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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.

Neuroprotective General Anesthesia for Emergency Cesarean Section in a Patient with Obstructive Hydrocephalus from a Vestibular Schwannoma Reza Ariestyawan Ramadhan; Isngadi; 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.v6i2.774

Introduction: The confluence of advanced pregnancy and a large intracranial neoplasm presents a profound clinical challenge. This report details the management of a parturient with a vestibular schwannoma causing obstructive hydrocephalus and critical intracranial hypertension (ICP), a scenario where standard obstetric anesthetic practices are absolutely contraindicated. Case presentation: A 35-year-old G3P1 parturient at 36 weeks gestation with progressive blindness from a vestibular schwannoma presented for an emergency cesarean section due to fetal compromise. With clear signs of severe ICP, general anesthesia was administered. Anesthesia was induced with propofol and atracurium and maintained with sevoflurane and a remifentanil infusion, a regimen selected for maternal neuroprotection and fetal safety. Invasive arterial and central venous pressure monitoring guided hemodynamic management to ensure cerebral perfusion. A healthy infant was delivered. The family declined postoperative neurosurgery; the patient was managed conservatively with medical therapy and discharged in stable condition, with long-term follow-up confirming favorable maternal and infant outcomes. Conclusion: This case demonstrates that a meticulously planned general anesthetic, centered on neuroprotective principles and guided by advanced physiological monitoring, can ensure a safe outcome for both mother and child in the face of critical intracranial hypertension. This success underscores the paramount importance of a deep pathophysiological understanding and seamless multidisciplinary collaboration.

Dexmedetomidine versus Lidocaine for Hemodynamic Stability During Airway Management in Patients with Traumatic Brain Injury: A Randomized Clinical Trial Shallahudin; Aswoco Andyk Asmoro; Ristiawan Muji Laksono; 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.v6i2.787

Introduction: The profound sympathoadrenal stress response to endotracheal intubation in patients with traumatic brain injury (TBI) presents a significant risk for secondary brain injury by inducing perilous hemodynamic instability. Pharmacological attenuation is critical, yet direct comparative evidence between commonly used agents is lacking. This study aimed to rigorously compare the efficacy of dexmedetomidine, a central sympatholytic, versus lidocaine, a peripheral membrane stabilizer, in maintaining hemodynamic stability during airway management in the TBI population. Methods: In this prospective, randomized, double-blind clinical trial, seventy-one adult patients with TBI (ASA I-III) were allocated to receive either intravenous dexmedetomidine (1 μg/kg over 10 minutes; n=37) or intravenous lidocaine (1.5 mg/kg over 2 minutes, with total infusion time matched to 10 minutes with saline; n=34) prior to a standardized anesthesia induction. The prespecified primary outcome was the change in mean arterial pressure (MAP) from baseline to one minute post-intubation. Secondary outcomes included changes in heart rate (HR) and hemodynamic profiles over 10 minutes. Results: Baseline patient characteristics, including TBI severity, were well-balanced between groups. Both interventions effectively blunted the pressor response, causing a significant decrease in MAP and HR from baseline (p<0.001 for all). The primary outcome, the change in MAP at one minute post-intubation, was not statistically different between the dexmedetomidine and lidocaine groups (-12.8 ± 6.1 mmHg vs. -11.5 ± 5.9 mmHg, respectively; p=0.412). Similarly, no significant differences in HR or MAP were observed between groups at any time point up to 10 minutes post-intubation. The incidence of rescue therapy for hypotension or bradycardia was low and comparable. Conclusion: In patients with TBI, both dexmedetomidine and lidocaine are effective and safe for attenuating the hemodynamic stress of intubation. At the doses studied, neither agent demonstrated clinical superiority, providing clinicians with two valid, mechanistically distinct options. The choice can therefore be guided by the specific clinical context, including desired onset, duration of action, and sedative profile.

Early Risk Stratification in a High-Mortality Study of Adult Trauma Patients: A Comparative Validation of RTS, SI, and ISS Denny Prasetyo; Arie Zainul Fatoni; Ristiawan Muji Laksono; 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.v6i2.788

Introduction: Accurate, early risk stratification is paramount in managing severe trauma, especially in resource-limited settings. This study aimed to compare the predictive performance of the revised trauma score (RTS), shock index (SI), and injury severity score (ISS) for in-hospital mortality in a group of severely injured adult trauma patients at a tertiary center in Indonesia. Methods: A retrospective analysis was conducted on a purposively selected study population of 100 adult trauma patients (age 20-60) admitted to the Emergency Department of Dr. Saiful Anwar Regional General Hospital over a three-month period in 2023. This selection method yielded a high-mortality sample (50% mortality) to ensure sufficient statistical power for analyzing fatal outcomes. The predictive performance of RTS, SI, and ISS was evaluated using individual logistic regression models. Discriminatory ability was assessed by calculating the area under the receiver operating characteristic curve (AUC-ROC) for each score. Model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Results: All three scoring systems were significant predictors of mortality in individual regression analyses. The injury severity score (ISS) demonstrated the highest discriminatory power for predicting mortality with an AUC of 0.88 (95% CI, 0.81-0.95). The revised trauma score (RTS) also showed good discrimination with an AUC of 0.83 (95% CI, 0.75-0.91). The Shock Index (SI) was a significant predictor but had the most modest discriminatory ability with an AUC of 0.76 (95% CI, 0.67-0.85). All models were well-calibrated. Conclusion: In this study of severely injured adult trauma patients, the anatomically-based ISS was the most accurate predictor of mortality. The physiological scores, RTS and SI, remain valuable for their utility in rapid, initial patient assessment. The findings support a complementary approach, using the simple physiological scores for immediate triage and the more comprehensive ISS for definitive prognostication.

The Novice Overshoot: A Bispectral Index-Based Analysis of the Anesthesiology Resident Learning Curve for Anesthetic Depth Control in Supervised Practice Rizki Suhadayanti; Isngadi; Buyung Hartiyo Laksono; Ristiawan Muji 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.v6i2.790

Introduction: The skillful management of anesthetic depth is a cornerstone of anesthesiology, yet the objective characterization of the resident learning curve remains underexplored. This study aimed to quantitatively map the developmental trajectory of anesthetic depth control among anesthesiology residents in a supervised clinical environment. Methods: We conducted a prospective, cross-sectional, observational study involving 21 anesthesiology residents (from seven sequential semesters of training) and 105 ASA I-II adult patients at a tertiary academic hospital. Under standardized supervision, residents induced general anesthesia. The primary outcome was the Bispectral Index (BIS) value and its categorical distribution (Deep: <40, General: 40-60, Sedation: >60) at 2 minutes post-intubation. Secondary outcomes included propofol induction dose and hemodynamic responses. Data were analyzed using ANOVA, Kruskal-Wallis, and Chi-square tests. Results: Post-intubation mean BIS values showed a non-significant trend towards being lower in junior residents compared to seniors (p=0.088). However, the categorical distribution of BIS values differed significantly across training levels (p=0.015). Junior residents (Semesters I-II) induced a state of deep anesthesia (BIS < 40) in 46.7% of their patients, compared to only 11.1% for senior residents (Semesters V-VII) (p<0.001). This correlated with junior residents using significantly higher weight-adjusted propofol doses (2.4 ± 0.3 mg/kg vs. 1.9 ± 0.2 mg/kg; p<0.001). Conclusion: The anesthesiology resident learning curve is characterized by a distinct pattern of initial over-titration, or a "novice overshoot," leading to a higher incidence of unnecessarily deep anesthesia. While mean BIS values did not differ significantly, the distribution of hypnotic states reveals a critical educational target. BIS monitoring serves as a valuable objective tool for tracking the performance of the resident-supervisor dyad, offering data-driven insights for enhancing competency-based training and patient safety.

Early versus Late Percutaneous Tracheostomy in Critically Ill Stroke Patients: A Competing Risk Analysis of Ventilator Liberation and Complications Wiyogo; Aswoco Andyk Asmoro; Arie Zainul Fatoni; 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.v6i2.791

Introduction: The optimal timing of percutaneous dilatational tracheostomy (PDT) in critically ill stroke patients remains controversial. The procedure may facilitate ventilator weaning and neurological assessment, but carries inherent risks. This study aimed to determine the impact of early versus late PDT on clinical outcomes in this specific and vulnerable population. Methods: This retrospective cohort study was conducted at a single tertiary care center. We included all mechanically ventilated adult stroke patients who underwent PDT between January 2024 and December 2024. Patients were categorized into an Early PDT group (≤7 days of intubation) and a Late PDT group (>7 days). The primary outcome was time to ventilator liberation, with in-hospital death as a competing risk. This was analyzed using a Fine-Gray subdistribution hazard model. Secondary outcomes included ICU and hospital mortality, length of stay (LOS), and ventilator-associated pneumonia (VAP), analyzed with multivariable regression. Results: Seventy patients were included (34 Early PDT, 36 Late PDT). After adjusting for age, admission GCS, NIHSS, and stroke type, early PDT remained significantly associated with a higher probability of ventilator liberation (adjusted subdistribution Hazard Ratio [sHR]: 2.48; 95% CI: 1.41–4.36; p=0.002). Early PDT was also independently associated with lower odds of developing VAP (adjusted Odds Ratio [aOR]: 0.31; 95% CI: 0.10–0.94; p=0.038). There were no significant differences in ICU mortality (aOR: 0.82; 95% CI: 0.28–2.41; p=0.721) or hospital mortality (aOR: 0.70; 95% CI: 0.25–1.96; p=0.495). Conclusion: In critically ill stroke patients, an early tracheostomy strategy is independently associated with a significantly shorter time to ventilator liberation and lower odds of VAP, after accounting for competing risks and baseline confounders. While not associated with a survival benefit, early PDT should be considered a key strategy to optimize respiratory management and reduce pulmonary complications in this 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.

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.

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