Penatalaksanaan Anestesi untuk Seksio Sesarea pada Multigravida dengan Kardiomiopati Peripartum
Abstract
Peripartum Cardiomyopathy (PPCM) merupakan salah satu jenis kardiomiopati dilatasi tanpa diketahui penyebabnya yang terjadi pada wanita hamil usia reproduktif yang jarang terjadi. Patofisiologi PPCM masih kontroversial, penyebab PPCM tidak bisa dijelaskan dengan etiologi tunggal, karena memiliki penyebab multifaktor. Pasien wanita, 43 tahun, ASA III dengan preeklamsi berat pada multigravida hamil preterm belum dalam persalinan dengan PPCM NYHA II riwayat seksio sesarea 10 tahun rencana dilakukan re-seksio sesarea elektif. Pada pasien ini didapatkan pada pemeriksaan kardiovaskuler dengan murmur pansistolik. Ekokardiografi ventrikel kiri dilatasi, kontraktilitas ventrikel kiri menurun ejection fraction 31%, fungsi diastolik restriktif, mitral regurgitasi ringan. Rencana dilakukan anestesi dengan teknik epidural namun dalam pelaksanaannya gagal epidural kemudian dikonversi menjadi anestesi umum intubasi oral. Secara umum, target hemodinamik pada berbagai teknik anestesi adalah sama, yaitu mengurangi kardiak preload dan afterload serta mencegah penurunan kontraktilitas kardiak yang sudah buruk sebelumnya. Teknik anestesi yang menghasilkan penurunan mendadak pada tahanan pembuluh darah sistemik sebaiknya dihindari. Manajemen anestesi pada pasien dengan PPCM, teknik regional anestesi maupun anestesi umum dapat diterapkan. Namun tetap mempertimbangkan beberapa faktor seperti kondisi pasien dan kemampuan dari dokter anestesi itu sendiri.
Anesthetic Management for Caesarean Section in Multygravida with Peripartum Cardiomyopathy
Abstract
Peripartum Cardiomyopathy (PPCM) is one type of dilated cardiomyopathy without known cause in pregnant women in reproductive age are rare. Pathophysiology of PPCM is still controversial, the cause of PPCM can not be explained by a single etiology because it has multifactor. Female patient, 43 years, ASA III with severe preeclamsia pregnancy, preterm, multigravida and not yet in labor with PPCM NYHA II and history of caesarian section 10 years ago planned for elective re-caesarian section. In this patient was obatained pansistolic murmur on cardiovascular examination. Echocardiography was obtained dilated left ventricle, left ventricular contractility decrease with ejection fraction 31%, restrictive diastolic function, mild mitral regurgitation. Planned for anesthesia with epidural technique but in implementation the epidural was fail then converted into general anesthesia oral intubation. In general, hemodynamic targets in anesthesia techniques are the same, ie reducing cardiac preload and afterload and preventing a decline in bad cardiac contractility. Anesthesia techniques that produce a sudden decrease in systemic vascular resistance should be avoided. Anesthesia management in patient with PPCM both regional and general anesthesia technique can be applied. But still considering several factors such as patient’s condition and the ability of the anesthesiologist itself.
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References
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