Anestesia Spinal Dosis Rendah untuk Seksio Sesarea pada Pasien Mitral Stenosis Berat
Abstract
Penyakit jantung pada kehamilan meningkatkan angka morbiditas dan mortalitas ibu dan janin. Mitral stenosis adalah lesi katup jantung yang paling sering didapatkan pada wanita hamil dan hampir selalu disebabkan oleh penyakit jantung rematik. Perubahan fisiologis yang terjadi selama kehamilan dan periode peripartum dapat memperburuk gejala dan derajat penyakit jantung. Akibatnya, banyak wanita pertama kali didiagnosis penyakit jantung selama kehamilan. Seorang wanita berusia 24 tahun gravida 32–33 minggu dengan kongesti gagal jantung fungsional kelas III, mitral stenosis berat, ejection fraction (EF) 59%, regurgitasi trikuspid sedang, dan dilatasi atrium kiri menjalani seksio sesarea dengan anestesi spinal dosis rendah menggunakan bupivakaine 0,5% hiperbarik 7,5 mg ditambah fentanyl 50 mcg secara intratekal. Blok sensoris dicapai setinggi torakal 6 dalam waktu 4 menit 20 detik. Hemodinamik pasien stabil selama operasi maupun pasca operasi. Tidak diperlukan pemberian vasopresor. Pasca operasi pasien dirawat di intensive care unit (ICU) selama 3 hari dengan hemodinamik yang stabil. Laporan ini menyoroti bahwa anestesi spinal dosis rendah dapat menjadi pilihan yang baik dalam manajemen anestesi untuk seksio sesarea yang disertai dengan mitral stenosis berat.
Low Dose Spinal Anesthesia for Cesarean Section with Severe Mitral Stenosis
Abstract
Heart disease in pregnancy increases maternal and fetal morbidity and mortality. Mitral stenosis is the most common heart valve lesion in parturient and is almost always caused by rheumatic heart disease. Physiological changes that occur during pregnancy and the peripartum period can worsen symptoms and the degree of the heart disease. As a result, many women are first diagnosed with heart disease during pregnancy. Twenty four year old woman gravida 32–33 weeks with congestive heart failure class III, severe mitral stenosis, EF 59%, moderate tricuspid regurgitation, and left atrial dilatation undergoing cesarean section with low-dose spinal anesthesia using bupivacaine 0,5% hyperbaric 7.5 mg plus fentanyl 50 mcg intrathecally. Sensory blocks were reached as high as thoracic 6th in 4 minutes and 20 seconds. The patient's hemodynamics are stable during both surgery and post surgery. Vasopressors were not needed. After surgery the patient was transferred to ICU for 3 days with stable hemodynamics. This report highlights that low-dose spinal anesthesia can be a good choice in the management of anesthesia for cesarean section accompanied by severe mitral stenosis.
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