MANAJEMEN ANESTESI PADA OPERASI REVASKULARISASI MIOKARDIUM

At least there had been more than 70.000 cardiovascular surgeries were been conducted in United States at 1997, and 60.000 amongst them were CABG. Anesthesia in cardiovascular surgeries were interesting and challenging matter for an anasthesiologist. One of the principal in anasthesia for revascularization heart surgery was to maintain the balance of two important factors: maintain oxygen supply and lowering oxygen demand. The preperation of anasthesia in cardiovascular surgeries must be done carefully, including preperation of premedication, drugs of choice, drugs that need to be stopped, preperation of monitoring invasivelly and non invasivelly. Induction has to be monitored and signi cant hemodinamic changes need to be avoided. After anasthesia was achieved, pasient who had conventional corronary revascularization must also had shunting of the vessel with cardiopulmonary bypass device. The cardiopulmonary bypass device purpose is to avoid blood ow from body not pass trough cardio pulmonary ow. When the operation was near to nished, stopping the CPB is needed for getting good result. There are several techniques to reduce in patient time of coronary cardio surgery such as, fastract and offbump coronary artery bypass (OPCAB)

Pada tahun 1997 di Amerika, setidaknya > 70.000 prosedur operasi jantung dilakukan tiap tahunnya, dan lebih dari 60.000 diantaranya adalah operasi coronary artery bypass grafting (CABG). Pembiusan pada operasijantungmerupakansuatuhalyangmenariksekaligusmenantangbagiseorangahlianestesi. Salah satu prinsip dasar dalam tindakan anestesi bedah revaskularisasi jantung adalah menjaga keseimbangan dua faktor penting, yakni menjaga pasokan suplai oksigen, dan menurunkan kebutuhan / demand oksigen. Persiapan pembiusan pada operasi jantung harus dilakukan dengan matang, mulai dari persiapan premedikasi, pilihan obat yang harus diberikan atau dihentikan, persiapan monitor baik invasif maupun non invasif. Induksi dilakukan dengan pengawasan monitor dan gejolak hemodinamik yang signi kan sebisa mungkin dihindari dengan pemilihan obat dan penyesuaian terhadap pasien. Setelah teranestesi, pasien yang mengalami prosedur opersi revaskularisasi koroner konvensional harus mengalami proses shunting aliran darah dengan alat cardiopulmonary bypass (CPB) yang ertujuan agar aliran darah dari seluruh tubuh tidak melewati aliran jantung paru. Menjelang operasi selesai, penyapihan CPB perlu dilakukan agar mendapatkan hasil postoperasi yang baik. Beberapa teknik dikembangkan untuk mengurangi lama waktu rawat operasi jantung koroner, yakni teknik fastrack dan offpump coronary artery bypass (OPCAB).