Manajemen Anestesi untuk Reseksi Tumor Pineal Body dengan Posisi Duduk

Abstract

Perkembangan teknik operasi mikro yang semakin baik serta perkembangan neuroanesthesia dan critical care yang semakin canggih membuat reseksi tumor yang agresif menjadi pilihan untuk manajemen tumor regio pineal dan ventrikel III. Seorang laki laki 49 tahun dengan tumor pineal body pasca Ventriculo-Peritoneal shunt, akan dilakukan operasi kraniotomi reseksi tumor dengan posisi duduk. Pasien mengeluh nyeri kepala hebat, berkurang dengan obat tetapi sering kambuh. Sejak Maret 2013 penglihatan kabur, sempoyongan, mual muntah, dan telinga terasa berdenging. Operasi dilakukan dengan posisi duduk dalam anestesi umum, menggunakan pipa endotrakeal (ETT) no.7,5 non kinking, ventilasi kendali. Pipa nasogastrik (NGT) no.16 dipasang untuk dekompresi. Premedikasi dengan midazolam 2 mg iv, deksametason 20 mg iv. Koinduksi menggunakan fentanyl 100 μg iv, induksi dengan propofol 200 mg iv. Fasilitas intubasi dengan rokuronium 0,9 mg/KgBB. Pemeliharaan anestesi dengan O2 + air + sevofluran dengan fraksi oksigen 50%. Propofol kontinyu 100–200 mg/jam, vekuronium 6mg/jam. Monitoring tanda vital (tekanan darah, nadi, SaO2, elektrokardiografi), etCO2, arteri line dan kateter vena sentral (CVC). Reseksi tumor dilakukan selama 6 jam. Selama operasi hemodinamik relatif stabil, tekanan darah sistolik berkisar 90–110 mmHg, tekanan darah diastolik 60-80mmHg, laju nadi 50–70 x/mnt, SaO2 99–100 %, etCO2 30 mmHg. Pascaoperasi pasien masih dengan ventilasi kontrol di rawat di ruang perawatan intensif. Berbagai pendekatan bedah telah dikemukakan untuk tumor ventrikel III posterior dan regio pineal. Pilihan pendekatan dipengaruhi oleh lokasi tumor, temuan patologi, dan kenyamanan dokter bedah serta pertimbangan resiko komplikasi. Management of Anesthesia for Pineal Body Tumor Resection in the Sitting Position The development of micro-surgery techniques are advancing and the development of neuroanesthesia and critical care are growing increasingly sophisticated making aggressive tumor resection as an option for the management of tumors located in the pineal and third ventricle region. A 49 years old male with a pineal body tumor after Ventriculo-Peritoneal shunt, underwent a craniotomy tumor resection surgery conducted in a sitting position. The patient complained of severe headache which was reduced by drugs, however relapsed again. Blurred vision, staggering, nausea, vomiting, ringing in the ears, were experienced in March 2013. Surgery performed with general anesthesia in the sitting position, using non kinking endotracheal tube size 7.5 under controlled ventilation. Nasogastric tube no.16 was inserted for decompression. Premedication with midazolam 2 mg iv, dexamethasone 20 mg iv. Co induction using fentanyl 100 mcg iv, induced with propofol 200 mg iv. Facilities intubation with rocuronium 0.9 mg/KgBW. Maintenance of anesthesia with sevoflurane + O2 + air with oxygen fraction 50%. Continuous propofol 100–200 mg/hour, and vekuronium 6 mg/h were given. Monitoring vital signs (BP, HR, SaO2, ECG), etCO2, arterial line and CVC. Tumor resection was performed in 6 hours. Relatively stable hemodynamics during surgery, systolic blood pressure ranged within 90–110 mmHg, diastolic blood pressure of 60-80 mmHg, heart rate 50–70 x/min, SaO2 99–100%, etCO2 30 mmHg. Postoperatively the patient was managed in the ICU under controlled ventilation. Various surgical approaches have been put forward for the posterior third ventricular tumor and pineal region. Choice of approach is influenced by the location of the tumor, pathological findings, surgeon comfort and risk of complications

Keywords

• tumor pineal body
• posisi duduk
• pineal body tumors
• sitting position