Manajemen Anestesi pada Pasien Seksio Sesarea Primigravida 35 Minggu dengan Sindroma Nefrotik

Sindroma nefrotik adalah sekumpulan gejala berupa proteinuria, hipoalbuminemia, edema, hiperkolesterolemia, dan lipiduria yang ditandai peningkatan permeabilitas dinding kapiler terhadap protein serum. Sindroma nefrotik pada kehamilan jarang terjadi namun bila tidak dikelola dengan baik akan meningkatkan morbiditas. Sindroma anefrotik dapat muncul sebelum umur kehamilan 20 minggu dan sering disebabkan oleh glomerulonephritis, sedangkan yang muncul sesudah umur kehamilan 20 minggu patut diduga disebabkan atau disertai suatu preeklampsia. Dilaporkan pasien 35 minggu dengan diagnosis preeklamsia, sindroma nefrotik dan suspek edema pulmo. Pasien di diagnosis sindroma nefrotik sejak kehamilan 12 minggu dan mendapat terapi metilprednisolone 16 mg 1-0-0 hingga sekarang. Pada usia kehamilan 28 minggu pasien didiagnosis preeklamsia. Datang karena kontraksi yang semakin kencang. Pasien dilakukan seksio sesarea dengan tehnik regional anestesi epidural Levobupivacain 0.5% isobarik 11 ml, janin cukup viable dilahirkan. Pasca operasi pasien dirawat di high care unit dan pulang ke rumah setelah perawatan 8 hari dalam kondisi baik. Manajemen anestesia pada ibu hamil dengan sindroma nefrotik antara lain sering disertai tekanan darah tinggi atau preeklampsia, malnutrisi dan hilangnya zat-zat yang diperlukan tubuh bersamaan dengan hilangnya protein melalui urine. Pasien seharusnya ditangani melalui pendekatan multidisipliner dengan spesialis perinatologi, nefrologi, dan neonatologi, dengan pemahaman terhadap pentingnya menjaga keseimbangan agar sesuai dengan perubahan fisiologis wanita hamil normal akan memberikan prognosis yang baik dalam menurunkan tingkat morbiditas. Anesthesia Management of Caesarean Section in 35 Weeks Primigravida Patients with Nephrotic Syndrome Abstract Nephrotic syndrome is a set of symptoms in the form of proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and lipiduria which are characterized by an increase in capillary wall permeability to serum proteins. Nephrotic syndrome in pregnancy is rare but if not managed properly, it will increase a morbidity. Nephrotic syndrome can occur before 20 weeks of gestation and is often caused by glomerulonephritis, whereas if appears after 20 weeks' gestation is thought to be due to or accompanied by preeclampsia. A 35-week patient was reported with preeclampsia, nephrotic syndrome and suspected pulmonary edema. Patients were diagnosed with nephrotic syndrome since 12 weeks' gestation and were treated with methylprednisolone 16 mg 1-0-0 until now. At 28 weeks' gestation the patient was diagnosed with preeclampsia. she came to hospital due to primature contraction. Patient underwent SC with a 11 ml Levobupivacaine 0.5% drug isobaric epidural anesthesia regional technique, the fetus was viable enough to be born. After surgery the patient was treated at HCU and returned home after 8 days of treatment in good condition. Management of anesthesia in pregnant women with nephrotic syndrome is often accompanied by high blood pressure or preeclampsia, malnutrition and loss of substances needed by the body along with loss of protein through urine. Patients should be treated through a multidisciplinary approach, along with specialists in perinatology, nephrology, and neonatology. With an understanding of the importance of maintaining balance in accordance with the physiological changes of normal pregnant women will provide a good prognosis in reducing morbidity

Emboli Air Ketuban

Emboli cairan amnion (EAK) adalah komplikasi kehamilan yang jarang namun membawa angka mortalitas yang tinggi. Patogenesis yang tepat dari kondisi ini masih belum diketahui. Emboli air ketuban (EAK) atau amniotic fluid embolism (AFE) atau anaphylactoid syndrome of pregnancy adalah salah satu komplikasi kehamilan yang paling membahayakan. Cairan ketuban, debris fetal diduga menyebabkan kolaps kardiovaskular dengan cara memicu reaksi imun/anafilaktoid maternal. Patofisiologi EAK hingga kini masih belum jelas tetapi diduga melibatkan kaskade immunologis. Kematian maternal bisa terjadi karena cardiac arrest mendadak, perdarahan karena koagulopati, dan kegagalan organ multipel dengan acute respiratory distess syndrome (ARDS). Gejala dan tanda EAK antara lain dispnea akut, batuk, hipotensi, sianosis, bradikardia fetal, ensefalopati, hipertensi pulmoner akut, koagulopati, dan sebagainya. Diagnosis EAK adalah bersifat klinis dan ditegakkan setelah menyingkirkan kemungkinan penyebab lain. Penatalaksanaan bersifat suportif dan memerlukan persalinan janin jika diperlukan, support respiratorik, dan support hemodinamik. Prognosis maternal setelah EAK masih sangat buruk meski tingkat survival janin sekitar 70%. Pasien dengan EAK paling baik dikelola di unit perawatan kritis oleh tim multidisiplin dan dengan manajemen supportif.   Amniotic Fluid Embolism Abstract Amniotic fluid embolism (AFE) is a rare complication of pregnancy carrying a high mortality rate. The exact pathogenesis of the condition is still not known. Amniotic fluid embolism (AFE) or anaphylactoid syndrome of pregnancy is one of the most dangerous pregnancy complications. Amniotic fluid, fetal debris is thought to cause cardiovascular collapse by triggering a maternal immune / maternal anaphylactoid reaction. The pathophysiology of AFE remains unclear but is thought to involve an immunological cascade. Maternal deaths may occur due to sudden cardiac arrest, bleeding due to coagulopathy, and multiple organ failure with ARDS. AFE symptoms and signs include acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy. Management is supportive, respiratory support, and haemodynamic support. The maternal prognosis is very poor even though the survival rate of the fetus is about 70%. Patients with AFE are best managed in a critical care unit by a multidisciplinary team and management is largely supportiv

PERBANDINGAN KEJADIAN MUAL DAN MUNTAH PADA ANESTESI MIDAZOLAM 0,05 MG/KGBB IV - KETAMIN 0,3 MG/KGBB IV DAN MIDAZOLAM 0,05 MG/KGBB IV - PETHIDIN 2 MG/KGBB IV PADA TINDAKAN METODE OPERASI WANITA (MOW)

Background: The incidence of nausea and vomiting in all types of surgery and patient population is estimated at 25-30%, even among patients who have a high risk for the occurrence of nausea and vomiting can reach 80%. The state of hypovolemia, hypoperfusion, hypoxemia have contributed to the occurrence of postoperative nausea and vomiting. Midazolam is a sedative drug that has the benefit of preventing nausea and vomiting, but has the disadvantage that these drugs cause respiratory depression. Pethidine has advantages as an analgesic, has a faster onset than morphine when combined with midazolam, have good muscle relaxation. Ketamine has the advantage of being a powerful analgesic, sedative drugs, rapid onset (30 seconds), respiratory function and cardiovascular function is maintained, water soluble, stable and non-irritating. The purpose of the study: comparing between anesthesia with midazolam 0.05 mg / kg, ketamine 0.3 mg / kg and midazolam 0.05 mg/kg- pethidin 2 mg / kg in reducing the incidence of nausea and vomiting on famale sterilisation methode. Methods of research: study design using a double blind randomized trial. 54 study subjects who were divided into two groups: group A (midazolam 0.05 mg / kg iv ketamine + 0.3 mg / kg iv) and group B (midazolam 0.05 mg / kg iv + pethidin 2 mg / kg iv ). Inclusion criteria: Women do not smoke, do not have a history of motion sickness, physical status ASA I-II, aged 18-45 years, elective surgery procedures and BMI 18-25 kg/m2. Exclusion criteria: allergy to midazolam, ketamine and pethidi

EFEKTIFITAS PENAMBAHAN INFUS EFEDRIN 3MG/MENIT 2 MENIT SEBELUM BLOK SUBARAKHNOID DILANJUTKAN 1 MG/MENIT 18 MENIT BERIKUTNYA UNTUK MENGURANGI KEJADIAN HIPOTENSI KARENA BLOK SUBARAKHNOID PADA SEKSIO SESARIA

The objective of the present research was to investigate the prophylactic effectiveness of preloading 20 ml/kg Ringer�s lactate given 30 minutes prior to subarachnoid block, with infusion of 3 mg/minutes ephedrine administered 2 minutes prior to subarachnoid block and 1 mg/minutes of which at 18 minutes afterwards, to reduce the incidence of hypotension among patients undergoing caesarean section. The research design was double blind randomized controlled clinical trial. Altogether 92 female patients (ranging age from, BMI< 35 kg/m2, and ASA I & II physical status) ranging age from 20 to 45 years were enrolled in the study. The scope of this research were full-term pregnant women who underwent elective caesarean section with subarachnoid block anesthesia in Banyumas District Hospital operating room. Subjects were divided into 2 groups, 46 patients of each group. Group A was preloaded by 20ml/kg Ringer�s lactate with infusion of 100 ml 0,9% NaCl+100 mg ephedrine, while group B was preloaded by 20ml/kg Ringer�s lactate and infusion of 100 ml 0,9 NaCl+2 ml 0,9% NaCl. Systolic and diastolic blood pressure, MAP, and SpO2 of all subjects were measured after preloaded by Ringer�s lactate, after ephedrine infusion prior to subarachnoid block, and every 2 minutes until the 20th minute after the subarachnoid block was performed subsequently. Both complication and action rescue were recorded and reported. Using independent samples t � test, we analyzed the quantitative data, while the qualitative data was analyzed by Chi � square at 95% significance level. P < 0,05 and p < 0,001 was considered to be significant and very significant, respectively. The incidence of hypotension was measured by calculating the decline in systolic blood pressure from the baseline. In group A (ephedrine), hypotension was occurred in 7 patients (15,2%), it means incidence of hypotension reduced by 84,8%, while in group B (control) hypotension was occurred in 26 patients (56,5%) or incidence of hypotension reduced by 43,5%. The results suggest that there was significant difference between two groups p < 0,05 (p = 0,001). In conclusion, prophylactic effectiveness of preloading 20 ml/kg Ringer�s lactate given within 30 minutes prior to subarachnoid block, with infusion of 3 mg/minutes ephedrine administered 2 minutes prior to subarachnoid block and 1 mg/minutes of which at 18 minutes afterward