Manajemen Anestesi pada Pasien dengan Hernia Diafragmatika Kongenital

Congenital diaphragmatic hernia results from the anomalous closure of pericardioperitoneal canal. There are various challenges faced by anesthesiologists during management of such cases which include intraoperative complications including hypoxia and hypercarbia. Mortality remains high because of associated pulmonary hypoplasia and pulmonary hypertension. Here, we describe anesthetic management of a 7-days-old child with difficulty in breathing since birth, due to congenital diaphragmatic hernia who underwent diaphragmatic hernia repair. Patient came to hospital with breathing problem and was diagnosed as pneumonia. Patient was then intubated and from x-ray it was found that the patient has congenital diaphragmatical hernia. Preoperative assessment shows that the patient was in normal condition. A general anesthesia procedure was conducted to the patient with controlled breath intubation. A monitoring was held with NIBP, ECG, SpO2. The surgery lasted 2 hours. Durante surgery, the haemodynamic was stable. Post surgery the patient was still intubated and taken care in NICU. He was still stable and laboratory test shows normal result.

Hernia diafragmatika kongenital disebabkan oleh defek penutupan canalis pericardioperitoenal. Merupakan suatu tantangan tersendiri bagi dokter anestesi selama manajemen perioperasi pasien dengan hernia diafragmatika seperti komplikasi intraoperasi termasuk hipoksia dan hiperkarbia. Mortalitas tetap tinggi karena hipoplasia pulmonal dan hipertensi pulmonal. Kita akan membahas kasus seorang bayi laki-laki usia 7 hari dengan diagnosis hernia diafragmatika kongenital telah menjalani operasi laparotomi repair tutup defek diafragma. Pasien datang dengan sesak nafas dan terdiagnosa sebagai pneumonia. Pasien kemudian dilakukan intubasi dan dari pemeriksaan rontgen dada ditemukan hernia diafragmatika. Penilaian preoperatif menunjukkan pasien masih dalam kondisi yang optimal. Dilakukan anestesi teknik GA intubasi nafas kendali. Monitoring dilakukan dengan NIBP, EKG, SpO2. Operasi berlangsung 2 jam. Durante operasi hemodinamik stabil. Pasca operasi pasien masih terintubasi dan dirawat di NICU. Pasca operasi pasien tetap stabil dan uji laborat menunjukkan hasil dalam batas normal.