Managemen Anestesi untuk Seksio Sesarea dengan Strok Maternal Hemoragik

Abstract

Stroke is the third leading cause of morbidity and mortality in many developed countries. Cerebrovascular disease during pregnancy can result from three main mechanisms—bleeding, arterial infarction, and venous thrombosis. Maternal stroke can be either ischemic or hemorrhagic. Ischemic stroke is a common stroke caused by loss of blood supply to an area of the brain. Hemorrhagic stroke is caused by bleeding into the brain due to rupture of a blood vessel. Cesarean section or neurosurgical intervention should be prioritized or performed simultaneously is an important issue, as is the decision to use general anesthesia or spinal and epidural when a cesarean section is performed. The anesthesia technique used should be made taking into account the overall maternal risk. Hyperventilation to reduce intracranial pressure (ICP) should be kept in the range of 25-30 mmHg because the normal range of PaCO2 during pregnancy decreases to 30-32 mmHg due to increased ventilation and progesterone. The use of mannitol to control ICP, there are associated risks of fetal dehydration; While other reports show that 0.2 to 0.5mg/kg of mannitol has no significant effect on fetal fluid balance. Special consideration is needed for women with preeclampsia. General anesthesia for cesarean section is associated with an increased risk of stroke when compared to neuraxial anesthesia in preeclampsic women. Regardless of maternal preeclampic status, maintenance of adequate oxygenation and hemodynamic stability is important for maternal and fetal safety.