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All Journal Cermin Dunia Kedokteran Jurnal Neuroanestesi Indonesia

Umar, Nazaruddin

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Author-ID : 1139845

Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Trombosis Vena Otak Marwan, Kenanga; Jasa, Zafrullah Kany; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Trombosis vena otak (TVO) adalah trombosis pada vena otak dan sinus mayor duramater. Faktor resiko terjadinya TVO meliputi faktor genetik trombofilia dan penggunaan kontrasepsi hormonal. Manifestasi klinis TVO sangat bervariasi. Timbulnya gejala dan tanda bersifat akut, subakut, atau kronis. Empat sindrom utama yang muncul: hipertensi intrakranial terisolasi, kelainan neurologis fokal, kejang, dan ensefalopati. Sindrom ini dapat muncul dalam kombinasi atau terisolasi tergantung pada luas dan lokasi TVO. Tatalaksana fase akut dari TVO berfokus pada antikoagulan, manajemen dari sekuele seperti kejang, peningkatan tekanan intrakranial, dan infark vena.2 Penyebab utama kematian pasien TVO selama fase akut adalah herniasi transtentorial yang kebanyakan disebabkan karena perdarahan vena. Mayoritas pasien mengalami penyembuhan parsial dan sekitar 10% mengalami defisit neurologis permanen hingga 12 pasien terjadi pada bulan ketiga) dan akan terbatas setelahnya. Rekurensi dari TVO termasuk jarang (2,8%).Cerebral Venous ThrombosisCerebral venous thrombosis is a condition of thrombosis in cerebral veins and major sinus duramater. Risk factor of cerebral venous thrombosis include genetic factor like thrombophylia and hormonal contraception. There are variations in clinical manifestation of cerebral venous thrombosis. The sign and symptom could be divided into acute, subacute or chronic onset. There are 4 syndroms of clinical manifestations of cerebral venous thrombosis: isolated intracranial hypertension, focal neurologic deficits, seizure, and encephalopathy. The focus of treatment in cerebral venous thrombosis is anticoagulant therapy, sequele of seizure, to treat intracranial hypertension and venous infract. The main cause of death patient with acute onset cerebral venous thrombosis is transtentorial herniation due to venous bleeding. Partial recovery happens in mostly patient with cerebral venous thrombosis anda about 10% had permanent neurologic deficits untill 12 moths. Recanalisation occurs in the first month after cerebral venous thrmbosis (84% patient in the third month) and limited after that. Cerebral venous thrombosis recurrency is rare (2,8%).

Penatalaksanaan Perioperatif Cedera Otak Traumatik pada Pasien Berusia Lanjut Adriman, Silmi; Umar, Nazaruddin; Rasman, Marsudi
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Data epidemiologi terus menunjukkan peningkatan populasi penduduk berusia lanjut dan berdampak pada peningkatan permintaan layanan kesehatan, termasuk kebutuhan untuk menjalani prosedur pembedahan karena berbagai sebab. Salah satu penyebabnya adalah cedera otak traumatik (COT), termasuk di dalamnya perdarahan epidural, subdural dan intraserebral (epidural, subdural, intracerebral hemorrhage/EDH, SDH, ICH). Pada pasien berusia lanjut, COT bertanggung jawab terhadap lebih dari 80.000 kasus dengan tiga-perempat diantaranya harus menjalani rawat inap setiap tahunnya. Perencanaan penatalaksanaan perioperatif membutuhkan pertimbangkan beberapa hal untuk mencapai tingkat anestesi dan analgesi yang optimal pada pasien berusia lanjut. Seorang laki-laki, 65 tahun, dibawa ke rumah sakit dengan penurunan kesadaran pasca kecelakaan bermotor. Setelah resusitasi dan stabilisasi didapatkan jalan napas bebas, laju pernapasan 18 kali/menit, tekanan darah 140/80 mmHg, laju nadi 88 kali/menit. Pada pasien dilakukan tindakan kraniotomi evakuasi EDH dan kraniektomi evakuasi SDH dan ICH dengan anestesi umum dan dengan memperhatikan prinsip neuroanestesi serta geriatri anestesi selama tindakan bedah berlangsung.Perioperative Management of Traumatic Brain Injuryin Elderly Surgical PatientsCurrent epidemiological data showed an increasing number of elderly population, whereas in accordance with an increased demand for health care service, including surgical treatments for elderly. Traumatic brain injury (TBI), such as epidural hemorrhage (EDH), subdural hemorrhage (SDH) and intracerebral hemorrhage (ICH) are among the demanded surgery in elderly. In elderly population, TBI is responsible for more than 80.000 emergency department cases each year; with approximately three-quarters of these cases require further hospitalization. Perioperative management planning requires some considerationsin order to achieve the optimal level of anesthesia and analgesia in the elderly patients. A 65 years old male patient was admitted to the hospital with decreased level of consciousness after motor vehicle traffic injury. During resuscitation, airway was clear, respiratory rate was 18 x/min, blood pressure was 140/80 mmHg, heart rate was 88 x/min. Patient directly underwent an emergency craniotomy evacuation of EDH, SDH and ICH under general anesthesia with continue and comprehensive care of neuroanesthesia and geriatric anesthesia principles.

Perdarahan Epidural Spontan Akut pada Kombinasi Terapi Rivaroxaban, Clopidogrel dan Lumbrokinase Irina, Sinta; Umar, Nazaruddin; Arifin, Hasanul; Rehatta, Nancy Margareta; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perdarahan intrakranial spontan pada terapi antikoagulan rivaroxaban mulai sering ditemukan, apalagi bila dikombinasi dengan antiplatelet clopidogrel maupun fibrinolitik lumbrokinase merupakan hal yang sering ditemukan pada penderita trombosis. Perdarahan intrakranial spontan terbanyak adalah perdarahan intracerebral. Perdarahan spontan epidural (EDH) akut merupakan hal yang jarang ditemukan, biasanya terjadi karena ada penyakit yang mendasarinya. Penatalaksanaan pada kasus ini berdasarkan patofisiologinya dan melibatkan multidisiplin ilmu lainnya. Seorang laki-laki, 26 tahun berat badan 80 kg yang didiagnosa deep vein thrombosis (DVT) mengalami penurunan kesadaran mendadak, pupil anisokor 4 mm/1mm ketika sedang beraktivitas. Tidak dijumpai riwayat cedera kepala. Setelah diresusitasi didapatkan hasil head CT-scan dengan EDH temporoparietal dextra 50 cc, dilakukan dekompresi craniektomi dan evakuasi EDH. Setelah 10 jam pasca operasi terjadi gejolak hemodinamik dan dilakukan head CT-scan ulang dan didapatkan EDH 80 cc dan minimal perdarahan intracerebral. Dilakukan redo craniektomi. Pasca operasi dirawat di ICU dengan koreksi faktor koagulasi. Pasien kembali komposmentis GCS 15 dengan gejala sisa hemiparese sinistra sementara.Acute Spontaneus Epidural Hemorrhage due to Combination Therapy Rivaroxaban, Clopidogrel and LumbrokinaseSpontaneous intracranial hemorrhage on anticoagulant therapy rivaroxaban lately often found, especially when combined with clopidogrel antiplatelet or fibrinolytic lumbrokinase is often found in patients with thrombosis. Spontaneous intracranial hemorrhage is most widely occured is intracerebral hemmorrhage. Spontaneous epidural hemorrhage (EDH) acute is a uncommon, usually occur because there is an underlying disease. Treatment on the case based on patophysiology and involves a multidisciplinary peer other sciences. A young man, 26 years old weight 80 kg which was diagnosed with deep vein thrombosis (DVT) awareness of sudden decline, the pupil anisokor 4 mm/1mm while activity. No head trauma history. After resuscitation, head Ct-scan with EDH temporoparietal dextra 50 cc, carried out the evacuation EDH and decompression craniektomi. After 10 hours of post-operative haemodynamic turmoil happened and done a head ct-scan and obtained EDH 80 cc and minimal intracerebral hemorrhage. Do redo craniektomi. Post-operative hospitalized in ICU with correction factor for coagulation. The patient recovers conciousness into composmentis GCS 15 with sequelae hemiparese sinistra temporary.

Implikasi Anestesi Pasien Cedera Kepala Traumatik dengan Penyakit Jantung Bawaan (PJB) Sianotik: Masalah Hiperviskositas Darah Suyasa, Agus Baratha; Umar, Nazaruddin; Oetoro, Bambang J.
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Saat ini banyak penderita penyakit jantung bawaan (PJB) yang mampu bertahan sampai dewasa (1525%). Penderita PJB memiliki anatomi serta fisiologi yang kompleks dan spesifik dengan morbiditas dan mortalitas perioperatif yang tinggi. Anak-anak dengan PJB meningkatkan resiko henti jantung serta mortalitas 30 hari setelah pembedahan mayor maupun minor dibandingkan dengan anak-anak yang sehat. Cedera otak traumatik merupakan salah satu kondisi yang mengancam jiwa dan merupakan penyebab utama kecacatan serta kematian pada dewasa dan anak-anak. Edema serebral sering ditemui dalam praktek klinis serta dapat menimbulkan masalah besar termasuk iskemia serebral, yang memperburuk aliran darah otak regional dan global, pergeseran kompartemen intrakranial akibat peningkatan tekanan intrakranial (TIK) sehingga menekan struktur vital otak. PJB sianotik memiliki kadar hematokrit yang meningkat dan diasumsikan berhubungan dengan resiko trombosis serebral dan stroke. Peningkatan massa sel darah merah dicurigai sebagai penyebab sindroma hiperviskositas dimana kadar hematokrit selanjutnya menjadi faktor resiko tejadinya infark serebral. Terdapat hubungan yang signifikan antara aliran darah otak dan kadar hematokrit namun belum jelas dinyatakan dalam literatur berapa batas kadar hematokrit, dan kriteria untuk dilakukan phlebotomi. Namun beberapa argumentasi menyatakan polisitemia (kadar hematokrit 60%) memiliki efek yang merugikan dan harus diturunkan dengan phlebotomi karena kompensasi yang berlebihan akan mengganggu aliran darah regional serta aliran darah serebralAnesthesia Implication in a Traumatic Brain Injury Patient with Cyanotic Congenital Heart Disease (CHD): Blood hyperviscosity problem Many patients with congenital heart disease (CHD) survive to adulthood period (1525%). Patients with CHD have a complex and specific anatomy and physiology with high perioperative morbidity and mortality. Children with congenital heart disease have an increased risk of cardiac arrest and 30 days mortality after both major and minor surgeries compared to healthy children. Traumatic brain injury is one of a life-threatening conditions which is the leading cause of disability and death in both adults and children. Cerebral edema is commonly encountered in clinical practice which have potential to cause major problems including cerebral ischemia, which was worsen the regional and global cerebral blood flow, intracranial compartment shift due to an increase in intracranial pressure (ICP) therefore pressing the vital structures of the brain. Cyanotic congenital heart disease patients have an increased hematocrit levels and this is assumed to be related to the risk of cerebral thrombosis and stroke. Increased red blood cell mass is suspected as the cause of hyperviscosity syndrome in which the hematocrit levels is a further risk factor for cerebral infarction is a significant relationship between cerebral blood flow and hematocrit levels. However the haematocrit unit and criterias for phlebotomy has not been explicitly stated in the literature. Some arguments stated that polycythemia (hematocrit levels 60%) had an adverse effect and should be reduced by phlebotomi as excessive compensation would disrupt the regional blood flow and cerebral blood flow.

Penatalaksanaan Perioperatif Cedera Kepala Traumatik yang Terlambat P, Alexander Samuel; Umar, Nazaruddin; Saleh, Siti Chasnak; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala traumatik merupakan salah satu pembunuh pada usia dewasa muda di seluruh dunia. Permasalahan yang sering timbul selain pasien dengan cedera kepala yang tidak dibawa ke rumah sakit, terkadang juga diagnostik yang dilakukan pada awal perjalanan penyakit tidak menunjukkan adanya masalah. Yang sering terlupakan adalah patologi cedera kepala tidaklah berhenti, namun dapat terus berlangsung. Laki-laki dengan berat badan 50 tahun dengan tinggi badan 172 cm BB 82kg dibawa ke Unit gawat darurat, menurut keluarga,pasien ditemukan dalam keadaan mata lebam di dalam rumah, tampak sakit kepala dan muntah-muntah di rumah sejak 18 jam sebelum masuk Rumah Sakit tanpa jelas mekanisme traumanya. Kesadaran GCS E34 M6 V5 pemeriksaan pupil kanan dan kiri 2mm isokor, kelopak mata kanan tampak jejas, TD tekanan darah 135/85, frekuensi nadi 5060x. Dari CT scan ditemukan adanya EDH pada daerah frontal-parietal dan ICH multipel. Dilakukan operasi darurat untuk evakuasi hematom, intra operatif terjadi perdarahan, pasca operasi pasien dirawat di ICU dengan sedasi propofol 5mg/kg/jam. Penatalaksanaan cedera kepala yang terlambat dan tidak adekuat dapat memberikan hasil yang kurang baik.Perioperative Management in Delayed Traumatic Brain InjuryTraumatic brain injury is one of the leading cause of death worldwide. Problems with these patient with traumatic brain injury was not administered to the hospital, sometimes from the diagnostic done in the early course of the disease does not indicate a problem. What is often forgotten is the course of the disease head injury did not stop, keep continue. Male weighing 50 years with a body height of 172 cm BB 82kg brought to emergency department , according to the family, the patient was found with bluish eyes in the house, severe headache and vomiting at home since 18 hours before entering the Hospital without obvious trauma mechanism. GCS was E3-4 M6 V5 pupillary examination 2mm isokor right and left, looked right eyelid injury, blood pressure 135/85, heart rate 50-60x. CT scans reveal any EDH in the frontal-parietal and multiple ICH. The neurosurgeon decide to performed emergency surgery, intraoperative major bleeding, postoperative patients admitted to the ICU with propofol sedation 5mg / kg / hour. Management of head injury late unhandled include rapid evaluation, resuscitation, surgery and intensive therapy management gives good outcome

Co-Authors Adriman, Silmi Bangun, Chrismas Gideon Dewi Yulianti Bisri Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Hamdi, Tasrif Hasanul Arifin Irina, Sinta Iwan Abdul Rachman Jasa, Zafrullah Kany Lian, Abdul Maharani, Nurmala Dewi Marwan, Kenanga MM Rudi Prihatno, MM Rudi Muhammad AR Oetoro, Bambang J. P, Alexander Samuel Prabowo, Haryo Radian Ahmad Halimi Rasman, Marsudi Rehatta, Nancy Margareta Saleh, Siti Chasnak Silalahi, David Suyasa, Agus Baratha Widiastuti, Monika Yutu Solihat

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