Anestesi Spinal Dosis Rendah Untuk Pasien Operasi Sesar dengan Stenosis Mitral Berat

*Ruddi Hartono -  Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Brawijaya/ RSU dr. Saiful Anwar Malang, Indonesia
Isngadi Isngadi -  Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Brawijaya/ RSU dr. Saiful Anwar Malang, Indonesia
Dewi Puspitorini Husodo -  Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Brawijaya/ RSU dr. Saiful Anwar Malang, Indonesia
Published: 1 Nov 2018.
Open Access
Citation Format:
Article Info
Section: Laporan Kasus
Language: ID
Full Text:
Supp. File(s):
Anestesi Spinal Dosis Rendah untuk Pasien Operasi Sesar dengan Stenosis Mitral Berat
Subject copyright transfer agreement
Type laporan kasus
  View (108KB)    Indexing metadata
In Vol 10, No 3 (2018): Jurnal Anestesiologi Indonesia
Statistics: 268 277
Abstract

Latar belakang: Stenosis mitral banyak ditemukan pada kehamilan, dimana sekitar 25% pasien akan mengalami gejala pada kehamilan pertama. Hal ini disebabkan karena adanya peningkatan volume darah dan nadi. Beberapa literatur menyebutkan bahwa anestesi spinal dikontraindikasikan pada pasien yang akan menjalani operasi dengan kelainan stenosis mitral karena risiko terjadinya hipotensi dan takikardia.

Kasus: Perempuan 24 tahun primigravida, usia kehamilan 32-34 minggu dengan stenosis mitral berat, regurgitasi mitral ringan, regurgitasi trikuspid sedang, regurgitasi pulmonal sedang (EF 62%), hipertensi pulmonal sedang (PASP 65 mmHg), gagal jantung stadium C kelas fungsional III menjalani operasi sesar dengan low dose anestesi spinal menggunakan 5 mg bupivacaine heavy 0,5% dan 50 mcg fentanyl volume total 2 ml. Blok spinal dicapai dalam waktu 5 menit. Hemodinamik stabil selama perioperatif. Tidak terjadi gagal jantung akut maupun perburukan hemodinamik pascaoperasi.

Pembahasan: Prinsip pembiusan pasien dengan mitral stenosis adalah menghindari takikardia, menjaga kondisi sinus rhytm  dan secara agresif mengatasi atrial fibrilasi baik farmakologis maupun dengan kardioversi terutama pada pasien dengan hemodinamik tidak stabil, menghindari penurunan SVR yang akan meningkatkan denyut jantung sehingga memperberat kerja jantung, menghindari hipovolemi, kelebihan cairan, dan faktor yang meningkatkan tekanan arteri pulmonal seperti hipoksia dan hiperkarbia maupun nyeri.

Kesimpulan: anestesi spinal dosis rendah menggunakan 5 mg bupivakain dan ajuvan fentanyl dapat digunakan pada operasi operasi sesar pada pasien dengan stenosis mitral berat karena awitan yang cepat, level blok yang adekuat, durasi blok hemodinamik yang stabil dan bayi yang lahir dengan kondisi yang baik.

Note: This article has supplementary file(s).

Keywords
anestesi spinal; blok neuraksial; dosis rendah; operasi sesar; stenosis mitral

Article Metrics:

  1. Boom, CE. Panduan Klinis Perioperatif Kardiovaskular Anestesia. Universitas Padjadjaran Bandung: Aksara Bermakna 2013
  2. Carapentis JR. Rheumatic heart disease In Asia. Circulation. 2008;118(25):2748-53
  3. Thamilarasan M, Civello K, Griffin BP. Mitral Valve Disease. Manual of cardiovascular medicine second edition. Philadelpia: Lippincot Williams and Wilkins ; 2004. p.314
  4. Gartner M, Youngblood C. Case report in anestesiology: essential pulmonary hypertension in a primigravida. Anestesiol Open J. 2016; 1(1): 24-27. doi: 10.17140/AOJ-1-106
  5. Grindheim G, Estensen ME, Langesaeter E, Rosseland LA, Toska K. Changes in blood pressure during healthy pregnancy: A longitudinal cohort study. J Hypertens.2012;30(2):342-50. doi: 10.1097/HJH.0b013e32834f0b1c
  6. Isngadi, Rafidya IS. 2017. Manajemen Anestesi Pada Kehamilan Dengan Penyakit Jantung .Departemen Anestesiologi dan Terapi Intensif FKUB RSUD Dr.Saiful Anwar, Malang. 2017 : 78
  7. Butterwort, John F, Mackey, David C, Wasnic, John D. Morgan and Mikhail’s Clinical Anestesiogy. USA: The McGraw Hill Companies; 2013: p 827-828
  8. Chestnut DH, et all. Chestnut’s Obstetric Anestesia 5th edition. Elsevier: Philadelphia; 2014: p 985
  9. Pardo CM, Miller RD. Basic of Anestesia 7th edition, Elsevier, Philadelphia, 2018: p.554-556
  10. Hensley FA, Martin DE, Gravlee GP. A Practical Approach to Cardiac Anestesia 5th Edition. Philadelphia: Lippincott William and Wilkins; 2013.p.337-341
  11. Hines RL, Marschall KE. Stoelting’s Anestesia and Coexisting Disease. Elsevier : Philadelphia; 2018: p 110-113
  12. Kannan M,Vijayanand G. Mitral Stenosis and Pregnancy: Current Concepts in Anesthetic Practice. Indian Journal of Anethesia. 2010: p 439-444
  13. Willson, Paul et all. Matrenal parameter in lower segment Cesarian section: comparative study of the effect of low dose spinal Anestesia. Kerala, India: International Journal of Reproduction, Contraception, Obestetric Gynecology; 2016
  14. Braunwald E, Bonow RO. Braunwald’s heart disease: a textbook cardiovascular medicine. 9th edition. Philadelphia: Saunders; 2012.
  15. Sarah T, Athena P. Mitral valve disease in pregnancy : outcomes and management. Obstetric Medicine 2009; 2: 6 –10. DOI: 10.1258/om.2008.080002
  16. Abhijit P, Sucharita D. Valvular heart disease and anaesthesia. Indian Journal of Anaesthesia. 2017;61 (9): 721-727
  17. Ruys TP, Roos-Hesselink JW, Hall R. Heart failure in pregnant women with cardiac disease: data from the ROPAC. Heart 2014; 100: 231
  18. Goldszmidt E, Macarthur A, Silversides C, et al. Anesthetic management of a consecutive cohort of women with heart disease for labor and delivery. Int J Obstet Anesth. 2010; 19:266.
  19. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63:e57.
  20. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018; 39:3165.
  21. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011-2013. Obstet Gynecol. 2017; 130:366.
  22. Hamlyn EL, Douglass CA, Plaat F, et al. Low-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease. Int J Obstet Anesth. 2005; 14:355.
  23. Bonnin M, Mercier FJ, Sitbon O, et al. Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases. Anestesiology. 2005; 102:1133.
  24. Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001; 37:893.
  25. Leśniak-Sobelga A, Tracz W, KostKiewicz M, et al. Clinical and echocardiographic assessment of pregnant women with valvular heart diseases--maternal and fetal outcome. Int J Cardiol. 2004; 94:15.

The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to JAI (Jurnal Anestesiologi Indonesia) and Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University as publisher of the journal. Copyright encompasses exclusive rights to reproduce and deliver the article in all form and media, including reprints, photographs, microfilms, and any other similar reproductions, as well as translations. 

JAI (Jurnal Anestesiologi Indonesia) and Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University and the Editors make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in JAI (Jurnal Anestesiologi Indonesia) are the sole and exclusive responsibility of their respective authors and advertisers.

The Copyright Transfer Form can be downloaded here:[Copyright Transfer Form JAI]. The copyright form should be signed originally and send to the Editorial Office in the form of original mail, scanned document:  

 

Uripno Budiono (Editor-in-Chief)

Editorial Office of JAI (Jurnal Anestesiologi Indonesia

Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University/ Dr. Kariadi General Hospital Medical Center (RSUP Dr. Kariadi)

Jl. Dr. Soetomo No. 16 Semarang, Central Java, Indonesia, 50231

Telp. : (024) 8444346

Email : janestesiolgo@gmail.com