Anestesi Scalp Block dan Occipital Block pada Tindakan External Ventricular Drainage (EVD) pada Kehamilan 32 Minggu

Abstract

Hidrosefalus adalah pembesaran ventrikel otak sebagai akibat peningkatan jumlah cairan serebrospinal (CSS) yang disebabkan oleh ketidakseimbangan antara produksi, sirkulasi dan absorbsinya. Perkiraan wanita hamil yang dilakukan operasi non obstetric sekitar 1–2%. Pasien obstetri dengan penyakit bedah saraf selalu dirawat di ICU. Insidensi operasi selama kehamilan dilaporkan 42% prosedur pembedahan terjadi pada trimester pertama, 35% pada trimester kedua, dan 23% pada trimester ketiga. Seorang wanita 35 tahun dengan usia kehamilan 32–33 minggu datang ke IGD dengan penurunan kesadaran tanpa riwayat trauma, tidak dijumpai tekanan darah tinggi. Dari pemeriksaan CT-Scan ditemukan adanya hidrosefalus, sehingga dilakukan tindakan external ventricular drainage (EVD). Anestesi untuk pasien dalam keadaan hamil harus mempertimbangkan bayi dalam kandungan sehingga dilakukan pembiusan scalp block dan occipital block. Obat yang digunakan ropivakain HCl 0,375 % (sebanyak 10cc). Setelah operasi pasien dirawat di ruang pemulihan, 2 jam kemudian dirawat di ruang high care unit (HCU). Pencegahan terhadap hipoksia dan hipotensi adalah keharusan, walaupun periode hipoksemia yang pendek masih bisa ditoleransi. Hipoksemia maternal yang berkepanjangan akan menyebabkan vasokonstriksi sirkulasi uteroplasental yang pada akhirnya menurunkan perfusi sehingga menyebabkan hipoksemia, asidosis dan kematian janin.

Scalp Block and Occipital Block Anesthesia for External Ventricular Drainage (EVD) in 32-Week Pregnancy

Abstract

Hydrocephalus is enlargement of the brain ventricles as a result of an increase in the amount of cerebrospinal fluid (CSS) caused by an imbalance between production, circulation and absorption. Estimates of pregnant women in non-obstetric surgery are around 1–2%. Obstetric patients with neurosurgery disorders are always treated in the ICU. The incidence of surgery during pregnancy was reported in 42% of surgical procedures occurred in the first trimester, 35% in the second trimester, and 23% in the third trimester. A 35-year-old woman with 32-33 weeks' gestation came to the emergency room with decreased consciousness yet no history of trauma and high blood pressure. Hydrocephalus were found in CT scan, and the external ventricular drainage (EVD) is taken. The patient has intrauterine pregnancy so the anesthesia choice is scalp block and occipital block. Ropivacaine HCl 0.375% (as much 10cc) was used. After surgery the patient was treated in the recovery room for 2 hours, and discharged to the high care unit (HCU) afterwards. Hypoxia and hypotension is a challenge in short periods of hypoxemia that can still be tolerated. Prolonged maternal hypoxemia prevention will cause uteroplacental circulation vasoconstriction which ultimately reduces perfusion, causing foetal hypoxemia, acidosis and death.