Manajemen Anestesi untuk Evakuasi Hematoma akibat Perdarahan Intraserebral pada Kehamilan 22–24 Minggu: Non Seksio Sesarea

Abstract

Sekitar 50% dari semua kematian karena trauma berhubungan dengan cedera kepala. Tinjauan terbaru, angka kematian yang disebabkan trauma pada ibu hamil karena cedera langsung pada kepala sekitar 10%. Pertimbangan anestesi untuk pembedahan selama kehamilan mencakup keselamatan terhadap ibu dan janin. Perubahan anatomi dan fisiologi ibu yang disebabkan kehamilan memiliki dampak klinis dan risiko tinggi bagi ibu dan janin yang menjalani tindakan anestesi. Wanita berusia 22 tahun yang tengah hamil 22 minggu (G1P0A0) tertabrak mobil saat mengendarai sepeda motor tanpa menggunakan helm 4 jam sebelum masuk rumah sakit. Pasien menderita cedera kepala disertai penurunan kesadaran. Dari pemeriksaan fisik didapatkan GCS 9 (E2M5V2), tekanan darah 120/80 mmHg, denyut jantung 92 x/menit, respirasi 22–24 x/menit dan saturasi oksigen 99% dengan sungkup muka non-rebreathing (SMNR) 8 liter per menit. Kraniotomi evakuasi dilakukan dalam anestesi umum, induksi anestesi dengan menggunakan isofluran 2 vol%, lidokain 75 mg, fentanil 100 mcg, propofol 80 mg, vecuronium 5 mg dan O2: udara 50:50. Denyut jantung janin diperiksa setiap jam dengan hasil sekitar 120–130 x/menit. Pada trauma selama kehamilan, janin dapat mengalami cedera langsung atau tidak langsung yang disebabkan karena pengaruh obat-obatan (inotropik, manitol, furosemid), hipotensi, hipoksemia atau tindakan yang dilakukan terhadap ibu (hiperventilasi untuk mengontrol tekanan intrakranial). Seksio sesarea tidak dilakukan kecuali untuk alasan obstetrik.

Anesthesia Management for Hematoma Evacuation caused by Intracranial Hemorrhagic on Pregnant Woman with 22–24 Gestational Weeks: Non Cesarean Section

Approximately 50% of all trauma deaths are associated with head injury. In a recent review of pregnant trauma deaths, approximately 10% of maternal trauma deaths were directly due to head injury. Anesthetic considerations for surgery during pregnancy include concern for the safety of both the mother and fetus. Alterations in maternal anatomy and physiology induced by pregnancy have clinical anesthetic implications and present potential hazards for the mother and fetus undergoing anesthesia. A 22 years old female with 22 weeks of gestation (G1P0A0) hit by a car while riding a motorcycle without using helmet 4 hours before admission. She got a traumatic head injury with drecreased level of consciousness. The physical examinations were GCS 9 (E2M5V2), blood pressure 120/80 mmHg, heart rate 92 bpm, respiration rate 22–24 times per minute and SpO2 99% with simple mask non rebreathing 8 liter per minute. Emergency craniotomy surgery was held under general anesthesia by using isoflurane 2 vol%, lidocaine 75 mg, fentanyl 100 mcg, propofol 80 mg, vecuronium 5 mg with O2 : air 50:50. The fetal heart sound was checked every hour which was approximately 120–130 bpm. In trauma during pregnancy, the fetus may have affected by the direct injury itself or affected by any other insult caused by hypotension, hypoxemia or maternal therapeutic drugs or maneuvers (e.g. inotropes, mannitol, furosemide, hyperventilation for control of intracranial pressure). Caesarean delivery is not performed except only for obstetric reasons.