Manajemen Anestesi dan Perawatan Intensif pada Pasien Guillain-Barré Syndrome dengan Gagal Napas akibat Kelemahan Otot Respirasi Progresif
Keywords:
Guillain-Barré Syndrome, gagal napas, ventilasi mekanik, anestesi, EGRISAbstract
Pendahuluan: Guillain-Barré syndrome (GBS) dapat berkembang cepat menjadi gagal napas akibat kelemahan otot respirasi dan disfungsi bulbar, sehingga identifikasi dini pasien berisiko tinggi penting untuk perencanaan perawatan intensif dan pengamanan jalan napas.
Kasus: Seorang laki-laki 42 tahun dengan kelemahan progresif keempat ekstremitas, baal, disartria, dan sesak memburuk hingga mengalami distress napas, gangguan oksigenasi, penurunan kesadaran, serta keterlibatan bulbar di ruang ICU. Pasien kemudian dilakukan intubasi terencana (fentanyl, propofol, dan rocuronium; suksinilkolin dihindari karena risiko hiperkalemia), dilanjutkan ventilasi mekanik, sedasi, terapi suportif, dan plasmapheresis serial hingga berhasil disapih dan diekstubasi.
Pembahasan: Kasus ini menegaskan pentingnya penilaian risiko respirasi sejak awal, termasuk Erasmus GBS Respiratory Insufficiency Score (EGRIS), sebagai pelengkap (bukan pengganti) penilaian klinis serial, fungsi bulbar, dan pemeriksaan fungsi respirasi bedside, serta pentingnya pemilihan obat anestesi yang tepat, ventilasi individual, imunomodulasi, dan weaning berbasis pemulihan fungsi.
Simpulan: Pada GBS dengan progresivitas cepat dan keterlibatan bulbar, EGRIS dapat memperkuat keputusan untuk melakukan pemantauan di ICU dan menyiapkan pengamanan jalan napas secara terencana. Pendekatan terpadu berpotensi mencegah keterlambatan intubasi dan komplikasi respirasi
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