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All Journal Jurnal Anestesi Obstetri Indonesia Jurnal Neuroanestesi Indonesia
Ardi Zulfariansyah
Faculty of Medicine Universitas Padjadjaran Bandung
Biochemistry, Genetics & Molecular Biology Education Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Anesthesic Management in Pregnant Woman with Eisenmenger Syndrome Stefi Soefviana; Ardi Zulfariansyah
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.51

Abstract

The mortality rate in pregnant woman with cardiovascular disease is high.1 Eisenmenger syndrome is a congenital heart disease with a shunt abnormality between the systemic and pulmonary circulation where pulmonary hypertension occurs with right to left shunt at the level of the atria, ventricles or aortopulmonary arteries.2 Patients with Eisenmenger syndrome have a mortality rate up to 56% .1 A 29 years old woman, Gravida 28-29 weeks with a history of congenital heart disease Atrial Septal Defect (ASD) Secundum 27mm-35mm, moderate tricuspid regurgitation, severe pulmonary hypertension with MPAP 78mmHg, ejection fraction (EF) 88%, by bidirectional shunt with Eisenmenger syndrome. The patient underwent elective cesarean section under general anesthesia using Ketamine, Midazolam and Atracurium. The duration of surgery is about 1 hours with stable hemodynamics, EtCO2 within normal limits and no desaturation with a total bleeding of 350 cc. A baby boy was born with a weight range of 1100gr with an APGAR Score of 6/8. Extubation is done by deep extubation. For postoperative, the patient was transferred to the CICU for 3 days for hemodynamic monitoring and moved to the ward for 1 day of treatment and the patient went home. Pregnancy with Eisenmenger syndrome has a high mortality rate. Multidisciplinary team management is required in both elective surgery and the emergency department. Both general and regional anesthesia have their advantages and disadvantages. The principle of anesthesia management is to maintain the balance of the PVR and SVR so that there is no right to left shunt that causes death. Key words: cesarean section, congenital heart disease, Eisenmenger syndrome
Tatalaksana Pasien Post Ventriculo Peritoneal (VP) Shunt et causa Meningitis disertai Aspirasi Pneumonia dan Gagal Napas di Ruang Rawat Intensif Arief Kurniawan; Ardi Zulfariansyah
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2493.446 KB) | DOI: 10.24244/jni.v9i2.245

Abstract

Ventriculo Peritoneal (VP) Shunt adalah tindakan operasi pemasangan kateter yang menghubungkan ventrikel otak dan rongga peritoneum. Tindakan VP Shunt bertujuan menurunkan tekanan intrakranial yang tinggi pada hidrosefalus. Pasien hidrosefalus akibat meningitis sering mengalami gagal napas akibat gangguan otak atau aspirasi pneumonia. Terapi ventilasi mekanik diperlukan sebelum, selama dan setelah operasi VP Shunt. Laporan kasus laki-laki 21 tahun datang ke rumah sakit karena gangguan kesadaran dan didiagnosis dengan meningitis. Pasien mengalami gagal napas akibat aspirasi pneumonia dan mendapat terapi ventilasi mekanik, kemudian menjalani operasi VP Shunt atas indikasi hidrosefalus komunikan. Induksi anestesi menggunakan fentanil dan propofol, pemeliharaan anestesi menggunakan sevofluran dan analgesi pascabedah menggunakan fentanil kontinyu. Berdasarkan pemeriksaan cairan serebrospinal pasien didiagnosis meningitis serosa akibat Tuberkulosis. Pasien mendapat terapi antibiotik empirik untuk aspirasi pneumonia dan antituberkulosis. Setelah kesadaran membaik dan weaning ventilator pasien dipindahkan dari ruang perawatan intensif. Management Patient Post Ventriculo Peritoneal (VP) shunt et causa Meningitis with Pneumonia Aspiration and Respiratory Failure in ICUAbstractVentriculo Peritoneal (VP) Shunt is a surgery that connects the brain ventricles and the peritoneal cavity with a catheter. VP Shunt aims to reduce high intracranial pressure in hydrocephalus. Hydrocephalus patients due to meningitis often experience respiratory failure from brain disorder or pneumonia aspiration. Mechanical ventilation therapy is needed before, during and after VP Shunt surgery. Case report of 21-year-old came to the hospital with decreased of conciousness and diagnosed with meningitis. The patient experienced respiratory failure and received mechanical ventilation therapy in the intensive care unit. The patient underwent VP Shunt surgery for indications of communicant hydrocephalus. Induction of anesthesia used fentanyl and propofol, maintenance of anesthesia used sevoflurane and postoperative analgesia used continuous fentanyl. Based on the results of the examination of cerebrospinal fluid, the diagnosis leads to serous meningitis due to Tuberculosis bacteria. Empiric antibiotics therapy for aspiration pneumonia and antituberculosis were given even if no bacteria was found in the blood or cerebrospinal fluid. After improvement in clinical condition and weaning from mechanical ventilator, the patient discharge from the ICU and sent to the ward.
Co-Authors Arief Kurniawan Stefi Soefviana