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

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Preserving Spontaneous Ventilation in ASA III Patients: Transtracheal Block as a Primary Anesthetic Strategy for Complex Bronchoscopy Yoga Indrawan Pratama; Ruddi Hartono; Muhammad Farlyzhar Yusuf
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.v7i1.854

Abstract

Introduction: Fiberoptic bronchoscopy (FOB) in patients with American Society of Anesthesiologists (ASA) physical status III presents a significant anesthetic challenge. General anesthesia carries risks of hemodynamic instability and respiratory compromise, while conventional topical anesthesia is often insufficient for cough suppression. This study evaluates the efficacy of transtracheal block (TTB) combined with dexmedetomidine as a primary anesthetic strategy to preserve spontaneous ventilation in high-risk patients. Case presentation: We present a serial case report of four adult males (aged 43-66 years) with severe pulmonary comorbidities, including advanced lung malignancies, atelectasis, and massive pleural effusion. All patients were classified as ASA III. The anesthetic protocol utilized a multimodal approach: intravenous dexmedetomidine sedation (loading dose 1 mcg/kg, maintenance 0.2-0.7 mcg/kg/hr) combined with a TTB using 20 mg of 2% lidocaine. All procedures were successfully completed without conversion to general anesthesia. Hemodynamic monitoring revealed that mean arterial pressure (MAP) and heart rate variability remained within 15% of baseline. No episodes of desaturation (SpO2 < 90%) or significant periprocedural respiratory distress were observed. Patients demonstrated rapid recovery with minimal coughing (Visual Analog Scale for Cough < 2/10) and were discharged from the ICU within 24 hours. Conclusion: Transtracheal block combined with dexmedetomidine provides profound airway anesthesia while maintaining spontaneous ventilation and hemodynamic stability. This technique represents a superior safety profile compared to general anesthesia for complex bronchoscopy in patients with compromised respiratory reserve.
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 Ahmad Feza Fadhlurrahman Ella Priliandini Ruddi Hartono Yoga Indrawan Pratama