Tatalaksana Anestesi Pasien Adenoma Hipofisis dengan Riwayat Hipotiroid

Nurmala Dewi Maharani, Dewi Yulianti Bisri, Nazaruddin Umar

Abstract


Adenoma hipofisis merupakan tumor otak dengan gejala klinis tergantung hormon yang dihasilkan oleh sel tumor, ukuran, dan invasi lokal. Perempuan 50 tahun dengan adenoma hipofisis dengan riwayat hipotiroid. Pada pemeriksaan prabedah GCS E4M6V5, tekanan darah 114/76 mmHg, denyut nadi 81x/menit, pernafasan 18x/menit, dan saturasi 99%. Pada pemeriksaan fisik berat badan dan visus mata kanan menurun. Pemeriksaan fungsi tiroid kesan hipotiroid, lalu pasien diterapi levotiroksin natrium 100 µg perhari tablet selama 14 hari sampai dengan eutiroid. Tatalaksana lanjutan yang dilakukan adalah kraniotomi reseksi adenoma hipofisis. Premedikasi hidrokortison 100 mg dan midazolam 0,1mg/kgbb intravena. Induksi propofol 1 mg/kgbb, fentanyl 2µg/kgbb, rocuronium 1 mg/kgbb, lidokain 1 mg/kgbb dan propofol pengulangan dosis 0,5 mg/kgbb. Manitol diberikan 0,5 mg/kgbb dan dexamethason 10 mg. Rumatan anestesi sevoflurane 0,5% dan propofol 50–100 µg/kgbb/menit. Pasca operasi pasien di ICU diberikan dexmedetomidine 0,2 µg/kgbb/jam dan suplemen steroid H-1 diberikan 25 mg hidrokortison setiap 12 jam. Pada H-2 diberikan 20 mg hidrokortison pagi hari dan 10 mg sore hari kemudian dapat dihentikan. Pasien dirawat di ICU 3 hari sebelum pindah ruang rawat biasa. Manajemen perioperatif adenoma hipofisis dengan riwayat hipotiroid adalah mengoptimalkan pra operasi pasien sehingga pasien mencapai eutiroid, menjaga stabilitas hemodinamik, mengoptimalkan oksigenasi serebral, mencegah serta mengatasi komplikasi.

 

Anesthesia Management of Patient with Pituitary Adenoma with Hystory of Hypothyroidism

Abstract

Pituitary adenoma is a brain tumor has clinical symptoms depending on hormones produced by tumor cells, size, and local invasion. A 50-year-old woman with pituitary adenoma with history of hypothyroidism. On preoperative, GCS E4M6V5, blood pressure was 114/76 mmHg, pulse was 81x/minute, respiration was 18x/minute, and saturation was 99%. On physical examination, body weight and the visual acuity in the right eye decreased. Examination of thyroid function suggests hypothyroidism before surgery, patient was treated with levothyroxine sodium 100 g per day tablets for 14 days until euthyroid. The next treatment was resection craniotomy of the pituitary adenoma. Premedicated with hydrocortisone 100 mg and midazolam 0.1 mg/kg body weight. Induction propofol 1 mg/kg body weight, fentanyl 2 µg/kg body weight, rocuronium 1 mg/kg body weight, lidocaine 1 mg/kg body weight and repeated doses of 0.5 mg/kg body weight propofol. Mannitol was given 0.5 mg/kgbw and dexamethasone 10 mg. Maintenance anesthesia with sevoflurane 0.5% and propofol 50-100 µg/kgbw/min. Postoperative the patient in the ICU was given dexmedetomidine 0.2 µg/kgbw/hour and steroid supplement day-1 was given 25 mg hydrocortisone every 12 hours. On day-2, 20 mg of hydrocortisone in the morning and 10 mg in the evening, then can be discontinued. The patient was admitted to the ICU for 3 days before moving to the ward. Perioperative management of pituitary adenoma with a history of hypothyroidism is optimizing preoperatively the patient reaches euthyroid, maintaining hemodynamics, optimizing cerebral oxygenation, preventing and treatment if there are complications.


Keywords


Anestesi, adenoma hipofisis, hipotiroid

Full Text:

PDF

References


McCutcheon IE. Pituitary adenomas: surgery and radiotherapy in the age of molecular diagnostics and pathology. Curr Probl Cancer. 2013; 37:6–37.

Mary A. Perioperative management of patients with pituitary tumours. Journal of Neuroanaesth and Critical Care. 2016: 211–18.

Dunn LK, Edward C. Anesthesia for transsphenoidal pituitary surgery. Current Opinion in Anesth. 2013; (26): 549–54.

Baduni N, Sinha SK, Sanwal MK. Perioperative management of a patient with myxedema coma and septicemic shock. Indian J Crit Care Med. 2012; 16(4): 228–30.

Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R. Endocrine function in Clinical Anesthesia 8th edition. Wolters Kluwer, 2017: 3326–327.

Gaus S, Bisri T. Penatalaksanaan anestesi untuk tumor neuroendokrin. Jurnal Neuroanestesi Indonesia. 2020; 1(3): 217–33.

Anyetei-Anum CS, Roggero VR, Allison LA. Thyroid hormone receptor localization in target tissues. J Endocrinol. 2018; 237(1): 19–34.

Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP, Oppenheimer JH. Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. N Engl J Med. 1987; 26: 316(13):764–70.

Harijono B, Saleh SC. Pengelolaan perioperatif anestesi pada pasien dengan pembedahan hipofisis surgery. Jurnal Neuroanestesi Indonesia. 2012; 1(2): 133–43.

Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Lise Jaffrain M. Diagnosis and management of pituitary tumours in the elderly: A review based on personal experience and evidence of literature. European Journal of Endocrinology, 2005; 153(6): 723–35.

Inder W, Hunt P. Glucocorticoid replacement in pituitary surgery: Guidelines for perioperative assessment and management. The Journal of Clinical Endocrinology & Metabolism. 2002; 87(6): 2745–50.

Pamela F, James R, Richard DU. In: Intravenous sedatives and hypnotics. Stoelting Pharmacology and Physiology 6th Edition. Philadelphia. Elsevier. 2021: 535–642.

Butterworth J, Mackey D, Wasnick J. In: Anesthesia for patients with endokrin disease Morgan and Mikhail’s. Mcgraw Hill. 2018: 1205–7.




DOI: https://doi.org/10.24244/jni.v11i2.469

Refbacks

  • There are currently no refbacks.


 

DOI:  https://doi.org/10.24244/jni 

pISSN: 2088-9674 | eISSN: 2460-2302

This Journal Indexed on:

                

                                    

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License