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All Journal Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Bali Journal of Anesthesiology Majalah Anestesia dan Critical Care Jurnal Anestesi Obstetri Indonesia Interdisciplinary Social Studies Journal of Applied Nursing and Health Jurnal Neuroanestesi Indonesia Acta Medical and Health Sciences (AMHS)

Tatang Bisri

Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung

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Biochemistry, Genetics & Molecular Biology Chemistry Dentistry Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary Other

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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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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.

Penanganan Anestesi Wanita Hamil untuk Kraniotomi Emergensi Hematoma Subdural Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Trauma selama kehamilan, termasuk cedera kepala, adalah penyebab morbiditas dan kematian ibu akibat kecelakaan dan merupakan 6%-7% penyulit dari keseluruhan kehamilan dan pengelolaan pasien harus multidisiplin. Spesialis anestesiologi harus memahami perubahan fisiologi pada wanita hamil, implikasinya, dan risiko khusus pemberian anestesi selama kehamilan sehingga dapat dibuat perencaan penanganannya. Perubahan fisiologi yang unik dari kehamilan, terutama sistem kardiovaskuler, mempunyai keuntungan dan kerugian setelah trauma. Kami melaporkan seorang pasien, umur 28 tahun, dengan umur kehamilam 27-28 minggu masuk ke departemen emergensi akibat kecelakaan sepeda motor dengan Glasgow Coma Scale (GCS) E1M4Vt, tekanan darah 130/70 mmHg, laju nadi 72 x/menit, laju nafas 16 x/menit, telah diintubasi dengan pipa endotrakhea no.6.5, pupil isokor, refleks cahaya positif, laju jantung fetus 140-144 x/menit, dan hasil CT-scan menunjukkan adanya subdural hematoma temporoparietal kanan. Anestesia endotrakheal dengan isofluran, oksigen/udara dengan monitor standar dan Doppler untuk memantau laju jantung fetus. Tujuan utama intervensi bedah saraf pada wanita hamil adalah adalah untuk kelangsungan hidup ibu dan anak. Sasaran utama penanganan anestesi untuk wanita hamil yang tidak dilakukan operasi obstetri adalah mempertahankan perfusi uteroplasenta. Peranan tim multidisiplin dalam penanganan pasien parturien dengan risiko tinggi tidak dapat diremehkanAnesthetic Management of Pregnant Woman for Emergency Craniotomy Subdural Hematoma Trauma during pregnancy, including head injury, is the leading cause of accidental maternal death and morbidity, and complicates 6%-7% of all pregnancies which requires multidisciplinary patients management. The anesthesiologist must understand the physiological changes of pregnancy, their implications, and the specific risks of anesthesia during pregnancy, so that the best anesthetic approach can be performed. The unique physiologic changes of pregnancy, particularly on the cardiovascular system, are both have advantage and disadvantage after acute traumatic injury. We reported a 28 years old parturient patient at 27-28 weeks of pregnancy who was admitted to emergency department due to motorcycle accident with Glasgow Coma Scale (GCS) of E1M4Vt, Blood Pressure 130/70 mmHg, Heart Rate 72 x/minute, Respiratory Rate 16 x/minute.The patient was already intubated using an endotracheal tube no.6.5, the pupils were equal, round and still reactive to light stimulation, fetal heart rate (FHR) was 140-144 x/minute, and head computed tomography scan showed right temporoparietal subdural hematoma. Endotracheal anesthesia was given with isoflurane, oxygen/air, with implementation of standard monitors and Doppler for FHR. The main aim of a neurosurgical intervention in a pregnant woman is to preserve the viability of both the mother and the infant. The main goal in the management of anesthesia for pregnant woman undergoing a non-obstetric surgery is to maintain the uteroplacental perfusion. The role of a multidisciplinary team in the care of high risk parturient patients cannot be avoided.

The Management of Peritumoral Brain Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.586

Brain edema is classified into four main types: vasogenic, cellular, osmotic, and interstitial. These types may be triggered by various conditions, such as head injuries, vascular ischemia, intracranial lesions, and obstructive hydrocephalus. Several factors are associated with the development of (the swelling of the brain including tumors, physical injuries, insufficient oxygen supply (hypoxia), infections, disruption in metabolism, or acute hypertension. Vasogenic brain edema, the most prevalent form of brain edema, is characterized by a blood- brain barrier (BBB) disorder. When the BBB is compromised, ions and proteins move more easily into the extravascular space, creating an osmotic effect that fluid into the brain’s interstitium. In brain tumors, cerebral edema occurs due to leakage of plasma into the parenchyma caused by impaired function of cerebral capillaries. Management of brain edema focuses on two key strategies: preventing further damage caused by the increased fluid in the brain, and addressing the underlying cause of the edema. Corticosteroids are frequently used as a primary therapy for this condition. While low-dose corticosteroids are preferred to minimize serious adverse effects such as myopathy or diabetes, higher doses of dexamethasone-sometimes along with osmotherapy (e.g. mannitol) or surgical interventions- may be necessary in emergency situations. Careful tapering of corticosteroids is essential to prevent dependence or withdrawal symptoms. New therapies, such as vascular endothelial growth factor receptor inhibitors and corticotropin-releasing factor, require additional clinical evaluation. A thorough understanding of pathophysiology of brain edema is crucial for optimizing the treatment strategies both before and after surgical procedures.

Interaksi Otak-Paru pada Neurocritical Care Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Pasien cedera otak traumatik (COT) berat merupakan kasus trauma yang paling sering masuk ke ruang terapi intensif dan kemudian terjadi multiple organ dysfunction dengan morbiditas dan mortalitas yang tinggi. Disfungsi neurologik berat dihubungkan dengan terjadinya edema paru dan cedera paru yang akan memperburuk outcome, dapat terjadi pada cedera otak traumatik, subarachnoid hemorrhage, status epileptikus, dan mati otak. Ventilasi mekanis yang sering digunakan dalam pengelolaan pasien sakit kritis, juga dapat memicu respons paru dan organ lain termasuk otak akibat terjadinya inflamasi. Pengaruh dari paru ke otak terlihat bahwa kebanyakan pasien yang selamat dari acute respiratory distress syndrome (ARDS) menunjukkan kemunduran kognitif yang menetap saat dipulangkan. Mekanisme yang mendasarinya belum diketahui, tapi hiperglikemia, hipotensi dan hipoksia/hipoksemia di ICU secara nyata berkorelasi dengan outcome neurologik yang tidak baik tersebut. Sebaliknya, pengaruh dari otak ke paru terlihat bahwa sepertiga dari pasien COT terjadi acute lung injury (ALI), yang memperburuk outcome, tapi penyebabnya belum jelas, namun kemungkinan mekanismenya antara lain neurogenic lung/pulmonary edema, mediator inflamasi, infeksi nosokomial, dan efek buruk dari terapi neuroproteksi. Neurogenic pulmonary edema merupakan komplikasi cedera SSP yang telah dikenal dengan baik akibat pelepasan katekolamine masif. Sebagai simpulan pada pasien dengan cedera otak dan gagal nafas akut, pencegahan dari cedera otak iskemik dan penggunaan strategi proteksi paru yang hati-hati merupakan hal yang utama. Sejak cross-talk antara otak dan paru diketahui dapat terjadi melalui berbagai jalur yang berbeda, pengendalian variabel fisiologis merupakan hal penting untuk proteksi otak.Brain-Lung Interaction in Neurocritical CareSevere traumatic brain injury patient is one of the most frequent traumatic cases admitted to intensive care unit (ICU) and develop multiple organ dysfunction with high rate of morbidity and mortality. Severe neurological dysfunction associated with pulmonary edema and pulmonary injury which can further worsen clinical outcome has been observed in traumatic brain injury, subarachnoid hemorrhage, status epilepticus, and in brain death cases. Mechanical ventilation that is commonly used in the management of critically ill patients can also trigger pulmonary and other organs responses including the brain, in relation to the inflammation caused. The effect from lung to the brain can be seen by the fact that many acute respiratory distress syndrome (ARDS) survivors showed a persistent cognitive deterioration when discharge. The underlying mechanisms remains unknow, but hyperglycemia, hypotension and hypoxia/hypoxemia in ICU are significantly correlated with this unfavorable neurological outcome. On the other hand, the effect from brain to the lung can be seen by the fact that one-third of acute brain injury patients develop acute lung injury (ALI), that worsen the clinical outcome, but the cause remaining obscure. The possible mechanisms include neurogenic lung edema, inflammatory mediators, nosocomial infection, and the adverse effect of neuroprotective therapy. Neurogenic pulmonary edema is a well-recognized complication of central nervous system insult attributed to a massive catecholamine release. As conclusion in patient with brain injury and acute lung injury, prevention of inadvertent ischemic brain insult and the use of protective lung strategies are mandatory. Since the cross-talk between the brain and lungs may occurs through different pathway, greater control of physiological variables might be important to protect the brain.

Reaktif Oksigen Spesies Pada Cedera Otak Traumatik Suarjaya, I Putu Pramana; Bisri, Tatang; Wargahadibrata, A. Himendra
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Cedera otak traumatik menyebabkan mortalitas dan morbiditas karena terjadinya cedera primer yang diikuti oleh cedera sekunder. Cedera sekunder yang terjadi meliputi peningkatan asam amino eksitatif, ketidak seimbangan ion, penurunan kadar ATP, aktivasi enzim proteolitik dan stres oksidatif yang akan menyebabkan terjadinya disfungsi neuron sampai kematian neuron. Terdapat kaitan erat antara beratnya stres oksidatif yang terjadi dengan beratnya cedera otak yang terjadi, sebagai akibat terganggunya hemostasis kalsium, gangguan pembentukan energi dan meningkatnya proses peroksidasi lipid. Pada telaah ini didiskusikan bagaimana stres oksidatif yang terjadi pada cedera otak traumatik, dan pengaruhnya pada proses pathologi sedera otak traumatik.Reactive Oxygen Species in Traumatic Brain InjuryTraumatic Brain Injury (TBI) morbidity and mortality are due to primary and secondary injury. Primary injury is due to mechanical forces during the trauma process and secondary injury is subsequent process following the primary impact. This secondary injury processes involving increased excitatory amino acids, ionic imbalance, decreased ATP level, unusual proteolytic enzyme activity, and oxidative stress which contibute to delayed neuronal dysfunction and neuronal death. The mammalian brain is vulnerable to oxidative stress because of the high oxygen consumption needed for maintaining neuronal ion homoeostasis during the propagation of action potentials.There is a close relationship between degree of oxidative stress and severity of brain insults, which results from a perturbation of calcium homeostasis, energy metabolism, and increased lipid peroxidation. In this review we discuss oxidative stress during traumatic brain injury, and its implication on pathology of traumatic brain injury.

Penggunaan FOUR Skor dalam Manajemen Anestesi untuk Evakuasi Hematoma Epidural pada Pasien dengan Intoksikasi Alkohol Firdaus, Riyadh; Lalenoh, Diana C.; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
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Manajemen neuroanestesia untuk cedera kepala bertujuan untuk mengoptimalkan perfusi otak, memfasilitasi pembedahan dan mencegah cedera otak sekunder. Bagi pasien cedera kepala yang mengalami toksisitas alkohol, diperlukan perhatian khusus dalam mengevaluasi dan menentukan dosis obat anestesia. Walaupun GCS dapat digunakan sebagai modalitas penilaian pasien dengan intoksikasi alkohol, penilaian menggunakan FOUR adalah alternatif yang lebih baik. FOUR lebih spesifik dalam menilai penurunan kesadaran bila ada defek neurologi, bahkan bagi pasien yang terintubasi. Selama pembiusan, dosis perlu diperhatikan karena konsumsi alkohol jangka panjang dapat meningkatkan kebutuhan dosis obat anestesia. Sebaliknya, intoksikasi alkohol memerlukan dosis obat induksi yang lebih kecil. Seorang laki-laki usia 38 tahun dibawa ke IGD dengan penurunan kesadaran pasca trauma kepala sejak 3 jam sebelum masuk rumah sakit. Pasien memiliki riwayat konsumsi alkohol. Berdasarkan anamnesis, pemeriksaan fisis dan pemeriksaan penunjang, ditegakkan diagnosis Hematom Epidural. Pasien menjalani kraniotomi evakuasi Hematom Epidural selama 4 jam. Pascaoperasi pasien tidak dilakukan ekstubasi dan dirawat di perawatan ICU selama 7 hari.Use of Four Score in Anesthesia Management for Epidural Hematoma Evacuation in Patient with Alcohol IntoxicationNeuroanesthetic management for brain trauma aims to maintain optimal cerebral perfusion and facilitate surgery while preventing secondary brain injury. For patients with brain trauma under alcohol toxicity, careful monitoring is needed to assess and determine drug dosing. Although GCS is reliable for assessing conciousness in patients with alcohol intoxication, evaluation using FOUR is a reasonable alternative. FOUR is more spesific in identifying level of conciousness in neurologic defects, even in intubated condition. Throughout anesthesia, special attention should be given, as long term alcohol consumption may increase the dose needed for general anesthesia. However, a smaller dose of induction agent is needed in alcohol intoxication. We describe a case of a 38 years old male, who was admitted to emergency department with loss of conciousness following head trauma for 3 hours prior to admission. There was history of alcohol consumption. History and physical findings were consistent with epidural hematoma. Patient underwent craniotomy for epidural hematoma evacuation. The surgery took four hours. Post surgery, patient remained intubated and stayed in ICU for seven days.

Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi Of Fallot Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Tetralogi of Fallot (TOF), pertama kali diperkenalkan pada tahun 1888 oleh seorang dokter dari Prancis yang bernama Etienne-Louis Arthur Fallot. Tetralogi of Fallot (TOF) merupakan salah satu jenis cacat jantung bawaan sianotik yang paling banyak diketemukan. Tetralogi of Fallot (TOF) memiliki empat kelainan yaitu: (1) stenosis infundibulum pulmonari, (2) Ventricular Septal Defect (VSD), (3) overidding aorta, dan (4) hipertrofi ventrikel kanan. Pasien dengan penyakit kongenital jantung sianotik (right to left shunt) memiliki resiko terjadinya abses otak. Penyakit jantung sianotik terhitung sekitar 12.8-69,4% dari semua kasus abses otak dan insidensi tertinggi terjadi pada anak-anak. Kami melaporkan seorang anak laki-laki berusia 8 tahun, berat badan 16 kg dengan abses otak multiple yang disertai dengan cacat jantung bawaan sianotik Tetralogi of Fallot (TOF) yang akan dilakukan aspirasi abses. Pasien datang dengan suhu tubuh 39oC, GCS 13, Tekanan darah 90/50 mmHg, nadi 120 x/menit, SpO2 90% dengan simple mask 6 L/menit. Hasil lab menunjukan Hb14gr%, Hematokrit 41%, thrombosit 250.000/mm3. PT/aPTT 13,2/26,9. Sudah terpasang infus dari UGD, selanjutnya diberikan premedikasi midazolam 1 mg intravena, induksi dengan propofol, fentanyl, vecuronium, rumatan anestesi dengan oksigenudara, sevoflurane. 12 Jurnal Neuroanestesia Indonesia Operasi berlangsung selama 1,5 jam, pemberian cairan dengan target normovolume, pascaoperasi dirawat di neurointensive care unit selama 3 hari. Puasa prabedah harus diperhitungkan sebaik-baiknya karena pasien harus tetap terhidrasi dengan baik. Pasien TOF dengan polisitemia, apabila terjadi dehidrasi akan meningkatkan viskositas dan sludging. Pasien ini sudah terhidrasi dengan baik dan cairan pengganti puasa diberikan melalui infus. Pasien harus dalam keadaan tenang dan rileks. Pasien diberikan premedikasi midazolam intravena. Premedikasi dengan suntikan intramuskuler harus dihindari karena kecemasan dan stress dapat menyebabkan tet spell. Premedikasi berat juga harus dihindari karena adanya depresi nafas yang menimbulkan hiperkarbia dapat meningkatkan Pulmonary Vascular Resistance (PVR) dan menimbulkan peningkatan shunting dari kanan ke kiri. Aspirasi abses serebri tidak dapat dilakukan dengan anestesi lokal karena akan meningkatkan kecemasan, tekanan darah pasien. Anestesi harus dilakukan dengan anestesi umum. Pengelolaan perioperatif pasien TOF yang dilakukan operasi ditempat lain (bukan operasi TOFnya) memerlukan pemahaman tentang patofisiologik TOF dan teknik neuroanestesi untuk mendapatkan outcome yang baik.Anesthesia Management For Brain Abscess Drainage Patient With Tetralogy Of FallotTetralogy of Fallot (TOF) was first described in 1888 by a French physician named Etienne-Louis Arthur Fallot. Tetralogy of Fallot (TOF) is one type of cyanotic congenital heart defect most widely found. Tetralogy of Fallot (TOF) has four abnormalities: (1) pulmonary infundibulum stenosis, (2) VSD (Ventricular Septal Defect), (3) overriding aorta, and (4) right ventricular hypertrophy. Patients with congenital cyanotic heart disease (right to left shunt) have a risk of brain abscess. The incidences of cyanotic heart disease is about 12.8-69,4% of all cases of brain abscess and the highest incidence occurs in children. We reported an 8-years old 16-kg boy with multiple brain abscesses accompanied with cyanotic congenital heart defect Tetralogy of Fallot (TOF) and whom abscess aspiration would be performed. Patients was present with body temperature 39oC, GCS 13, blood pressure 90/50 mmHg, pulse 120 beats/min, SpO2 90% with a simple mask using oxygenation of 6 L/min. Lab results showed Hb 14gr%, hematocrit 41%, platelet count 250.000/mm3, PT /aPTT: 13.2/26.9. Patient was mounted infusion from the emergency ward (ER), given 1 mg intravenous midazolam premedication, induction with propofol, fentanyl, vecuronium, maintenance with oxygen-air anesthesia and sevoflurane. The operation lasted for 1.5 hours, the infusion targeted to normal volume, postoperative care was given in the neurointensive care unit for 3 days. Pre-surgical fasting plan plays an important role because the patient must remains well hydrated. TOF patients with polycythemia when dehydrated, will increase the viscosity and sludging events. This patient was well hydrated and fasting replacement fluid therapy was given intravenously. Patients should be in a state of calm and relaxed. Patient was given intravenous midazolam premedication. Premedication with intramuscular injections should be avoided, since anxiety and stress may lead to "tet" spell. Heavy premedication should also be avoided because of respiratory depression leading to hypercarbia can increase the Pulmonary Vascular Resistance (PVR) and precipitate increased shunting from right to the left. Cerebral abscess aspiration can not be performed under local anesthesia because it increases the anxiety and the patient's blood pressure. Anesthesia should be performed under general anesthesia. Management of perioperative TOF patients who will underwent surgery elsewhere (not for TOF) requires deep understanding on TOF pathophysiology and neuro-anesthesia techniques to get a good outcome

Korelasi antara Rentang Waktu Cedera Otak Traumatik dengan Dimulainya Terapi Pembedahan Kraniotomi terhadap Kejadian dan Beratnya Post Traumatic Headache (PTH) Halimi, Radian Ahmad; Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Latar Belakang dan Tujuan: Keluhan nyeri kepala setelah terjadinya Cedera Otak Traumatik (COT) dikenal sebagai Post Traumatic Headache (PTH) yang dapat terjadi setelah cedera kepala ringan, sedang, atau berat. Tujuan penelitian ini adalah mencari apakah ada korelasi antara rentang waktu kejadian COT hingga dilakukannya terapi pembedahan kraniotomi terhadap angka kejadian dan beratnya PTH. Subjek dan Metode: Penelitian observasional kohort prospektif pada 33 orang pasien COT derajat ringan atau sedang dengan pengambilan data secara consequetif sampling. Parameter yang dicatat dalam penelitian ini antara lain usia, jenis kelamin, berat badan, GCS, rentang waktu dari kejadian COT hingga dilakukannya terapi pembedahan kraniotomi, angka kejadian PTH, derajat berat nyeri dengan menggunakan sistem penilaian Numeric Rating Scale (NRS). Analisis korelasi linear dua variabel dihitung berdasarkan analisis korelasi Spearman. Hubungan korelasi bermakna bila koefisien korelasi (R) 0,4 dan nilai p0,05. Hasil: Hasil penelitian menunjukkan adanya korelasi yang kuat antara rentang waktu terhadap kejadian PTH (r = 0,75) dengan korelasi searah dan bermakna (p0,05). Terdapat korelasi yang kuat antara rentang waktu terhadap derajat beratnya PTH (r = 0,82) dengan korelasi searah dan bermakna (p0,05). Simpulan: semakin lama rentang waktu dari kejadian COT hingga dilakukannya terapi pembedahan kraniotomi maka akan semakin banyak angka kejadian dan semakin berat PTH.The Correlation between The Interval of Traumatic Brain Injury with Craniotomy Surgery Start on The Incidence and Severity of Post Traumatic Headache (PTH)Background and Objective: Complaints of headache in the aftermath of Traumatic Brain Injury (TBI) is known as Post Traumatic Headache (PTH), which can occur after mild, moderate, or severe head injury. The purpose of this study is to find a correlation between the time span from the TBI events until the craniotomy surgical therapy was performed with the incidence and severity of PTH.Subject and Method: Prospective observational cohort study in 33 patients with mild or moderate TBI with data retrieval consequetif sampling. The parameters recorded in this study including age, gender, weight, GCS, time interval between the events of TBI until the craniotomy surgical therapy was performed, the incidence of PTH, severity of pain using NRS score. Analysis of linear correlation of two variables calculated by Spearman correlation analysis. Significant correlation when the correlation coefficient (R) 0.4 and p 0.05.Result: The results showed a strong correlation between the interval of the incidence with the incidence of PTH (r = 0.75) with unidirectional and significant correlation (p 0.05). There is a strong correlation between the time span from TBI events until the craniotomy surgical therapy with the severity of PTH (r = 0.82) with unidirectional and significant correlation ( p 0.05).Conclusions: the longer of interval between the TBI events to craniotomy surgical treatment, the more of the incidence and severity of PTH.

Tatalaksana Anestesi pada Bedah Minimal Invasif Deep Brain Stimulation (DBS) Fithrah, Bona Akhmad; Fuadi, Iwan; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
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Otak adalah organ terpenting dalam tubuh manusia. Pada neuroanestesi otak ini dimanipulasi dengan berbagai obat hingga dapat dilakukan pembedahan pada otak itu sendiri. Saat ini berkembang berbagai prosedur bedah syaraf yang bersifat minimal invasif. Dengan hadirnya pembedahan minimal ini diharapkan keluaran bedah syaraf semakin baik dan komplikasi minimal. Salah satu prosedur bedah minimal invasif adalah Deep Brain stimulation (DBS). Prosedur ini memiliki beberapa hal yang harus dipertimbangkan yang bila tidak diperhatikan maka akan menyulitkan operator dan anestesi sendiri. Hal terpenting dari prosedur ini adalah keakuratan untuk menempatkan electrode pada nuclei yang akan dilakukan stimulasi. Anestesi hadir untuk memfasilitasi prosedur minimal invasif ini. Target anestesi pada bedah syaraf minimal invasif tetap sama yaitu perfusi otak yang adekuat. Dan untuk mencapai perfusi otak yang adekuat ini tetap memerlukan persiapan pasien yang baik. Teknik anestesi yang dilakukan berbeda dengan anestesi rutin bedah syaraf. Tekhnik yang umum dikerjakan saat ini adalah monitored anesthesia care dengan local anesthesia, conscious sedation dan anestesi umum. Setiap tekhnik ini memiliki keuntungan, kerugian, pemilihan obat anestesi dan dapat disesuaikan dengan kondisi rumah sakit. DBS sendiri setelah ditanamkan memiliki standar keamanan tersendiri yang harus dipatuhi agar tetap bekerja dengan baik. DBS saat ini dapat ditawarkan sebagai terapi alternatif bagi pasien parkinson yang gagal dengan terapi medikamentosa.Anesthesia for Minimally Invasive Surgery Deep Brain Stimulation (DBS)Brain is the important part from human body. In neuroanesthesia brain is manipulated so surgery can conduct in the brain itsef. Nowadays there are several minimally invasive neurosurgery procedure. What we expect from the minimally invasive surgery is the outcome will be better and or with minimal complication. One of the minimally invasive procedure is Deep Brain Stimulation (DBS). This procedure have some concern to considered if not would complicate the surgeon and the anesthesiologist. Anesthesia come to facilitate this minimally invasive neurosurgery. The goal of anesthesia attending this minimal invasive procedure still the same with routine neurosurgery. which is to make sure adequate cerebral perfusion pressure. Anesthesia procedure litle bit different with common neurosurgery. Anesthesia procedure that recommend nowadays are monitored anesthesia care with local anesthesia, conscious sedation and general anesthesia. All the procedure have advantages and disadvantages, anesthesia drug chosen and customizing with hospital condition. After implanted DBS has certain procedure to be followed if not would endanger or destroyed the DBS itself. Nowadays DBS can be offered as an alternative therapy for the patients which failed with medical therapy.

Pengaruh Asam Traneksamat Intravena terhadap Jumlah Perdarahan Intraoperatif dan Kebutuhan Transfusi pada Operasi Meningioma Sutanto, Sigit; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Meningioma merupakan tumor otak yang berisiko tinggi terjadi perdarahan pada reseksi massa. Penelitian dengan rancangan double blind RCT dilakukan pada 40 subjek meningioma di RSUP Dr Hasan Sadikin Bandung dengan tujuan melihat pengaruh asam traneksamat (TXA) dalam mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi. Subjek dan Metode: Subjek penelitian dibagi dua kelompok, kelompok A diberikan asam traneksamat intravena 20 mg/kg dalam NaCl 0,9% 100 mL dan kelompok B diberikan NaCl 0,9% 100 mL sebelum insisi. Data hemodinamik, jumlah cairan, jumlah transfusi dan jumlah perdarahan intraoperatif dicatat per jam. Dilakukan pemeriksaan kadar Hb, Ht dan faktor pembekuan pascaoperasi dan 24 jam pascaoperasi. Data hasil penelitian diuji secara statistik menggunakan uji t tidak berpasangan dan uji Mann-Whitney. Hasil: Perdarahan intraoperatif (1008,51327,192 vs 1347539,120 ml; p=0,021), kebutuhan pada transfusi packed red cell (PRC) intraoperatif (89,30152,970 ml vs 306,85224,631 ml; p=0,003), kebutuhan transfusi PRC 24 jam pasca operasi (88,50153,014 ml vs 212,00212,505 ml; p=0,028) pada kelompok A secara signifikan lebih kecil dari kelompok B.Simpulan: Asam traneksamat 20 mg/kg yang diberikan intravena sebelum insisi dapat mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi pada operasi tumor otak suspek meningioma.Effects of Intravenous Tranexamic Acid on Blood Loss and Transfusion Requirements in Tumor Removal Surgery of Suspected MeningiomaBackground and objective: Meningiomas are highly vascular brain neoplasms that often associated with substantial blood loss. This experimental, double-blind RCT conducted in Dr. Hasan Sadikin Hospital, enrolled 40 subjects with intracranial meningioma underwent surgical excision. The objective of this study is to see the effect of tranexamic acid (TXA) in reducing bleeding and transfusion requirementsSubjects and Method: Subjects divided into two groups, group A received tranexamic acid 20 mg/kg body weight in 100 mL normal saline, and group B received 100 mL normal saline before incision. Intraoperative hemodynamics, amount of fluid, transfusions, and blood loss were recorded hourly. Hemoglobin, hematocrit, and coagulation factors measured in postoperative, and subjects were followed up for the first 24 hours to record transfusion requirements and laboratorium work up. We analyzed the data using t-test and Mann-Whitney test. Results: Intraoperative blood loss (1008,51327,192 vs 1347539,120 ml; p=0,021), intraoperative packed red cell (PRC) transfusion requirement (89,30152,970 ml vs 306,85224,631 ml, p=0,003), PRC transfusion requirement in first 24 hours postoperative (88,50153,014 ml vs 212,00212,505 ml, p=0,028) in group A significantly less than group B Conclusions: Administration of intravenous tranexamic acid 20 mg/kg before incision can reduce intraoperative blood loss and transfusion requirement in patients underwent surgical excision of meningioma

Co-Authors , Rizki , Suwarman - Irwan, - A. Himendra Wargahadibrata A. Muthalib Nawawi Agus Junaidi Aini, Quratul Akbar, Ieva B Alifahna, Muhammad Rezanda Andie Muhari Barzah, Andie Muhari Ardi Zulfariansyah Arief Kurniawan Bambang Suryono, Bambang Christanto, Sandhi Christanto, Sandhi christiana, monica Dedi Fitri Yadi Dewi Yulianti Bisri Diana C. Lalenoh, Diana C. Diana Lalenoh Erias, Muhammad Erwin Pradian Ezra Oktaliansah Firdaus, Riyadh Firdaus, Riyadh Fithrah, Bona Akhmad Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Giovanni, Cindy Giovanni, Cindy Hamzah, Hanzah Hermawanto, Agung Hindun Saadah, Hindun Ida Bagus Krisna Jaya Sutawan Ieva B. Akbar Ike Sri Redjeki Indrayani, Ratih Rizki Iwan Abdul Rachman Iwan Fuadi Jasa, Zafrullah Khany Kusuma Harimin, Kusuma Laksono, Buyung Hartiyo Lalenoh, Diana Christine Lalenoh, Diana Christine Limawan, Michaela Arshanty M. Dwi Satriyanto M. Erias Erlangga, M. Erias M. Sofyan Harahap Mariko Gunadi Martinus, Fardian Martinus, Fardian MM Rudi Prihatno, MM Rudi Muh. Rumli Ahmad Muhamad Adli Boesoirie, Muhamad Adli Muhammad Habibi Ningsih, Diana Fitria Ningsih, Diana Fitria Noer Rochmah, Elly Nugraha, Ade Aria Nugraha, Ade Aria Nuryanda, Dian Oetoro, Bambang J. Oetoro, Bambang J. Okatria, Ahmado Pontjosudargo, Fransiska Ambarukmi Priyadi, Hendri Putri, Andika C. Putu Pramana Suarjaya Radian Ahmad Halimi Rahmadsyah, Teuku Rahordjo, Sri Rasman, Marsudi Rasman, Marsudi Reza Widianto Sudjud Rose Mafiana Rovina Ruslami, Rovina Ruby Satria Nugraha Ruli Herman Sitanggang Saleh, Siti Chasnak Saleh, Siti Chasnak Saputra, Tengku Addi Saputra, Tengku Addi SATRIYAS ILYAS Septiani, Gusti Ayu Pitria Soefviana, Stefi Berlian Sri Rahardjo Stella, Angela Subekti, Bambang Eko Subekti, Bambang Eko Suryaningrat, IGB Susanto, Bahtiar Sutanto, Sigit Sutanto, Sigit Suwarman Suwarman, Suwarman Suwarman, S Suwarman, S Syafruddin Gaus Thayeb, Srilina Theresia C. Sipahutar Theresia Monica Rahardjo Uhud, Akhyar Nur Widiastuti, Monika - Wirawijaya, Dear Mohtar Wirawijaya, Dear Mohtar Wirawijaya Wullur, Caroline Wullur, Caroline Yunita Susanto Putri Zaka Anwary, Army

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