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Perioperative Anesthetic Management of Brain Abscess Evacuation in a Child with Double Outlet Right Ventricle: A Case Report Rio Kharisma Putra; Buyung Hartiyo Laksono; Eko Nofiyanto; Fanniyah; Ruddi Hartono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.668

Introduction: Double outlet right ventricle (DORV) is a rare congenital heart defect where both the aorta and pulmonary artery arise from the right ventricle. This anomaly poses unique challenges for anesthetic management, especially during intracranial surgeries. Case presentation: We present the case of a 7-year-old female child diagnosed with a brain abscess and DORV, who underwent open evacuation and cranioplasty. Anesthetic management focuses on maintaining hemodynamic stability and ensuring adequate oxygenation. The patient was successfully extubated postoperatively and transferred to the intensive care unit (ICU) for close monitoring. Conclusion: Surgical interventions in patients with DORV require careful preoperative evaluation and close perioperative monitoring to minimize morbidity and mortality. This case highlights the importance of a multidisciplinary approach and meticulous anesthetic management in ensuring a successful outcome.

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.

Awake Fiberoptic Intubation for a Giant Multinodular Struma Presenting with Acute Respiratory Failure: A Case Report Abdulrahman Rizky Sulajman; Jeffri Prasetyo Utomo; Buyung Hartiyo Laksono
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (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.v5i5.769

A giant multinodular struma can cause severe upper airway obstruction, presenting a formidable challenge to anesthesiologists and emergency physicians. Securing the airway is a priority, yet conventional intubation methods carry a high risk of failure and complete airway collapse. Awake Tracheal Intubation (ATI) is a critical technique for managing these anticipated difficult airways, allowing for the maintenance of spontaneous respiration while securing a definitive airway. This report details the emergency management of a patient with near-fatal airway compromise due to a massive goiter. A 51-year-old female presented to the emergency department with severe dyspnea that had worsened over three days. She had a 20-year history of a progressively enlarging neck mass, which was now of a massive size. The patient exhibited signs of acute respiratory failure, including stridor, subcostal retractions, a respiratory rate of 30 breaths/minute, and a decreased level of consciousness. Imaging confirmed a large soft tissue mass causing significant tracheal narrowing from the C4 to C6 vertebral levels. Given the impending airway collapse, an emergency awake fiberoptic intubation was performed. With minimal sedation and continuous oxygenation, a size 6.0 endotracheal tube was successfully placed into the trachea under direct bronchoscopic guidance. The patient’s oxygenation and ventilation improved immediately post-procedure. In conclusion, this case underscores the lifesaving potential of awake fiberoptic intubation in patients with a critically compromised airway from a giant multinodular struma. The ability to maintain spontaneous breathing and provide continuous oxygenation during the procedure is paramount in preventing catastrophic outcomes. This technique should be a core competency for clinicians managing difficult airways in the emergency setting.

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.

Emergency Neuroanesthesia for Spontaneous Subdural Hematoma in a Pediatric Patient with Hemophilia A: A Protocol-Based Multidisciplinary Approach Sulistiyawati; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1532

Background: Spontaneous subdural hematoma (SDH) in pediatric patients with Hemophilia A is a rare, life-threatening emergency requiring a delicate balance between hemostatic correction and neuroprotective anesthesia. The mortality rate is high without immediate surgical decompression, yet the surgery itself poses catastrophic bleeding risks. Case presentation: We report the case of an 11-year-old male (25 kg) with severe Hemophilia A (Factor VIII <1%) who presented with a three-day history of headache and vomiting, culminating in a sudden loss of consciousness (GCS E2V2M5). Neuroimaging revealed a massive left frontotemporoparietal SDH (8 mm thickness) with a 12 mm midline shift and non-communicating hydrocephalus. The patient had discontinued prophylaxis five months prior. Management involved a strict multidisciplinary protocol. Preoperatively, aggressive Factor VIII replacement was initiated to achieve 100% activity. Intraoperatively, a total intravenous anesthesia (TIVA) strategy utilizing propofol, fentanyl, and dexmedetomidine was employed to maintain cerebral perfusion pressure (CPP) while strictly controlling intracranial pressure (ICP). Tranexamic acid was used as an adjunct. The patient underwent successful craniotomy and hematoma evacuation with minimal blood loss. Postoperative care focused on serial factor VIII replacement and neurological monitoring, resulting in a favorable discharge outcome. Conclusion: Successful management of spontaneous SDH in hemophilia requires a target-controlled approach to both hemostasis and hemodynamics. The integration of preoperative factor loading, neuroprotective anesthesia with dexmedetomidine, and postoperative vigilance is critical for survival.

Emergency Neuroanesthesia for Spontaneous Subdural Hematoma in a Pediatric Patient with Hemophilia A: A Protocol-Based Multidisciplinary Approach Sulistiyawati; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1532

Background: Spontaneous subdural hematoma (SDH) in pediatric patients with Hemophilia A is a rare, life-threatening emergency requiring a delicate balance between hemostatic correction and neuroprotective anesthesia. The mortality rate is high without immediate surgical decompression, yet the surgery itself poses catastrophic bleeding risks. Case presentation: We report the case of an 11-year-old male (25 kg) with severe Hemophilia A (Factor VIII <1%) who presented with a three-day history of headache and vomiting, culminating in a sudden loss of consciousness (GCS E2V2M5). Neuroimaging revealed a massive left frontotemporoparietal SDH (8 mm thickness) with a 12 mm midline shift and non-communicating hydrocephalus. The patient had discontinued prophylaxis five months prior. Management involved a strict multidisciplinary protocol. Preoperatively, aggressive Factor VIII replacement was initiated to achieve 100% activity. Intraoperatively, a total intravenous anesthesia (TIVA) strategy utilizing propofol, fentanyl, and dexmedetomidine was employed to maintain cerebral perfusion pressure (CPP) while strictly controlling intracranial pressure (ICP). Tranexamic acid was used as an adjunct. The patient underwent successful craniotomy and hematoma evacuation with minimal blood loss. Postoperative care focused on serial factor VIII replacement and neurological monitoring, resulting in a favorable discharge outcome. Conclusion: Successful management of spontaneous SDH in hemophilia requires a target-controlled approach to both hemostasis and hemodynamics. The integration of preoperative factor loading, neuroprotective anesthesia with dexmedetomidine, and postoperative vigilance is critical for survival.

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