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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.
Co-Authors Aswoco Andyk Asmoro Mustaqiem Isda Priscilla Tulong Ristiawan Muji Laksono