Manajemen Anestesi untuk Awake Craniotomy pada Space Occupying Lesion Lobus Frontalis Kiri

Abstract

Tumor intrakranial adalah suatu lesi ekspansif yang membentuk massa dalam ruang tengkorak. Kami melaporkan manajemen anestesi pada pasien dengan tumor intrakranial yang menjalani prosedur awake craniotomy. Seorang laki-laki berumur 39 tahun, berat badan 60 kg dengan riwayat epilepsi ditemukan space occupying lession pada lobus frontalis kiri setelah dilakukan CT-scan kepala. Prosedur awake craniotomy untuk pengangkatan tumor dilakukan karena lokasi tumor berada di dekat area Broca. Awake craniotomy dilakukan dengan kombinasi anestesi intravena (i.v) dexmedetomidin dan blok scalp. Premedikasi midazolam 2 mg i.v dan oksigenasi 3 liter/menit nasal diberikan dari awal proses operasi. Pasien diberikan dexmedetomidine loading dose 1 mcg/kgBB dalam 15 menit dan fentanyl 1 mcg/kgBB i.v sebelum dilakukan blok scalp dengan injeksi bupivacain isobarik 0,5% dicampur pehacain 1:1, total 40 ml untuk kedua sisi kepala. Infiltrasi larutan bupivacain-pehacain tambahan diberikan 2,5 ml pada setiap titik pin holder fiksasi kepala dipasang. Pemeliharaan anestesi dijaga dengan infus kontinyu dexmedetomidin 0,5-0,7 mcg/KgBB/jam i.v selama pasien terbangun dan propofol 0,05 – 0,1 mg/kgBB/menit i.v ditambahkan apabila pasien ditidurkan. Mannitol 1 g/kgBB i.v diberikan 15 menit sebelum duramater dibuka. Proses kraniotomi berjalan 4 jam. Selama operasi berlangsung pasien tidak mengalami perubahan hemodinamik yang signifikan, tekanan darah rata-rata 95–69 mmHg, laju nadi 56–63 x/mnt, SpO2 100% dengan VAS 0-1. Pasca operasi, pasien stabil dan pindah ke ruangan setelah diobservasi selama 1 jam di ruang pemulihan.

Anesthesia Management for Awake Craniotomy on Left Frontal Lobe Solid Occupiying Lesion

Intracranial tumors are an expansive lesion that forms masses in the skull space. We report anesthesia management in patients with intracranial tumors who undergo awake craniotomy procedures. A 39-year-old male weighing 60 kg with a history of epilepsy found space occupying lession in the left frontal lobe after a head CT scan. The awake craniotomy procedure for removal of the tumor is done because the location of the tumor is near the Broca area. Awake craniotomy is performed with a combination of dexmedetomidine intravenous (i.v) and scalp block. Premedication with 2 mg midazolam i.v and oxygenation of 3 liters / minute nasal was given from the beginning of the surgery. The patient was given dexmedetomidine loading dose of 1 mcg/kg in 15 minutes and fentanyl 1 mcg/kg i.v before scalp block was done with 0.5% isobaric bupivacain injection mixed with 1: 1 Pehacain, a total of 40 ml for both sides of the head. Additional infiltration of bupivacain-pehacain solution was given 2.5 ml at each point the head fixation pin holder was installed. Maintenance of anesthesia is maintained with a continuous infusion of dexmedetomidine 0.5-0.7 mcg/Kg/h i.v as long as the patient is awake and propofol 0.05 - 0.1 mg/kg/minute i.v is added when the patient is put to sleep. Mannitol 1 g/kg i.v is given, 15 minutes before the duramater is opened. The craniotomy process runs 4 hours. During surgery, the patient does not experience significant hemodynamic changes, Mean Blood Pressure is 95-69 mmHg, heart rate 56-63 x/min, SpO2 100% with VAS 0-1. After surgery, the patient was stable and moved to the ward after being observed for 1 hour in the recovery room.