Induksi Ventilasi Spontan pada Manajemen Anestesi Massa Mediastinum Anterior Berisiko Tinggi: Laporan Kasus
DOI:
https://doi.org/10.35790/49kcnf85Keywords:
tumor mediastinum; ventilasi spontan; airway collapse; kompresi trakeaAbstract
Abstract: Mediastinal tumors pose significant challenges in anesthetic management due to the risk of airway compression and hemodynamic compromise. Induction of anesthesia may precipitate life-threatening airway collapse. We reported a 53-year-old male with an anterior mediastinal tumor presented with progressive dyspnea worsening in the supine position (orthopnea). Comorbidities included uncontrolled type 2 diabetes mellitus, anemia, hyponatremia, thrombocytosis, and a heavy smoking history. The patient was classified as ASA III. Anesthetic management involved maintaining spontaneous ventilation during induction with sevoflurane, followed by endotracheal intubation with careful tube size adjustments. Total anesthesia time was 3 hours 50 minutes, with a surgical duration of 1 hour 40 minutes, and blood loss of 250 mL. The patient was successfully extubated in the operating room and transferred to the intensive care unit (ICU) under stable conditions. Maintaining spontaneous ventilation and proper airway management are crucial in preventing catastrophic airway collapse in patients with severe tracheal compression. Systemic comorbidities significantly increase perioperative risk and require careful optimization. In conclusion, an individualized, risk-stratified anesthetic approach is essential in managing mediastinal tumors to ensure patient safety and avoid major cardiovascular or respiratory complications.
Keywords: mediastinal tumor; spontaneous ventilation; airway collapse; tracheal compression
Abstrak: Tumor mediastinum merupakan kondisi dengan risiko tinggi dalam manajemen anestesi akibat potensi kompresi jalan napas dan gangguan hemodinamik. Induksi anestesi dapat memicu kolaps jalan napas yang bersifat fatal. Kasus seorang laki-laki, 53 tahun, dengan tumor mediastinum anterior, datang dengan keluhan sesak napas yang memberat saat posisi terlentang (ortopnea). Pasien memiliki komorbid diabetes melitus tipe 2 tidak terkontrol, anemia, hiponatremia, trombositosis, serta riwayat merokok berat. Status fisik diklasifikasikan sebagai ASA III. Manajemen anestesi dilakukan dengan teknik spontaneous ventilation induction (induksi ventilasi spontan) menggunakan sevoflurane, diikuti intubasi dan penyesuaian ukuran endotracheal tube (ETT) secara hati-hati. Lama anestesi berlangsung selama 3 jam 50 menit dan operasi selama 1 jam 40 menit dengan perdarahan sebesar 250 mL. Pasien berhasil diekstubasi di kamar operasi dan dirawat di intensive care unit (ICU) dengan hemodinamik stabil. Strategi mempertahankan ventilasi spontan serta pemilihan teknik intubasi yang tepat merupakan kunci utama untuk mencegah kolaps jalan napas pada pasien dengan kompresi trakea berat. Komorbid sistemik meningkatkan risiko perioperatif dan memerlukan optimasi serta pemantauan ketat. Simpulan studi ini ialah manajemen anestesi pada tumor mediastinum memerlukan pendekatan individual berbasis stratifikasi risiko dengan perencanaan yang matang untuk mencegah kolaps respirasi dan kardiovaskular.
Kata kunci: tumor mediastinum; ventilasi spontan; airway collapse; kompresi trakea
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