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.
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Anestesi Spinal Dosis Rendah untuk Pasien Operasi Sesar dengan Stenosis Mitral Berat
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In Vol 10, No 3 (2018): Jurnal Anestesiologi Indonesia
Statistics: 374 482
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

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