{"title":"心房败血症与肺动脉高压约为Sesarea secesio","authors":"Muhammad Rodli, Isngadi Isngadi","doi":"10.47507/obstetri.v1i1.24","DOIUrl":null,"url":null,"abstract":"Kelainan jantung kongenital dan sistem kardiovaskular terjadi pada 7 sampai 10 per 1.000 kelahiran hidup (0,7%–1,0%). Penyakit jantung kongenital adalah bentuk penyakit bawaan yang paling umum dan sekitar 30% dari semua kejadian penyakit bawaan. Cacat jantung kongenital yang paling sering terabaikan pada masa kanak-kanak adalah Atrial Septal Defect (ASD) sekundum. Resiko operasi non-jantung akan meningkat jika ditemukan gagal jantung, hipertensi pulmonal dan sianosis. Dilaporkan kasus primigravida berumur 33 tahun, dengan usia kehamilan 32–34 minggu yang menjalani seksio sesarea. Pada pemeriksaan fisik didapatkan nadi 100 x/menit (reguler), tekanan darah 115/74 mmHg, saturasi oksigen 90-94% dengan suplemen oksigen 10 L/menit, edema pada kedua tungkai, tekanan vena jugular (JVP) tidak meningkat. Hasil laboratorium dalam batas normal. Hasil echocardiografi menunjukkan adanya ASD sekundum (berdiameter 2–3 cm), bidirectional shunt dominan kanan ke kiri (sindroma Eisenmenger), regurgitasi trikuspid, hipertensi pulmonal berat dengan perkiraan tekanan sistolik ventrikel kanan 109 mmHg dan ejeksi sistolik ventrikel kiri 67%. Teknik anestesi yang digunakan adalah anestesi epidural. Dilakukan pemasangan kateter vena sentral untuk memantau tekanan vena sentral. Regimen epidural yang digunakan adalah bupivacaine plain 0,3% dan fentanyl 50 mcg total volume 15 ml dengan teknik titrasi. Selama seksio sesarea, tekanan darah stabil, detak jantung dan saturasi oksigen baik. Pasien dipantau di ruang pemulihan selama 1 jam dan kemudian dipindahkan ke ICU dan dipulangkan pada hari ke 10 pasca operasi. Kesimpulan, pasien dengan ASD dan hipertensi pulmonal yang menjalani seksio sesarea dapat dilakukan anestesi epidural dengan teknik titrasi. \n \nAtrial Septal Defect with Severe Pulmonary Hypertension was Scheduled for Cesarean Section \nAbstract \nCongenital abnormalities of the heart and cardiovascular system occur in 7 to 10 per 1,000 of live births (0.7 - 1.0%). Congenital heart disease is the most common form of congenital diseases and amounted to approximately 30% of all incidents of congenital diseases. Congenital heart defects are most often neglected in childhood is secundum atrial septal defect (ASD). The risk for non-cardiac surgery would increase if found heart failure, pulmonary hypertension and cyanosis. A 33-years old primigravida, in labor at 32-34 weeks of gestation who underwent caesarean section under epidural anesthesia. On physical examination pulse was 100 x/min, blood pressure was 115/74 mmHg, oxygen saturation was 90-94% with oxygen supplement 10 L/min, bilateral pitting pedal edema was present. All the laboratory results within normal limits. 2D Echo results osteum secundum ASD (2-3 cm in diameter), bidirectional shunt dominan right to left shunt (Eisenmenger’s syndrome), Tricuspid Regurgitation, Severe Pulmonary Hypertension with an estimated right ventricle systolic pressure of 109 mmHg and left ventricle systolic ejection fraction of 67%. The anesthetic technique was epidural anesthesia. We performed central venous catheter to monitoring central venous pressure. The epidural regimens used were bupivacaine plain 0,3% and fentanyl 50 mcg total volume 15 ml with titration techniques. During cesarean section, patient was stable blood pressure, heart rate and oxygen saturation. Patient was monitored in recovery room for 1 hour and then transferred to ICU and discharged on 10th postoperative day. Conclusion, patients with ASD and severe pulmonary hipertention, we can perform epidural anesthesia with titration techniques.","PeriodicalId":203301,"journal":{"name":"Jurnal Anestesi Obstetri Indonesia","volume":"37 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2020-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Atrial Septal Defect dengan Hipertensi Pulmonal Berat yang Dijadwalkan untuk Seksio Sesarea\",\"authors\":\"Muhammad Rodli, Isngadi Isngadi\",\"doi\":\"10.47507/obstetri.v1i1.24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Kelainan jantung kongenital dan sistem kardiovaskular terjadi pada 7 sampai 10 per 1.000 kelahiran hidup (0,7%–1,0%). Penyakit jantung kongenital adalah bentuk penyakit bawaan yang paling umum dan sekitar 30% dari semua kejadian penyakit bawaan. Cacat jantung kongenital yang paling sering terabaikan pada masa kanak-kanak adalah Atrial Septal Defect (ASD) sekundum. Resiko operasi non-jantung akan meningkat jika ditemukan gagal jantung, hipertensi pulmonal dan sianosis. Dilaporkan kasus primigravida berumur 33 tahun, dengan usia kehamilan 32–34 minggu yang menjalani seksio sesarea. Pada pemeriksaan fisik didapatkan nadi 100 x/menit (reguler), tekanan darah 115/74 mmHg, saturasi oksigen 90-94% dengan suplemen oksigen 10 L/menit, edema pada kedua tungkai, tekanan vena jugular (JVP) tidak meningkat. Hasil laboratorium dalam batas normal. Hasil echocardiografi menunjukkan adanya ASD sekundum (berdiameter 2–3 cm), bidirectional shunt dominan kanan ke kiri (sindroma Eisenmenger), regurgitasi trikuspid, hipertensi pulmonal berat dengan perkiraan tekanan sistolik ventrikel kanan 109 mmHg dan ejeksi sistolik ventrikel kiri 67%. Teknik anestesi yang digunakan adalah anestesi epidural. Dilakukan pemasangan kateter vena sentral untuk memantau tekanan vena sentral. Regimen epidural yang digunakan adalah bupivacaine plain 0,3% dan fentanyl 50 mcg total volume 15 ml dengan teknik titrasi. Selama seksio sesarea, tekanan darah stabil, detak jantung dan saturasi oksigen baik. Pasien dipantau di ruang pemulihan selama 1 jam dan kemudian dipindahkan ke ICU dan dipulangkan pada hari ke 10 pasca operasi. Kesimpulan, pasien dengan ASD dan hipertensi pulmonal yang menjalani seksio sesarea dapat dilakukan anestesi epidural dengan teknik titrasi. \\n \\nAtrial Septal Defect with Severe Pulmonary Hypertension was Scheduled for Cesarean Section \\nAbstract \\nCongenital abnormalities of the heart and cardiovascular system occur in 7 to 10 per 1,000 of live births (0.7 - 1.0%). Congenital heart disease is the most common form of congenital diseases and amounted to approximately 30% of all incidents of congenital diseases. Congenital heart defects are most often neglected in childhood is secundum atrial septal defect (ASD). The risk for non-cardiac surgery would increase if found heart failure, pulmonary hypertension and cyanosis. A 33-years old primigravida, in labor at 32-34 weeks of gestation who underwent caesarean section under epidural anesthesia. On physical examination pulse was 100 x/min, blood pressure was 115/74 mmHg, oxygen saturation was 90-94% with oxygen supplement 10 L/min, bilateral pitting pedal edema was present. All the laboratory results within normal limits. 2D Echo results osteum secundum ASD (2-3 cm in diameter), bidirectional shunt dominan right to left shunt (Eisenmenger’s syndrome), Tricuspid Regurgitation, Severe Pulmonary Hypertension with an estimated right ventricle systolic pressure of 109 mmHg and left ventricle systolic ejection fraction of 67%. The anesthetic technique was epidural anesthesia. We performed central venous catheter to monitoring central venous pressure. The epidural regimens used were bupivacaine plain 0,3% and fentanyl 50 mcg total volume 15 ml with titration techniques. During cesarean section, patient was stable blood pressure, heart rate and oxygen saturation. Patient was monitored in recovery room for 1 hour and then transferred to ICU and discharged on 10th postoperative day. Conclusion, patients with ASD and severe pulmonary hipertention, we can perform epidural anesthesia with titration techniques.\",\"PeriodicalId\":203301,\"journal\":{\"name\":\"Jurnal Anestesi Obstetri Indonesia\",\"volume\":\"37 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-04-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Jurnal Anestesi Obstetri Indonesia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.47507/obstetri.v1i1.24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Jurnal Anestesi Obstetri Indonesia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.47507/obstetri.v1i1.24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
遗传性心脏和心血管系统疾病的发生率为每1000次(0.7%—1.0%)。先天性心脏病是最常见的先天性疾病形式,约占先天性疾病的30%。儿童中最常被忽视的先天性心脏病是非正常胸痛。如果发现心脏衰竭、肺动脉高血压和肝硬化,非心脏手术的风险就会增加。据报道,33岁的primigravida已怀孕32 - 34周,接受sesarea secesio。在生理检查中,血压为100 /分钟(正常),血压115,74 mmHg,氧饱和度为90-94%,补充氧气10 L/分钟,四肢水肿,颈静脉压力(JVP)没有增加。实验室结果在可接受的范围内。回声心算结果显示,向右至左的双方向分流锤(直径2 - 3厘米)、三分之二分流分流、三轴肌制衡、三轴肌高血压、肺动脉高压、右心室109 mmHg和左心室渗出率为67%。麻醉技术使用的是硬膜外麻醉。安装中央静脉导管以监测中央静脉的压力。使用的硬膜养生药物是0.3%的布皮瓦卡因和芬太尼50 mcg共15毫升的体积与乳头技术。sesarea sesarea期间,血压稳定,心率稳定,氧饱和度良好。病人在康复室观察1小时,然后被转移到重症监护室,在手术后10天被送回。最后,患有肺动脉高压和肺动脉高压的肺动脉高压患者可以通过乳头技术进行硬膜麻醉。心脏和心脏血管功能出了严重的缺陷。心脏疾病是最常见的生殖器切除和隆起30%的生殖器疾病。心脏的缺陷在儿童中最严重的是童年的中庭是败血症。如果发现心脏衰竭、肺动脉肥大和cyanosis,非心脏外科手术风险将增加。三十年前的primigravida在实验室工作,耗时32周,在麻醉麻醉下进行腹股沟手术剖腹生产。在身体来晚脉冲x是100 / min,血压力是115/74 mmHg和氧,氧saturation是90-94% supplement 10 L / min,双边核踏板是呈现水肿。在正常的限制内所有的实验室results。2D骨回波回收率为麻醉技术是麻醉麻醉。我们向中央电视台报告了中央电视台的压力。表皮区域使用的是0.3%的plain和fentanyl 50 mcg共长15毫升,使用专利技术。在剖腹产期间,病人处于稳定的血液压力、心率和氧饱和度。病人被监视了一小时,然后被转移到重症监护室,在第十站被解除职务。Conclusion, patients with ASD and severe pulmonary夸张,我们可以用麻醉技术进行麻醉麻醉。
Atrial Septal Defect dengan Hipertensi Pulmonal Berat yang Dijadwalkan untuk Seksio Sesarea
Kelainan jantung kongenital dan sistem kardiovaskular terjadi pada 7 sampai 10 per 1.000 kelahiran hidup (0,7%–1,0%). Penyakit jantung kongenital adalah bentuk penyakit bawaan yang paling umum dan sekitar 30% dari semua kejadian penyakit bawaan. Cacat jantung kongenital yang paling sering terabaikan pada masa kanak-kanak adalah Atrial Septal Defect (ASD) sekundum. Resiko operasi non-jantung akan meningkat jika ditemukan gagal jantung, hipertensi pulmonal dan sianosis. Dilaporkan kasus primigravida berumur 33 tahun, dengan usia kehamilan 32–34 minggu yang menjalani seksio sesarea. Pada pemeriksaan fisik didapatkan nadi 100 x/menit (reguler), tekanan darah 115/74 mmHg, saturasi oksigen 90-94% dengan suplemen oksigen 10 L/menit, edema pada kedua tungkai, tekanan vena jugular (JVP) tidak meningkat. Hasil laboratorium dalam batas normal. Hasil echocardiografi menunjukkan adanya ASD sekundum (berdiameter 2–3 cm), bidirectional shunt dominan kanan ke kiri (sindroma Eisenmenger), regurgitasi trikuspid, hipertensi pulmonal berat dengan perkiraan tekanan sistolik ventrikel kanan 109 mmHg dan ejeksi sistolik ventrikel kiri 67%. Teknik anestesi yang digunakan adalah anestesi epidural. Dilakukan pemasangan kateter vena sentral untuk memantau tekanan vena sentral. Regimen epidural yang digunakan adalah bupivacaine plain 0,3% dan fentanyl 50 mcg total volume 15 ml dengan teknik titrasi. Selama seksio sesarea, tekanan darah stabil, detak jantung dan saturasi oksigen baik. Pasien dipantau di ruang pemulihan selama 1 jam dan kemudian dipindahkan ke ICU dan dipulangkan pada hari ke 10 pasca operasi. Kesimpulan, pasien dengan ASD dan hipertensi pulmonal yang menjalani seksio sesarea dapat dilakukan anestesi epidural dengan teknik titrasi.
Atrial Septal Defect with Severe Pulmonary Hypertension was Scheduled for Cesarean Section
Abstract
Congenital abnormalities of the heart and cardiovascular system occur in 7 to 10 per 1,000 of live births (0.7 - 1.0%). Congenital heart disease is the most common form of congenital diseases and amounted to approximately 30% of all incidents of congenital diseases. Congenital heart defects are most often neglected in childhood is secundum atrial septal defect (ASD). The risk for non-cardiac surgery would increase if found heart failure, pulmonary hypertension and cyanosis. A 33-years old primigravida, in labor at 32-34 weeks of gestation who underwent caesarean section under epidural anesthesia. On physical examination pulse was 100 x/min, blood pressure was 115/74 mmHg, oxygen saturation was 90-94% with oxygen supplement 10 L/min, bilateral pitting pedal edema was present. All the laboratory results within normal limits. 2D Echo results osteum secundum ASD (2-3 cm in diameter), bidirectional shunt dominan right to left shunt (Eisenmenger’s syndrome), Tricuspid Regurgitation, Severe Pulmonary Hypertension with an estimated right ventricle systolic pressure of 109 mmHg and left ventricle systolic ejection fraction of 67%. The anesthetic technique was epidural anesthesia. We performed central venous catheter to monitoring central venous pressure. The epidural regimens used were bupivacaine plain 0,3% and fentanyl 50 mcg total volume 15 ml with titration techniques. During cesarean section, patient was stable blood pressure, heart rate and oxygen saturation. Patient was monitored in recovery room for 1 hour and then transferred to ICU and discharged on 10th postoperative day. Conclusion, patients with ASD and severe pulmonary hipertention, we can perform epidural anesthesia with titration techniques.