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The role of vitamin D and fish oil supplementation in a critically ill myasthenia crisis patient: A case report Walter, Beatrice Cynthia; Jamal, Fachrul; Youlpi, Indah Mutiara; Gurning, Andi Sarikawan
World Nutrition Journal Vol. 9 No. S1 (2025): Vol. 9 No. S1 (2025): Selected conference proceedings of the Nutri Symposium 2
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V09.S1.0027

Abstract

Background and objectives: Myasthenia gravis (MG) is a rare, chronic autoimmune disease with an incidence of 1.7-28 cases per 1,000,000 person-years. It can progress to myasthenic crisis (MC), a life-threatening complication characterized by respiratory failure. Most MC patients require mechanical ventilation (MV) and often have trouble during MV weaning. This case report aims to describe the potential role of vitamin D and fish oil supplementation in facilitating MV weaning in a patient with MC in the intensive care unit (ICU).
Perlukah Central Venous Cathether (CVC) untuk Pengelolaan Anestesi Reseksi Tumor Pineal Body dengan Posisi Parkbench? Kulsum, Kulsum; Jasa, Zafrullah Kany; Jamal, Fachrul
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (518.995 KB) | DOI: 10.24244/jni.vol8i1.199

Abstract

Tumor pineal body di Indonesia termasuk kasus yang jarang dengan insidens 10% dari seluruh tumor otak. Reseksi tumor otak bisa dilakukan dengan berbagai posisi tergantung letak tumor, operator dan fasilitas yang tersedia. Perdarahan pada kasus tumor pineal body sekitar 510% sehingga pemasangan Central Venous Catheter (CVC) tergantung kebutuhan saat operasi. Tujuan laporan kasus ini untuk mengetahui apakah harus dipasang CVC pada kasus tumor otak. Pengelolaan operasi reseksi tumor pineal body dilakukan dengan posisi parkbench tanpa dipasang alat CVC dengan manajemen neuroanestesi. Seorang anak laki laki 10 tahun, berat badan 21 kg mengeluh nyeri kepala hebat, mual muntah, kejang kejang, mata menonjol, pandangan kabur, badan spastik telah dilakukan ventriculo peritoneal shunt (VP-Shunt) 3 bulan yang lalu. Premedikasi menggunakan midazolam dan fentanyl. Induksi menggunakan propofol dan ada penambahan saat laringoskopi dan intubasi. Fasilitas intubasi dengan atracurium. Pemeliharaan anestesi dengan O2+ udara+ sevofluran dengan fraksi oksigen 50% + Propofol dan atracurium secara kontinyu. Monitoring tanda vital (tekanan darah, denyut jantung, frekuensi nafas, saturasi oksigen, jumlah dan warna urin) serta end tidal CO2. Hasil reseksi tumor pineal body selama 4 jam hemodinamik relatif stabil, tekanan darah sistolik berkisar 9010 mmHg, tekanan darah diastolik 40-60 mmHg. Pengelolaan kasus reseksi tumor pineal body dengan posisi parkbench tanpa pemasangan CVC tetap masih bisa dilakukan dengan syarat monitoring ketat dan atasi segera setiap permasalahan yang terjadi.Does it Need CVC for the Management of The Pineal Body Tumor with Parkbench Position?Pineal body tumors in Indonesia is a rare cases with 10% incidence of all brain tumors. Brain tumor resection can be done with various positions depending on the location of tumors, operators and facilities available. Bleeding in case of pineal body tumor is about 5-10% so the installation of Central Venous Catheter (CVC) depends on the need for operation. The purpose of this case report is to determine whether CVC should be installed in cases of brain tumors. The management of pineal body tumor resection surgery is done by parkbench position without CVC with neuroanesthesia management. A 10-year-old boy weighing 21 kg complained of severe headache, nausea, vomiting, convulsions, prominent eyes, blurred vision, spastic body had been done Ventriculo Peritoneal Shunt (VP Shunt) 3 months ago. Premedication using midazolam and fentanyl. Induction uses propofol and there is addition in laryngoscopy and intubation. Intubation facility with atracurium. Maintenance of anesthesia with O2 + water + sevofluran with 50% + oxygen fraction + Propofol and atracurium continuously. Monitoring of vital signs (blood pressure, heart rate, breath frequency, oxygen saturation, amount and color of urine) and end tidal CO2. Resection of pineal body tumor for 4 hours hemodynamically relatively stable, systolic blood pressure ranged from 90-110 mmHg, blood pressure diastolic 40-60 mmHg. Management of pineal body tumor resection case with parkbench position without CVC installation still can be done with tight monitoring condition and solve immediately every problem that happened.