Manajemen Anestesi pada Wanita Hamil dengan  Eklampsia  dan Asma Akut Berat  yang Menjalani Seksio Sesarea

Eklampsia dengan asma merupakan kondisi medis yang paling sering terjadi dalam kehamilan. Eklampsia dengan asma akut berat dalam kehamilan merupakan problem yang sulit. Kejadian eklampsia sekitar 2–8% diseluruh dunia dan merupakan penyebab kematian tertinggi kedua setelah perdarahan. Prevalensi terjadinya 0,3%–0,7% pada negara berkembang. Asma merupakan penyakit inflamasi kronis saluran nafas yang melibatkan banyak sel dan elemen seluler yang mengakibatkan terjadinya hiperresponsif jalan nafas yang dapat menimbulkan gejala episodik berulang berupa wheezing, sesak nafas, dada berat dan batuk. Di Indonesia prevalensi berkisar 5-6% dari populasi penduduk, dimana serangan asma biasanya timbul pada usia kehamilan 24–36 minggu. Seorang wanita 28 tahun G1P0A0 datang hamil 35 minggu dengan keluhan sesak, nyeri kepala, kejang tiga kali, kaki bengkak. Dilakukan seksio sesarea dengan anestesi umum. Ventilator mekanik selama seksio sesarea harus disesuaikan untuk menjaga PCO2 30–32 mmHg. Intubasi dilakukan dengan rapid sequence induction dan setelah pipa endotrakheal masuk dijaga tekanan darah supaya tidak meningkat. Setelah operasi selesai dilakukan ekstubasi dalam untuk mencegah gejolak hemodinamik dan mengurangi iritasi saluran nafas. Pasca operasi pasien masuk intensive care unit untuk pemantauan lebih lanjut. Penanganan anestesi yang efektif pada pasien ini akan meningkatkan survival serta memberikan prognosis yang lebih baik Management of Anesthesia in Caesarean Section for Patient with Eclampsia and SevereAcute Asthma Abstract Eclampsia with asthma is the most common medical condition in pregnancy. Eclampsia with severe acute asthma in pregnancy is a difficult problem. The incidence of eckampsia is around 2–8% worldwide and is the second highest cause of death after bleeding. The prevalence of occurrence is 0.3% –0.7% in developing countries. Asthma is a chronic inflammatory airway disease that involves many cells and cellular elements that cause airway hyperresponsiveness which can cause recurrent episodic symptoms such as wheezing, shortness of breath, heavy chest and coughing. In Indonesia the prevalence ranges from 5–6% of the population, where asthma attacks usually occur at 24–36 weeks' gestation. A 28-year-old woman G1P0A0 comes 35 weeks pregnant with complaints of tightness, headache, seizures three times, swollen feet. Caesarean section was performed under general anesthesia. Mechanical ventilator during cesarean section must be adjusted to maintain PCO2 30–32 mmHg. Intubation was done by rapid sequence induction and after the endotracheal tube has been entered, the intracranial pressure is maintained so it did not increase. After the operation was complete, extubation was done to prevent hemodynamic fluctuations and reduce airway irritation. Postoperatively the patient was admitted to the intensive care unit for further monitoring. Effective anesthetic treatment in these patients will increase survival and provide a better prognosis

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Difficult airway in the Paediatric Intensive Care Unit

Challenging Concepts in Paediatric Critical Care ◽

10.1093/med/9780198794592.003.0010 ◽

2020 ◽

pp. 115-128

Author(s):

Elizabeth O’Donohoe ◽

Thomas Breen ◽

Fiona Reynolds

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Rapid Sequence Induction ◽

Upper Airway ◽

Difficult Tracheal Intubation ◽

Respiratory Physiology ◽

Safe Management ◽

Rapid Sequence ◽

Sequence Induction ◽

Difficult Airways

Children with difficult airways can come to significant harm if not appropriately assessed and managed. Chapter 10 discusses the signs of airway compromise in children and indications for intubation in the Intensive Care Unit (ICU). The role of the paediatric airway in respiratory physiology is examined. Recognizing a difficult paediatric airway is vital in the ICU—common causes of upper airway obstruction are listed and techniques for assessing paediatric airways addressed. The choice of drugs for rapid sequence induction in the Paediatric ICU is explained, and algorithms for the management of the unanticipated difficult tracheal intubation and ‘cannot intubate, cannot ventilate’ illustrated. Finally, the chapter includes the fundamental concepts of team brief, checklists, and crisis resource management in the safe management of difficult airways in children.

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Serial Kasus: Manajemen Anestesi pada Wanita Hamil dengan Plasenta Akreta yang Direncanakan Tindakan Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v3i1.40 ◽

2020 ◽

Vol 3 (1) ◽

pp. 26-34

Author(s):

Purwoko Purwoko ◽

Rio Rusman ◽

M. Ridho Aditya

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Loss ◽

General Anesthesia ◽

Postpartum Hemorrhage ◽

Placenta Accreta ◽

Placenta Previa ◽

Rapid Sequence Induction ◽

Rapid Sequence ◽

Sequence Induction

Perdarahan postpartum merupakan salah satu penyebab utama kematian ibu selain penyakit kardiovaskuler. Diantara penyebab perdarahan post partum adalah plasenta akreta dimana insidennya semakin meningkat dari tahun ke tahun seiring dengan peningkatan jumlah persalinan dengan seksio sesarea. Kami laporkan dua kasus ibu hamil dengan plasenta akreta yang direncanakan tindakan seksio sesarea emergency yang dikelola dengan general anesthesia rapid sequence induction. Kasus pertama, perempuan berusia 31 tahun G3P1A1 usia kehamilan 36–37 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 7000 cc, dan diberikan transfusi 8 unit PRC, 4 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan komplikasi yang terjadi produk drain abdomen sekitar 1900 cc bercampur darah. tidak ada komplikasi mayor lainnya, pasien pindah ruang rawat inap pada hari keempat pascaoperasi. Kasus kedua, perempuan berusia 40 tahun G3P2A0 usia kehamilan 37–38 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 9000 cc, dan dilakukan transfusi 8 unit PRC, 8 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan. tidak ada komplikasi signifikan terjadi. Hari kedua pascaoperasi pasien pindah ke ruang rawat inap. Case Series: Anesthesia Management in Pregnant Woman with Placenta Accreta Planned for Caesarean Section Abstract Postpartum hemorrhage is one of the leading causes of maternal morbidity besides cardiovascular disease. Among the causes of postpartum hemorrhage is placenta accreta, where the incidence increases from year to year along with the increase in the number of cesarean delivery. We report two cases of pregnant women with placenta accreta planned for emergency cesarean section managed with general anesthesia rapid sequence induction. The first case, 31-year-old woman G3P1A1 36–37 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 7000 cc, and given transfusion of 8 units of PRC, 4 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and complications that occurred around 1900 cc of abdominal drain product mixed with blood. After that, there were no other major complications, then the patient moved the ward on the fourth day. The second case, a 40-year-old woman G3P2A0 37–38 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 9000 cc, and given transfusion of 8 units of PRC, 8 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and no significant complications happen. The second day after surgery the patient moved to the ward.

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