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All Journal Record and Library Journal JURNAL PENGABDIAN KEPADA MASYARAKAT Bioscientia Medicina : Journal of Biomedicine and Translational Research Nabla Dewantara : Jurnal Pendidikan Matematika International Journal of Health, Economics, and Social Sciences (IJHESS) Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research Logic : Jurnal Rancang Bangun Dan Teknologi Jurnal Teknik Ilmu dan Aplikasi Journal of Educational Management Research Jurnal Teknik Mesin Sriwijaya Journal of Otorhinolaryngology Jurnal Pengabdian Masyarakat dan Riset Pendidikan Mathematics Education Journal
Purwoko
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Agriculture, Biological Sciences & Forestry Humanities Automotive Engineering Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Civil Engineering, Building, Construction & Architecture Computer Science & IT Control & Systems Engineering Economics, Econometrics & Finance Education Electrical & Electronics Engineering Energy Engineering Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Library & Information Science Mathematics Mechanical Engineering Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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General Anesthesia and Modified Rapid Sequence Induction for Emergency Cesarean Delivery in an Eclamptic Adolescent with Severe Thrombocytopenia Yohannes Baptista Paskah Prasanto; Purwoko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1579

Abstract

Background: Eclampsia complicated by severe thrombocytopenia presents a critical anesthetic challenge, often representing an absolute contraindication to neuraxial anesthesia. When alternative approaches are mandated, General Anesthesia with Rapid Sequence Induction or a modified rapid sequence approach is crucial for high-risk obstetric emergencies. Case presentation: A 16-year-old primigravida at 35 weeks gestation presented with eclampsia, acute fetal distress, and severe thrombocytopenia. Initial vitals showed a blood pressure of 150/98 mmHg. Laboratory findings confirmed severe preeclampsia with a critical platelet count of 42,000/µL. An airway assessment revealed a Mallampati class II airway with mild pharyngolaryngeal edema. Due to the high risk of spinal epidural hematoma, neuraxial anesthesia was contraindicated. An emergency cesarean section was performed using a modified rapid sequence induction. Following preoxygenation, induction was achieved with fentanyl 100 µg, midazolam 3 mg, and propofol 100 mg. Due to institutional unavailability of rocuronium, atracurium 30 mg was utilized. After a 2.5-minute onset interval utilizing apneic oxygenation and continuous cricoid pressure, the patient was successfully intubated on the first attempt with a Macintosh size 3 blade. The intraoperative course was hemodynamically stable. Conclusion: A modified rapid sequence induction utilizing atracurium provides an effective alternative for airway control and physiological stability in eclamptic adolescents with coagulopathy, particularly in resource-limited settings where standard rapid-acting non-depolarizing agents are unavailable.
Co-Authors Adiptya Cahya Mahendra Aditya Akbar Anugrah Anggit Murdani Ashri Hidayati Bambang Novianto Putro Bayu Pranoto Billy Suandito Cahyono, Hiding Darmawijoyo, Darmawijoyo Deny Setiawan Dinal ‘Ulya Fernando Feliz Christyan Fitri Hapsari Dewi Fitrianty Munaka Fitroh Adhilla Helmawati Helmi Ananta Marini Fitriani Maryono Misdalina Muhammad Husni Thamrin Mutrofin Nanda Bimantara Naufal Reza Putra Nurchajat NURHADI Nurlaili Nyimas Aisyah Pratiaksa, Ardian Pratiwi, Weni Dwi R.N. Akhsanu Takwim, R.N. Akhsanu Rohana Rojikin, Setyo Santoso Septian Adi Permana Suprihartini Syahrul Fauzi Syamsul Hadi Trimurti Saleh Widyatmike Gede Mulawarman WINARSIH Yahya, Masrur Yohannes Baptista Paskah Prasanto Yusuf Hartono Zainuri, Ach. Muhib Zulkardi