Manajemen Anestesi pada bayi prematur dengan asosiasi VACTERL
ABSTRACT

Background: VACTREL syndrome is a congenital disorder involving vertebral malformations, anal atresia, cardiovascular anomalies, kidney malformations and structural abnormalities of the limbs. Anesthetic management in such patients carries a high risk of mortality due to cardiac and renal anomalies that may affect the hemodynamic status.

Case : Presented an anesthetic management of a preterm male infant at 28 weeks gestation, weighing 1,795gr who underwent colonostomy due to anal atresia. Heart rate 157x/minute, Respiratory rate 40x/minute, there were crackles on both lung and systolic murmur. Patient’ s oxygen saturation 98% using nasal continuous positive airway pressure (NCPAP) oxygen inspiration fraction 40%. Induction using 0,2 mg midazolam, 2 mg ketamin, 2 mcg FentanylR . Rapid sequence intubation with 100% oxygen ventilation using Jackson-Rees circuit respiratory rate 50-60x /minute. Anesthetic maintenance using oxygen 100% 4 L / minute and 1 volume percent isoflurane. After the use of isoflurane, patients experienced desaturation up to 92% and bradycardia up to 125 x / minute. Isoflurane discontinued replaced with ketamine. After hemodynamically stable, the incision begins. During the surgical procedure, the heart rate range at 125-155 x / minute with 98-100% oxygen saturation. Duration of operation was 95 minutes. Post surgery treated in the NICU. The patient died on day 12 post-operative care in the NICU

Summary: The management of anesthesia in patients VACTERL mainly focused on existing cardiovascular abnormalitiesand also the balance between the SVR and PVR.

 

Keywords : anesthetic management, infant, VACTERL
ABSTRAK

Latar Belakang: Sindrom VACTERL merupakan kelainan kongenital yang melibatkan malformasi vertebra, atresia anal, anomali kardiovaskular, malformasi ginjal dan kelainan struktur pada tungkai. Manajemen anestesi pada pasien tersebut memiliki risiko mortalitas tinggi karena adanya anomali jantung dan ginjal yang dapat mempengaruhi status hemodinamik.

Kasus :Dilaporkan penanganan anestesi pada bayi prematur berusia 28 minggu berat 1,795gr menjalani operasi kolonostomi atresia ani.  Frekuensi nadi 157x/menit, frekuensi napas 40x/menit, terdapat ronki pada kedua lapang paru dan murmur sistolik. Saturasi oksigen pasien 98% menggunakan nasal continuous positive airway pressure (NCPAP) fraksi inspirasi oksigen 40%.Induksi menggunakan 0,2 mg midazolam, 2 mg ketamin, 2 mcg FentanylR . Rapid sequence intubation diberikan ventilasi dengan oksigen 100% menggunakan sirkuit Jackson-Rees frekuensi pernapasan 50-60 kali/menit. Rumatan anestesi dilakukan menggunakan oksigen 100% 4 liter per menit dan 1 volume percent isofluran. Setelah penggunaan isofluran, pasien mengalami desaturasi hingga 92% dan bradikardia hingga 125 kali per menit. Isofluran dihentikan diganti denganketamin. Setelah hemodinamik stabil, insisi dimulai. Selama prosedur operasi, denyut jantung berkisar di 125-155 kali per menit dengan saturasi oksigen 98-100%. Lama operasi 95 menit. Post operasi dirawat di NICU. Pasien meninggal pada hari ke-12 perawatan pasca operasi di NICU.

Ringkasan: Tata laksana anestesi pada pasien VACTERL terutama di fokuskan pada kelainan kardiovaskuler yang ada  dengan memperhatikan keseimbangan antara SVR dan PVR.

 

Kata kunci : bayi, manajemen anestesi, VACTERL
Artikel Sekarang
Dipublikasi pada 01 March 2015
Penulis :
» Primartanto Wibowo
» Corry Quando Yahya
Kategori : Laporan Kasus
Berkas Artikel (PDF)
Dari Jurnal
Volume VII Nomor 1, Maret 2015 Cover JAI
Daftar Isi | Berkas Full (PDF)

 

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