Dexmedetomidine sebagai Terapi Ajuvan untuk Operasi Tumor Fossa Posterior pada Bayi

Abstract

Dexmedetomidine, agonis reseptor α2 adrenergik-memberikan efek "sedasi kooperatif," ansiolitik, dan analgesia tanpa depresi pernafasan, efek simpatolitik dan antinosisepsi memungkinkan untuk stabilitas hemodinamik perioperatif. Kasus ini akan membahas neurofarmakologi dan neurofisiologi dari α2-adrenergik agonis dan penerapan dexmedetomidine sebagai ajuvan. Bayi 1 tahun,10 kg, didiagnosa hidrosefalus obstruktif oleh adanya tumor di regio fossa posterior (yang telah menjalani 3 kali revisi VP-shunt), GCS10: E4V2M4, tekanan darah 90/40mmHg, laju nadi 150 x/menit, laju nafas 30 x/menit, suhu 36,8°C, akan menjalani kraniektomi untuk pengangkatan tumor di regio fossa posterior pada posisi prone. Monitor non-invasif (tekanan darah, denyut jantung, SpO2, EKG, Kapnograph dan kateter urin). Premedikasi dengan midazolam 0,5 mg intravena. Induksi anestesi dengan ajuvan dexmedetomidine. Pemeliharaan anestesi dengan oksigen/udara, sevoflurane 0,6-1,0%, infus kontinyu dexmedetomidine dan pemberian selimut penghangat 370C. Pemantauan ketat dilakukan di ICU anak (PICU) dengan ventilasi mekanik dan diekstubasi pada esok pagi. Setelah hari ke-10 rawatan di PICU, pasien dipindahkan ke ruangan tanpa komplikasi neurologis perioperatif (GCS 12: E4V3M5). Manajemen, evaluasi serta pencegahan yang tepat terhadap kemungkinan komplikasi yang terjadi dapat meningkatkan luaran pasien. 

Dexmedetomidine as Ajuvant Therapy for Infant Undergoing Posterior Fossa Surgery

Dexmedetomidine, an α2-adrenergic receptor agonist offers a unique “cooperative sedation,” anxiolysis, analgesia without respiratory depression, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments both for neurosurgical stimulation and emergence phase of anesthesia. One year infant, 10 kgs, admitted with loss of consciousness and head enlargement since 2 months of age, diagnosed obstructive hydrocephalus due to posterior fossa tumor and had underwent three VP-shunt revision surgeries. Preoperative with GCS8 E4V1M3, blood pressure 90/40mmHg, heart rate 150 beats/minute, respiratory rate 30/minute, temperature 36.8°C, underwent craniectomy tumor removal for posterior fossa tumor in prone position. Premedication with midazolam 0.5 mg intravenous. Induction of anesthesia with ajuvant dexmedetomidine. Maintenance of anesthesia used oxygen/air with sevoflurane 0,6-1,0%, continuous infusion of dexmedetomidine, insertion of subclavian central vein cannulation and temperature preservation with warm blanket set to 370C. Post operation, patient was mechanically ventilated and monitored in Pediatric Intensive Care Unit (PICU) and extubated on the next morning. During in PICU, hemodynamic was stable and no worsening complication of neurologic deficit (GCS11 E4V3M5). After 10 days, patient moved to ward. The proper management, evaluation and prevention the possibility of these complications may improve patient outcome