BERADA DI UJUNG TANDUK: MANAJEMEN ANESTESI PADA LANSIA DENGAN PERITONITIS YANG MENGALAMI GAGAL JANTUNG STADIUM AKHIR
BALANCING ON THE BRINK: ANESTHETIC MANAGEMENT IN GERIATRIC PERITONITIS WITH END-STAGE HEART FAILURE
Abstract
Anesthetic management in geriatric patients with peritonitis complicated by advanced cardiac failure represents a complex clinical challenge associated with high mortality risk. This condition is characterized by the interplay between sepsis-induced systemic inflammation and limited cardiac reserve, resulting in a fragile hemodynamic state. This study aims to explore a physiology-guided anesthetic approach to optimize perioperative hemodynamic stability. The method employed is a narrative review of recent international literature focusing on fluid management strategies, anesthetic agent selection, and vasoactive therapy in patients with severe ventricular dysfunction. The findings suggest that individualized management, supported by dynamic hemodynamic monitoring, cautious fluid resuscitation, and the use of agents that minimize myocardial depression, is essential to maintain adequate organ perfusion without exacerbating cardiac dysfunction. The discussion highlights the need to balance septic perfusion demands with the risk of fluid overload in compromised cardiac conditions. In conclusion, anesthetic management in this population should be multidisciplinary, adaptive, and guided by physiological targets to improve clinical outcomes. This approach may serve as a key strategy to reduce perioperative morbidity and mortality in high-risk geriatric patients.
Abstrak
Manajemen anestesi pada pasien geriatri dengan peritonitis yang disertai gagal jantung lanjut merupakan tantangan klinis kompleks dengan risiko mortalitas tinggi. Kondisi ini ditandai oleh kombinasi inflamasi sistemik akibat sepsis dan keterbatasan cadangan jantung, yang menciptakan ketidakseimbangan hemodinamik yang sangat rapuh. Studi ini bertujuan untuk mengeksplorasi pendekatan anestesi berbasis fisiologi dalam mengoptimalkan stabilitas hemodinamik selama periode perioperatif. Metode yang digunakan berupa tinjauan naratif berbasis literatur internasional terkini yang menyoroti strategi manajemen cairan, penggunaan agen anestesi, serta terapi vasoaktif pada pasien dengan disfungsi ventrikel berat. Hasil menunjukkan bahwa pendekatan individualisasi dengan pemantauan hemodinamik dinamis, resusitasi cairan yang hati-hati, serta pemilihan obat yang meminimalkan depresi miokard merupakan kunci dalam menjaga perfusi organ tanpa memperburuk gagal jantung. Diskusi menekankan pentingnya keseimbangan antara kebutuhan perfusi akibat sepsis dan risiko overload cairan pada jantung yang sudah terganggu. Kesimpulannya, manajemen anestesi pada populasi ini harus bersifat multidisiplin, adaptif, dan berbasis target fisiologis untuk meningkatkan luaran klinis. Pendekatan ini berpotensi menjadi strategi utama dalam menurunkan morbiditas dan mortalitas perioperatif pada pasien berisiko tinggi.
References
Iadarola GM, Lusardi P, Milia VL, et al. Peritoneal ultrafiltration in patients with advanced decompensated heart failure. PubMed . June 2015:159. doi:10.5301/jn.2013.11639
Pereira IV, Lima CVR de, Cavalcanti-da-Silva M, et al. Anesthesia and Patients With Cardiovascular Diseases: Challenges and Approaches. Revista de Gestão Social e Ambiental . 2024;18(6). doi:10.24857/rgsa.v18n6-159
Çınar F, PARLAK G, Aslan FE. The effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery: a systematic review and metaanalysis. TURKISH JOURNAL OF MEDICAL SCIENCES . 2020;51(1):61. doi:10.3906/sag-2001-27
Diepen S van, Bakal JA, McAlister FA, Ezekowitz JA. Mortality and Readmission of Patients With Heart Failure, Atrial Fibrillation, or Coronary Artery Disease Undergoing Noncardiac Surgery. Circulation . 2011;124(3):289. doi:10.1161/circulationaha.110.011130
Beattie WS, Wijeysundera DN. The Growing Burden of Perioperative Heart Failure. Anesthesia & Analgesia . 2014;119(3):506. doi:10.1213/ane.0000000000000370
Hernández G, Teboul J. Fourth Surviving Sepsis Campaign’s hemodynamic recommendations: a step forward or a return to chaos? Critical Care . 2017;21(1). doi:10.1186/s13054-017-1708-z
Ravi C, Johnson DW. Optimizing Fluid Resuscitation and Preventing Fluid Overload in Patients with Septic Shock. Seminars in Respiratory and Critical Care Medicine . 2021;42(5):698. doi:10.1055/s-0041-1733898
Habal M, Garan AR. Long-term management of end-stage heart failure. Best Practice & Research Clinical Anaesthesiology . 2017;31(2):153. doi:10.1016/j.bpa.2017.07.003
Duncan CF, Bowcock E, Pathan F, Orde S. Mitral regurgitation in the critically ill: the devil is in the detail. Annals of Intensive Care . 2023;13(1). doi:10.1186/s13613-023-01163-4
Lobo SM, Mendes CL, Rezende E, Dias FS. Optimizing perioperative hemodynamics. Current Opinion in Critical Care . 2013;19(4):346. doi:10.1097/mcc.0b013e3283632ef1
Laet IED, Malbrain MLNG, Waele JJD. A clinician’s guide to management of intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients. Crit Care. 2020;24(1). doi:10.1186/s13054-020-2782-1.
Núñez J, Espriella R de la, Rossignol P, Voors AA, Müllens W, Metra M, et al. Congestion in heart failure: a circulating biomarker-based perspective. A review from the Biomarkers Working Group of the Heart Failure Association, European Society of Cardiology. Eur J Heart Fail. 2022;24(10):1751–1766. doi:10.1002/ejhf.2664.
Maurer MJ, Packer M. Impaired systemic venous capacitance: the neglected mechanism in patients with heart failure and a preserved ejection fraction? Eur J Heart Fail. 2020;22(2):173–176. doi:10.1002/ejhf.1702.
Pinsky MR, Cecconi M, Chew MS, Backer DD, Douglas IS, Edwards M, et al. Effective hemodynamic monitoring. Crit Care. 2022;26(1). doi:10.1186/s13054-022-04173-z.
Advances in Complex Valvular Disease. IntechOpen; 2020. doi:10.5772/intechopen.87381.
Voldby AW, Aaen AA, Møller AM, Brandstrup B. The association of the perioperative fluid balance and cardiopulmonary complications in emergency gastrointestinal surgery: exploration of a randomized trial. Perioper Med. 2024;13(1). doi:10.1186/s13741-024-00390-y.
Shin J, Suh S. Influence of perioperative fluid balance on clinical outcomes after hepatic resection in patients with left ventricular diastolic dysfunction. Res Sq. 2022. doi:10.21203/rs.3.rs-1845876/v1.
Biais M, Ouattara A, Janvier G, Sztark F, Riou B. Case scenario. Anesthesiology. 2012;116(6):1354–1361. doi:10.1097/ALN.0b013e318256ee28.
Sander M, Schneck E, Habicher M. Management of perioperative volume therapy: monitoring and pitfalls. Korean J Anesthesiol. 2020;73(2):103–113. doi:10.4097/kja.20022.
Nassar MA, Almohisin E, Alnasser A, Alaid A, Shahini Z, Jassas BA, et al. Perioperative haemodynamic optimization strategies in high-risk surgical patients. J Healthc Sci. 2023;3(9):281–288. doi:10.52533/johs.2023.30901.
Irani J, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc. 2023;37(1):5–30. doi:10.1007/s00464-022-09758-x.
Gkounti G, Loutradis C, Tzimou M, Katsioulis C, Nevras V, Pitoulias AG, et al. The impact of spinal anesthesia on cardiac function in euvolemic vascular surgery patients: insights from echocardiography and biomarkers. Int J Cardiovasc Imaging. 2024;40(11):2305–2315. doi:10.1007/s10554-024-03228-2.
Gkoudi G, Loutradis C, Tzimou M, Katsioulis C, Nevras V, Pitoulias AG, et al. The impact of spinal anesthesia on cardiac function in euvolemic vascular surgery patients: insights from echocardiography and biomarkers. Res Sq. 2024. doi:10.21203/rs.3.rs-3958571/v1.
Iwata S, Yokokawa S, Sato M, Ozaki M. Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report. BMC Anesthesiol. 2020;20(1). doi:10.1186/s12871-020-0933-1.
Kumar V, Swain M, M IB, Vineesha G. Anesthetic considerations in supravalvular aortic stenosis: a case series. Asian J Med Sci. 2023;14(11):320–325. doi:10.3126/ajms.v14i11.56880.
Tamunobelema DMS, Uruaka CI. General anaesthetic agents and its implication on the cardiovascular system: a systemic review. Saudi J Med Pharm Sci. 2023;9(3):171–183. doi:10.36348/sjmps.2023.v09i03.006.
Saugel B, Bebert EJ, Briesenick L, Hoppe P, Greiwe G, Yang D, et al. Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study. J Clin Monit Comput. 2022;36(2):341–347. doi:10.1007/s10877-021-00653-9.
Mori S, Ito H, Sugimoto S, Hibi D, Kameyama A, Kawakami M, et al. Anesthesia management of laparoscopic right colectomy in an older patient with postoperative tetralogy of Fallot with residual anomaly. JA Clin Rep. 2024;10(1). doi:10.1186/s40981-024-00707-2.
Estèbe JP, Morel M, Daouphars T, Ardant E, Rousseau C, Drouet A, et al. Lessons from the analysis of a retrospective cohort of patients who underwent large open abdominal surgery under total intravenous opioid-free anesthesia. Drugs Real World Outcomes. 2021;8(1):85–93. doi:10.1007/s40801-020-00218-3.
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826–3924. doi:10.1093/eurheartj/ehac270.
Nasr M, Kossaif M, Kossaify A. Pre-operative cardiovascular evaluation in elective noncardiac surgery, risk scores, and managerial insight for patients with different cardiac morbidities. Open Access Maced J Med Sci. 2020;8:41–51. doi:10.3889/oamjms.2020.3372.
Hadipourzadeh F, Mousavi S, Heydarpur A, Sadeghi A, Ferasatkish R. Evaluation of the adding paracetamol to dexmedetomidine in pain management after adult cardiac surgery. Anesth Pain Med. 2021;11(3). doi:10.5812/aapm.110274.
Jaggar S, Laycock H. Pain in the intensive cardiovascular care unit. In: Oxford University Press eBooks. Oxford University Press; 2021. p. 956–968. doi:10.1093/med/9780198849346.003.0072.
Eshak MEH, Mohamed A, Morsi O, Soliman AM, Mina J, Elkhouly K, et al. Different modalities of perioperative pain management. In: IntechOpen eBooks. IntechOpen; 2026. doi:10.5772/intechopen.1014742.
Hejles RA, Alabdulwahed R, Kalagi AS, Alsherbi MS, Binateeq MA, Aldubayyan MA, et al. Optimizing postoperative pain control: evidence-based approaches in anesthesia practice. Saudi J Med Public Health. 2024;1(1):489–500. doi:10.64483/jmph-149.
Havakuk O, Hochstadt A, Sadon S, Perl ML, Sadeh B, Milwidsky A, et al. Successful conservative management of left ventricular assist device candidates. ESC Heart Fail. 2023;10(1):601–615. doi:10.1002/ehf2.14223.
Madison R, Brotman I. Post-operative care of elderly patients. In: BENTHAM SCIENCE PUBLISHERS eBooks. Bentham Science Publishers; 2024. p. 65–80. doi:10.2174/9789815238877124010007.
Kleiman AM, Tsang S, Walters SM, McNeil JS, Yarboro LT, Wu I, et al. Multimodal analgesia and enhanced recovery outcomes in cardiac surgical patients: an observational cohort study. Anesth Analg. 2025;142(2):220–230. doi:10.1213/ANE.0000000000007612.
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