Hydatidiform mole or molar pregnancy is a benign Gestational Trophoblastic Disease (GTD) that originates from the placenta. Treatment consists of vacuum evacuation but rarely hysterectomy may be required. One common complication of molar pregnancy is hyperthyroid. Anesthetic management is often complicated by the associated systemic complications. These complications cannot be prevented, but with a better understanding of the disease, some measurements to avoid maternal mortality can be performed.
Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by vascular thrombosis or pregnancy complications with the presence of antiphospholipid antibodies. It is a rare disease affecting 40–50/100,000 population yet responsible for 10%–15% of recurrent pregnancy loss. Diagnosis requires at least one clinical and one laboratory criteria to be met. Perioperative management in obstetric APS underwent cesarean section stressed on the management of anticoagulation and proper choice of anesthesia technique. We report the case of a 21-years-old woman, 39 weeks pregnant, diagnosed with APS since the 8th week of gestation. She had two previous miscarriages and an elevated level of anticardiolipin antibody (aCL IgG: 21 GPL U/ml) with normal aCL IgM and lupus anticoagulant. She was treated with a prophylactic dose of low-molecular-weight heparin (0.4 IU subcutaneous enoxaparin) and oral aspirin 80 mg daily. She presented to the obstetric department and scheduled for an urgent cesarean section. Enoxaparin was held, and the surgery was done with spinal anesthesia. Anticoagulation resumed 12 h after surgery. No complications on the mother and baby were found after 3 days of observation.
Introduction: Chronic kidney disease (CKD) is marked by the presence of kidney damage (usually defined as estimated GFR < 60 mL/ min/1.73 m2) for 3 or more months, and it may be caused by a multitude of disease processes. Management of patients with CKD includes aggressive treatment of the underlying cause, pharmacologic therapy to delay disease progression and prevent complications, and preparation for hemodialysis as ESRD ensues.
Case presentation: In this case report, a 48-year-old man with a pseudoaneurysms due to the insertion of a vascular access for hemodialysis, undergo repair pseudoaneurysms surgery under general anesthesia, at the Sanglah General Hospital, October 2020. The patient came with fully awareness, blood pressure 145/95 mmHg, heart rate 85 times per minute regular and oxygen saturation 97% with room air.
Conclusion: General anesthesia in patients with CKD requires an understanding of the pathologic changes that accompany renal disease, co-existing medical conditions, and the impact of reduced renal function on drug pharmacokinetics.
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