Article Per Year (5 Year)
p-Index From 2021 - 2026
1.94
P-Index
This Author published in this journals
All Journal Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Althea Medical Journal Majalah Anestesia dan Critical Care Jurnal Neuroanestesi Indonesia Acta Medical and Health Sciences (AMHS) Neurona
Iwan Fuadi
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

Published : 81 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 81 Documents
Search

 5   6   7   8   9 
Manajemen Anestesi untuk Evakuasi Perdarahan Subdural Pasien Cedera Otak Traumatik dengan Gagal Ginjal Kronis Maharani, Nurmala Dewi; Prihatno, MM Rudi; Fuadi, Iwan; Hamzah, Hamzah
Jurnal Neuroanestesi Indonesia Vol 11, No 3 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v11i3.507

Abstract

Pengelolaan anestesi pada kasus subdural hematom disertai penyakit ginjal kronis dengan riwayat hemodialisis memberikan permasalahan bagi ahli anestesi Perubahan hemodinamik perioperatif serta perubahan farmakodinamik dan farmakokinetik obat membuat manajemen perioperatif dan pemilihan regimen anestesi serta cairan harus dipertimbangkan intraoperatif terhadap efek penurunan fungsi ekskresi ginjal pada pasien penyakit gagal ginjal kronik dengan riwayat hemodialisa. Pasien laki-laki, 56 tahun dibawa ke instalasi gawat darurat mengalami penurunan kesadaran setelah kecelakaan lalu lintas sejak 1 hari yang lalu. Pasien dengan riwayat penyakit gagal ginjal kronis serta rutin hemodialisis tiap seminggu sekali. Pada pemeriksaan CT Scan kepala didapatkan hematom subdural di regio temporoparietal sinistra. Pasien preoperatif dilakukan hemodialisa tanpa menggunakan heparin. Diputuskan untuk dilakukan kraniotomi evakuasi dengan induksi anestesi dengan propofol 1 mg/kgbb, fentanyl 2 gr /kgbb, lidokain 1 mg/kgbb dan rocuronium 0.5 mg/kgbb. Pasien diintubasi dengan ETT 7,5 dilanjutkan rumatan anestesi dengan propofol 50 gr /kgbb/menit, fentanyl 2 gr/kg/jam dan rocuronium 5 gr/kg/menit. Monitoring standar elektrokardiografi, SpO2, dan arteri line. Setelah operasi pasien dirawat diruang intensif selama 3 hari. Pasien post operatif diberikan sedasi analgetik dengan dexmedetomidine 0,2- 0,7 gr /kg/jam
Correlation Between Physical Activity and Fitness Level Among Anesthesiology and Intensive Care Residents Firdaus, Wildan; Fuadi, Iwan; Erlangga, M. Erias
Majalah Kedokteran Bandung Vol 55, No 4 (2023)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v55n4.3007

Abstract

Anesthesiologists have a highly varied scope of work. Previous studies demonstrated that the physical activity of anesthesiologists and their residency program in the work environment does not meet the recommended standards. This study aimed to determine the relationship between physical activity and level of physical fitness among anesthesiology residents. This study was an analytical observational study with a cross-sectional design conducted on residents of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Padjadjaran, Indonesia, between January and April 2022. All anesthesiology residents were asked to fill out the International Physical Activity Questionnaire (IPAQ) and had their number of steps measured using a pedometer while the physical fitness level was assessed using the Harvard Step Test. Physical activity was assessed based on the IPAQ and pedometer. The results of IPAQ measurement showed that more subjects had low physical activity (n=44) compared to good physical activity (n=31). When measured using a pedometer, 38 subjects were classified as having low physical activity while 36 had good physical activity. Low fitness level (n=43) was associated with less physical activity on IPAQ (41 and 2)and pedometer (30 and 13). No residents had moderate or better fitness levels. Correlation analysis between physical activity and physical fitness showed a significantpositive correlation with a p-value <0.05 (Spearman Rho: 0.618). Thus,physical activity and fitness level are well-correlated among of Anesthesiology and Intensive Care residents.
HUBUNGAN ANTARA DERAJAT KEPARAHAN STROKE DENGAN KEJADIAN STROKE-ASSOCIATED PNEUMONIA Wandira, Rega Dwi; Amalia, Lisda; Fuadi, Iwan
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 35 No 2 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i2.20

Abstract

ASSOCIATION BETWEEN STROKE SEVERITY AND STROKE-ASSOCIATED PNEUMONIAABSTRACTIntroduction: Stroke-associated pneumonia (SAP) occurs in 5-26% and decreases the quality of life and clinical outcomes of stroke patients. One of the factors that affect the incidence of SAP is the stroke severity.Aims: To determine the association between the stroke severity and the incidence of stroke-associated pneumonia in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung.Methods: This is an analytic retrospective (historical) cohort design study. The study population was stroke patients who were treated in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung between 2014-2016. Exclusion criteria were patient with pneumonia other than SAP and using mechanical ventilation. Stroke severity was assessed using NIHSS (National Institute of Health Stroke Scale). Chi-square was used to determine inter-variable association.Results: Among 81 subjects, 24 were assessed as SAP (29.6%). The SAP prevalence were mostly male (58.3%), age group between 65-74 year old (41.7%) with hypertension risk (87.5%), stroke onset <48 hours, lesion location on left hemisphere, onset of SAP≥48 hours, and those with consciousness impairment. Those with high stroke severity tend to have higher risk of pneumonia 3.063 times compare to patients with low stroke severity.Discussion: There was a significant association between the severity of stroke and the incidence of SAP in the neu- rological ward of Dr. Hasan Sadikin Hospital, Bandung.Keywords: NIHSS, stroke-associated pneumonia, stroke severityABSTRAKPendahuluan: Stroke-associated pneumonia (SAP) cukup sering terjadi (5-26%) pada pasien stroke, sehingga menurunkan angka kualitas hidup dan luaran klinis. Salah satu faktor yang memengaruhi kejadian SAP adalah derajat keparahan stroke.Tujuan: Mengetahui hubungan antara derajat keparahan stroke dengan kejadian SAP di Ruang Rawat NeurologiRSUP Dr. Hasan Sadikin, Bandung.Metode: Penelitian analitik dengan desain kohort retrospektif (historikal) terhadap pasien stroke iskemik yang di rawat di Ruang Rawat Neurologi RSUP Dr. Hasan Sadikin, Bandung pada tahun 2014-2016. Kriteria eksklusi adalah pasien dengan pneumonia selain SAP dan menggunakan alat ventilasi mekanik. Derajat keparahan stroke dinilai menggu- nakan skor NIHSS (National Institutes of Health Stroke Scale). Uji korelasi Chi-square digunakan untuk melihat hubungan antar-variabel.Hasil: Didapatkan 81 subjek yang 24 orang di antaranya  mengalami SAP (29,6%). Prevalensi SAP tertinggi pada laki-laki (58,3%) kelompok usia 65-74 tahun (41,7%) dengan faktor risiko hipertensi (87,5%), onset stroke<48 jam, lokasi lesi di hemisfer kiri, onset SAP≥48 jam, serta pada subjek dengan penurunan kesadaran. Subjek dengan derajat keparahan stroke berat memiliki risiko terjadinya pneumonia 3,063 lebih tinggi dibandingkan dengan derajat keparahan ringan.Diskusi: Terdapat hubungan yang bermakna antara derajat keparahan stroke dengan kejadian SAP di Ruang Rawat Neurologi RSUP Dr. Hasan Sadikin, Bandung.Kata kunci: Derajat keparahan stroke, NIHSS, stroke-associated pneumonia
Dexmedetomidine as an Adjunct in Anesthesia for Adolescent Idiopathic Scoliosis (AIS) Surgery: A Case Series Nofiyanto, Eko; Halimi, Radian Ahmad; Fuadi, Iwan; Abdul rachman, Iwan
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.682

Abstract

Scoliosis is a spinal curvature deformity 10, with Adolescent Idiopathic Scoliosis (AIS) affecting those aged 10-18 years. The global prevalence of AIS is between 1%-2%, while in Indonesia, it stands at 2,93%, with a female-to-male ratio of 4.7:1. Perioperative challenges include nerve damage, bleeding, and postoperative pain. Neuromonitoring (MEP and SSEP) helps prevent injury, while careful drug selection supports spinal protection. Three female patients scoliosis reconstructions were performed under general anesthesia. All received target- controlled infusion (TCI) propofol, dexmedetomidine, and fentanyl, with stable hemodynamics and no neurological changes post-surgery. Epidemiological data showed that AIS predominantly affects females. The study included patients with curve progression impacting activity, with no motor or sensory abnormalities observed. Anesthesia was induced with propofol TCI (4 ?g/mL) and dexmedetomidine (0.3-0.7 mcg/kg/hr), reducing propofol and opioid use. Dexmedetomidine targets ?2-adrenergic receptors, reducing sympathetic outflow, stabilizing hemodynamics, blocking pain transmission, and improving recovery by reducing blood loss and inflammation. Dexmedetomidine provides sedation, analgesia, and stable hemodynamics in scoliosis surgery, minimizing blood loss and transfusion needs. It supports neurophysiological monitoring, reduces postoperative pain, and enhances recovery.
Tatalaksana Anestesi pada Pasien Anak dengan Cystic Craniopharyngioma yang Menjalani Gamma Knife Radiosurgery Widiastuti, Monika -; Halimi, Radian Ahmad; Fuadi, Iwan; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3082.611 KB) | DOI: 10.24244/jni.v10i2.353

Abstract

Kraniofaringioma merupakan tumor otak jinak dengan karakteristik kistik dan kalsifikasi, yang letaknya dikeliingi oleh stuktur vital sehingga sulit untuk dilakukan reseksi total. Terapi kombinasi dengan Gamma knife radiosurgery (GKRS) merupakan pilihan terapi paling tepat. Prosedur GKRS yang kompleks meliputi banyak tahap dengan durasi 6-10 jam, memerlukan pemberian anestesi pada pasien yang tidak kooperatif. Kasus ini mengenai pasien anak perempuan berusia 4 tahun dengan cystic craniopharyngioma. Pasien dengan keluhan pandangan mata buram, dari pemeriksaan fisik didapatkan papil atrofi bilateral. Hasil magnetic resonance imaging (MRI) menunjukkan massa tumor yang menekan kelenjar hipofise inferior. Pasien menjalani prosedur GKRS selama 6 jam dengan anestesi sedasi sedang menggunakan Propofol 75 mcg/kg/menit. Hemodinamika selama prosedur stabil, tidak terjadi komplikasi. Pemilihan teknik anestesi dapat berupa anestesi umum atau sedasi, tergantung pada kondisi pasien, dokter anestesi, operator, dan fasilitas. Pertimbangan anestesi pada GKRS antara lain prosedur dilakukan di luar kamar operasi, durasi panjang, transportasi ke beberapa tempat seperti radiologi dan cathlab, imobilisasi kepala untuk mencegah pergeseran frame stereotaktik, pasien sendiri di dalam ruang radiasi, prinsip neuroanestesi pediatrik.Anesthetic Management of Pediatric Patient with Cystic Craniopharyngioma Underwent Gamma Knife RadiosurgeryAbstractCraniopharyngioma is a benign tumor characterized by cystic and calcification, surrounded by vital structures therefor it is difficult to perform total tumor resection. Combination with Gamma knife radiosurgery (GKRS) is the best treatment option. The complexities of GKRS consisting of several phases lasts for 6-10 hours. Anesthesia is needed for uncooperative patients. This is a case of a 4-year-old girl with cystic craniopharyngioma. The patient had chief complaint of blurry vision, physical examinations revealed bilateral papil atrophy. Result of MRI showed tumor mass compressing inferior hypophyse. Patient underwent the procedure under moderate sedation with Propofol at 75 mcg/kg/min for 6 hours. Intraoperative hemodynamic condition was stable without adverse events. Choice of anesthesia either general anesthesia or sedation, depends on the condition of patient, considerations from anesthesiologist dan neurosurgeon, dan availability of facilities. Unique considerations for GKRS are; a non-operating room anesthesia, long duration, transportation to other units such as radiology and cathlab, head of the patients need to be immobilized to prevent frame displacement, the patient will be alone in the treatment room, and principles of pediatric anesthesia and neuroanesthesia.
Perbandingan Osmolaritas, Kadar Natrium dan Klorida Plasma setelah Pemberian NaClRL (3:1) dengan Ringerfundin pada Pasien Tumor Otak Martinus, Fardian; Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2233.519 KB) | DOI: 10.24244/jni.vol3i1.127

Abstract

Latar Belakang dan Tujuan : Kristaloid NaCl 0,9% merupakan cairan dasar yang sering digunakan pada perioperatif pasien tumor otak, namun berpotensi menyebabkan asidosis hiperkloremia sehingga dikombinasikan dengan Ringer Laktat. Ringerfundin, kristaloid yang komposisi elektrolitnya hampir ideal, namun belum banyak penelitiannya dalam kasus bedah saraf. Tujuan penelitian adalah membandingkan pemberian cairan kombinasi NaCl 0,9%: RL (3:1) dengan cairan Ringerfundin pada pasien tumor otak untuk melihat osmolaritas, natrium dan klorida plasma. Subjek dan Metode: Penelitian Randomized Controlled Trial (RCT) pada 36 pasien tumor otak yang menjalani kraniotomi, di Rumah Sakit Hasan Sadikin. Sampel dibagi menjadi kelompok NaCl 0,9%:RL (3:1) dan kelompok Ringerfundin. Dilakukan pemeriksaan natrium, klorida plasma dan osmolaritas plasma sebelum dan setelah pemberian cairan sebanyak 1 liter. Data penelitian dianalisis dengan uji t.Hasil: Analisis statistik menunjukkan tidak terdapat perbedaan yang bermakna kedua kelompok setelah pemberian cairan dalam perhitungan osmolaritas plasma 291,42 vs 290,21 (p=0,63) dan natrium plasma 141,28 vs 141,06 (p=0,82). Terdapat perbedaan yang bermakna kadar klorida kelompok NaCl 0,9%: RL dibandingkan dengan kelompok ringerfundin 106,33 vs 104,39 (p=0,02). Simpulan: Ringerfundin dapat menjadi cairan alternatif dari NaCl 0,9%: RL dengan tidak menyebabkan perubahan pada osmolaritas, peningkatan kadar natrium dan kadar klorida plasma.The Comparison of Osmolarity, Plasma Natrium and Chloride Level After Administering NaCI-RL (3:1) and Ringerfundin in Brain Tumor Patients Undergoing CraniotomyBackground and Objective: One of most commonly used crystalloid for perioperative fluid administration in patients with brain tumor is NaCl 0,9%, and because it has potential to cause hyperchloremic acidosis, its administration usually combined with Ringer Lactate. Ringerfundin is a crystalloid solution which contains electrolyte composition that is considered as the most ideal solution, but has not been frequently used in neurosurgery procedure. The aim of this study is to compare the plasma osmolarity, sodium and chloride levels in brain tumor patient after the administration NaCl 0,9% combined with: RL solution in 3:1 ratio and after ringerfundin administration.Subject and Method: Thirty six patients underwent craniotomy tumor removal were assigned randomly to receive NaCl 0,9%: RL (3:1) or ringerfundin solutions. Sodium and chloride plasma level and calculated plasma osmolarity were recorded at baseline and after one liter of fluid adminisitration. Data were analyzed with by using t-test analysis. Result: Statistic analysis showed no significant differences between the two groups in calculated plasma osmolarity (291,42 vs 290,21; (p=0,63) and sodium plasma level (141,28 vs 141,06; (p=0,82). A significant increased in chloride plasma level after one liter of fluid administration was observed in NaCl 0,9%: RL group compared to ringerfundin group (106,33 vs 104,39 respectively; (p=0,02).Conclusion: Ringerfundin is safe and can be use as an alternative fluid aside the most commonly used fluid combination using NaCl 0,9% and RL solutions, without causing changes in plasma osmolarity, and sodium or chloride plasma level.
Perbandingan Mini Mental State Examination (MMSE) dan Clock Drawing Test (CDT) untuk Mendeteksi Disfungsi Kognitif pada Cedera Otak Traumatik Ringan dan Sedang Oktivia, Wenny; Fuadi, Iwan
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2337.759 KB)

Abstract

Latar Belakang dan Tujuan: Disfungsi kognitif sering terjadi pada pasien cedera otak traumatik (COT). Gangguan neuropsikologik yang disebabkan oleh cedera otak traumatik ringan dan sedang berupa penurunan kecepatan memproses informasi, gangguan perhatian, orientasi, dan fungsi eksekutif. Pemeriksaan disfungsi kognitif yang sering digunakan adalah Mini Mental State Examination (MMSE). Saat ini sedang dicari pemeriksaan lain yang lebih mudah dilakukan dan memiliki sensitifitas dan spesifisitas yang lebih baik, yaitu dengan Clock Drawing Test (CDT). Penelitian ini bertujuan membandingkan MMSE dan CDT dalam mendeteksi disfungsi kognitif pada COT ringan dan sedang. Subjek dan Metode: Penelitian menggunakan observasi analitik cross sectional, dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan Januari hingga April 2018. Pasien dibagi menjadi kelompok COT ringan (n=16) dan sedang (n=16) yang masing-masing dilakukan pemeriksaan MMSE dan CDT. Hasil: Dengan nilai cut-off MMSE 26,5 didapatkan sensitivitas 93,8% dan nilai spesifisitas 81,3%, sedangkan menggunakan nilai cut-off CDT 2,5 didapatkan sensitifitas dan spesifisitas CDT 100%. Simpulan: CDT memiliki sensitivitas dan spesifisitas yang lebih baik untuk mendeteksi disfungsi kognitif pada COT ringan dan sedang.Comparison of Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) on Detecting Cognitive Dysfunction on Mild and Moderate Traumatic Brain InjuryAbstractBackground and Objective: Cognitive dysfunction often found in Traumatic Brain Injury (TBI). TBI can triggers neurophysicological, such as slower information processing, attention deficit, orientation disturbance, and executive function. There are methods to evaluate cognitive dysfunction, but none are showing 100% sensitivity and specificity. The frequently used method is Mini Mental State Examination (MMSE). Currently, other examinations are being sought that are easier to do and have better sensitivity and specificity, namely the Clock Drawing Test (CDT). This study is aimed to compare MMSE and CDT to detect cognitive dysfunction in Mild and Moderate TBI. Subject and Method: This study is using analytical observation and cross-sectional study design, it was held in Hasan Sadikin Hospital Bandung throughout January 2017 to April 2018. Subjects are divided into Mild TBI group (n=16) and Moderate TBI group (n=16), both groups were given MMSE and CDT. Result: Using cut-off point 26,5 for MMSE the sensitivity and specificity are 93.8% and 81.3%, while CDT achieved 100% sensitivity and specificity. Conclusion: CDT has a better sensitivity and specificity on detecting cognitive dysfunction in Mild and Moderate TBI.
Penanganan Anestesi pada Ventriculo Peritoneal Shunt Cito e.c Hidrocephalus dengan Perdarahan Intraventricular Novitasari, Dian; Fuadi, Iwan; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (378.506 KB) | DOI: 10.24244/jni.vol6i3.55

Abstract

Perdarahan intraventrikular akibat perluasan perdarahan subarahnoid ke ruang intraventrikel atau akibat perdarahan intraserebral menyebabkan hidrosefalus merupakan prediktor independent prognosis yang buruk pada stroke hemoragik. Kondisi hidrosefalus dengan perdarahan intraventrikular membutuhkan Ventriculo Peritoneal (VP) Shunt segera untuk menghindari defisit neurologis permanen bahkan kematian. Pasien seorang laki-laki dewasa (56 tahun) dengan bb 75 kg, dengan hipertensi kronis dan penurunan kesadaran disertai hipertensi intrakranial dengan CT Scan menunjukkan adanya hidrosefalus disertai perdarahan intraventrikular luas. Dilakukan anestesi dengan kombinasi anestesia intravena menggunakan propofol, dexmedetomidine - sevofluran 1 MAC dapat menjadi pilihan dalam operasi bedah saraf. Tindakan VP Shunt segera pada pasien ini merupakan tindakan yang bersifat life saving dengan managemen anestesi yang baik memberikan outcome yang baik.Anesthesia Management for Emergency Ventriculo Peritoneal Shunt ec Hydrocephalus with Intraventricular HemorrhageIntraventricular hemorrhage due to the expansion of subarachnoid hemorrhage due to space intraventricular or intracerebral hemorrhage cause hydrocephalus is an independent predictor of poor prognosis in hemorrhagic stroke. Hydrocephalus condition with intraventricular hemorrhage requiring ventriculo peritoneal (VP) shunt immediately to avoid permanent neurological deficits and even death. In this case report will discuss the management of anaesthesia in emergency VP Shunt for a patient with chronic hypertension, history of loss of consciousness accompanied by intracranial hypertension and CT scan result showed the existence of intra-ventricular hemorrhage with hydrocephalus wide. The combination of intravenous anesthesia using propofol, dexmedetomidine - 1 MAC sevoflurane may be an option in the operation of neurosurgery. VP Shunt immediate action in these patients is an act that is life saving with good anesthetic management provides a good outcome.
Deep Vein Thrombosis (DVT) Pasca Cedera Otak Traumatik Berat Martaria, Nency; Fuadi, Iwan; Sudadi, Sudadi
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2969.489 KB) | DOI: 10.24244/jni.v8i3.236

Abstract

Cedera otak traumatik(COT) adalah penyebab utama kematian dan disabilitas. Deep vein thrombosis (DVT) adalah salah satu risiko tinggi dari COT. Faktor risiko DVT lain yang umum ditemukan pada pasien COTadalah paralisis, imobilisasi, dan cedera ortopedi. Deep vein thrombosis diduga terkait gangguan koagulasi yang sering ditemukan pada COT, terutama pada COT berat. Deep vein thrombosis dapat menyebabkan pulmonary embolism (PE) yang merupakan salah satu penyebab kematian lambat terbanyak pada pasien trauma. Diagnosis DVT didapatkan melalui stratifikasi risiko, pemeriksaan fisik, dan pemeriksaan penunjang yang mencakup pemeriksaan d-dimer, ultrasonografi, dan penunjang lain seperti spiral computed tomography venography. Tata laksana DVT pada pasien COT mencakup pemberian antikoagulan intravena yang dilanjutkan oral jangka panjang,stoking kompresi, dan pemasangan vena cava filter (VCF). Pada pasien COT, adanya risiko perdarahan intrakranial umumnya menimbulkan keraguan pada klinisi terkait inisiasi profilaksis farmakologis dengan antikoagulan. Profilaksis nonfarmakologis mencakup penggunaan graduated compression stocking (GCS), alat kompresi pneumatik (pneumatic compression devices/PCD), A-V foot pump, dan vena cava filter (VCF). Beberapa studi terkini menyarankan pemasangan PCD pada semua pasien COT pada awal perawatan selama tidak ditemukan kontraindikasi. Pemeriksaan CT selanjutnya dilakukan setelah 24 jam. Penemuan hasil yang stabil pada CT, profilaksis farmakologis dapat dimulai dalam 24-48 jam setelah CT. Selama pemberian antikoagulan, CT serial dapat dilakukan untuk memantau progresi perdarahan.Deep Vein Thrombosis (DVT) after Severe Traumatic Brain InjuryAbstractTraumatic brain injury (TBI) is a risk factor for deep vein thrombosis (DVT). Beside the common risk factors of DVT among TBI patients, this is associated with coagulopathycommonly foundin TBI, especially in severe TBI.Diagnosis and treatment of DVT are also crucial to prevent mortality. Deep vein thrombosis could be diagnosed through risk stratification, physical examination, and d-dimer as well as ultrasonography examination. Treatment includes intravena anticoagulant continue with longterm oral, stocking compression and the use of vein cava filter (VCF). Deep vein thrombosis could cause pulmonary embolism (PE), a common cause of late mortality in trauma patients. Deep vein thrombosis could be prevented pharmacologically (with anticoagulant) and nonpharmacologically. However, in TBI patients, the risk of intracranial hemorrhage usually considered an initiation of pharmacological prophylaxis. Nonpharmacological prophylaxisincludes graduated compression stocking (GCS), pneumatic compression devices (PCD), A-V foot pump, and vena cava filter (VCF). Latest studes suggest the use of PCD for all TBI patients without contraindication since administration. Computed tomography should be performed within 24 hours and if the resultis stable, pharmacological prophylaxis should be initiated within 24-48 hours.
Penatalaksanaan Anestesi pada Pasien dengan Sindroma Apert yang Dilakukan Suturektomi Rachman, Iwan Abdul; Fuadi, Iwan; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (345.332 KB) | DOI: 10.24244/jni.vol2i2.161

Abstract

Sindroma Apert adalah suatu gangguan genetik yang ditandai dengan penggabungan tulang yang terlalu dini (kraniosinostosis). Penggabungan dini tersebut menghambat pertumbuhan normal tulang dan mempengaruhi pertumbuhan bentuk kepala dan wajah. Penggabungan dini tulang kepala dapat mempengaruhi perkembangan otak bahkan menyebabkan peningkatan tekanan intrakranial, dan pada sindroma Apert juga didapatkan penggabungan beberapa jari tangan dan kaki (sindaktili). Seorang anak berusia 2 tahun dengan sindroma Apert. Tanda klinis peningkatan tekanan intrakranial belum didapatkan sehingga operasi dijadwalkan terencana dan pasien dirawat terlebih dahulu di ruangan. Kemungkinan kesulitan untuk intubasi dengan laringoskopi diantisipasi dengan persiapan intubasi menggunakan optik fiber dan trakeostomi. Pasien diberikan premedikasi midazolam 0,5 mg intravena pada saat pasien akan dibawa ke kamar operasi. Dilakukan anestesi umum, induksi menggunakan propofol 30 mg, fentanil 30 ?g diberikan 3 menit sebelum intubasi. Fasilitas intubasi dengan vekuronium 2 mg, pemeliharaan anestesi dengan N2O/O2 dan Sevofluran. Vekuronium diberikan 1 mg /jam. Ventilasi kendali menggunakan ETT no. 5,0. Operasi berlangsung selama 6 jam dengan posisi pasien terlentang. Hemodinamik selama operasi relatif stabil, tekanan darah sistolik berkisar 90-110 mmHg, tekanan darah diastolik 50-70 mmHg, laju nadi (HR) 87-110 x/mnt, SaO2 99-100 %. Setelah operasi berakhir pasien bernafas spontan adekuat dan dilakukan ekstubasi di kamar operasi. Pasca operasi pasien di rawat di PICU hingga hari ke-4 pasien dipindahkan ke ruangan. Gangguan penggabungan tulang kepala yang terlalu dini dapat menyebabkan gangguan pertumbuhan bentuk kepala, otak dan gangguan pendengaran dan penglihatan. Selain itu juga dapat menyebabkan terjadinya peningkatan tekanan intrakranial. Koreksi segera dengan melakukan suturektomi dan dekompresi dapat mencegah kemungkinan-kemungkinan tersebut.Anaesthetic management of patient with Apert syndrome which undergo suturectomy Apert syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. Early fusion of the skull bones also affects the development of the brain and even can increased the intracranial pressure. In apert syndrome there was also fusion of fingers and toes (syndactyly). A 2 years old child with Apert syndrome which undergo suturectomy and decompression. The clinical signs of raised intracranial pressure in this patient has not been obtained yet so the surgery was done as scheduled . Difficulties to perform intubation with direct laryngoscopy were anticipated through the use of fiber optic and preparation of tracheostomy. Patient has been given premedication using midazolam 0,5 mg given intravenously before his admission to the operating room. The surgery is performed with general anesthesia using propofol 30 mg then fentanyl 30mcg, 3 minutes before intubation. Vecuronium 2mg was given to facilitates intubation. Maintenance of anesthesia with Nitroons/O2 sevoflurane and Vecuronium 1mg/hour. Ventilation was controlled by using ETT no 5.0. Patient was in supine position, and it last for 6 hours. There was relatively stable hemodynamics, systolic blood pressure range 90-110 mmHg, diastolic blood pressure 50-70 mmHg, pulse rate 87-110x/minutes, SaO2 99-100%. After the operation, there was adequate spontaneous breathing so extubation was performed in the operating room, then he was referred to PICU. On day 4 patient was moved to the room. Premature fusion of skull bones will cause growth disorders of the head, brain, and hearing and vision impairment. It also can cause increased intracranial pressure. Immediate correction by suturectomy and decompression can prevent this possibility.
Co-Authors - Elvidiansyah - Elvidiansyah A Himendra Wargahadibrata A Himendra Wargahadibrata A. Muthalib Nawawi A.A. Ketut Agung Cahyawan W Abdul Muthalib Nawawi Abdul Muthalib Nawawi Abdul rachman, Iwan Abdul Rahman Aisyah Ummu Fahma Aminuyati Andre Aditya Andy Hutariyus Ardhana Risworo Anom Yuswono Ardhana Risworo Anom Yuswono Ardi Zulfariansyah Ardi Zulfariansyah Ardi Zulfariansyah Ari Saptadi Ari Saptadi Ariestian, Erick Army Zaka Anwary, Army Zaka Arna Fransisca Arsy Felisita Dausawati Arsy Felisita Dausawati Asyer Asyer Bisri, Tatang https://scholar.google.co.id/citations?u Bramantyo Pamugar Dedi Fitri Yadi Defri Aryu Dinata Defri Aryu Dinata, Defri Aryu Dessy Sutoyo Dewi Ramadani Dewi Ramadani Dewi Yulianti Bisri Dian Novitasari Doddy Tavianto Dzulfikar D. L. Hakim Eka Damayanti Eko Nofiyanto Eri Surahman Eri Surahman Erick Ariestian Erwin Pradian Eva Srigita Tari Ezra Oktaliansah Fahma, Aisyah Ummu Firdaus, Riyadh Fithrah, Bona Akhmad Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Hamzah Hamzah Hansen Wangsa Herman Harahap, M Sofyan Hidayat, Dede A Hunter D. Nainggolan Hunter D. Nainggolan Ike Sri Redjeki Ike Sri Redjeki Indra Wijaya Indriasari Indriasari Iwan Abdul Rachman Jimmy Setiadinata Jimmy Setiadinata, Jimmy Kartapraja, Roni D. Lisda Amalia Lukman Hidayat M Andy Prihartono M. Erias Erlangga M. Erias Erlangga, M. Erias Maharani, Nurmala Dewi Mariko Gunadi Mariko Gunadi Martaria, Nency Martinus, Fardian Martinus, Fardian Maulana Muhammad Maulana Muhammad, Maulana Mayasari, Ferra Mayasari, Ferra Muhammad Adjie Pratama Nadya, Siti Fairuz Oktivia, Wenny Pamugar, Bramantyo Pison, Osmond Muvtilof Prihatno, M. Mukhlis Rudi Putri, Dini Handayani R, Tubagus Yuli R, Tubagus Yuli Radian Ahmad Halimi Rahmadsyah, Teuku Rahmatisa, Dimas Rahordjo, Sri Richard Pahala Sitorus Rini Rustini Riyadh Firdaus Roni D. Kartapraja Rudi Kurniadi Kadarsah Ruli Herman Sitanggang S, Achmad Afif Saleh, Siti Chasnak Saleh, Siti Chasnak Setiawan Setiawan Sitanggang, Ruli H. Sitorus, Richard Pahala Sri Rahardjo Sri Rahardjo Sudadi Sudadi Suryadi Suryadi Suryadi Suryadi Sutoyo, Dessy Tantarto, Tamara Tatang Bisri Tatang Bisri Theresia C. Sipahutar Theresia C. Sipahutar Theresia Monica Rahardjo Thomas Thomas Tinni T. Maskoen Tinni T. Maskoen Tinni T. Maskoen Wandira, Rega Dwi Wargahadibrata, A. Hmendra Wargahadibrata, A. Hmendra Widiastuti, Monika - Wildan Firdaus Yunita Susanto Putri Yunita Susanto Putri Zamzami, Nyiemas Moya Zamzami, Nyiemas Moya