Jurnal Komplikasi Anestesi

Association between Comorbidities and Quality of Life Among Geriatric Patients Undergoing Anesthesia at Dr. Sardjito Hospital

Baiq Dessy Resmana Dewi — 2026-08-05

Background: Geriatricians undergo an aging process involving molecular and cellular changes that lead to physiological changes. These changes have led to the emergence of comorbidities suffered by 44% of geriatricians in Indonesia, such as hypertension, diabetes mellitus, chronic pulmonary obstruction, and others. Changing conditions during old age and comorbid factors affect a person's quality of life, especially in the geriatric population. This is a challenge for medical practitioners who will carry out anesthesia procedures. Quality of life is an important measure in assessing the success of patient treatment, especially geriatric patients with comorbidities undergoing anesthesia and operative procedures.
Objective: To determine the association between comorbid conditions and the quality of life of geriatric patients undergoing anesthesia procedures at Dr. Sardjito Hospital.
Methods: A retrospective observational study was conducted on secondary data of geriatric patients who underwent anesthesia at Dr Sardjito Hospital, Yogyakarta, in February-April 2021. Quality of life was measured using the Indonesian WHOQoL-BREF instrument, while comorbidity was measured using the Charlson Comorbidity Index (CCI) instrument. Association between CCI and WHOQoL-BREF was analyzed using the chi-square test, while multivariate analysis was carried out using logistic regression. ROC analysis was also carried out to determine the optimal cut-off point for the CCI score in predicting poor quality of life.
Results: The ROC graph shows that the cut-off score CCI=1 with a sensitivity of 64.4% and a specificity of 58.0% can predict WHOQoL-BREF <60, but with poor discrimination ability (AUC 0.612; 95% CI 0.515 – 0.709).

Outcome of Traumatic Brain Injury Patients with EDH, SDH, and ICH Bleeding Undergoing Craniotomy Surgery at Dr. General Sardjito Hospital, Yogyakarta

Muhammad Fiqih Hidayat — 2026-07-14

ABSTRACT

Background: Traumatic brain injury (TBI) is clinically divided into primary and secondary. CT Scan is a common examination as a diagnostic of TBI patients. Craniotomy surgery has been proven to be useful in treating TBI and reducing mortality rates. Clinical outcomes of TBI patients can be assessed using GOSE scale.

Objective: To determine the differences in clinical outcomes in traumatic brain injury patients with types of brain hemorrhage who underwent craniotomy surgery.

Methods: This study used a prospective observational study design with a prospective cohort study design. The sampling technique was whole sampling of traumatic brain injury patients who underwent craniotomy surgery with CT scan images of brain hemorrhage in the form of SDH, EDH, or ICH. Patient outcomes were assessed using the GOSE scale. Bivariate statistical tests used the Chi-squared test or Kruskal walls test. The test was declared significant when the p-value <0.05.

Results: A total of 36 subjects met the inclusion and exclusion criteria. The majority of subjects had good which were reported for SDH (100%), EDH (84.61%), and ICH (66.6%). There was no significant relationship between age (p=0.53), gender (p=0.63), TBI CT scan appearance (p=0.34), and GCS (p=0.54) with TBI patient outcomes.

Conclusion: The majority of TBI patients who underwent craniotomy had good patient outcomes. In this study, there was no statistically significant difference between the outcomes of TBI patients with EDH, SDH, and ICH bleeding who underwent craniotomy as measured by the GOSE scale.

Keywords: Traumatic brain injury, Types of Brain Hemorrhage, Craniotomy, GOSE

Association between the Clinically Assessed Blink Reflex and Bispectral Index during Propofol Induction of Anesthesia at Dr. Sardjito General Hospital, Yogyakarta

Christine Tirza JItmau — 2026-08-11

Background: Assessment of anesthetic depth during induction is essential to ensure patient safety and to prevent intraoperative awareness. The Bispectral Index (BIS) is a widely used objective monitor derived from electroencephalographic activity; however, its use may be limited by cost and equipment availability. The clinically assessed blink reflex is a simple bedside sign that may serve as a practical indicator during anesthetic induction.
Objective: To determine the association between the clinically assessed blink reflex and BIS values during propofol induction of anesthesia.
Methods: This was a prospective observational analytic study involving 59 adult patients aged 18–65 years with American Society of Anesthesiologists (ASA) physical status I–II who underwent elective surgery under general anesthesia at Dr. Sardjito General Hospital. All patients received propofol 1.5 mg/kg for induction. The clinically assessed blink reflex and BIS were evaluated at baseline and at 15, 30, and 60 seconds after induction. In this study, the blink reflex was defined as a bedside elicited eyelid-closure response recorded as present or absent. Data were analyzed using the chi-square test or Fisher’s exact test, followed by multivariable analysis.
Results: Before induction, all participants exhibited an intact blink reflex on bedside examination. At 15 seconds after induction, the blink reflex was still present in 36 patients (61.0%), decreasing to 8 patients (13.6%) at 30 seconds, and disappearing in all patients at 60 seconds.

Association Between Lactate Concentration and Acute Kidney Injury after Cardiac Surgery With Cardiopulmonary Bypass at Dr. Sardjito General Hospital

Nathanael Jaya Bimastani — 2026-08-26

Background: Cardiac surgery using a cardiopulmonary bypass (CPB) machine is a complex procedure that can trigger systemic inflammatory responses, tissue perfusion disorders, and lactate accumulation. Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious postoperative complication of cardiac surgery that increases morbidity, mortality, and duration of intensive care unit (ICU) stay.
Objective: This study aims to determine the relationship between lactate concentration and the incidence of CSA-AKI and to establish the lactate cut-off value as a risk marker for CSA-AKI in patients following cardiac surgery using a cardiopulmonary bypass machine at Dr. Sardjito General Hospital Yogyakarta.
Methods: A prospective cohort study (December 2025--February 2026) on elective cardiac surgery patients at Dr. Sardjito General Hospital. Inclusion criteria: age ≥18 years, NYHA <class III, and eGFR ≥60 mL/min/1.73 m². CSA-AKI was defined based on KDIGO 2012 criteria.
Results: Study subjects comprised 43 subjects (from a total of 45 patients, 2 dropouts). Mean age 46.84 ± 12.40 years, male (60.5%), EF 61.97 ± 9.17%. Procedures were dominated by CABG (37.2%) and valve surgery (37.2%), with CPB duration 96.13 ± 23.71 minutes. The incidence of CSA-AKI was 65.1%. ROC curve analysis of lactate 6 hours post-CPB showed AUC 0.800 (p=0.001) with optimal cut-off 3.44 mmol/L (sensitivity 71.4%, specificity 73.3%)
Conclusion: There is a positive relationship between lactate concentration 6 hours post-CPB and the incidence of CSA-AKI, and lactate cut-off value 6 hours post-CPB ≥3.44 mmol/L has potential as a risk marker for CSA-AKI in patients following cardiac surgery with a cardiopulmonary

Ultrasound-guided Adductor Canal and Popliteal Sciatic Nerve Blocks as Sole Anesthesia for Below-Knee Amputation in a Septic Patient

Aristi Intan Soraya — 2026-08-26

Background: Septic patients requiring urgent below-knee amputation (BKA) represent a particularly high-risk anesthetic population due to vasoplegia, myocardial dysfunction, and multiorgan impairment. In this setting, general anesthesia may exacerbate cardiovascular depression, while neuraxial techniques risk profound sympathectomy-induced hypotension.
Case: A 53-year-old man with sepsis secondary to a diabetic foot ulcer, complicated by chronic kidney disease and severe anemia, required urgent BKA. An ultrasound-guided adductor canal block with 2% lidocaine and a popliteal sciatic nerve block with 0.5% levobupivacaine were performed. Adequate surgical anesthesia was achieved without airway instrumentation or intraoperative opioid administration. The 90-minute procedure was completed with stable hemodynamics and no significant fluctuations. Postoperative pain scores remained below 3/10 during the first 12 hours under an opioid-free multimodal regimen. The patient’s septic condition improved, and he was discharged on postoperative day four without major complications.
Discussion: In septic patients, avoiding systemic vasodilation and myocardial depression is critical. PNBs provide targeted neural blockade while preserving sympathetic tone, potentially reducing intraoperative hypotension. Ultrasound guidance enhances precision and safety, making PNBs a viable primary anesthetic option in selected high-risk patients
Conclusion: Ultrasound-guided peripheral nerve blocks can provide effective surgical anesthesia with hemodynamic stability in septic patients undergoing urgent BKA, supporting their role as a strategic alternative in vulnerable populations

Triple Regional Block for Clavicle Surgery in a Pregnancy: A Combination of Interscalene, Superficial Cervical Plexus, and Clavipectoral Fascial Plane Blocks

Iin Suryanti — 2026-07-14

Background: Clavicle surgery is commonly performed under general anesthesia; however, this approach may pose additional risks in pregnant patients because of physiological airway changes and potential fetal exposure to anesthetic agents. Regional anesthesia may offer a safer alternative in selected cases.
Case: A 32-year-old woman at 28 weeks and 5 days of gestation presented with a closed midshaft fracture of the left clavicle following a motorcycle accident. Radiographic evaluation confirmed a comminuted midshaft clavicle fracture (Allman type I). The patient underwent open reduction and internal fixation under ultrasound- and nerve stimulator-guided triple regional anesthesia consisting of an interscalene block with 25 mL of 0.5% bupivacaine, a superficial cervical plexus block with 5 mL of 0.5% bupivacaine, and a clavipectoral fascial plane block with 5 mL of 2% lidocaine. Adequate surgical anesthesia was achieved with stable maternal hemodynamics and fetal heart rate, without conversion to general anesthesia.
Discussion: Clavicle surgery presents a challenge for regional anesthesia because of its complex innervation from both the cervical and brachial plexuses. In this pregnant patient, combining interscalene, superficial cervical plexus, and clavipectoral fascial plane block provided complementary sensory coverage and adequate surgical anesthesia without additional sedation or conversion to general anesthesia. This approach minimized airway manipulation and systemic anesthetic exposure, which are important.
considerations during pregnancy, while maintaining stable maternal hemodynamics and fetal heart rate throughout the procedure.
Conclusion: This case demonstrates that a triple regional block technique can provide adequate surgical anesthesia for clavicle fixation in pregnancy, with stable maternal and fetal well-being

Anesthesia Management in Neonate with Esophageal Atresia Undergoing Esophagotomy and Thoracotomy

Galih Puspitasari — 2026-03-17

Background: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are congenital malformations that often occur together and require surgery within the first few days of life. Anesthesia management for these procedures is challenging. This case report describes the anesthetic management of a neonate with esophageal atresia undergoing thoracotomy and esophagotomy.

Case: A five-day-old male infant presented with vomiting and respiratory distress after feeding attempts and was referred for specialized care to our hospital. Upon arrival, physical and diagnostic evaluations confirmed EA. After preoperative evaluation and optimization, the patient underwent surgery. General anesthesia with invasive monitoring was used.

Discussion: Surgical options for EA/TEF repair include thoracotomy and esophagostomy. Anesthesia management for this type of surgery in patients with esophageal atresia involves perioperative and postoperative considerations. Our patient presented several anesthetic challenges. Pneumonia and sepsis added further complexity. Mortality in neonates with EA/TEF is often multifactorial.

Conclusion: Effective anesthesia management for EA/TEF repair requires careful multidisciplinary planning and coordination, considering the high risks associated with the condition. Postoperative care in the NICU is essential for monitoring and managing potential complications.

When “Adequate” MAP Is Not Enough: Underresuscitation as a Driver of Multiple Organ Dysfunction Syndrome in Polytrauma

Vizzi Alvi Fitrah Nasution — 2026-08-11

Case: Male, 68 years old, with a history of coronary heart disease and stroke, had shock due to kidney trauma, tension pneumothorax, hemothorax, multiple rib fractures, complete left radius fracture, and right frontal laceration following a traffic accident while driving a car. The patient underwent fluid resuscitation, placed water seal drainage (WSD), and administered dobutamine and norepinephrine via central access in the emergency department. The patient was then transferred to the high care unit (HCU). After 31 hours of treatment, the patient experienced multiple organ dysfunction syndrome (MODS), then treated in the intensive care unit (ICU) on mechanical ventilation. During treatment in the ICU, the patient underwent continuous renal replacement therapy (CRRT) for 48 hours. There were clinical improvements during CRRT, but his condition deteriorated after CRRT terminated. He died on the fifth day.

Discussion: Trauma is the main preventable cause of morbidity and mortality in adults. Sepsis can increase the risk of mortality in trauma cases. Insufficient identification of shock etiology and lack of follow-up in this patient led to suboptimal resuscitation up to MODS and death. Mechanical ventilation should be performed during initial resuscitation to reduce oxygen consumption.

The Use of Laryngeal Mask Airway (LMA) in General Anesthesia for Elective Cesarean Section

Ahmad Fauzi — 2026-08-05

The Laryngeal Mask Airway (LMA) is a supraglottic airway device introduced by Archie Brain in 1988 and has become one of the most important innovations in anesthetic practice. The development of second-generation LMAs has demonstrated significant improvements in safety, particularly through the addition of gastric drainage channels and higher oropharyngeal seal pressures. These innovations aim to reduce the risk of aspiration and enhance the effectiveness of positive pressure ventilation. In obstetric practice, especially elective cesarean section, second- generation LMAs such as the ProSeal LMA (PLMA) and Supreme LMA (SLMA) have shown promising outcomes in patients with low aspiration risk. Multiple studies report high first-attempt insertion success rates (98–100%), rapid insertion times, and adequate ventilation and oxygenation. Additionally, LMA use is associated with more stable hemodynamic responses and a low incidence of complications, including aspiration, hypoxia, and airway spasm. However, the endotracheal tube remains the gold standard for airway management in obstetric anesthesia. Second-generation LMAs are recommended as an alternative in selected situations, particularly in cases of unexpected difficult or failed intubation. Their use requires careful patient selection, adherence to preoperative fasting guidelines, and operator experience to minimize potential complications. In conclusion, second-generation LMAs are effective and relatively safe airway devices for elective cesarean section in selected patients and play a crucial role in difficult airway management algorithms in modern anesthetic practice

Artificial Intelligence in Anesthesiology and Intensive Care: Recent Developments, Clinical Applications, Clinical Decision Support Systems and Implementation Challenges in the Era of Digital Medicine

Fitri Sepviyanti Sumardi — 2026-08-11

Artificial Intelligence (AI) is rapidly evolving and has become a transformative innovation in anesthesiology and intensive care. Technologies such as machine learning, deep learning, clinical decision support systems (CDSS), and Generative Artificial Intelligence (GenAI) offer significant potential to enhance clinical practice. This literature review discusses recent developments, clinical applications, implementation challenges, and future directions of AI in anesthesiology and intensive care units (ICU). Studies indicate that AI can enhance preoperative assessment through more accurate risk stratification, predict intraoperative hypotension, optimize fluid therapy and hemodynamic management, assist with monitoring anesthesia depth, and support ultrasound-guided regional anesthesia. In intensive care units, AI contributes to early sepsis detection, prediction of acute kidney injury, optimization of mechanical ventilation, identification of multiorgan failure risk, and mortality prediction. The emergence of GenAI and Large Language Models (LLMs) has further expanded AI applications in medical education, literature reviews, research, clinical documentation, and guideline development. However, AI implementation continues to face challenges, including limited prospective validation, algorithmic bias, insufficient explainability, the risk of LLM hallucinations, data security concerns, and ethical and medicolegal issues.Artificial Intelligence (AI) is not intended to replace anesthesiologists, but it serves as augmented intelligence that supports evidence-based clinical decision-making. Responsible AI implementation requires strengthening digital infrastructure, developing algorithms based on local data, and increasing literacy. Artificial Intelligence (AI) for health workers, as well as regulations that ensure security, transparency, and accountability. With this approach, AI has the potential to improve the quality, safety, efficiency, and personalization of anesthesiology services and intensive care.