Tatalaksana Anestesi pada Prosedur Minimal Invasive Neurosurgery: Kasus Perdarahan Intraserebral Traumatika

Abstract

Traumatic brain injury (TBI) menyumbang 70% kematian akibat trauma. Penyebab yang tersering adalah kecelakaan lalu lintas 49%. Tehnik minimal invasif cukup berkembang pada beberapa dekade ini, demikian juga pada bidang bedah saraf. Tujuan utama tatalaksana anestesia adalah immobilisasi intraoperatif, stabilitas kardiovaskuler, minimal komplikasi pascaoperasi, fasilitasi intraoperatif neurologi monitoring, kolaborasi tatalaksana peningkatan tekanan intrakranial (TIK) dan rapid emergence untuk pemeriksaan neurologis dini. Kasus laki-laki 50 tahun dengan perdarahan intraserebral (ICH) direncanakan operasi minimal invasive neuroendoscopy evakuasi hematom. Posisi selama operasi adalah true lateral yang juga menjadi perhatian tersendiri. Komplikasi akibat posisi harus dihindari karena rentan mempengaruhi luaran operasi. Operasi berjalan selama 3 jam dengan luaran optimal. Beberapa masalah penting menjadi perhatian khusus selama operasi dan pascaoperasi. Prinsip tatalaksana anestesi pada minimal invasif yang harus dicapai adalah pemeriksaan dan perencanaan preoperatif yang baik, kontrol hemodinamik serebral untuk menjamin tekanan perfusi otak (cerebral perfusion presure/CPP) optimal, immobilisasi penuh, dan dapat dilakukan rapid emergence untuk menilai status neurologis. Komunikasi antara operator dan ahli anestesi penting untuk keberhasilan kasus ini.

Anesthesia Management in Minimally Invasive Neurosurgery Procedure: Traumatic Intracerebral Hemorrhage Case

Traumatic brain injury (TBI) accounted for 70% of deaths from trauma. The most common causes of traffic accidents is 49%. Minimally invasive techniques sufficiently developed in the past few decades, as well as in the field of neurosurgery. The main objective is the treatment of immobilization intraoperative anesthesia, cardiovascular stability, minimal postoperative complications, facilitating intraoperative neurological monitoring, collaborative management of an increase in intracranial pressure (ICP) and the rapid emergence of early neurological examination. The case of a man 50 years with intracerebral hemorrhage (ICH) minimally invasive surgery neuroendoscopy planned evacuation of hematoma. Position during operation is true lateral is also a concern in itself. Complications due to the position should be avoided because it is vulnerable affect the outcome of the operation. Operations run for 3 hours with optimal outcomes. Some important issue is of particular concern during surgery and postoperatively. Procedural principle in minimally invasive anesthesia to be achieved is the examination and good preoperative planning, cerebral hemodynamic control to ensure optimal cerebral perfussion pressure (CPP), full immobilization, and can do rapid emergence to assess the neurological status. Communication between the operator and the anesthetist is important to the success of this case.