Manajemen Perioperatif Gejala Ekstrapiramidal (EPS) pada Hidrocephalus Tekanan Normal (NPH)

Abstract

Gejala ekstrapiramidal (EPS) merupakan gangguan gerak akibat efek samping obat penghambat reseptor dopamin. Gejala-gejala EPS antara lain dystonia, akathisia, dan parkinson. Gejala EPS pada kasus ini ditemukan pada hidrocephalus tekanan normal (NPH) yang tidak mengkonsumsi obat penghambat reseptor dopamin. Hidrocephalus tekanan normal adalah hidrocephalus yang tidak bersamaan dengan peninggian tekanan intrakranial (TIK). Melaporkan kasus laki-laki 57 tahun dengan penurunan kesadaran dan gejala ekstrapiramidal serta Normo pressure hydrocephalus (NPH), dilakukan operasi VP Shunt. Operasi dilakukan dengan anestesi umum, menggunakan ETT no 7,5 non kinking, ventilasi kendali. Premedikasi diberikan midazolam 2 mg iv, Co induksi dengan oxycodon 10 mg iv. Induksi dengan propofol 150 mg iv, fasilitas intubasi dengan rokuronium 30 mg iv, pemeliharaan dengan O2 : Air (50 : 50), sevofluran, propofol kontinyu 100 mg/jam, rokuronium 20 mg/jam.Hemodinamik stabil, TDS 130–150 mmHg, TDD 80–90 mmHg, HR 50–70 x/menit, saturasi O2 99–100%, etCO2 35–37. Pasca operasi pasien dirawat di ruang intensif (ICU) untuk pemantauan tekanan darah dan gejala ekstrapiramidal. Tujuan utama penanganan seharusnya tidak semata-mata untuk penanganan gejala akut EPS namun juga penanganan penyakit dasar penyebab EPS terkait morbiditas serta menjaga kualitas hidup. Manajemen multidisiplin (bedah saraf, saraf, anestesi intensif dan rehabilitasi medis) dibutuhkan untuk hasil jangka panjang yang lebih baik.

Perioperative Management Extrapyramidal Symptoms (EPS) in Normo Pressure Hydrocephalus (NPH)

Abstract

Extrapyramidal symptoms (EPS) are movement disorders due to side effects of dopamine receptor blocking agents. Symptoms of EPS include dystonia, akathisia, and parkinsonism. Symptoms of EPS in this case are found in normal pressure hydrocephalus (NPH) which does not consume dopamine receptor blocking drugs. Normal pressure hydrocephalus is hydrocephalus which does not coincide with intracranial pressure (ICT) elevation. Reported a case of a 57-year-old male with decreased consciousness and extrapyramidal symptoms and Normo pressure hydrocephalus (NPH), a V-P Shunt operation was performed. The operation was carried out under general anesthesia, using a non-kinking ETT no. 7.5, controlled ventilation. Premedication given midazolam 2 mg iv, Co induction with oxycodon 10 mg iv. Induction with propofol 150 mg iv, intubation facilities with rocketuronium 30 mg iv, maintenance with O2: Air (50: 50), sevoflurane, propofol continuous 100 mg/hour, rokuronium 20 mg/hour. Stable hemodynamics, SBP 130–150 mmHg, DBP 80–90 mmHg, HR 50–70 x/min, O2 saturation 99–100%, etCO2 35–37. After surgery the patient was treated in the intensive care unit (ICU) for monitoring blood pressure and extrapyramidal symptoms. The main goal of treatment should not be solely for the treatment of acute symptoms of EPS but also for the management of basic disease causing EPS related to morbidity and maintaining quality of life. Multidisciplinary management (neurosurgery, neurosurgery, intensive anesthesia and medical rehabilitation) are needed for better long-term results.