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RACHMAT HIDAYAT
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INDONESIA
Journal of Anesthesiology and Clinical Research
Published by HM Publisher
ISSN : -     EISSN : 27459497     DOI : https://doi.org/10.37275/jacr
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience
Journal of Anesthesiology and Clinical Research/JACR that focuses on anesthesiology; pain management; intensive care; emergency medicine; disaster management; pharmacology; physiology; clinical practice research; and palliative medicine.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 119 Documents
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Perioperative Considerations for ASD Device Closure in the First Trimester: A Case of Secundum ASD with Bidirectional Shunt Nugroho, Yusuf Agung; Isngadi; Ruddi Hartono
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.640

Abstract

Introduction: Atrial septal defect (ASD) closure during pregnancy is a complex procedure requiring careful consideration of maternal and fetal risks. This case report highlights the perioperative management of a secundum ASD with a bidirectional shunt in a patient during her first trimester. Case presentation: A 31-year-old woman, G3P2A0, presented at approximately 10-11 weeks gestation with a recently diagnosed large secundum ASD and pulmonary hypertension. She was on Sildenafil and Bisoprolol. Due to the potential risks associated with an unrepaired ASD during pregnancy, the decision was made to proceed with percutaneous ASD closure. General anesthesia was administered with meticulous hemodynamic monitoring. The procedure was successful, and the patient recovered without complications. Conclusion: ASD closure during the first trimester can be safely performed with careful planning and execution. Multidisciplinary collaboration and vigilant monitoring are crucial for optimal maternal and fetal outcomes.
Successful Management of Grade III Tetanus with Therapeutic Plasma Exchange: A Case Report Listyono Putro, Jati Febriyanto Adi; Andy Nugroho; Septian Adi Permana; Andi Hermawan
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.644

Abstract

Introduction: Tetanus, a severe neurologic disorder caused by Clostridium tetani neurotoxin, presents with progressive muscle rigidity and spasms. Grade III tetanus, characterized by generalized tetanus with severe spasms, carries a high mortality risk. Therapeutic plasma exchange (TPE) has emerged as an adjunctive therapy to remove circulating toxins and inflammatory mediators. Case presentation: We report a 50-year-old male with grade III tetanus following a minor injury. Despite standard treatment with tetanus immunoglobulin, antibiotics, and muscle relaxants, his condition deteriorated, necessitating intensive care unit (ICU) admission and mechanical ventilation. The patient underwent two sessions of TPE, demonstrating significant clinical improvement with reduced muscle spasms and successful ventilator weaning. Conclusion: This case highlights the potential benefit of TPE in managing severe tetanus, particularly in cases refractory to conventional therapy. Early recognition and aggressive management, including TPE, can improve outcomes in this life-threatening condition.
Anesthesia Management of Cesarean Section in Women with Peripartum Cardiomyopathy: A Case Series Praskita Pande; Ruddi Hartono
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.652

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a rare but serious heart condition that occurs during late pregnancy or within the first few months after delivery. It can lead to significant maternal and fetal morbidity and mortality. Anesthetic management of PPCM patients undergoing cesarean section (C-section) is challenging due to the hemodynamic instability and potential for complications. Case presentation: This case series describes the anesthetic management of four women with PPCM undergoing C-section. Various anesthetic techniques were employed, including combined spinal-epidural (CSE) and epidural anesthesia, with careful monitoring and individualized management strategies. Case 1 present a 34-year-old female with mild mitral regurgitation, mild tricuspid regurgitation, mild pulmonary regurgitation, intermediate probability pulmonary hypertension, hypertensive heart failure, and obesity underwent C-section under CSE anesthesia with ropivacaine and bupivacaine. Case 2 present a 26-year-old female with PPCM and mild mitral regurgitation underwent C-section under CSE anesthesia with ropivacaine and bupivacaine. Case 3 present a 26-year-old female with PPCM, thrombocytosis, and hypoalbuminemia underwent C-section under epidural anesthesia with ropivacaine and fentanyl. Case 4 present a 30-year-old female with PPCM, marginal placenta previa, uterine myoma, and severe myopia underwent C-section under epidural anesthesia with ropivacaine and fentanyl. Conclusion: Regional anesthesia, particularly CSE and epidural techniques, appears to be a safe and effective anesthetic approach for C-sections in women with PPCM. Meticulous hemodynamic monitoring and individualized management are crucial for successful outcomes.
Central Venous Catheterization in the ICU: A Comparison of Anatomical Landmark and Ultrasound-Guided Techniques Pratiaksa, Ardian; Purwoko; Muhammad Husni Thamrin; Bambang Novianto Putro; Fitri Hapsari Dewi
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.656

Abstract

Introduction: Central venous catheterization (CVC) is frequently required in intensive care units (ICUs) for administering medications, fluids, and monitoring central venous pressure. However, CVC insertion can lead to complications such as arterial puncture, hematoma formation, and pneumothorax. Ultrasound guidance has been advocated to reduce these complications, but its effectiveness in the ICU setting remains debated. This study compared the complication rates of anatomical landmark-guided versus ultrasound-guided CVC insertion in ICU patients. Methods: A prospective cohort study was conducted in the ICU of a tertiary care hospital. Patients requiring CVC were divided into two groups: anatomical landmark-guided and ultrasound-guided insertion. The primary outcome was the incidence of complications, including arterial puncture, hematoma, and pneumothorax. Secondary outcomes included cannulation time and the number of cannulation attempts. Results: A total of 39 patients were included in the study. The incidence of complications was significantly lower in the ultrasound-guided group (2 complications) compared to the anatomical landmark group (7 complications) (p=0.017). The most common complication was arterial puncture, occurring in 7 patients in the anatomical landmark group and 2 patients in the ultrasound-guided group. Conclusion: Ultrasound guidance significantly reduces the risk of complications during CVC insertion in the ICU. This technique should be considered the standard of care for CVC insertion in this setting.
Perioperative Anesthetic Management of Brain Abscess Evacuation in a Child with Double Outlet Right Ventricle: A Case Report Rio Kharisma Putra; Buyung Hartiyo Laksono; Eko Nofiyanto; Fanniyah; Ruddi Hartono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.668

Abstract

Introduction: Double outlet right ventricle (DORV) is a rare congenital heart defect where both the aorta and pulmonary artery arise from the right ventricle. This anomaly poses unique challenges for anesthetic management, especially during intracranial surgeries. Case presentation: We present the case of a 7-year-old female child diagnosed with a brain abscess and DORV, who underwent open evacuation and cranioplasty. Anesthetic management focuses on maintaining hemodynamic stability and ensuring adequate oxygenation. The patient was successfully extubated postoperatively and transferred to the intensive care unit (ICU) for close monitoring. Conclusion: Surgical interventions in patients with DORV require careful preoperative evaluation and close perioperative monitoring to minimize morbidity and mortality. This case highlights the importance of a multidisciplinary approach and meticulous anesthetic management in ensuring a successful outcome.
Successful Post-Resuscitation Care in End-Stage Renal Disease Patients: A Case Report Merry; Made Septyana Parama Adi; I Gusti Agung Gede Utara Hartawan; I Gusti Ngurah Mahaalit Aribawa; I Putu Fajar Narakusuma; I Gusti Agung Made Wibisana Kurniajaya
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.673

Abstract

Introduction: Cardiac arrest in end-stage renal disease (ESRD) patients presents unique challenges due to their complex medical conditions. Post-resuscitation care for these patients requires careful management of various factors, including hemodynamic instability, electrolyte imbalances, and fluid overload. This case report describes the successful post-resuscitation care of an ESRD patient who experienced cardiac arrest and achieved a return of spontaneous circulation (ROSC). Case presentation: A 50-year-old female with ESRD on hemodialysis (HD) presented with acute dyspnea and cardiac arrest. After 8 minutes of cardiopulmonary resuscitation (CPR), ROSC was achieved. The patient was managed with a comprehensive post-resuscitation care protocol, including brain resuscitation (targeted temperature management, ventilation optimization, and hemodynamic control) and sustained low-efficiency dialysis for fluid balance. Despite the severity of her condition, the patient showed significant neurological recovery and was successfully extubated after 7 days of mechanical ventilation. She was discharged after 12 days with follow-up for her chronic conditions. Conclusion: This case highlights the importance of individualized management strategies for ESRD patients post-cardiac arrest, including the need for prolonged resuscitation and careful monitoring to improve patient outcomes.
Airway Challenges and Solutions in Tracheal Reconstruction Surgery: A Case Report of Severe Post-Tracheostomy Stenosis Adiptya Cahya Mahendra; Purwoko
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.679

Abstract

Introduction: Tracheal stenosis, a narrowing of the trachea, can pose significant challenges for airway management, especially during tracheal reconstruction surgery. This case report presents the successful management of a complex airway in a patient with severe post-tracheostomy tracheal stenosis. Case presentation: A 28-year-old male presented with severe tracheal stenosis following a tracheostomy two years prior. The patient was scheduled for tracheal reconstruction surgery. Intraoperatively, the initial challenge was the poor patency of the existing tracheostomy tube, necessitating its replacement with an uncuffed endotracheal tube (ETT). Further airway challenges arose during the stenting procedure, requiring innovative solutions to maintain airway patency while facilitating surgical access. Conclusion: This case highlights the critical role of flexible and innovative airway management techniques in tracheal reconstruction surgery. Meticulous planning, close collaboration between the surgical and anesthesia teams, and the ability to adapt to unexpected intraoperative challenges are essential for successful outcomes in these complex cases.
Dexmedetomidine as a Neuroprotective Sedative Agent in Ultrasound-Guided Ulnar Nerve Block for a Patient with Traumatic Brain Injury: A Case Report Aryanda Widya Tazkagani Salsabila; Heri Dwi Purnomo
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.688

Abstract

Introduction: Traumatic brain injury (TBI) often presents alongside extracranial injuries requiring surgical intervention. General anesthesia in such cases poses significant challenges, particularly in patients with concomitant pulmonary complications. This case report describes the successful use of ultrasound-guided ulnar nerve block combined with dexmedetomidine sedation for a patient with moderate TBI and pulmonary contusion undergoing open reduction and internal fixation (ORIF) of a left-hand finger fracture. Case presentation: A 50-year-old male presented with moderate TBI, pulmonary contusion, and an open fracture of the fifth digit of his left hand following a motor vehicle accident. Due to the risks associated with general anesthesia, an ultrasound-guided ulnar nerve block was performed using levobupivacaine 0.375%. Dexmedetomidine was used as a sedative agent due to its neuroprotective properties and minimal respiratory depressant effects. The procedure was successful, with the patient maintaining stable hemodynamics and adequate sedation throughout the surgery. Conclusion: This case highlights the feasibility and safety of ultrasound-guided peripheral nerve block combined with dexmedetomidine sedation as an alternative to general anesthesia in patients with TBI and pulmonary contusion. Dexmedetomidine's neuroprotective effects and minimal respiratory depression make it a valuable tool in managing such complex cases.
Epidural Tunneling for Effective Management of Severe Cancer Pain: A Case Report Imam Safi'i; Ristiawan Muji Laksono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.714

Abstract

Introduction: Severe pain is a common and debilitating symptom for many cancer patients, often requiring multimodal approaches for effective management. While oral opioids and adjunctive therapies are frequently the first line, some patients with refractory pain necessitate interventional procedures. This case report describes the successful use of epidural tunneling for long-term pain management in a patient with severe cancer pain due to bone metastases. Case presentation: A 55-year-old woman with severe cancer pain secondary to bone metastases from breast cancer presented with intractable pain in her hips, buttocks, and legs, radiating to her feet with associated numbness. Despite high doses of oral opioids, paracetamol, amitriptyline, and a fentanyl syringe, her pain remained poorly controlled, significantly impacting her sleep and quality of life. A lumbosacral X-ray revealed osteolytic-blastic lesions with vertebral compression and other metastatic involvement. Given the severity and refractory nature of her pain, an epidural tunneling procedure was performed. Conclusion: Epidural tunneling proved to be a safe and effective method for managing severe, chronic cancer pain in this patient, leading to a substantial reduction in pain intensity and a decreased need for systemic opioids. This technique offers a valuable option for patients with persistent pain who have failed conventional analgesic therapies, particularly in advanced stages of cancer.
Successful Anesthetic Management of a CT Scan Procedure in Pediatric Conjoined Twins: A Case Report Priscilla Tulong; Rudy Vitraludyono
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.720

Abstract

Introduction: Conjoined twins represent a rare and complex congenital anomaly, posing significant challenges in medical management, particularly during diagnostic procedures requiring anesthesia. This case report details the successful anesthetic management of a four-month-old female thoracoabdominal conjoined twin pair undergoing a contrast-enhanced computed tomography (CT) scan in preparation for separation surgery. The rarity of this condition and the intricacies involved in providing safe and effective anesthesia for such patients warrant this report to contribute to the growing body of knowledge in this specialized area. Case presentation: A four-month-old female conjoined twin pair, fused at the thorax and abdomen, was referred to Dr. Saiful Anwar General Hospital in Malang, Indonesia, for separation surgery. Prior to the planned surgical intervention, a contrast-enhanced CT scan of the thoracoabdominal region was deemed necessary by the surgical team to delineate the extent of organ fusion and vascular involvement. The twins, designated as Baby One and Baby Two for the purpose of this report, were born via Cesarean section. Physical examination revealed a shared thoracoabdominal connection and bilateral labiopalatoschisis. Pre-operative laboratory investigations showed stable hematological and biochemical parameters for both twins. An abdominal ultrasound indicated liver surface fusion with vascular involvement, while an echocardiogram revealed normal cardiac structure and function in both individuals. The American Society of Anesthesiologists (ASA) physical status for both twins was classified as Class III. Conclusion: This case highlights the successful use of continuous dexmedetomidine infusion for sedation during an out-of-operating room CT scan procedure in pediatric thoracoabdominal conjoined twins. The meticulous pre-procedural planning, including simulation and the preparation of individualized equipment and monitoring for each twin, contributed significantly to the positive outcome. This case underscores the importance of a multidisciplinary team approach and tailored anesthetic strategies in managing complex cases of conjoined twins undergoing diagnostic imaging.

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