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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Archives of The Medicine and Case Reports Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research
Tjahya Aryasa
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Prothrombin Complex Concentrate as a Key Adjunct in Massive Hemorrhage Management in Placenta Accreta Spectrum Disorder: A Case Report Pramana, Putu Bagus Gin Gin; Tjokorda Gde Agung Senapathi; Pontisomaya Parami; Tjahya Aryasa
Archives of The Medicine and Case Reports Vol. 5 No. 3 (2024): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v5i3.599

Abstract

Placenta accreta spectrum disorder (PASD) is a severe obstetric complication associated with significant hemorrhage risk. This report highlights the successful use of prothrombin complex concentrate (PCC) as part of a multidisciplinary approach to managing a case of massive hemorrhage in PASD. A 36-year-old woman, G3P2002, at 33 weeks gestation, diagnosed with placenta previa totalis and suspected PASD, underwent a planned cesarean hysterectomy. The surgery was complicated by 5200 mL hemorrhage due to placental invasion and bladder injury. Hemodynamic instability was managed with massive transfusion protocol activation, including PCC, tranexamic acid, and packed red blood cells. Intra-abdominal packing was performed for hemostasis, and the bladder injury was repaired. Continued PCC administration in the ICU, along with other supportive measures, resulted in hemorrhage control and stabilization. The patient was successfully extubated and discharged after a second surgery to remove packing. This case emphasizes the vital role of PCC in the multidisciplinary management of massive hemorrhage in PASD. Early recognition of PASD risk factors and prompt intervention, including PCC administration, are crucial for optimal maternal outcomes.
Anesthetic Management in Preeclampsia Patients with Thalassemia Minor B: A Case Report Dyatmika, Kadek Dwipa; Tjahya Aryasa; Otniel Adrians Labobar
Journal of Anesthesiology and Clinical Research Vol. 4 No. 2 (2023): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v4i2.330

Abstract

Introduction: One of the complications of anesthesia that can be encountered in thalassemia patients is cardiovascular instability caused by chronic anemia, cardiomyopathy, and endocrinopathy. In addition, patients with preeclampsia may also experience postoperative risks such as sustained hypertension, stroke, venous thromboembolism, and seizures. This case report will discuss the anesthetic management of pregnant women with preeclampsia and β thalassemia minor. Case presentation: The patient is a pregnant woman G6P0141, 34 weeks gestation, with preeclampsia and a history of minor β thalassemia without therapy. Patients with thalassemia minor are often asymptomatic before pregnancy, but physiological changes during pregnancy can contribute to anemia during pregnancy. Beta thalassemia minor is also associated with an increased incidence of hypertension in pregnancy. Neuraxial anesthesia is recommended in preeclamptic patients to avoid severe hypertension and has a protective effect against postoperative apnea in premature infants. Conclusion: Anesthetic management in asymptomatic patients with minor thalassemia is not much different from normal pregnant women. The risk of bleeding needs special attention, especially in thalassemia patients who have anemia. In patients with preeclampsia, neuraxial anesthesia is preferred over general anesthesia. Postoperative patient care is carried out in an obstetric high dependency unit (OHDU). The patient went home after being treated for 3 days without complications at the hospital.
Epidural Anesthesia in Management of Pregnant Eissenmenger’s Syndrome Patient Undergoing Caesarean Section Jayantha Ananda, I Gusti Ngurah Bagus; Tjahya Aryasa; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i2.932

Abstract

Background: Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population, and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Managing anesthesia in maternal patients with a cardiac abnormality might be particularly difficult because these individuals have inadequate circulatory reserves and altered maternal cardiovascular physiology. Case presentation: We present a 26-year-old 34 weeks pregnant woman with Eisenmenger’s syndrome (ES) scheduled for an elective caesarean section. The clinical findings reveal slight tachypnea with peripheral oxygen saturation of 82% with oxygen supplementation using a cannula at 3 lpm. The patient's baseline hemodynamics are stable, but a third-degree murmur is heard in the 3rd and 4th left intercostal space. The patient was managed with epidural anesthesia using bupivacaine 0.5% 20 ml without adjuvant. The epidural catheter was inserted in an interspinous process between L3-L4. The surgery was done in 90 minutes with stable hemodynamics, and postoperatively, the patient was monitored in the intensive cardiac care unit (ICCU). Conclusion: Epidural anesthesia has been shown to provide favorable outcomes due to its slow onset and reducing the likelihood of abrupt hemodynamic changes.
Epidural Anesthesia in Management of Pregnant Eissenmenger’s Syndrome Patient Undergoing Caesarean Section Jayantha Ananda, I Gusti Ngurah Bagus; Tjahya Aryasa; Tjokorda Gde Agung Senapathi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i2.932

Abstract

Background: Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population, and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Managing anesthesia in maternal patients with a cardiac abnormality might be particularly difficult because these individuals have inadequate circulatory reserves and altered maternal cardiovascular physiology. Case presentation: We present a 26-year-old 34 weeks pregnant woman with Eisenmenger’s syndrome (ES) scheduled for an elective caesarean section. The clinical findings reveal slight tachypnea with peripheral oxygen saturation of 82% with oxygen supplementation using a cannula at 3 lpm. The patient's baseline hemodynamics are stable, but a third-degree murmur is heard in the 3rd and 4th left intercostal space. The patient was managed with epidural anesthesia using bupivacaine 0.5% 20 ml without adjuvant. The epidural catheter was inserted in an interspinous process between L3-L4. The surgery was done in 90 minutes with stable hemodynamics, and postoperatively, the patient was monitored in the intensive cardiac care unit (ICCU). Conclusion: Epidural anesthesia has been shown to provide favorable outcomes due to its slow onset and reducing the likelihood of abrupt hemodynamic changes.
Co-Authors Dyatmika, Kadek Dwipa Jayantha Ananda, I Gusti Ngurah Bagus Otniel Adrians Labobar Pontisomaya Parami Pramana, Putu Bagus Gin Gin Tjokorda Gde Agung Senapathi