Anestesi Low-Dose Spinal dan Epidural pada Pasien Syok Hemoragik yang akan Dilakukan Histerektomi dengan Suspek COVID-19

Aulia Nailufar Rizki, Isngadi Isngadi

Abstract


Latar belakang: Syok hemoragik atau kondisi hipovolemia berat merupakan kontraindikasi anestesi neuraxial. Anestesi regional baik spinal maupun epidural merupakan pilihan utama untuk operasi obstetri ginekologi dengan COVID-19, untuk menghindari manipulasi jalan napas dan meminimalkan tindakan aerosol serta mengurangi risiko transmisi virus antara pasien dan tenaga kesehatan. Laporan kasus ini menggambarkan manajemen anestesi pada pasien yang mengalami syok hemoragik dengan kecurigaan COVID-19 yang dilakukan histerektomi darurat, menggunakan kombinasi anestesi spinal dosis rendah dan epidural.

Kasus: Perempuan 38 tahun dengan keluhan utama pendarahan aktif pervaginam, dengan riwayat demam datang ke IGD reguler dalam keadaan syok hemoragik dan dilakukan resusitasi cairan, transfusi darah, dan vasopressor. Pemeriksaan laboratorium menunjukkan anemia, trombositopenia, neutrofilia, limpofenia, peningkatan NLR, hipoalbuminemia; peningkatan CRP dan procalcitonin. X-Ray thorax menunjukkan pneumonia tipikal kesan viral. Penapisan pre-hospital dan intra-hospital menunjukkan kecurigaan infeksi COVID-19. Pasien direncanakan histerektomi darurat dengan anestesi spinal dosis rendah dan epidural di kamar operasi incovit. Paska operasi pasien dirawat di ruang IGD dikarenakan ruang rawat dan ICU incovit penuh. Hemodinamik paska operasi stabil, vasopressor dihentikan. Setelah swab 2 hari berturut-turut didapatkan hasil negatif dan pasien dipindahkan ke ruang rawat reguler.

Kesimpulan: Pasien syok hemoragik disertai kecurigaan COVID-19 dengan tindakan histerektomi dapat dilakukan anestesi kombinasi spinal dosis rendah dan epidural, serta memberikan outcome yang baik.

 

 

 

Keywords


COVID-19; hemorrhagic shock; low dose spinal; combined spinal epidural anaesthesia; case report

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DOI: http://dx.doi.org/10.21776/ub.jap.2021.002.01.06

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