Hipotensi terkendali pada reseksi tumor optic head meningioma

Abstract

Optic head meningioma comprises 1-2% of meningiomas. An optic head meningioma undergoes tumor resection surgery was a challenging case to do intra and postoperatively. We found that controlled hypotension effective to produce a safe anaesthesia. 1 35years old woman with right optic head nerve meningioma. Preoperative assessment presented with proptosis, headache, vision loss, and remarkable ICP raising. Induction was achieved with TCI Propofol 3mcg/ml/minute, analgesia achieved from 200mcg fentanyl, and continuous drip of vecuronium. Controlled hypotension achieved with 1mcg/kg clonidine. SBP controlled between 80-100mmHg to achieve 50-68 MAP. Slack brain achieved with 200ml Mannitol. Surgery time was 5hours with no hemodynamic alterations. Patient observed at ICU for 48hours, and discharged at 5 th day. Controlled hypotension is to reduce SBP to get 50-65mmHg MAP. A slack brain would facilitate tumor resection more clearly. 2 Controlled hypotension that safe for neurosurgery was at50-65mmHg MAP for 2hours. This is related with blood flow duration on neurologic function. Patient selection, careful monitoring, and adequate volume replacement are mandatories. 1