MANAJEMEN ANESTESI PADA PASIEN GAGAL GINJAL KRONIS DENGAN KRISIS HIPERTENSI: STUDI KASUS

Abstract

Manajemen perioperatif pada pasien gagal ginjal kronis (GGK) yang disertai dengan penyakit penyerta krisis hipertensi merupakan tantangan klinis yang kompleks. Team anestesi harus mempertimbangkan dengan matang manajemen perioperatif, dalam pemilihan obat anestesi, dan manajemen cairan selama operasi, terhadap efek penurunan fungsi ekskresi ginjal pada pasien penyakit gagal ginjal kronik. Seorang laki-laki dengan gagal ginjal kronis dan hemodialisis rutin 1 minggu 2x dan sudah menjalani hemodialisis selama 60 th, di jadwalkan ORIF clavicula kanan, riwayat hipertensi. Status fisik diklasifikasikan sebagai ASA IV manajemen anestesi dilakukan dengan general anestesi dengan pemasangan LMA (laringeal mask airway) dan obat-obatan yg diberikan SA 0,25 mg, fentanyl 100 mcg recofol 50mg, pemeliharaan sevoflurane 2%, N20 + oksigen dengan kosnsentrasi 2 lt/menit dengan perbandingan (50;50) obat intra operasi ondan 4 mg, santagesic 1 gr dan terpasang nikardipine kontinu 3 mg/jam. Operasi ORIF berlangsung selama 45 menit. Selama prosedur, hemodinamik pasien terpantau stabil dengan rata-rata nadi 86-89 x/menit dan tekanan darah terkontrol 130-149 mmHg dengan nicardipin kontinyu 3 cc/jam (3 mg/jam). Tidak ada kendala intra operasi,  tekanan darah tertinggi 146/84 mmHg. Pasca operasi pasien dipindahkan di ruang pemulihan.

Perioperative management of patients with chronic kidney disease (CKD) accompanied by concomitant hypertensive crisis is a complex clinical challenge. The anesthesia team must carefully consider perioperative management, the selection of anesthetic drugs, and fluid management during surgery, taking into account the effects of reduced renal excretory function in patients with chronic kidney disease. A male patient with chronic kidney disease undergoing routine hemodialysis twice a week for 60 years was scheduled for right clavicle ORIF. His physical status was classified as ASA IV. Anesthesia management was performed using general anesthesia with the placement of an LMA (laryngeal mask airway) and the administration of the following medications: SA 0.25 mg, fentanyl 100 mcg, recofol 50mg, maintenance with sevoflurane 2%, N2O + oxygen at a concentration of 2 L/min with a ratio of 50:50. Intraoperative medication: 4 mg of ondan, 1 g of santagesic, and continuous administration of 3 mg/hour of nicardipine. The ORIF surgery lasted 45 minutes. During the procedure, the patient's hemodynamics were monitored and remained stable with an average pulse of 86-89 beats per minute and controlled blood pressure of 130-149 mmHg with continuous nicardipine 3 cc/hour (3 mg/hour). Highest intraoperative blood pressure was 146/84 mmHg. Postoperatively, the patient was transferred to the recovery room.