Low Dose Spinal dan Epidural untuk Seksio Sesarea Pasien dengan Patent Ductus Arteriosus

Abstract

Wanita hamil dengan penyakit jantung bawaan terjadi perubahan hemodinamik peningkatan kardiovaskular, perhatian dan terapi yang khusus dibutuhkan. Penambahan obat opioid meningkatkan dosis anestesi lokal, hemodinamik stabil, meningkatkan efek analgetik. Kasus: Satu, wanita 26 tahun gravida 30–32 minggu, PDA besar L-R shunt, hipertropi konsentrik ventrikel kiri, trivial atrium regurgitasi, pulmonal regurgitasi sedang, trikuspid regurgitasi sedang, pulmonal hipertensi berat, EF 57%. Dua, wanita 22 tahun gravida 37–38 minggu, preterm premature rupture of membrane, PDA besar L-R shunt, pulmonal hipertensi berat, penurunan fungsi sistolik ventrikel kiri, EF 54%, bekas seksio sesarea. Keduanya menggunakan teknik regional anestesi dosis rendah. Pembahasan: Teknik menggunakan combine spinal epidural (CSE) dengan spinal 5 mg bupivacain heavy 0,5% dan fentanyl 50 mcg, epidural bupivacain 0,125% dan fentanyl 30 mcg meningkatkan anestesi untuk seksio sesarea, dan hemodinamik stabil pada pasien kelainan katup. Opioid intratekal mereduksi anestesi lokal dan hipotensi, kemampuan anestesi terjaga. Simpulan: Dosis rendah CSE dengan 5 mg bupivacain heavy 0,5 % dan 50 mcg, dengan epidural bupivacain 0,125% dan fentanyl 30 mcg adekuat untuk pasien seksio sesarea dengan kelainan jantung.   Low-dose Spinal and Epidural Patients for Caesarean Section Patients with Patent Ductus Arteriosus Abstract Pregnant women with congenital heart diseases hemodynamic changes during pregnancy increasing cardiovascular, it’s need attention and special treatment. Opiod addition scan decrease the dose of local anesthetic drugs, prevent hemodynamic fluctuation, increase the analgesia effect. Case: First case, female 26 years with gravida 30-32 weeks with large PDA Left to Right shunt, consentrik left ventrikel hipertrophy, trivial atrium regurgitation, moderate pulmonal regurgitation, moderate tricuspid regurgitation, severe pulmonal hypertension, EF 57%. Second case, female 22 years with gravida 37-38 weeks, PPROM , large PDA Left to Right shunt, pulmonal hypertension severe, function systolic left ventrikel decreasing, EF 54%, former section caesaria. Both of them undergoing section caesaria with low dose regional anesthesia. Discussion: In this case with used CSE with Spinal 5 mg Bupivacaine heavy 0,5 % and fentanyl 50 mcg, Epidural bupivacain 0,125 % and fentanyl 30 mcg provided adequate anaesthesia for section cesarean delivery, and haemodynamic stability in patient with valvular cardiac disease. The synergism between intrathecal opioid sareductionin the dose of local anaesthetic and reduce hypotension, while still maintaining adequate anaesthesia. Conclussion: Low dose CSE with 5 mg bupivacaine heavy 0,5% and fentanyl 50 mcg, and epidural bupivacain 0,125% and fentanyl 30 mcg provided adequate for sectio cesarian patient with cardiac disease, with stable of haemodynamic.