Laporan Kasus: Anestesi Blok Peribulbar pada Pasien dengan Gagal Jantung Kongestif yang Dilakukan Enukleasi

Abstract

Seorang pria berusia 73 tahun datang ke Instalasi Gawat Darurat Pusat Mata Nasional Rumah Sakit Mata Cicendo pada bulan November 2018 dengan keluhan nyeri mata yang mengeluarkan darah dan disertai dengan keluhan sesak. Pemeriksaan mata menunjukkan prolaps okuli dan direncanakan untuk dilakukan enukleasi. Ahli kardiologi mendiagnosis sebagai hypertensive heart disease, congestive heart failure functional class IV, moderate mitral regurgitation, moderate aortic regurgitation. Laporan kasus ini bertujuan memaparkan keberhasilan tata laksana anestesi pada pasien usia lanjut dengan gagal jantung kongestif yang dilakukan enukleasi dalam blok peribulbar. Teknik blok peribulbar dipilih agar tidak memperberat masalah kardiovaskular serta untuk meminimalisir depresi kardiak. Teknik ini dilakukan dengan menyuntikkan obat anestesi lokal levobupivakain 0,5% pada inferotemporal, medial kantus, dan superonasal. Operasi berlangsung tanpa keluhan nyeri dan fluktuasi hemodinamik yang signifikan. Pascaoperasi pasien sadar penuh dengan skala nyeri NRS 60 menit pascaoperasi 0. Hal ini menunjukkan bahwa teknik anestesi blok peribulbar memberikan hasil memuaskan pada tindakan enukleasi.

Enucleation under Peribulbar Block Anesthesia in Patients with Congestive Heart Failure: A Case Report

A 73-year-old male patient was presented to the emergency department of the National Eye Center Cicendo Hospital with a painful and bloody eye as well as shortness of breath. Eye examination revealed ocular prolapse and patient was scheduled for enucleation. The cardiologist diagnosed the patient with hypertensive heart disease, congestive heart failure functional class IV, moderate mitral regurgitation, and moderate aortic regurgitation. Patient then underwent treatment for six days. This case report aimed to describe the successful management of anesthesia in elderly patients with congestive heart failure who underwent peribulbar block for enucleation procedure. To prevent further cardiac problems and to minimize the risk of cardiac depression in this patient, the anesthetic technique chosen was peribulbar block with the injection of local anesthetic drug levobupivacaine 0.5% at the inferotemporal, medial canthus, and superonasal. The surgary took place without complaints of intraoperative pain and without significant hemodynamic fluctuations. Postoperatively, the patient was fully conscious and sixty minutes postoperative pain scale (Numeric Rating Scale) in this patient was 0. This shows that the peribulbar block anesthesia technique can provide satisfactory results for enucleation procedure.