Background With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). Conclusion Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

<p><strong>Background</strong>: Enhanced Recovery After Cesarean Section (ERACS) protocol includes every component of the pre-operative, intra-operative and post-operative pathway. In the pre-operative phase, the protocol applied to this patient included the shortest possible fasting interval, oral intake of liquid carbohydrate and patient counselling. For intra-operative pathway, the components applied are prevention of hypotension, maintenance of normothermia, optimal uterotonic administration, IONV (intra-operative nausea and vomiting)/PONV (post-operative nausea and vomiting) prophylaxis, multi-modal analgesia and optimization of fluid administration. Post-operatively, the patient was given early nutritional intake, early mobilization, urinary catheter removal, venous thrombo-embolism prophylaxis, multi-modal analgesia and glycemic control. ERACS prove useful for early discharge, improving outcomes such as breastfeeding or reducing post-discharge opioid use.</p><p><strong>Case Illustration</strong>: A 31-year-old woman came with the chief complaint of fluid discharge since ± 3 hours prior to admission to the hospital. Based on the medical history, physical examination, and laboratory findings, the patient was diagnosed with premature rupture of membranes in a gestational age of 37-38 weeks and had a live, single-headed presentation of the fetus. Patient’s physical status is ASA II and scheduled for elective C-section procedure with spinal anesthesia.</p><p><strong>Conclusion</strong>: The implementation of the ERACS protocol in this case has been shown to reduce the rate of infection and post operative complications as well as reducing length of stay for the mother.</p>

Background Aging is an irreversible, progressive and cumulative process that involves biological, anatomical, physiological, and functional changes that occur over a period of time. Emergency surgery in geriatrics is challenging due to the limited time for surgery planning. Charlson Age Comorbidity Index (CACI) can be used as a predictor of mortality in geriatric patients undergoing surgery. The study’s aim is to determine the association between CACI and mortality in geriatric patients undergoing emergency surgery. Methods This study was a prospective analytic observational multicenter study. This study was conducted from February 2021 to April 2021. This study used the whole sampling method and was followed up 30 days after surgery. The data were analyzed using regression and the ROC Curve test with a confidence interval of 95%. Results We obtained 116 geriatric patients undergoing emergency surgery with a 30-day mortality rate of 11.2%. CACI significantly correlated with 30 day-mortality in geriatric underwent emergency surgery (p = 0.000) with B = 4.831. The AUC of the CACI score was 0.966, with a cut-off value of 5.5. For geriatric patients with CACI scores > 5.5, the risk of mortality within 30 days of treatment is 125.33 times greater (95% CI: 14.58–1077.67) than for patients with CACI scores < 5.5. Conclusion CACI is associated with 30-day mortality in geriatric patients undergoing emergency surgery. CACI score also could be used to predict 30-day mortality in geriatric underwent emergency surgery.

Peningkatan angka sectio caesarea secara global telah menjadi topik yang paling sering diperdebatkan dalam asuhan maternitas. Sectio caesarea merupakan salah satu pelayanan kesehatan ibu yang menimbulkan berbagai kontroversi. Menurut WHO, angka sectio caesarea yang direkomendasikan berkisar antara 10-15%. Tujuan penelitian ini adalah untuk menilai profil pasien sectio caesarea di Rumah Sakit Umum Daerah dr. Zainoel Abidin (RSUDZA) Banda Aceh Tahun 2019. Metode penelitian ini berupa penelitian deskriptif menggunakan data retrospektif. Subjek penelitian ini ialah 330 pasien yang menjalani sectio caesarea pada tahun 2019. Pengambilan data dilakukan menggunakan teknik simple random sampling. Penelitian ini dimulai dari bulan Oktober hingga November 2020. Analisis yang digunakan ialah uji univariat untuk melihat profil pasien. Hasil penelitian menunjukkan bahwa persentase sectio caesarea tahun 2019 mencapai 65.3%, dengan angka terbanyak diperoleh pada kelompok tingkat pendidikan SMA/Sederajat sebanyak 154 responden (46.7%), pekerjaan pada kelompok ibu rumah tangga sebanyak 235 responden (71.2%), usia ibu pada kelompok 20-35 sebanyak 284 responden (75.2%), usia kehamilan pada kelompok aterm sebanyak 257 responden (77.9%), paritas pada kelompok multigravida sebanyak 213 responden (64.5%%), sectio caesarea dengan riwayat sectio caesarea sebelumnya sebanyak 88 responden (26.7%), perencanaan tindakan secara emergency sebanyak 302 responden (91.5%), dan teknik anestesi didominasi oleh anestesi spinal sebanyak 307 responden (93%). Kesimpulan pada penelitian ini menunjukkan angka sectio caesarea yang masih tinggi dengan indikasi terbanyak yaitu riwayat sectio caesarea sebelumnya, sehingga diperlukan suatu intervensi tindakan serta edukasi untuk mengurangi angka sectio caesarea.Kata kunci: Sectio Caesarea, Profil Pasien, Banda Aceh

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan–Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04–18.07; p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03–5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96–7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32–5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32–8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p < 0.05. The six comorbidities that have log-rank p < 0.05 are moderate-to-severe renal disease (log-rank p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic.

Background: With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting.Methods: We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis.Results: We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson's Comorbidity Index Score >5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival rates than subjects without those conditions (p < 0.005).Conclusion: Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

Background As life expectancy increases, the worldwide population aged 60 years and older increases year by year. Consequently, more older people receive medical attention, especially those who undergo surgery. In addition, the COVID-19 pandemic has had a global impact on elderly patients, especially those undergoing surgery. This study aims to describe the characteristics and analyze the survival rate of elderly patients who receive anesthesia services, especially those with comorbidities and COVID-19. Methods A prospective cohort study at 14 central hospitals in Indonesia analyzed 1621 elderly patients (67.1 ± 6.2 years old). The variables that were recorded included patient characteristics, comorbidities, the COVID-19 status, and the survival rate, including 30-day mortality. Results The 30-day mortality was 4.4%. The most comorbidity was hypertension (30.0). Patients with a Charlson's Comorbidity Index Score of 3-4 had a higher death rate (15.3%). The highest mortality rates were in the patients who had dementia, rheumatologic disease, liver disease, previous myocardial infarction, and diabetes with chronic complications as comorbidities. The percent of patients with COVID-19 who died was 26.6%. Patients with several comorbidities and COVID-19 had a lower survival rate than those without (log-rank p<0.05) Conclusion Approximately four in ten elderly patients receiving anesthesia died, and the percent increased when the patients had comorbidities and COVID-19.

Cervical extradural tumor is one of the rare tumors and can cause progressive neurological problems. Neurological deficit in productive age greatly affects the patient's quality of life. Surgical management is carried out with the aim of reducing pain, improving neurological conditions, and improving the patient's quality of life. A 25-year-old woman had progressive tetraparesis since 2 months prior to admission, MRI showed an extradural mass compressing the spinal cord at the level of the C1-3. The surgery was performed under the principles of neuroanaesthesia. On postoperative assessment, motor strength function has improved significantly. A extradural tumor patient was excision by operation with 850 mm bleeds and good recovery with improvement motoric function in all extremities Good perioperative management is needed in patients with spinal tumors, especially patient with tumors on the cervical levels. The anticipation of iatrogenic spinal cord trauma and bleeding has to be maintained during the surgery. Neurological evaluation and rehabilitation of patients is carried out by involving a multidisciplinary team. Spinal cord tumour with excise in neurosurgery at the right time and good perioperative neuroanesthesia will good outcome and improve neurologicals deficit.