Anestesi untuk Seksio Sesarea Elektif Pasien dengan Morbid Obesitas, Preeklampsia dan Asma Bronkial
Abstract
Obesitas telah berkembang sebagai faktor risiko utama dan sering sebagai komplikasi pada kehamilan berupa hipertensi, diabetes melitus gestasional, seksio sesarea, dan infeksi pascapersalinan dan pascaoperasi, insiden emboli paru dan perdarahan postpartum primer. Preeklampsia mempengaruhi 2% hingga 8% dari semua kehamilan merupakan gangguan kehamilan spesifik yang mengakibatkan hipertensi dan disfungsi multiorgan dan menetap setelah persalinan serta merupakan penyebab utama kematian ibu di seluruh dunia. Seorang wanita, 41 tahun, G4P1A2, berat badan 135 kg, tinggi badan 161 cm, BMI 52,1 kg/m2, obese kelas III, bekas seksio sesarea satu kali 15 tahun yang lalu, lingkar leher 51 cm, jarak thyromental lebih dari 3 jari, skor Mallampati 2, wheezing positif pada kedua lapang paru akan dilakukan seksio sesarea karena preeklampsi. Obat-obatan yang dikonsumsi adalah acetylsalicylic acid yang dihentikan 1 hari yang lalu, nifedipin, metildopa, salbutamol spray. Induksi anestesi dengan propofol, pelumpuh otot dengan atracurium, dan rumatan anestesi dengan N2O/O2 sevofluran. Dilahirkan bayi perempuan dengan berat badan 2,2 kg, panjang badan 44 cm, APGAR score 1 menit 6 dan 5 menit 9. Diberikan metilergometrin 0,2 mg intravena dan 0,2 mg intramuskuler dan oksitosin 20 IU dilarutkan dalam 500 mL RL. Linier analog score (LAS score) 6-7-8. Total perdarahan 600 mL. Lama operasi 90 menit. Selesai operasi, ibu bisa diekstubasi.
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Jurnal Anestesi Obstetri Indonesia
