Penatalaksanaan Anestesi Tindakan Bedah Endoskopi Evakuasi Perdarahan Intraserebral karena Stroke Hemoragik

I Putu Pramana Suarjaya, Ida Bagus Krisna J Sutawan, Muhammad Aris Sugiharso

Abstract


Penatalaksanaan utama perdarahan intraserebral di daerah supratentorial adalah manajemen konservatif dengan penatalaksanaan optimal tekanan darah, penatalaksanaan komplikasi seperti pencegahan kejang, tromboemboli dan peningkatan tekanan intrakranial. Pembedahan untuk evakuasi perdarahan dilakukan bila terjadi penambahan bermakna volume perdarahan intraserebral yang meningkatkan morbiditas dan mortalitas. Prosedur neuroendoskopi saat ini menjadi pilihan karena pendekatan yang invasif minimal dan tingkat keberhasilan yang tinggi, insiden komplikasi lebih rendah, proteksi jaringan otak lebih baik, dan cedera yang berhubungan dengan teknik pembedahan lebih rendah dibanding kraniotomi terbuka. Pasien laki-laki, 44 tahun, obesitas dengan indeks massa tubuh 36,73 kg/m2, riwayat hipertensi, mengalami penurunan kesadaran dan lumpuh separo badan yang terjadi secara tiba-tiba. Pasien dirawat secara konservatif dan mengalami perbaikan sampai kesadaran pulih penuh, dengan gejala sisa hemiparese sinistra dan paresis nervus VII supranuklear sinistra. Pada hari keempatbelas perawatan, pasien didapatkan mengalami penambahan volume perdarahan intraserebral yang bermakna dan dilakukan operasi endoskopi evakuasi perdarahan intraserebral. Manajemen anestesi untuk pasien stroke hemoragik dengan riwayat hipertensi yang menjalani pembedahan neuroendoskopi merupakan tantangan untuk dokter anestesi selama periode perioperatif untuk mampu menyediakan kondisi operasi yang optimal, melakukan upaya proteksi jaringan otak dan menjamin pasien pulih segera dengan baik.

 

Anesthetics Management for Endoscopic Evacuation of Intracerebral Hemorrhage due to Hemorrhagic Stroke

Abstract

Medical conservative treatment is a mainstay of supratentorial intracerebral hemorrhage management, which include blood pressure and increased intracranial pressure management, as well as seizure and thromboembolic prevention. Surgical intervention is an option if the intracerebral hematoma is expanding significantly and increase morbidity and mortality. Neuroendoscopic procedure is an attractive option which is less invasive and also provides high hemorrhage evacuation rate, low incidence of complication, better protection of brain tissue, and fever surgery-related injuries compared to open craniotomy. In this report, we presented a case of a man 44 years old, obese with body mass index of 36.73 kg/m2, hypertensive, who suffered from intracerebral hemorrhage and underwent endoscopic intracerebral blood clot evacuation. Medical management was done and the patient regained full consciousness, with left hemiparesis and the left supranuclear nerve VII sequelae. Due to the expanding volume of the hematoma, the patient underwent endoscopic surgical blood clot evacuation. Minimally invasive intracerebral blood clot evacuation of expanding hemorrhagic stroke in patient gives the anesthesiologist enormous challenge during the perioperative periods to provide optimal surgical conditions, performing brain protection, and ensure patients have early excellent recovery.


Keywords


Bedah endoskopi, manajemen anestesi, perdarahan intraserebral

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DOI: https://doi.org/10.24244/jni.v11i2.483

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