Husodo, Dewi Puspitorini (2018) Retrospective Study: Low Dose Spinal Anestesi Pada Sectio Cesaria Pasien Dengan Kelainan Jantung. Magister thesis, Universitas Brawijaya.
Abstract
Pendahuluan : Jumlahwanitadenganpenyakitjantungatau yang mengalamikelainanjantungselamakehamilanbertambahpesat di seluruh dunia. Kematian maternal berkisar 0,4% padapasiendenganNew York Heart Association (NYHA) kelas 1-2 hingga 6,8% padakelas 3-4. Sebagianbesarmenunjukanpenurunankondisiselamakehamilankarenaperubahanfisiologiskeha milandanpeningkatankerjasistemkardiovaskular. Anestesi regional adalahteknikanestesi yang paling seringdigunakanpadasectiocaesaria. Namunadabeberapakekhawatiranpenggunaananestesi spinal padapasiendenganpenyakitjantungmengingatresikohipotensidanperubahanhemodinamik. Penelitianterbarumembuktikanperubahanhemodinamikpadaanestesi spinal bergantungpadadosisobat yang digunakan. Penggunaan spinal anestesidosisrendahtelahterbuktitidakmembuatperubahanhemodinamik. Tujuandaripenelitianiniadalahuntukmemahamiefekdari spinal anestesidosisrendah yang dikombinasikandenganadjuvan opioid terhadaphemodinamikpadapasien yang menjalanisectiocaesariadengankomorbidkelainanjantung. Metode : Kami melakukanpenelitianretrospectifpadapasiendengankelainanjantung yang menjalanisectiocaesariadengan spinal anestesidosisrendah di RS Saiful Anwar Malang padakurun September 2017- Sepetember 2018. ix Dalamkurunwaktutersebutdidapatkan418kasussectiocaesaria, 33 diantaranyaadalahpenderitakelainanjantung yang menjalaninyadenganteknik spinal anestesidosisrendah. Dosis spinal yang digunakanadalah bupivacaine 0,5% heavy dan fentanyl 50mcg. Kami mengevaluasihemodinamikpreoperatif, setelah spinal anestesidiinjeksikan, setelahkelahiran, akhirpembedahan, danpascaoperasi. Kami juga mengevaluasiwaktuketikabromage score dan target bloktercapai, apgar scorebayi, dankepuasaan operator terhadaprelaksasimotorik Hasil : Demografijeniskelainanjantungpada 33 pasientersebutantara lain mitral stenosis 6 pasien,mitralregurgitasi 6 pasien, atrial septal defek (ASD) 3 pasien, ventrikel septal defek (VSD) 3 pasien, patent ductus arteriosus (PDA) 3 pasien, pulmonal hipertensi (PH) 3 pasien, tetralogy of fallot (TOF) 2 pasien, aorta regurgitas 1 pasien, cardiomyopathy 2 pasien, lainlain 4 pasien. Penggunaan spinal anestesidosisrendahdenganmenggunakan 5 mg bupivacaine heavy 0,5% dengan fentanyl 50 mcg untuksectiocaesariatidakmebuathipotensi yang significant. Teknik tersebutterbuktistabilterhadaaphemodinamikbaiksaatindeksi, post indeksi, setelahkelahiran, pascaoperasimaupun di ruangpemulihan. Target bloktercapaidenganbaikpadasemuakasus, APGAR scorebaik, dan operator puasdenganrelaksasimotorik. Kesimpulan :Spinal anestesidosisrendahdenganmenggunakan 5 mg bupivacaine heavy 0,5% denganadjuvan opioid fentanyl 50 mcg dapatdigunakandengansuksesuntukoperasisectiocaesariabaikdalamhal onset, adekuatanestesi, level, durasiblok , stabilitashemodinamik, dankondisibayilahir yang baiksertastabilitaskardiovaskular yang baik.
English Abstract
Introduction : Worldwide, the number of women who have a pre-existing cardiovascular disease or develop cardiac problems during pregnancy are increasing. Maternal mortality ranges from 0.4% in the New York Heart Association (NYHA) class I–II disease to 6.8% in class III–IV disease. Most of them show decrease of clinical condition during pregnancy due to pregnancy physiological changes and increase of demand on the cardiovascular system.Regional anesthesia is the most used technique of anesthesia in section caesaria patient. But there is worry to use spinal anesthesia in patient with heart disease because significant effect of hypotension and hemodynamic change. Recent research have proved hemodynamic change in spinal anesthesia is dose dependent. Using low dose spinal in some cases have been proved didn’t make significant hemodynamic change. The aim of this research is understanding the effects of the low dose spinal anesthetic in combination with an opioid adjuvant towards the hemodynamic for the SectioCesaria delivery in patient with maternal heart disease Method : We do retrospective study in patient with maternal heart disease that undergoing sectiocaesaria under low dose spinal anesthesia in Saiful Anwar Hospital Malang from September 2017 until September 2018. During that time there are 418sectiocaesarias, among them there are 33 cases patient with maternal heart disease that undergoing low dose spinal anesthesia. The spinal regimen was 5 mg bupivacaine heavy 0,5% combined with 50 mcg fentanyl . We evaluated the haemodynamic preoperative, after the spinal anesthetics was injected, post delivery, at the end of surgery and postoperative. We also evaluated time when each bromage score and target blocked are reached, apgar score of the baby, and relaxation satisfication from operator. xi Results : The maternal heart diseases among 33 patients were mitral stenosis 6 patients, mitral regurgitation6 patients, atrial septal defect 3 patients, venticle septal defect 3 patients , tetralogy of fallot 2 patients, patent ductus arteriousus 3 patients, pulmonalhypertention3 patients, aortaregurgitation 1 patients, cardiomyopathy 2 patients, others cardiac disease 4 patients.. An application of low dose spinal anesthesia with 5mg bupivacaine heavy 0,5% combined with 50mcg fentanyl for the SectioCesarea delivery didnt make significant hypotension. It stabilized the hemodynamic prior to injection, post injection, after delivery, post operative as well as in the recovery room. Target blocked is reached well in all case. There’s no significant change in apgar score. Operator satisfied with motoric relaxation. Conclution : Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0,5% and adjuvant opioid fentanyl 50 mcg can be succesfully used for the performance of Cesarean delivery as regards to onset, adequacy, level, duration of the block and haemodinamyc stability and good fetal outcome, with impressive cardiovascular stability.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.12/HUS/r/2018/041901970 |
| Uncontrolled Keywords: | HEART , DISEASES , TREATMENT , ANESTHESIA |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.1 Diseases of cardiovascular system > 616.12 Diseases of heart |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 15 Jan 2020 02:33 |
| Last Modified: | 15 Jan 2020 02:33 |
| URI: | http://repository.ub.ac.id/id/eprint/177920 |
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