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Ari Wahyuni
Medical Faculty of Lampung University
Education Medicine & Pharmacology Neuroscience Public Health

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Anestesi Spinal pada Sectio Caesarea dengan indikasi Preeklampsia Berat: Sebuah Laporan Kasus Ari Wahyuni; Devi Octiara
Medula Vol 11 No 1 (2021): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v11i1.208

Abstract

Severe preeclampsia is a disorder that occurs at the age of 20 weeks of pregnancy until approaching labor characterized by systolic blood pressure ≥160 mmHg and diastolic blood pressure ≥110 mmHg, proteinuria ≥2+ on dipstick, platelets <100.000/μL, elevated levels of liver enzymes; AST and ALT, oliguria <400 ml/24 hours, creatinine serum >1.2 mg/dl, epigastric pain, pulmonary edema, headaches in the frontal region, diplopia or blurred vision, and retinal bleeding. Pre-survey results in 2016 at H. Abdul Moeloek Regional Hospital in Lampung Province as many as 46 cases of maternal deaths caused by preeclampsia. Delay in handling the patient can cause worsening conditions for the mother and fetus so that many emergency conditions that force labor must be done by sectio caesarea (SC). Sectio caesarea is a method for delivering babies through incisions in the abdomen and uterus. In sectio caesarea, regional spinal anesthesia is generally chosen because it has many advantages. The method of management of spinal anesthesia is obtained by injecting local anesthetic drugs directly into the cerebro spinal fluid in the subarachnoid space. Mrs. L, age 28 years came with complaints of heartburn since 20 hours before being admitted to the hospital accompanied by high blood pressure that appeared since the age of 7 months of pregnancy. Patients performed sectio caesarea with some consideration of previous anesthesia. Good preoperative, intraoperative, and postoperative management will make this caesarean section successful and unobstructed.
High-Flow Nasal Cannula Oxygenation pada Pasien Lanjut Usia dengan Kegagalan Pernafasan Akut Terkait SARS-CoV-2: High-Flow Nasal Cannula Oxygenation in Older Patients with SARS-CoV-2-Related Acute Respiratory Failure Faris Putra Haryanto; Khadafi Indrawan; Ari Wahyuni
Medula Vol 11 No 2 (2021): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v11i2.313

Abstract

Currently, In this World, many cases about comparing the mortality and comfort associated with method of high-flow nasal cannula oxygenation (HFNCO) and high-concentration mask (HCM) in older SARS-CoV-2 infected patients done hospitalized in non-intensive care units. In this retrospective cohort study, author included all consecutive patients aged 75 years and older who were hospitalized for acute respiratory failure in either an acute geriatric unit or an acute pulmonary care unit, and tested positive for SARS-CoV-2. This journal compared the in-hospital prognosis between patients treated with HFNCO and patients treated with HCM. To determinate another bias factor, this journal created a propensity score for HFNCO. From March 2020 to January 2021, 67 patients (median age 87 years, 41 men) were hospitalized with SARS-CoV-2-related akut respiratory failure, of whom 41 (61%) received HFNCO and 26 (39%) did not. Age and comorbidities did not significantly differ in the two groups, whereas clinical presentation was more severe in the HFNCO group (NEW2 score: 8 (5–11) vs. 7 (5–8), p = 0.02, and Sp02/Fi02: 88 (98–120) vs. 117 (114–148), p = 0.03). Seven (17%) vs. two (5%) patients survived at 30 days in the HFNCO and HCM group, respectively. Overall, HFNCO was significantly associated with greater survival (adjusted hazard ratio (AHR) 0.57, 95% CI 0.33–0.99; p = 0.04). HFNCO use was associated with a lower need for morphine (AHR 0.39, 95% CI 0.21–0.71; p = 0.005), but not for midazolam (AHR 0.66, 95% CI 0.37–1.19; p = 0.17). In conclusion, HFNCO use in non-intensive care units may reduce mortality and discomfort in older inpatients with SARS-CoV-2-related akut respiratory failure.  
Co-Authors Devi Octiara Faris Putra Haryanto Khadafi Indrawan