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Yudhistira, Rafael Bagus
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Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health

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Perioperative Management in Parturient with Severe Preeclampsia, Obesity, and COVID-19 Yudhistira, Rafael Bagus; Yudhistira, Muhammad Yurizar; Supraptomo, Raden Theodorus
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 2 (2021): October 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (360.903 KB) | DOI: 10.20961/soja.v1i2.54984

Abstract

The elevated cases of pregnant women infected with COVID-19 who needed to undergo caesarean section is a great challenge to anesthesiologists. Morbid obesity and preeclampsia in pregnancy are also another challenge to medical practice especially when the patient requires caesarean section. To describe the perioperative management of a morbidly obese preeclamptic patient with COVID-19. A pregnant woman with mild case of COVID-19, severe preeclampsia and obesity underwent an emergency caesarean section. Spinal anesthesia was performed using a Whitacre 26G spinal needle with 76 mm length, bupivacaine 0.5% 12.5 mg as spinal anesthesia agent and fentanyl 25 mcg as adjuvant. All operating teams use PPE according to COVID-19 guidelines and standard procedures. The operation went with a good outcome without any transmission to the operating team. The patient underwent treatment without postoperative complications. Spinal anesthesia is considered safe to be a usual technique for parturient with preeclampsia and morbid obesity. A proper COVID-19 surgery protocol is crucial in order to protect health workers handling COVID-19 patients.
Dexmedetomidine vs. Other Sedatives in Mechanically Ventilated Sepsis Patients: Updated Meta-analysis Putera, Rizky Eka; Yudhistira, Rafael Bagus; Onggowasito, Livilia Abigail; Sudiono, Nathania Ella
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 2 (2025): October 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i2.106536

Abstract

Introduction. Globally, the incidence of sepsis is estimated at over 400 cases per 100,000 population annually, making it a major public health concern.  .   In this setting, sedation is essential to ensure patient-ventilator synchrony and reduce physiological stress. Dexmedetomidine is a selective α₂-agonist often used instead of traditional sedatives because it provides light sedation, lowers the risk of delirium, and may reduce inflammation. However, clinical outcomes remain inconsistent across studies. To assess the clinical effects of dexmedetomidine compared to other sedatives in mechanically ventilated sepsis patients.Methods. A comprehensive literature search of Pubmed, Scopus, Cochrane Central, Scilit, and Epistemonikos was performed to identify studies published from 2020 to 2025. Inclusion criteria included Randomized Controlled Trial (RCT) studies that directly compared dexamethomidine as sedation and involving sepsis patients with mechanical ventilation. Risk of Bias was estimated using RoB2.0 and meta analysis was using Revman 5.4.Results. Eight randomized control trials (n = 1119) were included. Compared to other sedatives, dexmedetomidine prolonged hospital LOS significantly (MD = 1.47; 95% CI: 0.59 to 2.34; p = 0.001), reduced ICU LOS significantly (MD = -0.91; 95%CI = -1.51 to -0.29; p = 0.004), not improving the event of mortality insignificantly (OR = 0.99; 95% CI: 0.71–1.37; p = 0.95), reduced ventilator-free days insignificantly (MD = –0.85; 95% CI = –1.94 to 0.25; p = 0.13), and improved lactate clearance insignificantly (MD = 0.54; 95%CI = -0.41 to 1.49; p = 0.21)Conclusion. Dexmedetomidine reduces ICU length of stay and may offer early mortality benefits at 28 days in mechanically ventilated sepsis patients. However, its effects on hospital stay, lactate clearance, and ventilator-free days remain uncertain, and further standardized trials are needed.
Co-Authors Onggowasito, Livilia Abigail Putera, Rizky Eka Sudiono, Nathania Ella Supraptomo, Raden Theodorus Yudhistira, Muhammad Yurizar