Tatalaksana Anestesi pada Direct Clipping Aneurisma Otak - Buyung Hartiyo Laksono; Nazaruddin Umar; Marsudi Rasman (https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html, 2015)
Perdarahan subarachnoid (SAH) yang diakibatkan oleh pecahnya aneurisma otak menyumbang sekitar 85% dari kejadian SAH non traumatik. Insidensi sekitar 8–10 per 100.000 penduduk per tahun atau sekitar (0,008%). Rangkaian tatalaksana kasus SAH mempengaruhi outcome dari hasil terapi, mulai dari pertolongan pertama pada prehospital, transportasi, diagnosis awal, manajemen kegawatdaruratan dini, tindakan neuroradiologi intervensi ataupun pembedahan dan perawatan intensif pasca tindakan definitif. Pada laporan kasus ini, pasien wanita usia 65 tahun, berat badan 50 kg dengan diagnosa SAH hari ke 18 karena pecahnya aneurisma arteri serebri media disertai defisit neurologis ringan. Pembedahan dilakukan tindakan kraniotomi direct clipping aneurisma. Prinsip anestesi yang dilakukan adalah pemeliharaan homeostasis dan Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP) yang efektif, tindakan pencegahan peningkatan tekanan intrakranial (Intracranial Pressure-ICP), pembengkakan otak dan manajemen vasospasme serebral. Operasi berjalan 6 jam dan dilakukan rapid emergence. Outcome pembedahan sesuai yang diharapkan. Anestesi mempunyai peranan yang sangat penting dalam manajemen secara keseluruhan pada pasien ini untuk memberikan manajemen proteksi otak yang maksimal selama pembedahan sehingga memperoleh hasil akhir pembedahan yang sukses. Anesthetic Management in Direct Clipping Cerebral AneurysmaSubarachnoid hemorrhage (SAH) caused by rupture of a brain aneurysm accounts for about 85% of the incidence of non-traumatic SAH. The incidence is approximately 8-10 per 100,000 populations per year, or about (0.008%). The management of SAH affects the outcome, ranging from first aid in Prehospital, transportation, early diagnosis, early emergency management, neuroradiology action or surgical interventions and intensive therapy after definitive care. In this case report, a 65 years old female, 50 kgs, diagnosised with SAH day 18 due to middle cerebral artery aneurysm rupture with mild neurological deficits. Craniotomy was performed using direct aneurysm clipping. The anesthesia principle is to maintain adequate homeostasis and effective Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP), preventing increase in ICP, brain swelling and management of cerebral vasospasm. The operation was done in 6 hours with rapid emergence. The outcome of surgery was as expected. Anesthesia has a very important role in the overall management of these patients to provide optimal brain protection management during surgery in obtaining successful outcome.