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All Journal Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Anak Agung Gde Adistaya
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Health Professions Medicine & Pharmacology Physics

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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 I Gusti Ngurah Mahaalit Aribawa Ra Ratumasa, Marilaeta Cindryani Togi Stanislaus Patrick