Background: Approximately 25% of patients with mitral stenosis become symptomatic for the first time during pregnancy. It is because of increasing maternal blood volume and heart rate. Some literature mentioned that spinal anesthesia is contraindicated for the patient with mitral stenosis undergo operation due to the risk of hypotension and tachycardia. Case: A 24-years old primigravida in 32-34 weeks of gestation with severe mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation, moderate pulmonal regurgitation. Ejection Fraction (EF) was 62%, pulmonary hypertension with pulmonary artery systolic pressure (PASP) 65 mmHg, heart failure stage C Functional Class III. Caessarian section was performed under low dose spinal anesthesia using 5 mg of bupivacaine and 50 mcg of fentanyl as adjuvant. Complete neuraxial block was achieved in 5 minutes. The haemodynamic was stable during the operation. There is no evidence of acute heart failure and worsen of hemodynamic status in postoperative periods. The patient discharge safely from the hospital. Discussion: The main principles of anesthesia management is to prevent tachycardia, maintain sinus rhytm and aggressively treat new atrial fibrillation using pharmacologic drugs or cardioversion. Systemic vascular resistance (SVR) is kept normal especially in patient with unstable hemodynamic because the decrease of SVR can induce tachycardia. Another strategy are maintain normovolemia, prevent hypoxia, hipercarbia and pain. Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0,5% and adjuvant fentanyl can be safely used for caessarean section delivery in severe mitral stenosis patient because of the fast onset, adequacy level, duration of the block, haemodynamic stability and good fetal outcome. ABSTRAKLatar belakang: Stenosis mitral banyak ditemukan pada kehamilan, dimana sekitar 25% pasien akan mengalami gejala pada kehamilan pertama. Hal ini disebabkan karena adanya peningkatan volume darah dan nadi. Beberapa literatur menyebutkan bahwa anestesi spinal dikontraindikasikan pada pasien yang akan menjalani operasi dengan kelainan stenosis mitral karena risiko terjadinya hipotensi dan takikardia. Kasus: Perempuan 24 tahun primigravida, usia kehamilan 32-34 minggu dengan stenosis mitral berat, regurgitasi mitral ringan, regurgitasi trikuspid sedang, regurgitasi pulmonal sedang (EF 62%), hipertensi pulmonal sedang (PASP 65 mmHg), gagal jantung stadium C kelas fungsional III menjalani operasi sesar dengan low dose anestesi spinal menggunakan 5 mg bupivacaine heavy 0,5% dan 50 mcg fentanyl volume total 2 ml. Blok spinal dicapai dalam waktu 5 menit. Hemodinamik stabil selama perioperatif. Tidak terjadi gagal jantung akut maupun perburukan hemodinamik pascaoperasi. Pembahasan: Prinsip pembiusan pasien dengan mitral stenosis adalah menghindari takikardia, menjaga kondisi sinus rhytm dan secara agresif mengatasi atrial fibrilasi baik farmakologis maupun dengan kardioversi terutama pada pasien dengan hemodinamik tidak stabil, menghindari penurunan...

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 μg fentanyl for caesarean section in patient with heart disease.Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 μg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician.Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation.Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 μg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.Citation: Husodo DP, Isngadi I, Hartono R, Prasedya ES. Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease. Anaesth pain & intensive care 2019;23(3):274-278

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.

Disaster management is the obligation of the state in carrying out constitutional duties, namely protecting all spilled Indonesian blood. Disasters have the potential to cause casualties and property. Laws are needed as the basis for government decision making in disaster management. The effectiveness of implementing law number 24 of 2007 can be a benchmark for disaster management. The participation of civil society such as Muhammadiyah mass organizations is a supporting capacity in disaster management. This research is a normative study of the effectiveness of the law on disaster management and Muhammadiyah disaster management case study of Covid 19. The results of the research show that there are many things that need to be evaluated in the implementation of the implementation of the law.