Anestesi Epidural Pada Pasien Geriatri dengan Aorta Stenosis Berat yang Akan Menjalani Operasi Litotripsi
DOI:
https://doi.org/10.59680/anestesi.v4i3.2576Keywords:
Aortic Stenosis, Epidural Anesthesia, Geriatric Patient, Ureteroscopic Lithotripsy, Valvular Heart DiseaseAbstract
Background: Severe valvular heart disease in geriatric patients represents a major risk factor for non-cardiac surgery due to increased susceptibility to hemodynamic instability. Appropriate anesthetic management is crucial to maintain preload, afterload, and heart rate in patients with significant aortic stenosis. Case Presentation: An 84-year-old woman with grade IV right hydronephrosis caused by an 11 × 8 mm proximal ureteral stone and partial proximal ureteral stenosis was scheduled for ureteroscopic lithotripsy (URS). Her comorbidities included stage IV chronic kidney disease, anemia (hemoglobin 9.3 g/dL), heart failure with preserved ejection fraction (HFpEF) secondary to coronary artery disease, moderate-to-severe aortic stenosis, moderate aortic regurgitation, and moderate mitral regurgitation. Echocardiography demonstrated concentric left ventricular hypertrophy and segmental left ventricular hypokinesia. Epidural anesthesia was performed at the L2–L3 interspace using incremental administration of 12 mL of 0.5% plain levobupivacaine. Intraoperative monitoring included non-invasive blood pressure, electrocardiography, and pulse oximetry. Beta-blocker therapy was continued throughout the perioperative period. No post-epidural hypotension or significant hemodynamic instability occurred during the procedure. Postoperative analgesia consisted of oral paracetamol and intermittent epidural dosing. Conclusion: Incrementally titrated epidural anesthesia may be a safe anesthetic option for geriatric patients with moderate-to-severe aortic stenosis and HFpEF undergoing non-cardiac surgery. Successful anesthetic management relies on meticulous hemodynamic control, maintenance of preload and afterload, heart rate optimization, and a comprehensive multidisciplinary approach.
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