Anestesi untuk Kraniotomi Evakuasi Perdarahan Intraserebral pada Pasien Cedera Otak Traumatik dengan Tetralogy of Fallot

Dhania A Santosa, Hamzah Hamzah

Abstract


Penyakit jantung bawaan (PJB) merupakan salah satu penyakit bawaan yang paling sering terjadi, yaitu sekitar 8 dari 1000 kelahiran hidup. Sekitar 85% dari pasien dengan PJB diharapkan bertahan hidup sampai dengan usia dewasa di Amerika Serikat. Penanganan cedera otak traumatik dengan PJB memerlukan pemahaman patofisiologi PJB dengan teknik neuroanestesi yang baik. Seorang laki-laki usia 17 tahun mengalami kecelakaan lalu lintas dan didiagnosis dengan cedera otak traumatik sedang, perdarahan intraserebral (ICH) dan perdarahan epidural (EDH) serta edema serebri dengan komorbiditas PJB sianotik Tetralogy of Fallot, dilakukan pembedahan darurat kraniotomi evakuasi ICH. Pembedahan dilakukan dengan anestesi umum intubasi endotrakeal dan berjalan selama kurang lebih tiga jam. Tantangan selama anestesi dan pembedahan adalah mempertahankan hantaran oksigen optimal, menghindari peningkatan kebutuhan oksigen dan mencegah pelepasan katekolamin yang dapat memicu terjadinya hypercyanotic tet spell. Pascabedah pasien dirawat di Ruang Observasi Intensif dengan bantuan ventilator dan dilakukan ekstubasi pada sore hari pertama pascabedah. Pasien kemudian dirawat di Ruangan dan dipulangkan pada hari ke-14 pascabedah

 

Anesthesia Management for Craniotomy for Intracerebral Hemorrhage Evacuation in Traumatic Brain Injury Patient with Tetralogy of Fallot

Abstract

Congenital heart disease (CHD) is one of the leading congenital disease with the incidence of 8 patients of 1000 livebirth. Around 85% of patients with CHD is expected to reach adult age in United States of America. Management of traumatic brain injury in patients with CHD requires combination of fine understanding on pathophysiology of CHD and neuroanesthesia technique. A male patient, 17 years of age had a motor vehicle accident and was diagnosed with moderate traumatic brain injury, intracerebral hemorrhage, epidural hemorrhage and cerebral edema with Tetralogy of Fallot, underwent an emergency craniotomy for ICH evacuation. Surgery was done under general anesthesia and lasted for approximately 3 hours. Challenges during anesthesia and surgery include maintaining optimal oxygen delivery, avoiding increase in oxygen demand and preventing catecholamine release which may trigger hypercyanotic tet spell. Patient was observed and ventilator supported in Intensive Observation Ward and was extubated at the same post surgery day. Patient was then observed in the Ward and sent home on the 14th day after the incident.


Keywords


Anestesi, cedera otak traumatika, Tetralogy of Fallot, anesthesia management, traumatic brain injury, Tetralogy of Fallot

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References


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DOI: https://doi.org/10.24244/jni.v9i3.272

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