Hipotensi Berat Intraoperatif Tiba-Tiba saat Kraniotomi Pengangkatan Meningioma

Abstract

Tekanan darah adalah perkalian cardiac output (CO) dengan systemic vascular resistance (SVR) dan CO ditentukan oleh stroke volume dan frekuensi denyut jantung. Seorang wanita usia 61 tahun, berat badan 49 kg, tinggi badan 154 cm, datang di rumah sakit Santosa Bandung Central dengan keluhan benjolan pada bagian belakang kepala sejak 3 tahun lalu dan semakin lama semakin bertambah besar. Tidak terdapat tanda-tanda peningkatan tekanan intrakranial dan defisit neurologis lainnya, di diagnosa meningioma dengan hipertensi, dilakukan pengangkatan tumor dalam posisi telungkup. Induksi dengan propofol, fentanyl, vecuronium bromida, lidokain, rumatan anestesi dengan sevofluran-oksigen/udara dan propofol serta vecuronium kontinyu. Intraoperatif terjadi 2 kali penurunan tekanan darah yang terjadi tiba-tiba, bradikardia dan desaturasi. Diberikan cairan dengan ringerfundin, gelofusin 1 L, darah Pack Red Cell (PRC) 2 unit, sulfas atropin, efedrin dan dilanjutkan dengan norepinephrine. Pascabedah dirawat 1 hari di Intensive Care Unit (ICU) dan kemudian 1 hari lagi di High Care Unit (HCU), kemudian pindah ke ruang perawatan biasa dan dirawat selama 3 hari sebelum dipulangkan dari rumahsakit. Penurunan tekanan darah hebat disertai bradikardia berat dan desaturasi tidak mungkin disebabkan karena  perdarahan, tapi lebih mungkin dihubungkan dengan gangguan pada jantung. Terapi yang dilakukan dengan mengembalikan parameter tersebut ke nilai fisiologis sesegera mungkin. Sebagai simpulan, penurunan tekanan darah tiba-tiba disertai bradikardia dan desaturasi kemungkinan disebabkan karena terjadinya Bezold-Jarisch Reflexes (BJR). 

Sudden Intraoperative Severe Hypotension during Craniotomy of Meningioma Removal

Abstract

Blood pressure is the multiplication of cardiac output (CO) with systemic vascular resistance (SVR) and CO determined by stroke volume and heart rate frequency. A 61-year-old woman, weight 49 kg, height 154 cm, came to Santosa Hospital Bandung Central in with complaints of a lump on the back of the head that has gotten bigger since 3 years ago and the longer it gets bigger. There were no signs of increased intracranial pressure and other neurological deficits, diagnosed with meningioma with hypertension, tumor removal was carried out in a prone position. Induction with propofol, fentanyl, vecuronium bromide, lidocaine, anesthetic treatment with sevoflurane-oxygen/air and propofol and continuous vecuronium. Intraoperative suddenly occurs 2 times decrease in blood pressure, bradycardia and desaturation. Given liquid with ringerfundin, gelofusin 1 L, blood pack red cells (PRC) 2 units, sulfas atropine, ephedrine and continued with norepinephrine. Post-dissected treated 1 day in the Intensive Care Unit (ICU) and then another 1 day in the High Care Unit (HCU), then moved to the ward and was treated for 3 days before being discharged from the hospital. Severe drops in blood pressure accompanied by severe bradycardia and desaturation are unlikely to be caused by bleeding, but are more likely to be associated with heart disorders. Therapy is carried out by returning these parameters to physiological values as soon as possible. As conclusion, a sudden drop in blood pressure accompanied by bradycardia and desaturation may be due to the occurrence of Bezold-Jarisch Reflexes (BJR).