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Solo Journal of Anesthesi, Pain and Critical Care
Published by Universitas Sebelas Maret
ISSN : 27761770     EISSN : 27970035     DOI : https://doi.org/10.20961
Core Subject : Health, Engineering,
Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health
Case Report, Original Research and Review Article in the scope of : Life Support Emergency and Trauma Cardiovascular Anesthesia Pediatric Anesthesia Neuro Anesthesia Pain Management Intensive Care Obstetry Anesthesia Geriatric and Oncology Anesthesia Regional Anesthesia Ambulatory Anesthesia
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 5 Documents
 1 
Search results for , issue "Vol 1, No 1 (2021): April 2021" : 5 Documents clear
Anesthesia Management in VP Shunt Surgery in Neonates with Hypoplastic Left Heart Syndrome (HLHS) and Dandy Walker Syndrome Purwoko Purwoko; Fandi Ahmad Muttaqin
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 1 (2021): April 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (768.904 KB) | DOI: 10.20961/soja.v1i1.49476

Abstract

Introduction: Hypoplastic left heart syndrome (HLHS) is defined as the incomplete development of the left heart structures, including the mitral valve, left ventricle, aortic valve, and aortic arch. The clinical presentation of HLHS depends on the patency of the ductus arteriosus and the degree of restriction of the atrial septum. Common clinical manifestations include cyanosis, respiratory distress, and hemodynamic instability within hours of delivery. Delays in diagnosis and delay in intervention will increase the morbidity of neonates with HLHS.Purpose: To understand the mechanism of HLHS along with the principles of anesthesia in neuroaesthetics procedures in pediatrics in order to obtain a good outcome.Case Illustration: A 9-day old baby girl, weight 2522 grams with HLHS (aortic atresia) with patent ductus arteriosus (PDA), type II atrial septal defect (ASD) with a left to right shunt, and dandy walker syndrome. From the physical examination, the patient's condition is stable, with GCS E4V5M6, pulse 130-135 beats/minute, breath rate 48x / minute, and SpO2 94-98%. The patient's head was enlarged from birth, no heart sounds were found, regular I-II heart sounds. Blood laboratory tests showed a total bilirubin value of 11.7 mg / dL, direct bilirubin 0.64 mg / dL, indirect bilirubin 10.43 mg / dL, hemoglobin 20.1 g%, hematocrit 55%, with leukocytes 19.9x103 / L, platelets 216 x 103 / L, serum Na 122 mmol / L, K 7.8 mmol / L, Cl 101 mmol / L.Discussion: The anesthetic approach in HLHS is to maintain preoperative hemodynamic stability by maintaining heart rate, preload, and PGE1, balancing systemic vascular resistance and pulmonary vascular resistance, preventing too high PaO2, and administering inotropic agents to increase cardiac output and keep the patent ductus arteriosus open. The balance of systemic and pulmonary blood flow is a key principle in the management of HLHS anesthesia. Conclusion: The main goal of HLHS anesthesia is to minimize hemodynamic changes to prevent compromised hemodynamics in both circulations and maintaining stability is essential in preventing morbidity, complications, and increasing good outcomes in surgery..  
Anesthesia Management in Patient with Placenta Percreta Performed Intra-aortic Ballooning Caesarean Section RTh. Supraptomo; Alma Hepa Allan
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 1 (2021): April 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (680.345 KB) | DOI: 10.20961/soja.v1i1.49481

Abstract

Placenta accreta spectrum is one of maternal mortality’s causes which is related with severe obstetric bleeding that requires hysterectomy. The incidence rate of the spectrum placenta increases with increasing caesarean section. Placenta accreta spectrum is also close-related to placenta previa. The aim of this study is to  understand perioperative management in patient with placenta percreta performed with intra-aortic ballooning in caesarean section. We are following a case on a 36 year old female patient, multigravida at term pregnant with placenta percreta and history of caesarean section 5 and 2 years ago. The surgeries performed were caesarean section surgery as well as intra-aortic ballooning. Anesthetic technique used was general anesthesia. Operation duration approximately ± 180 minutes, bleeding 1500 cc. After the operation, the patient was admitted to the ICU. The patient going well and discharged from ICU to ward on the second day. After three days in ward, the patient discharged to home. Hemodynamic changes during balloon intra-aortic procedures are of particular concern to anesthetists. This is because the stopping of blood flow to the aorta in this case can cause an increase in blood vessel pressure, where the administration of nitroglycerin at low doses can reduce venous tone resulting in venous vasodilation which will maintain hemodynamic stability during the process of blocking blood vessels with a balloon. From the case we may conclude that anesthesia in pregnant women with placenta accreta spectrum should be carried out with caution and involve a multidisciplinary specialist given its high risk of bleeding. The intra-aortic balloon insertion technique can be an option used to reduce the risk of bleeding in patients with placenta accreta spectrum.
Perioperative Management of Patients with Ventricular Septal Defect, Severe Tricuspid Regurgitation and Gerbode Defects Purwoko Purwoko; Ardhana Surya Aji
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 1 (2021): April 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (711.277 KB) | DOI: 10.20961/soja.v1i1.49659

Abstract

Ventricular Septal Defect (VSD) is a congenital heart disease that causes the connection between left and right ventricles called a Gerbode defect. Manifestation of a Gerbode defect is damage to the opening tricuspid valve caused regurgitation of the tricuspid valve. Delay in diagnosis and intervention will affect pre-operative nutritional status and malnutrition.We reported a boy aged 2 months, weighing 3100 grams with biliary atresia followed by VSD, severe TR, and Gerbode defect who will undergo the Kasai procedure. Preoperative physical examination showed GCS E4V5M6, SpO2 100%. The skin gets icteric all over the body and conjunctiva. The cardiovascular system has a regular I-II heart sound, 2/3 mid clavicular S noise as high as 2 ICS and a pansystolic murmur. The examination of the abdomen is slight distended. Child pug score 8. Hemoglobin value 6.7gr%, hematocrite 37%, APTT 44.8 seconds, SGOT 443 U / L, SGPT 560 U / L, total bilirubin 23.89 mg / dl, direct bilirubin 13.92 mg / dl, and indirect bilirubin 9.97 mg / dl.The goal of anesthesia in VSD, Severe Tricuspid Regurgitation (TR) with Gerbode Defect is preventing excessive ventilation to avoid severe pulmonary hypertension. The choice of anesthetic agent is based on the patient's physiology and balancing pulmonary and systemic blood flow. Perioperative management of cases of VSD, TR Severe with Gerbode defect in the following report describes the importance of understanding the pathophysiology of VSD and Gerbode defects to obtain a good outcome.Perioperative management of VSD patients, severe tricuspid regurgitation with Gerbode defect requires more supervision, especially to minimize the increase in PVR, maintain systemic vascular resistance (SVR) and avoid excessive ventilation to prevent severe pulmonary hypertension.
Anesthesia Management at Postpartum et causa Atonic Uteri Bleeding in P3A0H3 Post SCTP Outside Dr. Moewardi Hospital RTh Supraptomo; Muhammad Ridho Aditya
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 1 (2021): April 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (369.062 KB) | DOI: 10.20961/soja.v1i1.49682

Abstract

Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, happens more in developing countries with an estimated mortality rate of 140,000 per year or one maternal death every four minutesTo understand anesthesia management at postpartum et causa atonic uteri bleeding outside Dr. Moewardi hospitalIn this case reported 25 years old patient was admitted to the emergency room at Dr. Moewardi Hospital Surakarta, on the 28/11/2019 at 15.30 WIB, sent by Waras Hospital Wiris Boyolali. On examination found the patient in a state of weakness, apathy awareness and blood pressure 90/60, heart rate 130, respiration rate 22, conjunctival anemic and palpable contractions of soft uterine contractions. The patient's condition is in accordance with the manifestation of grade III blood loss. The anesthesiology diagnosis is a 25-year-old woman with Postpartum hemorrhage et causa Atonic Bleeding of Uterine on P3A0H3 post SCTP Outside Dr. Moewardi Hospital + Hypovolemic Shock pro Emergency Laparotomy until Total Abdominal Hysterectomy with Physical Status ASA IVE Plan with RSI general anesthesia Control.Intraoperative Management of anesthesia uses RSI's general anesthesia technique to control hemodynamics and uses anesthesia drugs that do not worsen the patient's condition. At the time of surgery, we did the transfusion because there was a significant amount of bleeding during the procedure and was categorized as Class IV bleeding.Anesthesia care of patients with postpartum hemorrhage extends from the antenatal period to the postpartum period. Optimal postpartum hemorrhage management occurs when nurses, obstetricians and anesthesiologists recognize early the potential for excessive bleeding and trigger a 'major obstetric hemorrhage protocol' that describes specific tasks for each team player and the algorithm that must be followed according to etiology, circumstances and time during labor.
Perioperative Management of Sectio Caesarea Surgery in Patient With Heart Valve Disorders Purwoko Purwoko; Zidni Afrokhul Athir
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 1 (2021): April 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (473.702 KB) | DOI: 10.20961/soja.v1i1.49474

Abstract

Cardiovascular disease in pregnancy is common range from 1% to 3 and contributes to 10-15% of maternal mortality. Valvular heart disease accounts for about 25% of cases of cardiac complications in pregnancy and important cause of maternal mortality, some of which are mitral stenosis and mitral regurgitation. Cesarean delivery remains the preferred choice, as it reduces the hemodynamic changes that can occur in normal delivery and allows for better monitoring and hemodynamic management. Our paper provide in-depth information regarding the pathophysiology of heart valve disease in pregnant women and an appropriate perianesthesia approach to obtain a good prognosis. We report a case of a 26-year-old pregnant woman, with obstetric status G1P0A0, 36 weeks’ gestation, body weight 61 kg accompanied by severe mitral regurgitation and moderate mitral stenosis. This patient was planned to undergo elective cesarean section. The patient's condition in the perioperative examination was: GCS E4V5M6, other vital signs within normal limits, SpO2 98-99% in supine position. Other physical and laboratory examinations were also within normal limits. The goal of anesthesia during surgery in patients with heart valve disease undergoing cesarean section maintain pulmonary capillary pressure to prevent acute pulmonary edema. In this case, regional anesthesia of epidural anesthesia was chosen because it can reduce systemic vascular resistance and provide better post-cesarean section pain. The patient's hemodynamics perianesthesia tended to be stable without any complications such as pulmonary edema.    

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