skip to main content

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.

Citation Format:
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.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
CTA
Subject
Type Other
  Download (272KB)    Indexing metadata
Keywords: anestesi fast track; bedah jantung; ERAS-CS; perioperatif; regurgitasi mitral

Article Metrics:

  1. Manecke GR. Goal Directed Fluid Therapy, Enhanced Recovery, and the Perioperative Surgical Home for Cardiac Patients in Noncardiac Surgery. In: Kaplan JA, editor. Kaplan’s Cardiac Anesthesia for Cardiac and Noncardiac Surgery. Seventh. Elsevier Inc.; 2017. p. 1536–7
  2. Brown JK, Singh K, Dumitru R, Chan E, Kim MP. Benefits of ERAS programs and their application in Cardiothoracic surgery. Methodist Debakey Cardiovasc J. 2018;14(2):77–88
  3. Lu SY, Lai Y, Dalia AA. Implementing a Cardiac Enhanced Recovery After Surgery Protocol: Nuts and Bolts. J Cardiothorac Vasc Anesth [Internet]. 2020;34(11):3104–12. Available from: https://doi.org/10.1053/j.jvca.2019.12.022
  4. Martin J. Fast-Track Cardiac Anesthesia and Early Tracheal Extubation. In: Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery
  5. Noss C, Prusinkiewicz C, Nelson G, Patel PA, Augoustides JG, Gregory AJ. Enhanced Recovery for Cardiac Surgery. J Cardiothorac Vasc Anesth [Internet]. 2018;32(6):2760–70. Available from: http://dx.doi.org/10.1053/j.jvca.2018.01.045
  6. Bainbridge D. Fast-Track Posoperative Cardiac Recovery and Outcomes. In: Kaplan J, editor. Kaplan’s Cardiac Anesthesia for Cardiac and Noncardiac Surgery. Seventh. Philadelphia: Elsevier Inc.; 2017. p. 1314–5
  7. Fleming IO, Garratt C, Guha R, Desai J, Chaubey S, Wang Y, et al. Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth [Internet]. 2016;30(3):665–70. Available from: http://dx.doi.org/10.1053/j.jvca.2016.01.017
  8. Li M, Zhang J, Gan TJ, Qin G, Wang L, Zhu M, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: A randomized clinical trial. Eur J Cardio-thoracic Surg. 2018;54(3):491–7
  9. Zaouter C, Oses P, Assatourian S, Labrousse L, Rémy A, Ouattara A. Reduced Length of Hospital Stay for Cardiac Surgery—Implementing an Optimized Perioperative Pathway: Prospective Evaluation of an Enhanced Recovery After Surgery Program Designed for Mini-Invasive Aortic Valve Replacement. J Cardiothorac Vasc Anesth. 2019;33(11):3010–9
  10. Grant MC, Isada T, Ruzankin P, Whitman G, Lawton JS, Dodd-o J, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020;159(4):1393-1402.e7
  11. Williams JB, McConnell G, Allender JE, Woltz P, Kane K, Smith PK, et al. One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg. 2019 May 1;157(5):1881–8
  12. Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations. JAMA Surg. 2019;154(8):755–66
  13. Fariña G, Erpel H, Portilla M, González M. Ultrasound-guided parasternal intercostal nerve block for pain management in cardiac surgery. J Cardiothorac Vasc Anesth [Internet]. 2018;32:S29–30. Available from: http://dx.doi.org/10.1053/j.jvca.2018.08.071
  14. Akhtar MI, Momeni M, Szekely A, Hamid M, El Tahan MR, Rex S. Multicenter International Survey on the Clinical Practice of Ultra-Fast-Track Anesthesia with On-Table Extubation in Pediatric Congenital Cardiac Surgery. J Cardiothorac Vasc Anesth [Internet]. 2019;33(2):406–15. Available from: https://doi.org/10.1053/j.jvca.2018.07.006
  15. Xu J, Zhou G, Li Y, Li N. Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery. BMC Pediatr. 2019;19(1):4–8
  16. Kim KM, Kwak JG, Shin BCH, Kim ER, Lee JH, Kim EH, et al. Early experiences with ultra-fast-track extubation after surgery for congenital heart disease at a single center. Korean J Thorac Cardiovasc Surg. 2018;51(4):247–53
  17. Guerrero Gómez A, González Jaramillo N, Castro Pérez JA. Ultra-fast-track extubation vs. conventional extubation after cardiac surgery in a cardiovascular reference centre in Colombia. A longitudinal study. Rev Española Anestesiol y Reanim (English Ed [Internet]. 2019;66(1):10–7. Available from: http://dx.doi.org/10.1016/j.redare.2018.06.007
  18. Taware M, Sonkusale M, Deshpande R. Ultra-fast-tracking in cardiac anesthesia “Our Experience” in a rural setup. Vol. 12, Journal of Datta Meghe Institute of Medical Sciences University. 2017. p. 110–4
  19. Mudgalkar NN. Retrospective Analysis of Fast-Track Extubation Protocol for Cardiac Surgical Population in Tertiary Care Hospital: A 2 Years’ Experience. Int J Sci Study. 2016;4(5):18–21
  20. Iezzi F, di Summa M, Del Sarto P, Munene J. Fast-Track Extubation in Pediatric Cardiothoracic Surgery in Developing Countries. J Card Crit Care TSS. 2017;01(01):021–3
  21. Patryck Lloyd‑Donald, Wen‑Shen Lee, James W. Hooper, Dong Kyu Lee, Alice Moore NC, Peter McCall, Siven Seevanayagam, George Matalanis SW and LW. Fast‑track recovery program after cardiac surgery.pdf. BMC Res Notes. 2021;14:201
  22. Roberts K, Brindle M, McLuckie D. Enhanced recovery after surgery in paediatrics: a review of the literature. BJA Educ [Internet]. 2020;20(7):235–41. Available from: https://doi.org/10.1016/j.bjae.2020.03.004
  23. Ziyaeifard M, Alizadehasl A, Massoumi G. Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery. Res Cardiovasc Med. 2014;3(2):5

Last update:

No citation recorded.

Last update: 2024-05-23 03:32:37

No citation recorded.