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All Journal Jurnal Anestesiologi Indonesia Jurnal Anestesi Obstetri Indonesia Solo Journal of Anesthesi, Pain and Critical Care Jurnal Neuroanestesi Indonesia Jurnal Komplikasi Anestesi
Ratih Kumala Fajar Apsari
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Kesehatan Masyarakat Dan Keperawatan, Universitas Gadjah Mada, Yogyakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Management of Failed Spinal Anesthesia Hastuti, Wiji; Fajar Apsari, Ratih Kumala; Sudadi, Sudadi
Jurnal Komplikasi Anestesi Vol 13 No 1 (2025)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i1.27741

Abstract

The management of failed spinal anesthesia is a significant challenge in surgical procedures. Spinal anesthesia failure can occur either partially or totally, often leading to conversion to general anesthesia, which adds clinical risks and potential complications. The aim of this study is to evaluate the factors contributing to spinal anesthesia failure and identify effective management strategies. The study found that factors such as patient positioning, anesthesiologist experience, the number of attempts, and patient BMI significantly influenced spinal block success. Total spinal anesthesia failure often requires conversion to general anesthesia, whereas partial failures can be managed with adjuvant medications or repeated procedures. Understanding the management of failed spinal anesthesia is essential for providing safe and effective care
Risk Factors Associated with Morbidity and Mortality after Cervical Spine Injury at Dr Sardjito General Hospital Nashiruddin, Nashiruddin; Fajar Apsari, Ratih Kumala; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 13 No 1 (2025)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v13i1.28419

Abstract

Background: Cervical injury is a form of spinal cord trauma with high morbidity and mortality rates, especially in developing countries. Identifying risk factors is essential for prevention strategies, management, and improved patient outcomesObjective: This study aims to observe the effect of listening to music on the anxiety level of surgical patients undergoing subarachnoid block anesthesia. To analyze risk factors of cervical injury related to morbidity and mortality, and to present the demographic profile of cervical injury cases at Dr Sardjito General HospitalMethods: This study employed a retrospective case-control design involving 127 patients with cervical injury treated at Dr Sardjito General Hospital, Yogyakarta, from January 1, 2022, to December 31, 2024. Data were collected from medical records and analyzed using bivariate analysis (Fisher’s exact test). A p-value <0.05 was considered statistically significant.Results: The majority of patients were male (88.2%) with an average age of 50.57 years. The most common trauma mechanisms were falls from height (45.7%) and traffic accidents (44.9%). Severe disability as morbidity was experienced by 41.7% of patients, while mortality reached 31.5%. Risk factor analysis for morbidity did not find any variables significantly associated with clinical outcomes (P>0.05). Length of stay (LOS) was significantly associated with morbidity (p=0.001). Significant risk factors for mortality included respiratory comorbidity (OR 4.50; p=0.004)Conclusion: ASIA score, prolonged ventilator use, and tracheostomy were identified as risk factors for mortality in cervical injury patients at Dr Sardjito General Hospital. No statistically significant risk factors were found to be associated with morbidity
Acute Fatty Liver of Pregnancy Management in Intensive Care Atsari, Nadhila; Apsari, Ratih Kumala Fajar; Adiyanto, Bowo; Widodo, Untung
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 6, No 1 (2026): April 2026
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v6i1.78517

Abstract

Background: Acute fatty liver of pregnancy (AFLP) is an obstetric emergency with high mortality that usually requires treatment in the intensive care unit (ICU). The cause of AFLP is not known with certainty, but it is suspected due to a deficiency of long chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) in the fetus which causes accumulation of fatty acid metabolites from the fetus and placenta which are hepatotoxic. The clinical manifestations of AFLP are acute liver failure and progression to multiple organ dysfunction syndrome (MODS). This reported case was the only one successful case out of 3 incidences of AFLP recorded in RSUP Dr. Sardjito Yogykarta within a year of 2022. Case Illustration: A 24-years-old postpartum woman at 38 weeks' gestation admitted to resuscitation room with hypovolemic shock due to early postpartum hemorrhage. Patient was resuscitated and then taken to emergency operating room for uterine exploration under general anesthesia. Patient was subsequently admitted to the intensive care unit (ICU).  The patient's initial condition was intubated, requiring vasopressor support with epinephrine and norepinephrine, and the patient showed symptoms of encephalopathy, liver failure and kidney failure. AFLP diagnosis was then made with patient showing score 10 of Swansea criteria. Resuscitation, stabilization, and intensive care treatment was continued for up to eight days in the ICU. The patient's final condition was stable, there were no sequelae of AFLP and the patient was discharged from the hospital at the 14th day in good condition.Conclusion: AFLP is a serious complication during pregnancy and postpartum period that is reversible with a chance of complete recovery but has a high mortality associated with delayed treatment. Adequate early intensive care treatment with multidisciplinary approach essential for successful treatment of AFLP. 
Co-Authors Adi, Danis Woro Kuncoro Adrin, Olga Elenska Akhmad Yun Jufan Anasy, Naufal Apriyanto Arif Ikhwandi Atmadja, Linda Stefanie Atsari, Nadhila Bambang Suryono Bambang Suryono Suwondo Bambang Suryono, Bambang Bowo Adiyanto Calcarina Fitriani Retno Wisudarti Dede Frits Manambual Sinaga Dewi, Wahyu Jati Paramita Ekuarianto, Donny Erna Fitriana A Fadinie, Wulan Fitriati, Mariza Gunawan, Fanny Hadiwinoto, Bambang Hartono, Pinter Hendra, Maijoni Hermawan, Hendra Ikhwandi, Arif Juni Kurniawaty Muhdar Abubakar Djayanti Sari Kuncoro, Kusuma Edhi Mahmud Mahmud Nashiruddin, Nashiruddin Negara, Adista Yugadhyaksa Gupta Nugroho, Stefanus Danan Nurdiansyah, Elba Nurul Ulfah Hayatunnisa Oktavian Rizki Ilahi Prandani, Muhammad Yogi Prayunanto A.N, Eko Rahma, Aulia Zuhria Sari, Dhanty Dwita Satrio Adi Wicaksono SATRIYAS ILYAS Shinta Shinta Sri Rahardjo Sri Rahardjo Sudadi Sudadi Sudadi Suharso, Pamungkas Hary Suryasaputra, Wahyu Tjahya Aryasa Untung Widodo, Untung Utomo, Wandito Gayuh Wiji Hastuti, Wiji Wirawan, Angga Aditya Yoga Pranata Yunita Widyastuti Yusmein Uyun