Pengelolaan Anestesi untuk Seksio Sesarea Kehamilan Triplet dengan Skor LAS Intraoperatif 6
Indonesia
Abstract
Triplet (kembar tiga) dan kehamilan kembar yang lebih banyak lagi (higher multiple gestations) dihubungkan dengan peningkatan morbiditas ibu dan anak dibandingkan dengan kehamilan ganda atau kehamilan tunggal. Seksio sesarea adalah rute yang disukai untuk melahirkan pasien dengan kehamilan triplet. Seorang wanita, 31 tahun, G1P0A0 gravida aterm triplet hasil inseminasi, BB 72,5 kg, TB 168 cm, Mallampati 1, tekanan darah 130/90 mmHg, laju nadi 97x/menit, SpO2 100% dengan kanul binasal. Induksi dengan propofol 140 mg, atracurium 35 mg, intubasi dengan pipa endotrakheal no 6,5. Ventilasi mekanik dengan volume tidal 560 mL, laju nafas 12 x per menit, postive end expiratory pressure (PEEP) 5. Rumatan anestesi dengan N2O 40%, sevofluran 1-2 vol%. Analgetik fentanyl 100 ug diberikan setelah bayi lahir. Cairan RL 1500 mL, gelofusin 500 mL. Obat-obat lain: misoprostol 800 mcg perrectal, oxytocin 40 IU, methylergometrine 0,6 mg, asam traneksamat 1 gram, dextrose 40% 25 mL. Bayi ke-1 BB 2650 gr, pada jam 19.1, Apgar score 1 menit dan 5 menit 9, 10, Bayi ke-2 BB 2100 gr, Apgar score 1 menit dan 5 menit 9, 10, Bayi ke-3 BB 1900 gr, Apgar score 1 menit dan 5 menit 9, 10 lahir selang 1 menit. Tidak terjadi hipotensi, dan karena skor linear analog scale (LAS) 4-6 setelah terapi medikal maka dilakukan pengikatan uterus dengan tehnik B-Lynch suture, tidak terjadi postpartum hemorrhage, Hb postoperatif 10 g/dL, hematokrit 29%, tidak dilakukan transfusi darah. Analgetik pascabedah dengan petidin 100 mg dan dexketoprofen 100 mg dilarutkan dalam NaCl 0,9% 500 mL yang diberikan untuk 24 jam.
Anesthesia Management for Caesarean Section Triplet Pregnancy with Intraoperative LAS Score 6
Abstract
Triplet and higher multiple gestations associated with increase maternal and fetal morbidity compare with twin or singleton pregnancy. Caesarean section is route for delivery patient with triplet gestations. A woman, 31 years, G1P0A0 gravida aterm triplet insemination result, BW 72,5 kg, height 168 cm, Mallampati 1, blood pressure 130/90 mmHg, heart rate 97x/minute, SpO2 100% with canul binasal. Induction anesthesia with propofol 140 mg, atracurium 35 mg, intubated with endotracheal tube no 6,5. Mechanical ventilation with tidal volume 560 mL, respiratory rate 12 x per minutes, postive end expiratory pressure (PEEP) 5. Maintenance anesthesia with N2O 40%, sevoflurane 1-2 vol%. Analgetic fentanyl 100 ug given after baby delivery. Fluids with RL 1500 mL, gelofusin 500 mL. Other drugs are misoprostol 800 mcg perrectal, oxytocine 40 IU, methylergometrine 0.6 mg, tranexamic acid 1 gram, dextrose 40% 25 mL. First baby BW 2650 gr, Apgar score 1 minute and 5 minute 9, 10 at 19.21, second baby BW 2100 gr, Apgar score 1 minute and 5 minute 9, 10, third baby BW 1900 gr, Apgar score 1 minute and 5 minute 9, 10 delivered 1 minute interval. No evidence of hypotension and linear analog scale (LAS) score is 4-6 and so needed uterus binding with B-Lynch suture technique, no evidence of postpartum hemorrhage, postoperative Hb 19 g/dL, hematocrit 29%, no blood transfusion. Postoperative analgesia with petidine 100 mg and dexketoprofen 100 mg in NaCl 0,9% 500 mL for 24 hours.
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Jurnal Anestesi Obstetri Indonesia
