Keberhasilan Resuitasi Jantung Paru Otak (RJPO) dengan Posisi Telungkup pada Pada Pasien Pediatrik saat Pengangkatan Tumor Infratentorial

Abstract

Tumor infratentorial merupakan tumor yang paling sering ditemukan pada anak-anak dengan gejala klinis antara lain ataksia, kelainan saraf kranial, muntah, sakit kepala, penurunan kesadaran, dan hidrosefalus. Umumnya tumor infratentorial memerlukan tindakan bedah. Kasus seorang anak laki-laki 3 tahun dengan tumor infratentorial yang mendesak ventrikel IV, dilakukan tindakan craniotomy tumor removal dengan posisi telungkup. Saat tumor diangkat terjadi perdarahan dan menyebabkan perubahan hemodinamik sampai henti jantung yang berlangsung sangat cepat, kemudian operasi dan seluruh obat anestesi dihentikan, dilakukan Resusitasi Jantung Paru Otak (RJPO) dalam posisi telungkup dengan pemberian obat resusitasi (adrenalin dan sulfas atropin), dan melakukan pengisian intravaskuler volume (pemberian cairan dan darah), setelah dilakukan RJPO selama 10 menit hemodinamik kembali stabil. Tindakan operasi dilanjutkan untuk menutup luka operasi. Post operasi pasien di rawat di ICU dengan ventilasi mekanik (propofol dan vecuronium kontinu), pada hari ke 3 dilakukan operasi kembali untuk menyempurnakan operasi yang telah dilakukan. Post operasi pasien dirawat kembali di ICU, selama perawatan hemodinamik stabil, hari ke 4 pasien sadar dengan sequele motorik pada sisi tubuh sebelah kiri. Pada operasi pengangkatan tumor infratentorial, salah satu risiko yang dapat terjadi yaitu perdarahan masif selama operasi yang dapat mempengaruhi hemodinamik. Diperlukan persiapan dan pengawasan ketat selama operasi. Pada kasus ini, RJPO tetap dapat dilakukan pada posisi yang terbatas (posisi telungkup).

Successfully of Cardio Pulmonary Cerbral Resuscitation (CPCR) in Prone Position on Pediatric Patient during Infratentorial Tumor Surgery

Infratentorial tumor is more frequent in children, with sign and symptom of ataxia, cranial nerve disorder, vomiting, headache, decrease of consciousness level and hydrocephalus. Infratentorial tumor usually requires surgical removal. Case report of a 3 year old boy with infratentorial tumor, which depressed the 4th ventricle, undergone craniotomy tumor removal with prone position. When tumor was removed, massive bleeding occurred and caused sudden change in hemodynamic and cardiac arrest. The operation and anesthetic agents were discontinued, followed by Cardio Pulmonary Cerebral Resuscitation (CPCR) in prone position with resuscitation drugs (i.e adrenalin and sulfas atropin), as well as blood and fluids to replace the intravascular volume. After approximately 10 minutes of CPCR, hemodynamic was stable. Operation was continued to close operation wound. Post operation, patient was admitted to ICU and being treated with mechanical ventilation under sedation with continues propofol and vecuronium. On the 3rd day, re-operation was conducted to establish the previous operation as planned. The patient was admitted to the ICU post operatively. During management in ICU, hemodynamic was stable and the patient woke up on the 4th day with motoric squele on his left body side. In conducting an infratentorial tumor removal, an anesthesiologist should be aware for the risk of massive bleeding durante operation which could manipulate hemodynamic. There for special preparation and tight monitoring are required during the operation. In this case, CPCR can be done in limited position (prone position).