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Manajemen Anestesi Perioperatif Pasien Kardiomiopati Hipertrofi Obstruksi

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

Received: 15 Feb 2023; Published: 31 Mar 2023.

Citation Format:
Abstract

Latar Belakang: Kardiomiopati hipertrofi (HCM) adalah kondisi dominan autosomal. Penyebab penting kematian mendadak orang dewasa muda. Meskipun sering tanpa gejala, gejala yang muncul pada kardiomiopati hipertrofi adalah  gagal jantung seperti sesak napas, nyeri dada pada aktivitas, sinkop atau pra-sinkop, aritmia, dan kematian mendadak. Tanda-tanda yang bisa ditemukan seperti hipotensi, denyut nadi rendah, heave ventrikel kiri, murmur sistolik ejeksi, dan murmur regurgitasi mitral. Pasien dengan kondisi ini menjadi tantangan untuk ahli anestesi dalam operasi elektif dan gawat darurat.

Kasus: Pasien wanita 29 tahun, dengan diagnosa kardiomiopati hipertrofi obstruksi dan vegetasi yang akan dilakukan tindakan miektomi saluran keluar ventrikel kanan (RVOT), saluran keluar ventrikel kiri (LVOT), dan evakuasi vegetasi. Selama operasi hemodinamik dipertahankan untuk menjaga denyut jantung antara 60-90 denyut per menit, tekanan darah rata-rata 60-70 mmHg. End tidal carbon dioxide (EtCO2) dipertahankan antara 35-40 mmHg dan central venous pressure (CVP) dijaga tetap tinggi pada periode sebelum dan sesudah bypass. Periode weaning hingga pasca bypass, hemodinamik dipertahankan dengan milrinon (0,375 mcg/kgBB/menit) dan dilakukan pemasangan temporary pacemaker (TPM) karena didapatkan irama atrioventricular (AV) block. Pasien dilakukan miektomi septum, release LVOT, reseksi double chamber right ventricular (DCRV), dan evakuasi vegetasi. Pascaoperasi pasien dirawat di intensive care unit (ICU). Selama perawatan di ICU permasalahan yang dihadapi yaitu aritmia maligna.

Pembahasan: Teknik anestesi dan manajemen perioperatif pasien ini harus bertujuan untuk menjaga stabilitas hemodinamik, mempertahankan preload dan afterload yang memadai. Menghindari vasodilator dan menghindari agen yang meningkatkan kontraktilitas sangat penting dalam pengelolaan pasien ini. Tujuan intraoperatif termasuk mempertahankan irama sinus, meminimalkan rangsangan stres dan meminimalkan atau mencegah obstruksi saluran keluar ventrikel kiri.

Kesimpulan: Kardiomiopati hipertrofi menimbulkan banyak tantangan unik mengenai pelaksanaan anestesi. Preload yang memadai, kontrol stimulasi simpatik, denyut jantung dan peningkatan afterload diperlukan untuk mengurangi obstruksi saluran keluar ventrikel kiri.

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Perioperative Anesthesia Management of a Patient with Hypertrophic Obstructive Cardiomyopathy
Subject Perioperatif;Pasien;Kardiomiopati;Hipertrofi;Obstruksi;Laporan Kasus
Type Other
  Download (1MB)    Indexing metadata
Keywords: anestesi perioperatif; kardiomiopati hipertrofik obstruksi; miektomi; obstruksi saluran keluar ventrikel kiri; transesophageal echocardiography

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