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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Open Access Indonesian Journal of Medical Reviews Bioscientia Medicina : Journal of Biomedicine and Translational Research
Aura Ihsaniar
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Ultrasound-Guided Superficial Cervical Plexus Block for Anterior Cervical Discectomy and Fusion in a Patient with Herniated Nucleus Pulposus: A Case Report Elanda Rahmat Arifyanto; Aura Ihsaniar
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 1 (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.v5i1.689

Abstract

Anterior cervical discectomy and fusion (ACDF) is a surgical procedure performed to alleviate pressure on the spinal cord and nerve roots in the neck. Effective pain management is crucial for optimal postoperative recovery. Superficial cervical plexus block (SCPB) has emerged as a safe and effective regional anesthesia technique for head and neck surgeries. This case report describes the successful use of ultrasound-guided SCPB for ACDF in a patient with a herniated nucleus pulposus. In this study, a 48-year-old male patient presented with lower extremity weakness and hypoesthesia following a fall. Magnetic resonance imaging (MRI) revealed a herniated nucleus pulposus at the C5-6 level. The patient underwent ACDF surgery under ultrasound-guided SCPB. Levobupivacaine 0.5% 10 cc was administered bilaterally. The patient tolerated the procedure well, with no complications or adverse events. Postoperative pain was effectively managed with SCPB, and the patient's neurological symptoms improved significantly. In conclusion, ultrasound-guided SCPB is a safe and effective anesthetic technique for ACDF surgery in patients with herniated nucleus pulposus. It provides adequate pain control, reduces opioid requirements, and facilitates early mobilization and recovery.
Ultrasound-Guided Regional Anesthesia for Clavicle Fixation in a Pregnant Patient with Traumatic Brain Injury: A Case Report and Pathophysiological Review Koko Agung Tri Wibowo; Aura Ihsaniar; Husni Thamrin
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.v5i6.797

Abstract

The anesthetic management of a third-trimester pregnant patient with a concurrent traumatic brain injury (TBI) and a surgical fracture presents a profound clinical dilemma. The conflicting demands of maternal neuroprotection, fetal stability, and surgical anesthesia necessitate a carefully considered approach, as standard general anesthesia carries significant risks for both mother and fetus. A 25-year-old female at 28 weeks’ gestation presented after a motor vehicle accident with a displaced right clavicle fracture and a TBI characterized by a clinically mild presentation (Glasgow Coma Scale 14) and a radiologically significant acute subdural hemorrhage. To provide surgical anesthesia for open reduction and internal fixation while circumventing the risks of general anesthesia, a primary regional anesthetic was performed. An ultrasound-guided single-shot interscalene brachial plexus block, supplemented with a superficial cervical plexus block, provided dense surgical anesthesia. This technique ensured remarkable maternal hemodynamic stability, maintained a reassuring Category I fetal heart tracing throughout, and completely avoided intraoperative systemic opioids and sedatives. The postoperative course was notable for excellent, opioid-sparing analgesia and an uncomplicated recovery for both mother and infant. In conclusion, this case provides an illustrative example of how a meticulously executed regional anesthetic technique can serve as a primary and potentially superior modality in this high-risk patient population. It successfully navigated the competing pathophysiological demands, suggesting that regional anesthesia should be a first-line consideration in select, complex trauma scenarios involving pregnancy and TBI.
Therapeutic Plasma Exchange as Adjuvant Rescue Therapy for Weil’s Disease-Associated Acute Liver Failure in a Hemodialysis-Dependent Patient: A Case Report Ardana Tri Arianto; Aura Ihsaniar; Lichte Christian Purbono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 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.v10i2.1502

Abstract

Background: Weil’s disease, the severe form of leptospirosis, manifests as a triad of jaundice, renal failure, and hemorrhage. In patients with pre-existing end-stage renal disease (ESRD), the management of superimposed acute liver failure (ALF) is exceptionally challenging due to altered pharmacokinetics, fluid intolerance, and the inability of standard hemodialysis to clear protein-bound hepatic toxins. Case presentation: We present a 32-year-old anuric male with ESRD on maintenance hemodialysis who presented with fever, jaundice, and altered mental status following floodwater exposure. He developed severe metabolic encephalopathy (GCS E2V2M4), profound coagulopathy (INR 6.04), and hyperbilirubinemia (Total Bilirubin 18.31 mg/dL). Following the failure of broad-spectrum antibiotics and sustained low-efficiency dialysis (SLED) to halt clinical deterioration, two sessions of therapeutic plasma exchange (TPE) were initiated as salvage therapy. The intervention utilized 100% fresh frozen plasma (FFP) replacement to address hemostatic failure. TPE resulted in rapid biochemical clearance and clinical stabilization. Post-intervention, the INR decreased from 6.04 to 1.57 (74% reduction), Total bilirubin declined from 18.31 to 5.57 mg/dL (69.5% reduction), and platelet counts recovered from 45,000 to 142,000/µL. Neurological status normalized (GCS 15) within 48 hours of the second session. Conclusion: TPE served as an effective bridge to recovery by clearing albumin-bound toxins and restoring coagulation factors in a high-risk patient where standard renal replacement was insufficient.
Therapeutic Plasma Exchange as Adjuvant Rescue Therapy for Weil’s Disease-Associated Acute Liver Failure in a Hemodialysis-Dependent Patient: A Case Report Ardana Tri Arianto; Aura Ihsaniar; Lichte Christian Purbono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 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.v10i2.1502

Abstract

Background: Weil’s disease, the severe form of leptospirosis, manifests as a triad of jaundice, renal failure, and hemorrhage. In patients with pre-existing end-stage renal disease (ESRD), the management of superimposed acute liver failure (ALF) is exceptionally challenging due to altered pharmacokinetics, fluid intolerance, and the inability of standard hemodialysis to clear protein-bound hepatic toxins. Case presentation: We present a 32-year-old anuric male with ESRD on maintenance hemodialysis who presented with fever, jaundice, and altered mental status following floodwater exposure. He developed severe metabolic encephalopathy (GCS E2V2M4), profound coagulopathy (INR 6.04), and hyperbilirubinemia (Total Bilirubin 18.31 mg/dL). Following the failure of broad-spectrum antibiotics and sustained low-efficiency dialysis (SLED) to halt clinical deterioration, two sessions of therapeutic plasma exchange (TPE) were initiated as salvage therapy. The intervention utilized 100% fresh frozen plasma (FFP) replacement to address hemostatic failure. TPE resulted in rapid biochemical clearance and clinical stabilization. Post-intervention, the INR decreased from 6.04 to 1.57 (74% reduction), Total bilirubin declined from 18.31 to 5.57 mg/dL (69.5% reduction), and platelet counts recovered from 45,000 to 142,000/µL. Neurological status normalized (GCS 15) within 48 hours of the second session. Conclusion: TPE served as an effective bridge to recovery by clearing albumin-bound toxins and restoring coagulation factors in a high-risk patient where standard renal replacement was insufficient.
Co-Authors Ardana Tri Arianto Elanda Rahmat Arifyanto Husni Thamrin Koko Agung Tri Wibowo Lichte Christian Purbono