Manajemen Post-Operatif Pasien dengan Revaskularissi Occipital Artery-Middle Cerebral Artery Bypass Moyamoya Suzuki IV di Ruang Rawat Intensif: Sebuah Laporan Kasus
DOI:
https://doi.org/10.55497/majanestcricar.v44i3.512Keywords:
Hemodinamik, penyakit moyamoya, perawatan intensif, perawatan pascaoperasi, revaskularisasi serebralAbstract
Pendahuluan: Penyakit Moyamoya adalah penyakit serebrovaskular progresif yang ditandai dengan oklusi bertahap arteri karotis interna dan pembentukan kolateral abnormal di dasar otak. Penyakit ini dapat menyebabkan stroke iskemik maupun hemoragik berulang dan memerlukan penanganan komprehensif melalui tindakan revaskularisasi.
Deskripsi Kasus: Seorang perempuan berusia 55 tahun dengan penyakit Moyamoya disease stadium Suzuki IV menjalani tindakan Occipital Artery–Middle Cerebral Artery (OA–MCA) bypass di bawah anestesi umum. Pasien dirawat pascaoperasi di ruang intensif dengan tujuan mempertahankan perfusi serebral optimal dan mencegah komplikasi hiperperfusi maupun hipoperfusi. Perawatan pascaoperasi menitikberatkan pada pengendalian hemodinamik yang ketat menggunakan titrasi nikardipin dan ramipril, pemberian nimodipin untuk menjaga vasodilatasi serebral, kontrol glikemik dengan insulin, serta pemberian antiplatelet klopidogrel untuk menjaga patensi bypass. Evaluasi dan tatalaksana harian yang dilakukan dengan pendekatan FASTHUGS BID diterapkan dalam laporan kasus ini dan dapat membuahkan hasil yang baik tanpa menimbulkan komplikasi sehingga pendekatan ini berpotensi dapat menjadi strategi perawatan pasien penyakit Moyamoya. Pasien menunjukkan stabilitas hemodinamik bertahap dan perbaikan klinis progresif tanpa komplikasi neurologis, tetapi didapatkan komplikasi melena yang tidak berat akibat klopidogrel.
Simpulan: Keberhasilan manajemen pascaoperasi penyakit Moyamoya bergantung pada kolaborasi multidisiplin serta pemantauan intensif berbasis prinsip FASTHUGS BID untuk menjaga keseimbangan perfusi otak dan stabilitas sistemik.
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