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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 123 Documents
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Dexamethasone as an Adjuvant to Lidocaine 2% and Levobupivacaine 0,5% in Transversus Abdominis Plane (TAP) Block after Appendectomy Surgery: A Case Report Pradnya Niti, Ida Ayu Apsari; Albertus Medianto; Agus Suardhesana
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.558

Abstract

Introduction: Post-appendectomy pain can hinder patient recovery and increase opioid consumption. TAP (transversus abdominis plane) block is an effective regional anesthetic technique for controlling pain after abdominal surgery. Dexamethasone, as an anti-inflammatory, can be added as an adjuvant to enhance the analgesic effect. Case presentation: This study describes the effectiveness of TAP block with adjuvant dexamethasone in patient A, a 17-year-old woman who underwent appendectomy. The patient received a TAP block with lidocaine 20 ml, levobupivacaine 10 ml, and dexamethasone 10 mg. Patient pain was measured using the numeric rating scale (NRS) at 1, 2, 6, 12, and 24 hours after surgery. Patients experienced low NRS values, even 0 at 1, 2, 6, 12, and 24 hours after surgery. Adjuvant dexamethasone to TAP block likely increases the analgesic effect and reduces opioid requirements. Conclusion: TAP block with adjuvant dexamethasone is an effective regional anesthesia technique for controlling post-appendectomy pain, increasing patient comfort, and speeding recovery.
Management and Consideration of Anesthesia Procedures in Eclampsia: A Case Report Rauwelio, Alvin; I Wayan Widana
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.560

Abstract

Introduction: Eclampsia is a serious pregnancy complication with high maternal and fetal mortality rates. The choice of anesthetic technique in eclamptic patients must consider various factors, including the condition of the mother and fetus, the risk of complications, and the experience of the anesthesia team. Case presentation: We report the case of a 21-year-old 39-week-old primigravida (G1P0A0) with severe eclampsia who experienced two tonic-clonic seizures. The patient was intubated in the emergency room and underwent an emergency caesarean section under general anesthesia. The patient was treated in the ICU for one day and extubated on the second day. Conclusion: The choice of anesthetic technique in eclamptic patients must be done individually by considering various factors. The anesthesia team must be experienced in treating eclamptic patients and have the readiness to deal with complications that may occur.
Intensive Management of Post Caesarean Section with Eclampsia: A Case Report Pratiaksa, Ardian; Eko Setijanto
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.568

Abstract

Introduction: Eclampsia, a severe form of pre-eclampsia characterized by high blood pressure and seizures, poses a significant threat to both maternal and fetal health. With a global incidence of 2-8% among pregnancies affected by pre-eclampsia, eklampsia remains a leading cause of maternal mortality, particularly in low-resource settings. Given the potential for serious complications associated with postpartum eklampsia, it is crucial for anesthesia teams to possess a comprehensive understanding of the condition's management and the specific considerations required in the postpartum setting. Case presentation: We report a 19 years old woman post caesarean section with eclampsia. The patient had a recurrent seizure on the first day at the ICU. After had an intensive therapy at the ICU the patient showed a clinically improvement and extubated on the second day. The case highlights the importance of a holistic and comprehensive approach to postpartum care in eklampsia patients. By addressing not only the immediate symptoms but also the underlying physiological and neurological derangements, the ICU team was able to effectively manage the patient's condition and facilitate her recovery. Conclusion: Postpartum care in the intensive care unit needs to be hollistic and comprehensive with the aim of not aggravating the patient's condition and worsening the patient's prognosis.
Fast-Track Anesthesia for Cito Craniotomy Evacuation Hematoma Due to Temporoparietal Subdural Hemorrhagic Hematoma in a Pediatric Patient: A Case Report Wardhana, Anggia Rarasati; Ardana Tri Arianto
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.569

Abstract

Introduction: Subdural hematoma (SDH) in early childhood is a serious condition that requires immediate surgical intervention. Fast-track anesthesia is an approach that aims to speed up the patient's recovery after surgery. This case report presents the experience of fast-track anesthesia in a 4-month-old pediatric patient with SDH who underwent a cito craniotomy. Case presentation: A 4-month-old child with a history of head trauma due to shaking experienced recurrent seizures. CT scan examination showed left temporoparietal SDH with intraparenchymal hemorrhage. The patient was classified as ASA IIIE and underwent a cito craniotomy. A fast-track anesthesia strategy was implemented using rapid induction, multimodal analgesia, and strict fluid management. Conclusion: Fast-track anesthesia was successfully applied to pediatric patients with SDH undergoing cito craniotomy. This approach allows for a quicker recovery, reduces postoperative complications, and shortens the length of hospital stay.
USG Guided Interscalene Nerve Block as Perioperative Management in Close Fracture Clavicula with Traumatic Brain Injury Patient and Contusio Pulmonum: A Case Report Prasetya, Novandi Lisyam; Muhammad Husni Thamrin; Ellen Josephine Handoko
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.582

Abstract

Introduction: Blunt trauma from motor vehicle accidents (MVA) often results in multisystem injuries, including chest, head, and musculoskeletal injuries. Management of these complex injuries requires a multidisciplinary approach and can present unique anesthetic challenges. Case presentation: A 22-year-old man was treated in the emergency department (ER) after experiencing an MVA. The patient experienced chest and shoulder pain and was found to have anemia, increased creatinine, respiratory acidosis, prolonged prothrombin time (PT), and increased serum glutamic oxaloacetic transaminase (SGOT). Radiological examination revealed left tension hydropneumothorax, right hydropneumothorax, bilateral lung contusions, fractures of the ribs, clavicle, and scapula. In addition, the patient also experienced subarachnoid hemorrhage (SAH) in the left parietotemporal region and right cistern (Fisher Scale III), brain edema, right pneumo-orbita, type III septal deviation, bilateral inferior nasal concha hypertrophy, and concha bullosa on the medial nasal concha. The patient's physical status was assessed as ASA III. The patient underwent open reduction and internal fixation (ORIF) with an S-plate on the right clavicle. Anesthesia was provided with an interscalene block using 0.375% levobupivacaine and premedication with Fentanyl and Midazolam. Conclusion: This case highlights the complexity of managing blunt trauma patients with multisystem injuries. A multidisciplinary approach, including careful airway management, hemodynamic monitoring, and selection of appropriate anesthetic techniques, is essential for optimal results.
Anesthetic Management and Perioperative Care in Neonates with Esophageal Atresia: A Case Report Adithya, Krisna Tri; Eko Setijanto
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.590

Abstract

Introduction: Esophageal atresia is a congenital disorder that requires immediate surgical intervention. Careful anesthetic management and perioperative care are crucial for successful therapy in neonates with this condition. Case presentation: A 20-day-old male infant with esophageal atresia underwent anastomotic thoracotomy surgery. Premedication, induction, and maintenance of anesthesia were performed with a combination of Sevoflurane, Ketamine, and Fentanyl. Postoperatively, the baby was treated in the NICU with mechanical ventilation and antibiotic therapy. Conclusion: Comprehensive anesthetic management and perioperative care in neonates with esophageal atresia include prevention of aspiration, adequate ventilation, pain management, and close postoperative monitoring to ensure optimal outcomes.
Challenges of Anesthetic Management in Pediatric Patients with Hernia Inguinalis Lateralis Dextra Reponibilis: A Case Report Lestari, Puspita Wahyu; Muh Iswan Wahab; Gede Indrajaya
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.598

Abstract

Introduction: Hernia inguinalis lateralis dextra reponibilis (HILD repr.) is a common condition in infants and children, but anesthetic management in these pediatric patients requires special attention. Children's unique physiological and pharmacological characteristics, potential comorbidities, and risk of postoperative pain demand a careful and integrated approach. Case presentation: This case report presents comprehensive anesthetic management of a 6-month-old male infant who underwent elective herniotomy for HILD repr. The anesthesia procedure involved induction with sevoflurane and fentanyl, maintenance of anesthesia with sevoflurane, and multimodal pain management with paracetamol and bupivacaine. The surgery was successful without complications, and the patient recovered well. Conclusion: This case highlights the importance of implementing modern anesthetic practices in pediatric patients with HILD repr., including selection of appropriate anesthetic agents, close monitoring, and multimodal pain management. Specific challenges such as unique airway anatomy, variability in drug pharmacokinetics, and risk of perioperative complications are also highlighted. The successful anesthetic management of this case highlights the importance of an individualized approach and close monitoring to optimize clinical outcomes and minimize complications in pediatric patients with HILD repr.
Acute Respiratory Distress Syndrome in a Patient with Myasthenia Gravis and Septic Shock: A Case Report Nur Amin, Taufiqurrochman; Septian Adi Permana
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.613

Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune disorder characterized by muscle weakness, often affecting respiratory and oropharyngeal muscles. This predisposition to respiratory compromise, coupled with impaired swallowing and the potential need for immunosuppressive therapies, increases the risk of pneumonia and subsequent sepsis in MG patients. Sepsis, in turn, is a significant risk factor for acute respiratory distress syndrome (ARDS), a severe lung condition with high mortality. Case presentation: We present the case of a 47-year-old male with a 4-year history of MG who was admitted to our hospital with progressive dyspnea and dysphagia. His condition deteriorated rapidly, leading to septic shock and respiratory failure necessitating invasive mechanical ventilation. Blood cultures identified Klebsiella pneumoniae with extended-spectrum beta-lactamase (ESBL) production. Despite aggressive treatment, including therapeutic plasma exchange (TPE), the patient's hospital course was complicated. Conclusion: This case underscores the critical importance of vigilant monitoring and early intervention in MG patients presenting with respiratory symptoms or signs of infection. Prompt recognition and aggressive management of sepsis are crucial to mitigate the risk of ARDS and improve outcomes in this vulnerable patient population.
Microbiological Landscape of Intensive Care Unit: A Retrospective Analysis of Bacterial Pathogens and Their Implications Sukmantara, I Putu Bayu; Dewa Ayu Putu Diah Dharmayanti; Dewa Ngakan Gde Dwija Sanjaya
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.616

Abstract

Introduction: The intensive care unit (ICU) is a high-risk environment for hospital-acquired infections (HAIs) due to the complex interplay of patient vulnerability, invasive procedures, and the selective pressure of antimicrobial use. Understanding the local epidemiology of bacterial pathogens is crucial for effective infection prevention and control strategies. This study aimed to characterize the bacterial profile in an ICU setting, providing insights into the prevalent pathogens and their potential implications for patient care. Methods: A retrospective cross-sectional study was conducted, encompassing patients admitted to the ICU of Bangli Hospital Bali in 2023 and 2024. Data on patient demographics, sample sources, and microbiological findings were collected from medical records. Samples included blood cultures, sputum cultures (from both endotracheal tubes and spontaneous expectoration), wound swabs, and other sterile site cultures. Microbiological identification was performed using standard laboratory techniques. Results: A total of 219 patients were included in the study. The most common sample source was blood culture (42.9%), followed by sputum culture from endotracheal tubes (39.3%). A significant proportion of cultures showed no growth (34.7%), highlighting the challenges in identifying causative pathogens in the ICU. Among the identified pathogens, Staphylococcus spp. was predominant (15.5%), followed by Stenotrophomonas maltophilia (9.6%) and coagulase-negative staphylococci (8.7%). The distribution of pathogens varied across sample sources, with Staphylococcus spp. being prevalent in sputum cultures from endotracheal tubes and Klebsiella pneumoniae in sputum cultures. Conclusion: This study underscores the dynamic nature of the microbiological landscape in the ICU. The predominance of Staphylococcus spp., Stenotrophomonas maltophilia, and other opportunistic pathogens emphasizes the need for robust infection prevention and control measures. Further research is warranted to explore the impact of these pathogens on patient outcomes and to optimize antimicrobial stewardship in this critical care setting.
Successful Management of Myasthenia Gravis Crisis with Septic Shock and Arrhythmia using Plasmapheresis: A Case Report Viandini, Riska Yulinta; Arie Zainul Fatoni
Journal of Anesthesiology and Clinical Research Vol. 5 No. 3 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i3.638

Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune disorder that causes muscle weakness. In severe cases, it can lead to myasthenic crisis, a life-threatening condition characterized by respiratory failure. Sepsis, a systemic inflammatory response to infection, can further complicate MG and increase the risk of mortality. This case report describes the successful management of a patient with MG crisis complicated by septic shock and arrhythmia using plasmapheresis. Case presentation: A 52-year-old male with a history of MG presented with progressive dyspnea, decreased consciousness, and oxygen desaturation. He was diagnosed with MG crisis, septic shock, and arrhythmia. The patient was treated with plasmapheresis, antibiotics, and supportive care. Following plasmapheresis, the patient showed significant improvement in muscle strength, respiratory function, and hemodynamic stability. The arrhythmia resolved, and the patient was eventually weaned off mechanical ventilation. Conclusion: This case report highlights the potential benefits of plasmapheresis in managing MG crisis complicated by septic shock and arrhythmia. Plasmapheresis may be considered as a therapeutic option in such cases to improve patient outcomes.

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