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Manajemen Anestesi pada Seksio Sesarea dengan Preeklamsia Berat dan Morbid Obese RTH Supraptomo; Yusmein Uyun
Jurnal Anestesi Obstetri Indonesia Vol 2 No 1 (2019): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v2i1.33

Pendahuluan: Preeklampsia adalah terjadinya trias preeklampsia (hipertensi, hipoalbuminemia, dan edema) yang mendadak setelah 20 minggu kehamilan. Pasien obesitas memiliki banyak implikasi klinis dalam tatalaksana anestesi. Kasus: Wanita, 22 tahun G2P1A0 hamil 39 minggu dengan preeklampsia berat, KPD 12 jam, obesitas morbid akan dilakukan seksio sesarea emergency dengan status fisik ASA IIIE, dilakukan pembiusan dengan teknik regional anestesi subarachnoid block dengan puncture di L3–L4 median, menggunakan agen levobupivakain 15 mg dan fentanyl 25 mcg. Operasi berlangsung selama 1 jam 15 menit, dengan perdarahan 350 cc, hemodinamik stabil. Lahir bayi laki-laki, BB 3400 gr, APGAR Score 8–9–10. Diskusi: Preeklampsia adalah penyakit multiorgan yang spesifik terhadap kehamilan manusia, namun etiologi spesifik yang mendasari tetap belum diketahui. Tatalaksana bersifat suportif, melahirkan bayi dan plasenta tetap menjadi satu-satunya terapi definitif. Pasien obesitas memiliki banyak implikasi klinis untuk dipertimbangkan. Pemahaman mengenai patofisiologi akan membantu memberikan tatalaksana anestesi yang lebih baik. Simpulan: Pemilihan teknik neuraksial anestesi lebih direkomendasikan karena menghindari kemungkinan intubasi sulit pada kasus emergensi, perfusi uteroplasenta yang lebih baik, kualitas analgesi/anestesia yang baik, mengurangi obat yang masuk ke sirkulasi uteroplasenta, menurunkan stress operasi, dan psikologis ibu yang dapat melihat bayinya saat dilahirkan. Anesthesia Management in Caesarean Section with Severe Preeclampsia and Morbid Obese Abstract Introduction: Preeclampsia is a sudden triad of preeclampsia (hypertension, hypoalbuminemia and edema) after 20 weeks of pregnancy, Obese patients have many clinical implications to consider. Case: Female, 22 years old with G2P1A0, 39 weeks pregnant with severe preeclampsia, 12 hours PROM, pro morbid obesity SCTP-E with ASA IIIE physical status. Labor pain management was carried out using regional subarachnoid block anesthesia technique with puncture in median L3-L4, clear CSF (+), blood (-) using levobupivacaine 15 mg + fentanyl 25 mcg. The operation lasted for 1 hour 15 minutes, with 350 cc bleeding, hemodynamically stable. Born a baby boy, BW 3400 gr, APGAR Score 8-9-10. Discussion: Preeclampsia is a multiorgan disease that is specific to human pregnancy, and the underlying specific etiology remains unknown. Management is supportive, giving birth to the baby and placenta remains the only definitive therapy. Obese patients have many clinical implications to consider. Understanding of pathophysiology will help provide better anesthesia management. Conclusion: The neuraxial anesthesia technique is recommended to avoids the possibility of difficult intubation, better uteroplacental perfusion, good analgesia / anesthesia quality, reducing drugs that enter the uteroplacental circulation, decreasing surgical stress, and maternal psychological to be able to see the baby at birth.

Perbandingan Efektivitas Kombinasi Fentanyl–Paracetamol dan Fentanyl–Ketorolac terhadap Numerical Rating Scale (NRS) Post Operasi Seksio Sesarea Andy H; Sugeng Budi Santoso; RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 3 No 2 (2020): September
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v3i2.49

Latar Belakang: Nyeri post operasi seksio sesarea merupakan nyeri sedang berat dengan intensitas akut. Saat ini terdapat dua kombinasi obat anti nyeri yang umum digunakan untuk mengatasi nyeri post operasi seksio sesarea yaitu kombinasi parasetamol-fentanyl serta kombinasi ketorolac-fentanyl. Interaksi kedua obat tersebut dapat menurunkan ambang nyeri yang dapat kita periksa dengan skor Numerical Rating Scale (NRS). Tujuan: Untuk mengetahui adanya perbedaan efektivitas antara pemberian kombinasi parasetamol-fentanyl dengan ketorolac-fentanyl dalam mengatasi nyeri post operasi seksio sesarea.Subjek dan Metode: Penelitian eksperimental dengan pendekatan uji klinis menggunakan 30 subjek pasien hamil dengan umur 20-40 tahun dengan status fisik ASA I-II yang akan menjalani operasi seksio sesarea dengan spinal anestesi lidocain 5% hiperbarik. Grup pertama diberikan 1000mg paracetamol dan 0,3mcg/kg/jam fentanyl intravena sebagai analgesik. Grup ke 2 diberikan ketorolac 30mg dan fentanyl o,3mcg/kg/jamPada penelitian ini dilakukan analisis univariat dan bivariat. Hasil: Hasil uji beda terhadap karakteristik subyek penelitian didapatkan pada kelompok parasetamol dan fentanyl terdapat perbedaan yang signifikan pada post operasi dengan nilai p=0,005 (p<0,05), pada ketorolac dan fentanyl terdapat perbedaan yang signifikan post operasi dengan nilai p=0,023 (p<0,05) dSimpulan: Kombinasi parasetamol fentanyl lebih efektif dibandingkan dengan ketorolac fentanyl. The Comparison of the Effectiveness of Combination Fentanyl-Paracetamol with Fentanyl–Ketorolac on Numerical Rating Scale (NRS) Post Caesarean Section Abstract Background: Postoperative cesarean section pain is moderate-to-severe pain with acute intensity. There are two common anti-pain drug combinations used to treat post-cesarean section pain, namely the parasetamol-fentanyl combination and the ketorolac-fentanyl combination. The interaction of the two drugs can lower the pain threshold which we can check with the Numerical Rating Scale (NRS) score.Objective: To determine the difference in effectiveness between the combination of parasetamol-fentanyl and ketorolac-fentanyl in dealing with post-cesarean section surgery pain.Subject and Method: This study is an experimental study with a clinical trial approach using 30 subjects of pregnant patients aged 20-40 years with ASA I-II physical status who will undergo cesarean section surgery with hyperbaric 5% lidocaine spinal anesthesia. The first group were given 1000 mg parasetamol and 0.3 mcg/kg/h fentanyl intravenous as analgesics. The second group were given ketorolac 30 mg and fentanyl 0.3 mcg/kg/h intravenously. In this study, univariate and bivariate analyzes were performed. Results: The results of different tests on the characteristics of research subjects were found in the paracetamol and fentanyl groups, there was a significant difference in the post-operation with a value of p = 0.005 (p <0.05), in ketorolac and fentanyl there was a significant difference post-surgery with a value of p = 0.023 (p <0.05) where the paracetamol and fentanyl groups with NRS scores tended to fall, and the ketorolac and fentanyl groups with NRS scores tended to increase.Conclusion: The combination of parasetamol and fentanyl was more effective than ketorolac and fentanyl.

Perbandingan Efektivitas Anestesi Spinal dengan Bupivacain 12,5 Mg dan Bupivacain 5 Mg yang ditambah Fentanyl 50 Mcg pada Seksio Sesarea Fritzky Indradata; Heri Dwi Purnomo; Muh. Husni Thamrin; Sugeng Budi Santoso; Ardana Tri Arianto; RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.55

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

Manajemen Anestesi untuk Seksio Sesarea pada Pasien Pre Eklampsia Berat yang Terinfeksi Covid-19 RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.59

Komplikasi hipertensi tercatat 6–8% pada kehamilan dan menjadi kontributor yang signifikan morbiditas dan mortalitas maternal dan perinatal. Di Amerika Serikat, preeklamsia menjadi satu dari tiga besar penyebab utama kematian ibu hamil. Penanganan yang tidak sesuai dengan standar, sering menjadi penyebab utama yang menyebabkan peningkatan morbiditas dan mortalitas pada ibu hamil. Seorang wanita 30 tahun early warning score (EWS) score 6 dengan preeklampsia pada sekundigravida (G2P1A0) hamil preterm belum dalam persalinan, riwayat seksio sesarea 1x pro seksio sesarea transperitoneal emergensi dengan status fisik ASA IIE, direncanakan dilakukan anestesi dengan teknik regional anestesi sub-arachnoid block (SAB). Manajemen anestesi pada kehamilan dengan pre-eklampsia meliputi preoperatif, intraoperatif dan postoperatif. Pada masa pandemi COVID-19 dibutuhkan penggunaan alat pelindung diri (APD) yang memadai selama tindakan perioperatif. Perhatian khusus pada anestesi pasien terinfeksi COVID-19 meliputi penggunaan ruangan bertekanan negatif, meminimalisir instrumentasi jalan nafas, serta penggunaan APD level 3. Anesthesia Management for Caesarean Section in Severe Pre-Eclampsia Patients Infected with Covid-19 Abstract Hypertensive complications account for 6-8% of pregnancy and are a significant contributor to maternal and perinatal morbidity and mortality. In the United States, preeclampsia is one of the top three causes of death for pregnant women. Handling that is not in accordance with standards is often the main cause that causes increased morbidity and mortality in pregnant women. A 30-year-old woman with early warning score (EWS) score 6 with preeclampsia in secondary pregnancy (G2P1A0) who is preterm pregnant yet in labor, a history of cesarean section 1x pro-cesarean section emergency transperitoneal with ASA IIE physical status, planning to perform anesthesia with regional anesthesia technique. sub-arachnoid block (SAB). Anesthesia management in pre-eclampsia pregnancy includes preoperative, intraoperative and postoperative. During the COVID-19 pandemic, adequate personal protective equipment (PPE) is required during perioperative measures. Special attention to anesthesia for patients infected with COVID-19 includes the use of negative pressure rooms, minimizing airway instrumentation, and the use of level 3 PPE.

Pengelolaan Anestesi untuk Bedah Laparoskopik dengan Emfisema Subkutis Intraoperatif RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 4 No 2 (2021): September
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i2.73

Laparoskopi telah berkembang dari prosedur bedah ginekologis terbatas yang hanya digunakan untuk diagnosis dan ligasi tuba menjadi alat bedah utama yang digunakan untuk banyak indikasi ginekologis. Emfisema subkutis adalah komplikasi dari bedah laparoskopik. Studi ini membahas pengelolaan anestesi untuk bedah laparoskopik dengan emfisema subkutis. Seorang wanita 37 tahun dengan adenomiosis dan kista coklat sinistra dengan rencana operasi reseksi adenomiosis dan kistektomi perlaparoskopi dengan status fisik ASA II Plan general anesthesia endotracheal tube (GAET). Operasi dilakukan tanggal 15 Oktober 2018, dengan durante operasi 5 jam. Saat infraoperatif, emfisema subkutis ditemukan dari diafragma hingga thorax. Emfisema subkutis dicurigai disebabkan karena terjadi penurunan kondisi pasien menjadi head down extreme (Trendelenburg position), dan insuflasi CO2 yang cukup ekstrim hingga 15–20 mmHg. Faktor tambahan lain juga disebabkan oleh banyaknya jaringan adiposa (IMT 32 kg/m2) sehingga menyulitkan operator untuk visualisasi pada lapang operasi. Pemantauan yang ketat selama durante operasi dan kepiawaian ahli anestesi dalam mendiagnosis serta melakukan intervensi respirasi merupakan hal yang krusial dalam mengendalikan kondisi emfisema subkutis agar tidak bertambah komplikasinya

Successful Use of Epidural Anesthesia Following Guideline-Based Anticoagulation Bridging for Hip Surgery in a Patient with Acute Pulmonary Embolism: A Case Report Ayudya Tarita Alda; Paramita Putri Hapsari; RTH Supraptomo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1370

Background: The perioperative management of patients with acute pulmonary embolism (PE) requiring major surgery presents a formidable clinical challenge. Therapeutic anticoagulation, essential for treating PE, is a significant relative contraindication for neuraxial anesthesia due to the risk of spinal hematoma. General anesthesia, however, carries a high risk of hemodynamic collapse in patients with compromised cardiopulmonary reserves. This report describes the successful application of a multidisciplinary, guideline-adherent strategy to manage this complex clinical scenario. Case presentation: A 56-year-old, obese female (BMI 30 kg/m²) with an extensive history of cardiovascular disease—including hypertensive heart disease, prior myocardial infarction, and an aortic dissection repaired via EVAR—presented with a post-traumatic left hip dislocation. Her presentation was critically complicated by an acute massive pulmonary embolism, diagnosed via echocardiography, which revealed large thrombi in the pulmonary arteries, and confirmed with a chest X-ray showing a Westermark sign. The patient required an open reduction and repair of the hip. A collaborative, multidisciplinary plan was formulated to enable the use of epidural anesthesia. Her anticoagulation with rivaroxaban was stopped five days preoperatively and bridged with a therapeutic infusion of unfractionated heparin (UFH). The UFH was discontinued six hours before the procedure, and surgery proceeded only after confirming normalization of coagulation parameters (INR < 1.5). Epidural anesthesia was successfully administered, providing excellent hemodynamic stability throughout the surgery. The patient was monitored in a cardiac intensive care unit postoperatively, with no neurological or bleeding complications. Conclusion: This case demonstrates that epidural anesthesia is a viable and potentially superior option for high-risk patients with acute PE, provided that a meticulous, guideline-concordant anticoagulation bridging strategy is implemented. Successful outcomes in such complex cases are predicated on rigorous multidisciplinary planning, patient selection, and vigilant postoperative monitoring. This approach validates current safety guidelines rather than challenging them, showcasing their utility in enabling advanced anesthetic care.

Successful Use of Epidural Anesthesia Following Guideline-Based Anticoagulation Bridging for Hip Surgery in a Patient with Acute Pulmonary Embolism: A Case Report Ayudya Tarita Alda; Paramita Putri Hapsari; RTH Supraptomo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1370

Background: The perioperative management of patients with acute pulmonary embolism (PE) requiring major surgery presents a formidable clinical challenge. Therapeutic anticoagulation, essential for treating PE, is a significant relative contraindication for neuraxial anesthesia due to the risk of spinal hematoma. General anesthesia, however, carries a high risk of hemodynamic collapse in patients with compromised cardiopulmonary reserves. This report describes the successful application of a multidisciplinary, guideline-adherent strategy to manage this complex clinical scenario. Case presentation: A 56-year-old, obese female (BMI 30 kg/m²) with an extensive history of cardiovascular disease—including hypertensive heart disease, prior myocardial infarction, and an aortic dissection repaired via EVAR—presented with a post-traumatic left hip dislocation. Her presentation was critically complicated by an acute massive pulmonary embolism, diagnosed via echocardiography, which revealed large thrombi in the pulmonary arteries, and confirmed with a chest X-ray showing a Westermark sign. The patient required an open reduction and repair of the hip. A collaborative, multidisciplinary plan was formulated to enable the use of epidural anesthesia. Her anticoagulation with rivaroxaban was stopped five days preoperatively and bridged with a therapeutic infusion of unfractionated heparin (UFH). The UFH was discontinued six hours before the procedure, and surgery proceeded only after confirming normalization of coagulation parameters (INR < 1.5). Epidural anesthesia was successfully administered, providing excellent hemodynamic stability throughout the surgery. The patient was monitored in a cardiac intensive care unit postoperatively, with no neurological or bleeding complications. Conclusion: This case demonstrates that epidural anesthesia is a viable and potentially superior option for high-risk patients with acute PE, provided that a meticulous, guideline-concordant anticoagulation bridging strategy is implemented. Successful outcomes in such complex cases are predicated on rigorous multidisciplinary planning, patient selection, and vigilant postoperative monitoring. This approach validates current safety guidelines rather than challenging them, showcasing their utility in enabling advanced anesthetic care.

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