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Penatalaksanaan Anestesia Pada Pasien Cretin Dengan Hipopituitarisme Sekunder Akibat Kraniofaringioma (Anesthesia Management in Cretin Patient With Hypopitutarism Secondary of Craniopharyngioma)

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Craniopharyngioma is a sellar and parasellar tumor, which accounts to 6-10% of childhood brain tumors. Common symptoms are signs of increase intracranial pressure, like headache, vomiting and visual dysfunction. A signijicant endocrine dysfunction is an usual feature of craniopharyngioma due to the proximity of the tumor to hypothalamus and pituitary gland. Short statue found in 50-86% patient with subnormal growth rates and delayed puberty.
AmaIe, 20 yrs cretin patient with hypopituitarism secondary of craniopharyngioma had a craniotomy tumor removal and placement of omaya shunt. He had a history of headache since 13 yrs ago accompanied by visual disturbance, started from his left eye, now he is totally blind. H e also suffered from growth failure and delayed puberty, has a physic of a boy regardless his age as 20 yrs old adult, with height 140 cm and weight 40 kg. He has an elevated TSHs but normal T3 and fT4, a decreased LH and FSH, a normal prolactin, a normal but low growth hormon and a decreased cortisol. Anesthetic technique used was general anesthesia. Induction was done with fentanyl, pentotal, lidocaine and vecuronium with a mixture of N2O/O2 and isoflurane. Anesthesia was maintained with isoflurane and a mixture of O2/air. Patient was in controlled breathing with an incremental dose of vecuronium to maintaine the relaxation. Mannitol and furosemide were given to reduce intracranial pressure. The procedure took about 5 hours. After 5 days lCU stayed, the patient was referred back to his room at Kemuning.
The problems in this patient are a raised of intracranial pressure, an endocrine dysfunction and a possibility of airway difficulty related to his short statue. Corticosteroid as hormone replacement therapy was given before the operation. Based on his short statue, induction dose of anesthetic agents were adjusted and smaller laryngoscope blade and endotracheal tube were used for intubation. Avoidance of nitrous oxide, low concentration of volatile agent and dominant used of intravenous anesthetic agent were applied during the operation. Post operative monitoring was done in lCU with specijic concern of hormone complications like diabetes insipidus and hyponatremia beside post operative pain control.
Patient with pituitary disease, in this case craniopharyngioma, accompanied by endocrine dysfunction and abnormal growth, need a very careful treatment from preoperative, intraoperative to postoperative period. A good management and cooperation between anesthesiologist, surgeon and endocrinologist can reduce the morbidity and mortality in this kind of d{sease.
Key word: cretin, hypopituitarism, craniopharyngioma

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Series Title

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Call Number

Jurnal Neuroanastesia Indonesia, 1 (3) 2012 : 197-

Publisher

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

Collation

6p

Language

ISBN/ISSN

2088-9670

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Edition

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Subject(s)

PATIENT
ANASTHESIA
HYPOPITUITARISM
CRANIO PHARYNGIOMA

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