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Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity. Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable.Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Uterine atonic can result in postpartum hemorrhage, gravid hysterectomy and maternal mortality. Oxytocin is the most commonly used agent for the prevention and treatment of atonic uterine during cesarean section. However, the provision of rapid and increasing the dose may result in hemodynamic instability, cardiovascular collapse, and death. This study aimed to compare the effectiveness of oxytocin bolus 5 IU and oxytocin infusion 20 IU to contractions of the uterus and the hemodynamic response in cesarean section with spinal anesthesia. An experimental study, Randomized Controlled Trial (RCT) was conducted in the operating room Mohammad Hoesin Hospital Palembang from July to August 2016. It was obtained a 44 pregnant at term women who will do a cesarean section that meet the inclusion and exclusion criteria. The frequency and distribution of data are described in tables and comparisons between the two groups were analyzed using SPSS. Of the 44 pregnant women at term, 22 women in the group of oxytocin bolus 5 IU and 22 women in the group of oxytocin infusion 20 IU. By statistical analysis, there was no significant hemodynamic changes after bolus administration of oxytocin 5 IU or oxytocin infusion 20 IU (p> 0.05) and there were no significant hemodynamic differences between oxytocin bolus 5 IU and infusion of 20 IU oxytocin (p> 0.05). In addition, there are significant changes in uterine contractions after bolus administration of oxytocin 5 IU or oxytocin infusion 20 IU (p< 0.05) and there were significant differences in uterine contraction in the 3rd minute (p = 0.006), 6th minute ( p = 0.010) and 9th minute (p = 0.008) between oxytocin bolus 5 IU and infusion of oxytocin 20 IU. It can be concluded that there is no significant hemodynamic changes after administration of oxytocin 5 IU bolus and oxytocin infusion 20 IU and there are differences in uterine contractions significantly in the 3rd minute, 6th minute and 9th minute between oxytocin bolus 5 IU and oxytocin infusion 20 IU.

A B S T R A C TPain is an unpleasant sensory and emotional experience associated with actual orpotential tissue damage, or described in terms of such damage. APS-POQ-R (RevisedAmerican Pain Society Patient Outcome Questionnaire) is a measuring tool for assessingthe quality of postoperative pain management by exploring patient experiences andoutcomes. This research aims to assess the quality of postoperative pain managementat Mohammad Hoesin Hospital Palembang and to determine the factors that influenceit. The Cross-sectional observational analytic study was conducted toward 51respondents. Data was collected primarily by using questionnares and interview. Datawas analyzed by using chi-square. The study showed that the quality of postoperativepain management at RSUP Mohammad Hoesin General Hospital Palembang has goodquality with a total of 27 patients (52.9%). From statistical analysis there wassignificant relationship between the quality of post-operative pain management withage (p=0,037), gender (p=0,027), ethnicity (p=0,039), education level (p=0,039), andeconomic level (p=0,005). So it can be concluded that was a significant relationshipbetween the quality of post-operative pain management with age, gender, ethnicity,education level, and economic level.

Sindrom Dandy Walker termasuk hidrosefalus yang sangat jarang terjadi dengan insiden 1 kasus dari 65 kasus hidrosefalus berdasarkan penelitian profil hidrosefalus di RSUDZA Banda Aceh. Insiden di Indonesia sebanyak 50–60% kasus dari operasi bedah saraf. Kasus berikut seorang bayi laki-laki lahir prematur, umur 1 bulan, berat badan 3,5 kg, ukuran lingkar kepala 45 cm, muntah dan kejang. CT-Scan terdapat kista, kalium 7 mmol/l ditegakkan diagnosa sindrom Dandy Walker dengan hiperkalemia. Manajemen neuroanestesi dengan cara premedikasi dan pemasangan kateter intravena 24G dengan sevofluran via masker O2 100% setelah jalur vena terpasang, diberikan fentanil 10 mcg sebagai analgetik dan induksi propofol 10 mg. Rocuronium 3,5 mg sebagai fasilitas intubasi. Pemeliharaan anestesi dengan sevofluran dan oksigen. Ventilasi frekuensi nafas 30 x/menit dilakukan manual dan kemudian dengan ventilator TV 30 ml, I:E = 1:1,5, RR 30 kali per menit, FiO2 100%. Monitoring hasil frekuensi nadi 100 – 130 kali per menit, SpO2 100%, suhu afebris, CO2 30 mmHg. Simpulan: sindrom Dandy Walker kasus yang sangat jarang terjadi dan hidrosefalus sering bersamaan dengan hiperkalemia terjadi pada bayi prematur karena gangguan reaborbsi kalium dan terjadi perpindahan kompartemen dari intraseluler ke ekstraseluler sehingga kalium banyak di ekstraseluler, maka diperlukan manajemen neuroanestesi pediatrik yang adekuat. Neuroanesthesia Management in Dandy Walker Syndrome with HyperkalemiaAbstractDandy Walker syndrome including hydrocephalus which is a very rare case with the incidence of 1 case out of 65 cases of hydrocephalus based on a study of hydrocephalus profile at Zainal Abidin Hospital, Banda Aceh. The incidence of Dandy-Walker syndrome in Indonesia are about 50 - 60% cases from all of neurosurgical cases. The following case was a premature baby, 1 month old, weight 3.5 kg, head cicumference 45 cm, vomit and seizure. Cyst was found in the head CT scan and the potassium level of 7 mmol/l. The patient was diagnosed with Dandy-Walker Syndrome with hyperkalemia. Neuroanesthesia management by premedication and infusion using intravenous cathether 24G with sevoflurane and 100% O2 mask After succesful intravenous cathether, given fentanyl 10 mcg as analgesic and propofol 10 mg as induction. Rocuronium 3.5 mg as a facility for intubation. Maintenance of anesthesia with sevoflurane and oxygen. Respiratory rate 30 breaths per minute with ventilation that was done manually and then with TV on ventilator 30 ml, I: E = 1: 1.5, RR 30x/min, FiO2 100%. Monitoring pulse frequency results of 100–130 beats per minute, 100% SpO2, temperature afebrile, CO2 30 mmHg. Conclusions: Dandy-Walker Syndrome was a very rare case and hydrocephalus was often followed with hyperkalemia that occur in premature infants due to potassium reaboration disorder and the displacement of compartment from intracellular to extracellular so that potassium was abundant at extracellular, hence adequate pediatric neuroanesthesia management was needed.

Kehamilan mempunyai dampak terhadap perubahan anatomi, fisiologi, farmakologi dan psikis pada sang ibu sehingga seksio sesarea pada ibu hamil merupakan tantangan tersendiri untuk spesialis anestesiologi, karena pertimbangannya terhadap keselamatan ibu dan anak. Apabila kehamilan disertai dengan penyulit yang lain, maka kondisi ini akan semakin kompleks. Kasus ini mengemukakan ibu hamil penderita HIV/AIDS dengan penyulit Space Occupying Lession (SOL), pertimbangan seksio sesarea dilakukan sebagai terminasi kehamilan untuk mengurangi paparan Maternal to Child Transmission (MTCT) terhadap anak yang dilahirkan. Pertimbangan pemilihan tehnik anestesinya berdasarkan fisiologi kehamilan, patofisiologi HIV/AIDS, efek samping obat Anti Viral (ARV), interaksi obat ARV dengan obat anestesi, komplikasi HIV/AIDS pada otak berupa SOL yang berhubungan dengan peningkatan TIK, dampak infeksius penyakot ini kepada lingkungannya serta antisipasi terhadap medis/paramedic yang ikut menangani tindakan terminasi. Pada penderita ini kami lakukan tehnik anestesi edpidural dengan bupivacaine 0,5 % sebagai bfasilitas anestesi selama seksio sesarea. Pascaoperasi dilanjutkan nyeri melalui kateter epiduralnya. Anesthesia Management of Sectio Caesaria HIV/AIDS Patient with Space Occupying Lession (SOL) Sectio caesarea on prenatal vidual have challenge in anaesthesia because influence safety mothers and children. Pregnancy to changes anatomy, physiology, pharmacology and psychology on the mother moreover that’s can accompanied by another complications, and make change this increasingly complex. In this case was pregnant mothers HIV/AIDS sufferes with a complication space occupying lesion (SOL). Sectio caesaria done to termination of pregnancy to reduce exposure transmission against children born gord loan-to- maternal child transmission (MCTC), Consideration of anestesinya technique based on pregnancy, physiology, pahtopfisiologi HIV/AIDS, adverse side effects anti retro viral (ARV) and interaction with medicine. Anaethetic complication SOL in HIV/AIDS in the brain associated with increased intracranial pressure. The impact of infectious disease that contaminate the environment and anticipations for medical paramedics / anaesthetic to prevent its. We did the patient with ep[idural anaethetic technique and used bupivacaine 0.5 % as facilitate anesthesia during section caesaria. Postoperaive continued pain releave through her catheter epidural.

Shaken Baby Syndrom adalah suatu kondisi perdarahan intraserebral atau intraokuler tanpa atau dengan hanya minimal trauma pada kepala, leher atau wajah. Kasus ini sering disebut kasus kekerasan anak- orang tua. Jumlah kejadian ini cukup banyak terjadi di US, sekitar 50.000 kasus pertahun, sepertiganya meninggal dunia dan setengah dari kasus yang bertahan hidup mengalami defisit neurologis yang berat. Umumnya prognosa penderita buruk. Di Indonesia sendiri data mengenai hal ini belum ada. Tapi mempunyai kecenderungan untuk meningkat.Gejala yang sering didapat adalah hematom subdural, perdarahan retina dan edema otak. Sering diikuti juga dengan multipel fraktur, trauma cervical dan jaringan leher lainnya. Peneliti lain melaporkan banyaknya kasus Diffuse Axonal Injury (DAI) pada kasus ini. Penanganan neuroanestesinya secara umum sama dengan neuroanestesi cedera otak traumatika pada pediatrik, karena terjadi peningkatan ICP sehingga mempengaruhi CBF, CMRO 2 dan autoregulasi otak. Obat, tehnik anestesi yang digunakan dan perhitungan cairan selama operasi diusahakan tidak memperburuk keadaan . Pasca operasi penderita dirawat dan diobservasi di PICU. Anesthesia Management For Shaken Baby Syndrome Shaken Baby Syndrome is a condition of intracerebral hemorrhage or intraocular without or with only minimal trauma to the head, neck or face. This case is often referred to cases of child-parent violence. This cases in the U.S, approximately 50,000 cases per year. From all event, one third died and half of the cases that survive with severe neurological deficit. Generally, prognosis of patients is poor. In Indonesia data on this subject does not exist. But it has a tendency to increase. Symptoms of a subdural hematoma is often obtained, retinal hemorrhages and brain edema.This case often followed by multiple fractures, cervical and other neck trauma tissues. Diffuse axonal injury researchers often reported for this case. Generally neuroanestesi technique for pediatric equal with pediatric trauma neuroanesthesia. Anesthesi challenges for this case was ICP, because increased ICP could influence for CBF, CMRO2 and cerebral autoregulation. Avoid anesthesi drugs , technique and the calculation of fluid during surgery to damaged this condition. Postoperative patients were treated and observed in the PICU.