Teknik Anestesi Bebas Opioid dalam Mendukung Konsep ERAS pada Kraniotomi Reseksi Tumor Metastasis Otak

Abstract

Teknik anestesi bebas opioid (opioid free) semakin sering digunakan akhir-akhir ini untuk menurunkan komplikasi pascaoperasi yang berkaitan dengan konsumsi opioid. Dilaporkan keberhasilan penanganan anestesi dengan teknik opioid free pada wanita usia 61 tahun yang dilakukan kraniotomi reseksi tumor metastasis. Pada pemeriksaan preoperatif didapatkan kesadaran pasien compos mentis, tekanan darah 150/80 mmHg, nadi 72 kali/menit, reguler, frekuensi nafas 24 kali/menit, suhu badan 36,6 ºC, saturasi oksigen 99%. Sebelum induksi pasien diberikan nebulisasi lidokain 4%, diberikan sedasi menggunakan propofol Target Controlled Infussion (TCI) Target Effect 0,5 – 1 mcg/ml dan deksmedetomidine kontinu  sebelum dilakukan pemasangan pemantauan akses intraarteri (arterial line). Induksi anestesia dilakukan dengan TCI propofol 3,5-4 mcg/ml, dilanjutkan dengan injeksi lidokain 4% melalui suntikan pada membran kriko-tiroid sebelum dilakukan intubasi. Pemeliharaan dilakukan dengan sevofluran 0,5-1 MAC, O2, compressed air (FiO2 50%), Target Controlled Infusion (TCI) propofol serta deksmedetomidine kontinu. Operasi berlangsung selama tiga setengah jam, pasien berhasil diekstubasi dan dipindahkan ke ruang intensif. Pasien dirawat selama 1 hari di intensive care unit (ICU) dengan kombinasi analgetik parasetamol 1 gram dan deksketoprofen 25 mg tiap 8 jam intravena. Teknik opioid free pada kraniotomi mendukung konsep Enhanced Recovery After Surgery (ERAS) pada operasi bedah saraf, namun tentunya harus dengan penggunaan agen multimodal dalam hal anestesi maupun analgesi yang bisa dimulai sejak preoperatif hingga pascaoperatif.

Opioid Free Anesthetic Technique in Supporting the ERASConcept
in Brain Metastatic Tumor Resection Craniotomy

Abstract

Opioid-free anesthetic techniques are increasingly popular lately to reduce postoperative complications associated with opioid consumption. Reported the success of opioid free techniques in a 61-year-old woman who underwent craniotomy resection of metastatic tumors. On preoperative examination, level of consciousness was compos mentis, blood pressure 150/80 mmHg, pulse 72 beats per minute, respiratory rate 24 times/minute, body temperature 36.6 ºC, oxygen saturation 99%. Prior to induction, patient was nebulized with 4% lidocaine, sedation was used for inserting the arterial line with target controlled infusion (TCI) propofol 0.5–1 mcg/ml and dexmedetomidine continuously. Anesthesia induction was performed by increasing the TCI to 3.5–4 mcg/ml, followed by injection of 4% lidocaine at the cricoid membrane before intubation. Maintenance was carried out with sevoflurane 0.5–1 MAC, O2, compressed air (FiO2 50%), TCI propofol and dexmedetomidine continuously. The surgery lasted three and a half hours, the patient was successfully extubated and transferred to the intensive care unit. The patient was treated for 1 day in the ICU with an analgesic combination of 1 gram paracetamol and 25 mg dexketoprofen every 8 hours intravenously. Opioid free technique in craniotomy supports Enhanced Recovery After Surgery (ERAS) concept in neurosurgery, but the usage should be with analgesia and anesthesia multimodal agents, preoperatively until postoperatively