Penatalaksanaan Anestesi pada Operasi Epilepsi

Rebecca Sidhapramudita Mangastuti, Sri Rahardjo, A Himendra Wrgahadibrata

Abstract


Kejang adalah perubahan fungsi otak secara mendadak dan sementara akibat aktifitas nueron yang abnormal sehingga terjadi pelepasan listrik serebral yang berlebihan. Aktivitas ini dapat bersifat parsial atau general, berasal dari daerah spesifik korteks serebri atau melibatkan kedua hemisfer otak. Kejang disebabkan oleh banyak faktor, yaitu penyakit serebrovaskuler (stroke iskemik, stroke hemoragik), gangguan neurodegeneratif, tumor, trauma kepala, gangguan metabolik, infeksi susunan saraf pusat (SSP) seperti ensefalitis, meningitis. Penyebab lain adalah gangguan tidur, stimulasi sensori atau emosi, perubahan hormon, kehamilan, penggunaan obat-obatan yang menginduksi kejang (teofilin dosis tinggi, fenotiazin dosis tinggi), antidepresan (maprotilin atau bupropion), kebiasaan minum alkohol. Berdasarkan International League Against Epilepsy (ILAE) dan International Bureau for Epilepsy (IBE) pada tahun 1981, epilepsi adalah suatu kelainan otak yang ditandai adanya faktor predisposisi yang dapat mencetuskan bangkitan epileptik, perubahan neurologis, kognitif, psikologis dan adanya konsekuensi sosial yang diakibatkannya. Diagnosa epilepsi ditegakkan melalui anamnesa, pemeriksaan fisik dan electroencephalography (EEG). Umumnya, epilepsi diterapi dengan obat antiepilepsi atau anti konvulsan. Apabila kejang tidak teratasi dengan obat oral, dapat dilakukan terapi invasif atau pembedahan, berupa non brain epilepsy surgery atau brain epilepsy surgery. Di Inggris, diperkirakan 0,5–2% total penduduk, menderita epilepsi, dimana 13% memerlukan terapi invasif atau pembedahan. Studi retrospektif, membuktikan, pengobatan invasif atau pembedahan pada epilepsi yang tidak respons terhadap obat oral, telah berhasil mengurangi serangan kejang. Penatalaksanaan anestesi pada epilepsi merupakan tantangan tersendiri bagi dokter anestesi. Diperlukan pemilihan gas, anestetika intravena dan teknik anestesi yang tidak memicu serangan kejang selama operasi. Interaksi dan efek samping obat anti epilepsi harus diperhitungkan saat anestesi.

Anesthesia Management on Epilepsy Surgey

Seizures are sudden changes in brain function and activity of abnormal neuron activity causing cerebral excessive electrical discharges. May be partial or general, comes from a spesific region of the cerebral cortex or both hemispheres. Caused by cerebrovascular disease (ischemic stroke, hemorrhagic stroke), neurodegenerative disorders, tumors, head trauma, metabolic disorder, central nervous system infection (encephalitis, meningitis). Another factor are sleep disorder, sensory of emotional stimulation, hormonal changes, pregnancy, use of drugs induce seizures (theophyline high-dose, phenothiazine high-dose), antidepresants (maprotilin or bupropion), drinking alkohol.

International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) in 1981, epilepsy is a brain disorder that can trigger epileptic seizures, neurological changes, cognitive, psychological and social consequences resulting. Diagnose is anamnesa, physical examnination and electroencephalography. Treated with antiepileptic drugs or anticonvulsant. If the seizures are not resolved, can be invasive or surgical therapy (non brain epilepsy surgery or brain surgery). In UK, 0,5 - 2% suffer from epilesy, 13% require surgical therapy. A retrospective study, prove that invasive treatment has succeeded. Management of anesthesia is a challenge for anesthesiology. Election necessary gas, intravenous and anesthesia techniques that do not trigger a seizure. Interaction and side effects of anti epileptic drugs should be calculated.

 


Keywords


anestesi; epilepsi; kejang; anesthesia; epilepsy; seizures

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DOI: http://dx.doi.org/10.24244/jni.vol5i2.64

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DOI:  https://doi.org/10.24244/jni 

pISSN: 2088-9674 | eISSN: 2460-2302

 

 

 

 

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