Low Dose Spinal Anesthesia Bupivakain 0,5% 5 mg dengan Adjuvan Fentanyl 50 mcg untuk Pasien dengan Uncorrected Tetralogy of Fallot yang Menjalani Seksio Sesarea
Abstract
Pasien hamil dengan uncorrected tetralogy of fallot yang menjalani seksio sesarea merupakan tantangan tersendiri bagi dokter anestesi. Tetralogy of Fallot terdiri dari ventricular septal defect, hipertrofi ventrikel kanan, overriding aorta dan stenosis pulmonal. Prinsip anestesi pada pasien ini adalah mempertahankan systemic vascular resistence (SVR) dan menghindari peningkatan pulmonary vascular resistance (PVR). Pasien Ibu hamil, 19 tahun dengan berat badan 50 kg, tinggi badan 150 cm, G3P000Ab200 Gravida 36–37 minggu, tunggal hidup, fetal distress dan tali pusat menumbung dengan tetralogy of fallot, akan dilakukan seksio sesarea cito. Penatalaksanaan anestesi pasien ini dengan low dose spinal anesthesia bupivakain 0,5% 5 mg dan adjuvan fentanyl 50 mcg. Hemodinamik stabil setelah tindakan spinal. Tekanan darah sebelum dilakukan spinal 100/60 mmHg dengan laju nadi 67 kali per menit dan saturasi oksigen 80% menggunakan non rebreathing mask (NRBM) 10 liter per menit. Tekanan darah pada saat operasi dimulai adalah 96/57 mmHg dan laju nadi 77 kali per menit serta saturasi 78% menggunakan NRBM 10 liter per menit. Setelah bayi dilahirkan, hemodinamik stabil hingga akhir operasi, tidak ditemukan periode hipotensi yang berat dan tidak digunakan obat vasopressor selama operasi. Pasien dipindahkan ke ICU untuk observasi pasca operasi selama 2 hari. Selama perawatan di ICU, kondisi pasien tetap stabil dan kemudian dipindahkan ke ruang perawatan biasa. Low dose spinal anesthesia mencegah risiko hipotensi karena intensitas blok simpatis yang lebih minimal sehingga penurunan SVR dapat dihindari. Teknik ini dapat digunakan sebagai alternatif pembiusan pada pasien dengan tetralogy of fallot tetapi tergantung kondisi pasien saat akan dilakukan pembiusan.
Low Dose Spinal Anesthesia Bupivacaine 0,5% 5 mg with Adjuvant Fentanyl 50 mcg for Cesarean Section Patient with Uncorrected Tetralogy of Fallot
Abstract
Cesarean delivery in parturient with uncorrected tetralogy of fallot poses significant challenge for anesthesiologist. Tetralogy of Fallot consists of ventricular septal defect, right ventricular hypertrophy, overriding aorta and stenosis pulmonum. Main principle of anesthesia for tetralogy of fallot is maintenance of systemic vascular resistance dan avoidance of increasing pulmonary vascular resistance. Parturient, 19 years old, body weigt 50 kg, height 150 cm, G3P000Ab200 36 – 37 weeks, fetal distress and umbilical cord prolapse with tetralogy of fallot will perform cesarean section. Patient anesthesized with low dose spinal anesthesia using bupivacaine 0,5% 5cmg with adjuvant fentanyl 50 mcg. Haemodynamic before spinal with blood pressure is 100/60 mmHg, heart rate 67 beat per minute (BPM), saturation is 80% using 10 liter of oxygen non rebreathing mask (NRBM) . Blood pressure during incision 96/57 mmHg heart rate 77 BPM with saturation 78% using 10 liter of NRBM. Haemodynamic is stable after baby is born until the operation is done, without any episode of severe hypotension and there is no using of vasopressor drugs. Patient is moved to ICU after the operation for further observation and for 2 days periode the haemodynamic is stable and then patient is moved to regular ward. Low dose spinal anesthesia avoid the incidence of hypotension by causing less intense blocked sympathetic system than traditional dose and thus providing a stable SVR. This technique could be an alternative for anesthesizing for parturient with tetralogy of fallot but its depend on patient condition before operation.
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Jurnal Anestesi Obstetri Indonesia
