Surgical Drainage Cystogastrostomy in Patient with Pancreatic Pseudocyst

Background: Pancreatic pseudocysts are often managed through surgical drainage, which is common in rural areas for several reasons, including limited facilities. Case: Therefore, this study presents a successful treatment of three pancreatic pseudocyst cases using surgical drainage cystogastrostomy. Furthermore, this treatment method was selected due to the ease of performance in rural hospitals and was successfully performed without any complications. Conclusion: The diagnoses of pancreatic pseudocysts were confirmed by anamnesis, physical examination, and CT-scan imaging. The operations were also performed successfully without any complications. However, the patients will also undergo follow-up for two years to enable the doctors to observe for any possible long-term complications

Penggunaan Remifentanil pada Pasien Pediatrik dengan Meningokel yang Dilakukan Tindakan Eksisi Meningokel

Meningokel adalah kondisi kegagalan fusi selubung saraf medulla spinalis yang umum ditemui pada pasien pediatrik. Koreksi meningokel dilakukan dalam posisi prone yang memerlukan tatalaksana anestesi yang hati-hati. Fisiologi neonatus dan infant berbeda dengan orang dewasa, karena fungsi fisiologis system organ masih imatur dan menyebabkan safety margin terbatas, sehingga pilihan obat adalah yang metabolismenya tidak tergantung pada fungsi hati dan ginjal normal. Dalam bidang neuroanestesi pediatrik, penggunaan remifentanil semakin luas, karena onset cepat, efek analgesik poten dan eliminasi cepat. Seorang bayi laki-laki, usia 7 bulan dengan berat badan 7 kg, diagnosis meningokel lumbosacral dilakukan tindakan eksisi meningokel. Pasien diberikan remifentanil 1 mcg/kgbb selama 1 menit dilanjutkan dengan remifentanil kontinyus 0.05-1mcg/kgbb/mnt. Induksi dengan propofol, diberikan atracurium sebelum intubasi. Selama operasi kondisi stabil, tidak terjadi episode bradikardi dan pascaoperasi pasien langsung diekstubasi. Penggunaan remifentanil menjadi pilihan karena onset cepat, efek analgesik poten, eliminasi cepat dan memberikan stabilitas hemodinamik selama operasi. Operasi dengan posisi prone pada pasien pediatrik memerlukan kehati-hatian terutama saat memposisikan pasien, dimana harus yakin pipa ett tidak mengalami dislokasi atau kinking, mencegah  efek penekanan pada mata dan pencegahan terjadinya neuropati perioperatif. Pemakaian remifentanil pada kasus ini memberikan stabilitas hemodinamik yang baik dan pulih sadar yang cepat.   Using Remifentanyl For Pediatrik Patient With Meningocele Underwent Meningocelectomy Under General Anesthesia Abstract Meningocele is failure of the neural tube to close during first trimester pregnancy which is the most common conditions in pediatrik patient. Correction is performed under prone position with carefull anesthestic procedure. The physiology of neonates and infants are different from that of adults. Immaturity of their vital organ systems narrows the safety margin of perioperative management including anesthesia. Remifentanil is becoming increasingly popular for this purpose. Remifentanil has favorable characteristics for anesthesia in neonates such as rapid onset, potent analgesic effect, and rapid elimination. A baby boy 7 months old, 7 kg, with meningocele lumbosacral underwent meningocelectomy. The patient was given remifentanil 1 mcg/kgbw/iv in one minute and continuous 0.05-0.1 mcg/kgbw/mnt. Induction with propofol iv, atracurium before intubation. Stability hemodynamic during the operation, no episode of bradycardia and patient extubated early after the operation. Remifentanil is an ultra-short-acting opioid, with rapid onset, produces profound analgesia, rapid offset and good stability of hemodynamic during the operation. The operations are carried out prone, careful positioning is paramount to avoid complications like dislodging or kinking of the endotracheal tube, corneal abrasion or perioperative neuropathy. Using remifentanyl in this case report given good hemodynamic stability dan rapid emergence

Korelasi antara Skor Intracerebral Hemorrhage (ICH) dengan Mortalitas Pasien Perdarahan Intraserebral di RSUD Ulin Banjarmasin

Latar Belakang dan Tujuan: Perdarahan intraserebral (PIS) merupakan kejadian medis yang meningkatkan angka kematian dan kecacatan tinggi. Secara teori, mortalitas PIS dapat diprediksi dengan menggunakan komponen skor Intracerebral Hemorrhage (ICH). Tujuan penelitian ini untuk mengetahui bagaimana korelasi antara skor ICH dengan mortalitas pasien PIS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sebanyak 53 sampel didapatkan secara consecutive sampling. Data hasil penelitian diuji dengan uji Regresi Logistik. Hasil: Dalam penelitian ini pasien skor ICH 0 meninggal sebanyak 15%, 36% skor ICH 1, 71% skor ICH 2, 86% skor ICH 3 dan 100% skor ICH 4 dan 5. Hasil analisis data penelitian ini, diperoleh OR = 0,02; 0,06; 0,3 untuk masing-masing skor ICH 1, 2 dan ≥3; dengan p=0,001. Simpulan: Terdapat korelasi yang sangat signifikan dan hubungan positif antara skor ICH dengan mortalitas pasien PIS di RSUD Ulin Banjarmasin, sebagai prediktor independen.   Correlation between ICH Score with ICH Patient’s Mortality at Ulin General Hospital Banjarmasin Abstract Background and Objective: Intracerebral hemorrhage (ICH) is the medical events that increases the mortality and disability. Theoretically, mortality can be predict by ICH score’s components. The purpose of this study is to determine the correlation between ICH scores and mortality of ICH patients in Ulin General Hospital Banjarmasin. Subject and Method: This research is an analytic observational with cross sectional approach. A total of 53 samples were obtained by consecutive. Data analysis of this study used the Logistic Regression test. Result: In this study, it was found that patients with ICH score 0 died 15%, 36% score 1, 71% score 2, 86% score 3 and 100% score 4 and 5. Data analysis of this study showing OR= 0,02; 0,06; 0,3 for ICH score 1, 2 and ≥3 respectively; with p=0,001. Conclusion: There is a very significant correlation and enough positive relationship between the ICH score and mortality of ICH patients in Ulin General Hospital Banjarmasin, as independent predictor

Hubungan Kadar Gula Darah dan Hematokrit dengan Luaran Pasien Cedera Otak Traumatik Berdasarkan Skor GCS di RSUD Ulin Banjarmasin

Latar Belakang dan Tujuan: Tingkat keparahan dari cedera otak traumatik (COT) dapat dinilai menggunakan Glasgow Coma Scale (GCS). Saat terjadi COT, tubuh mengeluarkan hormon sebagai respons stres fase akut sehingga terjadi peningkatan kadar gula darah reaktif. Selain itu juga memengaruhi pembuluh dan komponen darah sehingga akan memengaruhi hematokrit. Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara kadar gula darah dan hematokrit dengan luaran pasien COT berdasarkan skor GCS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross-sectional. Data diambil secara prospektif dengan metode consecutive sampling. Data yang terkumpul dianalisis hasilnya menggunakan uji korelasi non-parametrik Spearman. Hasil: Sebanyak 45 sampel didapat secara consecutive sampling. Pada hari ke-7, 40 pasien memiliki luaran baik dan 5 pasien memiliki luaran buruk. Analisis menggunakan uji korelasi Spearman menunjukkan terdapat hubungan kadar gula darah dengan luaran pasien COT (p=0,044; r=0,302) tetapi tidak terdapat hubungan antara hematokrit dengan luaran (p=0,958). Simpulan: Terdapat hubungan kadar gula darah dengan luaran pasien COT, tetapi tidak terdapat hubungan hematokrit dengan luaran pasien COT berdasarkan skor GCS.   Association of Blood Sugar Levels and Hematocrit with TBI Patient Outcome Based on GCS Score at Ulin General Hospital Banjarmasin Abstract Background and Objective: Glasgow coma scale (GCS) examination is done to categorize the severity and determine the outcome in TBI. When TBI occurs, the body release hormones in the acute phase of stress response which will occur an increase blood sugar levels. It will also affect hematocrit. The purpose of this study was analyze correlation between blood sugar levels and hematocrit with TBI patients outcome based on GCS score in Ulin General Hospital Banjarmasin. Subject and Method: The design of this study was observational analytic with cross-sectional approach. Data acquired prospectively with consecutive sampling method. The collected data will be analyzed using the Spearman non-parametric trial. Result: Total of 45 samples were obtained by consecutive sampling. On day 7, 40 patients had good outcomes and 5 patients had poor outcomes. Analysis using the Spearman correlation test showed association between blood sugar levels and TBI patients outcome (p=0,044; r=0,302) but no association between hematocit and TBI patients outcome (p=0,958). Conclusion: It was concluded that there is an association between blood sugar levels and TBI patients outcome, but there is no association between hematocrit and TBI patients outcome based on GCS score

Tatalaksana Gagal Nafas pada Pasien Peripartum Kardiomiopati

Peripartum cardiomyopathy (PPCM) adalah kardiomiopati idiopatik pada kehamilan dengan manifestasi klinis gagal jantung akibat disfungsi sistolik ventrikel kiri tanpa adanya penyakit jantung yang mendasari. Terjadi pada kehamilan trimester akhir atau 1–5 minggu pasca kelahiran. Gagal napas pada PPCM terjadi karena adanya edem paru yang berasal dari gagal jantung akut. Wanita 25 tahun dengan G2P0A1 hamil 36 minggu + intrauterine fetal death + preeklamsi berat + gagal napas ec PPCM. Sesak bertambah berat saat tidur terlentang, pink froaty positif. Tanda vital: tekanan darah 131/100 mmHg, laju nadi 141x/menit, laju nafas 37x/menit, SpO2 76% dengan non rebreathing mask 15 liter/ menit, auskultasi paru ronki diseluruh lapangan paru kanan dan kiri, terdapat suara jantung tambahan murmur dan gallop. Echocardiografi didapatkan katup jantung mitral regurgitasi ringan sedang, trikuspid regurgitasi ringan, dan ejection fraction (EF) 36%. Pasien didiagnosa PPCM berdasarkan gejala klinis dan pemeriksaan penunjang, pasien mengalami gagal napas tipe 1 berdasarkan hasil analisa gas darah didapatkan nilai PO2 57,0 dan PCO2 35 mmHg. Intubasi dilakukan pada pasien PPCM dengan target saturasi O2 >95%. Tatalaksana PPCM bersifat suportif/non spesifik dan kausatif/spesifik secara simultan. Penatalaksanaan non spesifik secara tidak langsung ditujukan untuk memperbaiki pertukaran gas, berupa: mengatasi hipoksemia dengan terapi oksigen, atasi hiperkapnia dengan memperbaiki ventilasi hingga melakukan ventilasi mekanik dan fisioterapi dada. Telah dilaporkan pasien gagal napas akibat PPCM yang dilakukan tindakan ventilasi mekanik dan terapi multidisiplin memberikan keberhasilan terapi yang baik

Manajemen Anestesi pada Pasien Preeklampsia Berat disertai Impending Thyroid Storm yang Dilakukan Seksio Sesarea

Hipertiroid yang tidak terkontrol selama kehamilan dapat menyebabkan preeklamsia. Preeklamsia merupakan salah satu penyebab utama morbiditas dan kematian maternal. Wanita hamil yang mengalami preeklamsia dan hipertiroid tidak terkontrol memerlukan pemantuaan ketat dan terminasi kehamilan. Manajemen perioperatif dan anestesi yang tepat diperlukan pada kasus ini untuk mencegah terjadinya badai tiroid dan perburukan pasien akibat preeklamsia. Wanita 26 tahun dengan preeklampsia berat dan hipertiroid. Pada pemeriksaan fisik terdapat pembesaran kelenjar tiroid, eksoftalmus, tremor dan telapak tangan teraba lembab. Tekanan darah 160/100 mmHg, nadi 145 kali permenit, temperatur 36,7°C, SpO2 99% dengan O2 simple mask 5 lpm. pemeriksaan laboratorium didapatkan hemoglobin 12,7 gr/dL, FT4 33,08 ug/dl TSH 0,002 uU/ml, dan protein urin positif. Skor indeks Wayne 24 dan skala Burch Wartofsky’s 35. Sebelum operasi, pasien mendapatkan MgSO4 40% intravena, thyrozol, propanolol dan lugol. Pasien menjalani seksio sesarea dengan anestesi spinal menggunakan bupivakain hiperbarik 0,5% 12,5 mg dan ajuvan fentanil 25 mcg. Pasien menjalani perawatan selama empat hari dengan hemodinamik stabil dan dipulangkan tanpa komplikasi. Manajemen perioperatif dan anestesi yang tepat pada wanita hamil yang disertai preeklamsia berat dan hipertiroid tidak terkontrol dapat mencegah terjadinya perburukan kondisi pasien. Pemilihan anestesi spinal memiliki keuntungan dan aman dilakukan pada kasus ini.

Perioperative Factors Impact on Mortality and Survival Rate of Geriatric Patients Undergoing Surgery in the COVID-19 Pandemic: A Prospective Cohort Study in Indonesia

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan–Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03–5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96–7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32–5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32–8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p p p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic

Comorbidities and COVID-19 status influence the survival rate of geriatric patients in intensive care units: a prospective cohort study from the Indonesian Society of Anaesthesiology and Intensive Therapy

Background: With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods: We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results: We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). Conclusion: Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status