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All Journal Bali Journal of Anesthesiology Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia
Auerkari, Aino Nindya
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran Universitas Indonesia-RS Cipto Mangunkusumo
Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Public Health Other

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Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors Auerkari, Aino Nindya; Tantri, Aida Rosita; Alatas, Anas
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (306.902 KB) | DOI: 10.15562/bjoa.v3i2.156

Abstract

Over half of soft tissue tumor surgeries require intraoperative Packed Red Cell (PRC) transfusion. Transfusion should be sufficient, as inadequacy will increase risk of tissue ischemia, morbidity and mortality. On the other hand, liberal transfusion is related to infection, tumor recurrence, and immunosuppression. Therefore, good PRC planning measures in preoperative period are essential. Several factors that can be identified in the preoperative period, have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. These factors are ASA score, preoperative hemoglobin (Hb) value, malignancy, size, and location of tumor. By acknowledging influencing factors, a system for predicting blood requirement can be established to promote patient safety and avoid waste. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion.A retrospective cohort was analyzed on 84 records of orthopaedic soft tissue tumor surgery during 2014-2018. In all subjects, the aforementioned factors, amount of intraoperative bleeding and intraoperative PRC transfusion was recorded. Data was analyzed by linear regression to see the relationship of factors to the amount of bleeding and by logistic regression to assess the probability of receiving intraoperative PRC transfusions. A multivariate analysis identified tumor size as an independent determining factor of bleeding. In further analysis, it was found that tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion. 
MANAJEMEN ANESTESIA PADA SINDROM HUNTER Aino Nindya Auerkari; Andi Ade Wijaya Ramlan
Majalah Kedokteran Indonesia Vol 69 No 10 (2019): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia Volu
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.1234/jinma.v69i10.182

Abstract

Pendahuluan: Sindrom Hunter adalah kumpulan kelainan metabolik bawaan akibat defisiensi enzim lisosom. Pada kelainan ini, terjadi gangguan pemecahan glikosaminoglikans, suatu jenis mukopolisakarida. Karena tidak dipecah secara sempurna, terdapat penumpukan glikosaminoglikans di jaringan, yang mengganggu fungsi organ dan menimbulkan gejala. Penumpukan glikosaminoglikans progresif di jaringan menyebabkan pengidap sindrom Hunter akan dihadapkan pada operasi berkali-kali dalam hidupnya. Anestesiologis diharapkan dapat mempersiapkan pemeriksaan praoperasi, mengelola intraoperasi, dan merawat pascaoperasi pasien ini dengan baik. Deposit substrat, terutama di jalan napas, dapat menjadi penyulit anestesia. Kami menjabarkan pengalaman manajemen jalan napas sulit pada pasien Sindrom Hunter yang telah menjalani terapi sulih enzim. Kesulitan utama pada pasien adalah leher pendek dan keterbatasan gerak sendi. Selain jalan napas, tumpukan glikosaminoglikans di berbagai organ seperti sendi, tulang belakang, dan jantung juga menjadi perhatian khusus dalam manajemen anestesia. Metabolisme obat-obat anestesia juga dapat berbeda jika dibandingkan populasi normal. Karena merupakan penyakit jarang, penyandang sindrom Hunter sebaiknya menjalani pembiusan oleh anestesiologis yang sudah berpengalaman, di pusat kesehatan yang berpengalaman menangani sindrom Hunter.
Manajemen Anestesia pada Sindrom Hunter Aino Nindya Auerkari; Andi Ade Wijaya Ramlan
Majalah Kedokteran Indonesia Vol 69 No 10 (2019): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, V
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.69.10-2020-182

Abstract

Background: Hunter’s syndrome is characterized by congenital metabolic defect due to lysosomal enzyme deficiency. In this syndrome, glycosaminoglycans, a type of mucopolysaccharide cannot be metabolized, and therefore its deposit accumulates in tissue. This substrate deposits progressively over time and eventually interfere with organ function and causes symptoms. Multiple surgeries would be needed to counter its effect throughout patients’ life. Anesthesiologists are expected to prepare the patient for anesthesia, manage intraoperative, and provide postoperative care. The substrate accumulation on airway presents a special challenge for airway management. We describe a case of difficult airway management in a patient with Hunter’s Syndrome who was under enzyme therapy. The main airway challenge are short neck and limited neck extention. Glycosaminoglycans in joints, spine, and heart also require anesthetist’s attention. Drug metabolism in Hunter Syndrome may be different from normal. As this is a rare disease, patients with Hunter’s syndrome is recommended to undergo anesthesia with experienced anesthesiologist in health care facilities with experience in provide care for Hunter’s syndrome.
Co-Authors Alatas, Anas Andi Ade Wijaya Ramlan Solly Aryza Tantri, Aida Rosita