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All Journal PREPOTIF : Jurnal Kesehatan Masyarakat Promotor: Jurnal Mahasiswa Kesehatan Masyarakat
Arisadika, Putu Bagus
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Nursing Public Health Other

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CASE REPORT : A NON MUSCLE RELAXANT TECHNIQUE FOR A MYASTHENIA GRAVIS PATIENT UNDERGOING VIDEO-ASSISTED THORACOSCOPIC SURGERY Ratumasa, Marilaeta Cindryani Ra ,; Putra, Kadek Agus Heryana; Arisadika, Putu Bagus
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 2 (2025): AGUSTUS 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i2.45656

Abstract

Miastenia gravis (MG) adalah kelainan autoimun kronis langka yang mengganggu transmisi neuromuskular dan ditandai dengan kelemahan otot rangka yang berfluktuasi. Penatalaksanaan anestesi pada pasien dengan MG menghadirkan tantangan yang signifikan, terutama karena sensitivitas mereka yang berubah terhadap agen anestesi dan peningkatan risiko komplikasi pernapasan pascaoperasi. Seorang pria berusia 54 tahun yang didiagnosis dengan MG dijadwalkan menjalani operasi torakoskopi berbantuan video (VATS) untuk membuat jendela perikardial dan mendapatkan biopsi, yang dipicu oleh adanya efusi perikardial melingkar sedang hingga berat. Riwayat medisnya meliputi kesulitan pernapasan dan penyakit paru restriktif, yang memerlukan pendekatan anestesi yang cermat yang menghindari penggunaan agen penghambat neuromuskular untuk mencegah risiko kelumpuhan yang berkepanjangan. Anestesi dipertahankan dengan aman menggunakan kombinasi remifentanil dan propofol, dan isolasi paru-paru dicapai secara efektif dengan pemasangan tabung endotrakeal lumen ganda. Pendekatan ini memungkinkan upaya pernapasan spontan dan kondisi intraoperatif yang stabil. Kasus ini menggambarkan pentingnya perencanaan anestesi individual pada pasien MG, dengan menekankan perlunya menghindari relaksan otot dan mempertahankan fungsi pernapasan, terutama dalam prosedur bedah toraks. Dengan menyesuaikan strategi anestesi dengan pertimbangan patofisiologi spesifik MG, hasil perioperatif yang optimal dapat dicapai pada populasi berisiko tinggi ini.
Anesthetic Management of a Severe Chronic Obstructive Pulmonary Disease Patient Undergoing Video-Assisted Thoracoscopic Surgery for Diaphragmatic Hernia Repair Arisadika, Putu Bagus; Sinardja, Cynthia Dewi
PROMOTOR Vol. 8 No. 6 (2025): DESEMBER
Publisher : Universitas Ibn Khaldun Bogor

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32832/pro.v8i6.1551

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that increases the risk of perioperative complications, particularly in thoracic surgery requiring one-lung ventilation (OLV). Patients with severe COPD are prone to respiratory failure, which make the anesthetic management challenging, escpecially to prevent acute exacerbation. A 58-year-old female with severe COPD and acute exacerbation underwent video-assisted thoracoscopic surgery (VATS) for diaphragmatic hernia repair. Preoperative optimization included nebulization therapy, glucose control, and respiratory muscle training. General anesthesia was maintained with sevoflurane. Lung isolation achieved with placement of double-lumen tube. Midway through surgery, the patient developed acute respiratory distress, requiring manual ventilation with 100 oxygen and PEEP 5 cmH₂O, deepened anesthesia with sevoflurane 4 MAC, rocuronium 10 mg IV, and methylprednisolone 125 mg IV. After stabilization, mechanical ventilation was resumed with down titration of oxygen fraction, and the procedure was completed successfully. This case highlights the importance of perioperative planning in severe COPD, particularly the need for preoperative pulmonary optimization and intraoperative vigilance. Rapid recognition and intervention in acute exacerbations are crucial to preventing hypoxemia and ventilatory failure. The use of tailored ventilation strategies and bronchodilator therapy contributed to the successful management of this high-risk patient. Anesthetic management in severe COPD requires a multidisciplinary approach, including preoperative pulmonary preparation, intraoperative lung-protective ventilation, and immediate intervention during exacerbations. This case underscores the importance of individualized anesthetic strategies to optimize surgical outcomes in patients with compromised respiratory function.
Co-Authors Cynthia Dewi Sinardja Kadek Agus Heryana Putra, Kadek Agus Ratumasa, Marilaeta Cindryani Ra ,