Perdarahan postpartum merupakan salah satu penyebab utama kematian ibu selain penyakit kardiovaskuler. Diantara penyebab perdarahan post partum adalah plasenta akreta dimana insidennya semakin meningkat dari tahun ke tahun seiring dengan peningkatan jumlah persalinan dengan seksio sesarea. Kami laporkan dua kasus ibu hamil dengan plasenta akreta yang direncanakan tindakan seksio sesarea emergency yang dikelola dengan general anesthesia rapid sequence induction. Kasus pertama, perempuan berusia 31 tahun G3P1A1 usia kehamilan 36–37 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 7000 cc, dan diberikan transfusi 8 unit PRC, 4 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan komplikasi yang terjadi produk drain abdomen sekitar 1900 cc bercampur darah. tidak ada komplikasi mayor lainnya, pasien pindah ruang rawat inap pada hari keempat pascaoperasi. Kasus kedua, perempuan berusia 40 tahun G3P2A0 usia kehamilan 37–38 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 9000 cc, dan dilakukan transfusi 8 unit PRC, 8 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan. tidak ada komplikasi signifikan terjadi. Hari kedua pascaoperasi pasien pindah ke ruang rawat inap. Case Series: Anesthesia Management in Pregnant Woman with Placenta Accreta Planned for Caesarean Section Abstract Postpartum hemorrhage is one of the leading causes of maternal morbidity besides cardiovascular disease. Among the causes of postpartum hemorrhage is placenta accreta, where the incidence increases from year to year along with the increase in the number of cesarean delivery. We report two cases of pregnant women with placenta accreta planned for emergency cesarean section managed with general anesthesia rapid sequence induction. The first case, 31-year-old woman G3P1A1 36–37 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 7000 cc, and given transfusion of 8 units of PRC, 4 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and complications that occurred around 1900 cc of abdominal drain product mixed with blood. After that, there were no other major complications, then the patient moved the ward on the fourth day. The second case, a 40-year-old woman G3P2A0 37–38 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 9000 cc, and given transfusion of 8 units of PRC, 8 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and no significant complications happen. The second day after surgery the patient moved to the ward.

Currently, continuous epidural anesthesia was one of the regional anesthesia technique used on daily anesthesia practice. It could be used for single anesthesia on surgery, adjuvant of general anesthesia, pain management of post surgery and chronic pain management of malignancy. One of the problems faced on continuous epidural procedure was migration of epidural catheter out from epidural space. In the beginning catheter was placed on epidural space and confirmed by Loss of Resistance (LOR) technique, hanging drop, or by ultrasonography. Due to many factors, epidural catheter could migrate from the place that should be. This surely affected the effectivity of anesthesia from epidural technique itself, and became fatal if a certain amount of local anesthesia regiment entered to other spaces through the catheter which previously moved to subarachnoidea space, intravascular, or subdural space. Migration of catheter could be caused by malposition on placement or patient's movement, and increased of epidural space pressure. Thus, it's important for anesthesiologist to know what factors that would increase the risk of epidural catheter migration and how to prevent and manage the complication that could happen. ABSTRAKEpidural kontinyu saat ini merupakan salah satu satu tekhnik regional anestesia yang mulai sering digunakan dalam praktek anesthesia sehari-hari. Dapat digunakan untuk anestesia tunggal dalam pembedahan, adjuvan anestesia umum, manajemen nyeri paska operasi serta menajemen nyeri kronis pada pasien keganasan. Salah satu permasalahan yang banyak dihadapi pada prosedur epidural kontinyu adalah kejadian migrasi kateter epidural keluar dari ruang epidural. Kateter pada awalnya telah berada di rongga epidural dan telah dikonfirmasi dengan teknik Loss of

Background — Most malignancy patients that undergo radiotherapy with or without chemotherapy, especially those with malignancy of the pelvic region, are accompanied by hypoalbuminemia and kidney injury. Human albumin has been shown to have nephroprotective effects. Snakehead fish extract, a consumable source of albumin, can be an effective and cheap alternative to reduce the risk of kidney injury in malignancy patients. Objective — Analyze the effect of snakehead fish extract on urea, creatinine, and albumin serum levels in radiotherapy patients. Material and Methods — This study was conducted on patients undergoing radiotherapy. They were divided into two groups, each consisting of 15 patients; the control group was given a placebo and the experimental group was given snakehead fish extract. Albumin, urea, and creatinine serum levels were determined respectively by the bromocresol green method, urease method, and jaffe method, both before and after treatment. All data were analyzed using SPSS 22.0. Results — The serum albumin level decreased in both groups. While it dropped further in the treatment group than in the control group, the difference was not significant. Urea and creatinine serum levels decreased in the experimental group and increased in the control group. Once more, however, this difference was not statistically significant. Conclusion — The administration of snakehead fish extract had no significant effect on albumin, urea, or creatinine serum levels in patients undergoing radiotherapy.