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All Journal Majalah Anestesia & Critical Care (MACC) Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Togi Stanislaus Patrick
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Health Professions Medicine & Pharmacology Physics

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Opioid-Free Anesthesia as a Part of Multimodal Anesthesia Approach in Modified Radical Mastectomy: A Case Report Togi Stanislaus Patrick; Sinardja, Cynthia Dewi; Senapathi, Tjokorda Gde Agung; Ra Ratumasa, Marilaeta Cindryani
Majalah Anestesia & Critical Care Vol 43 No 3 (2025): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i3.445

Abstract

Introduction: The shift towards opioid-free anesthesia (OFA) reflects a growing effort to enhance patient safety and reduce opioid-related adverse effects, particularly in oncology surgeries such as modified radical mastectomy (MRM). Case Description: We describe the anesthetic management of a 51-year-old female with infiltrating ductal carcinoma of the left breast who underwent MRM under an opioid-free anesthetic protocol. Induction was performed with propofol via target-controlled infusion (TCI), followed by intraoperative dexmedetomidine infusion for sedation and analgesia. An ultrasound-guided erector spinae plane (ESP) block at the T5 level was performed with 0.375% ropivacaine and dexamethasone to provide regional analgesia. Intraoperative hemodynamics remained stable, no rescue opioids were required, and blood loss was minimal. Postoperative pain control was achieved with a low-dose dexmedetomidine infusion, intravenous ketorolac, and oral paracetamol. The patient reported minimal pain (NRS 0–1/10), had no nausea, vomiting, or respiratory depression, and recovered uneventfully. Conclusion: OFA offers oncological advantages by preserving immune function and reducing tumor- promoting factors, making it a promising alternative in cancer surgery. This report supports the feasibility and benefits of OFA in major breast cancer procedures, underscoring its role in enhancing recovery and potentially improving long-term oncologic outcomes.
Low-Flow Anesthesia Management in Pediatric Laparoscopic Choledochal Cyst Excision and Hepaticojejunostomy: A Case Report Togi Stanislaus Patrick; Aribawa, I Gusti Ngurah Mahaalit; Ra Ratumasa, Marilaeta Cindryani; Anak Agung Gde Adistaya
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/xqsck350

Abstract

Laparoscopic surgery offers significant benefits in pediatric populations but presents anesthetic challenges, especially during prolonged procedures. This case report describes the anesthetic management of an 11-year-old boy who underwent nearly 12 hours of laparoscopic choledochal cyst excision, Roux-en-Y hepaticojejunostomy, and cholecystectomy. Low-flow anesthesia using sevoflurane was administered via a Dräger Perseus A500, enabling precise control of anesthetic delivery, oxygenation, and ventilation. Throughout the procedure, inspired oxygen fraction (FiO₂) was maintained above 30%, and end-tidal CO₂ (EtCO₂) remained stable around 35 mmHg. Volatile agent consumption was reduced, with age-adjusted MAC (xMAC) consistently between 0.85 and 0.90. Intraoperative hemodynamics and postoperative recovery were stable, with no immediate complications. This case highlights the safety, efficiency, and cost-effectiveness of low-flow anesthesia in complex pediatric laparoscopic surgery when guided by advanced monitoring systems and supports its broader adoption in resource-limited healthcare settings.
Low-Flow Anesthesia Management in Pediatric Laparoscopic Choledochal Cyst Excision and Hepaticojejunostomy: A Case Report Togi Stanislaus Patrick; Aribawa, I Gusti Ngurah Mahaalit; Ra Ratumasa, Marilaeta Cindryani; Anak Agung Gde Adistaya
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/xqsck350

Abstract

Laparoscopic surgery offers significant benefits in pediatric populations but presents anesthetic challenges, especially during prolonged procedures. This case report describes the anesthetic management of an 11-year-old boy who underwent nearly 12 hours of laparoscopic choledochal cyst excision, Roux-en-Y hepaticojejunostomy, and cholecystectomy. Low-flow anesthesia using sevoflurane was administered via a Dräger Perseus A500, enabling precise control of anesthetic delivery, oxygenation, and ventilation. Throughout the procedure, inspired oxygen fraction (FiO₂) was maintained above 30%, and end-tidal CO₂ (EtCO₂) remained stable around 35 mmHg. Volatile agent consumption was reduced, with age-adjusted MAC (xMAC) consistently between 0.85 and 0.90. Intraoperative hemodynamics and postoperative recovery were stable, with no immediate complications. This case highlights the safety, efficiency, and cost-effectiveness of low-flow anesthesia in complex pediatric laparoscopic surgery when guided by advanced monitoring systems and supports its broader adoption in resource-limited healthcare settings.
Co-Authors Anak Agung Gde Adistaya Cynthia Dewi Sinardja I Gusti Ngurah Mahaalit Aribawa Ra Ratumasa, Marilaeta Cindryani Tjokorda Gde Agung Senapathi