Anestesia Spinal untuk Seksio Sesarea pada Pasien Hipotiroid

Abstract

Disfungsi tiroid sering dijumpai pada populasi perempuan usia masa reproduksi. Efek disfungsi tiroid bermanifestasi pada berbagai organ dan mungkin menimbulkan komplikasi pembedahan dan kehamilan. Seorang perempuan 37 tahun dengan hipotiroid akan menjalani seksio sesarea. Kadar tiroid timulating hormone (TSH): dan tiroksin (T4) adalah 14,87 µUI/mL dan 71 nmol/L. Pasien mendapat terapi levotiroksin selama 6 minggu. Pada pemeriksaan fisik, pasien dalam keadaan umum baik. Anestesia spinal dilakukan dengan bupivakain 0,5% 7,5 mg dan fentanyl 25 µg. Bayi lahir dengan skor Apgar 8/9, hemodinamik stabil selama operasi. Pasien pulang dari rumah sakit setelah hari ke tiga operasi. Pasien hipotiroid dapat mengalami komplikasi koma miksedema, gangguan respirasi, maupun hipotensi selama pembedahan. Pembedahan elektif sebaiknya ditunda sampai kondisi eutiroid. Anestesia spinal dosis rendah, monitoring adekuat, pencegahan hipotermia, pengurangan opioid, dan terapi levotiroksin perioperatif dibutuhkan untuk mencegah komplikasi jika kondisi eutiroid belum tercapai. Sebagai kesimpulan anestesia spinal dapat dilakukan pada pasien hipotiroid yang menjalani seksio sesarea. Anesthesia for Cesarean Section in Hypothyroid Patient Abstract Thyroid disfunction is common in woman of child-bearing age population. Multiple organ are influenced with thyroid dysfunction and may contribute to complication during surgery and pregnancy. A 37-years-old female with hypothyroid was scheduled for cesarean section. Thyroid stimulating hormone (TSH) and thyroxine (T4) level was 14,87 µUI/mL and 71 nmol/L. The patient had levothyroxine therapy for 6 weeks. On physical examination, the general condition was good. She underwent spinal anesthesia with bupivacaine 0,5% 7,5 mg and fentanyl 25 µg. The baby was born with Apgar score 8/9 and the surgery was done without any complication. The patient was discharged from the hospital on the 3rd day after surgery. The hypothyroid patient may experience complication of myxedema comatous, respiratory disorder and hypotension during surgery. The elective surgery was best postponed until a euthyroid state was achieved. Low dose spinal anesthesia, adequate monitoring, hypothermia prevention, reducing opioid dose and continuing levothyroxine therapy was needed to prevent the complication if the euthyroid state was able not able to achieve. As conclusion : spinal anesthesia may be done for cesarean section in hypothyroid patient.

Keywords

• anestesia spinal
• hipotiroid
• seksio sesarea
• cesarean section
• hypothyroid
• spinal anesthesia