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Seksio Sesarea pada Wanita G2P1A0 Hamil Aterm dengan Confirmed COVID-19 Disertai Diabetes Mellitus Dalam Terapi Insulin dan HIV Positif

Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro/ RSUP Dr. Kariadi Semarang, Indonesia

Published: 30 Nov 2022.

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Abstract

Latar Belakang: Coronavirus disease 2019 (COVID-19) adalah penyakit sistem pernapasan akut yang disebabkan oleh virus corona jenis baru (SARS-CoV-2) yang pertama kali ditemukan pada bulan Desember 2019 di Wuhan, Provinsi Hubei, China. Beberapa penyakit salah satunya diabetes mellitus, menjadi penyakit predisposisi perjalanan penyakit yang berat dan meningkatkan risiko kematian akibat COVID-19.  Penderita COVID-19, terlebih yang memiliki predisposisi penyakit lain seperti diabetes mellitus dan HIV, menjadi hal yang perlu diperhatikan dalam pengelolaan perioperatif. Laporan kasus ini akan membahas teknik anestesi yang dipilih pada pasien ini, yang mana pasien dalam kondisi hamil, dengan COVID-19, diabetes mellitus, dan HIV positif.

Kasus: Kami melaporkan sebuah kasus, seorang wanita 31 tahun dengan diagnosis G2P1A0 hamil aterm dirujuk ke RSUP Dr. Kariadi dengan HIV positif diabetes mellitus on insulin, bekas seksio sesarea, penderita dalam pengawasan (PDP) COVID-19. Penderita memiliki riwayat diabetes mellitus dengan insulin sejak 6 tahun lalu dan dinyatakan positif HIV sejak tahun 2019. Penderita memiliki keluhan batuk kering sejak 1 bulan yang lalu. Pada pemeriksaan fisik didapatkan keadaan umum penderita tampak baik dengan kesadaran composmentis, tanda vital dalam batas normal. Swab antigen COVID-19 dinyatakan positif. Pada pemeriksaan laboratorium didapatkan keadaan anemia ringan dan hiponatremia. Penderita menjalani operasi seksio sesarea dengan anestesi spinal.

Pembahasan: Sebelum operasi, selama operasi dan pascaoperasi seksio sesarea, hemodinamik penderita dalam keadaan stabil, hasil lab gula darah didapatkan hasil normal.  Penderita kemudian dirawat di ruangan dengan perawatan isolasi COVID-19.

Kesimpulan: Anestesi regional merupakan pilihan untuk penderita dengan COVID-19 bila memungkinkan. Teknik anestesi regional yang tepat dapat menjaga fungsi pernapasan dan menghindari aerosolisasi untuk mencegah penularan virus COVID-19 dengan tetap memperhatikan level Alat Pelindung Diri dan penggunaan ruangan bertekanan negatif. Obat-obat anestesi umum dapat berbahaya bila berinteraksi dengan obat HIV, maka dari itu, anestesi regional lebih dipilih.

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Keywords: anestesi spinal; DM dengan insulin; HIV; kehamilan pada COVID-19; seksio sesarea

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