ANESTHETIC MANAGEMENT OF PATIENT WITH INTRADURA TUMOR LEVEL VTH-12-L1 SUSPECTED

SCHWANOMA ACCOMPANIED BY CHF NYHA II AND ATRIAL FIBRILLATION

Irdyansyah*, Doso Sutiyono*

Department of Anesthesiology and Intensive Therapy,

School of Medicine Diponegoro University, Doctor Kariadi Hospital

Introduction :
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 management of this tumor underwent simple
procedure. But because of there are other comorbidities such as Congestive heart failure NYHA
II with LVEF 33,7% and atrial fibrillation. Such cases are always a challenge to the
anesthesiologist as they are most commonly complicated by progressive cardiac failure.

Case Presentation : A 68-year-old woman is consulted to the Anesthesia Department of the

Kariadi General Hospital Semarang in April 2019 with complaints of shortness of breath since
2 weeks ago. From the MRI examination, there were two lobulated intradural-extramedular
cystic lesions at the level VTh12-L1 on the anterior aspect and the lateral aspect accompanied
by spinal cord compression at that level. The drugs used for premedication are
Metochlorpramid 10 mg and Ranitidin 50 mg, induction using Fentanil 100 mcg,and
maintenance using Dobutamine 10 mcg / kg / minute, and Roculax 30 mg / hour via syringe
pump, opioid using Fentanyl 100 mcg and muscle relaxant using Roculax 40 mg. Throughout
the surgery, patient was hemodinamically stable and blood loss was minimal

Conclusion : In patients with heart problems, moderate reduction in heart rate often occurs,
and can induce severe bradycardia related to induction agent. It is important to maintain the
adequacy of CO that requires an inotropic agent to augment contractility and improves
circulation. The inotropic choice is a β-agonist (e.g.,dobutamine), causes much less
vasodilation, increasing contractility, and adjuncts to augment contractility in the setting of
significant hypotension

Key Words : Spinal Cystic Intradural Schwannoma, Congestive Heart Failure, atrial
fibrillation, ejection fraction, inotropic