Manajemen Neuroanestesi pada Operasi Carotid Endarterectomy: Pasien dengan Riwayat Stroke Berulang

• Published in: Jurnal Neuroanestesi Indonesia Vol. 10; no. 1; pp. 22 - 28
• Main Authors: Chrismas Gideon Bangun, RR. Sinta Irina, Dewi Yulianti Bisri, Eri Surahman
• Format: Journal Article
• Language: Indonesian
• Published: Indonesian Society of Neuroanesthesia & Critical Care (INA-SNACC) 01.02.2021
• Subjects: baroreceptor disruption; carotid endarterectomy; electroencephalogram; elektroensefalogram; gangguan baroreseptor; gejolak hemodinamik; hemodynamic turmoil; intraoperative monitoring; monitoring intraoperatif
• ISSN: 2088-9674; 2460-2302
• DOI: 10.24244/jni.v10i1.323

Carotid endarterectomy (CEA) adalah prosedur bedah yang dilakukan untuk memulihkan aliran darah karotis dan mengurangi kejadian stroke embolik dan trombotik. Walaupun merupakan prosedur preventif, CEA membawa risiko komplikasi perioperatif: neurologik dan kardiak. Komplikasi mayor CEA adalah stroke intra dan postoperatif, infark miokard, dan kematian. Untuk mengurangi angka kejadian stroke intraoperatif maka dikembangkan teknologi monitoring intraoperatif salah satunya dengan elektroensefalogram (EEG). Pada kasus ini pasien laki-laki, 62 tahun, dengan riwayat stroke iskemik berulang dan kelemahan tungkai kiri direncanakan untuk CEA dengan anestesi umum. Ahli bedah memutuskan untuk menggunakan shunt secara selektif dengan menilai monitoring EEG saat dilakukan clamping. Akhirnya shunt tidak jadi dilakukan, operasi berjalan selama 6 jam, diwarnai dengan gejolak hemodinamik yang sering terjadi pada pasien dengan penyakit karotis akibat gangguan baroreseptor. Dengan penanganan anestesi yang cermat selama dan sesudah operasi, operasi berhasil dilakukan, dan hasil postoperasi kekuatan motorik kaki kiri meningkat dari 2 ke 4.   Management Neuroanesthesia for Carotid Endarterectomy: Patients with a History of Recurrent Stroke Abstract Carotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.