<p>Placenta accreta spectrum is one of maternal mortality’s causes which is related with severe obstetric bleeding that requires hysterectomy. The incidence rate of the spectrum placenta increases with increasing caesarean section. Placenta accreta spectrum is also close-related to placenta previa. The aim of this study is to  understand perioperative management in patient with placenta percreta performed with intra-aortic ballooning in caesarean section. We are following a case on a 36 year old female patient, multigravida at term pregnant with placenta percreta and history of caesarean section 5 and 2 years ago. The surgeries performed were caesarean section surgery as well as intra-aortic ballooning. Anesthetic technique used was general anesthesia. Operation duration approximately ± 180 minutes, bleeding 1500 cc. After the operation, the patient was admitted to the ICU. The patient going well and discharged from ICU to ward on the second day. After three days in ward, the patient discharged to home. Hemodynamic changes during balloon intra-aortic procedures are of particular concern to anesthetists. This is because the stopping of blood flow to the aorta in this case can cause an increase in blood vessel pressure, where the administration of nitroglycerin at low doses can reduce venous tone resulting in venous vasodilation which will maintain hemodynamic stability during the process of blocking blood vessels with a balloon. From the case we may conclude that anesthesia in pregnant women with placenta accreta spectrum should be carried out with caution and involve a multidisciplinary specialist given its high risk of bleeding. The intra-aortic balloon insertion technique can be an option used to reduce the risk of bleeding in patients with placenta accreta spectrum.</p>

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea   Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

Background: Maternal mortality in Indonesia is caused by multifactors that are both direct and indirect factors. Complications during pregnancy and after delivery, including preeclampsia is the direct cause of 90% of maternal deaths. This case report aimed to describe the anaesthesia management on the incidence of severe preeclampsia to prevent the complications. Subjects and Method: We reported a 33-year-old G3P2A0 woman with 33 weeks of gestational age, diagnosed with severe pre-eclampsia partial HELLP syndrome, fetal dis-tress, type II diabetes mellitus pro SCTP emergency with physical status ASA II. Regional anaesthesia with sub-arachnoid block was performed by using Lidodex 75 mg and fentanyl 25 mcg intrathecally. Results: From the operation process, a baby boy with birth weight 2.900 gram and APGAR Score 7-8-9 was born. Two-hour post operation examination on patient showed compos mentis (consciousness), blood pressure 121/ 80 mmHg, heart rate 64 bpm, respiration rate 20 breath per minute, blood oxygen saturation levels (SpO2) 99% with 3 L/min nasal cannula. Patient was administered to HCU post operation to be monitored vital sign and signs of impending eclampsia. Post-operative refeeding was performed after bowel sound was positive. Conclusion: Selection of appropriate anaesthetic management in severe preeclampsia cases can prevent complications. Keywords: severe preeclampsia, sectio caesaria, regional anesthesia, subarachnoid block Correspondence: R. Th. Supraptomo. Department of Anaesthesiology and Intensive Therapy Dr. Moewardi Hospital. Jl Kolonel Sutarto 132 Jebres, Surakarta, Central Java, 57126. Email: ekasatrio-@gmail.com. Mobile: +6281329025599. DOI: https://doi.org/10.26911/the7thicph.05.29

Pendahuluan: Preeklampsia adalah terjadinya trias preeklampsia (hipertensi, hipoalbuminemia, dan edema) yang mendadak setelah 20 minggu kehamilan. Pasien obesitas memiliki banyak implikasi klinis dalam tatalaksana anestesi. Kasus: Wanita, 22 tahun G2P1A0 hamil 39 minggu dengan preeklampsia berat, KPD 12 jam, obesitas morbid akan dilakukan seksio sesarea emergency dengan status fisik ASA IIIE, dilakukan pembiusan dengan teknik regional anestesi subarachnoid block dengan puncture di L3–L4 median, menggunakan agen levobupivakain 15 mg dan fentanyl 25 mcg. Operasi berlangsung selama 1 jam 15 menit, dengan perdarahan 350 cc, hemodinamik stabil. Lahir bayi laki-laki, BB 3400 gr, APGAR Score 8–9–10. Diskusi: Preeklampsia adalah penyakit multiorgan yang spesifik terhadap kehamilan manusia, namun etiologi spesifik yang mendasari tetap belum diketahui. Tatalaksana bersifat suportif, melahirkan bayi dan plasenta tetap menjadi satu-satunya terapi definitif. Pasien obesitas memiliki banyak implikasi klinis untuk dipertimbangkan. Pemahaman mengenai patofisiologi akan membantu memberikan tatalaksana anestesi yang lebih baik. Simpulan: Pemilihan teknik neuraksial anestesi lebih direkomendasikan karena menghindari kemungkinan intubasi sulit pada kasus emergensi, perfusi uteroplasenta yang lebih baik, kualitas analgesi/anestesia yang baik, mengurangi obat yang masuk ke sirkulasi uteroplasenta, menurunkan stress operasi, dan psikologis ibu yang dapat melihat bayinya saat dilahirkan.   Anesthesia Management in Caesarean Section with Severe Preeclampsia and Morbid Obese Abstract Introduction: Preeclampsia is a sudden triad of preeclampsia (hypertension, hypoalbuminemia and edema) after 20 weeks of pregnancy, Obese patients have many clinical implications to consider. Case: Female, 22 years old with G2P1A0, 39 weeks pregnant with severe preeclampsia, 12 hours PROM, pro morbid obesity SCTP-E with ASA IIIE physical status. Labor pain management was carried out using regional subarachnoid block anesthesia technique with puncture in median L3-L4, clear CSF (+), blood (-) using levobupivacaine 15 mg + fentanyl 25 mcg. The operation lasted for 1 hour 15 minutes, with 350 cc bleeding, hemodynamically stable. Born a baby boy, BW 3400 gr, APGAR Score 8-9-10. Discussion: Preeclampsia is a multiorgan disease that is specific to human pregnancy, and the underlying specific etiology remains unknown. Management is supportive, giving birth to the baby and placenta remains the only definitive therapy. Obese patients have many clinical implications to consider. Understanding of pathophysiology will help provide better anesthesia management. Conclusion: The neuraxial anesthesia technique is recommended to avoids the possibility of difficult intubation, better uteroplacental perfusion, good analgesia / anesthesia quality, reducing drugs that enter the uteroplacental circulation, decreasing surgical stress, and maternal psychological to be able to see the baby at birth.

Background: Incision techniques that are often used in cholecystectomy laparotomy are the Kocher incision and midline incision. This study was carried out to compare the pain in the Kocher's incision and midline incision in patients with postoperative cholecystectomy laparotomy. Subjects and Method: : This study was an observational randomized controlled trial double sampling study conducted at the Department of Surgery Dr. Moewardi Hospital Surakarta in October 2018 to February 2019. The sample of this study was 30 patients aged 18-65 years old who were diagnosed with symptomatic cholelithiasis based on clinical, laboratory, and radiological tests. The samples were selected by simple random sampling. The dependent variable of this study was the pain. The independent variables were the Kocher and midline incision techniques. The pain was measured on a 24-hour postopera-tive VAS scale, range 1-10. Data were analyzed by t-test. Results: There was no significant difference in pain level between the Kocher group (Mean= 2.33; SD=0.72) and the midline group (Mean= 2.20; SD=0.97) with p=0.192. Conclusion:There is no difference in pain level due to the Kocher incision technique and the midline incision technique.