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.

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.