GAGAL SPINAL PADA PASIEN OPERASI AMPUTASI TRANSFEMORAL DENGAN DEBRIDEMEN DAN PENATALAKSANAANNYA

Seorang laki-laki usia 65 tahun mengalami kecelakaan lalu lintas 12 jam yang lalu dengan crush injury di regio femur dan cruris dekstra, akan dilakukan tindakan transfemoral amputation dan debridement oleh TS Orthopedi. Pasien telah dipuasakan 8 jam. Pasien dengan Hb 8,4 telah masuk komponen darah 2 PRC dan hemodinamik stabil. Pasien dimonitor di ruang HCU (High Care Unit). Vital Sign, pre operasi, T: 110/55, N: 110x/m, RR: 22x/m, SpO2: 97%. Akan dilakukan teknik regional anestesia blok spinal. Preloading cairan RL 500 ml, Analgetik: Fentanyl 25 mcq intravena, pasien posisi sitting position, dilakukan spinal anestesia di L4-L5, LCS (+), darah (-), obat Bupivacaine 0,5% hiperbarik 15 mg + fentanyl 25 mcq, dilakukan aspirasi, barbotage sampai dengan 4 cc. kemudian pasien diposisikan supine. Dilakukan pin prick, blok sensorik (-), blok motorik (-), dievaluasi ulang 10 menit, hanya muncul kesemutan. Blok dinyatakan gagal dilakukan konversi ke anestesi umum LMA. Durasi operasi 2 jam, pasien post operatif di ruang HCU.

A man 64 years old had a traf c accident 12 hours ago, resulting in crush injury on regio left femur and cruris. This man has fasted and for 8 hours and was planned to undergo debridement and transfemoral amputation surgery by orthopedics. The hemodynamic pro le of this patient preoperative: stable with HB 8.4, had two colfs of PRC blood transfusion. Vital sign BP 110/55, HR 110x/minute, RR 22x/minute, SpO2 97%. The anesthesia technique planned for the surgery is spinal block anasthesia. Fluid preloading RL 500 ml, intravenous analgesics fentanyl 25 mcq, sitting position, spinal anesthesia L4-L5, CSF (+), blood (-), agent: bupivacaine 0,5 % hyperbaric 15 mg + fentanyl 25 mcq, aspiration (+) barbotage until 4cc. Thus, supine position after spinal anesthesia. Pin Prick result, Sensoric test (-), Motoric Bromage 0, evaluated until 10 minutes, just parasthesia. Pin prick, result sensoric test no sensoric. Block declared failed, conversion to General Anesthesia LMA. Operation held for 2 hours, post-operative patient transfers to High Unit Care.