Penerapan Prinsip Enhanced Recovery After Surgery (ERAS) Terpilih pada Manajemen Anestesi Pasien Geriatri dengan Akut Traumatik Subdural Hematom yang Menjalani Kraniotomi Evakuasi Hematom
Keywords:
ERAS, Geriatri, perdarahan subduralAbstract
Pendahuluan: Perdarahan subdural merupakan jenis cedera yang paling sering terjadi pada geriatri dengan angka morbiditas dan mortalitas yang tinggi. Penurunan fungsi organ seiring bertambahnya usia menyebabkan disfungsi organ yang dapat berpengaruh pada farmakokinetik dan farmakodinamika dari obat anestesi.
Kasus: Pasien perempuan 74 tahun datang dengan keluhan nyeri kepala paska terjatuh kepala terbentur 1 jam sebelum masuk rumah sakit. Pada pemeriksaan fisik didapat kesadaran composmentis tanpa ada defisit neurologis dan hemodinamik stabil. Dari pemeriksaan penunjang CT-scan kepala ditemukan subdural hematoma di regio frontotemporal parietooccipital dextra dengan midline shift. Operasi kraniotomi evakuasi hematom dilakukan selama 60 menit dengan anestesi umum.
Diskusi: Pada kasus ini diterapkan beberapa prinsip ERAS terpilih dalam manajemen anestesi, meliputi penggunaan agen anestesi kerja singkat dengan dosis terukur pada geriatri, kontrol ventilasi dan hemodinamik yang optimal, serta ekstubasi dini untuk memungkinkan evaluasi neurologis segera.
Simpulan: Implementasi sebagian komponen ERAS dapat berkontribusi terhadap percepatan pemulihan dan peningkatan luaran pada pasien geriatri dengan subdural hematoma yang menjalani kraniotomi
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References
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