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Tatang Bisri
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
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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SUPINE HYPOTENSION SYNDROME PADA KEHAMILAN Bisri, Dewi Yulianti; Redjeki, Ike Sri; Bisri, Tatang
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (566.711 KB)

Abstract

Supine hypotension syndrome (SHS) dapat terjadi mulai kehamilan trimester 2 dan didefinisikan sebagai penurunan tekanan sistol ?30% pada posisi supine dibanding dengan lateral. Tujuan penelitian mengetahui insidensi SHS pada wanita hamil aterm di Indonesia. Penelitian observasional pada 200 wanita hamil aterm, kehamilan pertama dan kedua, usia 18?40 tahun, tidak memiliki penyakit sertaan, dan akan dilakukan seksio sesarea elektif di Rumah Sakit Ibu dan Anak Melinda dalam periode Maret?Juli 2012. Pasien diberikan 500 cc cairan kristaloid Ringer laktat sebagai pengganti puasa, kemudian dilakukan pemeriksaan tekanan sistol, diastol, rata-rata, laju nadi, dan saturasi oksigen selama 5 menit dengan jarak 1 menit pada posisi supine dan miring kiri 45O. Hasil pengukuran tekanan sistol supine 113,49 (13,20) mmHg, miring 105,20 (12,08) mmHg dengan nilai p=0,93. Tekanan diastol supine  69,05 (7,31) mmHg dan miring 58,58 (7,73) mmHg (p=0,51). Tekanan darah rata-rata supine 84,59 (8,38) mmHg dan miring 75,87 (8,82) mmHg (p=0,62). Laju nadi supine 88,95 (12,19) x/menit, dan miring 86,26 (11,47) x/menit, (p=0,86). SpO2 supine 99,95 (1,11)% dan miring 99,64 (0,67)% (p=0,07). Simpulan, tidak ada perbedaan tekanan sistol, diastol, rata-rata, laju nadi, dan SpO2 wanita hamil aterm pada posisi berbaring dengan posisi miring kiri 450. [MKB. 2015;47(2):102?8]Kata kunci: Posisi supine, posisi miring kekiri, supine hypotension syndrome, wanita hamil atermSupine Hypotension Syndrome in PregnanciesAbstractSupine hypotension syndrome (SHS) can occur starting from the second trimester of pregnancy and is defined as a reduction of systolic blood pressure of ?30% in the supine position compared to lateral position. The purpose of this study was to determine the incidence of SHS in full term pregnant women in Indonesia. An observational study on 200 full term pregnant women, first and second pregnancy, aged 18?40 years, no coexisting diseases, and was going to have an elective cesarean section in Melinda Woman and Child Hospital in the period of March?July 2012. Patients were given 500 cc of Ringer?s lactate crystalloid fluid instead of fasting. Systolic and diastolic blood pressure, mean blood pressure, pulse rate, and oxygen saturation for 5 minutes were then examined every  minute. The examination was conducted in the supine and left lateral position of 45O. The results show a systolic blood pressure in supine position of 113.49 (13.20) mmHg and in lateral position of 105.20 (12.08) mmHg (p=0.93). Meanwhile, the supine diastolic blood pressure was  69.05 (7.31) mmHg and lateral position was 58.58 (7.73) mmHg (p=0.51). The mean blood pressure in supine position was 84.59 (8.38) mmHg and 75.87 (8.82) mmHg (p=0.62) in lateral position . The pulse rates for supine and lateral position were 88.95 (12.19)x/min and 86.26 (11.47) x/min (p=0.86), respectively. Supine SpO­2 was 99.95 (1.11) % and lateral SpO2 was 99.64 (0.67) % (p=0.07). In conclusion, there is no differences in systolic, diastolic, mean blood pressure, pulse rate and SpO2 of full term pregnant women in supine or left lateral position of 45O. [MKB. 2015;47(2):102?8]Key words: Full term pregnant women, left lateral decubitus, supine hypotension syndrome, supine DOI: 10.15395/mkb.v47n2.461
Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna? Ahmad, Muh. Rumli; Bisri, Tatang
Majalah Kedokteran Bandung Vol 45, No 3 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Analgesia preemtif adalah pemberian regimen analgesik sebelum onset stimulus noksius. Kerusakan jaringan akibat pembedahan menimbulkan rangsang noksius, melalui dua jalur input noksius ke susunan saraf pusat (SSP), melalui jalur neural dan jalur sirkulasi. Penelitian uji klinik tersamar ganda mengikutsertakan 48 pasien yang menjalani pembedahan orthopedi tungkai bawah. Dibagi 2 kelompok: kelompok I (n=24) diberikan bupivakain 0,25% 10 mL dan kelompok II (n=24) diberikan NaCl 0,9% melalui epidural sebagai kontrol sebelum dilakukan induksi. Kedua kelompok diberikan anestesi umum. Selama pembedahan pada kelompok I diberikan 5 mL bupivakain 0,25% selang 90 menit, sedangkan pada kelompok kontrol diberikan 5 mL NaCl 0,9% dengan selang waktu yang sama. Pascabedah kedua kelompok diberikan bupivakain 0,25% secara kontinu 4 mL/jam sampai 24 jam pascabedah. Pengukuran kadar sitokin: tumor necrosis factor- α (TNF-α), interleukin-1β (IL-1β), IL-6 dan IL-10 dilakukan sebelum induksi anestesi, pascabedah dini, jam ke-4, 8, dan 24 pascabedah. Kelompok I memperlihatkan dinamika kadar proinflamasi lebih rendah dibandingkan dengan kelompok II namun secara statisik tidak bermakna (p>0,05). Sebaliknya, kadar sitokin antiinflamasi lebih tinggi pada kelompok epidural, namun tidak berbeda bermakna (p>0,05). Intensitas nyeri pada 4 jam, 8 jam, 24 jam pascabedah secara nyata lebih rendah pada kelompok I (p<0,05). Respons hemodinamik juga ditemukan lebih rendah pada kelompok I walaupun tidak berbeda nyata ( p>0,05) kecuali pada pascabedah dini namun tidak secara sempurna. Simpulan, pemberian analgetik epidural preemtif menghasilkan analgesia disertai hemodinamik yang stabil dibandingkan tanpa epidural preemtif, namun epidural premtif tidak dapat menekan produksi sitokin proinflamasi dan antiinflamasi. [MKB. 2013;45(3):147–54]Kata kunci: Epidural preemtif, hemodinamik, intensitas nyeri, sitokin Does Preemptive Epidural Analgesia Completely Blok Surgical Stress Responses?Preemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS) by two pathways, neural pathway and circulatory pathway. This study is a double- blinded clinical trial that included 48 patients undergoing lower extremity orthopedic surgery. The subjects were divided into two groups: group I (n=24) received 10 mL bupivacaine 0.25% from epidural route, and group II (n=24) received 10 mL NaCl 0.9% from epidural route as the control group before induction of anesthesia. Both groups were anesthetized under general anesthesia. Group I received 5 mL bupivacaine 0,5% every 90 minutes and group II received 5 mL NaCl 0,9 with similar time intraoperatively. Post-operatively, both groups received continuous bupivacaine 0,25% 4 mL/ hour until 24 hours after surgery. Measurements of cytokine levels: tumor necrosis factor-α (TNF-α), interleukin- 1β (IL-1β), IL-6 and IL-10 were done before induction of anesthesia, in the early post-operative period, at 4, 8, and 24 hours after surgery. Group I showed lower level proinflammatory cytokines level compared with group II but the difference was not statistically significant (p>0.05). The level of anti-inflammatory cytokine was higher in group I, but the difference was not statistically significant (p>0.05). Pain intensity at 4 hours, 8 hours, 24 jam hours post operative was lower significantly (p<0.05) Hemodynamic responses was lower in group I but not significant (p>0.05) excepst at early postoperative period (p<0.05). Generally, preemptive epidural analgesia was able to suppress the cytokine responses, but not completely. In conclusion, preemptive epidural analgesia is associated with better analgesia and better hemodynamic stability compared without preemptive epidural, but unable to suppress the production of proinflammatory and anti-inflammatory cytokines. [MKB. 2013;45(3):147–54]Key words: Cytokines, hemodynamic, pain intensity, preemptive epidural DOI: http://dx.doi.org/10.15395/mkb.v45n3.144
Penyakit Serebrovaskuler pada Preeklampsia Yulianti Bisri, Dewi; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 7 No 1 (2024): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v7i1.175

Abstract

Preeklamsia, penyakit hipertensi yang mempengaruhi 5% hingga 8% kehamilan, adalah gangguan multisistem, dengan disfungsi pembuluh darah menjadi pusat penyakit. Pembuluh darah otak ibu sangat rentan terhadap efek samping preeklampsia. Komplikasi serebrovaskular jangka pendek dan jangka panjang dari preeklampsi termasuk sindrom ensefalopati reversibel posterior (posterior reversible encephalopathy syndrome/PRES), sindrom vasokonstriksi serebral reversibel (reversible cerebral vasoconstriction syndrome/RCVS), stroke hemoragik dan iskemik, penyakit vasokonstriksi serebral, dan demensia vaskular. Gangguan serebrovaskular akut, termasuk PRES, RCVS, stroke iskemik dan hemoragik, dan trombosis sinus vena serebral (cerebral venous sinus thrombosis/CVST), adalah komplikasi preeklampsia yang ditakuti yang dapat mengakibatkan kecacatan ibu permanen atau kematian. Risiko penyakit serebrovaskular akut pada kehamilan yang dipersulit oleh preeklampsi sebesar 1 dari 500 persalinan; sebagai perbandingan, risiko keseluruhan penyakit serebrovaskular akut terkait kehamilan adalah ≈30 per 100.000 persalinan. PRES adalah sindrom edema vasogenik dan kerusakan sawar darah otak, yang mempengaruhi struktur kortikal dan subkortikal dan semua daerah otak. Ada kecenderungan pada lobus parietal dan oksipital, kadang-kadang mengakibatkan gangguan penglihatan atau kebutaan kortikal. Hadir dengan keluhan sakit kepala thunderclap yang parah, RCVS menyebabkan vasospasme arteri sirkulus Willisi dan dapat dikaitkan dengan stroke iskemik dan subarachnoid hemorrhagic (SAH) nonaneurisma, biasanya di atas convexitas serebral.
Anestesi untuk Seksio Sesarea Elektif Pasien dengan Morbid Obesitas, Preeklampsia dan Asma Bronkial Yulianti Bisri, Dewi; Zaka Anwary, Army; Soefviana, Stefi Berlian; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 7 No 2 (2024): Juli
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v7i2.187

Abstract

Obesitas telah berkembang sebagai faktor risiko utama dan sering sebagai komplikasi pada kehamilan berupa hipertensi, diabetes melitus gestasional, seksio sesarea, dan infeksi pascapersalinan dan pascaoperasi, insiden emboli paru dan perdarahan postpartum primer. Preeklampsia mempengaruhi 2% hingga 8% dari semua kehamilan merupakan gangguan kehamilan spesifik yang mengakibatkan hipertensi dan disfungsi multiorgan dan menetap setelah persalinan serta merupakan penyebab utama kematian ibu di seluruh dunia. Seorang wanita, 41 tahun, G4P1A2, berat badan 135 kg, tinggi badan 161 cm, BMI 52,1 kg/m2, obese kelas III, bekas seksio sesarea satu kali 15 tahun yang lalu, lingkar leher 51 cm, jarak thyromental lebih dari 3 jari, skor Mallampati 2, wheezing positif pada kedua lapang paru akan dilakukan seksio sesarea karena preeklampsi. Obat-obatan yang dikonsumsi adalah acetylsalicylic acid yang dihentikan 1 hari yang lalu, nifedipin, metildopa, salbutamol spray. Induksi anestesi dengan propofol, pelumpuh otot dengan atracurium, dan rumatan anestesi dengan N2O/O2 sevofluran. Dilahirkan bayi perempuan dengan berat badan 2,2 kg, panjang badan 44 cm, APGAR score 1 menit 6 dan 5 menit 9. Diberikan metilergometrin 0,2 mg intravena dan 0,2 mg intramuskuler dan oksitosin 20 IU dilarutkan dalam 500 mL RL. Linier analog score (LAS score) 6-7-8. Total perdarahan 600 mL. Lama operasi 90 menit. Selesai operasi, ibu bisa diekstubasi.
Hipotensi Berat Intraoperatif Tiba-Tiba saat Kraniotomi Pengangkatan Meningioma Bisri, Dewi Yulianti; Habibi, Muhammad; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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.v12i2.550

Abstract

Tekanan darah adalah perkalian cardiac output (CO) dengan systemic vascular resistance (SVR) dan CO ditentukan oleh stroke volume dan frekuensi denyut jantung. Seorang wanita usia 61 tahun, berat badan 49 kg, tinggi badan 154 cm, datang di rumah sakit Santosa Bandung Central dengan keluhan benjolan pada bagian belakang kepala sejak 3 tahun lalu dan semakin lama semakin bertambah besar. Tidak terdapat tanda-tanda peningkatan tekanan intrakranial dan defisit neurologis lainnya, di diagnosa meningioma dengan hipertensi, dilakukan pengangkatan tumor dalam posisi telungkup. Induksi dengan propofol, fentanyl, vecuronium bromida, lidokain, rumatan anestesi dengan sevofluran-oksigen/udara dan propofol serta vecuronium kontinyu. Intraoperatif terjadi 2 kali penurunan tekanan darah yang terjadi tiba-tiba, bradikardia dan desaturasi. Diberikan cairan dengan ringerfundin, gelofusin 1 L, darah Pack Red Cell (PRC) 2 unit, sulfas atropin, efedrin dan dilanjutkan dengan norepinephrine. Pascabedah dirawat 1 hari di Intensive Care Unit (ICU) dan kemudian 1 hari lagi di High Care Unit (HCU), kemudian pindah ke ruang perawatan biasa dan dirawat selama 3 hari sebelum dipulangkan dari rumahsakit. Penurunan tekanan darah hebat disertai bradikardia berat dan desaturasi tidak mungkin disebabkan karena perdarahan, tapi lebih mungkin dihubungkan dengan gangguan pada jantung. Terapi yang dilakukan dengan mengembalikan parameter tersebut ke nilai fisiologis sesegera mungkin. Sebagai simpulan, penurunan tekanan darah tiba-tiba disertai bradikardia dan desaturasi kemungkinan disebabkan karena terjadinya Bezold-Jarisch Reflexes (BJR).Sudden Intraoperative Severe Hypotension during Craniotomy of Meningioma RemovalAbstractBlood pressure is the multiplication of cardiac output (CO) with systemic vascular resistance (SVR) and CO determined by stroke volume and heart rate frequency. A 61-year-old woman, weight 49 kg, height 154 cm, came to Santosa Hospital Bandung Central in with complaints of a lump on the back of the head that has gotten bigger since 3 years ago and the longer it gets bigger. There were no signs of increased intracranial pressure and other neurological deficits, diagnosed with meningioma with hypertension, tumor removal was carried out in a prone position. Induction with propofol, fentanyl, vecuronium bromide, lidocaine, anesthetic treatment with sevoflurane-oxygen/air and propofol and continuous vecuronium. Intraoperative suddenly occurs 2 times decrease in blood pressure, bradycardia and desaturation. Given liquid with ringerfundin, gelofusin 1 L, blood pack red cells (PRC) 2 units, sulfas atropine, ephedrine and continued with norepinephrine. Post-dissected treated 1 day in the Intensive Care Unit (ICU) and then another 1 day in the High Care Unit (HCU), then moved to the ward and was treated for 3 days before being discharged from the hospital. Severe drops in blood pressure accompanied by severe bradycardia and desaturation are unlikely to be caused by bleeding, but are more likely to be associated with heart disorders. Therapy is carried out by returning these parameters to physiological values as soon as possible. As conclusion, a sudden drop in blood pressure accompanied by bradycardia and desaturation may be due to the occurrence of Bezold-Jarisch Reflexes (BJR).
Perioperative Management Patients with Meningioma C1-2 Bisri, Dewi Yulianti; Indrayani, Ratih Rizki; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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.v13i1.587

Abstract

Removal of spinal meningiomas in cervical 1 and 2 has several problems, especially regarding the respiratory and cardiovascular systems. A woman, 33 years old, admit Santosa Bandung Central Hospital with complaints of weakness in her left hand and both legs since 4 months ago. Weight 50 kg, height 155 cm, blood pressure 146/102 mmHg, pulse rate 105 x/min, temperature 36.50C, SpO2 98% with room air. At diagnosis of cervical myelopathy due to space occupying lesion (SOL) intradural meningioma suspect. Induction of anesthesia with fentanyl 100 mcg, propofol 60 mg, rocuronium 40 mg, ventilated with 100% oxygen and sevoflurane 3 vol% (1.5 MAC), before laryngoscopy-intubation repeated half the initial dose of propofol. The patient is intubated in an in-line position. Anesthesia maintenance with sevoflurane 1 vol%, oxygen: air 50%, dexmedetomidine continuous 0.4 mcg/kg per hour, and continuous rocuronium 10 mcg/kgBW/min. Ventilation is controlled with a tidal volume of 360 ml, frequency 14 times/min. Then the patient is positioned in the prone position. Post-surgery is admitted to the ICU and day 5 the patient can be discharged from the hospital. The effects of C12 spinal cord tumors can affect the respiratory and cardiovascular systems. Surgical trauma can aggravate the injury before recovery occurs, so it is necessary to do ventilation assistance and cardiovascular support before recovery.
Apa yang Baru dalam Neuroanestesi untuk Cedera Otak Traumatik? Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2422.671 KB) | DOI: 10.24244/jni.v11i1.447

Abstract

Konsep dasar Neuroanestesi Neuro Critical Care disebut sebagai ABCDE neuroanestesi. Early Brain Injury (EBI) dahulu dikenal sebagai cedera otak primer. Pada EBI terjadi hilangnya autoregulasi, hilangnya integritas barier darah otak. Adanya Trias Cushing menunjukkan adanya hipertensi intrakranial. Target tekanan darah pada cedera otak traumatik (traumatic brain injury/TBI) adalah hindari tekanan darah sistolik 110 mmHg, pertahankan tekanan perfusi otak (cerebral perfusion pressure/CPP) 60-70 mmHg, target pengaturan PaCO2 adalah normokarbia, PaCO2 3540 mmHg, penggunaan profilaksis phenytoin atau valproate tidak direkomendasikan untuk mencegah late post traumatic seizure (late PTS). Masih perlu menganalisa terapi decompressive craniectomy (DECRA) dibandingkan dengan terapi medikal kontinyu untuk peningkatan tekanan intrakranial (intracranial pressure/ICP) yang refrakter setelah TBI. Anestesi umum untuk pasien dengan TBI berat lebih baik dengan total intravenous anesthesia (TIVA), pemberian cairan harus mempertimbangkan osmolaritas cairan tersebut. Pada konsep yang baru, pada pasien dengan peningkatan ICP, konsentrasi anestetika volatil harus dibatasi sampai 0,5 MAC. Target gula darah adalah normoglikemia. Hipotermi profilaksis atau terapeutik tampaknya tidak memiliki tempat dalam pengelolaan cedera otak berat.What is New in Neuroanesthesia for Traumatic Brain Injury?AbstractThe basic concept of Neuroanesthesia and Neuro Critical Care is referred to as ABCDE neuroanesthesia. Early Brain Injury (EBI) was formerly know as primary brain injury. In EBI, there is loss of autoregulation, loss of integrity of the blood-brain barriere. The presence of Cushings triad indicates the presence of intracranial hypertension. Blood pressure target in traumatic brain injury is to avoid systolic blood pressure less than 110 mmHg, maintain cerebral perfusion pressure (CPP) 60-70 mmHg, target PaCO2 regulation is normocarbia, PaCO2 35-40 mmHg, prophylactic use of phenytoin or valproate is not recommended to prevent late post traumatic seizure (late PTS). Still need to analyse decompressive craniectomy (DECRA) compare with continuous medical therapy for refractory increase in intracranial pressure (ICP) after TBI. General anesthesia for patient with severe TBI is better with total intravenous anesthesia (TIVA), administration of fluids must consider the osmolarity of the fluid. In a new concept in patient with elevated ICP, volatile anesthetic concentaratiom should be limited to 0.5 MAC.Blood glucose target is normoglycemia. Prophylactic and therapeutic hypothermia not recommended for severe traumatic brain injury management.
Tantangan dalam Menjaga Cerebral Perfusion Pressure (CPP) yang Aman pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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.v12i1.531

Abstract

Tekanan perfusi serebral (cerebral perfusion pressure/CPP) adalah gradien tekanan yang mendorong pengiriman oksigen ke jaringan serebral, perbedaan antara tekanan arteri rata-rata (MAP) dan tekanan intrakranial (ICP), CPP = MAP-CVP atau CPP = MAP ICP jika ICPCVP. Tekanan perfusi serebral harus dipertahankan dalam rentang yang sempit karena tekanan yang terlalu rendah dapat menyebabkan jaringan otak menjadi iskemik, dan bila terlalu tinggi dapat meningkatkan tekanan intrakranial. Tekanan perfusi serebral yang aman adalah antara 60-80 mmHg, tetapi nilai-nilai ini dapat bergeser ke kiri atau kanan tergantung pada fisiologi individu pasien. Karena CPP adalah ukuran yang dihitung, MAP dan ICP harus diukur secara bersamaan, paling sering dengan cara invasif. Ketika terjadi cedera otak, kapiler serebral bisa menjadi "bocor" atau lebih permeabel terhadap air. Selain itu, pembuluh darah serebral dapat melebar dalam respon terhadap cedera jaringan otak, hipoksemia, hiperkarbia, asidosis, atau hipotensi. Jika tekanan darah meningkat, peningkatan CPP dapat menyebabkan peningkatan aliran darah serebral. Tujuan yang disarankan dari CPP berdasarkan pedoman dari Brain Trauma Foundation adalah 50-70 mmHg. Menargetkan CPP tinggi 70 mmHg belum terbukti bermanfaat pada pasien dengan cedera otak traumatik dan dikaitkan dengan peningkatan risiko sindrom gangguan pernapasan akut (ARDS).Challenges in Maintaining Safe Cerebral Perfusion Pressure (CPP) in Traumatic Brain InjuryAbstractCerebral perfusion pressure (CPP) is the net pressure gradient that drives oxygen delivery to cerebral tissue. It is the difference between the mean arterial pressure (MAP) and the intracranial pressure (ICP), CPP = MAP-CVP or CPP =MAP ICP if ICPCVP. Cerebral perfusion pressure must be maintained within narrow limits because too litle pressure could cause brain tissue become ischemic, and too much could raise intracranial pressure. The normal range lies between 60 and 80 mmHg, but these values can shift to the left or right depending on individual patient physiology. As CPP is a calculated measure, MAP and ICP must be measured simultaneously, most commonly by invasive means. When brain injury occurs, cerebral capillaries can become leaky or more permeable to water. In addition, cerebral blood vessels may dilate in respons to brain tissue injury, hypoxemia, hypercarbia, acidosis, or hypotension. If blood pressure becomes elevated, the increased CPP can lead to increased cerebral blood flow. The recommended goal of CPP per the Brain Trauma Foundation (BTF) guideline is 50-70 mmHg. Targeting high CPP 70 mmHg has not been shown to be beneficial in patient with traumatic brain injury and is associated with an increased risk of acute respiratory distress syndrome (ARDS).
Konsep GHOST- CAP untuk Proteksi Otak Perioperatif pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (463.3 KB) | DOI: 10.24244/jni.v11i2.472

Abstract

Kerusakan otak adalah cedera yang menyebabkan rusak atau memburuknya sel otak yang disebabkan oleh berbagai kondisi seperti trauma kepala, pasokan oksigen yang tidak memadai, infeksi atau perdarahan intrakranial. Proteksi otak adalah intervensi terapeutik preemptif untuk memperbaiki outcome neurologik pada pasien yang berisiko terjadinya iskemi serebral, sedangkan resusitasi otak merujuk ke intervensi terapeutik yang dimulai setelah terjadinya iskemi. Targetnya adalah terapi iskemi dan mengurangi cedera neuron. Kerusakan otak perioperatif adalah salah satu komplikasi merugikan yang paling serius dari operasi dan anestesi, mengakibatkan defisit neurologis baru pasca operasi. Konsep GHOST-CAP, yang merupakan akronim dari Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure dan PaCO2, digunakan pada periode pascaoperatif. G: target level glukosa antara 80 dan 180?mg/dL. H: hemoglobin, ambang batas 79g/dL. O: oksigen, targetkan SpO2 antara 94 dan 97%. S: konsentrasi sodium mempengaruhi volume otak, kadar sodium hingga 155?mEq/L dapat ditoleransi. T: temperatur diatur untuk mengoptimalkan fungsi seluler, tetapi suhu inti ?38,0C harus dihindari. C: kenyamanan pasien (comfort), termasuk kontrol nyeri, agitasi, kecemasan, dan menggigil. A: tekanan darah arteri adalah penentu utama aliran darah otak (CBF), pertahankan tekanan arteri rata-rata (MAP) 80?mmHg dan tekanan perfusi otak (CPP) 60?mmHg. P: perubahan akut PaCO2 menyebabkan perubahan CBF, maka PaCO2 tidak boleh kurang dari 35 mmHg. Tulisan ini mengkaji konsep GHOST-CAP untuk proteksi otak perioperatif, apakah cukup memadai atau harus ditambah.GHOST-CAP Concept for Perioperative Brain Protection in Traumatic Brain InjuryAbstractBrain damage is an injury that causes damage or worsening of brain cells caused by various conditions such as head trauma, inadequate oxygen supply, infection or intracranial hemorrhage. Brain protection is a preemptive measure of therapeutic interventions to improve neurological outcomes in patients at risk of cerebral ischemic, while brain resuscitation refers to therapeutic interventions that begin after the occurrence of ischemic. The target is ischemic therapy and reducing neuronal injury. Perioperative brain damage is one of the most serious adverse complications of surgery and anesthesia, resulting in new postoperative neurological deficits. The concept of GHOST-CAP, an acronym for Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure and PaCO2, can be used in the postoperative period. G: The target level of glucose is between 80 and 180 mg/dL. H: hemoglobin threshold is 7-9 g/dL. O: oxygen, target SpO2 between 94 and 97%. S: Sodium concentration affects brain volume, sodium levels up to 155 mEq/L are tolerable. T: temperatures regulated to optimize cellular function, but core temperatures 38.0C should be avoided. C: patient comfort, including pain control, agitation, anxiety, and chills. A: Arterial blood pressure is the main determinant of cerebral blood flow (CBF), maintaining an mean arterial pressure (MAP) of 80 mmHg and cerebral perfusion pressure (CPP) of 60 mmHg. P: Acute changes in PaCO2 cause CBF changes, PaCO2 not to be less than 35 mmHg. This paper examines the GHOST-CAP concept for perioperative brain protection, whether adequate or should be supplemented
Thiopental-Dexmedetomidine as Adjuvant Anesthesia for Craniotomy Tumor Removal: A Case Report Bisri, Dewi Yulianti; Nuryanda, Dian; Alifahna, Muhammad Rezanda; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.595

Abstract

Brain tumor surgery requires special anesthesia to get a slack brain and perform perioperative brain protection. The selected anesthetic drugs and adjuvants have the ability of anesthesia sparring effect and have a brain protective effect. Not many have done the combination of thiopental adjuvant with dexmedetomidine. The purpose of this case report is to see the effect of the combination of thiopental with dexmedetomidine as an adjuvant anesthesia on hemodynamics and slack brain and successful removal of brain tumors. A woman, 32 years old, with meningiomas had surgery to remove a brain tumor at Santosa Bandung Central Hospital. Preoperative examination showed blood lab results within normal limits, the presence of large meningioma and midline shift. Induction of anesthesia with thiopental 5 mg/kgBW, rocuronium bromide 0.9 mg/kgBW, fentanyl 3 mcg/kg and anesthetic maintenance with sevoflurane below 1.5 MAC, oxygen/air, continuous rocuronium 0.5 mg/kgBW/hour, thiopental and continuous dexmedetomidine. The anesthetic adjuvant used was thiopental 1-3 mg/kg/hour and continuous dexmedetomidine 0.40.7 mcg/kg/hour. A slack brain is obtained, and 90% of the tumor could be removed, and transfused during surgery 4 units pack red cells (PRC), crystalloid liquid as much as 2,500 cc, and colloidal fluid as much as 2,000 cc. The length of surgery is 11 hours. Post-surgery was treated in the ICU for 5 days, then moved to the ward for 2 days then the patient could be discharged from the hospital. The use of thiopental and dexmedetomidine continuously can produce slack brain and almost the entire tumor can be removed.
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