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RACHMAT HIDAYAT
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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 132 Documents
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Successful Use of Low-Dose Combined Spinal-Epidural Anesthesia for Cesarean Section in a Parturient with Eisenmenger Syndrome: A Case Report Sahala Trident Sitorus; Isngadi
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.821

Abstract

Introduction: Eisenmenger syndrome (ES) in pregnancy is a catastrophic condition associated with maternal mortality rates of 30-50%. The profound physiological changes of pregnancy, particularly the decrease in systemic vascular resistance (SVR), exacerbate right-to-left (R-L) shunting, leading to severe hypoxemia and right ventricular failure. Anesthetic management is perilous, as both general and neuraxial anesthesia can precipitate hemodynamic collapse. Case presentation: We present the case of a 25-year-old G2P101Ab000 parturient at 32-34 weeks of gestation with ES secondary to a large secundum atrial septal defect and severe pulmonary hypertension. She presented for an urgent Cesarean section due to labor. A meticulous anesthetic plan was executed, centered on a low-dose Combined Spinal-Epidural (CSE) technique. This involved an intrathecal injection of 7.5 mg hyperbaric bupivacaine with 50 mcg fentanyl, followed by incremental epidural titration of 0.2% ropivacaine. Hemodynamic stability was proactively managed with inline infusions of phenylephrine and milrinone. The procedure was successful, maintaining stable maternal hemodynamics, SVR, and oxygen saturation. A healthy infant was delivered with APGAR scores of 7 and 8. The patient had an uncomplicated postoperative recovery. Conclusion: This case demonstrates that a carefully titrated, low-dose CSE technique, combined with invasive monitoring and proactive pharmacological support, can be a safe and effective strategy for Cesarean section in ES patients. This approach successfully navigates the hemodynamic dilemma by providing excellent analgesia while preventing a clinically significant drop in SVR.
Admission GCS, Age, and Pupillary Response as a Multivariable Triad for Predicting Outcomes Following Emergent Surgery for Traumatic Brain Injury Ramadhan Saputro; Aswoco Andyk Asmoro; Buyung Hartiyo Laksono
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.v7i1.822

Abstract

Introduction: Early prognostication for patients with moderate-to-severe traumatic brain injury (TBI) requiring emergent surgery and intensive care is critical but complex. While the Glasgow Coma Scale (GCS) is foundational, its standalone predictive power, especially when unadjusted for known confounders, can be misleading. This study aimed to determine the independent predictive value of admission GCS within a multivariable model including other key clinical predictors. Methods: We conducted a retrospective, descriptive-analytic study at a tertiary referral center in Indonesia, analyzing a specific cohort of 150 patients with moderate-to-severe TBI (GCS 3–12) who all underwent the emergent ED-OR-ICU pathway between July and December 2024. Data on admission GCS, patient age, pupillary reactivity, and CT findings (Marshall score) were extracted. We built multivariable logistic regression models to predict two primary outcomes: (1) In-Hospital Mortality and (2) Unfavorable Functional Outcome (a composite of mortality or discharge to a skilled nursing/palliative care facility). Results: A univariate analysis identifying a GCS cut-off of 9.5 produced a statistically unstable odds ratio (OR) for mortality of 104.87, consistent with quasi-complete separation. However, in the multivariable model, this effect was resolved. After adjusting for confounders, GCS remained a significant independent predictor of mortality (Adjusted OR 2.78 per point decrease) and unfavorable outcome (aOR 3.11 per point decrease). Crucially, non-reactive pupils (aOR 5.12 for mortality) and patient age (aOR 1.07 per year for unfavorable outcome) were found to be equally, if not more, powerful independent predictors. Conclusion: Admission GCS is a robust and independent predictor of outcome in high-risk surgical TBI patients, but its true value is only revealed when used as part of a multivariable assessment. The statistical power of univariate GCS is easily inflated by confounding. We conclude that prognostication in this cohort must be a multivariable exercise, incorporating GCS, pupillary response, and age as an essential prognostic triad.
Risk-Adapted Anesthesia and Sympathetic Attenuation in Geriatric Cardiometabolic Multimorbidity: Navigating the Limited Physiologic Reserve Luh Ayu Mahetri; Ketut Jayati Utami Dewi
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.v7i1.825

Abstract

Introduction: The aging surgical population is defined by homeostenosis, a critical reduction in physiologic reserve that leaves patients vulnerable to perioperative stressors. This vulnerability is exponentially increased by the cardiometabolic triad of hypertension, coronary artery disease, and type II diabetes mellitus. This report illustrates the management of these competing physiological demands during high-stress open abdominal surgery. Case presentation: A 71-year-old male, ASA III, body mass index 27 kg/m², with stage II hypertension, insulin-dependent type II diabetes, and ischemic heart disease, presented for open cholecystectomy. Preoperative functional capacity was less than 4 METs. Baseline ward blood pressure was 138/84 mmHg. Intraoperatively, surgical traction on the gallbladder mesentery precipitated a sympathetic surge, with systolic blood pressure spiking to 171/95 mmHg, representing a 24% increase from baseline mean arterial pressure, without compensatory tachycardia (heart rate stable at 83 bpm), indicative of autonomic neuropathy. Utilizing a risk-adapted protocol, anesthesia was deepened with Sevoflurane to 3.5% and a targeted Fentanyl bolus of 50 mcg was administered. This intervention successfully attenuated the surge, reducing systolic blood pressure to less than 150 mmHg within 4 minutes. A restrictive fluid strategy of 500 mL total input was employed. Postoperative renal function remained stable with a Creatinine of 1.05 mg/dL, and the patient was discharged with a pain score of 2 out of 10. Conclusion: Successful management of the geriatric vascular stiffness phenotype requires anticipating the dissociation between heart rate and blood pressure. Vigilant, physiologically-guided titration of volatile agents and opioids, rather than invasive technology alone, can mitigate myocardial ischemia in low-resource settings.
Comparative Efficacy of Prophylactic Bolus Phenylephrine versus Ephedrine on Maternal Hemodynamics and Neonatal APGAR Scores in Elective Cesarean Section: A Randomized Controlled Trial Pande Made Praskita Putra Soma; Ruddi Hartono; Isngadi
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.v7i1.838

Abstract

Introduction: Spinal anesthesia-induced hypotension is a pervasive physiological challenge during cesarean delivery, precipitating maternal hemodynamic instability and compromising uteroplacental perfusion. While phenylephrine and ephedrine are the mainstay vasopressors for prophylaxis, their comparative impact on immediate neonatal vitality in the context of bolus administration remains a critical subject of investigation, particularly in resource-limited settings where infusion pumps are not universally available. This study aimed to rigorously compare the efficacy of prophylactic intravenous bolus phenylephrine versus ephedrine regarding maternal blood pressure control and neonatal APGAR scores. Methods: We conducted a prospective, randomized, double-blind experimental study at Dr. Saiful Anwar Regional General Hospital, Malang. Forty-two parturients classified as ASA I or II undergoing elective cesarean section were randomized into two groups. Immediately following subarachnoid block, Group P received a bolus of Phenylephrine (125 µg), and Group E received Ephedrine (10 mg). Hemodynamic parameters were recorded at baseline and at 1, 3, 6, 9, 12, 15, and 18 minutes post-anesthesia. The primary outcome was the neonatal APGAR score at the first minute. Results: Both vasopressor regimens successfully mitigated severe spinal-induced hypotension. There were no statistically significant differences in the magnitude of systolic or diastolic blood pressure reduction between the Phenylephrine and Ephedrine groups at any observed time point (p>0.05). However, a significant divergence was observed in neonatal outcomes. The mean first-minute APGAR score in the Phenylephrine group was significantly higher (7.62 ± 0.97) compared to the Ephedrine group (7.05 ± 0.74) with a p-value of 0.038. Conclusion: Phenylephrine and ephedrine demonstrated equipotent efficacy in maintaining maternal hemodynamic stability when administered as prophylactic boluses. However, phenylephrine prophylaxis resulted in superior immediate neonatal vitality as evidenced by significantly higher first-minute APGAR scores. Phenylephrine should be prioritized as the vasopressor of choice to optimize neonatal safety during cesarean delivery.
Comparative Efficacy of Low-Dose Ketamine versus Midazolam Co-induction on Hemodynamic Stability and Early Neurocognitive Recovery in Geriatric Anesthesia: A Randomized Double-Blind Pilot Trial Aditya Guna Wicaksono Panatagama; Aswoco Andyk Asmoro; Arie Zainul Fatoni; Rudy Vitraludyono
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.v7i1.849

Abstract

Introduction: Geriatric patients undergoing general anesthesia are susceptible to hemodynamic instability and delayed neurocognitive recovery. The choice of co-induction agent significantly influences these outcomes. This study compares the effects of low-dose Ketamine versus Midazolam co-induction on intraoperative hemodynamic stability and immediate post-operative cognitive trajectory. Methods: A prospective, double-blind, randomized controlled pilot trial was conducted on 32 geriatric patients aged 65 years or older classified as American Society of Anesthesiologists (ASA) physical status II or III undergoing elective surgery. Patients were randomized to receive either intravenous Ketamine (0.3 mg/kg, n=16) or Midazolam (0.075 mg/kg, n=16) prior to Propofol induction. The primary outcome was the magnitude of early cognitive change measured by the Mini-Mental State Examination (MMSE) at 1-hour post-operation relative to baseline. Secondary outcomes included intraoperative mean arterial pressure (MAP), incidence of hypotension, total Propofol consumption, and time to extubation. Data were analyzed using Analysis of Covariance (ANCOVA) and independent t-tests; effect sizes were calculated using Cohen’s d. Results: Baseline characteristics were comparable between groups. The Ketamine group exhibited significantly superior early cognitive preservation with a mean decline of -0.50 ± 0.63 compared to the Midazolam group, which showed a decline of -1.25 ± 0.93 (p = 0.012; Cohen’s d = 0.93). Hemodynamically, the Ketamine group maintained significantly higher Mean Arterial Pressure post-induction (p = 0.003) with a lower risk of hypotension (Relative Risk 0.29, 95% Confidence Interval 0.07–1.18). Additionally, the Ketamine group required significantly less induction of Propofol (p < 0.001) and achieved faster extubation times (p < 0.001). Conclusion: Co-induction with sub-anesthetic Ketamine provides superior hemodynamic stability and facilitates faster early neurocognitive recovery compared to Midazolam in geriatric patients. These findings suggest Ketamine is a preferable adjuvant for optimizing emergence profiles and maintaining perfusion pressure in the aging population.
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.
Efficacy of Particulate versus Non-Particulate Corticosteroids as Adjuvants for Popliteal Sciatic Nerve Block: A Randomized Controlled Superiority Trial Erma Rosita; Taufiq Agus Siswagama; Rudy Vitraludyono; Buyung Hartiyo Laksono
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.v7i1.853

Abstract

Introduction: Single-shot ultrasound-guided popliteal sciatic nerve blocks are the gold standard for distal lower limb analgesia but are limited by a finite duration, often necessitating adjuvants. While dexamethasone (non-particulate) is the standard of care, methylprednisolone (particulate) theoretically offers a depot effect for sustained release. This study aimed to determine if perineural methylprednisolone provides superior analgesic duration compared to dexamethasone. Methods: In this prospective, double-blind, randomized controlled trial, 36 ASA I-III patients undergoing distal lower limb surgery were randomized (1:1) to receive 20 mL of 0.5% Ropivacaine with either Dexamethasone 8 mg (Group D) or Methylprednisolone 40 mg (Group M). To ensure blinding, solutions were prepared by an independent pharmacist and administered via opaque syringes. The primary outcome was the duration of analgesia (time to Numeric Rating Scale [NRS] greater than 3), analyzed using Kaplan-Meier survival curves and Log-Rank tests. Secondary outcomes included cumulative opioid consumption, rebound pain severity, and block onset time. The study was powered for superiority with a clinically significant difference of 4 hours. Results: Thirty-six patients completed the study. Demographic and surgical characteristics were comparable. The median duration of analgesia was 18.4 (SD 3.2) hours in Group D and 19.1 (SD 3.5) hours in Group M (p = 0.58; Log-Rank p = 0.61). Pain scores at 12, 24, and 48 hours showed no significant difference, with both groups demonstrating a floor effect due to multimodal analgesia (Median NRS less than 2). No adverse events, including neurotoxicity or infection, were observed. Conclusion: Perineural methylprednisolone failed to demonstrate superior analgesic duration compared to dexamethasone in this cohort. The theoretical depot advantage did not translate to clinical superiority, likely due to vascular clearance in the popliteal fossa. Given the comparable efficacy but superior safety profile of non-particulate agents, dexamethasone remains the preferred adjuvant. Methylprednisolone serves as a viable alternative only when non-particulate options are unavailable.
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.
Precision Anesthetic Management of the Triple-Pathology Parturient: Graded Epidural Technique for Emergency Cesarean Section in Severe Tricuspid Regurgitation, Pulmonary Hypertension, and Systemic Neurofibromatosis Purwoko; Fitri Hapsari Dewi; Helmi Ananta
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.v7i1.856

Abstract

Introduction: Maternal cardiac disease, specifically right-sided valvular lesions exacerbated by pulmonary hypertension, remains a primary driver of maternal mortality. The physiological demands of pregnancy act as a cardiovascular stress test, often leading to decompensation in patients with underlying pathology. This case describes the management of a triple-pathology parturient. Case presentation: A 37-year-old female (G2P1A0) at 34 weeks’ gestation presented with NYHA Class IV symptoms, including progressive dyspnea and orthopnea. Echocardiography revealed severe tricuspid regurgitation (regurgitant volume 112 mL), right ventricular dilatation, and a high probability of pulmonary hypertension with a mean pulmonary arterial pressure of 50.39 mmHg and a systolic pulmonary arterial pressure of 79.32 mmHg. Systemic neurofibromatosis added concerns regarding neuraxial anatomy and airway management. An emergency Cesarean Section was performed under a graded epidural technique using 0.375 percent Levobupivacaine and 50 mcg Fentanyl, administered in 3 mL increments every 5 minutes. Hemodynamic stability was maintained through strict fluid restriction of 300 mL and titrated vasopressors. Conclusion: A carefully titrated graded epidural provides superior stability in the hostile hemodynamics of right heart failure by allowing a slow, compensatory sympathetic blockade. Early multidisciplinary coordination is essential for success in complex cardio-obstetric cases.
Neuroprotective Anesthetic Management Using Thiopental in a 17-Year-Old with Multifocal Epidural Hematoma and Impending Brain Herniation: A Case Report Sutan Malik Maulana Syah; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
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.v7i1.862

Abstract

Introduction: Epidural hematoma resulting from severe traumatic brain injury demands immediate neuroanesthetic intervention. Multifocal lesions accompanied by pneumocephalus and impending brain herniation present profound perioperative challenges requiring targeted cerebral perfusion management. Case presentation: A 17-year-old male weighing 50 kg sustained severe polytrauma, presenting with a Glasgow Coma Scale of 12 and active auditory canal bleeding. Imaging revealed multifocal epidural hematomas in the right frontotemporal (66 cc) and right parietal (43 cc) regions, alongside pneumocephalus, a 1.5 cm subfalcine herniation, and downward transtentorial herniation. The patient, classified as ASA physical status 4E, required an emergent decompressive craniotomy and concurrent facial reconstruction. A neuroprotective anesthetic strategy was deployed utilizing thiopental, fentanyl, and atracurium to minimize the cerebral metabolic rate and control intracranial pressure. Anesthesia was maintained with sevoflurane. Hemodynamics were strictly titrated to ensure optimal cerebral perfusion pressure. Following successful surgical hematoma evacuation, the patient was admitted to the intensive care unit and demonstrated an excellent neurological recovery after a five-day admission. Conclusion: Thiopental serves as a highly effective neuroprotective induction agent for severe traumatic brain injury with intracranial hypertension. Meticulous hemodynamic control and targeted reduction of cerebral metabolism are critical in preventing secondary ischemic cascades and improving functional outcomes in polytrauma patients.

Page 13 of 14 | Total Record : 132

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