Perubahan Manajemen Anestesi Seksio Sesarea Dengan Spektrum Plasenta Akreta di RSUP H. Adam Malik Medan

Wulan Fadinie, dr. Ratih Kumala Fajar Apsari, SpAn, M.Sc, KAO.; Dr.dr. Yusmein Uyun, SpAn-TI, Subs, AO(K)

2023 | Tesis-Subspesialis | SUBSPESIALIS ANESTESIOLOGI DAN TERAPI INTENSIF

Latar Belakang: Spektrum Plasenta Akreta (SPA) merupakan iastilah umum untuk berbagai komplikasi kehamilan yang disebabkan oleh implantasi plasenta yang tidak normal. Seksio sesarea merupakan pilihan persalinan pada kondisi ini dengan menggunakan anestesi umum, kini anestesi neurakasial menjadi pilihan. Peneliti ingin menilai perubahan manajemen anestesi seksio sesarea dengan SPA di RSUP H. Adam Malik Meda. Metode: Penelitian deskriptif analitik kohort retrospektif, menggunakan data sekunder dari rekam medis untuk menilai perubahan manajemen anestesi seksio sesarea dengan SPA di RSUP H. Adam Malik Medan dari 2020 hingga 2023. Hasil: Dari 200 sampel yang terkumpul, didapatkan perubahan manajemen anestesi seksio sesarea pada pasien dengan SPA di RSUP. H. Adam Malik Medan, yaitu perubahan dari anestesi umum ke anestesi spinal (Nilai P=0,036, dan Nilai P Post Hoc=0,043). Dipengaruhi oleh kedaruratan seksio sesarea (Nilai P=0,000), skor PASS (Nilai P=0,011) dan lama operasi (Nilai P=0,011). Pada anestesi umum dijumpai kasus emergensi, skor PASS 3 dan lama operasi > 3 jam. Pada anestesi neuraksial dijumpai kasus elektif, skor PASS 0 dan lama operasi 1-3 jam. Ada perbedaan skor APGAR menit pertama (Nilai P= 0,003), skor APGAR 4-6 pada anestesi umum dan skor APGAR 7-10 pada anestesi neuraksial. Kesimpulan : Didapatkan perubahan anestesi yang bermakna dari anestesi umum ke anestesi neuraksial (spinal) pada SPA yang dipengaruhi oleh kedaruratan seksio sesarea, skor PASS dan lama operasi serta dijumpai perbedaan pada skor APGAR menit pertama.

Background: Placenta accreta spectrum (PAS) is a collective term for various pregnancy complications caused by abnormal placental implantation. Cesarean section under general anaesthesia is the preferred method of delivery in this condition, but neuraxial anaesthesia is now an option. Researcher want to assess changes in anaesthetic management of caesarean section with SPA at H. Adam Malik Hospital Medan. Methods: Retrospective cohort analytical descriptive study using secondary data from medical records to assess changes in anaesthetic management of caesarean section with SPA at H. Adam Malik Hospital Medan from 2020 to 2023. Results: Of the 200 samples collected, there were changes in anaesthesia management of caesarean section in patients with SPA at RSUP. H. Adam Malik Medan, namely a change from general anaesthesia to spinal anaesthesia (P value = 0.036, and post hoc P value =0.043). Influenced by emergency caesarean section (P=0.000), PASS score (P=0.011) and duration of surgery (P=0.011). General anaesthesia was associated with emergency, PASS score of 3 and duration of surgery > 3 hours. Neuraxial anaesthesia was associated with elective cases, PASS score 0 and duration of surgery 1-3 hours. There was a difference in the first minute APGAR score (P value = 0.003), APGAR score 4-6 in general anaesthesia and APGAR score 7-10 in neuraxial anaesthesia. Conclusions: There was a significant change in anaesthesia from general anaesthesia to neuraxial (spinal) anaesthesia in SPA, which was influenced by the emergency of caesarean section, PASS score and duration of surgery, and there was a difference in the first minute APGAR score.

Kata Kunci : Anestesi, Perubahan Teknik Anestesi, Spektrum Plasenta Akreta, Seksio Sesarea, Anaesthesia, Changes In Anaesthetic Technique, Placenta Accreta Spectrum,Caesarean Section