Mohamad Sofyan Harahap
Bagian Anestesiologi dan Terapi Intensif FK Undip/ RSUP Dr. Kariadi, Semarang

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Masalah Respirasi pada Penderita Cedera Medula Spinalis Servikal Hermawan, Freddy; Harahap, Mohamad Sofyan
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.v12i1.504

Abstract

Masalah pada sistem respirasi merupakan komplikasi yang sering menyebabkan morbiditas dan mortalitas pada pasien dengan Spinal Cord Injury (SCI) baik pada fase akut maupun kronik. Hal tersebut disebabkan adanya kelumpuhan otot-otot inspirasi dan ekspirasi yang motor neuronnya berasal dari nervus spinalis C3C5, melemahnya refleks batuk dan stagnansi sekret. Cedera tulang belakang servikal dapat terjadi baik langsung maupun tidak langsung, dapat menyebabkan defisit neurologis ataupun kematian. Cedera medula spinalis servikal terjadi 23% dari seluruh kejadian cedera dan 8,2% dari semua cedera yang menyebabkan kematian. Pada artikel ini disajikan kasus pasien dengan SCI setinggi C3C6, pasien menjalani operasi laminektomi dekompresi. Pascaoperasi pasien dirawat di ICU dikontrol menggunakan ventilator dengan mode Synchronized Intermittent Mandatory Ventilation (SIMV). Setelah pasien diekstubasi, saturasi turun, dari pemeriksaan fisik didapatkan ronkhi minimal, pasien didiagnosis dengan Hospital-Acquired Pneumonia (HAP) dan sepsis. Saturasi pasien membaik menjadi 99% setelah direintubasi disertai dengan program nebul combivent dan bisolvon 20 tetes/6 jam. Weaning ventilator pada pasien ditunda. Pasien diberikan vancomysin dan meropenem sebagai antibiotik definitif setelah dilakukan kultur bakteri.Respiration Problems in Cervical Spine Injury PatientsAbstractRespiratory complications associated with spinal cord injury (SCI) are the most important cause of morbidity and mortality in both the acute phase and a long-term perspective. This is due to paralysis of the inspiratory and expiratory muscles whose motor neurons originate from the C3C5 spinal nerves, weakened cough reflexes and stagnation of secretions. Cervical spinal cord injuries can occur directly or inderectly that can cause neurological disorder or death. Cervical injuries occur 23% of all cedera events and 8,2% of all cederas that cause of death. In this article, we present a case of a patient with SCI at C3C6, a patient undergoing decompressive laminectomy surgery. Postoperation, the patient was treated in the ICU controlled using a ventilator with Synchronized Intermittent Mandatory Ventilation (SIMV) mode. After the patient was extubated, the saturation dropped, on physical examination, there were minimal rhonchi, the patient was diagnosed with Hospital-Acquired Pneumonia (HAP) and sepsis. Patient saturation improved to 99% after reintubation accompanied by nebul combivent program and bisolvon 20 drops every 6 hours. Ventilator weaning in patient was delayed. The patient was given vancomycin and meropenem as definitive antibiotics after bacterial culture was performed.
Anesthetic Management in Patient with Traumatic Brain Injury undergoing Elective Spinal Surgery Soedibjo, Dennis Prakas; Harahap, Mohamad Sofyan; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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.v15i1.728

Abstract

The incidence of traumatic brain injury that concurrent with injuries such us traumatic spinal injuries is relatively high. When considering anesthetic management for patients with acute traumatic brain injury undergoing non-brain surgery procedures, understanding of the implications of traumatic brain injury on anesthesia management is essential for achieving favorable surgical results while minimizing the risk of secondary brain injury to ensure patient safety and optimal outcomes. We report a case of a 25 years old man who presented with decrease of consciousness 3 days prior admission to the hospital after sudden fall in the bathroom. Complaints were accompanied with vomiting, weakness and paresthesia in both bilateral upper extremities and lower extremities. Supportive examination revealed an epidural hematoma at regio frontoparietal sinistra, minimal subdural hematomas at regio anterior falx cerebelli and bilateral tentorium cerebelli, subgaleae hematomas at regio bilateral parietal, with multiple cervical fracture at the C5 level with associated cervical canal narrowing. Due to the minor intracranial bleeding with no significant symptoms for days, patient then scheduled for elective C4-C6 laminectomy and posterior stabilization surgery. Anesthesia management for patient with traumatic brain injury that undergoes non-brain surgery comes with challenges, mainly on how to prevent secondary brain injury and minimizing complications. Comprehensive perioperative planning and vigilant monitoring are essential to ensure patient safety and optimal outcomes
Lower Preoperative and Postoperative Hemoglobin Levels in Patients with Postoperative Cognitive Dysfunction Compared to Those Without Postoperative Cognitive Dysfunction Following Heart Valve Replacement Nurcahyo, Widya Istanto; Manapa, Chandra Hermawan; Muttaqin, Zainal; Boom, Cindy Elfira; Farhan, Muhammad; Harahap, Mohamad Sofyan; Tugasworo, Dodik; Sianturi, Rea Sava Kinanti
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.79631

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a prevalent complication that occurs after surgery, impacting cognitive function. Cognitive performance may be hindered by anemia, as it reduces the delivery of oxygen to the brain and leads to tissue hypoxia, affecting metabolism and ultimately diminishing cognitive function.Objective: The objective of this study is to examine the potential correlation between hemoglobin levels and the occurrence of POCD in individuals undergoing heart valve replacement surgery.Methods: This retrospective cohort study included all individuals aged 20 years and above who underwent heart valve replacement surgery from July to December 2021. Hemoglobin levels were assessed both before and after the surgical procedure, and cognitive function was evaluated using the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third day after the operation. Statistical analysis involved the use of either Student's t-test or the Mann–Whitney nonparametric test.Results: A total of 70 participants were included in the study from July to December 2021. The majority of the participants were female (57.1%), and a significant proportion were below 60 years old (81.4%). The average preoperative hemoglobin levels were higher (13.30 g/dL) than the average postoperative hemoglobin levels (10.78 g/dL). In terms of cognitive function, 61.4% of participants experienced postoperative cognitive dysfunction (POCD), with a higher mean MoCA-INA score before surgery (28.41) than after surgery (22.37), along with a delta Hb of -0.27. Furthermore, postoperative hemoglobin levels were significantly lower in POCD patients than preoperatively (p = 0.003).Conclusion: The occurrence of postoperative cognitive dysfunction (POCD) was linked to the hemoglobin levels after heart valve replacement.