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All Journal Archives of The Medicine and Case Reports Journal of Anesthesiology and Clinical Research
Ahmad Feza Fadhlurrahman
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Hemodynamic Attenuation During Tracheal Intubation: A Randomized Comparative Analysis of Video vs. Direct Laryngoscopy in Adult Elective Surgery Imam Safi'i; Arie Zainul Fatoni; Taufiq Agus Siswagama; Ahmad Feza Fadhlurrahman
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.v7i1.850

Abstract

Introduction: Laryngoscopy and tracheal intubation inevitably trigger a sympathoadrenal response, manifesting as tachycardia and hypertension. While video laryngoscopy (VL) offers improved glottic visualization compared to direct laryngoscopy (DL), its efficacy in specifically attenuating this hemodynamic stress remains a subject of debate. This study investigates whether VL provides superior hemodynamic stability during the critical post-intubation period by analyzing the rate pressure product (RPP) and temporal hemodynamic interactions. Methods: In this prospective, single-blind, randomized controlled trial, 40 adult patients (ASA I-II) undergoing elective surgery were allocated to either Group VL (GlideScope, n=20) or Group DL (Macintosh, n=20). Anesthesia was strictly standardized with Fentanyl 2 mcg/kg, Propofol 2 mg/kg, and Atracurium 0.5 mg/kg. Hemodynamic parameters, including systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR), were recorded at baseline (T0) and at 1 (T1), 2 (T2), and 5 (T5) minutes post-intubation. The primary analysis utilized a general linear model (Repeated Measures ANOVA) to assess Time-Group interactions, corrected for sphericity. Results: Demographics were homogeneous between groups. A significant Time-Group interaction was observed for MAP (p less than 0.001), indicating a blunted pressor response curve in the VL group. Heart Rate at 1-minute post-intubation was significantly lower in Group VL (75.45 plus or minus 11.23 bpm) compared to Group DL (90.15 plus or minus 15.22 bpm; p equals 0.001). Analysis of the rate pressure product revealed that Group DL approached ischemic thresholds, whereas Group VL maintained significantly lower myocardial workload at minutes 1 and 2 (p less than 0.01). Conclusion: Video laryngoscopy significantly attenuates the reflex tachycardia and arterial pressure surge associated with tracheal intubation compared to direct laryngoscopy. VL is recommended to minimize cardiovascular stress in susceptible surgical populations.
Navigating the Perfect Storm: Ultrasound-Guided Peripheral Nerve Block for Emergency Amputation in a Patient with Acute STEMI and Failed PCI Ella Priliandini; Ruddi Hartono; Ahmad Feza Fadhlurrahman; Muhammad Farlyzhar Yusuf
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.829

Abstract

Acute limb ischemia presenting concurrently with acute coronary syndrome creates a precarious clinical dilemma, often termed the "cardiac cripple" scenario. The mortality risk is compounded when patients have a history of failed percutaneous coronary intervention, severe left ventricular dysfunction, and require emergency major amputation while on active dual antiplatelet therapy. In these patients, general anesthesia poses a risk of hemodynamic collapse, while neuraxial anesthesia is contraindicated due to bleeding risks. A 75-year-old male presented with a Rutherford Grade III-IV "dead limb" of the right lower extremity and concurrent Acute Anterior STEMI (Killip II, TIMI 7/14, GRACE 137). His history included a failed percutaneous coronary intervention two months prior and three-vessel disease, resulting in a left ventricular ejection fraction of 32%. General anesthesia posed an unacceptable risk of exacerbating myocardial pump failure, while spinal anesthesia was contraindicated due to recent clopidogrel ingestion. A decision was made to perform a below-knee amputation using an ultrasound-guided femoral nerve block and a popliteal sciatic nerve block via the crosswise approach. The procedure utilized 0.5% ropivacaine with 2 mg dexamethasone. The patient remained hemodynamically stable without vasopressor support, reported a Visual Analogue Scale score of 0 intraoperatively, and avoided adverse cardiac events. In conclusion, peripheral nerve blockade, specifically the combined femoral and crosswise popliteal sciatic approach, serves as a superior anesthetic alternative in high-risk cardiac patients. It bypasses the sympatholytic risks of general anesthesia and the coagulation constraints of neuraxial techniques, offering a safe corridor for life-saving surgery.
Co-Authors Arie Zainul Fatoni Ella Priliandini Imam Safi'i Muhammad Farlyzhar Yusuf Ruddi Hartono Taufiq Agus Siswagama