ABSTRACT Introduction. Pre-eclampsia is a significant cause of maternal and fetal mortality and morbidity. Pre-eclampsia is characterized by hypertension (blood pressure ≥ 140/90 mmHg), oedema and amount of protein in urine 300 mg in the 24-hour, which appears after 20 weeks of gestation. Pre-eclampsia can cause complications, one of which is HELLP syndrome. This case report discusses the use of anaesthesia in a patient who underwent a cesarean section with indications for pre-eclampsia and partial HELLP syndrome.Case Presentation. A woman, 41 years old, G4P3A0 34 weeks pregnant with pre-eclampsia + syndrome HELLP will undergo emergency cesarean section with ASA IIE physical statusLabouror pain management was carried out using regional spinal anaesthesia technique, using bupivacaine 0.5% hyperbaric agent 12.5 mg. The operation lasted for 1 hour 30 minutes, with 300 ml bleeding, hemodynamically stable.Conclusion. Difficult intubation in emergency cases can be avoided by choosing of neuraxial anaesthesia technique is recommended. It will lead to better uteroplacental perfusion, good analgesia/anaesthesia quality, reducing surgical stress, reducing drugs that enter the uteroplacental circulation, and maternal psychological to be able to see the baby at birth.
Introduction: Aerosol box is a usefull tools to prevent aerosol and droplet contaminations during laryngoscopy and intubation in COVID-19 pandemic. Video laryngoscope is recommended during this era to increase the operator and patient’s distance during the procedure. However, many anesthesiologists still use direct laryngoscopes due to their availability and familiarity. This study aims to compare endotracheal tube intubation with video laryngoscope compared to direct laryngoscope in elective surgery patients. Methods: This study was a quasi-experimental study. The sample size in each group (video and direct laryngoscope) was 35 subjects. The primary outcome of this study was to compare the duration of intubation between video laryngoscope and direct laryngoscope, while the secondary outcome was to evaluate complications such as broken teeth and sore throat 24 hours post intubation. Results: Direct laryngoscope had shorter intubation duration than video laryngoscope [12.3 (8.9-21.0) vs 13.3 (11.4 – 21.6; p =0.07) respectively. Two complication reported on video laryngoscope groups. Conclusion: Duration of ETT intubation using a direct laryngoscope was shorter during intubation with aerosol box compared to video laryngoscope in elective surgery patients. The box which was being used may limit the space of movement making it difficult to intubate.
Introduction: Pain is a problem often encountered in postoperative patients. Study has shown after a procedure, 80% patients experience acute pain. This postoperative pain will affect patient’s quality of life therefore necessitating quick and proper treatment. Tissue trauma during surgery will have influence on body system, including endocrine. One of endocrine system response is cortisol secretion. Cortisol levels may be attenuated by bupivacaine and oxycodone. The aim of this study was to determine the efficacy of bupivacaine0,125% and oxycodone 5 mg on pain perception measured by cortisol in patients undergoing orthopedic surgery of the lower limb. Methods: A randomized clinical trial, double-blind study was performed at Mohammad Hoesin General Hospital in Palembang, South Sumatra, from November to May 2021. There were forty samples and divided into two groups (bupivacaine 0,125% and oxycodone 5 mg). Groups were divided by block randomization by computerized random number generator. Blinding were done by making analgesic has the same packages to prevent knowledge of which intervention is being done. Data were analyzed using independent t-test, ANOVA, Mann-Whitney and Chi Square with SPSS version 22.0. Results: There were no statistically significant differences between the two groups on age, gender, body mass index and duration of surgery. In bupivacaine group, cortisol level decreased from 12.94±6.99 µg/dl to 11.32±5.42 µg/dl meanwhile oxycodone group cortisol levels increased from 11.81±8.47 µg/dl to 11.82±7.56 µg/dl. There were no significant difference between two groups relating to cortisol levels. Conclusions: No significant difference was found on administration of bupivacaine 0,125% and oxycodone 5 mg as epidural analgesia on cortisol level in postoperative orthopedic surgery of the lower limb patient.
Background. Assessing pain in mechanically ventilated patients is an important thing for leads to improved outcome and better quality life of patients in the ICU. CPOT and BPS has been developed for measuring nonverbal patients. Aims. To validate suitability the use of CPOT and BPS in ICU RSMH. Methods. Observational analytic with cross sectional design was chosen for 50 samples conducted on July 2020 in ICU RSMH. Data was collected before and after pain procedure. Result. From 50 patients mostly 27(54%) male with age majority > 30 years old 39 (78%). The lowest GCS 2 and the highest 10. Length of treatment in ICU was 1 – 20 days. Bleeding variations was 0 - 1200 cc. BPS average before painful procedure was 2 – 5 and after panful procedure was 5 – 7. CPOT average before painful procedure was 1 – 6 and after painful procedure was 3 - 8. Kappa before painful procedure are moderate (kappa=0,435) and after painful procedure are fair (kappa=0,248) with strongly correlated in Pearson correlation (r = 0,644, r = 0,610) (p < 0,05). Conclusion. This study demonstrated that CPOT more detail than BPS for measuring pain in intubated patients. Keywords. BPS, CPOT, ICU, Intubated, Pain
Introduction. Sepsis is a group of symptoms of organ dysfunction that can be life-threatening because of dysregulation of body response toward ongoing infection. Organ dysfunction in sepsis can be measured by Sequential Organ Failure Assessment (SOFA) and T3 hormone. The study was aimed to identify the correlation of T3 in predicting mortality of 28 days patients in Intensive Care Unit RSMH Palembang. Method. This study design is cohort prospective. The inclusion criteria consist of a patient diagnosed with sepsis and septic shock in the Intensive Care Unit, 18-64 years old. Patients with a history of thyroid disease, pregnant or post-pregnancy, the patient admitted in referral from other hospitals, and patients with a history of psychiatry medication and thyroid medication were excluded. Data collected is the patient whose stay in Intensive Care Unit RSMH followed in 28 days from January 2021 until the sample was fulfilled (39 samples). Analyzing data was SPSS version 23 with chi-square analysis and Fisher's Exact to identify the relationship. Pearson correlation to identify correlation coefficient, and Medical application to measure AUC, cutoff value, sensitivity, and specificity. Result. The result showed that age (p=0,445). gender (p=1,00), need of ICU (p=0,228), isolation-nonisolation ward (p=0,437) didn't have any significant relationship toward mortality. SOFA score correlate statistically with positive correlation and medium strength (0,633) toward mortality of sepsis patient (p=0,000). T3 hormon correlate positively with medium strength (0,514) toward mortality of sepsis patient (p=0,001). T3 hormone toward SOFA correlate negatively (-0,365) with significant correlation (p=0,22). T3 hormone has AUC 0,291 with sensitivity 3,3% and specificity 67,7%. Conclusion. T3 hormone has a significant negative correlation to mortality in sepsis patients but cannot be used to predict mortality with a low AUC value (0,291).
Abstract Background: The cause of weaning failure is multifactorial. One of the causes was Ventilator Induced Diaphragm Dysfunction (VIDD) due to thinning process of the diaphragm thickness. Decreased diaphragm muscle mass might occur due to inflammatory process. Methods: The study was an observational analytic study from September 2018 to January 2019 in Mohammad Hoesin Hospital, Palembang – Indonesia. Ethical appoval for the study was obtained from Ethics Committee and subjects were recruited after signing the informed consents. Only 30 subjects were involved in the end of the study. About 6 mL of blood sample from cubital vein was withdrawn from each subject to measure neutrophils and lymphocytes. Patients’ diaphragm thickness was measured by using ultrasonography on 0th, 3rd, 5th day. Collected data were then analyzed with STATA 15. Results: The chi-square test showed that the relationship of NLR (neutophil to lymphocyte ratio) of the 0th day to the decrease in diaphragm thickness on the 3rd day was not significant (p = 0.254), while the decrease in diaphragm thickness on the 5th day was significant (p = 0.015). Subjects with initial NLR values >7 had a significant higher risk of having decreased diaphragm thickness compared to subjects with initial NLR values ​​≤7 (RR = 1.62 (0.99-2.64); p-value = 0.003). Conclusion: Neutrophil to lymphocyte ratio affected the decrease of diaphragm thickness in patients using mechanical ventilation.
Respons stres adalah perubahan hormon dan metabolik yang terjadi setelah trauma seperti pembedahan, salah satunya terjadi peningkatan kadar kortisol. Dexmedetomidine dapat menurunkan respons stres dengan menghambat sintesis kortisol. Tujuan penelitian ini adalah mengetahui efek dexmedetomidine terhadap kadar kortisol pada pasien yang menjalani operasi ginekologi dalam anestesi umum yang dilakukan di RSUP dr. Mohammad Hoesin Palembang dari Januari-Maret 2018. Jumlah sampel 30 orang yang dibagi menjadi 2 kelompok, kelompok dexmedetomidine dan kelompok plasebo. Kelompok dexmedetomidine mendapatkan dosis dexmedetomidine awal 1 µg/kgBB selama 10 menit dilanjutkan 0,5 µg/kgBB/jam, 20 menit sebelum induksi. Pada kelompok plasebo menggunakan NaCl 0,9%. Induksi menggunakan propofol, fentanil 2 µg/ kgBB, dan atrakurium 0,5 µg/kgBB serta pemeliharaan menggunakan sevofluran 3% dalam O2 dan N2O 50%:50%. Kemudian 1 jam pascaekstubasi diambil sampel darah kembali untuk pemeriksaan kadar kortisol. Hasil penelitian pada kedua kelompok terjadi peningkatan kadar kortisol saat 1 jam pascaekstubasi dibanding dengan awal (9,638±7,082 µg/dL menjadi 14,503±7,082 µg/dL pada kelompok dexmedetomidine dan 10,276±3,166 µg/dL menjadi 19,99±6,273 µg/dL pada kelompok placebo). Namun, kadar kortisol signifikan lebih tinggi pada kelompok plasebo. Simpulan, pada kedua kelompok terjadi peningkatan kadar kortisol dibanding dengan nilai awal, tetapi kadar lebih rendah pada kelompok dexmedetomidine.
Introduction: Post-surgical pain is a complex problem, if not treated properly it can have multisystem negative effects. Hormone cortisol can be increased in stressful situations. A study on the effectiveness of ketorolac and another opioid on cortisol levels has been shown. However, a study about the effect of oxycodone on cortisol levels and its comparison with Ketorolac has never been done before. This study aimed to compare the effect of preemptive administration of 30 mg ketorolac and 5 mg oxycodone on plasma cortisol levels in patients undergoing spinal anesthesia. Methods: A double-blind randomized clinical trial was carried out between October and December 2020 in the central operating room of dr. Mohammad Hoesin Palembang. Surgical patients according to the inclusion criteria who received spinal anesthesia were randomly given 5 mg oxycodone and 30 mg ketorolac intravenously shortly after spinal anesthesia. Cortisol levels were measured before and after the intervention. Data analysis using SPSS ver. 20 Windows with a 95% confidence interval. Result: In total, 56 subjects were included. 29 samples in the ketorolac group and 27 samples in the oxycodone group. There were no significant differences in age, sex, nutritional status, blood sugar, and VAS score. There was no significant difference in the mean of cortisol levels before the intervention in the ketorolac group 12.9421 + 6.096 m/dL and the oxycodone group 14.033 + 4.315 m/dL (p = 0.446). The mean value of cortisol levels after intervention in the ketorolac group was 12.979 + 6.280 m/dL and oxycodone 15.353 + 11.704 m/dL, there was no significant difference in changes in cortisol before and after intervention in the Ketorolac group (p = 0.692) and Oxycodone (p = 0.552). The comparison level of cortisol changes between the two groups was not significantly different (p = 0.267). Conclusion: There was no difference in the comparison of the effect of preemptive administration of 30 mg IV ketorolac and 5 mg IV oxycodone on plasma cortisol levels in patients undergoing spinal anesthesia.
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