Coronary Heart Disease: Diagnosis and Therapy

<p>Coronary heart disease (CHD), is one of the non-communicable diseases that has a tendency to increase every year and have an impact not only on developed countries, but also in developing countries. According to the World Health Organization (WHO), in 2012 there were 56 million deaths worldwide caused by non-communicable disease and heart disease contributed 46.2% or caused 17.5 million deaths. This review article to give brief explanation about CHD from risk factors, diagnosed criteria, management therapy and prognosis. Risk factors for CHD can be distinguished into major risk factors and minor risk factors. Symptoms of CHD are discomfort in the chest ranging from pain crushed during activity and improved with rest to continuous chest pain. The diagnosis of CHD is established based on anamnesis, physical examination, and laboratory examination. The CHD classification consists of Stable Angina Pectoris (APS) and Acute Coronary Syndrome (ACS). Lifestyle changes accompanied<em> </em>by right medication can reduce complications caused by CHD.</p>

Management of Patient Primigravida 36-37 Weeks with Chronic Myeloid Leukemia, Anemia, and Thrombocytopenia: A Case Report

<p>Chronic myelogenous leukemia (CML) is a type of cancer caused by a disturbance in the hematopoietic stem cells. CML itself rarely occur on women who are in labor and an advanced procedure in this event has become a special challenge for medics, especially an anesthesiologist. This limits the development of standard anesthesia guidelines, so in this case we describe the incidence of CML in pregnancies performed by Cesarean section with general anesthesia.</p><p>The first pregnant patient was 36 weeks pregnant; the patient was first diagnosed with Chronic myelogenous leukemia (CML) at the age of 26-28 weeks, at that time the patient complained of frequent dizziness, abdominal pain and weakness, then the patient complained of bleeding gums, and currently the patient complained of nosebleeds. The Bone Marrow shows Conclusion an accelerated phase chronic myeloid leukemia (CML) (suspected atypical CML) with nutritional deficiency. We perform General Anesthesia technique Rapid Sequence Intubation with Regimen Fentanyl 100 mcg, Propofol 80 mg and Rocuronium 50 mg.</p><p>The patient was admitted to the ICU for 2 days before transferring to intensive care and the patient received intravenous paracetamol 1 gram four times, cefazolin 1 gram twice a day, lansoprazole 30 mg once a day, tranexamic acid 1gr three times a day, and 15 mcg per hour fentanyl contionously. Hemodynamic patients in the ICU are in a stable condition. On the second postoperative day of care, the patient was transferred to the High care ward, then at the third postoperative day the patient's hemodynamics was stable and the patient was transferred to a normal room.</p>

Perioperative Management of Subdural Hemorrhage (SDH) Trepanation Decompression with Hemophilia A

<p>Hemophilia is a serious inherited blood disease, transmitted by women, that affects mainly men and lasts for a lifetime. Hemophilia A is the most common form. If any of the factors necessary for blood clotting are absent or insufficient, the clotting mechanism is disturbed, causing insatiable bleeding. The most common cause of death in hemophilia patients is cerebral hemorrhage due to head trauma. In cases of intracranial hemorrhage, surgery should be performed immediately to obtain a better prognosis. A 17-year-old man diagnosed with a 2x4 loss of consciousness due to intracranial subdural hemorrhage (SDH) in the left frontotemporoparietal region and cerebral edema on day 4 accompanied by subfalcine herniation to the right with hemophilia A, planned trepanation decompression for SDH evacuation. The patient received 4000 units of factor VIII injection before surgery. Bleeding during surgery was 1100cc and he received a transfusion of 1940cc blood products until hemodynamically stable. In the postoperative phase, he was admitted to the ICU for 8 days, extubation was performed after the condition improved. In patient with hemophilia, evacuation of bleeding should be performed immediately, but there is a high risk of rebleeding. A recombinant factor VIII substitute should be administered immediately for the treatment of acute bleeding in patients with severe haemophilia A. Anesthetic maintenance should include reducing the risk of hypertension and tachycardia to minimize bleeding.</p>

Management of Intracranial Pressure Control in Reciprocal Grade 3 Astrocytoma Patient In Dr. Moewardi General Hospital Surakarta: Case Report

<p><strong></strong>Surgery in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patients. Management of patients with intracranial hypertension can be guided by monitoring intracranial pressure (ICP) perioperatively. A variety of ventricular, intraparenchymal, and subdural equipment can be installed by neurosurgeons to provide ICP measurements.</p><p>We reported a 50-year-old female patient, with a complaint of having a speech disorder since four years ago. Preoperative physical examination showed GCS E4V5M6, patient's body mass index was 29.29 kg/m² (obese). Patient’s physical status was assessed with ASA 3. There was no significant abnormality in laboratory examination. MRI Brain contrast examination showed solid cystic lesion in supratentorial left temporal lobe with size 2.3x3.5x4.7cm accompanied by broad perifocal edema in the left frontal, temporal and parietal lobe. The chest X-ray showed cardiomegaly and pneumonia. Electrocardiography showed normal sinus rhythm.</p><p>Craniotomy in patients with astrocytoma is performed based on the size of the tumor in the brain and the functional status of the patient. Preoperative evaluation for patients undergoing craniotomy should be carried out to determine the presence or absence of intracranial hypertension. In principle, postoperative management in the ICU is to control the respiratory system, optimize the cardiovascular system, and prevent possible complications.</p><p>Management of intracranial pressure control in reciprocal grade 3 astrocytoma patient should be paid attention to various things and consider the condition of the patients. Preoperative preparations, as well as perioperative and postoperative monitoring, should be carefully observed to prevent complications that will adversely affect patients.</p><p> </p>

Perioperative Management in Parturient with Severe Preeclampsia, Obesity, and COVID-19

<p>The elevated cases of pregnant women infected with COVID-19 who needed to undergo caesarean section is a great challenge to anesthesiologists. Morbid obesity and preeclampsia in pregnancy are also another challenge to medical practice especially when the patient requires caesarean section. To describe the perioperative management of a morbidly obese preeclamptic patient with COVID-19. A pregnant woman with mild case of COVID-19, severe preeclampsia and obesity underwent an emergency caesarean section. Spinal anesthesia was performed using a Whitacre 26G spinal needle with 76 mm length, bupivacaine 0.5% 12.5 mg as spinal anesthesia agent and fentanyl 25 mcg as adjuvant. All operating teams use PPE according to COVID-19 guidelines and standard procedures. The operation went with a good outcome without any transmission to the operating team. The patient underwent treatment without postoperative complications. Spinal anesthesia is considered safe to be a usual technique for parturient with preeclampsia and morbid obesity. A proper COVID-19 surgery protocol is crucial in order to protect health workers handling COVID-19 patients.</p>

Perioperative Management of Sectio Caesarea Surgery in Patient With Heart Valve Disorders

<div class="WordSection1"><p>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.</p><p> </p><p> </p></div><br clear="all" /> <br /><p> </p>

Perioperative Management of Patients with Ventricular Septal Defect, Severe Tricuspid Regurgitation and Gerbode Defects

<p>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.</p><p>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.</p><p>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.</p><p>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.</p>

Anesthesia Management at Postpartum et causa Atonic Uteri Bleeding in P3A0H3 Post SCTP Outside Dr. Moewardi Hospital

<p>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 minutes</p><p>To understand anesthesia management at postpartum et causa atonic uteri bleeding outside Dr. Moewardi hospital</p><p>In 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.</p><p>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.</p><p>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.</p>

Anesthesia Management in VP Shunt Surgery in Neonates with Hypoplastic Left Heart Syndrome (HLHS) and Dandy Walker Syndrome

<p><strong>Introduction:</strong> 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.</p><p><strong>Purpose:</strong> To understand the mechanism of HLHS along with the principles of anesthesia in neuroaesthetics procedures in pediatrics in order to obtain a good outcome.</p><p><strong>Case Illustration:</strong> 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.</p><p><strong>Discussion:</strong> 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. </p><p><strong>Conclusion:</strong> 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..</p><p> </p><p> </p>

Anesthesia Management in Patient with Placenta Percreta Performed Intra-aortic Ballooning Caesarean Section

<p>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.</p>