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Penatalaksanaan Anestesi Untuk Tindakan Anterior Cervical Dissection Fussion Pada Pasien Dengan Fraktur Kompresi Vertebra Servikalls 5 (Anesthetic Management For Anterior Cervical Dissection'fussion Procedure In Patient With Compression Fracture of The 5th Cervical Spine)

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Trauma is still the most cause of death in the world. In America more than 90,000 people die because of trauma, mostly traffic accident and violence. Around 20% of the victim had multiple trauma and spinal cord injury. Around 55 % patient of spine injury was located at cervical part and 5% of patient with head injury should have spine injury. AmaIe, 21 years old, with spinal cord injury in complete lesion FrankIe C because of compression fracture of the 5th cervical spine undergone ACDF (Anterior Cervical Dissection Fusion) procedure. Seven days before enter the hospital, the patient has fell down from the roof. He was unable to move his hands and legs. The procedure was perform in general anesthesia, using ETT No 7,5, controlled ventilation. In line position while performed laringoscopy intubations. Fentanyl 100 µg intravenous, lidocain 1,5 mg/Kg 3 minutes before intubations has used as premedications. Induction of anesthesia was performed with propofol100mg and atracurium 0,5mglKg for intubations fa cilitation. Maintenance of anesthesia was used O2, N2O, Isoflurane and Propofol 100 mg/hour. During the operation, haemodynamic remain stable, systolic blood pressure 90 - 125 mmHg, diastolic blood pressure 42-78 mmHg, heart rate 62-82 bpm and SaO2 99 %. The patient was extubated in the operating theatre after the end of surgery. Post operative patient was transferred to the NCCU.
Anatomic structure of the cervical spine are thin, these make them vulnerable to injury. The spinal cord is vulnerable also when fracture of the spine occur. Spinal cord and the neuronal tissue may in jure from stretching, compression and laceration. Physical disruption of spinal cord can cause the complete and irreversible loss of function. The main principle in manage spine fracture do not worsen the existing spinal cord injury by protecting the spinal cord mechanically and chemically. Maintain the spinal cord blood flow and prevent the edema may improve the patient outcome. Early assessment for spine fracture including airway, breathing and circulation must be done, and resuscitation performed simultaneously. Excessive extension or axial traction must be avoided. Stabilization of the spine can be done by cervical collar or manual in line position during intubations. Prevent the spinal shock complication and further spinal cord injury. Use the anesthetic agent which has the spinal cord protection effect.
Key Word: Anesthesia, Cervical Spine Fracture, Spinal Cord Injury, Spinal Cord Protection

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Jurnal Neuroanestesia Indonesia 01 (01) 2012 : 1-9

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Bandung : Indonesian Society of Neuroanesthesia & Critical Care INA_SNACC.,

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9p

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2088-9670

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