Dewi Husodo - Academia.edu (original) (raw)

Papers by Dewi Husodo

Jurnal Anestesi Obstetri Indonesia

Pendahuluan sindroma Eisenmenger adalah penyakit jantung bawaan sianotik, termasuk di dalamnya hi... more Pendahuluan sindroma Eisenmenger adalah penyakit jantung bawaan sianotik, termasuk di dalamnya hipertensi pulmonal dengan bidirectional maupun R-L shunt. Penurunan resistensi pembuluh darah sistemik dalam kehamilan akan meningkatan derajat R-L shunt. Mortilitas maternal pada kehamilan dengan sindroma Eisenmenger dilaporkan sekitar 30–70%. Wanita 35 tahun, gravida 32–33 minggu dengan atrial septal defect (ASD )sekundum 1,5cm, regurgitasi tricuspid berat, regurgitasi pulmonal sedang, pulmonal hipertensi berat, ejection fraction (EF) 34%, gagal jantung stage C fungsional klas III, sindroma Eisenmenmenger, saturasi preinduksi 90% dengan non rebreathing mask (NRM) 10 lpm. Kasus kedua, wanita gravida 32 minggu dengan ASD sekundum, regurgitasi trikuspid berat, regurgitasi pulmonal sedang, EF 13%, gagal jantung stage C fungsional klas IV, sindroma Eisenmenger, saturasi preindukasi 66% dengan non rebreathing mask (NRM) 10 lpm. Keduanya menjalani seksio sesarea dengan anestesi umum. Pada kasu...

JAI (Jurnal Anestesiologi Indonesia), Nov 1, 2018

Background: Approximately 25% of patients with mitral stenosis become symptomatic for the first t... more Background: Approximately 25% of patients with mitral stenosis become symptomatic for the first time during pregnancy. It is because of increasing maternal blood volume and heart rate. Some literature mentioned that spinal anesthesia is contraindicated for the patient with mitral stenosis undergo operation due to the risk of hypotension and tachycardia. Case: A 24-years old primigravida in 32-34 weeks of gestation with severe mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation, moderate pulmonal regurgitation. Ejection Fraction (EF) was 62%, pulmonary hypertension with pulmonary artery systolic pressure (PASP) 65 mmHg, heart failure stage C Functional Class III. Caessarian section was performed under low dose spinal anesthesia using 5 mg of bupivacaine and 50 mcg of fentanyl as adjuvant. Complete neuraxial block was achieved in 5 minutes. The haemodynamic was stable during the operation. There is no evidence of acute heart failure and worsen of hemodynamic status in postoperative periods. The patient discharge safely from the hospital. Discussion: The main principles of anesthesia management is to prevent tachycardia, maintain sinus rhytm and aggressively treat new atrial fibrillation using pharmacologic drugs or cardioversion. Systemic vascular resistance (SVR) is kept normal especially in patient with unstable hemodynamic because the decrease of SVR can induce tachycardia. Another strategy are maintain normovolemia, prevent hypoxia, hipercarbia and pain. Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0,5% and adjuvant fentanyl can be safely used for caessarean section delivery in severe mitral stenosis patient because of the fast onset, adequacy level, duration of the block, haemodynamic stability and good fetal outcome.

Anaesthesia, Pain & Intensive Care, Dec 13, 2019

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their ... more Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 µg fentanyl for caesarean section in patient with heart disease. Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 µg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician. Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation. Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 µg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.

Jurnal Anestesi Obstetri Indonesia

Pendahuluan sindroma Eisenmenger adalah penyakit jantung bawaan sianotik, termasuk di dalamnya hi... more Pendahuluan sindroma Eisenmenger adalah penyakit jantung bawaan sianotik, termasuk di dalamnya hipertensi pulmonal dengan bidirectional maupun R-L shunt. Penurunan resistensi pembuluh darah sistemik dalam kehamilan akan meningkatan derajat R-L shunt. Mortilitas maternal pada kehamilan dengan sindroma Eisenmenger dilaporkan sekitar 30–70%. Wanita 35 tahun, gravida 32–33 minggu dengan atrial septal defect (ASD )sekundum 1,5cm, regurgitasi tricuspid berat, regurgitasi pulmonal sedang, pulmonal hipertensi berat, ejection fraction (EF) 34%, gagal jantung stage C fungsional klas III, sindroma Eisenmenmenger, saturasi preinduksi 90% dengan non rebreathing mask (NRM) 10 lpm. Kasus kedua, wanita gravida 32 minggu dengan ASD sekundum, regurgitasi trikuspid berat, regurgitasi pulmonal sedang, EF 13%, gagal jantung stage C fungsional klas IV, sindroma Eisenmenger, saturasi preindukasi 66% dengan non rebreathing mask (NRM) 10 lpm. Keduanya menjalani seksio sesarea dengan anestesi umum. Pada kasu...

JAI (Jurnal Anestesiologi Indonesia), Nov 1, 2018

Background: Approximately 25% of patients with mitral stenosis become symptomatic for the first t... more Background: Approximately 25% of patients with mitral stenosis become symptomatic for the first time during pregnancy. It is because of increasing maternal blood volume and heart rate. Some literature mentioned that spinal anesthesia is contraindicated for the patient with mitral stenosis undergo operation due to the risk of hypotension and tachycardia. Case: A 24-years old primigravida in 32-34 weeks of gestation with severe mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation, moderate pulmonal regurgitation. Ejection Fraction (EF) was 62%, pulmonary hypertension with pulmonary artery systolic pressure (PASP) 65 mmHg, heart failure stage C Functional Class III. Caessarian section was performed under low dose spinal anesthesia using 5 mg of bupivacaine and 50 mcg of fentanyl as adjuvant. Complete neuraxial block was achieved in 5 minutes. The haemodynamic was stable during the operation. There is no evidence of acute heart failure and worsen of hemodynamic status in postoperative periods. The patient discharge safely from the hospital. Discussion: The main principles of anesthesia management is to prevent tachycardia, maintain sinus rhytm and aggressively treat new atrial fibrillation using pharmacologic drugs or cardioversion. Systemic vascular resistance (SVR) is kept normal especially in patient with unstable hemodynamic because the decrease of SVR can induce tachycardia. Another strategy are maintain normovolemia, prevent hypoxia, hipercarbia and pain. Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0,5% and adjuvant fentanyl can be safely used for caessarean section delivery in severe mitral stenosis patient because of the fast onset, adequacy level, duration of the block, haemodynamic stability and good fetal outcome.

Anaesthesia, Pain & Intensive Care, Dec 13, 2019

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their ... more Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 µg fentanyl for caesarean section in patient with heart disease. Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 µg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician. Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation. Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 µg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.