I Wayan Widana
Departemen Anestesiologi dan Terapi Intensif RSUD Wangaya, Denpasar, Bali, Indonesia

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Manajemen anestesi pada operasi koreksi deformitas skoliosis Moses Wijaya; I Wayan Widana
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (501.169 KB) | DOI: 10.15562/ism.v13i2.1411

Abstract

Background: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine with a bulge angle of at least 10°, with no underlying neuromuscular or congenital abnormality. Surgery is the best treatment for patients with AIS. The main goal of AIS surgery is to prevent progression due to fusion, but there are various potential risks, such as the postoperative period. Case: The patient was a 26-year-old female patient with complaints of an misaligned spine. The patient was diagnosed with adolescent idiopathic scoliosis and planned for scoliosis deformity correction. The X-ray shows a thoracic curve with convexity to the right (7th thoracic vertebrae – 1st lumbar vertebra), Cobb angle 54 degrees, right Cobb bending angle 34 degrees, flexibility 20 degrees, left Cobb bending angle 70 degrees, flexibility 26 degrees. The operation was performed using the general anesthesia-orotracheal tube (GA-OTT) technique. After induction, the patient was placed in the prone position. Maintenance of anesthesia with O2, N2O, dexmetomidine, intermittent fentanyl, and rocuronium. The operation lasted for 6 hours, the bleeding during the operation was 1000 ml and was hemodynamically stable. Post-operatively the patient is well conscious and adequate spontaneous breathing. Patient care is carried out in the ICU with the administration of analgesics. Conclusion: Adolescent idiopathic scoliosis is an exception diagnosis from other forms of scoliosis. An approach to find out the causes, risk factors, methods of diagnosis and treatment of patients with adolescent idiopathic scoliosis are needed in order to increase the success of therapy and the quality of life of the patients.   Latar Belakang: Adolescent Idiopathic Scoliosis (AIS) adalah kelengkungan lateral tulang belakang dengan sudut tonjolan minimal 10°, tanpa kelainan neuromuskular atau bawaan yang mendasarinya. Pembedahan adalah pengobatan terbaik untuk pasien dengan AIS. Tujuan utama operasi AIS adalah untuk mencegah perkembangan akibat fusi, tetapi ada berbagai potensi risiko, seperti periode pasca operasi. Laporan Kasus: Pasien wanita berusia 26 tahun dengan keluhan bentuk tulang belakang yang tidak lurus. Pasien didiagnosis dengan adolescent idiopathic scoliosis dan direncanakan untuk scoliosis deformity correction. Pada rongent tampak curve thoracalis dengan konveksitas ke kanan (vertebra thorakalis 7 – vertebra lumbal 1), sudut Cobb 54 derajat, sudut Cobb Bending kanan 34 derajat, flexibilitas 20 derajat, sudut Cobb Bending kiri 70 derajat, flexibilitas 26 derajat. Operasi dilakukan dengan teknik anestesi general anesthesia-orotracheal tube (GA-OTT). Setelah dilakukan induksi, pasien diatur ke posisi prone. Pemeliharaan anestesi dengan O2, N2O, dexmetomidine, fentanyl intermitten, dan rocuronium. operasi berlangsung selama 6 jam, perdarahan selama operasi 1000 ml dan hemodinamik stabil. Post-operative pasien sadar baik dan bernafas spontan adekuat. Perawatan pasien dilakukan di ICU dengan pemberian analgetik. Simpulan: Adolescent idiopathic scoliosis adalah diagnosis pengecualian dari bentuk skoliosis lainnya. Penelusuran untuk mengetahui penyebab, faktor risiko, metode diagnosis dan tatalaksana dari pasien dengan adolescent idiopathic scoliosis diperlukan agar dapat meningkatkan keberhasilan terapi dan kualitas hidup dari pasien.
Penggunaan High Flow Nasal Cannula sebagai Terapi Oksigen pada Kasus Covid-19 Berat dengan Obesitas: Laporan Kasus Pratama Yulius Prabowo; Ida Bagus Gede Dwi Dharmayana; Ida Ayu Manik; I Wayan Widana; I Gede Agus Shuarsedana
Jurnal Ilmiah Kedokteran Wijaya Kusuma Vol 11, No 1 (2022): MARET 2022
Publisher : Universitas Wijaya Kusuma Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (584.022 KB) | DOI: 10.30742/jikw.v11i1.1630

Abstract

Coronavirus Disease 2019 (COVID-19) is a disease which caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In December 2019, this disease was encountered in Wuhan, China. Covid-19 is still a global pandemic to this day. Obesity is one of the comorbidities which has been shown to increase the severity of COVID-19 cases. There is research which stated that invasive mechanical ventilation may contribute to mortality rate in severe case of COVID-19. Other than that, the increase rate of severe COVID-19 cases and the limited availability of facilities and infrastructure makes the usage of high flow nasal cannula (HFNC) begins to be considered. Aim of this case report is to represent the outcome of obese COVID-19 patient whom treated with HFNC, furthermore could evoke readers to take further research of the effectiveness of HFC usage as an oxygen therapy in severe COVID-19 cases. Case summary: 21 years old woman came to Emergency Department in Wangaya Regional Hospital with shortness of breath, unproductive cough, sore throat, and inability to smell. Patient was treated and diagnosed with confirmed severe COVID-19. She got obesity as comorbidity (weight 105 kg; height 160 cm; Body Mass Index (BMI) 41.02 kg/m2). Patient was treated for 15 days, which include 10 days of treatment in negative pressure ward in Intensive Care Unit Department (ICU). During the treatment course, patient received pharmacologic and non-pharmacologic treatment, including the administration of HFNC. After five days of HFNC usage, oxygen supplementation was downgraded to conventional oxygen supplementation (non-rebreather mask and nasal cannula). Patient then discharge without any complain and proceed self-quarantine at home. HFNC could be considered as one of non-invasive oxygen supplementation treatment in patient with severe COVID-19 disease. The initiation of usage of HFNC could be started with 30 L/minute flow, with 40% fraction of inspired oxygen (FiO2) in accordance to patient comfort with Sp02 target 92-96%. If there is an increased breathing effort, high respiratory rate, and unachieved Sp02 target, flow and inspiration fraction titrated gradually. ROX index could be used as a treatment failure indication and the need of invasive ventilation.