Pengelolaan Anestesi untuk Cedera Otak Traumatik pada Pasien dengan Stroke Iskemik

Nency Martaria, Iwan Abdul Rachman, MM. Rudi Prihatno

Abstract


Cedera otak traumatik (COT) merupakan salah satu penyebab utama kematian dan disabilitas di seluruh dunia. Kelompok yang paling berisiko mengalami COT adalah pasien geriatrik, dimana mayoritas disebabkan oleh jatuh. Kejadian jatuh salah satunya dikaitkan dengan hemiparesis akibat riwayat stroke. Seorang laki-laki, 68 tahun dengan Glasgow Coma Scale (GCS) M3V1E4. Pasien mengalami cedera kepala akibat jatuh ketika naik tangga. Pasien memiliki riwayat gangguan keseimbangan akibat stroke iskemik dan mendapatkan terapi clopidogrel. Hasil pemeriksaan CT scan memperlihatkan adanya perdarahan akut sub dural dengan penyimpangan garis tengah 0,9 cm. Operasi pertama yang dilakukan adalah kraniektomi dekompresi dan pemasangan kasa untuk kontrol perdarahan. Perdarahan baru ketika operasi, timbul di midparietal kanan dan diduga berasal dari vena penghubung yang dekat dengan sinus. Perdarahan sulit dihentikan dengan total perdarahan 2500 cc. Tanda vital selama operasi stabil dengan topangan norepinefrin 0,2 mcg/kg/menit. Anestesi dengan menggunakan fentanyl 200 mcg, propofol 100 mg dan vecuronium berkelanjutan. Pemeliharaan dengan oksigen, compressed air dan sevofluran 2%. Pasien ditransfusi pack red cel (PRC) 700 ml. Setelah delapan hari perawatan ICU, kadar fibrinogen dan hemoglobin menjadi normal,dilakukan pengangkatan kassa dari dalam kepala pasien. Saat ini pasien telah dipulangkan dari rumah sakit dengan Glasgow Outcome Scale 3 dan hemiparese sinistra. Pengelolaan anestesi pada operasi pasien memperhatikan kondisi otak akibat COT, stroke iskemik dan efek dari terapi Clopidogrel pada operasi cito. Brain Trauma Foundation memberikan panduan untuk pengelolaan COT yang bertujuan untuk memberikan luaran yang lebih baik.

 

Anesthetic Management for Traumatic Brain Injury in Patient with Ischemic Stroke

Abstract

Traumatic brain injury (TBI) is one of the leading cause of death and disability around the world. Geriatric being the most vulnerable group, mainly because of falling, of which associated with hemiparesis following stroke. A 68 years old man with Glaslow Coma Scale (GCS) M3V1E4 had brain injury after falling from stairs. The patient is having balance disorder following stroke and receiving clopidogrel afterwards. CT-scan showed acute subdural hemorrhage (SDH) with 0.9cm midline shift. Decompression craniectomy and gauze insertion to stop the bleeding was done on the first surgery. New onset of bleeding occurred in right midparietal. Bleeding was uncontrollable with total volume of 2500cc. Vital signs remained stable with norepinephrine 0.2mcg/kg/min. Anesthesia under fentanyl 200 mcg, propofol 100mg, and continuous vecuronium. Patient was transfused with pack red cel (PRC) total of 700 cc. After eight days in ICU, fibrinogen and hemoglobin returned to normal level, therefore the patient undergone gauze removal. The patient discharged with GOS 3 and left hemiparesis. Anesthesia management in this patient’ surgery focused on brain condition following TBI, ischemic stroke and the effect of clopidogrel therapy in emergency operation. Brain Trauma Foundation issued a management guideline of TBI for better outcome.


Keywords


cedera otak traumatik; stroke iskemik; traumatic brain injury; ischemic stroke

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DOI: https://doi.org/10.24244/jni.v8i3.235

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DOI:  https://doi.org/10.24244/jni 

pISSN: 2088-9674 | eISSN: 2460-2302

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