AbstrakMastektomi merupakan prosedur operasi pengangkatan kanker payudara yang dapat menimbulkan nyeri akut pascaoperasi, bahkan pada 20-30% pasien berlanjut menjadi sindrom nyeri kronik pascamastektomi sehingga diperlukan penatalaksanaan nyeri secara adekuat agar pasien tidak mengalami episode nyeri yang dapat mengganggu produktivitas. Tujuan penelitian ini membandingkan efek pemberian analgesia pre-emtif parecoxib dengan parasetamol dalam menurunkan nyeri pascaoperasi radikal mastektomi. Penelitian dilakukan secara prospektif single blind randomized controlled trial terhadap 30 pasien dewasa yang menjalani operasi radikal mastektomi di Rumah Sakit Dr. Hasan Sadikin Bandung periode SeptemberNovember 2014. Subjek dibagi dalam dua kelompok, analgesia pre-emtif parasetamol 1 g dan parecoxib 40 mg diberikan 30 menit sebelum sayatan pertama dilakukan. Setelah operasi selesai dicatat skala nyeri berdasarkan numeric rating scale (NRS) hingga 12 jam pascaoperasi di ruang perawatan. Analisis data menggunakan uji-t dan diolah dengan program statistical package for social science (SPSS) versi 21.0 for windows. Kelompok analgesia pre-emtif parecoxib 40 mg lebih lama membutuhkan analgetik pertolongan dan menurunkan NRS lebih rendah dibanding dengan kelompok analgesia preemtif parasetamol 1 g (p<0,05). Simpulan, parecoxib 40 mg lebih baik dibanding dengan analgesia pre-emtif parasetamol 1 g dalam menurunkan nyeri pascaoperasi radikal mastektomi berdasarkan NRS.Kata kunci: Analgesia pre-emtif, numeric rating scale, nyeri pascaoperasi, parasetamol, parecoxib, radikal mastektomi Comparative Effect of Preemptive Analgesia Parecoxib with Paracetamol against Postoperative Radical Mastectomy Pain Using Numeric Rating Scale AbstractMastectomy is a breast cancer surgery procedure that can lead to acute postoperative pain with 20-30% of patients may progress to postmastectomy chronic pain syndrome (PMPS). Therefore, it is necessary provide an adequate pain management so patients will not experience episodes of pain that can disrupt their productivity. The purpose of this study was to compare the effect of preemptive analgesia parecoxib with paracetamol in reducing radical mastectomy postoperative pain.The study was a prospective single blinded randomized controlled clinical trials on 30 adult patients who underwent radical mastectomy surgery in Dr. Hasan Sadikin General Hospital between September and November 2014. Subjects were divided randomly into two groups, 1 gram paracetamol preemptive analgesia and 40 miligram parecoxib which given 30 minutes before the first incision has been made. After the surgery was completed, we record the pain scale using the numeric rating scale (NRS). The data were recorded starting from the recovery room to 12 hours postoperative in the ward. Statistical analysis was performed using the t-test with statistical package for social science (SPSS) version 21.0 for Windows software. The results showed that the 40 miligram parecoxib preemptive analgesia group required longer rescue analgesics and lowerNRS t...

Eklampsia adalah kelainan pada kehamilan yang ditandai dengan peningkatan tekanan darah disertai dengan proteinuria positif dan kejang yang muncul setelah minggu ke-20 kehamilan. Eklampsia dapat menimbulkan komplikasi terhadap ibu dan janin. Diantara komplikasi terhadap ibu yang muncul akibat eklampsia adalah edema paru akut. Edema paru akut terjadi pada 0,08% hingga 1,5% kehamilan dan merupakan salah satu penyebab kematian ibu hamil sehingga tergolong suatu keadaan darurat dan memerlukan penanganan segera. Faktor sirkulasi angiogenik, penurunan tekanan onkotik koloid, disfungsi sel endotel, atau peningkatan tekanan intravaskular disertai dengan peningkatan beban jantung diduga menjadi faktor penyebab terjadinya edema paru akut pada eklampsia. Penegakan diagnosa serta pemberian terapi yang tepat pada edema paru akut harus dilakukan sesegera mungkin untuk menurunkan angka mortalitas dan morbiditasnya. Terapi yang diberikan meliputi pemberian obat -obatan dan atau bantuan ventilasi mekanik. Penggunaan bantuan ventilasi mekanik dilakukan dengan pendekatan strategi lung recruitment yang bertujuan untuk memperbaiki oksigenasi paru dan mampu meningkatkan kemampuan penyapihan ventilator serta mencegah kerusakan paru iatrogenik. Disamping pemantauan hemodinamik secara berkesinambungan, penggunaan ventilasi mekanik merupakan indikasi bagi pasien eklampsia dengan edema paru akut untuk menjalani perawatan di ruang rawat intensif. Acute Pulmonary Edema in Patient with Eclampsia: are Really Need a Intensive Care Unit Treatment? Abstract Eclampsia is a disorder in pregnancy which is characterized by an increase in blood pressure accompanied by positive proteinuria and seizures that appear after the 20th week of pregnancy. Eclampsia can cause complications for the mother and fetus. Among the complications of the mother that arise due to eclampsia are acute pulmonary edema. Acute pulmonary edema occurs in 0.08% to 1.5% of pregnancy and is one of the causes of death of pregnant women so it is classified as an emergency and requires immediate treatment. Angiogenic circulation factors, a decrease in colloid oncotic pressure, endothelial cell dysfunction, or an increase in intravascular pressure accompanied by an increase in cardiac load are thought to be factors causing the occurrence of acute pulmonary edema in eclampsia. The diagnosis and the provision of appropriate therapy in acute pulmonary edema must be done as soon as possible to reduce its mortality and morbidity. The therapy provided includes the administration of medicines and or mechanical ventilation assistance. The use of mechanical ventilation assistance is carried out with a lung recruitment strategy approach that aims to improve lung oxygenation and be able to improve ventilator weaning capabilities and prevent iatrogenic lung damage. In addition to continuous hemodynamic monitoring, the use of mechanical ventilation is an indication for eclampsia patients with acute pulmonary edema to undergo treatment in the intensive care unit.

Sindroma nefrotik adalah sekumpulan gejala berupa proteinuria, hipoalbuminemia, edema, hiperkolesterolemia, dan lipiduria yang ditandai peningkatan permeabilitas dinding kapiler terhadap protein serum. Sindroma nefrotik pada kehamilan jarang terjadi namun bila tidak dikelola dengan baik akan meningkatkan morbiditas. Sindroma anefrotik dapat muncul sebelum umur kehamilan 20 minggu dan sering disebabkan oleh glomerulonephritis, sedangkan yang muncul sesudah umur kehamilan 20 minggu patut diduga disebabkan atau disertai suatu preeklampsia. Dilaporkan pasien 35 minggu dengan diagnosis preeklamsia, sindroma nefrotik dan suspek edema pulmo. Pasien di diagnosis sindroma nefrotik sejak kehamilan 12 minggu dan mendapat terapi metilprednisolone 16 mg 1-0-0 hingga sekarang. Pada usia kehamilan 28 minggu pasien didiagnosis preeklamsia. Datang karena kontraksi yang semakin kencang. Pasien dilakukan seksio sesarea dengan tehnik regional anestesi epidural Levobupivacain 0.5% isobarik 11 ml, janin cukup viable dilahirkan. Pasca operasi pasien dirawat di high care unit dan pulang ke rumah setelah perawatan 8 hari dalam kondisi baik. Manajemen anestesia pada ibu hamil dengan sindroma nefrotik antara lain sering disertai tekanan darah tinggi atau preeklampsia, malnutrisi dan hilangnya zat-zat yang diperlukan tubuh bersamaan dengan hilangnya protein melalui urine. Pasien seharusnya ditangani melalui pendekatan multidisipliner dengan spesialis perinatologi, nefrologi, dan neonatologi, dengan pemahaman terhadap pentingnya menjaga keseimbangan agar sesuai dengan perubahan fisiologis wanita hamil normal akan memberikan prognosis yang baik dalam menurunkan tingkat morbiditas. Anesthesia Management of Caesarean Section in 35 Weeks Primigravida Patients with Nephrotic Syndrome Abstract Nephrotic syndrome is a set of symptoms in the form of proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and lipiduria which are characterized by an increase in capillary wall permeability to serum proteins. Nephrotic syndrome in pregnancy is rare but if not managed properly, it will increase a morbidity. Nephrotic syndrome can occur before 20 weeks of gestation and is often caused by glomerulonephritis, whereas if appears after 20 weeks' gestation is thought to be due to or accompanied by preeclampsia. A 35-week patient was reported with preeclampsia, nephrotic syndrome and suspected pulmonary edema. Patients were diagnosed with nephrotic syndrome since 12 weeks' gestation and were treated with methylprednisolone 16 mg 1-0-0 until now. At 28 weeks' gestation the patient was diagnosed with preeclampsia. she came to hospital due to primature contraction. Patient underwent SC with a 11 ml Levobupivacaine 0.5% drug isobaric epidural anesthesia regional technique, the fetus was viable enough to be born. After surgery the patient was treated at HCU and returned home after 8 days of treatment in good condition. Management of anesthesia in pregnant women with nephrotic syndrome is often accompanied by high blood pressure or preeclampsia, malnutrition and loss of substances needed by the body along with loss of protein through urine. Patients should be treated through a multidisciplinary approach, along with specialists in perinatology, nephrology, and neonatology. With an understanding of the importance of maintaining balance in accordance with the physiological changes of normal pregnant women will provide a good prognosis in reducing morbidity.