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Anesthesia Management in a Neonate with Esophageal Atresia Undergoing Esophagotomy and Thoracotomy: A Case Report Galih Puspitasari; Muhammad Ridho Aditya; Raden Theodorus Soepraptomo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 4 (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.v9i4.1247

Background: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are congenital anomalies requiring surgical repair in the neonatal period. Anesthetic management for these cases is complex, involving careful planning and execution to ensure a safe perioperative course. This case report details the anesthetic challenges and management of a neonate with EA undergoing thoracotomy and esophagotomy. Case presentation: A five-day-old male infant presented with EA, pneumonia, and sepsis. After preoperative optimization, the neonate underwent thoracotomy and esophagotomy under general anesthesia with invasive monitoring. The perioperative course was complicated by the patient's comorbidities, requiring meticulous airway management, hemodynamic monitoring, and temperature regulation. Conclusion: Successful anesthetic management of neonates with EA undergoing thoracotomy necessitates a multidisciplinary approach, addressing the unique challenges posed by the condition and associated comorbidities. This case highlights the importance of preoperative optimization, careful intraoperative management, and vigilant postoperative care in achieving a positive outcome.

Ultrasound-Guided Supraclavicular Block as a Primary Anesthetic for Humerus Biopsy in a High-Risk Patient with a Compressive Goiter and Atrial Fibrillation: A Case Report Muhammad Husni Thamrin; Muhammad Ridho Aditya; Nabila Vika Intansari
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.795

The anesthetic management of patients with multiple severe comorbidities presents a formidable clinical challenge. Pathological fractures secondary to metastatic disease often require procedural intervention in individuals with pre-existing cardiopulmonary, airway, and cerebrovascular compromise. General anesthesia in such patients carries a prohibitively high risk of hemodynamic collapse, airway loss, and perioperative mortality. We present a case where a targeted regional anesthetic technique was pivotal in ensuring patient safety. A 59-year-old woman with a pathological fracture of the right humerus, suspected to be a metastasis from thyroid carcinoma, was scheduled for a core needle biopsy. Her medical history was profoundly complex, including a massive, airway-compressing thyroid goiter, persistent atrial fibrillation, recent ischemic stroke with residual hemiparesis, bilateral pneumonia with pulmonary edema, uncontrolled type 2 diabetes mellitus, and acute-on-chronic kidney disease. Given the extreme risks associated with general anesthesia and airway manipulation, we opted for an ultrasound-guided right supraclavicular brachial plexus block as the sole anesthetic. The block was performed successfully using 20 mL of 1.5% lidocaine with epinephrine, providing dense sensorimotor anesthesia of the upper limb. The patient remained hemodynamically stable, spontaneously breathing, and comfortable throughout the procedure, with no perioperative complications. In conclusion, this case demonstrates that an ultrasound-guided supraclavicular block is a safe, effective, and hemodynamically superior alternative to general anesthesia for upper limb procedures in a patient with a confluence of critical airway, cardiac, pulmonary, and neurological comorbidities. This approach obviates the need for airway instrumentation, preserves spontaneous ventilation, and minimizes systemic physiological trespass, thereby enhancing patient safety in the highest-risk surgical populations.

Navigating Pneumoperitoneum in Severe HFrEF: A Case Report on a Physiology-Based Anesthetic Strategy Setia Hilmi Mustajabah; Andy Nugroho; Muhammad Ridho Aditya
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.806

Laparoscopic surgery in patients with severe heart failure with reduced ejection fraction (HFrEF) presents a formidable anesthetic challenge. The cardiovascular sequelae of pneumoperitoneum can precipitate acute hemodynamic collapse in a myocardium with minimal contractile reserve. This report details the anesthetic management of a high-risk patient with an extremely low ejection fraction undergoing laparoscopic cholecystectomy, focusing on a physiology-based approach. A 63-year-old, 72 kg male with severe HFrEF (ejection fraction 24%) and NYHA class III symptoms was scheduled for laparoscopic cholecystectomy. His ASA physical status was IV. Preoperative optimization ensured he was euvolemic and on guideline-directed medical therapy. Anesthetic induction was achieved with fentanyl (1.4 mcg/kg), atracurium (0.35 mg/kg), and ketamine (1 mg/kg). Following CO₂ insufflation, the patient developed profound bradycardia (42 bpm) and hypotension (MAP 58 mmHg). This anticipated crisis was managed with atropine and a supplemental ketamine bolus (0.3 mg/kg), successfully restoring hemodynamic stability. The procedure was completed uneventfully. In conclusion, this case demonstrates that a tailored anesthetic regimen, focused on intrinsic hemodynamic support and proactive crisis management, can be a safe and effective strategy in this high-risk cohort. The successful outcome hinged not on a single agent but on a comprehensive perioperative process encompassing meticulous optimization, a deliberate choice of anesthetic modality based on patient pathophysiology, goal-directed intraoperative therapy, and a structured transition to postoperative care.

Anesthesia Management in a Neonate with Esophageal Atresia Undergoing Esophagotomy and Thoracotomy: A Case Report Galih Puspitasari; Muhammad Ridho Aditya; Raden Theodorus Soepraptomo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 4 (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.v9i4.1247

Background: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are congenital anomalies requiring surgical repair in the neonatal period. Anesthetic management for these cases is complex, involving careful planning and execution to ensure a safe perioperative course. This case report details the anesthetic challenges and management of a neonate with EA undergoing thoracotomy and esophagotomy. Case presentation: A five-day-old male infant presented with EA, pneumonia, and sepsis. After preoperative optimization, the neonate underwent thoracotomy and esophagotomy under general anesthesia with invasive monitoring. The perioperative course was complicated by the patient's comorbidities, requiring meticulous airway management, hemodynamic monitoring, and temperature regulation. Conclusion: Successful anesthetic management of neonates with EA undergoing thoracotomy necessitates a multidisciplinary approach, addressing the unique challenges posed by the condition and associated comorbidities. This case highlights the importance of preoperative optimization, careful intraoperative management, and vigilant postoperative care in achieving a positive outcome.

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