Anestesi untuk seksio sesarea dapat dilakukan dengan anestesi spinal, epidural, combined spinal-epidural atau anestesi umum. Akan tetapi, pilihan utama anestesi untuk seksio sesarea adalah anestesi spinal karena murah, mudah dilakukan, cepat bekerja dan risiko aspirasi tidak ada serta tidak ada masalah pengelolaan jalan nafas. Masalah utama spinal anestesi adalah adanya hipotensi, mual muntah intraoperatif, postdural puncture headache (PDPH), dan merupakan kontraindikasi bila dilakukan pada orang dengan ekstrim pendek karena ketakutan terjadi hipotensi berat. Dua orang wanita gravida aterm ekstrim pendek, dilakukan seksio sesarea (SC) dengan anestesi spinal di Rumah Sakit Melinda Bandung. Pasien pertama dengan berat badan 61 kg, tinggi badan 145 cm, pasien kedua dengan berat badan 64 kg, tinggi badan 146 cm. Keduanya dilakukan spinal anestesi dengan bupivacain hiperbarik 0,5%, ditambah fentanyl dan morfin. Pengaturan dosis bupivacain berdasarkan kombinasi berat badan dan tinggi badan. Tidak ada kejadian penurunan tekanan darah >20% dari tekanan darah awal pada kedua pasien tersebut.
The use of the anesthetic technique for cesarean section is still debatable because of the side effects caused by anesthesia for mothers and neonates. The succeed to determine anesthetic technique can be seen from the outcome of the final condition of the mother and the neonates. The assessment of the succeed to determine anesthetic technique in neonates has been using the Apgar score by assessing the clinical status of the newborn in the first and fifth minutes. This research is aimed to understand the comparison between Apgar scores in cesarean section using general anesthesia sevoflurane and spinal anesthesia bupivacaine. This research is analytical retrospective with a cross-sectional study approach, using a total sample of 40 patients who performed cesarean section from August to November 2021, the samples were taken by consecutive sampling. The data was taken from the medical records of the Melinda Mother and Child Hospital, Bandung. The results of this research showed that there was no significant difference in the APGAR Score first minute between general anesthesia and spinal anesthesia (p=0,054) in the fifth minute (p=0,708). There was no effect on APGAR scores in the general anesthesia sevoflurane group and spinal anesthesia bupivacaine group, and both anesthetic groups had a good effect on neonates
Seksio sesarea telah dikaitkan dengan emboli udara vena (venous air embolism/VAE). Sinus uterus rentan sebagai pintu masuk udara, terutama dengan adanya plasenta previa. Insiden VAE selama seksio sesarea telah dilaporkan antara 9,5% dan 65%, dan ini dapat terjadi selama anestesi epidural, anestesi spinal, dan anestesi umum. Emboli udara dalam sirkulasi paru dapat menyebabkan ketidakcocokan ventilasi/perfusi dan dapat menurunkan saturasi oksigen. Nyeri dada dan dyspnea dapat dikaitkan dengan VAE, dan juga telah diamati adanya perubahan ECG. Sebagian besar perubahan terjadi pada sayatan uterus dan persalinan serta pada saat eksteriorisasi uterus. Oleh karena itu, saturasi oksigen, tekanan darah, dan denyut nadi harus dipantau secara ketat selama persalinan dan segera pascapersalinan
Brain damage is an injury that causes damage or worsening of brain cells caused by various conditions such as head trauma, inadequate oxygen supply, infection or intracranial hemorrhage. Brain protection is a preemptive measure of therapeutic interventions to improve neurological outcomes in patients at risk of cerebral ischemic, while brain resuscitation refers to therapeutic interventions that begin after the occurrence of ischemic. The target is ischemic therapy and reducing neuronal injury. Perioperative brain damage is one of the most serious adverse complications of surgery and anesthesia, resulting in new postoperative neurological deficits. The concept of GHOST-CAP, an acronym for Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure and PaCO2, can be used in the postoperative period. G: The target level of glucose is between 80 and 180 mg/dL. H: hemoglobin threshold is 7-9 g/dL. O: oxygen, target SpO2 between 94 and 97%. S: Sodium concentration affects brain volume, sodium levels up to 155 mEq/L are tolerable. T: temperatures regulated to optimize cellular function, but core temperatures > 38.0°C should be avoided. C: patient comfort, including pain control, agitation, anxiety, and chills. A: Arterial blood pressure is the main determinant of cerebral blood flow (CBF), maintaining an mean arterial pressure (MAP) of 80 mmHg and cerebral perfusion pressure (CPP) of 60 mmHg. P: Acute changes in PaCO2 cause CBF changes, PaCO2 not to be less than 35 mmHg. This paper examines the GHOST-CAP concept for perioperative brain protection, whether adequate or should be supplemented
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