Penatalaksanaan Anestesi pada Bedah Pintas Arteri Koroner Off-Pump

*Ni Made Supradnyawati  -  KSM Anestesi dan Terapi Intensif RSUP Fatmawati; Jakarta, Indonesia
Yudi Hadinata  -  SMF Anestesi dan Perawatan Intensif Pascabedah; Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita; Jakarta, Indonesia
Published: 1 Jul 2020.
DOI: https://doi.org/10.14710/jai.v12i2.30041 View
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Abstract

Penyakit jantung koroner merupakan penyebab kematian terbanyak di dunia. Menurut kriteria American Heart Association (AHA) tahun 2017, lebih dari 360.000 kematian di Amerika disebabkan oleh penyakit jantung koroner setiap tahunnya. Bedah pintas arteri koroner merupakan prosedur standar tatalaksana revaskularisasi pasien dengan penyakit tiga pembuluh darah arteri koroner atau pembuluh darah arteri koroner utama kiri. Sebanyak 400.000 prosedur bedah pintas arteri koroner dilakukan di Amerika setiap tahunnya. Bedah pintas arteri koroner ini mulai dikenal sejak tahun 1950. Pada tahun 1970 hampir semua prosedur bedah pintas arteri koroner menggunakan cairan kardioplegia untuk menghentikan jantung dan mesin pintas jantung paru. Pada pertengahan tahun 1990, diperkenalkan teknik bedah pintas arteri koroner off-pump. Teknik ini memungkinkan dokter bedah melakukan anastomosis arteri koroner pada jantung yang berdetak tanpa menggunakan mesin pintas jantung paru. Tujuannya adalah untuk menghindari respons inflamasi akibat penggunaan mesin pintas jantung paru serta mengurangi risiko yang timbul akibat manipulasi aorta. Pada tahun 2002, hampir 25% bedah pintas arteri koroner di Amerika dilakukan secara off-pump. Oleh karena itu, dokter anestesi memiliki peranan penting dalam menjaga stabilitas sirkulasi selama manipulasi berlangsung, membantu pemulihan dan mobilisasi dini, menurunkan morbiditas dan mortalitas, serta mampu mengurangi biaya prosedur.

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Keywords: anestesi; arteri koroner; bedah pintas arteri koroner; off-pump; penyakit jantung koroner

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