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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research
Purwoko
Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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General Anesthesia and Modified Rapid Sequence Induction for Emergency Cesarean Delivery in an Eclamptic Adolescent with Severe Thrombocytopenia Yohannes Baptista Paskah Prasanto; Purwoko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (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.v10i5.1579

Abstract

Background: Eclampsia complicated by severe thrombocytopenia presents a critical anesthetic challenge, often representing an absolute contraindication to neuraxial anesthesia. When alternative approaches are mandated, General Anesthesia with Rapid Sequence Induction or a modified rapid sequence approach is crucial for high-risk obstetric emergencies. Case presentation: A 16-year-old primigravida at 35 weeks gestation presented with eclampsia, acute fetal distress, and severe thrombocytopenia. Initial vitals showed a blood pressure of 150/98 mmHg. Laboratory findings confirmed severe preeclampsia with a critical platelet count of 42,000/µL. An airway assessment revealed a Mallampati class II airway with mild pharyngolaryngeal edema. Due to the high risk of spinal epidural hematoma, neuraxial anesthesia was contraindicated. An emergency cesarean section was performed using a modified rapid sequence induction. Following preoxygenation, induction was achieved with fentanyl 100 µg, midazolam 3 mg, and propofol 100 mg. Due to institutional unavailability of rocuronium, atracurium 30 mg was utilized. After a 2.5-minute onset interval utilizing apneic oxygenation and continuous cricoid pressure, the patient was successfully intubated on the first attempt with a Macintosh size 3 blade. The intraoperative course was hemodynamically stable. Conclusion: A modified rapid sequence induction utilizing atracurium provides an effective alternative for airway control and physiological stability in eclamptic adolescents with coagulopathy, particularly in resource-limited settings where standard rapid-acting non-depolarizing agents are unavailable.
Admission Glucose-to-Potassium Ratio as a Predictor of Mortality Risk in Severe Traumatic Brain Injury Undergoing Craniotomy: A Retrospective Cohort Study Purwoko; Sugeng Budi Santosa; Lichte Christian Purbono
Journal of Anesthesiology and Clinical Research Vol. 7 No. 2 (2026): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v7i2.915

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability, and case fatality after emergency neurosurgery remains high, creating an urgent need for inexpensive, rapidly available prognostic tools. The admission glucose-to-potassium ratio (GKR) integrates the concurrent hyperglycaemia and hypokalaemia of the neuroendocrine stress response and may outperform either parameter alone; this study analysed its correlation with mortality risk in severe-TBI patients undergoing craniotomy. Methods: A retrospective cohort of 95 adults (18–60 years) with severe TBI (Glasgow Coma Scale ≤8) managed surgically at Dr. Moewardi Regional General Hospital, Surakarta (March–August 2024) was studied by consecutive sampling. GKR was calculated from admission blood glucose (mg/dL) divided by serum potassium (mmol/L); mortality risk was quantified with the MOST score (low 0–30, moderate 31–60, high 61–100). Analyses included Spearman correlation with 95% confidence intervals, Kruskal–Wallis testing with ε², ROC analysis, and multivariable logistic regression. Results: Median GKR was 35.14 (range 23.18–64.14) and rose monotonically across strata (26.94, 35.21, 55.67). GKR correlated with mortality risk (ρ = 0.376, 95% CI 0.19–0.54, p < 0.001), more strongly than glucose (ρ = 0.329, p = 0.001) or potassium (ρ = −0.243, p = 0.018). GKR discriminated high mortality risk with an area under the curve of 0.91 (95% CI 0.82–0.99) at a cut-off of 47.0, and each unit raised the adjusted odds of high risk 1.35-fold (95% CI 1.09–1.66, p = 0.006). Conclusion: Admission GKR is a simple, robust bedside marker for early mortality-risk stratification in severe-TBI craniotomy patients.
General Anesthesia and Modified Rapid Sequence Induction for Emergency Cesarean Delivery in an Eclamptic Adolescent with Severe Thrombocytopenia Yohannes Baptista Paskah Prasanto; Purwoko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (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.v10i5.1579

Abstract

Background: Eclampsia complicated by severe thrombocytopenia presents a critical anesthetic challenge, often representing an absolute contraindication to neuraxial anesthesia. When alternative approaches are mandated, General Anesthesia with Rapid Sequence Induction or a modified rapid sequence approach is crucial for high-risk obstetric emergencies. Case presentation: A 16-year-old primigravida at 35 weeks gestation presented with eclampsia, acute fetal distress, and severe thrombocytopenia. Initial vitals showed a blood pressure of 150/98 mmHg. Laboratory findings confirmed severe preeclampsia with a critical platelet count of 42,000/µL. An airway assessment revealed a Mallampati class II airway with mild pharyngolaryngeal edema. Due to the high risk of spinal epidural hematoma, neuraxial anesthesia was contraindicated. An emergency cesarean section was performed using a modified rapid sequence induction. Following preoxygenation, induction was achieved with fentanyl 100 µg, midazolam 3 mg, and propofol 100 mg. Due to institutional unavailability of rocuronium, atracurium 30 mg was utilized. After a 2.5-minute onset interval utilizing apneic oxygenation and continuous cricoid pressure, the patient was successfully intubated on the first attempt with a Macintosh size 3 blade. The intraoperative course was hemodynamically stable. Conclusion: A modified rapid sequence induction utilizing atracurium provides an effective alternative for airway control and physiological stability in eclamptic adolescents with coagulopathy, particularly in resource-limited settings where standard rapid-acting non-depolarizing agents are unavailable.
Co-Authors Lichte Christian Purbono Sugeng Budi Santosa Yohannes Baptista Paskah Prasanto