DOI: https://doi.org/10.14710/jai.v0i0.49417

ERAS pada Bedah Jantung Koreksi Katup Mitral: Laporan Kasus

SMF Anestesi dan Perawatan Intensif Pascabedah, Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Jakarta, Indonesia

Received: 6 Oct 2022; Published: 31 Jul 2023.

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Abstract

Latar Belakang: Enhanced recovery after cardiac surgery (ERAS-CS) merupakan manajemen perioperatif pada bedah jantung dengan pendekatan multidisiplin dan multifaktorial yang bertujuan mempercepat pemulihan dan mobilisasi, meminimalkan efek samping ventilator mekanik, mual muntah dan nyeri pascabedah, serta mengurangi lama rawat intensif dan biaya perawatan rumah sakit. Anestesi fast track merupakan bagian tidak terpisahkan dari ERAS-CS.

Kasus: Wanita, 16 tahun, dengan regurgitasi katup mitral berat dan katup trikuspid sedang, dilakukan bedah jantung mitral dengan annuloplasty. Informed consent, puasa enam jam, dan pemberian air putih manis dua jam sebelum pembedahan dilakukan sebagai persiapan anestesia. Induksi, intubasi, pemasangan akses vena sentral dan monitor hemodinamik invasif, serta blok interkostal parasternal dilakukan sebelum insisi kulit. Pembedahan berlangsung selama 180 menit dengan waktu cardiopulmonary bypass (CPB) 61 menit dan waktu klem silang aorta 35 menit. Hemodinamik stabil dengan analgetik fentanyl 2 mcg/kgBB saat induksi dan morfin 20 mcg/kgBB/jam selama pembedahan. Pemeriksaan transesophageal echocardiography (TEE) menunjukkan kontraktilitas baik tanpa disertai residual pascakoreksi. Ekstubasi dilakukan setelah penutupan luka operasi. Kesadaran penuh dan mobilisasi bebas dengan visual analogue scale (VAS) 0-1 didapatkan dalam dua jam pertama perawatan intensif.

Pembahasan: Tatalaksana ERAS-CS terdiri dari manajemen prabedah, pembedahan, dan pascabedah. Edukasi saat evaluasi praanestesi dilakukan untuk mengurangi kecemasan dan peningkatan ambang nyeri. Pembatasan puasa dan pemberian cairan jernih manis dua jam sebelum pembedahan dilakukan untuk mengurangsi risiko starvasi, resistensi insulin, dan hiperglikemik. Teknik blok saraf tepi interkostal dapat bermanfaat dalam mengurangi kebutuhan opioid. Ekstubasi ultra fast-track dilakukan secara terarah untuk mengurangsi risiko komplikasi dan mempercepat mobilisasi pascabedah. Pemulihan kesadaran secara cepat tanpa nyeri dan mual muntah pascabedah (PONV) didapatkan selama perawatan intensif.

Kesimpulan: Penerapan ERAS-CS secara tepat dapat memberikan pemulihan cepat serta mampu mengurangi komplikasi dan lama rawat intensif pascabedah.

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Keywords: anestesi fast track; bedah jantung; ERAS-CS; perioperatif; regurgitasi mitral

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Section: Case Reports
Language : ID
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