Tatalaksana Anestesi pada Pendarahan Intraserebral Spontan Non Trauma
Abstract
Pendarahan Intraserebral (PIS) adalah ekstravasasi darah yang masuk kedalam parenkim otak, yang dapat berkembang ke ruang ventrikel dan subarahnoid, yang terjadi secara spontan dan bukan disebabkan oleh trauma (non traumatis) dan salah satu penyebab tersering pada pasien yang dirawat di unit perawatan kritis saraf. Kejadian PIS berkisar 10–15% dari semua stroke dengan angka kematian tertinggi tingkat dari subtipe stroke dan diperkirakan 60% tidak bertahan lebih dari satu tahun. Laki-laki 18 tahun, datang dengan keluhan penurunan kesadaran setelah sebelumnya merasakan lemas pada anggota gerak kanan yang terjadi tiba-tiba saat mengendarai kendaraan. Pada pemeriksaan didapatkan kesadaran GCS E3M5V2 dengan hemodinamik cukup stabil, dan terdapat hemiplegi dextra. Pasien dirawat di perawatan intensif selama 4 hari, karena kesadaran menurun menjadi E2M4V2 maka dilakukan MSCT ulangan, dan ditemukan PIS bertambah (kurang lebih 30cc) dibandingkan dengan MSCT sebelumnya dengan midline shift lebih dari 5mm. Diputuskan untuk dilakukan tindakan kraniotomi evakuasi segera dengan pemeriksaan penunjang yang cukup. Tindakan kraniotomi evakuasi pada pasien PIS menjadi tantangan bagi seorang spesialis anestesiologi, sehingga diperlukan pengetahuan akan patofisiologi, mortalitas PIS dan tindakan anestesi yang harus dipersiapkan dan dikerjakan dengan tepat.
Anesthesia Management in Spontaneous-Non Traumatic Intracerebral Hemorrhage
Intracerebral hemorrhage (ICH) is the extravasations of blood into the brain parenchyma, which may develop into ventricular and subarachnoid space, that occurs spontaneously and not caused by trauma (non-traumatic), and one of the most common causes in patients treated in the neurological critical care unit. ICH represents approximately 10–15% of all strokes with the highest mortality rates of all stroke subtypes and about 60% of patients with ICH may not survive within the first year. A 18 years old male with loss of consciousness after suffering from sudden right limb weakness while driving a vehicle. On examination, the level of consciousness (GCS) was E3M5V2 with stable hemodynamic and right hemiplegia. Patients was managed in intensive care unit (ICU) for 4 (four) days, and because of the decreasing level of consciousness to E2M4V2, the MSCt test was performed and the result revealed an ICH (approximately 30cc) compared to the previous MSCt with more than 5mm midline shift. Immediate craniotomy evacuation was then performed. Craniotomy evacuation in ICH patients is challenging for an anesthesiologist.Therefor, require a thorough understanding of the pathophysiology as well as mortality of ICH and anesthetic management should be prepared and done properly.
Keywords
Full Text:
PDFReferences
Feen ES, Lavery AW, Suarez JI. Management of nontraumatic intracerebral hemorrhage. Dalam: Suarez JI, Tarsy D, eds. Critical Care Neurology and Neurosurgery. New Jersey: Humana Press; 2004, 353–64.
Manoach S, Charchaflieh JG. Traumatic brain injury, stroke and brain death. Dalam: Newfield P, Cottrell J, eds. Handbook of Neuroanesthesia, 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2007, 432–44.
Stoelting RK, Dierdorf SF. Anesthesia and Co-Existing Disease, 4th edition, Philadelphia: Churchill Livingstone; 2002, 160–1
Rost N, Rosand J. Intracerebral hemorrhage. Dalam: Torbey MT, eds. Neurocritical Care. New York: Cambridge University Press; 2010, 143–59.
Rincon F, Mayer SA. Review clinical review: critical care management of spontaneous intracerebral hemorrhage. Critical Care. 2008; 12(6):237–52.
Jabbour PM, Awad IA, Huddle D. Hemorrhagic cerebrovascular disease. Dalam: Layon AJ, Gabrielli A, Friedman WA, eds. Textbook of Neurointensive Care. Philadelphia: Saunders; 2004,155–78.
Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC, Tuhrim S. The ICH score: a simple, reliable grading scale for intracerebral. Stroke.2001; 32:891–7.
Dubourg J, Messerer M. State of the art in managing nontraumatic intracerebral hemorrhage. Neurosurg Focus. 2011; 30(6):1–7.
DOI: https://doi.org/10.24244/jni.vol4i1.102
Refbacks
- There are currently no refbacks.
JNI is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License