Penatalaksanaan Perioperatif pada Epidural Hemorrhage dengan Herniasi Serebral

Silmi Adriman, Sri Rahardjo, Siti Chasnak Saleh

Abstract


Cedera kepala merupakan masalah kesehatan utama, pemicu kecacatan dan kematian di seluruh dunia. Epidural Hemorrhage (EDH) adalah salah satu bentuk cedera kepala yang sering terjadi. Epidural Hemorrhage umumnya terjadi karena robeknya arteri dan menyebabkan perdarahan di ruangan antara duramater dan tulang tengkorak. Munculnya tanda Cushing pada EDH akan memperburuk prognosis. Penatalaksanaan cedera kepala saat ini difokuskan pada stabilisasi pasien dan menghindari gangguan intrakranial ataupun sistemik sehingga dapat menghindari cedera sekunder yang lebih buruk. Seorang laki-laki, 18 tahun, dibawa ke rumah sakit dengan penurunan kesadaran pasca jatuh dari ketinggian kurang lebih 5 meter dengan posisi badan sebelah kanan jatuh terlebih dahulu. Setelah resusitasi dan stabilisasi didapatkan jalan napas bebas, laju pernapasan 12 x/menit (ireguler), tekanan darah 155/100 mmHg, laju nadi 58 x/menit (reguler). Pada pasien dilakukan tindakan kraniotomi evakuasi hematoma dengan anestesi umum dan dengan memperhatikan prinsip neuroanestesi selama tindakan bedah berlangsung.

 

Perioperative Management of Epidural Hemorrhage with
Cerebral Herniation

Head trauma is a major health problem and considered as the leading cause of disability and death worldwide. Epidural Hemorrhage (EDH) is commonly seen in head trauma. Epidural Hemorrhage usually occurs due to ripped artery that coursing the skull causing blood collection between the skull and dura. Cushing sign revealed in EDH may worsen the outcome. Head trauma management is currently focusing on patient’s stability and prevention the intracranial and haemodynamic instability to prevent the secondary brain injury. A 18 years old male patient, admitted to the hospital with decreased level of consciousness after felt down from 5 meters height with his right side of body hit the ground first. On examination, no airway obstruction found, respiratory rate was 12 times/min (irregular), blood pressure 155/100 mmHg, heart rate 58 bpm (regular). Patient was managed with emergency hematoma evacuation under general anesthesia and with continues and comprehensive care using neuroanesthesia principles.


Keywords


Epidural hemorrhage; herniasi serebral; tanda Cushing; penatalaksanaan perioperatif; Epidural hemorrhage; cerebral herniation; Cushing’s triads; perioperative management

Full Text:

PDF

References


National Institute for Health and care Excellenge. Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Children, Young People and Adults. NICE Clinical Guideline. 2014.

Ul Haq, MI. Traumatic extradural hematoma. Professional Med J. 2014; 21(3): 540–43.

University of California Los Angeles Neurosurgery. Epidural Hematoma. Diakses dari: http://neurosurgery.ucla.edu/body.cfm?id=1123&ref=41& action=detail pada tanggal 16 september 2014.

Chowdury K, Islam KMT, Mahmood E, Hossain S. Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases. Turkish Neurosurgery. 2012; 22(1): 39–43.

Polinsky S, Muck K. Increased intracranial pressure and monitoring. Diakses dari: http://faculty.ksu.edu.sa/73717/Documents/Increased_Intracranial_Pressure_and_Monitoring_site.pdf pada tanggal 30 Desember 2014.

Bisri T. Penanganan Neuroanestesia dan Critical Care: Cedera Otak Traumatik. Bandung: FK Unpad. 2012; 83–124, 143-68, 187–208.

Saleh SC. Neuroanestesia Klinik. Surabaya: Zifatama Publisher. 2013; 47–162.

Hawthorne G, Gruen RL, Kaye AH. Traumatic brain injury and long-term quality of life: findings from an Australian study. J Neurotrauma. 2009; 26: 1623–33.

Miller JD, Piper IR, Jones PA. Pathophysiology of head injury. Dalam: Narayan RK, Wilberger JE, Povlishock JT, editors. Neurotrauma. New York: McGraw-Hill. 1996;61–69.

Baron EM, Jallo JI. Traumatic brain injury: pathology, pathophysiology, acute care and surgical management, critical care principles and outcome. Dalam: Zasler ND, Katz DI, Zafonte RD, editors. Brain Injury Medicine: Principles and Practice. New York: Demos Medical Publishing. 2007; 265–82.

Woods M. Aspect of perioperative neuroscience practice. Dalam: Smith B, Rawling P, Wicker P, Jones C, editors. Core Topics in Operating Departement Anaesthesia and Critical Care. Cambridge: Cambridge University Press. 2007;61–76.

Agrawal A, Timothy J, Cincu R, Agarwal T, Waghmare LB. Bradycardia in neurosurgery. Clinical Neurology and Neurosurgery. 2008; 321–27.

Smith M. Monitoring Intracranial pressure in traumatic brain injury. Anesth Analg. 2008; 106: 240–48.

Bendo AA. Perioperative management of adult patient with severe head injury. Dalam: Cottrell and Young’s Neuroanesthesia, 5th ed. Philadelphia: Mosby Elsevier; 2010, 317–26.

Bolognese PA, Milhorat TH. Intracranial pressure monitoring. Dalam: Cottrell and Young’s Neuroanesthesia, 5th ed. Philadelphia: Mosby Elsevier; 2010, 75–7.

Sakabe T, Matsumoto M. Effects of anesthetics agents and other drugs on cerebral blood flow, metabolism and intracranial pressure. Dalam: Cottrell and Young’s Neuroanesthesia, 5th ed. Philadelphia: Mosby Elsevier; 2010, 317–26.

Bajwa SJS, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: propofol-ketamine and propofol-fentanyl. Saudi J Anesth. 2010; 4(2): 72–79.

Bisri T. Dasar-Dasar Neuroanestesi, Edisi ke-2. Bandung: Saga Olah Citra. 2010; 1–74.

Ertmer C, Aken HV. Fluid therapy in patients with brain injury: what does physiology tell us? Critical Care. 2014; 18: 199.




DOI: https://doi.org/10.24244/jni.vol4i3.121

Refbacks

  • There are currently no refbacks.


                                    

 

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