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Operasi caesar dengan epidural anestesia pada pasien peripartum kardiomiopati dan hipotiroid

Abstract

Prinsip penanganan anestesi pada pasien dengan permasalahan kardiovaskuler adalah menjaga kestabilan hemodinamik dan mencegah adanya gejolak hemodinamik yang dapat menyebabkan perburukan kondisi pasien. Peripartum Kardiomiopati (PPCM) merupakan suatu keadaan kardiomiopati idiopatik yang berhubungan dengan kehamilan. PPCM muncul pada sebulan terakhir masa kehamilan atau 5 bulan setelah melahirkan, tanpa adanya riwayat, faktor resiko ataupun penyebab yang pasti, yang dapat menyebabkan munculnya gejala gagal jantung. Pada laporan kasus ini, terdapat pasien dengan kondisi gejala gagal jantung yang dirasakan mendadak pada bulan akhir kehamilan. Pasien datang dengan keluhan sesak napas berat yang membaik dengan posisi terduduk. Pasien ini tidak memiliki riwayat penyakit jantung sebelumnya. Riwayat keluhan yang sama saat kehamilan sebelumnya juga tidak ada. Hal ini sesuai dengan kriteria diagnosis PPCM dimana keluhan muncul pada bulan terakhir kehamilan, dan pasien tidak memiliki riwayat maupun resiko untuk terjadinya gagal jantung. Pasien juga dalam kondisi hipotiroid akibat operasi subtotal tiroidektomi 2 tahun yang lalu. Hal ini bisa menyebabkan perburukan kondisi pada pasien. Penanganan anestesi pada pasien ini adalah dengan regional anestesi, sesuai dengan yang disebutkan literatur, dimana dilakukan epidural block. Epidural anestesia merupakan regional anestesi dengan tipe blok segmental, dimana  penurunan Systemic Vein Resistance (SVR) terjadi secara gradual sehingga dapat menjaga kestabilan hemodinamik. Pasca operasi pasien dirawat diruang intensif selama 3 hari sebelum dipindahkan ke ruang intermediet.

The anesthesia handling principle in patients with cardiovascular problems is to maintain hemodynamic stability and prevent hemodynamic turmoil that can cause deterioration in the patient's condition. Peripartum Cardiomyopathy (PPCM) is a condition of idiopathic cardiomyopathy associated with pregnancy. PPCM appears in a month before pregnancy due date or 5 months after giving birth, without any history, risk factors or certain causes, which cause symptoms of heart failure. In this case report, there are patients with symptoms of heart failure that are felt suddenly in the final month of pregnancy. Patients complaint of severe shortness of breath that improves with a sitting position. This patient has no previous history of heart disease. There is no history of the same complaint during the previous pregnancy. This is in accordance with the diagnostic criteria for PPCM where complaints occur in the last month of pregnancy, and patients have no history or risk of heart failure. Patients were also hypothyroid due to subtotal thyroidectomy 2 years ago. This can cause deterioration in the patient's condition. Treatment of anesthesia in these patients is with regional anesthesia, according to the literature mentioned, where epidural block is performed. Epidural anesthesia is a regional anesthesia with segmental block type, in which a decrease in Systemic Vein Resistance (SVR) occurs gradually so that it can maintain hemodynamic stability. Postoperatively, patients are treated in an intensive room for 3 days before being transferred to the intermediate room.

References

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How to Cite

Kusuma Jayadi, I. G. A. B., & Subagiartha, I. M. (2019). Operasi caesar dengan epidural anestesia pada pasien peripartum kardiomiopati dan hipotiroid. Medicina, 50(2). https://doi.org/10.15562/medicina.v50i2.617

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