Penatalaksanaan Anestesi Neonatus yang Menjalani Pembedahan Koreksi Giant Unruptured Occipital Meningoencephalocele

Abstract

Meningoencephalocele adalah kelainan kongenital, duramater dan kranium tidak menutup sempurna sehingga sebagian jaringan intrakranial berada di luar kranium terbungkus kantong cele. Manajemen jalan nafas neonatus, memberikan tantangan karena anatomi jalan nafas yang khusus, fungsi organ pernafasan yang terbatas serta perbandingan ukuran kepala dan badan yang ekstrim. Meningoencephalocele oksipital akan menambah tingkat kesulitan tindakan intubasi serta kontrol jalan nafas saat tindakan anestesi dan pembedahan. Pasien laki–laki, usia sembilan hari, dengan benjolan di oksipital berukuran 17x12x8 cm menjalani reseksi meningoencephalocele. Induksi anestesi dilakukan dengan inhalasi sevofluran, rokuronium untuk fasilitas laringoskopi intubasi dengan videolaringoskop pada posisi terlentang dengan bantalan donat sesuai dengan bentuk dan ukuran cele.  Videolaringoskop dipilih karena visualisasi lebih optimal tanpa memerlukan ekstensi dan manipulasi berlebih dibanding laringoskop konvensional sehingga intubasi bisa dilakukan dalam posisi terlentang. Tindakan anestesi dan pembedahan berlangsung selama 2 jam 15 menit. Pascaoperasi pasien dirawat di ruang rawat intensif neonatus, ekstubasi 24 jam pascaoperasi dan diperbolehkan pulang pada hari kesepuluh. Tantangan terbesar pada anestesi reseksi meningoencephalocele oksipital adalah mengamankan jalan nafas sambil memastikan keutuhan kantong cele saat dilakukan manipulasi jalan nafas dan perubahan posisi selama pembedahan.

Airway Management for Neonates Underwent Giant Unruptured Occipital Meningoencephalocele Resection

Abstract

Meningoencephalocele is a rare congenital abnormality where duramater and cranium failed to close completely, leaving part of intracranial tissues outside the cranium wrapped in a sac. Neonate’s airway management, pose many challenges due to immaturity of airway anatomy, limited respiratory organ reserve and extreme head-to-body ratios. Occipital meningoencephalocele will also complicate the intubation and airway control during anesthesia and surgery. A nine days old male patient with an occipital lump measuring 17x12x8 cm underwent meningoencephalocele resection. Induction of anesthesia was performed by sevoflurane inhalation, rocuronium to facilitate videolaryngoscopy and intubation in supine position, supported by doughnut-shape pads which fits the size of the cele. Videolaryngoscope was chosen because it provides optimal visualization without hyperextension and over manipulation than conventional laryngoscope, therefore intubation can be done in supine position. Anesthesia and surgery duration was 2 hours and 15 minutes. The patient was treated in the neonatal intensive care unit after surgery, extubated 24 hours later, and discharged home 10 days after surgery. The greatest challenge in anesthesia management for occipital meningoencephalocele resection is securing the airway while ensuring the sac is not ruptured during airway manipulation and positional changes during anesthesia and surgery.