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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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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.

Page 14 of 14 | Total Record : 132

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