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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Wicaksana, Zulfikar Loka
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Medicine & Pharmacology

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Effectiveness and Safety of Prolonged Needle Decompression Procedures in Tension Pneumothorax Patients with COVID-19 Koeshardiandi, Mirza; Wicaksana, Zulfikar Loka; Semedi, Bambang Pujo; Avidar, Yoppie Prim
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 1 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (305.887 KB) | DOI: 10.20473/ijar.V4I12022.47-54

Abstract

Introduction: Coronavirus disease-19 (COVID-19) has become a pandemic that is still ongoing today. This is a new challenge for health workers in handling emergency cases. Several COVID-19 patients arrived at the hospital with severe respiratory problems. Meanwhile, other pathological conditions causing respiratory failure must also be considered, such as pneumothorax. Objective: This study aimed to examine the effective emergency procedures to treat COVID-19 cases with tension pneumothorax. Case Report: A 45-year-old male patient arrived with a referral letter from a pulmonologist with a diagnosis of simple pneumothorax and pneumonia. The patient also presented a positive SARS COV-2 PCR test result. The patient complained about a worsening of shortness of breath. A symptom of dry cough for 14 days was also reported. Chest radiograph examination subsequently indicated right tension pneumothorax. In the emergency ward, needle decompression procedure connected to the vial containing sterile intravenous fluids was performed. Re-examination of the chest x-ray demonstrated right pulmonary re-expansion. The patient was monitored and after four days, needle decompression was removed and no chest tube was inserted because complete resolution of the lungs had occurred. This case illustrates that tension pneumothorax causes worsening of the patient's condition with COVID-19 diagnosis. In another case of tension pneumothorax in a COVID-19 patient, needle decompression of the 2nd intercostal space and the mid-clavicular line was performed as initial treatment followed by chest tube insertion as definitive treatment. However, in this case, chest tube approach was not carried out because the patient had demonstrated clinical and radiological improvement and a worsening condition had not occurred. Conclusion: Prolonged needle decompression connected to a vial containing sterile intravenous fluids as deep as 2 cm from the water surface is an effective procedure in the management of tension pneumothorax even without the installation of a chest tube.
Administration of Nitrates After Spontaneous Delivery in Rheumatic Heart Disease Koeshardiandi, Mirza; Himawan, Muhammad Wildan Afif; Perdhana, Fajar; Wicaksana, Zulfikar Loka
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I12023.45-50

Abstract

Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.
Co-Authors Avidar, Yoppie Prim Himawan, Muhammad Wildan Afif Koeshardiandi, Mirza Perdhana, Fajar Semedi, Bambang Pujo