MANAJEMEN ANESTESI CEDERA VERTEBRA CERVICAL 4,5 DENGAN TINDAKAN LAMINEKTOMI DEKOMPRESI STABILISASI

Preoperative management of cervical fractures of particular concern include the level of injury, onset of occurrence and cardiorespiratory complications. Then continued the de nitive management of laminectomy requiring inline position intubation positions, invasive arterial line monitors and CVC, durante vasoactive drug support in case of hemodynamic decline. Equally important is postoperative intensive care, and treatment of complications of pneumonia, DVT, sepsis due to long immobilization.

Treatment of a 54-year-old male patient with a diagnosis of VC IV-V compression fracture, tetraplegi and increased transaminase enzyme. Patients were initially treated in HCU LOC 2 for 10 days with drug support and hemodynamic monitoring, then de nitive elective laminectomy, decompression, stabilization. The operation lasted for approximately ve hours with bleeding approximately 1200cc, urine output 2.5 cc / kgBW / hour. Post surgery patients treated in ICU with attached tracheostomy, connected with ventilator and vasoactive drug support. During treatment in ICU, hemodynamic monitoring with arterial line, ECG, pulse oximetry, temperature monitor and CVC were performed. Patients are positioned in line mobilization, ureter catheter installed and NGT.

Hemodynamic, blood pressure during ICU ranged from syst 100-110 mmHg, diastole blood pressure 50-80 mmHg, pulse 90-110 x / minute and saturation 93-100%. With supportive therapy of ceftriaxone injection, methylprednisolone, fentanyl, mecobalamin, omeprazole, and dobutamine and norepinephrine continue. The patient was treated for 5 days and after stabilizing the patient was returned to the ward.

Pengelolaan preoperatif fraktur cervical perlu perhatian khusus meliputi level cedera,onset kejadian dan komplikasi kardiorespirasi. Kemudian dilanjutkan penatalaksanaan de nitif laminektomi yang memerlukan intubasi posisi inline, monitor invasif arteri line dan CVC, support obat-obatan vasoaktif durante bila terjadi penurunan hemodinamik. Yang tidak kalah penting adalah perawatan intensif post operatif, dan penanganan komplikasi pneumonia, DVT, sepsis akibat immobilisasi lama.

Telah dilakukan perawatan terhadap seorang pasien laki-laki umur 54 tahun dengan diagnosis fraktur kompresi VC IV-V, tetraplegi dan peningkatan enzim transaminase. Pasien awalnya dirawat di HCU LOC 2 selama 10 hari dengan support obat dan pengawasan hemodinamik, lalu dilakukan tindakan de nitif elektif laminektomi, dekompresi, stabilisasi. Operasi berlangsung selama kurang lebih lima jam dengan perdarahan kira-kira 1200cc, urine output 2,5 cc/kgBB/jam. Post operasi pasien dirawat di ICU dengan terpasang tracheostomi, dihubungkan dengan ventilator dan support obat vasoaktif. Selama dirawat di ICU dilakukan monitoring hemodinamik dengan arteri line, EKG, pulse oksimetri, monitor suhu dan CVC. Pasien diposisikan in line mobilisasi, dipasang kateter urine dan NGT.

Hemodinamik, tekanan darah selama di ICU berkisar sistol 100-110 mmHg, tekanan darah diastol 50-80 mmHg, nadi 90-110 x/menit dan saturasi 93-100%. Dengan terapi suportif injeksi ceftriaxon, metilprednisolon, fentanyl, mecobalamin, omeprazole, serta dobutamin dan norepinefrin continue. Pasien dirawat selama 5 hari dan setelah stabil pasien dikembalikan ke bangsal.