Penatalaksanaan Anestesi pada Operasi Orif E.C Fraktur Ankle pada Pasien dengan Fraktur Servikal

Background. Cervical fracture occurs approximately 5-10 % of the patients who come to the ER in an unconscious state. Most fractures of the cervical spine occurs in 2 levels. One third of the fractures occurred at the level of C2 and 2/3 others occur at the level of C6 or C7.
Cases. It is reported that a management of anesthesia in ORIF surgery on male 22 years of age with an open fracture of the bimaleoler of left ankle, with cerebral edema and IV cervical fracture . Anesthesia was done with peripheral nerve block technique that is a combination of a femoral nerve block and nerve block distal sciatik . In the femoral nerfus blocks, local anesthetic drugs such as lidocaine 1% 20 cc is used and in the distal nerve block sciatik a local anesthetic drugs such as isobaric bupivacaine 0.5 % 25 cc give . The operation lasted for 3 hours 20 minutes. Durante operation, the hemodynamic was stable . Systolic blood pressure ranged from 100-125 mm Hg, diastolic 65-80 mm Hg , heart rate 70-95 x / min . Bleeding around 100 cc and 200 cc of urine output. Post surgery the patient returned back to the ward.

Latar Belakang. Fraktur cervical kira-kira terjadi ada 5-10% pasien yang datang ke Instalasi Gawat Darurat dalam keadaan tidak sadar. Kebanyakan fraktur cervical tersebut terjadi pada 2 level. Sepertiga dari fraktur terjadi pada level C2 dan 2/3 lainnya terjadi pada level C6 atau C7.
Kasus. Dilaporkan penatalaksanaan anestesi pada operasi ORIF terhadap seorang laki-laki umur 22 tahun dengan fraktur terbuka bimaleoler dari ankle kiri, dengan oedem cerebri dan fraktur cervical IV. Anestesi dilakuan dengan teknik blok saraf perifer yaitu kombinasi blok nervus femoralis dan blok nervus sciatik distal. Pada blok nerfus femoralis digunakan obat anetesi local berupa lidocaine 1% 20 cc dan pada blok nervus sciatik distal diberikan obat anestesi local berupa bupivacaine 0,5% isobaric 25 cc.
Operasi berlangsung selama 3 jam 20 menit. Durante operasi hemodinamik stabil. Tekanan darah sistolik berkisar 100-125 mmHg, diastolic 65-80 mmHg, frekuensi jantung 70-95 x/menit. Perdarahan sekitar 100 cc dan urine output 200 cc. Post operasi pasien kembali ke bangsal