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Neuraxial block-associated infection is a rare complication, this could be due to better aseptic technique and possibility of unreported events. There are four mechanisms by which microorganisms enter the body during insertion of an epidural catheter, include inoculation of microorganisms on the skin surface, pathways along the insertion of epidural catheter, contamination of local anesthetic drugs, and hematogenous spread. The aim of the study is to find out incidence of infectious complications and risk factors for infection in patients who had an epidural catheter inserted in dr. Zainoel Abidin hospital Banda Aceh. A cross-sectional study was conducted over 3 months period with 45 total sampling patients who received epidural blocks. Analysis was done to know relationship beetwen age, number of attempts at insertion of epidural needles, duration of catheter in situ, comorbid DM, malignancy, duration of postoperative bed rest, and blood leukocyte count, signs of inflammation, neurological deficits, and bacterial culture of the epidural catheter. No infection was found, however there were 14 positive epidural catheter culture obtained Gram-negative rods. Nine of the 14 positive culture samples were patients with malignancy. All patients with positive culture samples had bed rest ≥2 days (p=0.004). No asociation between dependent and independent variables in this study (p>0.05). Positive culture results cannot be defined as an infection, however colonization at epidural catheter tip is an early sign of an imminent infectious process.

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan–Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04–18.07; p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03–5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96–7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32–5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32–8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p < 0.05. The six comorbidities that have log-rank p < 0.05 are moderate-to-severe renal disease (log-rank p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic.

Background With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p p < 0.005, R coefficient 0.22). Conclusion Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

Background: Enhanced Recovery After Cesarean Section (ERACS) protocol includes every component of the pre-operative, intra-operative and post-operative pathway. In the pre-operative phase, the protocol applied to this patient included the shortest possible fasting interval, oral intake of liquid carbohydrate and patient counselling. For intra-operative pathway, the components applied are prevention of hypotension, maintenance of normothermia, optimal uterotonic administration, IONV (intra-operative nausea and vomiting)/PONV (post-operative nausea and vomiting) prophylaxis, multi-modal analgesia and optimization of fluid administration. Post-operatively, the patient was given early nutritional intake, early mobilization, urinary catheter removal, venous thrombo-embolism prophylaxis, multi-modal analgesia and glycemic control. ERACS prove useful for early discharge, improving outcomes such as breastfeeding or reducing post-discharge opioid use.Case Illustration: A 31-year-old woman came with the chief complaint of fluid discharge since ± 3 hours prior to admission to the hospital. Based on the medical history, physical examination, and laboratory findings, the patient was diagnosed with premature rupture of membranes in a gestational age of 37-38 weeks and had a live, single-headed presentation of the fetus. Patient’s physical status is ASA II and scheduled for elective C-section procedure with spinal anesthesia.Conclusion: The implementation of the ERACS protocol in this case has been shown to reduce the rate of infection and post operative complications as well as reducing length of stay for the mother.

Peningkatan angka sectio caesarea secara global telah menjadi topik yang paling sering diperdebatkan dalam asuhan maternitas. Sectio caesarea merupakan salah satu pelayanan kesehatan ibu yang menimbulkan berbagai kontroversi. Menurut WHO, angka sectio caesarea yang direkomendasikan berkisar antara 10-15%. Tujuan penelitian ini adalah untuk menilai profil pasien sectio caesarea di Rumah Sakit Umum Daerah dr. Zainoel Abidin (RSUDZA) Banda Aceh Tahun 2019. Metode penelitian ini berupa penelitian deskriptif menggunakan data retrospektif. Subjek penelitian ini ialah 330 pasien yang menjalani sectio caesarea pada tahun 2019. Pengambilan data dilakukan menggunakan teknik simple random sampling . Penelitian ini dimulai dari bulan Oktober hingga November 2020. Analisis yang digunakan ialah uji univariat untuk melihat profil pasien. Hasil penelitian menunjukkan bahwa persentase sectio caesarea tahun 2019 mencapai 65.3%, dengan angka terbanyak diperoleh pada kelompok tingkat pendidikan SMA/Sederajat sebanyak 154 responden (46.7%), pekerjaan pada kelompok ibu rumah tangga sebanyak 235 responden (71.2%), usia ibu pada kelompok 20-35 sebanyak 284 responden (75.2%), usia kehamilan pada kelompok aterm sebanyak 257 responden (77.9%), paritas pada kelompok multigravida sebanyak 213 responden (64.5%%), sectio caesarea dengan riwayat sectio caesarea sebelumnya sebanyak 88 responden (26.7%), perencanaan tindakan secara emergency sebanyak 302 responden (91.5%), dan teknik anestesi didominasi oleh anestesi spinal sebanyak 307 responden (93%). Kesimpulan pada penelitian ini menunjukkan angka sectio caesarea yang masih tinggi dengan indikasi terbanyak yaitu riwayat sectio caesarea sebelumnya, sehingga diperlukan suatu intervensi tindakan serta edukasi untuk mengurangi angka sectio caesarea. Kata kunci : Sectio Caesarea , Profil Pasien, Banda Aceh

Latar Belakang dan Tujuan : Kraniotomi evakuasi hematoma dan kraniektomi dekompresi merupakan suatu tindakan definitif terhadap pasien cedera kepala berat. Perlu dilakukan suatu evaluasi untuk mengetahui luaran tindakan pembedahan sebagai informasi dalam memperbaiki dan mengurangi morbiditas dan mortalitas baik di bidang anestesi maupun bedah saraf. Subjek dan Metode : Penelitian deskriptif ini dilakukan di Rumah Sakit Umum Dr. Zainoel Abidin terhadap 83 pasien pasien cedera kepala berat yang dilakukan tindakan kraniotomi evakuasi hematoma atau kraniektomi dekompresi yang kemudian di rawat di ICU selama tahun 2012. Pasien dilakukan operasi dalam 24 jam setelah masuk rumah sakit dan kemudian dirawat di ICU. Dilakukan pencatatan umur, jenis kelamin dan luaran setelah operasi yaitu perbaikan fungsi motorik dan angka kematian selama rawatan 5 hari di ICU. Hasil : Pasien yang masuk dalam penelitian dengan jumlah 56 (67%) laki-laki dan 27 (33%) perempuan dengan usia sebagian besar 15-20 tahun 27% usia lebih dari 40 tahun 35%. Terdapat perbaikan fungsi motorik dalam skala penilaian GCS pada pasien setelah operasi terutama pada skala motorik 1 sampai 3 menjadi skala 2 sampai 5 setelah operasi. Angka kematian dalam 5 hari rawatan mencapai 57% (48 pasien) dan pasien yang hidup setelah 5 hari pasca operasi 43% (35 pasien). Sebagian besar kematian terjadi pada perawatan hari ke 2 (25%) dan hari ke 3 (35%). Simpulan : Tindakan operasi kraniotomi untuk evakuasi hematoma atau kraniektomi dekompresi pada pasien cedera kepala berat dapat memperbaiki fungsi motorik dan angka kematian 57% setelah 5 hari rawatan awal di ICU. Postoperative Outcome of Patients with Severe Traumatic Brain Injury Undergoing Craniotomy to Evacuate Hematoma or Decompressive Craniectomy at Dr. Zainoel Abidin Hospital Banda Aceh Backgroud and Objective : Craniotomy to evacuate hematoma and decompressive craniectomy is definitive treatment for severe head injury patients. We need to evaluate the outcome after surgery as the basis information for improve management and to reduce mortality and morbidity rate in neuroanesthesia or neurosurgery as well. Subject and Method : This descriptive research was conducted in Zainoel Abidin Hospital Banda Aceh on 83 severe head injury patients undergoing craniotomy to evacuate hematoma or decompressive craniectomy continued with postoperative care in the intensive care unit in 2012. Age, sex, and outcome motoric function on GCS scale and morbidity were recorded during 5 day care in the ICU. Results : Eighty three severe head injury patients at Zainoel Abidin Hospital Banda Aceh underwent craniotomy to evacuate hematoma or decompressive craniectomy continued with postoperative care in the ICU in 2012 were included with 56 (67%) male and 27(33%) female, aged 15‒20 y.o (27%) and >40 y.o (35%). Motoric function was improved from 1‒3 to 2‒5 according to GCS scale after the surgery. There were 48 (57%) patients died and 35 (43%) patients survived after undergoing surgery and 5 day tratment in the ICU. Most of death happened on day 2 (25%) and day 3 (35%). Conclusion : Craniotomy to evacute hematoma or decompressive craniectomy may improve the motoric function with mortality rate 57% during initial 5 day in ICU.