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Subdural Hematom Dengan Atrial Fibrilasi Dan Penyakit Jantung Hipertensi (Subdural Hematom In Patient With Atrial Fibrilation And Hypertensive Heart Disease)

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Traumatic Brain Injury (TBl) is one of the serious life-threatening condition in trauma victim, and as the major cause of disability and death in adult and children. Subdural hematoma is the most often focal intracraniallesion found, with the incidence of 24% in elose head injury cases. Approximatelly 6-24% of Atrial Fibrilation (AF) contributes to ischemic stroke and sudden death because of heart failure.
We reported a 63 years old female, diagnosed with subdural hematoma of the right temporoparietal, atrial fibrillation and hypertensive heart disease, who arrivde at the hospital with history of unconsciousness, and severe headache due to motor vehiele accident, and undergone a craniotomy elot evacuation and reposition fixation of the fractured bones. The procedure was performed under general anesthesia, using ETT No 7,5., controlled ventilation. NGT no 16 was inserted for gastric decompression. Two mg of Midazolam and 1,5 mglKgBW of lidocain given intravenously 3 minutes prior to intubations was used as premedications, 100 µg intravenou Fentanyl, was given as co induction. Induction anesthesia was performed using 100 mg propofol and 0,1mglKgBW vecuronium to facilitate intubations. Maintenance of anesthesia was obtained using O2, N2O, sevofiorane, continuous drip of 100 mg/hour propofol, 6mg/hour vecuronium,and 0,25mg/24hours of digoxin continuous drip was given. The procedure was done in 4 hours. During the operation, haemodynamic remained stable with SBP 130 - 150 mmHg, DBP 70-90 mmHg, HR 90-110 bpm irregular and SaO2 99-100% EtCO2 level was 30-33. The patient was not extubated by end of surgery, because ECG monitor showed VES bigemini and rapid ventricular response of AF. The patient was directly transferred to the ICU after the procedure.
Decreased in brain tissue oxygenation is the physiological impact of body system. Hypertension, arrhythmia, hyperglycemia, hyperthermia and hypernatremia can occur due to sympathetic storm. The most common arrhythmias that could occur are bradycardia, ectopic beat, irregular beat, atrial jibrillation and supraventricular tachycardia. Arrhythmias due to myocardial infarction or thromboemboli (AF and SVT) must be treated immediately when considered as a life threatening condition which provokes a hemodynamic instability and cerebral hypoxia Optimal pre-operative management including oxygenation, cardiorespiration stabilization, Jrrhythmia managemen and, adequate fiuid status, will improve the outcome.
Keywords: Traumatic Brain Injury, Subdural Hematom, Atrial Fibrilation, Hypertensive Heart Disease.

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Detail Information

Series Title

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Call Number

Jurnal Neuroanastesia Indonesia, 1 (3) 2012 : 178-

Publisher

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

Collation

11p

Language

ISBN/ISSN

2088-9670

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Edition

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Subject(s)

heart diseases
ATRIAL FEBRILLATION
HEMATOMA, SUBDURAL

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