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

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Penatalaksanaan Anestesi untuk Gabungan Tindakan Seksio Sesarea dan Kraniotomi Tumor Otak Wullur, Caroline; Boesoirie, M. Adli; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2077.444 KB) | DOI: 10.24244/jni.vol4i3.122

Abstract

Angka kejadian tumor intrakranial pada masa kehamilan sangat jarang. Keluhan seperti mual, muntah, nyeri kepala dan gangguan penglihatan serupa dengan hiperemesis dan eklampsia. Sebagian besar pasien tidak memerlukan tindakan emergensi namun pada beberapa kasus, kraniotomi tumor otak dilakukan lebih awal atau bahkan bersamaan dengan seksio sesarea. Seorang wanita 40 tahun, G3P2A0 datang dengan penurunan kesadaran GCS 6 (E2M2V2). CT-scan menunjukkan adanya masa pada daerah temporoparietal kiri, curiga high grade glioma, disertai dengan pergeseran midline dan perdarahan intratumoral. Pemeriksaan obstetri menunjukkan usia kehamilan 32 minggu dengan gawat janin. Dengan pertimbangan resiko herniasi dan gawat janin, pasien menjalani operasi emergensi seksio sesarea diikuti dengan kraniotomi tumor otak. Operasi berlangsung selama 6 jam. Pada pasien hamil dengan tumor otak, waktu pembedahan bergantung pada jenis tumor, usia kehamilan dan kondisi janin. Keberhasilan anestesi bergantung pada pengetahuan menyeluruh mengenai fisiologi dan farmakologi wanita hamil yang disesuaikan dengan individu terkait untuk mengontrol tekanan intrakranial, dengan tujuan menjaga kesejahteraan ibu dan anak.Anaesthetic Management for Combined Emergency Cesarean Section and Craniotomy Tumor RemovalThe occurrence of primary intracranial tumors in pregnancy is an extremely rare event. Symptoms of brain tumor include nausea, vomitting, headache, visual disturbances and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. These central nervous system disorders seldom require immediate surgical attention during pregnancy. However in very few cases, craniotomy tumor removal is performed earlier or even simultaneous with fetal delivery. A 40-year-old woman at 32 weeks of gestation presented to the emergency room with decreased level of consciousness GCS 6 (E2M2V2). CT scan revealed a mass lesion over the left temporoparietal region, suggestive of a high grade glioma, with midline shift and intratumoral bleeding. Obstetric examination revealed a single live fetus of 32 weeks gestation in distress. In view of high risk of herniation and fetal distress, she underwent emergency cesaren section followed by craniotomy tumor removal. Both procedures were completed in 6 hours. In a parturient with brain tumor, the time of combined surgery of tumor removal and cesarean section is decided upon clinical symptoms, type of tumor, gestational age and fetal viability. A successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of both mother and fetus.
Penatalaksanaan Anestesi pada Pasien dengan Tumor Supratentorial Berukuran Besar Suspek Konveksitas Meningioma Wullur, Caroline; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (771.278 KB) | DOI: 10.24244/jni.vol3i2.139

Abstract

Penatalaksanaan anestesi untuk kasus meningioma memiliki beberapa hal khusus yang penting untuk dilaksanakan. Jaringan otak tertutup oleh tulang kranium. Karena hubungan kontinu dari aliran darah dan volume jaringan otak, maka resiko perdarahan dan edema sangat tinggi. Tanpa pendekatan anestesi yang tepat, maka dapat meningkatkan resiko edema dan perdarahan otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien berusia 35 tahun dengan keluhan nyeri kepala di daerah frontal disertai dengan penurunan penglihatan sejak 1 tahun sebelum masuk rumah sakit. Pasien tidak pernah mengalami kejang ataupun penurunan kesadaran. Pasien didiagnosa dengan tumor supratentorial ec suspek conveksitas meningioma yang direncanakan dilakukan pembedahan kraniotomi untuk pengangkatan tumor. Status fisik ASA 2 dengan defisit neurologis. Pasien dilakukan dengan anestesi umum dengan intubasi. Induksi dengan fentanil, propofol dan vecuronium. Operasi berlangsung selama 7,5 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif selama 2 hari sebelum pindah ke ruangan. Perlakuan anestesi dan pengaturan faktor fisiologi mempunyai dampak yang besar terhadap jaringan otak. Dokter anestesi harus mempunyai pengetahuan mengenai efek obat dan manipulasi lainnya untuk mencapai hasil operasi yang baik.Anaesthetic Management of a Patient with Large Supratentorial Brain Tumor Suspected Convexity MeningiomaAnesthesia for meningioma cases has several specific important considerations. The brain is enclosed in a rigid skull. Brain tissue is highly vascularized therefore the risk of bleeding and edema are very high. Without the correct anaesthetic approach, the risk of bleeding and edema due to surgical manipulation may be increased. This phenomenon may have negative impact since the visual of surgical field will be limited. In this case, we reported a 35-year old female patient with severe headache at the frontal region accompanied with visual impairment since 1 year prior to hospital admittance. This patient was never experienced any seizures or inconsiousness. Patient was diagnosed with supratentorial tumor caused by suspect of convexity meningioma and was planned tumor removal craniotomy. ASA II physical status with neurological deficit. The patient was on general anaesthesia with intubation. Induction was performed using fentanyl, propofol and vecuronium while continuous propofol and vecuronium were used for maintenance. The surgery lasted for 7.5 hours. After surgery, the patient was treated in the Intensive Care Unit for 2 days prior to inpatient ward transfer. Anaesthetic management and physiological factors control have a positive impact on the brain tissue. Anaesthesiologist must have the comprehensive knowledge on drug effects and other manipulations to achieve positive result of a surgery.
Perbandingan antara Sevofluran dan Isofluran terhadap Gangguan Fungsi Kognitif Pascabedah Tumor Otak menggunakan Mini Mental State Examination (MMSE Wullur, Caroline; Redjeki, Ike Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2053.839 KB) | DOI: 10.24244/jni.vol5i3.71

Abstract

Latar Belakang dan Tujuan: Pasien dengan tumor otak sering mengalami gangguan fungsi kognitif yang berdampak terhadap fungsi fisik, psikologis, sosial, dan vokasional. Post operative cognitive dysfunction (POCD) adalah ganggguan kognitif pascabedah yang paling sering terjadi. Anestesi umum yang digunakan dapat berpengaruh terhadap gangguan fungsi kognitif. Anestetika inhalasi sevofluran dan isofluran merupakan anestetika inhalasi yang paling sering digunakan untuk prosedur kraniotomi tumor otak. Tujuan penelitian adalah untuk mengetahui perbandingan efek antara sevofluran dan isofluran terhadap fungsi kognitif pascabedah tumor otak.Subjek dan Metode: eksperimental acak terkontrol buta tunggal melibatkan 44 pasien dengan tumor otak yang menjalani kraniotomi tumor otak pada bulan April?Oktober 2015. Data dianalisis dengan uji-t tidak berpasangan, Chi kuadrat, Mann Whitney dan Komolgorov Smirnov, nilai p0,05 dianggap bermakna. Fungsi kognitif diukur menggunakan uji mini mental state examination (MMSE) yang dinilai saat pre-operatif dan pascabedah pada jam ke 6, 12, 18, 24, 48, 72, 96, dan 120. Hasil penelitian menunjukkan MMSE pascabedah pada kelompok anestetika inhalasi sevofluran lebih tinggi dibanding dengan isofluran pada 6, 12, 18, 18, 24, 48 dan 72 jam pascabedah dengan perbedaan bermakna (p0,05).Simpulan: Anestetik inhalasi sevofluran menimbulkan gangguan fungsi kognitif pascabedah yang lebih ringan dibanding dengan isofluran pada pasien yang menjalani kraniotomi tumor otak.Comparison between Sevoflurane and Isoflurane on Cognitive Dysfunction Post Craniotomy Tumor Removal assessed using Mini Mental State Examination (MMSE)Background and Objective: Patients with brain tumor often experience cognitive dysfunction that may have an impact on physical functioning, psychology, social and vocacional functioning. Post operative cognitive dysfunction (POCD) is the most common post surgical cognitive dysfunction. General anaesthesia may have an impact on POCD. Sevofluran and isoflurane are the two most commonly used inhaled anaesthetic agents for craniotomy tumor removal. The aim of this study is to compare the effects between sevoflurane and isoflurane on cognitive functions after brain tumor surgery.Subject and Method: This is a randomized controlled trial involving 44 ASA II patients who underwent craniotomy tumor removal under general anaesthesia between period of April?October 2015. Statistical analysis using unpaired t-test, Chi Square, Mann Whitney and Komolgorov Smirnov test with p0,05 as statistically significant. Cognitive function was assessed using mini mental state examination (MMSE) preoperatively and postoperatively at 6, 12, 18, 24, 48, 72, 96 and 120 hour postoperative. Result: shows that postoperative MMSE was higher in sevoflurane group compared to isoflurane on 6, 12, 18, 24, 48, 72 hours postoperatively with statistical significance (p0,05). Conclusion: Inhaled anaesthetic agent sevoflurane causes less postoperative cognitive disturbance compared to isoflurane on patients undergoing craniotomy tumor removal.
Co-Authors Boesoirie, M. Adli Dewi Yulianti Bisri Ike Sri Redjeki Tatang Bisri