Penatalaksanaan Anestesi dengan TIVA Propofol-Dexmedetomidine-Fentanyl untuk Operasi Meningioma Frontalis Sinistra

Abstract

Meningioma merupakan tumor intrakranial jinak yang sering ditemukan. Berasal dari jaringan meningen dan medulla spinalis, tidak tumbuh dari jaringan otak. Pada kasus ini, pasien laki-laki, 46 tahun, 80 kg, datang ke rumah sakit dengan keluhan kejang berulang dan sakit kepala yang hilang timbul sejak 5 bulan yang lalu. Kesadaran composmentis, GCS 15, pupil isokor bilateral 2 mm, hemodinamik stabil, jantung dan paru tidak ada kelainan dan tidak ada kelumpuhan atau kelemahan pada ke empat ekstremitas. Magnetic Resonance Imaging (MRI) brain ditemukan masa hipointens yang melekat dengan meningen di frontal kiri ukuran 52x48x43 mm, kesan convexitas meningioma disertai perifokal edema dengan midline shift ke kanan sekitar 7 mm. Disimpulkan meningioma frontal sinistra dan dianjurkan kraniotomi pengangkatan tumor. Operasi dilakukan dengan anestesi umum. Tehnik anestesi menggunakan Total Intra Venous Anesthesia (TIVA) dengan syringe pump. Operasi berlangsung selama 7 jam dan tumor dapat terangkat semua. Jumlah perdarahan 1000 mL. Pasien mendapat 300 ml Fresh Frozen Plasma (FFP) dan 500 ml Packed Red Cell (PRC) intraoperasi. Untuk mengurangi tekanan intrakranial, diberikan manitol 0,5 gram/kgBB dan drainase cairan serebrospinal 10–20 mL langsung ke ventrikel lateral oleh operator. Pascaoperasi, pasien diekstubasi dan rawat diruang ICU. Dengan data five year survival rate untuk meningioma jinak 70%, meningioma ganas 55%, diharapkan prognosis pasien pascaoperasi adalah dubia ad bonam.

Management Anesthesia with TIVA Propofol-Dexmedetomidine-Fentanyl for Meningioma Frontalis Sinistra Operation

Meningiomas are the most common benign intracranial tumors. These tumors originate from the meninges and spinal cord, not from the brain tissue. A 46 year old 80 kgs male patient, was admited to the hospital with recurrent seizures and intermittent headaches that occured since five months ago. He was fully alert, GCS 15, both pupils were isokor (2 mm), with stable hemodynamic, no parese in all extremities and normal heart and lung. Magnectic Resonance Imaging (MRI) result showed a 52x48x43 mm mass attached to the meninges at the left frontal with perifocal tumour edema and midline shifted to the right about 7 mm. The patients was diagnosed with the left frontal meningioma and suggested for craniotomy tumour removal. The surgery was performed under general anesthesia using. Total Intra Venous Anesthesia (TIVA) with syringe pump. The 7 hours surgery performed uneventfully with total bleeding of 1000 mL and the patient was received 300 mL Fresh Frozen Plasma (FFP) and 500 ml Packed Red Cell (PRC) intraoperatively. To reduce intracranial pressure, a 0.5gr/kg mannitol was and a 10–20 cc of cerebrospinal liquor drainage through the lateral ventricle was performed by the operator. The patient was extubated after the operation and admitted the ICU for futher management. With the five year survival rate of 70% for benign meningioma and 55% for malignant meningiomas, the prognosis of this patient is dubia ad bonam.