ANESTHESIA FOR PATENT DUCTUS ARTERIOSUS LIGATION SURGERY IN ADULT
DOI:
https://doi.org/10.31004/jkt.v5i4.35551Keywords:
Cardiopulmonary bypass, Deep hypothermic circulatory arrest, Patent ductus arteriosusAbstract
Patent Ductus Arteriosus (PDA) adalah suatu kondisi jantung bawaan yang terjadi ketika pembuluh darah normal janin yang disebut ductus arteriosus, yang menghubungkan arteri pulmonalis dan aorta di dalam rahim, gagal menutup setelah bayi lahir. Laporan kasus ini berfokus pada manajemen anestesi pada pasien PDA dewasa yang menjalani operasi ligasi PDA, kemudian dilakukan teknik deep hypothermic circulatory arrest (DHCA) yang tidak terencana karena terjadi ruptur aorta. Seorang wanita berusia 33 tahun, mengalami gejala kelelahan, sesak napas, dan intoleransi latihan yang memburuk sejak pertama kali didiagnosis 12 tahun lalu. Setelah pemeriksaan menyeluruh, pasien didiagnosis dengan PDA bidirectional shunt, hipertensi pulmonal dengan high flow high resistance, dan tes oksigen reaktif. Prosedur pembedahan pasien meliputi penutupan PDA melalui median sternotomi dengan mesin cardiopulmonary bypass (CPB). Anestesi yang digunakan yaitu anestesi berbasis opioid dengan DHCA selama 9 menit. Beberapa faktor yang perlu diperhatikan dalam DHCA yang tidak terencana antara lain: (1) respon, keterampilan, dan kemampuan adaptasi terhadap situasi dari ahli bedah; (2) pembagian waktu yang baik; (3) pemberian es blok di area sekitar kepala pasien; dan (4) pemberian agen-agen farmakologis seperti midazolam, steroid dan manitol untuk menekan laju konsumsi oksigen serebral serta memberikan proteksi serebral pada kondisi ini. CPB dan DGCA yang disertai dengan tindakan neuroprotektif dan pemantauan yang tepat, dapat menjadi metode anestesi yang aman untuk pasien dewasa penderita PDA dan hipertensi pulmonal yang menjalani operasi ligasi PDA.References
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