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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 123 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 (2025): 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 (2025): 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.

Page 13 of 13 | Total Record : 123

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