Manajemen Anestesi pada Pasien dengan Preeklampsia Berat, Sindrom HELLP Parsial, Gangguan Ginjal Kronis dalam Dialisis dan Riwayat Edema Paru Akut
Abstract
Preeklampsia merupakan salah satu penyebab dari kematian maternal, selain perdarahan dan infeksi. Manajemen anestesi preoperatif, intraoperatif dan postoperatif yang tepat diperlukan untuk mengurangi angka mortalitas pascaoperasi seksio sesarea pada pasien preeklampsia berat dengan sindrom HELLP parsial. Pada kasus ini, seorang wanita berusia 29 tahun, G2P0A1, pada usia kehamilan 30 minggu, didiagnosa dengan preeklampsia berat, sindrom HELLP parsial, gangguan ginjal kronis dalam dialisis, serta riwayat edema paru akut. Pasien direncanakan untuk menjalani operasi seksio sesarea dengan anestesi spinal. Anestesi spinal diberikan dengan bupivakain spinal 0,5% hiperbarik 10 mg, fentanil 25 mcg dan morfin 0,1mg. Hemodinamik pasien saat operasi cenderung stabil. Blok Transversus Abdominis Plane (TAP), dengan 20 mL bupivakain 0,25% pada kedua sisi abdomen, diberikan sebagai strategi analgesi pascabedah. Manajemen preoperatif, intraoperatif, dan postoperatif pada pasien pre- eklampsia berat penting dalam melakukan terminasi kehamilan. Optimalisasi kondisi pasien dapat menurunkan kemungkinan mortalitas. Anestesi regional spinal direkomendasikan untuk pasien dengan preeklampsia dan strategi blok TAP dapat menjadi opsi untuk menangani nyeri postoperatif.
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Jurnal Anestesi Obstetri Indonesia
