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Comparative Analysis of Early Postoperative Cognitive Decline Following Isoflurane versus Sevoflurane Anesthesia in Geriatric Patients: A Prospective Observational Study Recky Antoni; Nopian Hidayat; Dino Irawan
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.v10i3.1534

Background: As the global geriatric population expands, postoperative cognitive dysfunction (POCD) has emerged as a critical perioperative complication. While volatile anesthetics are standard for maintenance, conflicting evidence exists regarding the comparative neurotoxicity of Isoflurane and Sevoflurane, particularly in resource-limited settings where cost influences agent choice. This study aimed to evaluate and compare the magnitude of early cognitive decline associated with these two agents in an Indonesian geriatric cohort. Methods: We conducted a prospective comparative observational study involving 40 geriatric patients (aged ≥60 years, ASA II-III) undergoing elective non-cardiac surgery at Arifin Achmad Regional General Hospital, Indonesia. Patients were recruited via consecutive sampling and allocated to receive maintenance anesthesia with either Sevoflurane (n=20) or Isoflurane (n=20) according to standard clinical protocols. Cognitive function was assessed preoperatively and at 72 hours postoperatively using the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). The primary outcome was the magnitude of cognitive change (Delta score) and the incidence of cognitive decline. Results: Baseline characteristics were homogenous (p > 0.05). The Sevoflurane group exhibited a non-significant trend toward decline (Pre: 26.85 ± 1.09 vs. Post: 26.45 ± 1.28; p = 0.057) with a mean delta of 0.40. Conversely, the Isoflurane group demonstrated a statistically significant deterioration (Pre: 26.90 ± 1.07 vs. Post: 25.90 ± 1.55; p = 0.008) with a mean delta of 1.00. The magnitude of decline was significantly greater in the Isoflurane group (p = 0.026). The incidence of early cognitive decline was 25% for Isoflurane versus 10% for Sevoflurane. Conclusion: Isoflurane anesthesia is associated with a greater magnitude of early postoperative cognitive decline compared to Sevoflurane in geriatric patients. While Sevoflurane is not devoid of cognitive impact, it appears to offer a superior safety profile for early neurocognitive recovery. These findings suggest Sevoflurane may be the preferable agent for geriatric anesthesia in settings where newer agents like Desflurane are unavailable.

Precision Recovery in Interventional Pulmonology: A Randomized Controlled Trial Comparing Propofol Target-Controlled Infusion versus Sevoflurane Inhalation on Emergence Kinetics and Hemodynamic Stability Putra Setiawan; Dino Irawan; Tengku Addi Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (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.v10i4.1566

Background: Achieving a rapid and high-quality recovery is a cornerstone of modern procedural sedation, particularly in high-turnover ambulatory bronchoscopy suites. Patients presenting for bronchoscopy often exhibit significant pulmonary pathology, including ventilation-perfusion mismatch, which may theoretically impede the alveolar washout of volatile anesthetics. This study aimed to compare the recovery kinetics, hemodynamic stability, and adverse event profiles of Propofol Target-Controlled Infusion (TCI) utilizing the Schnider model versus standard Sevoflurane inhalational anesthesia. Methods: In this single-blind, prospective, randomized controlled trial, 36 adult patients (ASA I–III) undergoing elective flexible bronchoscopy were recruited. Participants were randomly allocated to receive either Propofol TCI (Group P; Schnider model, target effect-site concentration 4–6 micrograms/mL) or Sevoflurane (Group S; 2 volume percent). The depth of anesthesia was strictly titrated using Bispectral Index (BIS) monitoring to maintain a range between 40 and 60. The primary outcome was recovery time, defined as the duration from anesthetic discontinuation to eye-opening upon verbal command. Secondary outcomes included intraoperative hemodynamic stability (Mean Arterial Pressure and Heart Rate), BIS values at the moment of emergence, and the incidence of postoperative nausea and vomiting (PONV). Results: The Propofol TCI group demonstrated a statistically significant reduction in recovery time (9.72 ± 1.52 minutes) compared to the Sevoflurane group (12.11 ± 1.49 minutes; p < 0.001). Procedural duration was comparable between groups (p = 0.412), eliminating surgical time as a confounding variable. Group P exhibited superior hemodynamic stability, with significantly less deviation from baseline Mean Arterial Pressure at 10 and 15 minutes into the procedure (p < 0.05). Furthermore, BIS values at the moment of eye-opening were significantly higher in Group P (88.4 ± 4.2) compared to Group S (82.1 ± 5.1; p = 0.021), suggesting a distinct emergence neurophysiology. The incidence of PONV was notably lower in the Propofol group (5.5 percent) compared to the Sevoflurane group (22.2 percent). Conclusion: Propofol target-controlled infusion facilitates significantly faster emergence and greater hemodynamic stability than Sevoflurane in patients undergoing flexible bronchoscopy. The pharmacokinetic independence of Propofol from pulmonary gas exchange offers a distinct physiological advantage in this specific patient population. These findings support the adoption of TIVA-TCI as the standard of care for optimizing throughput in interventional pulmonology.

Perioperative Anesthesia Challenges in a Neonate with Concurrent Intussusception and Abdominal Compartment Syndrome: A Rare Clinical Scenario Pratama Nanda; Dino Irawan; Aditya Permana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1612

Background: Intussusception and abdominal compartment syndrome (ACS) are severe surgical emergencies in pediatric populations, particularly in neonates. The concurrent presentation of both conditions is exceptionally rare and presents formidable perioperative anesthetic challenges. Case presentation: We report the case of a 2-month-old male neonate weighing 6.9 kg who presented with a 4-day history of bloody stools and bilious vomiting following blunt abdominal trauma inflicted by a 12 kg sibling. Clinical examination and imaging confirmed concurrent intussusception with abdominal compartment syndrome. The patient presented with significant hematologic derangements including severe leukopenia (WBC 1,180/μL), anemia (hemoglobin 9.2 g/dL), thrombocytosis, coagulopathy (INR 1.88), and electrolyte abnormalities. Emergency rapid sequence induction anesthesia was employed with careful fluid management utilizing the Holliday-Segar formula to prevent exacerbation of compartment pressures. A successful exploratory laparotomy with resection of necrotic small bowel segments was performed. Conclusion: The case demonstrates the critical importance of comprehensive preoperative assessment, meticulous fluid management strategies, and multidisciplinary collaboration in managing complex neonatal surgical emergencies. This rare clinical scenario highlights unique anesthetic considerations and provides valuable insights into perioperative management of ACS in the neonatal population.

Comparative Analysis of Early Postoperative Cognitive Decline Following Isoflurane versus Sevoflurane Anesthesia in Geriatric Patients: A Prospective Observational Study Recky Antoni; Nopian Hidayat; Dino Irawan
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.v10i3.1534

Background: As the global geriatric population expands, postoperative cognitive dysfunction (POCD) has emerged as a critical perioperative complication. While volatile anesthetics are standard for maintenance, conflicting evidence exists regarding the comparative neurotoxicity of Isoflurane and Sevoflurane, particularly in resource-limited settings where cost influences agent choice. This study aimed to evaluate and compare the magnitude of early cognitive decline associated with these two agents in an Indonesian geriatric cohort. Methods: We conducted a prospective comparative observational study involving 40 geriatric patients (aged ≥60 years, ASA II-III) undergoing elective non-cardiac surgery at Arifin Achmad Regional General Hospital, Indonesia. Patients were recruited via consecutive sampling and allocated to receive maintenance anesthesia with either Sevoflurane (n=20) or Isoflurane (n=20) according to standard clinical protocols. Cognitive function was assessed preoperatively and at 72 hours postoperatively using the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). The primary outcome was the magnitude of cognitive change (Delta score) and the incidence of cognitive decline. Results: Baseline characteristics were homogenous (p > 0.05). The Sevoflurane group exhibited a non-significant trend toward decline (Pre: 26.85 ± 1.09 vs. Post: 26.45 ± 1.28; p = 0.057) with a mean delta of 0.40. Conversely, the Isoflurane group demonstrated a statistically significant deterioration (Pre: 26.90 ± 1.07 vs. Post: 25.90 ± 1.55; p = 0.008) with a mean delta of 1.00. The magnitude of decline was significantly greater in the Isoflurane group (p = 0.026). The incidence of early cognitive decline was 25% for Isoflurane versus 10% for Sevoflurane. Conclusion: Isoflurane anesthesia is associated with a greater magnitude of early postoperative cognitive decline compared to Sevoflurane in geriatric patients. While Sevoflurane is not devoid of cognitive impact, it appears to offer a superior safety profile for early neurocognitive recovery. These findings suggest Sevoflurane may be the preferable agent for geriatric anesthesia in settings where newer agents like Desflurane are unavailable.

Precision Recovery in Interventional Pulmonology: A Randomized Controlled Trial Comparing Propofol Target-Controlled Infusion versus Sevoflurane Inhalation on Emergence Kinetics and Hemodynamic Stability Putra Setiawan; Dino Irawan; Tengku Addi Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (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.v10i4.1566

Background: Achieving a rapid and high-quality recovery is a cornerstone of modern procedural sedation, particularly in high-turnover ambulatory bronchoscopy suites. Patients presenting for bronchoscopy often exhibit significant pulmonary pathology, including ventilation-perfusion mismatch, which may theoretically impede the alveolar washout of volatile anesthetics. This study aimed to compare the recovery kinetics, hemodynamic stability, and adverse event profiles of Propofol Target-Controlled Infusion (TCI) utilizing the Schnider model versus standard Sevoflurane inhalational anesthesia. Methods: In this single-blind, prospective, randomized controlled trial, 36 adult patients (ASA I–III) undergoing elective flexible bronchoscopy were recruited. Participants were randomly allocated to receive either Propofol TCI (Group P; Schnider model, target effect-site concentration 4–6 micrograms/mL) or Sevoflurane (Group S; 2 volume percent). The depth of anesthesia was strictly titrated using Bispectral Index (BIS) monitoring to maintain a range between 40 and 60. The primary outcome was recovery time, defined as the duration from anesthetic discontinuation to eye-opening upon verbal command. Secondary outcomes included intraoperative hemodynamic stability (Mean Arterial Pressure and Heart Rate), BIS values at the moment of emergence, and the incidence of postoperative nausea and vomiting (PONV). Results: The Propofol TCI group demonstrated a statistically significant reduction in recovery time (9.72 ± 1.52 minutes) compared to the Sevoflurane group (12.11 ± 1.49 minutes; p < 0.001). Procedural duration was comparable between groups (p = 0.412), eliminating surgical time as a confounding variable. Group P exhibited superior hemodynamic stability, with significantly less deviation from baseline Mean Arterial Pressure at 10 and 15 minutes into the procedure (p < 0.05). Furthermore, BIS values at the moment of eye-opening were significantly higher in Group P (88.4 ± 4.2) compared to Group S (82.1 ± 5.1; p = 0.021), suggesting a distinct emergence neurophysiology. The incidence of PONV was notably lower in the Propofol group (5.5 percent) compared to the Sevoflurane group (22.2 percent). Conclusion: Propofol target-controlled infusion facilitates significantly faster emergence and greater hemodynamic stability than Sevoflurane in patients undergoing flexible bronchoscopy. The pharmacokinetic independence of Propofol from pulmonary gas exchange offers a distinct physiological advantage in this specific patient population. These findings support the adoption of TIVA-TCI as the standard of care for optimizing throughput in interventional pulmonology.

Perioperative Anesthesia Challenges in a Neonate with Concurrent Intussusception and Abdominal Compartment Syndrome: A Rare Clinical Scenario Pratama Nanda; Dino Irawan; Aditya Permana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1612

Background: Intussusception and abdominal compartment syndrome (ACS) are severe surgical emergencies in pediatric populations, particularly in neonates. The concurrent presentation of both conditions is exceptionally rare and presents formidable perioperative anesthetic challenges. Case presentation: We report the case of a 2-month-old male neonate weighing 6.9 kg who presented with a 4-day history of bloody stools and bilious vomiting following blunt abdominal trauma inflicted by a 12 kg sibling. Clinical examination and imaging confirmed concurrent intussusception with abdominal compartment syndrome. The patient presented with significant hematologic derangements including severe leukopenia (WBC 1,180/μL), anemia (hemoglobin 9.2 g/dL), thrombocytosis, coagulopathy (INR 1.88), and electrolyte abnormalities. Emergency rapid sequence induction anesthesia was employed with careful fluid management utilizing the Holliday-Segar formula to prevent exacerbation of compartment pressures. A successful exploratory laparotomy with resection of necrotic small bowel segments was performed. Conclusion: The case demonstrates the critical importance of comprehensive preoperative assessment, meticulous fluid management strategies, and multidisciplinary collaboration in managing complex neonatal surgical emergencies. This rare clinical scenario highlights unique anesthetic considerations and provides valuable insights into perioperative management of ACS in the neonatal population.

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