Penggunaan Calcium Channel Blocker pada Tatalaksana Anestesi Clipping Aneurisma Otak

Fanda Ayyu Rindiati, Himawan Sasongko, M Sofyan Harahap

Abstract


Perdarahan subarachnoid dapat diartikan sebagai proses pecahnya pembuluh darah di ruang yang berada dibawah arakhnoid (subarachnoid). Prevalensi terjadinya perdarahan subaraknoid dapat mencapai hingga 33.000 orang per tahun di Amerika Serikat. Penyebab paling sering perdarahan subarachnoid adalah ruptur aneurisma salah satu arteri di dasar otak dan adanya malformasi arteriovena (MAV). Pada umumnya aneurisma terjadi pada sekitar 5% dari populasi orang dewasa, terutama pada wanita. Penanganan pada aneurisma pembuluh darah otak salah satunya dengan clipping aneurisma. Tindakan tersebut beresiko terjadi vasospasme serebral. Nimodipine adalah suatu calcium chanel blocker yang penting dalam pengelolaan operasi aneurisma karena mempunyai efek vasodilatasi pembuluh darah serebral dan termasuk dalam bagian dari manajemen vasospasme serebral. Pada laporan ini, dilaporkan dua kasus tindaan clipping aneurisma. Pasien pertama adalah wanita usia 69 tahun, berat badan 60 kg dengan diagnosa SAH hari ke 18 yang mengalami defisit neurologi berupa hemiparese dextra dan afasia motorik. Pasien kedua adalah wanita usia 57 tahun berat badan 60 kg dengan diagnosa SAH hari ke 20 dan mengalami defisit neurologi hemiparese kanan dan afasia sensorik. Pada kedua pasien dilakukan tindakan pembedahan kraniotomi clipping aneurisma. Kedua pasien memiliki hasil akhir yang baik. Akan tetapi, ada perbedaan lama perawatan antara pasien yang menjalani terapi awal nimodipine dan yang tidak menerima terapi tersebut.

Administration of Calcium Channel Blocker in Anaesthesia Management of Cerebral Aneurysm Clipping

Abstract

Subarachnoid hemorrhage can be interpreted as the process of rupture of blood vessels in the space under the arachnoid (subarachnoid). The prevalence of subarachnoid hemorrhage can reach up to 33,000 people per year in the United States. The most common causes of subarachnoid bleeding are ruptured aneurysm in one of the arteries at the base of the brain and the presence of arteriovenous malformations (MAV). In general, aneurysms occur in about 5% of the adult population, especially in women.Therapy in cerebral vascular aneurysms, one of which is clipping aneurysms. These actions are at risk of cerebral vasospasm. Nimodipine is a calcium channel blocker which is important in the management of aneurysm surgery because it has a vasodilating effect on cerebral vessels and is included in the management of cerebral vasospasm. In this report, two cases of clipping aneurysm are reported. The first patient was a woman aged 69 years, body weight 60 kg with a diagnosis of SAH day 18 who had a neurological deficit in the form of hemiparese dextra and motor aphasia. The second patient was a 57-year-old woman weighing 60 kg with a diagnosis of SAH day 20 and had a neurological deficit in the form of right hemiparese and sensory aphasia. In both patients, clipping aneurysm was performed by craniotomy surgery. Both patients had good results. However, there is a difference in the length of stay between patients who underwent initial nimodipine therapy and who did not receive it.


Keywords


Calcium Channel Blocker; Clipping Aneurisma; Nimodipine; SAH; Vasospasme; Clipping Aneurysm; Calcium Channel Blocker; Nimodipine; SAH; Vasospasm

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References


Setyopranoto I. Penatalaksanaan Pendarahan Subarakhnoid. Contin Med Educ. 2012, 39; 807–811.

Mathias B, Frotscher M. Diagnosis topik neurologi duus: anatomi, fisiologi, tanda, gejala. Jakarta: Penerbit Buku Kedokteran EGC. 2010.

Bele S, Proescholdt MA, Hochreiter A, Schuierer G, Scheitzach J, Wendl C, et al. Continuous intra-arterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results. Acta Neurochir (Wien). 2015, 157; 2041–50.

Biondi A, Ricciardi GK, Puybasset L, Abdennour L, Longo M, Chiras J, et al. Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. Am J Neuroradiol. 2004, 25; 1067–76.

Karinen P, Koivukangas P, Öhinmaa A, Koivukangas J, Ohman J. Cost-effectiveness analysis of nimodipine treatment after aneurysmal subarachnoid hemorrhage and surgery. Neurosurgery. 1999;45:780–85.

Wolf S, Martin H, Landscheidt JF, Rodiek SO, Schürer L, Lumenta CB. Continuous selective intraarterial infusion of nimodipine for therapy of refractory cerebral vasospasm. Neurocrit Care. 2010, 12; 346–51.

Ott S, Jedlicka S, Wolf S, Peter M, Pudenz C, Merker P, et al. Continuous selective intra-arterial application of nimodipine in refractory cerebral vasospasm due to aneurysmal subarachnoid hemorrhage. BioMed Res Int. 2014.

Pickard JD, Murray GD, Illingworth R, Shaw MD, Teasdale GM, Foy PM, et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. Bmj. 1989, 298; 636–42.

Samseethong T, Suansanae T, Veerasarn K, Liengudom A, Suthisisang C. Impact of Early Versus Late Intravenous Followed by Oral Nimodipine Treatment on the Occurrence of Delayed Cerebral Ischemia Among Patients With Aneurysm Subarachnoid Hemorrhage. Ann Pharmacother. 2018, 52;1061–69.

Wainsztein N, Lucci FR. Cortical spreading depression and ischemia in neurocritical patients. Neurol Clin. 2017, 35;655–664




DOI: https://doi.org/10.24244/jni.v8i3.232

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DOI:  https://doi.org/10.24244/jni 

pISSN: 2088-9674 | eISSN: 2460-2302

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