Anestesia untuk Seksio Sesarea pada Pasien dengan Korioamnionitis dan Trombositopenia

Indonesia

  • Dina Paramita
  • Ery Laksana Faculty of Medicine Universitas Diponegoro Semarang
Keywords: anestesia, korioamnionitis, seksio, anesthesia, chorioamnionitis, section secarea

Abstract

Infeksi maternal adalah salah satu komplikasi perinatal yang paling umum terjadi. Kejadian kehamilan dengan korioamnionitis merupakan 1% dari kasus di Amerika atau di negara maju sedangkan di negara berkembang kasus ini lebih tinggi. Pasien G3P1A1 31 minggu, umur 23 tahun. Pada pemeriksaan didapatkan hemodinamik stabil dengan tekanan darah:110/70 mmHg, laju nadi: 76x/menit, laju nafas:18 x/menit, suhu 38oC, kesadaran compos mentis, kontak baik. Pada pemeriksaan jantung dan paru dalam batas normal. Pemeriksaan laboratorium didapatkan Hb: 7,2 g/dl, trombosit: 12.000 /ul, lekosit: 27,5/ul, SGOT: 210/ul, SGPT: 141/ul. Pasien diputuskan untuk dilakukan seksio sesarea emergensi. Persiapan operasi yang sebelumnya dilakukan transfusi dengan trombosit konsentrat 3 kolf. Pada saat induksi hemodinamik stabil dilakukan induksi di ruang operasi dengan fentanyl 50 ug, propofol 2 mg/kg BB, rokuronium 0,6 mg/kgBB, dan pemeliharaan anestesi dengan sevofluran, N2O/O2. Selama operasi hemodinamik pasien stabil, saturasi oksigen [SpO2] 99 %, operasi dilakukan selama 1 jam, lahir bayi dengan berat badan 1200 gram, dan dirawat di bangsal bayi resiko tinggi. Pasca bedah pasien sadar penuh dilakukan ekstubasi dan diberikan masker oksigen 6 lt/ mnt dan pasien dirawat di ICU. Pada pemeriksan didapatkan hasil analisa gas darah normal dan kenaikan trombosit yang bertahap. Pada hari ke 3 mencapai 40/ul disertai dengan menurunnya jumlah lekosit dan suhu pasien normal. Pasien diputuskan pindah bangsal dengan rawat bersama dengan penyakit dalam.

Anaesthetic for Caesarean Section in Patient with Chorioamnionitis and Thrombositopenia

Abstract

Maternal infection is one of the most common perinatal complications. The incidence of pregnancy with chorioamnionitis constitutes 1% of cases in the United States or in developed countries whereas in developing countries this case is higher. G3P1A1 patient 31 weeks, age 23 years. on examination, hemodynamically stable blood pressure: 110/70 mmHg, pulse rate: 76x / min, respiratory rate: 18 x / min, temperature 38 oC, composmentis awareness, good contact, on heart and lung examination are within normal limits. Laboratory examination obtained Hb: 7.2 g / dl, platelets: 12,000 / ul, leukocytes: 27.5 / ul, SGOT: 210 / ul, SGPT: 141 / ul. The patient was decided to do cesarean section. Preparation of surgery was done before transfusion with platelet concentrate 3 colf. At the time of stable hemodynamic induction, then induction was carried out in the operating room with 50 ug fentanyl, propofol 2 mg / kg BW, rocuronium 0.6 mg / kgBW and maintenance of anesthesia with sevoflurane, N2O / O2. During hemodynamic surgery the patient is stable, SpO2 is 99%, surgery is carried out for 1 hour, a baby is born weighing 1200 grams and is treated in a high-risk infant ward. After surgery the patient was fully conscious, extubated, and the patient was treated in the ICU. In the examination, the result of normal blood gas analysis and increased a platelets accompanied by a decrease in the number of leukocytes and normal temperature. The patient was decided to move the ward with care together with internal medicine.

Author Biography

Ery Laksana, Faculty of Medicine Universitas Diponegoro Semarang

Department Anesthessiology and Intensive Care general Hospital Dr. Kariadi Semarang

References

Su BH. Histological chorioamnionitis and neonatal outcome in preterm infants. Pediatr Neonatol. 2014;55(2):154–5.

Galinsky R, Polglase GR, Hooper SB, Black MJ, Moss TJM. The consequences of chorioamnionitis: Preterm birth and effects on development. J Pregnancy. 2013; 2013: 412831.

Bastek JA, Weber AL, McShea MA, Ryan ME, Elovitz MA. Prenatal inflammation is associated with adverse neonatal outcomes. Am J Obstet Gynecol. 2014 May;210(5):450.

Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA, Watterberg K, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Summary of a Workshop. Obstetrics and Gynecology. 2016; 127: 426–36.

Peng CC, Chang JH, Lin HY, Cheng PJ, Su BH. Intrauterine inflammation, infection, or both (Triple I): A new concept for chorioamnionitis. Pediatr Neonatol. 2018 Jun;59(3):231–7.

Puspita RD, Rodiani, Saputra BA. Kehamilan dengan trombositopenia. Medula, 2018, April;(8): 1.

Asif N, Hassan K. Thrombocytopenia in pregnancy. Hematology Transfusi int.j.2017, 5 ; 307-9.

Talaulikar VS. Anemia in pregnancy. University colege Hospital, London UK https;//www.glown.com/critical current. issue/page/25.

Rahmaniar H, Purnomo AB, Dewantiningrum J, Kristanto H, Arkhaesi N. Hubungan gambaran hitung jenis leukosit maternal dengan koriomnionitis pada ketuban pecah dini [studi pada usia kehamilan 28-42 minggu]. Med Hosp. 2018; (5); 1;5–10.

Murphy KE, Carthy FP. Chorioamnionitis: from pathogenesis to treatment. Clinical microbiologi and infection. 2011, 17; 1304–11.

Andrew WM, Tita AN. Diagnosis and management of clinical chorioamnionitis. NIH Public Access. 2010 june;37 [2];339–54.

Krzyztof MK. The febrile parturient : choice of anesthesia. Shouter African journal of Anesthesia and Analgesia. 2002; 8: 5–20.

Nel MR, Robinson PN, Lucas. Sepsis in obstetric and the role of anaesthetis. International Journal of Obstetric Anaesthesia. 2012, 21; 56–67.

Erando CL, Gimeno AM. Neuroaxial regional anaesthesia in patient with active infection and sepsis : A clinical narrative review. Turk J Anaesthesiol Reanim 2018; 46: 8–14.

Published
2020-09-17
Section
Case Report