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All Journal Open Access Indonesian Journal of Medical Reviews Journal of Anesthesiology and Clinical Research
Rudy Vitraludyono
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Successful Anesthetic Management of a CT Scan Procedure in Pediatric Conjoined Twins: A Case Report Priscilla Tulong; Rudy Vitraludyono
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.v6i1.720

Abstract

Introduction: Conjoined twins represent a rare and complex congenital anomaly, posing significant challenges in medical management, particularly during diagnostic procedures requiring anesthesia. This case report details the successful anesthetic management of a four-month-old female thoracoabdominal conjoined twin pair undergoing a contrast-enhanced computed tomography (CT) scan in preparation for separation surgery. The rarity of this condition and the intricacies involved in providing safe and effective anesthesia for such patients warrant this report to contribute to the growing body of knowledge in this specialized area. Case presentation: A four-month-old female conjoined twin pair, fused at the thorax and abdomen, was referred to Dr. Saiful Anwar General Hospital in Malang, Indonesia, for separation surgery. Prior to the planned surgical intervention, a contrast-enhanced CT scan of the thoracoabdominal region was deemed necessary by the surgical team to delineate the extent of organ fusion and vascular involvement. The twins, designated as Baby One and Baby Two for the purpose of this report, were born via Cesarean section. Physical examination revealed a shared thoracoabdominal connection and bilateral labiopalatoschisis. Pre-operative laboratory investigations showed stable hematological and biochemical parameters for both twins. An abdominal ultrasound indicated liver surface fusion with vascular involvement, while an echocardiogram revealed normal cardiac structure and function in both individuals. The American Society of Anesthesiologists (ASA) physical status for both twins was classified as Class III. Conclusion: This case highlights the successful use of continuous dexmedetomidine infusion for sedation during an out-of-operating room CT scan procedure in pediatric thoracoabdominal conjoined twins. The meticulous pre-procedural planning, including simulation and the preparation of individualized equipment and monitoring for each twin, contributed significantly to the positive outcome. This case underscores the importance of a multidisciplinary team approach and tailored anesthetic strategies in managing complex cases of conjoined twins undergoing diagnostic imaging.
Preoperative Fasting Duration as a Potential Predictor of Glycemic Instability in Non-Diabetic Emergency Surgery Patients: A Prospective Observational Pilot Study Mustaqiem Isda; Aswoco Andyk Asmoro; Ristiawan Muji Laksono; Rudy Vitraludyono
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.v5i5.789

Abstract

Preoperative fasting is a cornerstone of anesthetic safety, yet in emergency surgery, fasting periods are frequently prolonged and unregulated. The metabolic consequences of such extended fasting in non-diabetic patients, who are often assumed to be metabolically resilient, are poorly understood. This pilot study aimed to investigate the association between prolonged fasting and pre-induction glycemic instability. We conducted a prospective, observational pilot study at a tertiary referral hospital, enrolling 30 non-diabetic adult patients (ASA I-E/II-E) undergoing emergency surgery. The primary exposure was preoperative fasting duration, analyzed as both a continuous variable and a dichotomized category (≤8 vs. >8 hours). The primary outcomes were pre-induction blood glucose levels, analyzed continuously and with two categorical thresholds: glycemic instability (<85 mg/dL) and clinically significant hypoglycemia (<70 mg/dL). Associations were assessed using Chi-Square tests and Spearman's rank correlation. A majority of patients (60%) fasted for >8 hours. A strong negative correlation was found between the duration of fasting and pre-induction blood glucose levels (Spearman's ρ = -0.78, p<0.001). Using the <85 mg/dL threshold, 83.3% of patients fasting >8 hours exhibited glycemic instability, compared to 25% of those fasting ≤8 hours (p=0.002). Using the standard <70 mg/dL threshold, 55.6% of patients fasting >8 hours developed clinically significant hypoglycemia, compared to 8.3% of those fasting ≤8 hours (p=0.011). In conclusion, this pilot study provides a strong preliminary signal that prolonged preoperative fasting is significantly associated with a decline in blood glucose and an increased incidence of both glycemic instability and clinically significant hypoglycemia in non-diabetic emergency surgical patients. These findings challenge the assumption of metabolic security in this population and underscore the urgent need for larger, definitive studies. Routine pre-induction glucose monitoring should be strongly considered as a potential safety standard in this vulnerable group.
Comparative Efficacy of Low-Dose Ketamine versus Midazolam Co-induction on Hemodynamic Stability and Early Neurocognitive Recovery in Geriatric Anesthesia: A Randomized Double-Blind Pilot Trial Aditya Guna Wicaksono Panatagama; Aswoco Andyk Asmoro; Arie Zainul Fatoni; Rudy Vitraludyono
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.v7i1.849

Abstract

Introduction: Geriatric patients undergoing general anesthesia are susceptible to hemodynamic instability and delayed neurocognitive recovery. The choice of co-induction agent significantly influences these outcomes. This study compares the effects of low-dose Ketamine versus Midazolam co-induction on intraoperative hemodynamic stability and immediate post-operative cognitive trajectory. Methods: A prospective, double-blind, randomized controlled pilot trial was conducted on 32 geriatric patients aged 65 years or older classified as American Society of Anesthesiologists (ASA) physical status II or III undergoing elective surgery. Patients were randomized to receive either intravenous Ketamine (0.3 mg/kg, n=16) or Midazolam (0.075 mg/kg, n=16) prior to Propofol induction. The primary outcome was the magnitude of early cognitive change measured by the Mini-Mental State Examination (MMSE) at 1-hour post-operation relative to baseline. Secondary outcomes included intraoperative mean arterial pressure (MAP), incidence of hypotension, total Propofol consumption, and time to extubation. Data were analyzed using Analysis of Covariance (ANCOVA) and independent t-tests; effect sizes were calculated using Cohen’s d. Results: Baseline characteristics were comparable between groups. The Ketamine group exhibited significantly superior early cognitive preservation with a mean decline of -0.50 ± 0.63 compared to the Midazolam group, which showed a decline of -1.25 ± 0.93 (p = 0.012; Cohen’s d = 0.93). Hemodynamically, the Ketamine group maintained significantly higher Mean Arterial Pressure post-induction (p = 0.003) with a lower risk of hypotension (Relative Risk 0.29, 95% Confidence Interval 0.07–1.18). Additionally, the Ketamine group required significantly less induction of Propofol (p < 0.001) and achieved faster extubation times (p < 0.001). Conclusion: Co-induction with sub-anesthetic Ketamine provides superior hemodynamic stability and facilitates faster early neurocognitive recovery compared to Midazolam in geriatric patients. These findings suggest Ketamine is a preferable adjuvant for optimizing emergence profiles and maintaining perfusion pressure in the aging population.
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

Abstract

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.
Evaluation of Morphine-Sparing Efficacy with Low-Dose Ketamine in Pediatric Postoperative Pain: A Pilot Randomized Controlled Trial Naim Ismail Imunu; Isngadi; Rudy Vitraludyono; Arie Zainul Fatoni
Open Access Indonesian Journal of Medical Reviews Vol. 6 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.v6i1.835

Abstract

Postoperative pain management in the pediatric population requires a delicate balance between effective analgesia and the minimization of opioid-related adverse events, particularly respiratory depression. While multimodal analgesia is the standard of care, the optimal dose-reduction potential of opioids when combined with N-methyl-D-aspartate (NMDA) antagonists remains undefined. We conducted a prospective, single-center, pilot randomized controlled trial using a double-blind observer protocol. Twenty pediatric patients aged 2 months to 7 years undergoing elective surgery were randomized into four groups. The control group (Group M) received standard continuous morphine at 0.33 µg/kg/min. Three intervention groups received fixed low-dose ketamine at 0.33 µg/kg/min combined with tapered morphine doses: Group KM-1 at 0.23 µg/kg/min, Group KM-2 at 0.16 µg/kg/min, and Group KM-3 at 0.06 µg/kg/min. The primary outcome was analgesic efficacy assessed by FLACC scores at 24 hours. Secondary outcomes included hemodynamic stability and rescue analgesia requirements. Baseline characteristics were comparable across groups. At 24 hours, the median FLACC scores were comparable between the high-dose control (Median 2.0; Interquartile Range 1.5–2.0) and the lowest morphine group (Group KM-3: Median 2.0; Interquartile Range 1.5–2.0; p = 0.438). Group KM-3 achieved an 81% reduction in morphine consumption with a 0% rescue analgesia rate, identical to the control group. In conclusion, preliminary data from this pilot study suggest that low-dose ketamine may permit a substantial reduction in morphine dosage of up to 81% without compromising analgesic efficacy. These findings warrant confirmation in larger, fully powered multicenter trials.
Co-Authors Aditya Guna Wicaksono Panatagama Arie Zainul Fatoni Aswoco Andyk Asmoro Buyung Hartiyo Laksono Erma Rosita Isngadi Mustaqiem Isda Naim Ismail Imunu Priscilla Tulong Ristiawan Muji Laksono Taufiq Agus Siswagama