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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research
Dewi Arum Sawitri
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Emergency Neuroanesthesia for Spontaneous Subdural Hematoma in a Pediatric Patient with Hemophilia A: A Protocol-Based Multidisciplinary Approach Sulistiyawati; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1532

Abstract

Background: Spontaneous subdural hematoma (SDH) in pediatric patients with Hemophilia A is a rare, life-threatening emergency requiring a delicate balance between hemostatic correction and neuroprotective anesthesia. The mortality rate is high without immediate surgical decompression, yet the surgery itself poses catastrophic bleeding risks. Case presentation: We report the case of an 11-year-old male (25 kg) with severe Hemophilia A (Factor VIII <1%) who presented with a three-day history of headache and vomiting, culminating in a sudden loss of consciousness (GCS E2V2M5). Neuroimaging revealed a massive left frontotemporoparietal SDH (8 mm thickness) with a 12 mm midline shift and non-communicating hydrocephalus. The patient had discontinued prophylaxis five months prior. Management involved a strict multidisciplinary protocol. Preoperatively, aggressive Factor VIII replacement was initiated to achieve 100% activity. Intraoperatively, a total intravenous anesthesia (TIVA) strategy utilizing propofol, fentanyl, and dexmedetomidine was employed to maintain cerebral perfusion pressure (CPP) while strictly controlling intracranial pressure (ICP). Tranexamic acid was used as an adjunct. The patient underwent successful craniotomy and hematoma evacuation with minimal blood loss. Postoperative care focused on serial factor VIII replacement and neurological monitoring, resulting in a favorable discharge outcome. Conclusion: Successful management of spontaneous SDH in hemophilia requires a target-controlled approach to both hemostasis and hemodynamics. The integration of preoperative factor loading, neuroprotective anesthesia with dexmedetomidine, and postoperative vigilance is critical for survival.
Emergency Neuroanesthesia for Spontaneous Subdural Hematoma in a Pediatric Patient with Hemophilia A: A Protocol-Based Multidisciplinary Approach Sulistiyawati; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1532

Abstract

Background: Spontaneous subdural hematoma (SDH) in pediatric patients with Hemophilia A is a rare, life-threatening emergency requiring a delicate balance between hemostatic correction and neuroprotective anesthesia. The mortality rate is high without immediate surgical decompression, yet the surgery itself poses catastrophic bleeding risks. Case presentation: We report the case of an 11-year-old male (25 kg) with severe Hemophilia A (Factor VIII <1%) who presented with a three-day history of headache and vomiting, culminating in a sudden loss of consciousness (GCS E2V2M5). Neuroimaging revealed a massive left frontotemporoparietal SDH (8 mm thickness) with a 12 mm midline shift and non-communicating hydrocephalus. The patient had discontinued prophylaxis five months prior. Management involved a strict multidisciplinary protocol. Preoperatively, aggressive Factor VIII replacement was initiated to achieve 100% activity. Intraoperatively, a total intravenous anesthesia (TIVA) strategy utilizing propofol, fentanyl, and dexmedetomidine was employed to maintain cerebral perfusion pressure (CPP) while strictly controlling intracranial pressure (ICP). Tranexamic acid was used as an adjunct. The patient underwent successful craniotomy and hematoma evacuation with minimal blood loss. Postoperative care focused on serial factor VIII replacement and neurological monitoring, resulting in a favorable discharge outcome. Conclusion: Successful management of spontaneous SDH in hemophilia requires a target-controlled approach to both hemostasis and hemodynamics. The integration of preoperative factor loading, neuroprotective anesthesia with dexmedetomidine, and postoperative vigilance is critical for survival.
Neuroprotective Anesthetic Management Using Thiopental in a 17-Year-Old with Multifocal Epidural Hematoma and Impending Brain Herniation: A Case Report Sutan Malik Maulana Syah; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
Journal of Anesthesiology and Clinical Research Vol. 7 No. 1 (2026): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v7i1.862

Abstract

Introduction: Epidural hematoma resulting from severe traumatic brain injury demands immediate neuroanesthetic intervention. Multifocal lesions accompanied by pneumocephalus and impending brain herniation present profound perioperative challenges requiring targeted cerebral perfusion management. Case presentation: A 17-year-old male weighing 50 kg sustained severe polytrauma, presenting with a Glasgow Coma Scale of 12 and active auditory canal bleeding. Imaging revealed multifocal epidural hematomas in the right frontotemporal (66 cc) and right parietal (43 cc) regions, alongside pneumocephalus, a 1.5 cm subfalcine herniation, and downward transtentorial herniation. The patient, classified as ASA physical status 4E, required an emergent decompressive craniotomy and concurrent facial reconstruction. A neuroprotective anesthetic strategy was deployed utilizing thiopental, fentanyl, and atracurium to minimize the cerebral metabolic rate and control intracranial pressure. Anesthesia was maintained with sevoflurane. Hemodynamics were strictly titrated to ensure optimal cerebral perfusion pressure. Following successful surgical hematoma evacuation, the patient was admitted to the intensive care unit and demonstrated an excellent neurological recovery after a five-day admission. Conclusion: Thiopental serves as a highly effective neuroprotective induction agent for severe traumatic brain injury with intracranial hypertension. Meticulous hemodynamic control and targeted reduction of cerebral metabolism are critical in preventing secondary ischemic cascades and improving functional outcomes in polytrauma patients.
Co-Authors Buyung Hartiyo Laksono Eko Nofiyanto SULISTIYAWATI Sutan Malik Maulana Syah