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All Journal Jurnal Anestesiologi Indonesia Jurnal Neuroanestesi Indonesia
Adistaya, Anak Agung Gde Agung
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Anesthesia Considerations in Patients with Heart Failure who will Undergo Glioblastoma Tumor Removal Surgery Suranadi, I Wayan; Adistaya, Anak Agung Gde Agung; Jeanne, Bianca
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.v14i2.653

Abstract

Perioperative complications in neurosurgery encompass a range of issues, including hemodynamic instability, significant bleeding, extended procedure durations, and unusual patient positioning. Additionally, fluctuations in carbon dioxide levels, whether hypercapnia or hypocapnia, can contribute to secondary brain injury. Hemodynamic instability is particularly likely during critical moments such as laryngoscopy and intubation, head pins, and the manipulation of the scalp, bone, and dura mater. Patients with congestive heart failure (CHF) and other cardiovascular comorbidities require special attention throughout the entire surgical process, from the preoperative period through to postoperative care. Here, we present a case study on the successful anesthesia management of a patient with moderate heart failure undergoing glioblastoma tumor removal surgery. This case underscores the necessity of individualized anesthetic approaches and vigilant monitoring to minimize risks and ensure patient safety in complex neurosurgical procedures. The main goal of anesthesia in CHF patient undergo neurosurgical procedure are to maintain cerebral perfusion pressure, decrease Intracranial Pressure, Cardiovascular monitoring, maintain hemodynamic stability using vasopressor, inotrope, and fluid balance, and special consideration of position and long surgical time. By carefully managing these perioperative challenges, we can improve outcomes for patients with significant comorbidities undergoing high-risk surgeries.
Bad Lung Down Phenomenon During Spinal Positioning for Hip Hemiarthroplasty: A Case Report Putra, I Made Prema; Sudiantara, Putu Herdita; Aryawangsa, Anak Agung Ngurah; Wirananggala, Nyoman Bendhesa; Adistaya, Anak Agung Gde Agung; Senapathi, Tjokorda Gde Agung
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.v0i0.80577

Abstract

Background: Position-dependent hypoxemia during spinal anesthesia positioning is uncommon but may pose safety concerns in older patients with unilateral lung disease.Case: An 84-year-old woman (ASA III) with a proximal femoral fracture and clinical-radiographic features consistent with left-sided pneumonia was scheduled for bipolar hip hemiarthroplasty. Fracture-related pain and positioning limitations precluded the sitting position and right lateral decubitus, making the left lateral decubitus (LLD) position the only feasible option for spinal anesthesia. During LLD positioning with oxygen via nasal cannula, oxygen saturation dropped to 84-88% without dyspnea and promptly improved after returning to the supine position. Ancillary evaluation revealed preserved biventricular systolic function (left ventricular ejection fraction 60%, TAPSE 19 mm). Lung ultrasound showed no sonographic evidence of pulmonary edema. Spinal anesthesia was performed in the LLD position using 7.5 mg of 0.5% hyperbaric bupivacaine with 50 mcg intrathecal morphine. The surgery then proceeded with a supine-position modification, and hemodynamic and respiratory status remained stable without intraoperative complications.Discussion: In unilateral pneumonia, placing the diseased lung dependent can worsen ventilation-perfusion (V/Q) mismatch through the bad lung down phenomenon, leading to reversible position-dependent hypoxemia. In this case, desaturation occurred before intrathecal injection and before administration of sedatives or systemic opioids, making drug-induced hypoventilation unlikely. The absence of hypercapnic symptoms, preserved cardiac function, and lack of ultrasound evidence of pulmonary edema supported a predominantly pulmonary V/Q mechanism and illustrated silent hypoxemia in an older adult.Conclusion: Positioning should be regarded as a critical step in neuraxial anesthesia, particularly in frail or elderly patients with unilateral lung disease. In such patients, early detection of position-dependent desaturation and prompt correction of posture can allow surgery to proceed safely under regional anesthesia without the need to convert to general anesthesia. 
Co-Authors Aryawangsa, Anak Agung Ngurah I Made Prema Putra I Wayan Suranadi Jeanne, Bianca Putu Herdita Sudiantara, Putu Herdita Tjokorda Gde Agung Senapathi Wirananggala, Nyoman Bendhesa