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Albumin Levels in Nontraumatic Acute Abdomen Patients Undergoing Emergency Laparotomy: A Retrospective Study in the Intensive Observation Ward of Dr. Soetomo General Academic Hospital Fitri mazia; Maulydia; Edwin Danardono; Edward Kusuma
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 2 (2025): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V7I22025.100-108

Introduction: Acute abdomen is a critical medical emergency characterized by the abrupt onset of severe abdominal pain, often requiring emergency laparotomy. Emergency laparotomy, due to limited preoperative preparation, generally has a higher morbidity and mortality rate than elective surgery. Optimizing perioperative care, particularly by monitoring albumin levels, may improve outcomes, as albumin plays a crucial role in maintaining fluid balance, wound healing, and controlling inflammatory responses. Postoperative emergency patients at Dr. Soetomo General Academic Hospital are closely monitored in a specific ward known as the Intensive Observation Ward (Ruang Observasi Intensif/ROI). Objective: To evaluate albumin levels in nontraumatic acute abdomen patients treated in ROI following emergency laparotomy. Methods: This study used a retrospective descriptive study design and was conducted from January to June 2022. Patients under 18 with malignancy, trauma, gynecological or obstetrical cases, and incomplete medical records were excluded. Results: The male and female number of 90 patients was equal, most patients were aged 41-50, and had a normal BMI. Generalized peritonitis was the most common indication, followed by acute appendicitis and bowel obstruction. Appendectomy and exploratory laparotomy were the primary procedures, mostly done in under 3 hours. Most patients had no prior laparotomy history. Most patients had normal albumin levels preoperatively, but these shifted to mild hypoalbuminemia postoperatively. Of 13 deaths, 12 involved preoperative hypoalbuminemia. The predominant PS-ASA scores were 2 and 3. Electrolyte imbalance, especially hypokalemia, was the prevalent preoperative complication. Frequent comorbidities included kidney disorders and hypertension. The average ROI stay was 2.1±1.59 days, with most patients staying for 1 to 3 days. Operation-related complications included intra-abdominal infections and bleeding, while medical complications involved electrolyte imbalances, sepsis, and metabolic acidosis. Conclusion: Nontraumatic acute abdomen patients with low preoperative albumin levels tend to have higher rates of postoperative complications and mortality.

Severe Preeclamptic Patients in The Resuscitation Room of Dr. Soetomo General Academic Hospital Surabaya: A Retrospective Study Firmanto, Neissya Nastiti; Maulydia; Mulawardhana, Pungky; Fitriati, Mariza
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.62-71

Introduction: Preeclampsia is the leading cause of maternal and fetal death. This is an urgency in maternal health, especially in developing countries such as Indonesia. Patients with severe preeclampsia who had critical conditions tend to be admitted to the resuscitation room for assistance from more skilled personnel and more sophisticated technology. Objective: This study aims to determine the complications, treatments, and outcomes of severe preeclampsia patients managed in the resuscitation room at Dr. Soetomo General Academic Hospital from January 1st, 2018 – December 31th 2019. Methods: The method used in this study was retrospective descriptive using medical records and analyzed using Microsoft Excel. Eighty-one samples met the inclusion criteria. Results: The majority of patients were aged 20-35 years (65.43%) and had completed senior high school (88.89%). Most patients were having stage 2 obesity (44.44%) and multigravida (41.97%). A history of preeclampsia and hypertension was not found in the majority of patients. Most patients are diagnosed with late-onset preeclampsia (69.14%). The majority of patients were referred from secondary health facilities (96.30%). The most common complication was pulmonary edema(53.09%). The majority of patients had 2 complications (43.17%) with the most common combinations being eclampsia and HELPP syndrome (13.58%). Intubation is given to the majority of patients (70.37%) and most often in patients with eclampsia (56.14%). Termination of pregnancy by cesarean section is carried out in the majority of patients (72.84%). There were no cases of maternal death in this study. Most of the fetal born had prematurity (70.11%), low birth weight (60%), and asphyxia as assessed by the first minute APGAR score (72.97%) and fifth minute APGAR score (54.05%). Conclusion: The majority of preeclampsia patients with complications in the resuscitation room at Dr. Soetomo General Academic Hospital Surabaya from January 1st 2018-December 31rd 2019 had good maternal outcomes but not the fetal outcome.

Airway Foreign Bodies in Patients that Underwent Bronchoscopies with General Anesthesia in Dr. Soetomo General Academic Hospital Surabaya Sabrina, Annisa Maya; Maulydia; Perdana, Rizka Fathoni; Fitriati, Mariza
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.72-79

Introduction: Airway foreign body (AFBs) is the most common emergency for ENT-HN (Ear, Nose, Throat-Head Neck) that requires immediate treatment. The gold standard management for AFBs is a bronchoscopy performed under general anesthesia (GA). Objective: This study aims to determine the profile of AFBs patients who underwent bronchoscopies with GA at Dr. Soetomo General Hospital Surabaya from January 2018 – December 2019. Materials: This is a descriptive, retrospective study that uses data from medical records. Microsoft Excel was used to analyze the data. 22 patients met the inclusion criteria. Results: The most common ages were 11 to 20-year-olds (73%), 55% were female, and 45% were male. The patients were from outside (73%) and inside (27%) Surabaya. As much as 67% of the sampled patients had coughs and 23% were symptomless. The foreign bodies found were pins (67%), clipboard nails (14%), and nuts (9%). These AFBs were located in the left main bronchus (45%), trachea (32%), and right main bronchus (18%), and in 5% of these cases, the AFBs could not be located. The duration between the event and the bronchoscopy was mostly less than 1 day (54%), 2 days (32%), and 3 days (14%). Most cases (90%) were without AFBs complications, but some had obstruction (5%), and hemoptysis (5%). Most patients also had an uncomplicated bronchoscopy (81%), however, some suffered lesions (14%) and bleeding (5%). A majority of the patients were also ASA I (68%), and the remainder were classified as ASA II (18%), and III (14%). The premedication drugs administered were fentanyl (41%), and a combination of fentanyl and midazolam (41%). Meanwhile, the most frequently maintained anesthetic agent was Isoflurane+O2 (27%). Most patients also did not have any comorbid factors (85%), but some had anemia (5%), obstruction (5%), as well as obesity followed by sputum retention and hypernatremia (5%). Conclusion: Most AFB patients who underwent bronchoscopy under GA were 11-20 years old, female, and had a cough as a clinical symptom. Most AFBs were pins at the left main bronchus. The duration between the incident and the bronchoscopy was less than 1 day. There were also mostly no complications of AFBs and bronchoscopies. The most common physical status in patients was ASA I, with fentanyl only or fentanyl and midazolam as a premedication drug. The most common agent used to maintain the anesthesia was a combination of isoflurane and O2. Most patients also had no comorbid factors for GA.

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies Avidar, Yoppie Prim; Salinding, Agustina; Hamzah; Uhud, Akhyar Nur; Maulydia
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.87-97

Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.

Blood Transfusion Practices at The Intensive Observation Unit (Ruang Observasi Intensif/ROI) of Dr. Soetomo General Academic Hospital Surabaya Almira Saskia Sabila; Maulydia; Betty Agustina Tambunan; Edward Kusuma
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I12023.1-10

Introduction: Blood transfusion is the process of transferring blood or its components, such as red blood cells, plasma, and platelets, from donor to recipient. The major reason for blood transfusion is anemia and bleeding, frequently seen in critically ill trauma patients in Intensive Observation Unit (Ruang Observasi Intensif/ROI). One of the most prevalent causes of potentially preventable death in trauma patients is uncontrolled bleeding. In addition to controlling the bleeding by surgical or interventional procedures, blood transfusion is carried out to maintain oxygenation to tissue, preventing organ dysfunction due to hypoxia. Objective: This study aimed to determine the profile of blood transfusion carried out on the patients in the ROI of Dr. Soetomo General Academic Hospital. Methods: This retrospective descriptive study was conducted using medical records involving 258 patients who met the inclusion criteria. Results: The result showed that the majority of patients were female, aged 26-35 years, had blood type O, and Rhesus (Rh)-positive, accounting for 55.04%, 26.36%, 39.53%, and 100%, respectively. The most common indication for transfusion was anemia, with a percentage of 69.10%, particularly severe anemia, accounting for 48.45%. Furthermore, 57.36% of patients were from the surgery department, and 36.05% stayed in ROI for 2-3 days. The most common blood component and unit transfused was packed red blood cells (PRC), with a percentage of 57.50% and 439 units at 47.82%. Most of the transfusions, with a percentage of 37.80%, were carried out within 3-4 hours. Some patients were experiencing pruritus, febrile, urticaria, and chills, accounting for 0.39%, 0.39%, 0.39%, and 0.39%, respectively. Conclusion: Understanding transfusion practices, including blood type distribution, can prevent blood shortage, estimate the need for blood among ROI patients in Dr. Soetomo General Academic Hospital, and further ensure that all transfusions are ABO and Rh compatible.

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