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LEMBAR PENGESAHAN

Laporan Kasus dengan Judul :


Manajemen Anestesi pada Subdural Hemorrhage

Telah dipresentasikan oleh Andi Hermawan pada :


Hari

Tanggal

Waktu

Tempat: di ruang ilmiah SMF Anestesi dan Terapi Intensif


RSUD dr. Moewardi Surakarta

Surakarta,
Pembimbing

dr. Ardana Tri Arianto, M.Si Med, Sp.An

Laporan Kasus
Manajemen Anestesi pada Subdural Hemorrhage
Andi Hermawan, Ardana Tri Arianto, MH Soedjito
Departemen Anestesiologi dan Terapi Intensif
Fakultas Kedokteran Universitas Sebelas Maret
RSUD Dr. Moewardi
Abstrak
Subdural Hemorrhage (SDH) adalah perdarahan yang terjadi diantara duramater dan
arachnoid. Patofisiologi SDH terbagi menjadi tiga fase yaitu fase akut, fase sub akut, dan fase
kronik. Tindakan operasi dari SDH menunjukkan prognosis baik dimana 90% dapat kembali
seperti semula.
Seorang laki-laki 83 tahun datang dengan keluhan kelemahan anggota gerak sebelah
kiri sejak seminggu sebelum masuk rumah sakit, disertai riwayat hipertensi, dan tidak
didapatkan riwayat trauma sebelumnya. CT scan kepala tanpa kontras didapatkan subdural
hematom kronis regio frontotemporoparietalis dextra volume 70 ml yang menyempitkan
ventrikel lateralis dextra dan menyebabkan oedema cerebri dan hernia centralis dengan
midlineshift 1 cm. Dilakukan operasi craniotomi evakuasi. Operasi berlangsung 1 jam 30
menit. Hemodinamik selama operasi stabil. Paska operasi pasien dirawat di unit intensif
dengan napas spontan. Hemodinamik di Intensive Care Unit (ICU) stabil dan pasien sadar
penuh pada perawatan hari pertama di ICU.
Kata kunci : SDH, craniotomy, neuroanestesi
Abstract
Subdural hemorrhage (SDH) is bleeding that occur between duramater and
arachnoidmater. Patophysiology of SDH is divided into three phases which were acute,
subacute, and chronic phase. The prognosis for SDH operation is very good. Almost 90% of
patients will return to their previous condition.
An 83 years old man came to the hospital complaining about weakness in his upper
and lower left extremities since one week before admitting. He had history of hypertension
but never had trauma before. His contrast brain CT showed chronic SDH in
frontotemporoparietale region. The volume was 70 ml and constricted the right lateral
ventricle. It also caused cerebral edema and centralis herniation with 1 cm midline shift.
Evacuation craniotomy was done. The operation run for 1 hour and 30 minutes. The
hemodynamic during the operation was stable. After the operation the patient was treated in
Intensive Care Unit (ICU) with spontaneous breathing. The hemodynamic was stable and the
patient was fully awake in his first day care in the ICU.
Key word : SDH, craniotomy, neuroanesthesia

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DAFTAR ISI
Halaman
Lembar Pengesahan................................................................................................ i
Abstrak...................................................................................................................

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Daftar Isi................................................................................................................

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Daftar Gambar ......................................................................................................

iv

Daftar Singkatan ...................................................................................................

BAB I.

Pendahuluan..........................................................................................

BAB II. Tinjauan Pustaka...................................................................................

BAB III. Laporan Kasus......................................................................................

33

BAB IV. Pembahasan..........................................................................................

41

BAB V. Ringkasan..............................................................................................

47

Daftar Pustaka.......................................................................................................

48

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DAFTAR GAMBAR
Halaman
Gambar 1. Ruptur bridging vein .............................................................................. 2
Gambar 2. Subdural hematoma ............................................................................... 3
Gambar 3. SCALP .................................................................................................. 6
Gambar 4. Meningen ............................................................................................... 9
Gambar 5. Lobus-lobus Otak .................................................................................. 10
Gambar 6. Cairan cerebrospinalis ........................................................................... 11
Gambar 7. Glasgow Coma Scale ............................................................................ 18
Gambar 8. Gambaran crescent shape yang hiperdens dan bilateral ........................ 20
Gambar 9. Potongan axial pada hematoma subdural akut ...................................... 21
Gambar 10. SDH kronik setelah 3 minggu ............................................................ 22
Gambar 11. SDH kronik pada potongan coronal ................................................... 23
Gambar 12. MRI (T1-W) SDH hemisfer kiri ......................................................... 25
Gambar 13. SDH bilateral potongan coronal ......................................................... 25

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DAFTAR SINGKATAN
CBF

Cerebral Blood Flow

CFR

Case Fatality Rate

CMR

Cerebral Metabolic Rate

CPP

Cerebral Perfusion Pressure

CRT

Capillary Refill Time

CSS

Cairan Cerebro Spinalis

CSF

Cerebrospinal Fluid

FLAIR

Fluid Attenuation Inversion Recovery

GCS

Glasgow Coma Scale

ICP

Intra Cerebral Pressure

ICH

Intra Cerebral Hemorrhage

MAP

Mean Arterial Pressure

MRI

Magnetic Resonance Imaging

SDH

Subdural Hemorrhage

SDV

Suara Dasar Vesikuler

TMD

Thyromental Distance