<![CDATA[Pendahuluan sindroma Eisenmenger adalah penyakit jantung bawaan sianotik, termasuk di dalamnya hipertensi pulmonal dengan bidirectional maupun R-L shunt. Penurunan resistensi pembuluh darah sistemik dalam kehamilan akan meningkatan derajat R-L shunt. Mortilitas maternal pada kehamilan dengan sindroma Eisenmenger dilaporkan sekitar 30–70%. Wanita 35 tahun, gravida 32–33 minggu dengan atrial septal defect (ASD )sekundum 1,5cm, regurgitasi tricuspid berat, regurgitasi pulmonal sedang, pulmonal hipertensi berat, ejection fraction (EF) 34%, gagal jantung stage C fungsional klas III, sindroma Eisenmenmenger, saturasi preinduksi 90% dengan non rebreathing mask (NRM) 10 lpm. Kasus kedua, wanita gravida 32 minggu dengan ASD sekundum, regurgitasi trikuspid berat, regurgitasi pulmonal sedang, EF 13%, gagal jantung stage C fungsional klas IV, sindroma Eisenmenger, saturasi preindukasi 66% dengan non rebreathing mask (NRM) 10 lpm. Keduanya menjalani seksio sesarea dengan anestesi umum. Pada kasus pertama, didapatkan atonia uteri yang menyebabkan perdarahan masif dan penurunan tiba-tiba pada alirah darah balik sistemik yang berujung pada kematian. Pada kasus kedua, pasien tidak dapat beradaptasi dengan aliran darah balik uterus setelah bayi lahir. Hal tersebut menyebabkan penurunan saturasi dan hipotensi yang menurunkan tekanan ventrikel kanan, yang berujung pada kematian. Sebagai simpulan, kehamilan dengan sindroma Eisenmenger memiliki insidensi kematian tinggi. Penanganan intensif multidisiplin diperlukan baik dalam operasi elektif dan gawat darurat. Baik anestesi umum maupun regional memiliki kelebihan dan kekurangan tergantung kondisi pasien saat datang. Anesthesia Management in Eisenmenger Syndrome Patient Underwent Caesarean Section Abstract Eisenmenger syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt. The decreased of systemic vascular resistance is associated with pregnancy increases the degree of right to left shunting. The maternal mortality rate of pregnancy in the presence of Eisenmenger syndrome is reported 30–70%. Female 35yo, gravida 32-33 weeks with secundum ASD 1,5cm, severe tricupid regurgitation, moderate pulmonal regurgiation, severe pulmonal hypertension, ejection fraction (EF) 34%, heart failure stage C functional class III, Eisenmenger syndrome, preinduction oxygen saturation 90% on non rebreathing mask 10 lpm. Second case, 32 weeks pregnant woman with secundum ASD, severe tricupid regurgitation, moderate pulmonal regurgiation, EF 13%, heart failure stage D functional class IV, Eisenmenger syndrome, saturation preinduction 66% on NRM 10 lpm. Both of them undergoing section caesaria with general anesthesia. In first case, uterine atony that leads to massive bleeding makes sudden decrease in systemic vascular resistence and may result in sudden death. In second case, the patient can not adapt the uterine back flow after delivery that makes the saturation decrease and sudden hypotention which make insufficient right ventricular pressure leading to mortality. As conclusion, pregnancy with Eisenmenger syndrome has high mortality incidence. Multidicipline high care treatment is needed for this case, both in elective and emergency setting. Both general and regional anesthesia have advantage and disadvantage, depends on the patient condition.]]>
