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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 147 Documents
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Anesthetic Management of a Child with Severe Hydrocephalus, Predicted Difficult Airway, Obstructive Ileus, and Sepsis Undergoing Exploratory Laparotomy: A Case Report Ardana Tri Artanto; Aura Ihsaniar; Joni Riana Mustaqim
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.v7i2.899

Abstract

Introduction: Severe hydrocephalus with macrocephaly creates a predicted difficult airway and raised intracranial pressure (ICP), a challenge magnified when it coexists with obstructive ileus and sepsis. The simultaneous demand to protect the brain, secure a distorted airway, prevent aspiration, and preserve perfusion in a septic, malnourished child makes anesthetic planning exceptionally complex. Case presentation: A 5-year-old boy with cerebral palsy and untreated severe communicating hydrocephalus (head circumference 81 cm) presented with vomiting, abdominal distension, and obstipation. He was septic, severely dehydrated, and marasmic, with imaging confirming severe hydrocephalus, agenesis of the corpus callosum, and low small-bowel obstruction. Exploratory laparotomy was prioritized over ventriculoperitoneal shunting. Anesthesia used a modified rapid sequence induction with a ketamine-based regimen and ramp positioning to align the head-body axis for intubation. Surgery lasted 2.5 hours with stable hemodynamics. The child was transferred intubated to the pediatric intensive care unit for controlled ventilation and neurological monitoring. Conclusion: Integrated, individualized planning allowed safe anesthesia in a child with colliding neurological, surgical, infectious, and nutritional emergencies. A ketamine-based modified rapid sequence induction with ramp positioning, neuroprotective maintenance, surgical sequencing, and planned postoperative ventilation balanced ICP control against septic hemodynamic stability.
Anesthetic Management of a Child with Fraser Syndrome and an Atrial Septal Defect Undergoing Laparoscopic Orchidopexy: A Case Report Purwoko; Bambang Novianto; Samsul Rizal
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.v7i2.911

Abstract

Introduction: Fraser syndrome is a rare autosomal recessive disorder with multisystem manifestations, including craniofacial, ocular, urogenital, and musculoskeletal anomalies, and it may create anesthetic challenges related to difficult airway management. The risk is magnified when congenital heart disease and laparoscopic surgery coexist, because each adds an independent physiologic burden to a child with limited reserve. Case presentation: A 10-year-old boy weighing 8.3 kg and measuring 80 cm, with Fraser syndrome, bilateral anophthalmia, intellectual disability, a history of congenital cytomegalovirus infection, and marasmic malnutrition, underwent laparoscopic exploration of the right testis and orchidopexy of the left testis. Echocardiography demonstrated an atrial septal defect with right atrial and right ventricular dilatation; the patient was classified as American Society of Anesthesiologists physical status III. After midazolam 1 mg premedication, anesthesia was induced with fentanyl 3 mcg/kg, sevoflurane 1-2 vol%, atracurium 5 mg, and dexamethasone 4 mg, and the trachea was intubated with a 4.5-mm cuffed tube. Anesthesia was maintained with sevoflurane 1.5-2 vol% and 50% oxygen. Over the 2-hour procedure, hemodynamics were stable (blood pressure 100-130/60-68 mmHg, heart rate 82-95 beats/min) with a net positive fluid balance of 10 mL. The patient was extubated and remained stable through 24 hours. Conclusion: Safe anesthesia in this setting rested on a layered airway plan, an understanding of shunt physiology, close hemodynamic monitoring, and measured ventilation and fluid strategies rather than on any single drug regimen. The report also highlights data elements that should be documented prospectively to strengthen comparability across similar cases.
Epidural Anesthesia and Staged Inodilator–Vasopressor Support for Emergency Cesarean Section in a Parturient with Severe Tricuspid Regurgitation, Pulmonary Hypertension, and Systemic Lupus Erythematosus: A Case Report Fitri Hapsari Dewi; Propan Hanggada Satyamakti Mubarak; Aditya Baskoro
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.v7i2.913

Abstract

Introduction: Pregnancy imposes a progressive haemodynamic burden that can be lethal in women with fixed cardiac output states. The coexistence of severe tricuspid regurgitation, pulmonary hypertension and systemic lupus erythematosus (SLE) in a parturient is rare and carries a high risk of right ventricular decompensation, especially when an intracardiac right-to-left shunt is present. Case Presentation: We describe a 30-year-old gravida 3 para 2 woman at 37+1 weeks of gestation who presented with antepartum vaginal bleeding and known SLE, severe tricuspid regurgitation (effective regurgitant orifice area 0.4 cm², vena contracta 0.7 cm), high-probability pulmonary hypertension (estimated systolic pulmonary artery pressure 74.7 mmHg) and a patent foramen ovale with right-to-left shunt. Emergency caesarean section was performed under graded epidural anaesthesia with 0.5% levobupivacaine. Intraoperative haemodynamics were supported with titrated infusions of norepinephrine, milrinone, dobutamine and furosemide under deliberate fluid restriction. A 2.56 kg male neonate was delivered with Apgar scores of 7, 8 and 9. Transient maternal hypotension and tachycardia responded to vasoactive titration; pharmacological support was staged down and discontinued by postoperative day 2, and the patient was transferred to the ward on day 3 with an improved tricuspid regurgitant velocity. Conclusion: Graded epidural anaesthesia combined with a pathophysiology-driven, staged inodilator–vasopressor strategy and deliberate fluid restriction enabled a favourable maternal and neonatal outcome in a parturient with the tricuspid–pulmonary hypertension–lupus triad. Multidisciplinary planning and meticulous, lesion-specific haemodynamic monitoring were decisive.
Admission Glucose-to-Potassium Ratio as a Predictor of Mortality Risk in Severe Traumatic Brain Injury Undergoing Craniotomy: A Retrospective Cohort Study Purwoko; Sugeng Budi Santosa; Lichte Christian Purbono
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.v7i2.915

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability, and case fatality after emergency neurosurgery remains high, creating an urgent need for inexpensive, rapidly available prognostic tools. The admission glucose-to-potassium ratio (GKR) integrates the concurrent hyperglycaemia and hypokalaemia of the neuroendocrine stress response and may outperform either parameter alone; this study analysed its correlation with mortality risk in severe-TBI patients undergoing craniotomy. Methods: A retrospective cohort of 95 adults (18–60 years) with severe TBI (Glasgow Coma Scale ≤8) managed surgically at Dr. Moewardi Regional General Hospital, Surakarta (March–August 2024) was studied by consecutive sampling. GKR was calculated from admission blood glucose (mg/dL) divided by serum potassium (mmol/L); mortality risk was quantified with the MOST score (low 0–30, moderate 31–60, high 61–100). Analyses included Spearman correlation with 95% confidence intervals, Kruskal–Wallis testing with ε², ROC analysis, and multivariable logistic regression. Results: Median GKR was 35.14 (range 23.18–64.14) and rose monotonically across strata (26.94, 35.21, 55.67). GKR correlated with mortality risk (ρ = 0.376, 95% CI 0.19–0.54, p < 0.001), more strongly than glucose (ρ = 0.329, p = 0.001) or potassium (ρ = −0.243, p = 0.018). GKR discriminated high mortality risk with an area under the curve of 0.91 (95% CI 0.82–0.99) at a cut-off of 47.0, and each unit raised the adjusted odds of high risk 1.35-fold (95% CI 1.09–1.66, p = 0.006). Conclusion: Admission GKR is a simple, robust bedside marker for early mortality-risk stratification in severe-TBI craniotomy patients.
Corticosteroid Responsiveness in Acute Respiratory Distress Syndrome of Different Aetiologies: A Two-Patient Case Series Rahmad Dwi Saputra; Arie Zainul Fatoni; Rudy Vitraludyono
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.v7i2.916

Abstract

Introduction: Acute respiratory distress syndrome (ARDS) is a life-threatening, biologically heterogeneous form of acute hypoxaemic respiratory failure arising from a broad spectrum of direct and indirect pulmonary insults. Although lung-protective ventilation and supportive care remain the foundation of management, the role of corticosteroids is still debated, with benefit concentrated in carefully selected patients and specific inflammatory phenotypes. We describe two patients whose ARDS arose from distinct aetiologies yet responded favourably to low-dose corticosteroid therapy. Case Presentation: The first patient was a 14-year-old girl with Marfan syndrome who developed abrupt severe hypoxaemia with bilateral infiltrates within six hours of massive intraoperative transfusion during scoliosis correction, consistent with post-transfusion (transfusion-related) acute lung injury. The second was a 39-year-old man with severe ARDS from bilateral pulmonary contusion after blunt chest trauma, complicated by Acinetobacter baumannii and Enterobacteriaceae hospital-acquired pneumonia. Both received lung-protective mechanical ventilation with individualised positive end-expiratory pressure and intravenous methylprednisolone 62.5 mg/day. Oxygenation and radiographic appearance improved progressively, with the ratio of arterial oxygen tension to inspired oxygen fraction rising from 72 to 343 by day 5 in the first patient and from 72 to 357 by day 11 in the second, permitting successful liberation from the ventilator. Conclusion: In these two aetiologically distinct patients, early low-dose methylprednisolone added to lung-protective ventilation was associated with rapid clinical and radiographic recovery. The series supports an individualised, aetiology- and phenotype-aware approach to adjunctive corticosteroid therapy in ARDS rather than uniform application or avoidance.
Spinal Anesthesia for Emergency Cesarean Section in a Parturient with Coexisting Myasthenia Gravis, Ankylosing Spondylitis, and Multiple Sclerosis: A Rare Case Report and Structured Anesthetic Approach RTH Supraptomo; Andy Nugroho; Putri Junita Sari
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.v7i2.920

Abstract

Introduction: The simultaneous occurrence of myasthenia gravis, ankylosing spondylitis, and multiple sclerosis in a pregnant woman requiring emergency cesarean section is exceptionally rare and, to our knowledge, has not previously been documented. These autoimmune disorders impose overlapping neuromuscular, demyelinating, and axial-skeletal constraints that interact to make peripartum anesthetic decision-making uniquely hazardous. Case Presentation: A 34-year-old multiparous woman with a five-year history of myasthenia gravis, ankylosing spondylitis, and multiple sclerosis presented at 30 weeks' gestation with premature rupture of membranes, irregular contractions, and reduced fetal movement, alongside ptosis, diplopia, dysphagia, dysarthria, dysphonia, dyspnea, and limb weakness. She was maintained on pyridostigmine, methylprednisolone, and adalimumab with pregnancy-adjusted dosing. After multidisciplinary evaluation, emergency cesarean section was performed under single-shot spinal anesthesia using 0.5% bupivacaine 10 mg with fentanyl 25 mcg at L4-L5 via a 27-gauge Quincke needle in a single, uncomplicated pass, with a difficult-airway cart and rocuronium-sugammadex prepared as contingency. Hemodynamics remained stable apart from a transient rise in respiratory rate that resolved with oxygen. A preterm female infant weighing 1,415 g was delivered with Apgar scores of 5, 7, and 8. Mother and infant were monitored in intensive care; the mother reached the ward on postoperative day one without myasthenic crisis. Conclusion: Pregnancy with three coexisting autoimmune diseases generates synergistic, not merely additive, anesthetic risk. Carefully conducted spinal anesthesia, supported by multidisciplinary planning, disease-tailored drug selection, and a staged airway-rescue plan, achieved a safe outcome and offers a transferable framework for comparable emergencies.
Multimodal Neuroanesthesia with an Ultrasound-Guided Dexamethasone-Adjuvanted Scalp Block for Endoscopic Transsphenoidal Resection of a Giant Sellar-Suprasellar Rathke Cleft Cyst: A Case Report Angga Andre Fahrizal; Buyung Hartiyo Laksono; Dewi Arum Sawitri
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.v7i2.921

Abstract

Introduction: Sellar and suprasellar masses commonly present with visual failure and endocrinopathy, and the endoscopic endonasal transsphenoidal route is now the standard corridor for their resection. The procedure imposes intense but intermittent nociceptive surges upon a narrow, blood-intolerant surgical field, so the neuroanesthetic plan must reconcile profound analgesia, brain relaxation, hemodynamic stability, and rapid neurological emergence. We describe the perioperative management of a giant Rathke cleft cyst using a multimodal regimen anchored by a regional scalp block. Case Presentation: A 45-year-old woman (body mass index 31.1 kg/m²) presented with one year of progressive bitemporal visual field narrowing. Magnetic resonance imaging showed a cystic sellar-suprasellar mass with a mural nodule compressing the optic chiasm, favoring a giant Rathke cleft cyst over a sellar abscess. She was American Society of Anesthesiologists physical status III with stage 1 hypertension. Under total intravenous anesthesia titrated to a bispectral index of 40 to 60, a bilateral scalp block using 0.375% ropivacaine with 10 mg dexamethasone in 20 mL was performed after induction to blunt the sympathetic response. Mean arterial pressure was held at 65 to 80 mmHg across the five-hour endoscopic transnasal resection with sphenoidectomy and nasoseptal flap reconstruction. Emergence was smooth without bucking. In intensive care the patient was Glasgow Coma Scale 15 with no deficit; urine output reached 2.35 mL/kg/hr and sodium fell mildly to 132 mEq/L, and both were managed conservatively without desmopressin. Conclusion: Integrating a fully endoscopic transsphenoidal approach with a dexamethasone-adjuvanted scalp block and target-controlled total intravenous anesthesia delivered a bloodless field, immaculate hemodynamic control, and prompt neurological recovery. Structured intensive care surveillance for diabetes insipidus and dysnatremia secured a safe trajectory, offering a transferable framework for complex sellar tumor anesthesia.

Page 15 of 15 | Total Record : 147

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