Manajemen anestesi pada operasi koreksi deformitas skoliosis

Moses Wijaya; I Wayan Widana

doi:10.15562/ism.v13i2.1411

Manajemen anestesi pada operasi koreksi deformitas skoliosis

Moses Wijaya ,

I Wayan Widana ,

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DOI: https://doi.org/10.15562/ism.v13i2.1411 |
Published: 2022-08-29

Abstract

Background: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine with a bulge angle of at least 10°, with no underlying neuromuscular or congenital abnormality. Surgery is the best treatment for patients with AIS. The main goal of AIS surgery is to prevent progression due to fusion, but there are various potential risks, such as the postoperative period.

Case: The patient was a 26-year-old female patient with complaints of an misaligned spine. The patient was diagnosed with adolescent idiopathic scoliosis and planned for scoliosis deformity correction. The X-ray shows a thoracic curve with convexity to the right (7th thoracic vertebrae – 1st lumbar vertebra), Cobb angle 54 degrees, right Cobb bending angle 34 degrees, flexibility 20 degrees, left Cobb bending angle 70 degrees, flexibility 26 degrees. The operation was performed using the general anesthesia-orotracheal tube (GA-OTT) technique. After induction, the patient was placed in the prone position. Maintenance of anesthesia with O2, N2O, dexmetomidine, intermittent fentanyl, and rocuronium. The operation lasted for 6 hours, the bleeding during the operation was 1000 ml and was hemodynamically stable. Post-operatively the patient is well conscious and adequate spontaneous breathing. Patient care is carried out in the ICU with the administration of analgesics.

Conclusion: Adolescent idiopathic scoliosis is an exception diagnosis from other forms of scoliosis. An approach to find out the causes, risk factors, methods of diagnosis and treatment of patients with adolescent idiopathic scoliosis are needed in order to increase the success of therapy and the quality of life of the patients.

Latar Belakang: Adolescent Idiopathic Scoliosis (AIS) adalah kelengkungan lateral tulang belakang dengan sudut tonjolan minimal 10°, tanpa kelainan neuromuskular atau bawaan yang mendasarinya. Pembedahan adalah pengobatan terbaik untuk pasien dengan AIS. Tujuan utama operasi AIS adalah untuk mencegah perkembangan akibat fusi, tetapi ada berbagai potensi risiko, seperti periode pasca operasi.

Laporan Kasus: Pasien wanita berusia 26 tahun dengan keluhan bentuk tulang belakang yang tidak lurus. Pasien didiagnosis dengan adolescent idiopathic scoliosis dan direncanakan untuk scoliosis deformity correction. Pada rongent tampak curve thoracalis dengan konveksitas ke kanan (vertebra thorakalis 7 – vertebra lumbal 1), sudut Cobb 54 derajat, sudut Cobb Bending kanan 34 derajat, flexibilitas 20 derajat, sudut Cobb Bending kiri 70 derajat, flexibilitas 26 derajat. Operasi dilakukan dengan teknik anestesi general anesthesia-orotracheal tube (GA-OTT). Setelah dilakukan induksi, pasien diatur ke posisi prone. Pemeliharaan anestesi dengan O2, N2O, dexmetomidine, fentanyl intermitten, dan rocuronium. operasi berlangsung selama 6 jam, perdarahan selama operasi 1000 ml dan hemodinamik stabil. Post-operative pasien sadar baik dan bernafas spontan adekuat. Perawatan pasien dilakukan di ICU dengan pemberian analgetik.

Simpulan: Adolescent idiopathic scoliosis adalah diagnosis pengecualian dari bentuk skoliosis lainnya. Penelusuran untuk mengetahui penyebab, faktor risiko, metode diagnosis dan tatalaksana dari pasien dengan adolescent idiopathic scoliosis diperlukan agar dapat meningkatkan keberhasilan terapi dan kualitas hidup dari pasien.

References

Kuznia AL, Hernandez AK, Lee LU. Adolescent Idiopathic Scoliosis: Common Questions and Answers. Am Fam Physician. 2020;101(1):19–23.
Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512–1521.
Ahn UM, Ahn NU, Nallamshetty L, Buchowski JM, Rose PS, Miller NH, dkk. The etiology of adolescent idiopathic scoliosis. Am J Orthop (Belle Mead NJ). 2019;31(7):387–95.
Menger R, Sin A. Adolescent and Idiopathic Scoliosis. StatPearls Publishing. 2022.
Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, dkk. Adolescent idiopathic scoliosis. Nat Rev Dis Prim. 2015;1.
Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev. 2006;7(2):152–60.
Burton MS. Diagnosis and treatment of adolescent idiopathic scoliosis. Pediatr Ann. 2013;42(11):224–8.
Mangkung TW, Sutawan IBKJ, Senapathi TG, Wiryana IM. Monitoring neurofisiologis pada Adolescent Idiopathic Scoliosis yang menjalani operasi koreksi deformitas. Medicina (B Aires). 2021;52(1):1.
Zefrizon MU, Rosidi MR, Maharani S. Anestesi pada skoliosis. 2018;
Li Y, Swallow J, Robbins C, Caird MS, Leis A, Hong RA. Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis. J Orthop Surg Res. 2021;16(1):1–7.
Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth. 2003;91(6):886–904.
Chen E, Sites BD, Rubenberg LA, Meador GD, Braun JT, Schroeck H. Characterizing anesthetic management and perioperative outcomes associated with a novel, fusionless scoliosis surgery in adolescents. AANA J. 2019;87(5):404–10.
Young CD, McLuckie D, Spencer AO. Anaesthetic care for surgical management of adolescent idiopathic scoliosis. BJA Educ. 2019;19(7):232–7.
Borden TC, Bellaire LL, Fletcher ND. Improving perioperative care for adolescent idiopathic scoliosis patients: The impact of a multidisciplinary care approach. J Multidiscip Healthc. 2016;9:435–45.
Makaryus R, Miller TE, Gan TJ. Current concepts of fluid management in enhanced recovery pathways. Br J Anaesth. 2018; 120: 376e83
Ravish M, Muldowney B, Becker A, Hetzel S, McCarthy JJ, Nemeth BA, dkk. Pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: Combined intrathecal morphine and continuous epidural versus PCA. J Pediatr Orthop. 2012;32(8):799–804.

[1] Kuznia AL, Hernandez AK, Lee LU. Adolescent Idiopathic Scoliosis: Common Questions and Answers. Am Fam Physician. 2020;101(1):19–23.

[2] Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512–1521.

[3] Ahn UM, Ahn NU, Nallamshetty L, Buchowski JM, Rose PS, Miller NH, dkk. The etiology of adolescent idiopathic scoliosis. Am J Orthop (Belle Mead NJ). 2019;31(7):387–95.

[4] Menger R, Sin A. Adolescent and Idiopathic Scoliosis. StatPearls Publishing. 2022.

[5] Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, dkk. Adolescent idiopathic scoliosis. Nat Rev Dis Prim. 2015;1.

[6] Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev. 2006;7(2):152–60.

[7] Burton MS. Diagnosis and treatment of adolescent idiopathic scoliosis. Pediatr Ann. 2013;42(11):224–8.

[8] Mangkung TW, Sutawan IBKJ, Senapathi TG, Wiryana IM. Monitoring neurofisiologis pada Adolescent Idiopathic Scoliosis yang menjalani operasi koreksi deformitas. Medicina (B Aires). 2021;52(1):1.

[9] Zefrizon MU, Rosidi MR, Maharani S. Anestesi pada skoliosis. 2018;

[10] Li Y, Swallow J, Robbins C, Caird MS, Leis A, Hong RA. Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis. J Orthop Surg Res. 2021;16(1):1–7.

[11] Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth. 2003;91(6):886–904.

[12] Chen E, Sites BD, Rubenberg LA, Meador GD, Braun JT, Schroeck H. Characterizing anesthetic management and perioperative outcomes associated with a novel, fusionless scoliosis surgery in adolescents. AANA J. 2019;87(5):404–10.

[13] Young CD, McLuckie D, Spencer AO. Anaesthetic care for surgical management of adolescent idiopathic scoliosis. BJA Educ. 2019;19(7):232–7.

[14] Borden TC, Bellaire LL, Fletcher ND. Improving perioperative care for adolescent idiopathic scoliosis patients: The impact of a multidisciplinary care approach. J Multidiscip Healthc. 2016;9:435–45.

[15] Makaryus R, Miller TE, Gan TJ. Current concepts of fluid management in enhanced recovery pathways. Br J Anaesth. 2018; 120: 376e83

[16] Ravish M, Muldowney B, Becker A, Hetzel S, McCarthy JJ, Nemeth BA, dkk. Pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: Combined intrathecal morphine and continuous epidural versus PCA. J Pediatr Orthop. 2012;32(8):799–804.

Manajemen anestesi pada operasi koreksi deformitas skoliosis

Abstract

References

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