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All Journal Jurnal Anestesiologi Indonesia Jurnal Neuroanestesi Indonesia
Cobis, Albinus Yunus
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Opioid-Free Anesthesia Technique for Anterior Cervical Discectomy and Fusion (ACDF): Anesthesia Management Cobis, Albinus Yunus; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.660

Abstract

Anterior cervical discectomy and fusion (ACDF) is a safe and effective surgical procedure to treat cervical spine pathology. ACDF treats Cervical Spondylotic Myelopathy (CSM), where degeneration of the cervical vertebrae compresses the spinal cord, causing sensory, motor, reflex, and bowel function impairment. The use of opioids can have unpleasant effects, hence opioid-free anaesthesia techniques were developed as a strategy to reduce this risk. A man, 62 years old, complained of weakness in the upper limbs until it was difficult to move the hands. Supportive examination revealed cervical myeloradiculopathy due to multiple hernia nucleus pulposus (HNP). Management of opioid-free anaesthesia techniques using multimodal analgesics. During the operation, haemodynamics were relatively stable. Extubation was performed in the operating room and then the patient was transferred to the intensive care unit. The choice of opioid-free anaesthesia technique in the case was to provide multimodal using specific agents that have anaesthetic or analgesic properties. Opioid-free anaesthesia methods that support the Enhanced Recovery after Surgery (ERAS) concept are considered highly beneficial in accelerating recovery time, reducing length and cost of treatment and minimizing opioid-related unpleasant risks. The opioid-free anaesthetic technique in this case report demonstrates the feasibility and benefits of opioid-free anaesthesia in effective pain management and minimizing opioid-related risks, especially in ACDF surgical procedures. This technique is in line with the ERAS protocol.
Target-Controlled Infusion (TCI) Propofol in Ventriculoperitoneal (VP) Shunt Surgery during the First Trimester of Pregnancy Cobis, Albinus Yunus; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.73897

Abstract

Background: The use of target-controlled infusion (TCI) propofol in pregnant patients undergoing ventriculoperitoneal (VP) shunt surgery during the first trimester due to hydrocephalus presents a rare and complex challenge in neuroanesthesia. TCI propofol is favoured for its ability to maintain hemodynamic stability and effectively control intracranial pressure (ICP), both of which are crucial in neuro-obstetric management.Case: A 23-year-old woman, five weeks pregnant, with a history of communicating hydrocephalus and bilateral VP shunts, presented with severe headache. She underwent emergency VP shunt revision under general anesthesia using TCI propofol (Schnider model, target effect-site concentration 2.5–5 mcg/mL), fentanyl (2 mcg/kg), atracurium (0.5 mg/kg), and lidocaine (1.5 mg/kg). Intraoperative hemodynamics remained stable throughout the two-hour procedure. Postoperatively, her neurological status improved significantly, and no complications were observed.Discussion: Compared to inhalational agents such as sevoflurane, TCI propofol demonstrates superior control of ICP, maintains cerebral blood flow stability, and facilitates faster postoperative recovery. Fentanyl, atracurium, and lidocaine were selected due to their favourable safety profiles for short-term use in pregnancy. Postoperatively, progesterone was administered to support pregnancy maintenance by reducing uterine contractility and mitigating the risk of miscarriage associated with surgical and anesthetic stress.Conclusion: TCI propofol is an effective and safe anesthetic strategy for managing VP shunt procedures during the first trimester of pregnancy. A multidisciplinary approach is essential to achieve optimal neurological and obstetric outcomes. 
Co-Authors Dewi Yulianti Bisri Iwan Abdul Rachman