Pengaruh Regional Anesthesia Subarachnoid Block pada G3P2A0 dengan Preeklampsia Berat
Abstract
Preeklampsia adalah komplikasi kehamilan serius yang ditandai dengan hipertensi dan proteinuria, berpotensi menyebabkan komplikasi serius bagi ibu dan bayi. Preeklampsia yang disertai tanda prodromal ini disebut sebagai impending eklampsia atau imminent eclampsia. Indonesia merupakan salah satu negara di Asia Tenggara dengan Angka Kematian Ibu (AKI) yang tinggi, yakni 173:100.000 kelahiran, dengan persentase 25% disebabkan oleh hipertensi pada kehamilan. Sectio Caesarea Transperitoneal Profunda (SCTP) adalah metode persalinan melalui insisi dinding perut dan segmen bawah rahim. Kasus ini melibatkan seorang wanita 37 tahun G3P2A0 dengan usia kehamilan 30 minggu dan preeklampsia berat (PEB), direncanakan menjalani SCTP darurat menggunakan Regional Anesthesia Subarachnoid Block (RASAB) dengan levobupivacaine dan fentanyl. Anestesi regional dipilih karena durasi dan kualitas analgesia yang baik, serta stabilitas hemodinamik selama operasi. Levobupivacaine bekerja dengan memblokade natrium channel neuronal yang mencegah depolarisasi dan bersifat reversibel pada saraf sensorik maupun motorik. Kombinasi levobupivacaine dan fentanyl menghasilkan blok sensorik lebih lama tanpa memperpanjang blok motorik, mengurangi nyeri tanpa mengganggu fungsi motoriknya.
Downloads
References
Perkumpulan Obstetri dan Ginekologi Indonesia. Pedoman nasional pelayanan kedokteran diagnosis dan tata laksana preeklamsia. Himpunan Kedokteran Feto Maternal. 2016, 1–59.
Garovic V, Dechend R, Easterling T, Karumanchi SA, Baird SM, Magee LA, et al. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American heart association. Hypertension 2022;79(2):e21-e41. Doi: 10.1161/HYP.0000000000000208
Mustafa, R, Ahmed S, Gupta A, Venuto RC.A Comprehensive Review of Hypertension in Pregnancy. J Pregnancy. 2012:1–19. Doi; 10.1155/2012/105918
Parker SE, Werler MM, Gissler M, Tikkanen M, Ananth CV. Placenta abruption and subsequent risk of preeclampsia: a population based case control study. Paediatr Perinat Epidemiol. 2015;29(3): 211–9. Doi: 10.1111/ppe.12184
Lopez-Jaramillo P, Barajas J, Rueda-Quijano SM, Lopez-Lopez C, Felix C. Obesity and preeclampsia: common pathophysiological mechanisms. Frontiers in Physiology. 2018;9 (1838): 1–10. Doi: https://doi.org/10.3389/fphys.2018.01838
The American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia. Obstet Gynecol. 2020;135(6): 1492–5. Doi:10.1097/AOG.0000000000 003892
ACOG Practice Bulletin No. 203: Chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1): e26–e50. Doi: 10.1097/aog.0000000000003020
Alese MO, Moodley J, Naicker T. Preeclampsia and HELLP syndrome, the role of the liver. J Matern Fetal Neonatal Med. 2021;34(1): 117–23.Doi: 10.1080/14767058.2019.157273
Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM. Spong CY. Williams Obstetrics. 25th edition. McGraw Hill. 2018.
National Institute for Health and Clinical Excellence (NICE). Hypertension in pregnancy: the management of hypertensive disorder during pregnancy. Royal College of Obstetricians and Gynaecologists. London. 2011.
American Society of Anesthesiologists. Practice Guidelines for Obstetric Anesthesia (PGOA): an Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016;124(2): 270–300. Doi: 10.1097/ALN.0000000000000935
Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 188: Prelabor rupture of membranes. Obstet Gynecol. 2022];131(1): e1–e14. Doi:10.1097/AOG.0000000000 002455
Kalinderi K, Delkos D, Kalinderis M, Athanasiadis A, Kalogiannidis I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J Obstet Gynaecol [Internet]. 2018;38(4): 448–53. Available from: doi:10.1080/01443615.2017.13 70579
Amorim MM, Souza ASR, Katz L. Planned caesarean section versus planned vaginal birth for severe pre-eclampsia. Cochrane Database of Syst Rev. 2017;10(10):1–18. Doi: 10.1002/14651858.CD009430.pub2
Sulistyawan V, Isngadi, Laksono RM. Perbandingan outcome teknik spinal anestesi dosis rendah dibandingkan dosis biasa pada sectio caesarea darurat di rumah sakit dr.saiful anwar. Malang. J Anesth Pain. 2020;1(2): 3–10.
Setiawan YB, Sarosa P, Widodo U. Perbandingan efek penambahan antara klonidin (50 µg) dan fentanyl (25 µg) sebagai adjuvan bupivacain hiperbarik 0.5% 12,5 mg intrathekal sebagai anestesi spinal. J Komplikasi Anestesi. 2015;2(3):11–18.
Bajwa SJS, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol [Internet]. 2013;29(4):1–10. Doi: 10.4103/0970-9185.119172
Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s Clinical Anesthesiology. 6th edition. Mc-Graw Hill Education, 2018.
Bidikar M, Mudakanagoudar MS, Santhosh MCB. Comparison of intrathecal levobupivacaine and levobupivacaine plus fentanyl for cesarean section. Anesth Essays Res. 2017; 11(2): 495–98. Doi: 10.4103/aer.AER_16_17
Copyright (c) 2024 RTH Supraptomo
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Jurnal Anestesi Obstetri Indonesia
