Manajemen Anestesi pada Pasien dengan Glioma Multipel di Rumah Sakit Otak M. Hatta Bukittinggi: Laporan kasus
Keywords:
Glioma multipel, neuroanestesi, Total Intravenous Anesthesia (TIVA)Abstract
Pendahuluan: Tumor supratentorial, khususnya glioma multipel (GM), merupakan kasus langka (2%–20% dari GBM) dan menimbulkan tantangan anestesi akibat peningkatan tekanan intrakranial (TIK). Tujuan anestesi meliputi neuroproteksi, pemeliharaan homeostasis serebral, dan pemulihan kesadaran cepat untuk evaluasi neurologis berdasarkan prinsip ABCDE neuroanesthesia.
Kasus: Seorang pria 47 tahun dengan nyeri kepala didiagnosis tumor multipel intrakranial suspek glioma di frontal sinistra dan parietooksipital dextra, kemudian menjalani kraniotomi reseksi tumor. Manajemen berfokus pada kontrol TIK dan analgesia multimodal. Premedikasi menggunakan deksametason dan gabapentin 600 mg, induksi dengan lidokain, midazolam, dan tiopental, sedangkan pemeliharaan menggunakan TIVA berbasis TCI propofol (model Schnider, Ce 3–4 µg/mL) dengan dexmedetomidine sebagai propofol-sparing. BIS dipertahankan 44–54 dan EtCO2 27–32 mmHg. Pasien diekstubasi segera tanpa komplikasi neurologis, mendapat analgesia paracetamol dan dexketoprofen, serta dipulangkan hari ke-5.
Diskusi: Pengendalian TIK dan pemeliharaan perfusi serebral merupakan aspek utama anestesi GM. TIVA propofol memungkinkan kontrol kedalaman anestesi dan pemulihan cepat, sedangkan dexmedetomidine mengurangi kebutuhan propofol serta mendukung stabilitas hemodinamik. Pengendalian ventilasi dan pemantauan BIS mendukung kondisi serebral optimal dan ekstubasi dini.
Smpulan: TIVA berbasis propofol dengan pemantauan neurofisiologis dan manajemen cairan yang tepat mendukung homeostasis serebral, kontrol TIK, perfusi serebral, dan kondisi optimal untuk reseksi tumor
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