Jurnal Komplikasi Anestesi

The Relationship of Lactate-Albumin Ratio to Mortality and Length of Stay in Sepsis Patients at ICU Dr.Sardjito General Hospital

Desti Pasmawati — 2026-03-10

Background : Sepsis is one of the causes of morbidity and mortality patients hospitalized in the intensive care unit (ICU) which requires early detection and management to predict outcomes. Lactate-albumin ratio has a predictive value of mortality in patient with sepsis that is similar to APACHE II and SOFA scores.

Objective : To determine the relationship between the lactate-albumin ratio and mortality and length of stay patient with sepsis in ICU of Dr. Sardjito Hospital.

Method : Research design using a retrospective cohort observational study by collecting data from the medical records of sepsis patients at ICU of Dr. Sardjito Hospital. Data were calculate the optimal cutoff using the ROC curve. The relationship between lactate-albumin ratio levels and mortality was analyzed using the chi-square test method followed by logistic regression.

Results : The total study subjects were 136 patients. The cut-off value for the Lactate-Albumin ratio in predicting mortality 0,878, sensitivity 73.0 % and specificity 57.1% (AUC = 0,687; 95% CI 0,56-0,81; p=0,007). The cut-off value for the Lactate-Albumin ratio in predicting ICU length of stay 0,878, sensitivity 71,2% and specificity 63,6% (AUC = 0,684; 95% CI 0,53-0,84; p=0,043). Multivariate analysis showed that an increase in the Lactate-Albumin ratio was independent and significant factor as a predictor of mortality (OR=3,43; 95% CI 1,29-9,16; p=0,013) and ICU length of stay (OR=4,33; 95% CI 1,19-15,68; p=0,036).

Conclusion : An increase in the Lactate-Albumin ratio is independently and significantly associated with an increased risk of mortality and length of stay in sepsis patients.

The Correlation Between Syndecan-1 Post Cardiopulmonary Bypass and Duration of Ventilator Use in Open Heart Surgery Patients at Dr. Sardjito General Hospital, Yogyakarta

Fatmi Eka Putri — 2026-03-15

Background: Open heart surgery involves the use of a cardiopulmonary bypass machine (CBP) to replace the heart and lungs during surgery. The use of CBP can damage the endothelial glycocalyx, which triggers increased levels of syndecan-1, an indicator of endothelial degradation. Elevated syndecan-1 levels are associated with various complications, such as coagulation disorders, edema, and organ dysfunction. In the lungs, endothelial glycocalyx damage can lead to edema and lung parenchymal damage, which can impair overall lung function and lead to a decreased PaO2/FiO2 ratio, requiring prolonged postoperative ventilator use.
Objective: This study aimed to determine the relationship between post-CBP syndecan-1 levels and the duration of ventilator use in open heart surgery patients at Dr. Sardjito General Hospital, Yogyakarta.
Methods: This study was a prospective, analytical, observational cohort study conducted at Dr. Sardjito General Hospital, Yogyakarta. The sample consisted of adult patients undergoing open heart surgery, with the exclusion criteria being patients using preoperative mechanical assist devices. Syndecan-1 levels were measured using the ELISA method using the Elabscience Human SDC1 kit. Data were analyzed using SPSS. Bivariate and multivariate analyses were also performed to evaluate factors influencing ventilator duration.
Results: The study was conducted on 34 subjects with a mean age of 46 ± 13.71 years. The average CPB duration was 92.94 ± 47.57 minutes, with preoperative syndecan-1 levels of 8.86 ± 5.08 ng/ml, while post-CPB levels were 11.74 ± 3.71 ng/ml, with delta syndecan-1 levels of 2.87 ± 4.18 ng/ml.

Comparison of Post Dural Puncture Headache Occurrences During Spinal Anesthesia with 25g, 26g, and 27g Quincke Needles in Brachytherapy at Dr Sardjito Hospital, Yogyakarta

Christiana Trijayanti — 2026-03-15

Background: Spinal anesthesia is one of the anesthesia techniques for surgery in various fields, one of which is brachytherapy. Post dural puncture headache (PDPH) is one of the most common complications after spinal anesthesia, one of the risk factors of which is related to the size of the spinal needle used
Objective: To determine the relationship between the incidence of PDPH after spinal anesthesia with Quincke needles with sizes 25G, 26G, and 27G
Methods: The design of this study was an experimental study, randomized control trial and primary data collection was carried out on patients undergoing brachytherapy with spinal anesthesia in August-October 2024 until the sample size was met. The research data were tested using the Fisher's exact test and logistic regression.
Results: 32 patients underwent brachytherapy with spinal anesthesia, with each group consisting of 44 patients. The highest incidence of PDPH occurred in the group with a 25G needle, namely 10 patients, and in the groups using 26G and 27G needles, there were 2 patients each who experienced PDPH. In multivariate analysis, BMI had a greater influence on the incidence of PDPH than the number of punctures, but there was no significant difference between the two variables.
Conclusion: The use of 26G and 27G needles has a lower incidence of PDPH than the use of 25G needles

Comparison Between Charlson Comorbidity Index (CCI) and The American Society of Anesthesiologists Physical Status Classification (ASA) in Predicting Mortality in Geriatric Patients Undergoing Anesthesia at Dr Sardjito Hospital Yogyakarta

Ragil Catur Nugroho — 2026-03-17

Background: Geriatric patients tend to have more comorbidities accompanied by a decline in physiological and cognitive function, which impacts perioperative outcomes. The combination of physiological dysfunction, especially changes in pharmacodynamics and pharmacokinetics of drugs, leads to several challenges in administering anesthesia. The Charlson Comorbidity Index (CCI) has been used to predict mortality based on comorbidity assessment. The American Society of Anesthesiologists (ASA) categorizes physiological status to estimate patient health based on anesthesia expert assessment. Increased CCI and ASA scores are known to have significant correlation to increased mortality in geriatric patients undergoing surgery.
Objective: To compare the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification in predicting mortality in geriatric patients undergoing anesthesia at Dr. Sardjito Hospital, Yogyakarta
Methods: A retrospective observational study was conducted on all geriatric patients undergoing anesthesia procedures in the operating room of Dr. Sardjito Hospital, Yogyakarta, during the period of February-April 2021. Normality tests were performed using Kolmogorov-Smirnov. Bivariate analysis was conducted using the Chi-square test. A p-value of <0.05 was considered statistically significant. The predictive validity of CCI and ASA scores, as well as the optimal cutoff point for CCI scores, were evaluated using multivariate logistic regression analysis based on discrimination testing by observing the Area Under Curve (AUC) and the Hosmer-Lemeshow calibration test.

Results: There was a significant association between CCI scores and mortality (OR 4.589; 95% CI 1.257-16.747; p=0.021). Meanwhile, no significant association was found between ASA and mortality in geriatric patients undergoing anesthesia

Opioid-free Anesthesia Technique in Laparoscopic Hysterectomy: A Case Report

Tesha Islami Monika — 2026-03-08

Background: The use of opioid-free anesthesia techniques is increasingly recognized in efforts to reduce the risk of opioid-related postoperative side effects.
Case: This case report describes the use of opioid-free anesthesia technique in laparoscopic hysterectomy in a 50-year-old woman with multiple myomas. The patient had a history of fentanyl allergy and was classified as ASA I. Anesthesia induction was performed with a combination of dexmedetomidine, ketamine, and rocuronium, maintained with sevoflurane, rocuronium, and lidocaine. The patient did not experience any complications during postoperative monitoring.
Discussion: This case highlights that an opioid-free anesthesia approach can be safely implemented in patients with opioid allergies. The combination of dexmedetomidine, ketamine, and lidocaine provides adequate analgesia and hemodynamic stability, supporting its role as an effective alternative to opioid-based anesthesia
Conclusion: This anesthesia technique demonstrates good pain control without the use of opioids and minimizes opioid-related side effects

Anaphylaxis-Induced Acute Coronary Syndrome: A Critical Intersection of Allergic and Cardiac Events

Rizkan Triatmaja — 2026-03-10

Background: A 56-year-old man arrived at the Emergency Department with shortness of breath that had persisted for 30 minutes. He developed a rash, diaphoresis, and nausea shortly after taking sodium diclofenac. While in the Emergency Department, he experienced cardiac arrest and was successfully resuscitated.
Case: he patient had a medical history of hypertension, heart failure, and coronary artery disease, and had received a stent in the left anterior descending (LAD) artery one year prior. His initial vital signs showed blood pressure of 106/64 mmHg, heart rate of 65 bpm, respiratory rate of 25 breaths/min, and SpO2 of 98% on room air. Physical examination revealed an erythematous rash over the entire body and wheezing on pulmonary auscultation. Post–return of spontaneous circulation (ROSC) electrocardiogram (ECG) showed sinus rhythm with bifascicular block, inferior old myocardial infarction (OMI), ischemic changes, and occasional ventricular extrasystole (VES). Initial troponin I level was 0.01 (normal <0.02).
Discussion: The patient received intensive care unit (ICU) management after being intubated following cardiac arrest, which led to hemodynamic stabilization. Transthoracic echocardiography revealed reduced left ventricular systolic function with an ejection fraction of 38%.
Conclusion: The patient was successfully extubated on the fourth day and discharged nine days after admission with a diagnosis of suspected Kounis syndrome, although the specific type could not be determined due to diagnostic resource limitations

Opioid-Free Anesthesia Management in Anterior Cervical Decompression for Cervical Spondylotic Myelopathy

Bambang Ediwan Prabowo — 2026-03-12

Background: Cervical spondylotic myelopathy is degenerative pathology that occurred at spine and can caused neurologic and autonomic dysfunction. It is quite challenging in anesthesia management and to achieve the good outcome especially in maintain hemodynamic.
Case: A Case-Report about 54-year-old woman with history of anterior cervical decompression, Hypertension and diabetic. She was complaining about progressive tetraplegia and hypoesthesia at level thoracal 4. The patient underwent an anterior cervical fussion due to posterior longitudinal Ligament ossification. The vital sign and hemodynamic was stable. At Induction she was given Propofol 120 mg, Dexmeditomidine 1 mcg/kgbb, Rocuronium 50 mg, paracetamol 1000 mg and ketorolac 30 mg. superfivial cervical block was done using 5 ml of Bupivacaine 0,25%. Dexmeditomidine was given at second hour prior surgery with range dose 0,7-1 mcg/kg/hour with gradual reduction of 0,2 mcg per hours. Rocuronium was given until 5th hour of surgery.
Discussion: The operation lasted 6 hours with stable hemodynamics. Preoperative regulation of blood pressure and blood glucose contributed in maintaining stable haemodynamic intraoperative. In this case dexmedetomidine decreased opioid consumption intraoperative and post operative, but it might cause slight hypertension. in this case post operative outcome was good.
Conclusion: Cervical spondylosis myelopathy was a degenerative condition that can cause ototnom dysfunction and neurologic disorder. Anesthesia and analgesia management plays an important role in this case. Dexmeditomidine contributed in maintaining haemodynamic patient remain stable. Careful airway management and appropriate anesthetic strategy are crucial for the successful management of patients with phlegmon and morbid obesity.

Tracheal Stenosis in Neuro Myelitis Optica Spectrum Disorders: Airway Management in the ICU

Taufiqo Nugraha — 2026-03-10

Background: A woman, 32 years old, with Neuro Myelitis Optica Spectrum Disorder (NMOSD) came to the emergency department complaining dyspnea, productive cough, wheezing and low oxygen levels. She was intubated using an uncuff endotracheal tube (ETT) size. 5. Subsequently, an inadvertent dislodgement of the ETT in the intensive care unit (ICU). A Thoracic CT imaging showed tracheal narrowing at the thoracic 1-2 level, approximetely 58% of the lumen width. A Multidisciplinary case conference was convened to plan balloon dilatation bronchoscopy with a bedside tracheostomy as a backup crash airway protocol
Case: NMOSD attacks can be life-threatening, leading to respiratory failure requiring orotracheal intubation (OTI). Patient with a history of prolonged and repeated intubation in the ICU may develop post-intubation tracheal stenosis (PITS).
Discussion: The patient experienced ETT dislodgement, prompting reintubation with ETT cuffs number 4 and 6 using a video laryngoscope and an adult bougie. Reintubation with a larger ETT size was is necessitated by reduced mucosal edema following adequate steroid, inhalation, and antibiotic therapy. Balloon dilatation bronchoscopy of mucosal stenosis via LMA was successfully performed, followed by intubation using ETT cuff no. 8 with guided bronchoscopy. The patient was successfully weaned from mechanical ventilation with a leak test before extubation.
Conclusion: Airway management by considering the location and degree of stenosis as well as the patient's general condition. Balloon dilatation with bronchoscopy offers good results in patients with tracheal stenosis who are not eligible for surgery.

Acid-Base Disorders: Interpretation of the Stewart Approach

Shianita Stanie — 2026-03-10

Comprehension of physiological consequences arising from acid-base disturbances, together with manageable factors such as ventilation and perfusion that rapidly affect acid-base balance, is essential for anesthesiologists. The application of the Stewart acid-base model has advanced the mechanistic understanding of acid-base physiology. This model incorporates shifts in ions, including Cl-, K+, Na+, and PO43-, as well as the buffering capacity of albumin, to detect acid-base disorders. The Stewart approach is superior for identifying subtle and otherwise undetectable metabolic changes. It is founded on three core principles: electroneutrality, dissociation equilibria of incompletely dissociated substances, and mass conservation. In the Stewart method, [HCO3-] and pH in body fluids represent dependent variables determined by three independent variables: total CO2, strong ion difference (SID), and total weak non-volatile acid concentration (ATOT), which is primarily governed by albumin and phosphate levels.

Regional Anesthesia for Ophthalmic Surgery

Muhammad Ryan Radifan Gustisiya — 2026-03-27

Sub-Tenon’s block is a regional anesthetic technique widely used in ophthalmic surgery as a safer alternative to retrobulbar and peribulbar blocks. The technique involves injecting local anesthetic into the sub-Tenon’s space using a blunt cannula after a small incision is made in the conjunctiva and Tenon’s capsule. A thorough understanding of orbital anatomy, conjunctiva, Tenon’s capsule, vascular supply, and innervation of the eye is essential for the success of this block. Various local anesthetics can be used, either alone or in combination, with adjuvants such as hyaluronidase to enhance diffusion and improve block quality. Sub-Tenon’s block provides reliable analgesia with generally adequate akinesia for cataract, vitreoretinal, and other ophthalmic procedures, while carrying a relatively low risk of complications. Other advantages include greater patient comfort and suitability for high-risk groups where needle blocks are contraindicated, such as patients with high myopia or those receiving anticoagulant therapy. Nevertheless, limitations such as incomplete akinesia, particularly of the superior oblique muscle, and the occurrence of chemosis or subconjunctival hemorrhage should be anticipated. With strict aseptic technique, appropriate anesthetic volume, and skilled providers, Sub-Tenon’s block remains an effective, safe, and relevant option in modern ophthalmic anesthesia practice