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All Journal Indonesian Journal of Health Science Journal of Scientech Research and Development
Wahyuddin Suleman
Universitas Sam Ratulangi
Humanities Computer Science & IT Dentistry Education Health Professions Industrial & Manufacturing Engineering Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary

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Epidural anesthesia in patients with chronic coronary syndrome undergoing non-cardiac surgery Miranti I. Kumesan; Diana Ch. Lalenoh; Wahyuddin Suleman
Indonesian Journal of Health Science Vol 6 No 2 (2026)
Publisher : PT WIM Solusi Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54957/ijhs.v6i2.2135

Abstract

Patients with cardiovascular disease, particularly Chronic Coronary Syndrome (CCS), face high perioperative risks, including myocardial ischemia, arrhythmias, and hemodynamic instability. Appropriate anesthetic management aims to maintain the balance between oxygen supply and demand as well as hemodynamic stability, including through the use of regional anesthesia techniques as a safer alternative. We report the case of a 71-year-old male patient, ASA III, with CCS accompanied by valvular heart disease in the form of mild aortic regurgitation and moderate pulmonary regurgitation, who underwent Percutaneous Nephrolithotomy (PCNL). Anesthesia management utilized a lumbar epidural technique with catheter placement at the L1–L2 level, 6 cm intradural, and administration of 12 ml of 0.75% ropivacaine. The intended block coverage included the T10–L2 viscerotome and the T8–S2 dermatome. Hemodynamic and pain assessments were performed periodically during the intraoperative period and in the post-anesthesia care unit (PACU). The block depth reached the target within 20 minutes, allowing the surgery to begin immediately. During the 2-hour and 25-minute procedure, the patient’s hemodynamics remained stable without complaints of chest pain or shortness of breath, and no additional anesthetic agents were required. In the PACU, the patient’s sensory and motor functions returned to normal with a NRS pain score of 1. The epidural regional anesthesia technique in a patient with CCS undergoing non-cardiac surgery was shown to facilitate hemodynamic stability intra- and postoperative pain control, thereby potentially significantly minimizing the risk of perioperative ischemia.
CASE REPORT: PERIOPERATIVE ANESTHESIA MANAGEMENT OF ABRUPTIO PLACENTAE COMPLICATED BY HYPOVOLEMIC SHOCK AND SEVERE COAGULOPATHY Vicktor; Mordekhai Leopold Laihad; Wahyuddin Suleman
Journal of Scientech Research and Development Vol 8 No 1 (2026): JSRD, June 2026
Publisher : Ikatan Dosen Menulis

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56670/jsrd.v8i1.1519

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Introduction: Abruptio placentae is a critical obstetric emergency that contributes to significant maternal and perinatal morbidity and mortality worldwide. This condition often leads to massive hemorrhage, disseminated intravascular coagulation (DIC), and profound hypovolemic shock. Case Presentation: A 32-year-old female, weighing 80 kg, Body Mass Index (BMI) 36.5 kg/m², G5P4A0 at 36-37 weeks’ gestation, was referred with severe abdominal pain and dark vaginal bleeding. Upon arrival, the patient was in decompensated shock (blood pressure 74/40 mmHg, heart rate 101 bpm) with a diagnosis of abruptio placentae and Intrauterine Fetal Death (IUFD). Laboratory findings revealed anemia (hemoglobin 10.0 g/dL), severe thrombocytopenia (58,000/uL), and impaired coagulation profiles (prothrombin time 29.4 seconds, activated partial thromboplastin time 49.5 seconds). The patient underwent an emergency cesarean hysterectomy under general anesthesia with endotracheal intubation. Intraoperative blood loss reached 1,700 mL. Management strategies included aggressive fluid resuscitation, vasopressor support, and a massive transfusion protocol (packed red cells, fresh frozen plasma, and thrombocyte concentrate). Conclusion: The successful management of such cases relies on early recognition of shock, definitive airway management, and aggressive correction of coagulopathy. Synergistic coordination between the anesthetic and obstetric teams in deciding on a timely emergency hysterectomy is crucial to control the source of hemorrhage.
Co-Authors Diana Ch. Lalenoh Miranti I. Kumesan Mordekhai Leopold Laihad Vicktor