Anestesi Epidural pada Seksio Sesarea Maternal dengan Defek Septum Atrium Sekundum dan Kemungkinan Hipertensi Pulmonal Ringan
A case Report
Abstract
Anestesi epidural merupakan salah satu teknik pilihan pada seksio sesarea karena dosis anestetik dapat dititrasi bertahap melalui kateter sehingga perubahan hemodinamik lebih gradual. Pada pasien dengan penyakit jantung bawaan (PJB), perencanaan anestesi yang cermat, evaluasi jantung praoperasi, pemantauan hemodinamik kontinu, posisi miring kiri, dan pemilihan obat yang tepat penting untuk menjaga stabilitas kardiovaskular. Kasus: Perempuan 26 tahun, G1P0 usia kehamilan 37+5 minggu dengan letak lintang, KPD 1 minggu, inpartu kala I fase laten, ASD sekundum dengan left-to-right shunt, probabilitas rendah hipertensi pulmonal, ASA III-E, menjalani SC emergensi dan insersi IUD dengan anestesi epidural. Operasi dan periode pascaoperasi berlangsung tanpa komplikasi anestesi maupun kardiak yang bermakna. Kesimpulan: Anestesi epidural merupakan pilihan yang aman dan efektif pada pasien PJB terpilih yang menjalani seksio sesarea, dengan penilaian menyeluruh, tatalaksana individual, dan pemantauan hemodinamik ketat untuk mengoptimalkan luaran ibu dan janin.
Downloads
References
AHA. ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020:143(5):e72–e227. Tersedia dari: https://doi.org/10.1161/CIR.0000000000000923
Arumugham VB, Shahin MH. Therapeutic uses of diuretic agents. Statpearls [Internet]. 2023. Tersedia dari: https://www.ncbi.nlm.nih.gov/books/NBK557838/
Chun KJ, Han DC, Park YH, Lee SK. Late-onset cyanosis and finger clubbing in a 37-year-old female with ebstein's anomaly and atrial septal defect. Acta Cardiol Sin. 2013;29(6):565-8.
ESC. 2020 Guidelines for management of atrial fibrillation ESC clinical Practice Guidelines European Heart J. 2021: 42(5):1–25. Tersedia dari: https://doi.org/10.1093/eurheartj/ehaa612
Knight J, Nigam Y, Jones A Effects of bedrest 4: Renal, reproductive and immune systems. Nursing Times. 2019: 115(3);54–7.
Lardinois B, Hardy M, Michaux I, Horlait G, Rotens T, Jacqmin H, et al. Monitoring of unfractionated heparin therapy in the intensive care unit using a point-of-care APTT: A comparative, longitudinal observational study with laboratory-based APTT and Anti-Xa activity measurement. J Clin Med. 2022;11(5): 1–17. doi: 10.3390/JCM11051338/S1.
Meng ML, Arendt KW, Banayan JM, Bradley EA, Vaught AJ, Hameed AB, Harris J, Bryner B, Mehta LS. Anesthetic care of the pregnant patient with cardiovascular disease: a scientific statement from the american heart association. Circulation. 2023 147(11): E657–E673. doi: https://doi.org/10.1161/CIR.0000000000001121
Zaleski KL, Blazey MH, Carabuena JM, Economy KE, Valente AM, Nasr VG. Perioperative anesthetic management of the pregnant patient with congenital heart disease undergoing cardiac intervention: a systematic review. J Cardiothorac Vasc Anesth. 2022;36(12):4483–95. doi:10.1053/j.jvca.2022.09.001.
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2022 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2022;43(34):3826–924. doi:10.1093/eurheartj/ehac244.
Simpson C, Mittal R, Jain R, Jain, R. Peripartum cardiomyopathy: a review of current literature. Future cardiology. 2022; 18(4), 337–43. doi: https://doi.org/10.2217/fca-2021-0045
Carvalho VH, Azi LMTA, Carvalho LIM, Schmidt AP. Obstetric anesthesia: pearls and pitfalls in anesthesia for cesarean delivery. Brazilian journal of anesthesiology (Elsevier). 2022; 72(4): 441–43. doi: https://doi.org/10.1016/j.bjane.2022.05.006
Isselbacher EM, Preventza O, Hamilton Black J III, Augoustides JG, Beck AW, Bolen MA, et al. 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease. Circulation. 2022;146(15):e334–e482. doi:10.1161/CIR.0000000000001106.
Kinsella SM, Carvalho B, Dyer RA, Fernado R, McDonnelle N, Mercier FJ, t al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2020;75(1):71–92. doi:10.1111/anae.14841.
Sudhakaran Nair G, Mounir Soliman L, Maheshwari K, Sakr Esa WA. Importance of vigilant monitoring after continuous nerve block: lessons from a case report. Ochsner J [Internet]. 2013 [cited 2025 Apr 17];13(2):267. Tersedia dari: https://pmc.ncbi.nlm.nih.gov/articles/PMC3684339/
Copyright (c) 2026 Esha Perdana, Fitri Hapsari Dewi, Aura Ihsaniar
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Jurnal Anestesi Obstetri Indonesia
