallahudin; Ristiawan Muji Laksono; Taufiq Agus Siswagama; Aswoco Andyk Asmoro; Buyung Hartiyo Laksono
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 2 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i2.703

Cancer-related pain, particularly in cases of advanced colon cancer, presents a significant challenge to healthcare providers. Traditional pain management strategies, including opioids, often prove inadequate or are associated with undesirable side effects. Quadratus lumborum block (QLB) is an emerging regional anesthesia technique offering potential benefits in managing abdominal pain. This case report describes the successful implementation of combined QLB and transabdominal plane (TAP) blocks for effective pain management in a patient with colon cancer. A 53-year-old male patient with a history of colon cancer presented with severe abdominal pain at the site of his stoma radiating to his back. The pain was exacerbated by movement and significantly impacted his quality of life. Despite receiving a multimodal analgesic regimen, including a fentanyl patch and oral medications, his pain remained poorly controlled. After careful consideration, a combined QLB and TAP block was performed using ultrasound guidance. Following the procedure, the patient experienced significant pain relief, with his Numerical Rating Scale (NRS) score decreasing from 7-9 to 1-2 at rest and from 5-6 to 2-3 during movement. He reported no nausea or vomiting and was able to mobilize comfortably. This improvement in pain control facilitated his recovery and enhanced his overall well-being. In conclusion, this case report highlights the potential of combined QLB and TAP blocks as an effective pain management strategy for patients with colon cancer. This approach may offer a valuable alternative or adjunct to traditional methods, particularly in cases where opioid use is limited by side effects or tolerance. Further research is warranted to investigate the long-term efficacy and safety of this technique in a larger patient population.

Determinants of Postoperative ICU Admission in the Elderly: A Prospective Multicenter Study of Elective Surgeries in Indonesia Alief Ilman Zaelany; Isngadi Isngadi; Taufiq Agus Siswagama; Buyung Hartiyo Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.809

Introduction: The increasing global geriatric population presents significant challenges for surgical care, particularly regarding the allocation of Intensive Care Unit (ICU) resources. This study aimed to identify determinants of postoperative ICU admission among elderly patients in Indonesia, a setting with a rapidly aging demographic. Methods: We conducted a prospective, multicenter cohort study across 15 Indonesian hospitals from February to April 2021. Patients aged ≥60 years undergoing elective surgery were enrolled via consecutive sampling. Data on patient demographics, American Society of Anesthesiologists (ASA) physical status, Charlson Comorbidity Index (CCI), and type of anesthesia (general vs. regional) were collected. The primary outcome was postoperative ICU admission. Multivariate logistic regression was used to identify independent predictors. Results: Of 893 patients enrolled, 18.8% required postoperative ICU admission. The final multivariate model revealed that a higher ASA physical status was the strongest predictor of ICU admission (Odds Ratio [OR] 4.13; 95% CI 2.88-5.92; p < 0.001). The administration of general anesthesia was also independently associated with a significantly increased likelihood of ICU admission compared to regional anesthesia (OR 2.77; 95% CI 1.83-4.19; p < 0.001). While the CCI was a significant factor in unadjusted analyses, its effect was attenuated after inclusion of the ASA score. Conclusion: ASA physical status and the choice of general anesthesia are powerful, independent determinants of postoperative ICU admission in the Indonesian geriatric surgical population. These findings highlight the critical role of preoperative physiological assessment and suggest that the choice of anesthetic technique has significant implications for postoperative resource needs.

Awake Fiberoptic Intubation in a Patient with T4N2M1 Buccal Tumor and Pulmonary Metastasis: A Case Report and Anesthetic Challenges Numbi Akhmadi Teguh; Jeffri Prasetyo Utomo; Taufiq Agus Siswagama
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (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.v9i3.1208

Background: Advanced buccal cancer with pulmonary metastasis presents significant challenges for airway management due to potential anatomical distortions and respiratory compromise. Awake fiberoptic intubation (AFOI) is often the preferred technique in these cases. This report describes the successful anesthetic management of a patient with a T4N2M1 buccal tumor and lung metastasis using AFOI. Case presentation: A 64-year-old male with a T4N2M1 buccal tumor and pulmonary metastasis presented for an open biopsy and biopsy of the oral cavity. He had limited mouth opening (Mallampati 2), anemia, and hypoalbuminemia. AFOI was performed using dexmedetomidine and topical lidocaine. General anesthesia was induced with propofol and atracurium and maintained with sevoflurane. Postoperative pain was managed with paracetamol and ketorolac. The patient's recovery was uneventful. Conclusion: This case highlights the importance of AFOI in securing the airway for patients with advanced buccal cancer and pulmonary metastasis. Meticulous preoperative planning, including optimization of comorbidities and vigilant perioperative monitoring, is essential for successful outcomes in these complex cases.

Pharmacodynamic Mismatch in Adductor Canal Blockade: Dexamethasone Phosphate (Rapid-Salt) Outperforms Methylprednisolone Acetate (Depot-Suspension) for Early Mobilization Beny Firmansyah; Taufiq Agus Siswagama; Buyung Hartiyo Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.820

Introduction: The motor-sparing adductor canal block (ACB) is central to enhanced recovery after surgery (ERAS) protocols for knee surgery. Corticosteroid adjuvants are used to prolong analgesia, but a direct comparison of perineural Dexamethasone and Methylprednisolone is lacking. This study aimed to observe real-world associations between these adjuvants, postoperative pain, and functional recovery. Methods: This analytical, prospective, observational cohort study was conducted at a tertiary hospital from November 2024 to April 2025. Fifty-three patients undergoing knee surgery under subarachnoid anesthesia were enrolled. Following surgery, patients received an ultrasound-guided ACB with 20 mL of Ropivacaine 0.5% combined with either Dexamethasone 10 mg (n=24) or Methylprednisolone 60 mg (n=29), based on the attending anesthesiologist's preference. The primary functional outcome was time to mobilization. Secondary outcomes included Numerical Rating Scale (NRS) pain scores at 12, 24, and 48 hours. Results: A significant association was observed for the primary functional outcome: 87.5% of the Dexamethasone cohort mobilized within 24 hours, versus 62.1% of the Methylprednisolone cohort (p = 0.037). This functional advantage was congruent with a superior early analgesic profile; the Dexamethasone group reported significantly lower mean NRS scores at 12 hours (2.71 ± 0.81 vs. 3.86 ± 1.13; p < 0.001) and 24 hours (2.17 ± 0.56 vs. 3.24 ± 0.69; p < 0.001). A significant baseline difference in age distribution (p = 0.009) was identified as a key variable. Conclusion: This study provides the first clinical comparison of a rapid-acting salt (Dexamethasone Phosphate) versus a depot-suspension (Methylprednisolone Acetate) as perineural adjuvants in ACB. The observed superior functional and analgesic profile of Dexamethasone aligns with its pharmacokinetic properties, suggesting a pharmacodynamic mismatch between slow-release formulations and the pathophysiology of acute 24-hour postoperative pain.

A Comparative Analysis of Ipsilateral, Contralateral, and Bilateral Average ONSD in Correlating with Cerebral Midline Shift: Re-framing a Non-Invasive Tool from a Quantitative Predictor to a Clinical Classifier Ramadina Putri Cahyanti Ghofar; Buyung Hartiyo Laksono; Taufiq Agus Siswagama
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.823

In traumatic brain injury (TBI), non-invasive proxies for mass effect are crucial. The optic nerve sheath diameter (ONSD) is used to estimate intracranial pressure (ICP), but its correlation with structural outcomes like midline shift (MLS) is poorly defined, particularly regarding the optimal measurement method (unilateral vs. bilateral). We prospectively enrolled 38 adult TBI patients who received both a CT scan and a bedside ONSD ultrasound within 24 hours. Data was re-analyzed to classify ONSD relative to lesion location (Ipsilateral, Contralateral) and to correlate these, plus the Bilateral Average (ONSD-Avg), with CT-measured MLS using Spearman's correlation. We used linear regression to assess quantitative prediction (R-square) and binary logistic regression (ROC curve) to assess clinical classification (AUC) for predicting MLS >5mm. A significant, positive correlation was found between MLS and Ipsilateral-ONSD (rs = 0.450, p = 0.005) and ONSD-Avg (rs = 0.383, p = 0.018). The Contralateral-ONSD correlation was not significant (rs = 0.210, p = 0.206). A Wilcoxon test confirmed Ipsilateral-ONSD was significantly wider than Contralateral-ONSD (p < 0.01). The linear regression model for MLS quantification was statistically significant (p = 0.015) but had a very low predictive power (R-square = 0.153). In contrast, the logistic regression model found ONSD-Avg to be an excellent classifier for detecting surgical MLS (> 5mm), with an Area Under the Curve (AUC) of 0.88 (95% CI 0.75-0.96). In conclusion, ONSD measurement is significantly affected by asymmetric, unilateral TBI pathology. The bilateral average (ONSD-Avg) is the most reliable screening method, as it compensates for unilateral pressure gradients. The low R-square (15.3%) confirms ONSD is a poor quantitative predictor of MLS, reflecting the non-linear pressure-volume relationship. However, the high AUC (0.88) proves ONSD is an excellent clinical classifier for identifying patients with surgical-threshold mass effect. ONSD should not be used to "quantify" MLS, but rather to "classify" patient risk.

Hemodynamic Attenuation During Tracheal Intubation: A Randomized Comparative Analysis of Video vs. Direct Laryngoscopy in Adult Elective Surgery Imam Safi'i; Arie Zainul Fatoni; Taufiq Agus Siswagama; Ahmad Feza Fadhlurrahman
Journal of Anesthesiology and Clinical Research Vol. 7 No. 1 (2026): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v7i1.850

Introduction: Laryngoscopy and tracheal intubation inevitably trigger a sympathoadrenal response, manifesting as tachycardia and hypertension. While video laryngoscopy (VL) offers improved glottic visualization compared to direct laryngoscopy (DL), its efficacy in specifically attenuating this hemodynamic stress remains a subject of debate. This study investigates whether VL provides superior hemodynamic stability during the critical post-intubation period by analyzing the rate pressure product (RPP) and temporal hemodynamic interactions. Methods: In this prospective, single-blind, randomized controlled trial, 40 adult patients (ASA I-II) undergoing elective surgery were allocated to either Group VL (GlideScope, n=20) or Group DL (Macintosh, n=20). Anesthesia was strictly standardized with Fentanyl 2 mcg/kg, Propofol 2 mg/kg, and Atracurium 0.5 mg/kg. Hemodynamic parameters, including systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR), were recorded at baseline (T0) and at 1 (T1), 2 (T2), and 5 (T5) minutes post-intubation. The primary analysis utilized a general linear model (Repeated Measures ANOVA) to assess Time-Group interactions, corrected for sphericity. Results: Demographics were homogeneous between groups. A significant Time-Group interaction was observed for MAP (p less than 0.001), indicating a blunted pressor response curve in the VL group. Heart Rate at 1-minute post-intubation was significantly lower in Group VL (75.45 plus or minus 11.23 bpm) compared to Group DL (90.15 plus or minus 15.22 bpm; p equals 0.001). Analysis of the rate pressure product revealed that Group DL approached ischemic thresholds, whereas Group VL maintained significantly lower myocardial workload at minutes 1 and 2 (p less than 0.01). Conclusion: Video laryngoscopy significantly attenuates the reflex tachycardia and arterial pressure surge associated with tracheal intubation compared to direct laryngoscopy. VL is recommended to minimize cardiovascular stress in susceptible surgical populations.

Efficacy of Particulate versus Non-Particulate Corticosteroids as Adjuvants for Popliteal Sciatic Nerve Block: A Randomized Controlled Superiority Trial Erma Rosita; Taufiq Agus Siswagama; Rudy Vitraludyono; Buyung Hartiyo Laksono
Journal of Anesthesiology and Clinical Research Vol. 7 No. 1 (2026): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v7i1.853

Introduction: Single-shot ultrasound-guided popliteal sciatic nerve blocks are the gold standard for distal lower limb analgesia but are limited by a finite duration, often necessitating adjuvants. While dexamethasone (non-particulate) is the standard of care, methylprednisolone (particulate) theoretically offers a depot effect for sustained release. This study aimed to determine if perineural methylprednisolone provides superior analgesic duration compared to dexamethasone. Methods: In this prospective, double-blind, randomized controlled trial, 36 ASA I-III patients undergoing distal lower limb surgery were randomized (1:1) to receive 20 mL of 0.5% Ropivacaine with either Dexamethasone 8 mg (Group D) or Methylprednisolone 40 mg (Group M). To ensure blinding, solutions were prepared by an independent pharmacist and administered via opaque syringes. The primary outcome was the duration of analgesia (time to Numeric Rating Scale [NRS] greater than 3), analyzed using Kaplan-Meier survival curves and Log-Rank tests. Secondary outcomes included cumulative opioid consumption, rebound pain severity, and block onset time. The study was powered for superiority with a clinically significant difference of 4 hours. Results: Thirty-six patients completed the study. Demographic and surgical characteristics were comparable. The median duration of analgesia was 18.4 (SD 3.2) hours in Group D and 19.1 (SD 3.5) hours in Group M (p = 0.58; Log-Rank p = 0.61). Pain scores at 12, 24, and 48 hours showed no significant difference, with both groups demonstrating a floor effect due to multimodal analgesia (Median NRS less than 2). No adverse events, including neurotoxicity or infection, were observed. Conclusion: Perineural methylprednisolone failed to demonstrate superior analgesic duration compared to dexamethasone in this cohort. The theoretical depot advantage did not translate to clinical superiority, likely due to vascular clearance in the popliteal fossa. Given the comparable efficacy but superior safety profile of non-particulate agents, dexamethasone remains the preferred adjuvant. Methylprednisolone serves as a viable alternative only when non-particulate options are unavailable.

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