DOI: https://doi.org/10.14710/jai.v0i0.73897

Target-Controlled Infusion (TCI) Propofol in Ventriculoperitoneal (VP) Shunt Surgery during the First Trimester of Pregnancy

1SMF Anestesi dan terapi intensif, Indonesia

2RSUD Jayapura, Indonesia

3Department of Anaesthesia and Intensive Therapy, Faculty of Medicine, Padjajaran University - Hasan Sadikin Central General Hospital, Bandung, Indonesia

Received: 30 May 2025; Revised: 6 Sep 2025; Accepted: 24 Oct 2025; Available online: 24 Oct 2025.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Abstrak
Pendahuluan: Penggunaan propofol Target-Controlled Infusion (TCI) pada pasien hamil yang menjalani operasi pirau ventrikuloperitoneal (VP) selama trimester pertama karena hidrosefalus menghadirkan tantangan yang langka dan kompleks dalam neuroanestesi. Propofol TCI disukai karena kemampuannya untuk menjaga stabilitas hemodinamik dan secara efektif mengendalikan tekanan intrakranial (TIK), yang keduanya penting dalam manajemen neuro-obstetrik.

Kasus: Seorang wanita berusia 23 tahun, hamil lima minggu, dengan riwayat hidrosefalus komunikans dan pirau VP bilateral, datang dengan sakit kepala parah. Ia menjalani revisi pirau VP darurat dengan anestesi umum menggunakan propofol TCI (model Schnider, konsentrasi target-lokasi efek 2,5–5 mcg/mL), fentanil (2 mcg/kg), atrakurium (0,5 mg/kg), dan lidokain (1,5 mg/kg). Hemodinamik intraoperatif tetap stabil selama prosedur dua jam. Pascaoperasi, status neurologisnya membaik secara signifikan, dan tidak ada komplikasi yang diamati.

Pembahasan: Dibandingkan dengan agen inhalasi seperti sevoflurane, propofol TCI menunjukkan pengendalian tekanan intrakranial yang lebih baik, menjaga kestabilan aliran darah otak, dan memfasilitasi pemulihan pascaoperasi yang lebih cepat. Fentanyl, atracurium, dan lidocaine dipilih karena profil keamanannya yang baik untuk penggunaan jangka pendek selama kehamilan. Pascaoperasi, progesteron diberikan untuk mendukung pemeliharaan kehamilan dengan mengurangi kontraktilitas uterus dan mengurangi risiko keguguran yang terkait dengan stres bedah dan anestesi.

Kesimpulan: TCI propofol merupakan strategi anestesi yang efektif dan aman untuk menangani prosedur VP shunt selama trimester pertama kehamilan. Pendekatan multidisiplin sangat penting untuk mencapai hasil neurologis dan obstetrik yang optimal.

 

Kata kunci:  hidrosefalus, neuro-obstetri, propofol TCI, VP shunt.

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Keywords: TCI propofol, VP shunt, hydrocephalus, neuro-obstetrics.

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Section: Case Reports
Language : EN
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