Manajemen Anestesi Pada Operasi Craniotomi Anak Dengan Cedera Kepala Sedang

Ardi Pramono

Abstract


Anesthesia for craniotomy on brain injury needs a knowledge about cerebral phisiology and the effect ofanesthetic agent on brain metabolism. Brain must be prevent from secondary brain injury. Intracranial pressure must be blunt with choosing appropriate technique of induction and maintenance of anesthesia.
In this case, we choose general anesthesia technique with semiopen Jackson Rees circuit, endotracheal tube with diameter number 6, and controlled ventilation. Premedication uses fentanyl 25ug to blunt hemodynamic respon following to intubation, induction of anesthesia with pentothal 100 mg, muscle relaxant with atracurium 15 mg and maintenance anesthesia uses sevoflurane, N20 and oxygen. During operation, the mean arterial pressure is between 70-90 mmHg, heart rate about 110/minute and intracranial pressure is not increase. Operation take place about 1 hour and patient was taking care in intensive care unit (ICU) after that to prevent intracranial increased. After 2 days in ICU, patient was transported to ward.

Penanganan jejas otak karena trauma kepala mengalami kemajuan yang pesat dengan ditemukannya proses fisiologi otak pada trauma kepala. Manajemen anestesi pada operasi craniotomi memerlukan teknik khusus sehingga tidak menyebabkan cedera otak sekunder (secondary brain injury). Pada kasus bedah saraf, dipilih agen induksi dan rumatan anestesi yang tidak meningkatkan tekanan intrakranial serta perlakuan intubasi y mg smooth.
Pada kasus ini, anestesi dilakukan dengan teknik anestesi umum, semiopen sirkuit Jakcson Rees dengan endotrakheal tube (ET) nomor 6, nafas kendali. Premedikasi menggunakan fentanyl 25 ug dengan tujuan untuk menumpulkan respon hemodinamik saat intubasi, induksi menggunakan pentotal dosis 100 mg, fasilitas intubasi menggunakan atracurium 15 mg dan rumatan anestesi menggunakan sevofluran, N20 dan 02. Selama operasi, nilai MAP (mean arterialpressure) berkisar antara 70-90 mmHg dengan nadi sekitar 110 x/menit. Operasi berlangsung sekitar 1 jam. Setelah operasi, pasien dirawat di ICU selama 2 hari dan pulang kembali ke bangsal.

Keywords


anestesi; trauma kepala; cedera otak sekunder; tekanan intrakranial; anesthesia; brain injury; secondary brain injury; intracranial pressure

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DOI: https://doi.org/10.18196/mmjkk.v6i1.1891

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