Artikel Jurnal

Anaesthetic management in the patient with thoracic–lumbar intradural tumor accompanied by heart failure and atrial fibrillation: a case report

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Background: Spinal cystic intradural Schwannoma is a type of tumor that is rarely found, with an incidence of 0.3–
0.5/100,000 person per year. The operative procedure for this tumor was simple. However, some patients showed other
comorbidities, such as heart failure with low ejection fraction (EF) and atrial fibrillation. Such cases are a challenge to the
anaesthesiologist as they are most commonly complicated by progressive cardiac failure.
Case Presentation: A 68-year-old woman was consulted by the Anaesthesiology Department in dr. Kariadi General Hospital
Semarang in April 2019. She had been experiencing right lower extremity and lower back pain since April 2018, and they
have been getting worse since two weeks ago. She also complained of shortness of breath two weeks before, accompanied
by typical symptoms and signs of heart failure. Her electrocardiogram showed atrial fibrillation, and her echocardiogram
showed an LVEF of 33.7%. Magnetic resonance imaging (MRI) showed two lobulated intradural-extramedular cystic lesions
at thoracal vertebrae 12 until lumbar vertebrae 1 (VTh12–L1) that were a high suspicious of Schwannoma on the anterior
aspect and the lateral aspect accompanied by spinal cord compression at that level. The drugs used for premedication were
metoclopramide 10 mg and ranitidine 50 mg, for induction was fentanyl 100 μg, and for maintenance were dobutamine 10
μg/kgBW/minute, rocuronium bromide 30 mg/hour via syringe pump, opioid fentanyl 100 μg and muscle relaxant using
rocuronium bromide 40 mg. The patient was hemodynamically stable throughout the surgery, and blood loss was minimal.
Conclusion: In patients with heart problems, a moderate reduction in contractility and heart rate often occurs and may
induce mild to severe bradyarrhythmia or tachyarrhythmia related to induction agents. It is important to maintain adequate
cardiac output that requires inotropic agents to augment contractility and improve circulation. As an inotropic choice, a
β-agonist (e.g., dobutamine) causes less vasodilation, increased contractility, and adjuncts to augment contractility in the
setting of significant hypotension.

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Detail Information

Series Title

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Call Number

617.9 SAT a

Publisher

Bali : Bali Medical Journal., 2022

Collation

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Language

English

ISBN/ISSN

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Classification

617.9

Content Type

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Media Type

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Carrier Type

-

Edition

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Subject(s)

anesthesia
Spinal Cord Neoplasms
Heart Failure

Specific Detail Info

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Statement of Responsibility

Satrio Adi Wicaksono

Viewer

83

Other Information

Tanggal Pelaksanaan - Dari

2024-12-30

Tanggal Pelaksanaan - Sampai

2024-12-30

Akreditasi

Tidak

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