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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 139 Documents
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A Rare Complication of Vasovagal Syncope Induced by Pulsed Radiofrequency in a Patient with Cervical Spondylosis and Occipital Neuralgia: A Case Report Fajar Ristranda; Buyung Hartiyo Laksono; Taufiq Agus Siswagama
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.v7i1.869

Abstract

Introduction: Pulsed radiofrequency is widely utilized as a minimally invasive neuromodulation technique for managing chronic neuropathic pain, including cervical radicular pain and occipital neuralgia. While pulsed radiofrequency is generally celebrated for its robust safety profile and absence of thermal tissue destruction, unexpected autonomic complications remain poorly characterized in the literature. Case presentation: A 41-year-old female with a six-month history of chronic cervical root syndrome (C3-C6) and refractory occipital neuralgia presented for interventional pain management. Following a comprehensive clinical and radiological evaluation, the patient underwent fluoroscopy-guided pulsed radiofrequency of the bilateral C3 and C4 dorsal root ganglia and the greater and lesser occipital nerves. The procedure was technically successful and uneventful. However, approximately 24 hours post-procedure, the patient experienced a sudden, profound episode of vasovagal syncope, characterized by acute hypotension, bradycardia, and a precipitous drop in consciousness (Glasgow Coma Scale: E3V3M6). Immediate resuscitation, including intravenous fluid boluses and continuous hemodynamic monitoring, led to a full neurological recovery. At follow-up, the patient reported significant attenuation of both radicular and occipital pain scores. Conclusion: This report documents a rare and severe episode of delayed vasovagal syncope following upper cervical and occipital pulsed radiofrequency neuromodulation. The temporal association suggests a complex neuro-autonomic reflex, potentially mediated by the trigeminocervical complex and sudden withdrawal of chronic sympathetic tone. Clinicians performing cervical pulsed radiofrequency must remain vigilant regarding delayed autonomic dysregulation, necessitating extended postoperative observation protocols in susceptible individuals.
Optimizing Patient Blood Management: Successful Intraoperative Cell Salvage During Cesarean Hysterectomy for Placenta Accreta Spectrum - A Case Report Fathimah Azzahra; Ruddi Hartono
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.v7i1.871

Abstract

Introduction: Placenta accreta spectrum disorders represent a critical maternal health concern with a high risk of massive obstetric hemorrhage, which conventionally necessitates substantial allogeneic blood transfusion. Intraoperative cell salvage serves as a highly efficient autotransfusion alternative within modern patient blood management frameworks. Case presentation: A 37-year-old female (Gravida 4, Para 1) at 37-38 weeks of gestation presented with total placenta previa and a Placenta Accreta Index score of 6, correlating to a 69% probability of placenta accreta. A transperitoneal profunda cesarean section with subsequent hysterectomy was planned. A combined spinal-epidural anesthesia technique was utilized, justified by favorable airway metrics and supported by a proactive massive transfusion protocol. Surgical estimated blood loss was 3,500 mL. An intraoperative cell salvage device processed 2,438 mL of shed fluid, which included 1,000 mL of surgical irrigation. This yielded 451 mL of washed packed red blood cells that were successfully reinfused. The patient’s hemodynamics were stabilized using a continuous norepinephrine infusion. The patient received zero allogeneic blood products throughout her admission. Hemoglobin levels were maintained from 10.1 g/dL preoperatively to 9.2 g/dL at discharge. Postoperative coagulation profiles remained stable. The patient was discharged on postoperative day 5 without complications. Conclusion: The application of intraoperative cell salvage in major obstetric surgery is demonstrably safe and clinically beneficial. This technology provides a resource-optimized alternative to allogeneic transfusion.
Anesthetic Management of a Teenage Primigravida with Impending Eclampsia Undergoing Emergency Cesarean Section: A Comprehensive Case Report Paramita Putri Hapsari; Agung Nugroho
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.v7i1.886

Abstract

Introduction: Impending eclampsia represents a medical emergency requiring immediate maternal delivery to prevent progression to seizures and maternal-fetal compromise. The selection of an appropriate anesthetic technique for emergency cesarean section in severely preeclamptic patients remains clinically challenging, balancing the risks and benefits of regional versus general anesthesia. Case presentation: A 19-year-old primigravida at 35 weeks and 6 days of gestation presented with frontal headache, blurred vision, and nausea. Clinical evaluation revealed new-onset hypertension (131/81 mmHg), proteinuria (+2), and mild hypokalemia (3.4 mmol/L), consistent with impending eclampsia. Emergency cesarean section was performed under subarachnoid block utilizing heavy bupivacaine 15 mg with fentanyl 25 micrograms intrathecally. Hemodynamics remained stable throughout the operative period without vasopressor requirement. A male neonate was delivered with Apgar scores of 7-8-9 and a birth weight of 1825 grams. Both mother and infant had favorable postoperative outcomes with resolution of hypertensive crisis and normal neonatal transition. Conclusion: This case demonstrates the efficacy and safety of regional anesthesia in eclamptic parturients undergoing emergency cesarean delivery. Careful patient selection, appropriate drug dosing, and vigilant hemodynamic monitoring enable successful outcomes even in this high-risk scenario.
Daily Sedation Interruption Versus Continuous Sedation for Reducing Mechanical Ventilation Duration in the Intensive Care Unit: A Meta-Analysis Indah Ika Suryaningsih H; Ayu Yesi Agustina
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.v7i1.887

Abstract

Introduction: Mechanical ventilation is a critical intervention in intensive care units, yet prolonged ventilation increases complications including ventilator-associated pneumonia, delirium, and mortality. Daily sedation interruption (DSI) has been proposed as a strategy to reduce ventilation duration, but evidence remains inconsistent. Methods: A systematic review and meta-analysis was conducted searching PubMed, Embase, Cochrane Library, and Web of Science from inception to March 2024. Randomised controlled trials (RCTs) and observational studies comparing DSI with continuous sedation were included. The primary outcome was duration of mechanical ventilation. Pooled standardised mean difference (SMD) and 95% confidence intervals (CI) were calculated using Hedges’ g with a random-effects model. Heterogeneity was assessed using I² statistics, and subgroup analyses stratified by intensive care unit type and study design. Results: Ten studies comprising 2,011 participants were included. Pooled SMD for ventilation duration was −0.3655 (95% CI −0.7611 to 0.0301; p = 0.0662), indicating a non-significant trend favouring DSI, with very high heterogeneity (I² = 91.54%). Subgroup analysis in general intensive care units (three studies, n = 426) demonstrated significant reduction in ventilation duration (SMD = −0.6763, 95% CI −0.1265 to −0.2262; p = 0.0231; I² = 20.38%), whereas medical (three studies) and medical-surgical (three studies) units showed non-significant effects. Sensitivity analysis indicated robustness of findings when studies by Nassar Jr and Mehta (2016) were sequentially excluded. Conclusion: Daily sedation interruption showed a non-significant trend towards reducing mechanical ventilation duration in pooled analysis, with significant benefit demonstrated specifically in general intensive care units. High heterogeneity suggests practice variation in DSI protocols and patient populations influences outcomes. Future standardised DSI protocols and trials in homogeneous populations are warranted.
Vasovagal Syncope Following Pulsed Radiofrequency of Cervical Dorsal Root Ganglia and Occipital Nerves in a Patient with Chronic Cervical Radiculopathy and Occipital Neuralgia: A Case Report Kurnia Hendra Wijaya; 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.v7i1.890

Abstract

Introduction: Pulsed radiofrequency is a minimally invasive, non-destructive neuromodulation technique used to manage chronic cervical radicular pain and occipital neuralgia. It is generally considered safe, with common adverse events limited to mild transient dysaesthesia or local discomfort. Vasovagal syncope following pulsed radiofrequency of the cervical dorsal root ganglia and occipital nerves has not been well documented in the anaesthesia and pain medicine literature. Case presentation: A 41-year-old woman with chronic cervical radiculopathy attributable to C5–C6 herniated disc disease, tension-type headache with pericranial tenderness, a history of cluster headache, chronic spontaneous vertigo, and newly diagnosed hypertension underwent bilateral pulsed radiofrequency of the lesser and greater occipital nerves and of the C3 and C4 dorsal root ganglia under fluoroscopic guidance. The procedure was performed under light sedation with intravenous propofol and midazolam and completed without immediate complication. Approximately 20 hours later, the patient developed an acute decrease in consciousness with a nadir Glasgow Coma Scale of 12 and a heart-rate profile consistent with a reflex vasovagal event. Gradual spontaneous recovery of consciousness was documented over seven hours, reaching a Glasgow Coma Scale of 15 without any neurological deficit. Pre- and post-procedural symptom comparison showed clear improvement in cervical paraesthesia, vertigo, tinnitus, and cluster-type headache, while tension-type headache persisted at a similar intensity. Conclusion: Vasovagal syncope is a rare but clinically relevant adverse event after pulsed radiofrequency of the cervical dorsal root ganglia and occipital nerves. The likely pathophysiology involves afferent stimulation of the trigeminocervical complex and activation of the Bezold–Jarisch reflex in a susceptible patient. Multimodal monitoring, adequate hydration, careful sedation titration, and structured post-procedural observation are recommended to anticipate and manage this complication.
Opioid-Sparing Anesthetic Strategy with Ultrasound-Guided Superficial Cervical Plexus Block in Pediatric Recurrent Lymphangioma Surgery: A Case Report Rofiudin Ali; Rudy Vitraludyono; Buyung Hartiyo Laksono; 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.v7i1.891

Abstract

Introduction: Pediatric cervical mass surgery presents unique perioperative challenges, including airway proximity, hemodynamic lability, and the need for effective opioid-sparing analgesia. The superficial cervical plexus block (SCPB) targets the cutaneous branches of C2-C4 emerging at the posterior border of the sternocleidomastoid muscle, but its use in pediatric oncologic neck surgery is infrequently reported. Case presentation: A 9-year-old girl (24 kg) presented for excision of a progressively enlarging recurrent right cervical mass clinically and radiologically suggestive of a multiloculated lymphatic malformation. After balanced general anesthesia with endotracheal intubation, an ultrasound-guided right SCPB was performed using 8 mL of ropivacaine 0.2% with dexamethasone 5 mg as an adjuvant. The 2-hour excision proceeded with stable hemodynamics, no additional intraoperative opioid requirement after a single induction-phase fentanyl dose, and a positive fluid balance of +40 mL. The patient was extubated uneventfully, recovered in the post-anesthesia care unit (PACU) without rescue analgesic demand, and was transferred to the ward on postoperative day 1 with excellent analgesia and no neurologic, respiratory, or wound complications. Conclusion: Ultrasound-guided SCPB combining low-concentration ropivacaine with perineural dexamethasone provided effective opioid-sparing analgesia for pediatric cervical lymphangioma excision while preserving respiratory reserve and hemodynamic stability. Compared with previously published pediatric SCPB cases — predominantly in vocal cord, otologic, and tympanomastoid surgery — the present report extends documented experience to recurrent oncologic cervical mass excision, contributing to the developing pediatric regional anesthesia literature in the Indonesian and broader Asian setting.
Emergency General Anesthesia with Rapid Sequence Intubation for Cesarean Delivery in Severe Eclampsia Complicated by Pulmonary Edema and Premature Rupture of Membranes: A Multidisciplinary Critical Care Case Report Muhammad Ibrahim; Propan Hanggada Satyamakti Mubarak
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.v7i2.892

Abstract

Introduction: Eclampsia complicated by acute pulmonary edema is a life-threatening obstetric emergency that demands rapid, coordinated multidisciplinary intervention. Premature rupture of membranes (PROM) coexisting with refractory eclamptic seizures and respiratory failure further heightens maternal-fetal risk and complicates anesthetic decision-making. Optimal management requires individualized airway strategy, aggressive seizure control, and meticulous fluid balance under intensive care. Case presentation: A 28-year-old primigravida at term was referred from the emergency department after two generalized tonic-clonic seizures (5 minutes each), with severe hypertension (168/95 mmHg), tachypnea (RR 30/min), Glasgow Coma Scale 12 (sopor), bilateral basal rales, and oxygen desaturation to 92% on room air. Laboratory studies showed proteinuria +2, elevated transaminases (SGOT 62 U/L), and a PaO₂/FiO₂ ratio of 423 mmHg consistent with non-cardiogenic pulmonary edema. Emergency cesarean delivery was performed under general anesthesia with rapid sequence intubation (lidocaine-dexamethasone pretreatment, ketamine-propofol induction, rocuronium paralysis). A live male neonate (3420 g, APGAR 7-8-9) was delivered; surgery duration was 45 minutes. In the ICU, lung-protective mechanical ventilation, continuous furosemide infusion (5 mg/h, negative fluid balance strategy), and escalating multimodal anticonvulsant therapy (magnesium sulfate, midazolam, phenytoin) for refractory seizures were employed. The patient was extubated after 16 seizure-free hours, transferred to the ward on day 3, and discharged with her infant on day 4. Conclusion: Early recognition of eclampsia with pulmonary edema, individualized rapid sequence intubation general anesthesia, multimodal seizure control, and aggressive negative fluid balance under multidisciplinary critical care can yield favorable maternal-neonatal outcomes even in resource-constrained settings.
Ultrasound-Guided Axillary Brachial Plexus Block as a Definitive Anesthetic Strategy in a Patient with Anticipated Difficult Airway Following Post-Burn Cervical Flap Reconstruction: A Case Report Muhammad Husni Thamrin; Muhammad Ridho Aditya; Irfan Yuananda
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.v7i2.893

Abstract

Introduction: Airway management in patients with post-burn cervical flap reconstruction is challenging because hypertrophic scars, restricted neck mobility and limited mouth opening compromise both ventilation and laryngoscopy. Ultrasound-guided regional anesthesia is increasingly proposed as an alternative that preserves spontaneous ventilation and avoids airway instrumentation entirely. Case presentation: A 47-year-old woman scheduled for bilateral hand contracture release presented with extensive post-burn cervical flap reconstruction performed 15 years earlier, persistent neck contractures, facial scarring, Mallampati class III, limited inter-incisor distance and markedly reduced cervical extension. Routine laboratory and chest radiographic findings were within normal limits. An ultrasound-guided axillary brachial plexus block was selected as the sole anesthetic technique, using 20 mL of 2% lidocaine delivered in-plane around the median, ulnar, radial and musculocutaneous nerves. A complete sensorimotor block was achieved within 15 minutes. The procedure proceeded uneventfully without conversion to general anesthesia, and the patient remained hemodynamically stable with effective postoperative analgesia and no neurological deficit. Conclusion: Ultrasound-guided axillary brachial plexus block can serve as a safe and effective definitive anesthetic strategy for distal upper-limb surgery in post-burn cervical flap patients with anticipated difficult airway, supporting the principle that distance from the airway is itself a deliberate anesthetic plan.
Anesthetic Management of Emergency Esophagoscopy for Denture Foreign Body Extraction in an Adult with Uncorrected Pulmonary Atresia–Ventricular Septal Defect, Major Aortopulmonary Collateral Arteries, and Bacterial Pneumonia: A Case Report Eko Setijanto; Bara Adithya; Adhitya Sakti Nugraha
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.v7i2.894

Abstract

Introduction: Esophageal foreign body impaction is a common emergency, but its management becomes uniquely complex when superimposed on uncorrected cyanotic congenital heart disease and acute pulmonary infection. Adults with pulmonary atresia–ventricular septal defect (PA-VSD), major aortopulmonary collateral arteries (MAPCA) and patent ductus arteriosus represent a fragile physiology in which any deterioration in cardiac output, oxygenation or systemic vascular resistance may precipitate refractory hypoxemia. Case presentation: A 51-year-old man presented with sudden throat pain after accidentally swallowing a denture. Cervical radiography revealed an irregular opacity at C4–C5. He had longstanding uncorrected PA-VSD with MAPCA, patent ductus arteriosus and moderate aortic regurgitation; echocardiography showed cardiac output 2.9 L/min and cardiac index 1.86 L/min/m². He was concurrently diagnosed with Klebsiella pneumoniae bacterial pneumonia (chest radiograph: cardiothoracic ratio 75% with pulmonary edema; SpO₂ 94% on room air). Following multidisciplinary preoperative optimization—nebulized ipratropium-salbutamol, furosemide, digoxin, lansoprazole, warfarin, bisoprolol and spironolactone—he underwent emergency rigid esophagoscopy under general anesthesia with endotracheal intubation. Hemodynamic-protective induction preserved systemic vascular resistance and avoided hypoxic-hypercapnic shifts. The denture was extracted intact and the patient was transferred to the intensive care unit with blood products on standby. Conclusion: Successful management required prompt diagnosis, multidisciplinary preoperative optimization and a hemodynamic-protective anesthetic plan tailored to balanced systemic-pulmonary circulation. Awareness of the specific physiology of unrepaired PA-VSD with MAPCA and concurrent pneumonia is essential to safe perioperative care.

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