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All Journal Mandala of Health : A Scientific Journal Jurnal Komplikasi Anestesi
Pratomo, Bhirowo Yudho
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Dentistry Health Professions Medicine & Pharmacology Public Health

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Manajemen dan Komplikasi Transfusi Masif Anggraini, Diana; Wisudarti, Calcarina Fitriani Retno; Pratomo, Bhirowo Yudho
Jurnal Komplikasi Anestesi Vol 3 No 1 (2015): Volume 3 Number 1 (2015)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v3i1.7233

Abstract

Perdarahan tidak terkontrol yang membutuhkan transfusi masif sering terjadi pada operasi mayor dan trauma. Perdarahan mayor merupakan salah satu penyebab kematian. Penanganan perdarahan masif meliputi ekspansi volum, optimalisasi oksigenasi jaringan dengan transfusi sel darah merah, dan koreksi koagulopati. Transfusi masif mempunyai survival yang jelek. Dilaporkan terdapat mortalitas sekitar 45-67%. Usia pasien, durasi dan beratnya syok, DIC (Disseminated Intravascular Coagulation), dan jumlah darah yang ditransfusikan mempengaruhi hasil akhir. Angka mortalitas lebih tinggi pada pasien dengan berbagai komorbid. Peningkatan mortalitas berhubungan dengan jumlah PRBC (Packed Red Blood Cell) yang ditransfusikan (22%, 30%, 50%, dan 59% pada grup yang menerima secara berurutan 1-10 unit, 11-20 unit, 21-40 unit, dan > 40 unit).
ANESTHESIA MANAGEMENT FOR PATIENTS WITH LOW EJECTION FRACTION UNDERGOING CORONARY ARTERY BYPASS GRAFTING (CABG) Wibowo, Adi; Pratomo, Bhirowo Yudho
Mandala Of Health Vol 17 No 2 (2024): Mandala of Health: a Scientific Journal
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.mandala.2024.17.2.12982

Abstract

Background: Coronary Artery Disease (CAD) is a condition caused by the formation of blockages in the coronary blood vessels. The primary non-invasive procedure for CAD patients is Percutaneous Coronary Intervention (PCI). However, complications during PCI, such as unstable hemodynamic arrhythmias, can occur, possibly due to Abrupt Vessel Closure (AVC). This remains a major issue for PCI failure and necessitating Coronary Artery Bypass Grafting (CABG). Case: We report a 68-year-old male patient with CAD and total occlusion of the Right Coronary Artery (RCA) and total occlusion of the Left Circumflex (LCx) who was unable to undergo PCI at a previous hospital. Subsequently, re-catheterization at RSUP Dr. Sardjito, CAD3VD was diagnosed, leading to a planned CABG surgery. The patient’s clinical condition was relatively stable, though he had a low ejection fraction (41%). Induction, invasive monitoring placement, and intubation proceeded smoothly. CABG was performed with three grafts (LIMA-LAD, SVG-OM, SVG-PDA), and successful weaning was achieved with dobutamine support. The patient was in the ICU for 2 days for clinical and hemodynamic optimization before being transferred to the ICCU for further intensive care. Discussion: The main principle of anesthetic management in this case is to maintain a balance between myocardial oxygen supply and demand. Strict monitoring of hemodynamic changes during surgery is essential to guide necessary supportive therapy. Patients with low ejection fractions are at high risk for post-operative mortality and complications. Post-operative management in the ICU focuses on optimizing clinical condition and addressing any emerging potential issues. Conclusion: Surgery for patients with CABG requires complicated and complex anesthetic techniques. This operation requires collaboration and good communication between the surgeon and the anesthesiologist.
Co-Authors Adi Wibowo Anggraini, Diana Calcarina Fitriani Retno Wisudarti