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

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.

Difficult airway in the Paediatric Intensive Care Unit

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.

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

2020 ◽  
Vol 2 (2) ◽  
pp. 86-92
Author(s):  
Erna Fitriana A ◽  
Ratih Kumala Fajar Apsari ◽  
Yusmein Uyun
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Caesarean Section ◽  
Medical Condition ◽  
Rapid Sequence Induction ◽  
Airway Disease ◽  
Difficult Problem ◽  
Rapid Sequence ◽  
Sequence Induction ◽  
In Pregnancy

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  

scholarly journals Comparison of Rocuronium and Succinylcholine for Rapid Sequence Induction in patients undergoing surgery under General Anaesthesia

2020 ◽  
Vol 24 (2) ◽  
pp. 134-138
Author(s):  
Fasial Wahid ◽  
Aftab Hussain ◽  
Faiz Ur Rahman ◽  
Obaid Ur Rahman
Keyword(s):  
General Anesthesia ◽  
Randomized Control Trial ◽  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Study Results ◽  
Sequence Induction ◽  
Group A ◽  
Randomized Control ◽  
Group B ◽  
Intubation Condition

Objectives: To compare the frequency of excellent intubation condition with Succinylcholine and rocuronium for rapid sequence induction in patients undergoing surgery under general anesthesia. Design: Randomized control trial. Place and duration of study: Department of anesthesiology and pain medicine, Combined Military Hospital Malir Cantt Karachi from 25th June to 10th August 2019. Methodology: In this randomized control trial, a non-probability consecutive sampling technique was used. Anesthesia was given through a standard approach. Then patients were randomly divided into two equal groups. In group A, succinylcholine (1mg/Kg) was given while in group B, rocuronium (1mg/Kg) was given. Laryngoscopy was attempted after 60 seconds. Intubating conditions were labeled as excellent, good, poor, and impossible. All the data was collected in two groups, the data was entered and analyzed on SPSS version 21. Results: The mean age of the patients was 40.11±9.49 years. The male to female ratio of the patients was 0.7:1. The study results showed the excellent intubation conditions were noted in 11 from group A and 9 from group B, good intubation condition was noted in 29 from group A and 25 from group B, poor conditions were noted in 17 from group A and 16 from group B and the impossible intubation conditions were noted in 13 from group A and 20 from group B. Statistically insignificant difference was found between the study groups with intubation conditions i.e. p-value=0.570. Conclusion: It has been proved in our study that both the succinylcholine and rocuronium are statically equally effective in terms of excellent intubation conditions in the management of rapid sequence induction in patients undergoing surgery under general anesthesia.

scholarly journals A retrospective observational study of critically unwell patients retrieved from Thames Hospital between April 2018 and December 2020

2021 ◽  
Vol 13 (3) ◽  
pp. 231
Author(s):  
Rory Miller ◽  
Samuel Bell ◽  
Lisa TenEyck ◽  
Meg Topping
Keyword(s):  
Emergency Department ◽  
Intensive Care ◽  
Rapid Sequence Induction ◽  
Medical Officer ◽  
Rural Hospitals ◽  
Retrieval Processes ◽  
Rapid Sequence ◽  
Sequence Induction ◽  
Birthing Centre ◽  
After Hours

ABSTRACT INTRODUCTIONIn New Zealand, critically ill patients who present to rural hospitals are typically treated, stabilised and transferred to facilities where more appropriate resources are available. AIMThe aim of this study was to describe patients who presented critically unwell and required retrieval from Thames Hospital in the Waikato region. METHODSNotes were reviewed retrospectively for patients who were retrieved from Thames Hospital between 1 April 2018 and 31 December 2020. Patients were excluded if they were retrieved from the offsite birthing centre or their notes were not available to the authors. RESULTSDuring the study period, 56 patients were retrieved by intensive care teams based at Waikato, Starship or Auckland Hospitals. Patients had a median age of 57 years and most were female (60.7%). Māori patients were over-represented in the retrieval cohort compared with the population presenting to the emergency department (30.4% vs. 20.1%, P < 0.001). We found that 41% of patients presented after-hours when there was only one senior medical officer available on site and 70 procedures were performed, including rapid sequence induction, which was required by 19.6% of patients. DISCUSSIONThis study describes a population of critically unwell patients who were retrieved from a rural hospital. The key finding is that nearly half of these patients presented after-hours when there was only one senior medical officer available on site. This doctor also has sole responsibility for all other patients in the hospital. We recommend that referral centres streamline the retrieval processes for rural hospitals.

scholarly journals The effects of the association of placenta previa and placenta accreta on the short-term maternal morbidity

2020 ◽  
Vol 28 (3) ◽  
pp. 176-182
Author(s):  
Şener Gezer ◽  
Mehmet Zeki Türe ◽  
Sibel Balcı ◽  
İzzet Yücesoy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Maternal Morbidity ◽  
Blood Product ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Previous Cesarean Section ◽  
Short Term ◽  
History Of ◽  
Previous Cesarean

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p<0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p<0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone.

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