Manajemen Anestesi pada Pasien dengan Sindroma Eisenmenger yang Menjalani Seksio Sesarea

Dewi Puspitorini Husodo, Scarpia P, Rachma C, Isngadi Isngadi
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Abstract

Pendahuluan sindroma Eisenmenger adalah penyakit jantung bawaan sianotik, termasuk di dalamnya hipertensi pulmonal dengan bidirectional maupun R-L shunt. Penurunan resistensi pembuluh darah sistemik dalam kehamilan akan meningkatan derajat R-L shunt. Mortilitas maternal pada kehamilan dengan sindroma Eisenmenger dilaporkan sekitar 30–70%. Wanita 35 tahun, gravida 32–33 minggu dengan atrial septal defect (ASD )sekundum 1,5cm, regurgitasi tricuspid berat, regurgitasi pulmonal sedang, pulmonal hipertensi berat, ejection fraction (EF) 34%, gagal jantung stage C fungsional klas III, sindroma Eisenmenmenger, saturasi preinduksi 90% dengan non rebreathing mask (NRM) 10 lpm. Kasus kedua, wanita gravida 32 minggu dengan ASD sekundum, regurgitasi trikuspid berat, regurgitasi pulmonal sedang, EF 13%, gagal jantung stage C fungsional klas IV, sindroma Eisenmenger, saturasi preindukasi 66% dengan non rebreathing mask (NRM) 10 lpm. Keduanya menjalani seksio sesarea dengan anestesi umum. Pada kasus pertama, didapatkan atonia uteri yang menyebabkan perdarahan masif dan penurunan tiba-tiba pada alirah darah balik sistemik yang berujung pada kematian. Pada kasus kedua, pasien tidak dapat beradaptasi dengan aliran darah balik uterus setelah bayi lahir. Hal tersebut menyebabkan penurunan saturasi dan hipotensi yang menurunkan tekanan ventrikel kanan, yang berujung pada kematian. Sebagai simpulan, kehamilan dengan sindroma Eisenmenger memiliki insidensi kematian tinggi. Penanganan intensif multidisiplin diperlukan baik dalam operasi elektif dan gawat darurat. Baik anestesi umum maupun regional memiliki kelebihan dan kekurangan tergantung kondisi pasien saat datang.   Anesthesia Management in Eisenmenger Syndrome Patient Underwent Caesarean Section Abstract Eisenmenger syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt. The decreased of systemic vascular resistance is associated with pregnancy increases the degree of right to left shunting. The maternal mortality rate of pregnancy in the presence of Eisenmenger syndrome is reported 30–70%. Female 35yo, gravida 32-33 weeks with secundum ASD 1,5cm, severe tricupid regurgitation, moderate pulmonal regurgiation, severe pulmonal hypertension, ejection fraction (EF) 34%, heart failure stage C functional class III, Eisenmenger syndrome, preinduction oxygen saturation 90% on non rebreathing mask 10 lpm. Second case, 32 weeks pregnant woman with secundum ASD, severe tricupid regurgitation, moderate pulmonal regurgiation, EF 13%, heart failure stage D functional class IV, Eisenmenger syndrome, saturation preinduction 66% on NRM 10 lpm. Both of them undergoing section caesaria with general anesthesia. In first case, uterine atony that leads to massive bleeding makes sudden decrease in systemic vascular resistence and may result in sudden death. In second case, the patient can not adapt the uterine back flow after delivery that makes the saturation decrease and sudden hypotention which make insufficient right ventricular pressure leading to mortality. As conclusion, pregnancy with Eisenmenger syndrome has high mortality incidence. Multidicipline high care treatment is needed for this case, both in elective and emergency setting. Both general and regional anesthesia have advantage and disadvantage, depends on the patient condition.
艾森瀚患者的麻醉药管理。该患者患有西撒利亚综合征
艾森明氏综合征的前因后果是一种遗传性肺动脉疾病,包括肺动脉高血压和R-L分流综合征。怀孕时,系统血管阻力的降低将增加R-L分泌物水平。据报道,患爱森明氏综合征的母亲死亡率约为30 - 70%。35岁女性,引力达32 - 33周,与1.5厘米的中庭、严重的三冠曲调理、中度肺动脉、中度高血压、抛售技术(EF) 34%、心房功能障碍第二个案例是,在第二轮案件中,重力妇女32周接受了二级急诊、重度冠状动脉调配、中级肺调节、以弗所书13%、中级心房功能失败的klas IV,艾森门尔氏综合征,再摄取66%与非呼吸面膜(NRM) 10分。两人都接受了全身麻醉的sesarea sesarea。在第一个病例中,有一种尿道导致大量出血,并导致系统内血流成河导致死亡。在第二种情况下,患者无法适应婴儿出生后子宫内的血液流动。这导致饱和和低能降低右心室压力,导致死亡。总结一下,与艾森明氏综合症有关的怀孕死亡率很高。在选修课和紧急手术中,需要多纪律的强化处理。全身麻醉和区域麻醉的优点和缺点,视乎病人的病况而定。艾森门氏综合症的麻醉管理。系统血管阻力的瓦解与预告片有关,增加了从右到右转的程度。艾森瀚所报道的孕妇死亡率为30 - 70%。35号女孩,重力为32周,5厘米,severe tricupid调节,适度脉冲偏移,适度肺动脉高压,抛出情感障碍第三班,eisen免受综合症,90%的非呼吸面膜上的上升力。第二种情况,32周怀孕的女人与secundum ASD, severe tricupid调节,中间层脉冲调节,EF 13%,心脏失败的功能D功能四班,艾森门综合症,1预习前66%的NRM 10 lpm。他们都和anesthesia将军一起进行了剖腹产部分。在最初的情况下,导致大量出血导致系统血管存在和可能导致猝死的后果。在第二种情况下,病人在分娩后不可能存在uterine后的流动,这种释放会导致适当的心室压力导致死亡。作为结论,艾森明性综合症的pregnancy有高度死亡率。多任务处理需要这个案例,在第一级和紧急情况下。将军和地区麻醉师都有优势和缺点,这取决于病人。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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