Anestesi general pada pasien gravida di ruang operasi gawat darurat: sebuah laporan kasus

Achmad Munif; Pontisomaya Parami

doi:10.15562/ism.v14i2.1439

Anestesi general pada pasien gravida di ruang operasi gawat darurat: sebuah laporan kasus

Achmad Munif ,

Pontisomaya Parami ,

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DOI: https://doi.org/10.15562/ism.v14i2.1439 |
Published: 2023-08-28

Abstract

Background: The choice of anesthesia technique in pregnant women is determined by several factors, such as maternal safety considerations (airway evaluation and aspiration risk), technical issues, and anesthesiologist experience. Superimposed preeclampsia is chronic hypertension in pregnant women under gestational age >20 weeks. This disease can become an emergency if neurological symptoms arise and require immediate termination of pregnancy with the option of a section caesarian. This case report discusses general anesthesia in a pregnant patient with a history of hypertension.

Case: Female, 42 years old, 38-39 weeks of pregnancy with a history of hypertension and acute decompensated heart failure (ADHF) profile B, in an intubated state, underwent green code caesarean section under general anesthesia using propofol 200 mg, fentanyl 100 mcg and rocuronium 50 mg. The operation lasted for 50 minutes with stable hemodynamics, no desaturation, and a total bleeding of 300 ml. A Born male baby immediately cried with appearance, pulse, grimace, activity, and respiration (APGAR) score 8-9 and a birth weight of 2,410 grams. Post-cesarean section and anesthesia, the patient were in good condition without persistent complications.

Conclusion: The general anesthesia technique of caesarean section is preferred in patients with superimposed preeclampsia with neurological complications because it has rapid induction, optimal airway control, and lower risk of hypotension and cardiovascular instability.

Latar belakang: Pilihan teknik anestesi pada ibu hamil ditentukan beberapa faktor seperti pertimbangan keselamatan ibu (evaluasi jalan napas dan risiko aspirasi), masalah teknik, dan pengalaman ahli anestesi. Superiomposed preeclampsia adalah hipertensi kronik yang terjadi pada ibu hamil dengan usia kehamilan >20 minggu. Penyakit ini dapat menjadi suatu kondisi kegawatan apabila timbul gejala neurologis dan membutuhkan tindakan terminasi kehamilan dengan sesegera mungkin dengan pilihan operasi cesar. Laporan kasus ini membahas anestesi general pada pasien gravida dengan riwayat hipertensi.

Kasus: Perempuan, 42 tahun, gravida 38-39 minggu dengan riwayat penyakit hipertensi dan acute decompensated heart failure (ADHF) profil B, dalam keadaan sudah terintubasi telah menjalani bedah cesar green code dengan anestesi general menggunakan propofol 200 mg, fentanil 100 mcg dan rokuronium 50 mg. Operasi berlangsung selama 50 menit dengan hemodinamik stabil, tidak terjadi desaturasi dengan total perdarahan 300 ml. Lahir bayi laki-laki langsung menangis dengan skor appearance, pulse, grimace, activity, and respiration (APGAR) 8-9 dan berat badan lahir 2.410 gram. Pasca operasi pasien masih dalam pengaruh obat dan dirawat di ruang terapi intensif. Pasca operasi cesar dan anestesi, pasien didapatkan dalam kondisi baik dan tidak didapatkan komplikasi menetap.

Simpulan: Teknik anestesi general pada bedah cesar lebih dipilih pada pasien superimposed preeclampsia dengan komplikasi neurologis karena memiliki induksi yang cepat, pengendalian jalan nafas yang optimal, dan risiko hipotensi dan instabilitas kardiovaskular lebih rendah.

References

Mylonas L, Friese K. Indication for and Risk of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29–30):489–95.
Iddrisu M, Khan ZH. Anesthesia for cesarean delivery: general or regional anesthesia-a systematic review. Ain-Shams J Anesthesiol. 2021;13(1):1–7.
Kemenkes RI. Profil Kesehatan Indonesia Tahun 2019. Jakarta; 2019.
Kametas NA, Nzelu D, Nicolaides KH. Chronic hypertension and superimposed preeclampsia: screening and diagnosis. Am J Obstet Gynecol. 2022;226(2):S1182–95.
Garovic VD, Dechend R, Easterling T, Karumanchi SA, Baird SMM, Magee LA, et al. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022;79(2):E21–41.
American College of Obstetrician and Gynecologist. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obs Gynecol. 2020;135(6):237–60.
Trombarapu U, Dwarampudi A, Kodey P. Posterior reversible encephalopathy syndrome in preeclampsia. Int J Reprod Contracept Obs Gynecol. 2020;9(1):358–63.
Cipolla M, Kraig R. Seizures in Women with Preeclampsia: Mechanisms and Management. Fetal Matern Med Rev. 2011;22(2):91–108.
Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. Curr Anesth Rep. 2021;11:18–27.
Setiawan AH, Airlangga PS, Rahardjo E. Komplikasi Edema Paru pada Kasus Preeklampsia Berat dan Eklampsia. JAI (Jurnal Anestesiol Indones. 2019;11(3):136–44.
Setyawati A, Widiasih R, Ermiati E. Faktor-Faktor Yang Berhubungan Dengan Kejadian Preeklampsia di Indonesia. J Perawat Indones. 2018;2(1):32–40.
Kusuma AANJ, Widiyanti ES, Pranamartha AAGMK, Damanik ATB. High ratio of neutrophils to lymphocytes and high triglyceride levels in serum as risk factors for pre-eclampsia. Bali Med J. 2023;12(1):987–90.
Hamada K, Chigusa Y, Kondoh E, Ueda Y, Kawahara S, Mogami H, et al. Noninvasive Positive-Pressure Ventilation for Preeclampsia-Induced Pulmonary Edema: 3 Case Reports and a Literature Review. Case Rep Obstet Gynecol. 2018;2018:1–6.
Carvalho MA, Bejjani L, Francisco RPV, Patino EG, Vivanti A, Batista FS, et al. Outcomes following medical termination versus prolonged pregnancy in women with severe preeclampsia before 26 weeks. PLoS One. 2021;16(2 February):1–12.
Potter T, Schaefer T. Hypertensive Encephalopathy. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [Cited on 2022 Des 21]. p. 1–8.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK554499

[1] Mylonas L, Friese K. Indication for and Risk of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29–30):489–95.

[2] Iddrisu M, Khan ZH. Anesthesia for cesarean delivery: general or regional anesthesia-a systematic review. Ain-Shams J Anesthesiol. 2021;13(1):1–7.

[3] Kemenkes RI. Profil Kesehatan Indonesia Tahun 2019. Jakarta; 2019.

[4] Kametas NA, Nzelu D, Nicolaides KH. Chronic hypertension and superimposed preeclampsia: screening and diagnosis. Am J Obstet Gynecol. 2022;226(2):S1182–95.

[5] Garovic VD, Dechend R, Easterling T, Karumanchi SA, Baird SMM, Magee LA, et al. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022;79(2):E21–41.

[6] American College of Obstetrician and Gynecologist. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obs Gynecol. 2020;135(6):237–60.

[7] Trombarapu U, Dwarampudi A, Kodey P. Posterior reversible encephalopathy syndrome in preeclampsia. Int J Reprod Contracept Obs Gynecol. 2020;9(1):358–63.

[8] Cipolla M, Kraig R. Seizures in Women with Preeclampsia: Mechanisms and Management. Fetal Matern Med Rev. 2011;22(2):91–108.

[9] Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. Curr Anesth Rep. 2021;11:18–27.

[10] Setiawan AH, Airlangga PS, Rahardjo E. Komplikasi Edema Paru pada Kasus Preeklampsia Berat dan Eklampsia. JAI (Jurnal Anestesiol Indones. 2019;11(3):136–44.

[11] Setyawati A, Widiasih R, Ermiati E. Faktor-Faktor Yang Berhubungan Dengan Kejadian Preeklampsia di Indonesia. J Perawat Indones. 2018;2(1):32–40.

[12] Kusuma AANJ, Widiyanti ES, Pranamartha AAGMK, Damanik ATB. High ratio of neutrophils to lymphocytes and high triglyceride levels in serum as risk factors for pre-eclampsia. Bali Med J. 2023;12(1):987–90.

[13] Hamada K, Chigusa Y, Kondoh E, Ueda Y, Kawahara S, Mogami H, et al. Noninvasive Positive-Pressure Ventilation for Preeclampsia-Induced Pulmonary Edema: 3 Case Reports and a Literature Review. Case Rep Obstet Gynecol. 2018;2018:1–6.

[14] Carvalho MA, Bejjani L, Francisco RPV, Patino EG, Vivanti A, Batista FS, et al. Outcomes following medical termination versus prolonged pregnancy in women with severe preeclampsia before 26 weeks. PLoS One. 2021;16(2 February):1–12.

[15] Potter T, Schaefer T. Hypertensive Encephalopathy. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [Cited on 2022 Des 21]. p. 1–8.

[16] Available from: https://www.ncbi.nlm.nih.gov/books/NBK554499

Anestesi general pada pasien gravida di ruang operasi gawat darurat: sebuah laporan kasus

Abstract

References

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