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Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi of Fallot (Anesthesia Management For Brain Abscess Drainage Patient With Tetralogyof Fallot)

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Tetralogy of Fallot (TOF) was jirst described in 1888 by a French physician named Etienne-Louis Arthur Fallot. Tetralogy of Fallot (TOF) is one type of cyanotic congenital heart defect most widely found. Tetralogy of Fallot (TOF) has four abnormalities: (1) pulmonary infundibulum stenosis, (2) VSD (Ventricular Septal Defect), (3) overriding aorta, and (4) right ventricular hypertrophy. Patients with congenital cyanotic heart disease (right to left shunt) have a risk of brain abscess. The incidences of cyanotic heart disease is about 12.8-69,4% of all cases of brain abscess and the highest incidenee occurs in children.
We reported an 8-years old 16-kg boy with multiple brain abscesses accompanied with cyanotic congenital heart defect Tetralogy of Fallot (TOF) and whom abscess aspiration would be performed. Patients was present with body temperature 39°C, GCS 13, blood pressure 90/50 mmHg, pulse 120 beats/min, SpO2 90% with a simple mask using oxygenation of 6 Llmin. Lab results showed Hb 14gr% hematocrit 41% platelet count 250.000/mm3, PT /aPTT: 13.2/26.9. Patient was mounted infusion from the emergency ward (ER), given 1 mg intravenous midazolam premedication, induction with propofol, fentanyl, vecuronium, maintenance with oxygen-air anesthesia and sevoflurane. The operation lasted for 1.5 hours, the infusion targeted to normal volume, postoperative care was given in the neurointensive care unit for 3 days.
Pre-surgical fasting plan pZays an important role because the patient must remains well hydrated. TOF patients with polycythemia when dehydrated, will increase the viscosity and sludging events. This patient was well hydrated and fasting replacement fluid therapy was given intravenously. Patients should be in a state of calm and relaxed. Patient was given intravenous midazolam premedication. Premedication with intramuscular injections shouZd be avoided, since anxiety and stress may lead to "tet" spell. Heavy premedication should also be avoided because of respiratory depression leading to hypercarbia can increase the Pulmonary Vascular Resistance (PVR) and precipitate increased shunting from right to the left. Cerebral abscess aspiration can not be performed uhder local anesthesia because it increases the anxiety and the patient's blood pressure. Anesthesia should be performed under general anesthesia.
Management of perioperative TOF patients who will underwent surgery elsewhere (not for TOF) requires deep understanding on TOF pathophysiology and neuro-anesthesia techniques to get a good outcome.
Key words: Anesthesia, Tetralogy of Fallot, Abscess Drainage.

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Series Title

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Call Number

Jurnal Neuroanastesia Indonesia, 1 (2) 2012 : 76-8

Publisher

Jakarta : Indonesian Society of Neuroanesthesia & Critical Care INA_SNACC., 2012

Collation

5p

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ISBN/ISSN

2088-9670

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Subject(s)

anesthesia
tetralogy of fallot
BRAIN ABSCESS

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