Anestesi Regional pada Pasien dengan Penyakit Jantung/ Hemodinamik Tidak Stabil

*Widya Istanto Nurcahyo -  Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro Semarang, Indonesia
Published: 1 Mar 2019.
Open Access
Citation Format:
Article Info
Section: Tinjauan Pustaka
Language: ID
Full Text:
Supp. File(s):
CTA
Subject
Type Other
  View (1MB)    Indexing metadata
Statistics: 496 897
Abstract

Pembiusan pasien dengan penyakit jantung sebelumnya merupakan tantangan yang menarik. Penyebab paling umum morbiditas dan mortalitas perioperatif pada pasien jantung adalah penyakit jantung iskemik (PJI). Goldman dkk. melaporkan bahwa 500.000 hingga 900.000 infark miokard terjadi setiap tahun di seluruh dunia dengan mortalitas 10-25%. Keputusan untuk menggunakan anestesi regional tergantung pada banyak faktor. Karakteristik pasien, jenis operasi yang direncanakan, dan potensi risiko anestesi semuanya akan berdampak pada pilihan anestesi dan manajemen perioperatif.

Kerugian dari anestesi regional termasuk hipotensi dari blokade simpatis yang tidak   terkendali dan kebutuhan untuk loading volume dapat menyebabkan iskemia. Pemberian anetesi lokal dalam dosis besar juga harus mempertimbangkan risiko toksisitas depresi miokard. Pada pasien dengan penyakit kardiovaskular, teknik anestesi regional (baik tunggal atau dengan anestesi umum) bermanfaat perioperatif dalam mengurangi respon stres, simpatektomi jantung, ekstubasi lebih awal, lama rawat di rumah sakit lebih pendek, dan analgesia pascaoperasi yang baik. Selain jenis operasi yang dilakukan, dalam pelaksanaannya juga harus mempertimbangkan masalah yang ada pada masing-masing pasien. Anestesi umum juga memberikan peranan penting karena bersifat kardioprotektif dan dapat meningkatkan suplai oksigen. Keputusan untuk menggunakan anestesi regional harus dilakukan dengan hati-hati dan dilakukan dengan pemantauan yang tepat.

 

Note: This article has supplementary file(s).

Keywords
anestesi; hemodinamik; jantung; regional; umum

Article Metrics:

  1. Kaul TK, Tayal G. Anaesthetic Considerations in Cardiac Patients Undergoing Non Cardiac Surgery. 2007;51(6):280–6.
  2. Kraus M, Asgarian CD, Koyyalamudi V, Tran L, Alvord J, Kaye AD, et al. Regional Anesthesia and Cardiovascular Disease. Essentials Reg Anesth. 2018;529–40.
  3. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: Cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesth. Eur Heart J. 2014;35(35):2383–431.
  4. Goldman L, Caldera D, Nussbaum S, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845.
  5. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary [Internet]. Vol. 130, Circulation. 2014. 2215–2245 p. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000105
  6. DetskyAS, Abrams HB, Forbath N , et al. Cardiac assessment for patients undergoing noncardiac surgery.Amultifactorial clinical risk index. Arch InternMed 1986; 146:2131.
  7. Eagle K, Brundage B, Chaitman B, et al. Guidelines for perioperative cardiovascular evaluation for non-cardiac surgery. AHA/ACC task force report. J Am Coll Cardiol 1996; 27:910.
  8. Abbott TEF, Pearse RM, Archbold RA, et al. A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery: Results of the VISION Study. Anesth Analg 2018; 126:19.
  9. Helwani MA, Amin A, Lavigne P, et al. Etiology of Acute Coronary Syndrome after Noncardiac Surgery. Anesthesiology 2018; 128:1084.
  10. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart A.
  11. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary.Areport of theAmerican College of Cardiology /American HeartAssociation Task Force on Practice Guidelines .
  12. Dupuis JY, Labinaz M. Noncardiac surgery in patients with coronary artery stent : what should the anaesthesiologist know? Can JAnaesth 2005;52:356.
  13. Barash PG. Sequential monitoring of myocardial ischemia in the perioperative period. In:American Society of Anaesthesiologists Review Lectures. Atlanta: American Society of Anaesthesiology;2005.p.411.
  14. Nadia, Blakemore Hensley; Charles WH. Anesthesia for noncardiac surgery in patients with ischemic heart disease. uptodate. 2019;Jan.
  15. Bruder EA, Ball IM, Ridi S, et al. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev 2015; 1:CD010225.
  16. Agarwal B, Stowe DF, Dash RK, et al. Mitochondrial targets for volatile anesthetics against cardiac ischemia-reperfusion injury. Front Physiol 2014; 5:341.
  17. Uhlig C, Bluth T, Schwarz K, et al. Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2016; 124:1230.
  18. Breen P, ParkKW. General anesthesia versus regional anesthesia. IntAnesthesiol Clin 2002; 40:61.
  19. Madhusudhana R, Rajendra N. Anesthetic management of a patient with ischemic heart disease posted for open reduction internal fixation of the upper limb. Karnataka Anaesth J. 2015;1(2):69.
  20. Breivik H. Occurens of chronic pain after surgery. In: Refresher Course Lectures. Vienna: Euroanesthesia Austria; 2005. p. 231-2.
  21. Sigmund AE, Fang Y, Chin M, et al. Postoperative Tachycardia: Clinically Meaningful or Benign Consequence of Orthopedic Surgery? Mayo Clin Proc 2017; 92:98.
  22. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100:1043.
  23. Devereaux PJ, Goldman L, Cook DJ, et al. Perioperative cardiac events in patients undergoing noncardiac surgery: A review of the magnitude of the problem, the pathophysiology of the events, and methods to estimate and communicate risk. CMAJ 2005; 173:627.
  24. Edward R M. Management of acute perioperative pain. Elsiever. 2015;UpToDate(figure 2):1–52.
  25. Allen C. Adverse cardiovascular effects of NSAIDs. Inpharma Wkly. 2005;NA;(1508):19–20.