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All Journal BALI MEDICAL JOURNAL (BMJ) E-Jurnal Medika Udayana Jurnal Anestesi Perioperatif Paediatrica Indonesiana Bali Journal of Anesthesiology Syntax Literate: Jurnal Ilmiah Indonesia Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Anesthesiology and Clinical Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Ida Bagus Krisna Jaya Sutawan
Faculty Of Medicine Universitas Udayana Denpasar Bal
Humanities Biochemistry, Genetics & Molecular Biology Education Environmental Science Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Physics Public Health Social Sciences Other

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Diabetes Insipidus Pascaoperasi pada Pasien dengan Reseksi Tumor Kraniofaringioma Suarjaya, I Putu Pramana; Adhi Putra, Hendrikus Gede Surya; Sutawan, Ida Bagus Krisna Jaya
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.v12i2.526

Abstract

Kraniofaringioma merupakan malformasi embrionik pada area sella dan parasella. Kraniofaringioma memiliki angka kesintasan yang tinggi, walaupun kualitas hidup pasien sering terganggu karena tumor terletak berdekatan dengan struktur anatomi penting seperti saraf optik, kiasma optik dan aksis hipotalamus-pituitari. Reseksi kraniofaringioma dapat mengakibatkan terjadinya diabetes insipidus. Diabetes insipidus (DI) ditandai terjadinya poliuri, dehidrasi dan hipernatremia yang disebabkan oleh defisiensi vasopresin atau antidiuretic hormone (ADH). Pasien laki-laki usia 20 tahun mengeluh poliuria, parestesia pada kedua tangan, pertumbuhan badan yang cepat dan nyeri kepala. Hasil Magnetic resonance imaging (MRI) kepala dengan kontras menunjukkan adanya tumor ekstraaksial supratentorial pada regio sisterna parasella. Pasien menjalani kraniotomi evakuasi tumor dengan anestesi umum dan tambahan blok scalp. Pascaoperasi pasien mengalami peningkatan volume urine sampai 400ml/jam dan dilakukan penggantian cairan dengan Ringerfundin dan D5 NS. Pasien mengalami DI dan pemberian vasopresin tetap dilanjutkan selama periode pascaoperasi sampai produksi urine 2ml/kg/jam. Manajemen perioperatif kraniofaringioma bertujuan mengendalikan tekanan intrakranial, mencegah cedera otak sekunder serta pemantauan pascaoperasi di ruang intensif untuk mengatasi komplikasi termasuk DI. Pada kasus ini terjadi poliuri dan peningkatan kadar natrium plasma akibat DI yang dapat diatasi dengan pemberian vasopresin pascaoperasi dan rehidrasi untuk mempertahankan kecukupan cairan serta menjaga keseimbangan kadar natrium plasma.Postoperative Diabetes Insipidus in Patient with Craniopharyngioma Tumor ResectionAbstractCraniopharyngioma is an embryonic malformation in the sella and parasella areas. Craniopharyngioma has high survival rate, although the patient's quality of life is often compromised due to tumors location near important anatomical structures such as the optic nerve, optic chiasm, and hypothalamic-pituitary axis. Craniopharyngioma tumor resection can provoke diabetes insipidus. Diabetes insipidus (DI) is characterized by polyuria, dehydration and hypernatremia due to vasopressin or antidiuretic hormone (ADH) deficiency. A 20 years old male patient complained of polyuria, paresthesia in both hands, rapid body growth, and headaches. Brain magnetic resonance imaging (MRI) with contrast revealed cystic mass in the parasella cistern region suggested craniopharyngioma. This patient underwent craniotomy tumor resection under general anesthesia and additional scalp block. Postoperatively the patient experienced an increased urine volume up to 400 ml/hour and fluid replacement was performed with crystalloids Ringerfundin and D5 NS. The patient suffered DI and vasopressin was continued in the postoperative period until urine output reduced to 2 ml/kg/hour. Perioperative management of craniopharyngioma is controlling intracranial pressure, prevent secondary brain injury and postoperative monitoring in the intensive care unit to manage potential complications such as DI. In this case, patient suffered polyuria and increased plasma sodium levels which was safely treated by administration of vasopressin and rehydration to maintain fluid adequacy and balance of plasma sodium levels.
Penatalaksanaan Hipertensi Perioperatif dan Anestesia pada Kraniotomi Evakuasi Perdarahan Intraserebral Spontan Suarjaya, I Putu Pramana; Mulyadi, Win; Sutawan, IB Krisna Jaya
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.v11i3.499

Abstract

Pendarahan intraserebral spontan memiliki morbiditas dan mortalitas yang tinggi dengan case fatality rate satu bulan mencapai 40%. Pendarahan intraserebral adalah kasus gawat darurat. Evakuasi perdarahan intraserebral menjadi pilihan bila terjadi ekspansi volume bekuan darah yang bermakna disertai perburukan klinis. Penatalaksanaan perioperatif pendarahan intraserebral spontan yang baik akan menurunkan kejadian morbiditas dan mortalitas paska bedah. Pasien laki-laki 46 tahun datang dengan penurunan kesadaran, Glasgow Coma Scale (GCS) E3V5M6 dan lemas separuh badan sebelah kiri. Pada computerized tomography (CT) scan didapatkan pendarahan intraserebral pada lobus parieto-oksipital kanan dengan volume 22 ml disertai edema perifokal. Awalnya dilakukan penatalaksanaan konservatif, karena terjadi penurunan kesadaran dan perburukan klinis yang berlangsung dalam waktu singkat, dilakukan kraniotomi evakuasi bekuan darah intraserebral pada hari ketiga perawatan. Pasien dirawat di ruang rawat intensif pascabedah selama dua hari dan pindah ke ruang rawat biasa dengan GCS E4V5M6. Penatalaksanaan perioperatif untuk pasien stroke perdarahan intraserebral dengan riwayat hipertensi tak terkendali yang menjalani pembedahan evakuasi perdarahan segera karena terjadinya perburukan neurologis bertujuan untuk menjamin perfusi otak yang adekuat dan menyediakan kondisi lapangan pembedahan yang optimal. Tekanan darah yang stabil dan perfusi otak yang adekuat selama periode perioperatif, memungkinkan pasien pulih dengan morbiditas dan mortalitas yang rendah.
Manajemen Perioperatif untuk Pemulihan Dini Pascaoperasi pada Kraniotomi Evakuasi Tumor Supratentorial: Sebuah Laporan Kasus Suarjaya, I Putu Pramana; Supradnyana, I Nyoman Novi; Johanes, Kevin Paul; Sutawan, Ida Bagus Krisna Jaya
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.v12i2.546

Abstract

Early Recovery After Surgery (ERAS) merupakan suatu upaya pemulihan dini pascaoperasi yang masih terus dikembangkan untuk operasi bedah saraf. Upaya ERAS pada tumor otak supratentorial akan memberi keuntungan pemulihan fungsional pascaoperasi lebih cepat dan masa perawatan yang lebih singkat. Pasien wanita 45 tahun, dengan tumor ekstraaksial regio fronto-temporal kiri dengan diagnosa meningioma parasagital sinistra menjalani operasi kraniotomi evakuasi tumor. Pasien sadar penuh, mengeluh sakit kepala hilang timbul, pandangan kabur dan memiliki riwayat kraniotomi evakuasi tumor sebelumnya. Pasien menjalani kraniotomi dengan anestesi umum dan tambahan blok scalp. Operasi berlangsung selama 3 jam 20 menit dengan hemodinamik yang stabil selama anestesi dan pembedahan. Pascaoperasi, pasien segera diekstubasi dan dirawat di ruangan intensif selama 2 hari. Pasien pulang pada hari kelima dan kontrol rawat jalan. Penatalaksanaan perioperatif pada pasien tumor supratentorial yang menjalani kraniotomi pengangkatan tumor dapat dilakukan untuk memfasilitasi pemulihan dini pascaoperasi. Manajemen multidisiplin yang tepat pada tahap praoperasi, intraoperasi dan pascaoperasi, dengan mempertimbangkan penyakit penyerta pasien, penting untuk keberhasilan melakukan pemulihan dini pascaoperasi.Perioperative Management to Facilitate Early Recovery After Surgery for Supratentorial Tumor Resection: A Case ReportAbstractEarly Recovery After Surgery (ERAS) in neurosurgery is a promising and developing concept directed to enhance postoperative recovery for neurosurgical patient. ERAS application to supratentorial brain tumor patients will provide advantage of early functional recovery and shorter length of stay. We reported a successful anesthetic management for a 45-year-old woman, diagnosed with a left frontotemporal extra axial tumor, suspected left parasagittal meningioma. Preoperative, patient was fully conscious but complained occasional headache and blurred vision with normal hemodynamic parameters. We performed general anesthesia with additional scalp block for this patient to facilitate the surgery, which lasted 3 hours 20 minutes. The surgery went uneventful with a stable hemodynamic, patient was extubated in the operating theatre and monitored in the Intensive Care Unit (ICU). After two days in the ICU, we transferred the patient to the ward. She was discharged on the fifth day and controlled as an outpatient care. Perioperative management of patients with supratentorial tumor whom undergo craniotomy for tumor removal could be performed to facilitate early recovery. Appropriate multidisciplinary management in the preoperative, intraoperative and postoperative periods, with regard to the underlying disease, is important to successfully perform the ERAS
Navigating the Nexus: Anesthetic Management of Craniotomy for Brain Abscess in a Pediatric Patient with Uncorrected Tetralogy of Fallot Anak Agung Ngurah Aryawangsa; Ida Bagus Krisna Jaya Sutawan
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.766

Abstract

Introduction: Tetralogy of Fallot (TOF) is the most prevalent cyanotic congenital heart disease, predisposing patients to brain abscesses via right-to-left shunting that bypasses pulmonary bacterial filtration. Anesthetic management for craniotomy in pediatric patients with uncorrected TOF and a concurrent brain abscess presents a formidable challenge, requiring meticulous integration of neuroanesthetic and cardiac anesthetic principles. Literature detailing comprehensive perioperative anesthetic strategies for this specific dual pathology remains scarce. Case presentation: An 11-year-old male with uncorrected TOF and a large left frontoparietal brain abscess with significant mass effect underwent emergent craniotomy and abscess evacuation. Preoperative echocardiography confirmed TOF with severe pulmonary stenosis and right-to-left shunting. Anesthetic induction was achieved with titrated ketamine and propofol, followed by fentanyl and rocuronium. Maintenance involved sevoflurane, oxygen-air mixture, and intermittent fentanyl and rocuronium, focusing on normovolemia, normocapnia to slight hypocapnia, and invasive hemodynamic monitoring. Phenylephrine was utilized for blood pressure support. The perioperative period was uneventful, with the patient experiencing no neurological or cardiac complications. Conclusion: This case underscores the critical importance of a tailored anesthetic approach, integrating neuroprotective strategies with meticulous cardiovascular management, in children with uncorrected TOF undergoing major neurosurgery. Comprehensive preoperative assessment, vigilant intraoperative monitoring, strategic pharmacological interventions, and a deep understanding of the complex pathophysiology are paramount to preventing cyanotic spells, managing intracranial pressure, and ensuring a successful outcome in this high-risk cohort.
Navigating Frontal Lobe Arteriovenous Malformation Resection: A Case Report on TIVA with Propofol-Remifentanil TCI for Hemodynamic Stability and ICP Control I Gede Catur Wira Natanagara; I Putu Pramana Suarjaya; Ida Bagus Krisna Jaya Sutawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1353

Abstract

Background: Arteriovenous malformations (AVMs) located within the frontal lobe present considerable anesthetic challenges. These challenges arise from the critical functions governed by this brain region and the inherent risks associated with intracranial surgery, notably hemodynamic instability and the potential for elevated intracranial pressure (ICP). The utilization of Total Intravenous Anesthesia (TIVA) through Target-Controlled Infusion (TCI) systems for propofol and remifentanil provides a sophisticated strategy for achieving precise control over anesthetic depth and maintaining physiological homeostasis. This report offers a detailed account of such a case. Case presentation: A 25-year-old male patient, classified as ASA III, presented with a right frontal lobe Spetzler-Martin Grade I AVM and was scheduled for elective microsurgical resection. The anesthetic management centered on a TIVA approach, employing propofol administered via an Eleveld TCI model (target concentration range: 2-5 µg/mL) and remifentanil via a Minto TCI model (target concentration range: 4-6 ng/mL). Comprehensive intraoperative monitoring included invasive arterial blood pressure and central venous pressure. Pharmacological adjuncts included mannitol, dexamethasone, and tranexamic acid. Throughout the procedure, stable intraoperative hemodynamics (target Mean Arterial Pressure [MAP] 70-90 mmHg) were successfully maintained, and intracranial pressure was effectively controlled, thereby facilitating the complete AVM resection. The patient was extubated in the post-operative period, demonstrated a stable neurological status, and was subsequently managed in the Intensive Care Unit (ICU). Conclusion: A meticulously planned and executed TIVA-TCI regimen, featuring propofol and remifentanil, when integrated with thorough invasive monitoring and proactive pharmacological interventions, demonstrated effectiveness in preserving crucial hemodynamic stability and fostering optimal intracranial conditions. This comprehensive anesthetic strategy was instrumental in the successful surgical resection of a frontal lobe AVM and contributed to a favorable neurological outcome for the patient.
Navigating Frontal Lobe Arteriovenous Malformation Resection: A Case Report on TIVA with Propofol-Remifentanil TCI for Hemodynamic Stability and ICP Control I Gede Catur Wira Natanagara; I Putu Pramana Suarjaya; Ida Bagus Krisna Jaya Sutawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1353

Abstract

Background: Arteriovenous malformations (AVMs) located within the frontal lobe present considerable anesthetic challenges. These challenges arise from the critical functions governed by this brain region and the inherent risks associated with intracranial surgery, notably hemodynamic instability and the potential for elevated intracranial pressure (ICP). The utilization of Total Intravenous Anesthesia (TIVA) through Target-Controlled Infusion (TCI) systems for propofol and remifentanil provides a sophisticated strategy for achieving precise control over anesthetic depth and maintaining physiological homeostasis. This report offers a detailed account of such a case. Case presentation: A 25-year-old male patient, classified as ASA III, presented with a right frontal lobe Spetzler-Martin Grade I AVM and was scheduled for elective microsurgical resection. The anesthetic management centered on a TIVA approach, employing propofol administered via an Eleveld TCI model (target concentration range: 2-5 µg/mL) and remifentanil via a Minto TCI model (target concentration range: 4-6 ng/mL). Comprehensive intraoperative monitoring included invasive arterial blood pressure and central venous pressure. Pharmacological adjuncts included mannitol, dexamethasone, and tranexamic acid. Throughout the procedure, stable intraoperative hemodynamics (target Mean Arterial Pressure [MAP] 70-90 mmHg) were successfully maintained, and intracranial pressure was effectively controlled, thereby facilitating the complete AVM resection. The patient was extubated in the post-operative period, demonstrated a stable neurological status, and was subsequently managed in the Intensive Care Unit (ICU). Conclusion: A meticulously planned and executed TIVA-TCI regimen, featuring propofol and remifentanil, when integrated with thorough invasive monitoring and proactive pharmacological interventions, demonstrated effectiveness in preserving crucial hemodynamic stability and fostering optimal intracranial conditions. This comprehensive anesthetic strategy was instrumental in the successful surgical resection of a frontal lobe AVM and contributed to a favorable neurological outcome for the patient.
ASSOCIATION BETWEEN LOWER PLATELET-TO-LYMPHOCYTE RATIO AND MORTALITY RISK IN MODERATE-TO-SEVERE TRAUMATIC BRAIN INJURY : A RETROSPECTIVE COHORT STUDY Richard, Richard; Sutawan, Ida Bagus Krisna Jaya; Suarjaya, I Putu Pramana
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 2 (2025): AGUSTUS 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i2.46775

Abstract

Penelitian ini menyelidiki hubungan antara rasio trombosit terhadap limfosit dan risiko kematian pada pasien dewasa dengan COT sedang hingga berat di rumah sakit tersier di Indonesia. Sistem registrasi rumah sakit dikaji secara retrospektif untuk mengumpulkan rekam medis dari 77 pasien dewasa yang menjalani rawat inap dari 1 Juni 2024 hingga 31 Desember 2024 dan didiagnosis dengan COT sedang hingga berat. Rasio neutrofil terhadap limfosit (NLR) serta rasio trombosit terhadap limfosit (PLR) dibandingkan antara kelompok pasien yang bertahan hidup (n=59) dan yang tidak bertahan hidup (n=18). Kemampuan prediktif NLR dan PLR dianalisis menggunakan area di bawah kurva karakteristik operasi penerima (AUC). Analisis tabel kontingensi dilakukan untuk menentukan sensitivitas, spesifisitas, nilai prediksi positif (PPV), nilai prediksi negatif (NPV), akurasi, serta rasio odds (OR) dari NLR dan PLR dalam kaitannya dengan tingkat kematian. Variasi kelangsungan hidup di antara subkelompok PLR dievaluasi melalui analisis kelangsungan hidup Kaplan-Meier. PLR pada pasien yang meninggal secara signifikan lebih rendah dibandingkan dengan kelompok yang bertahan hidup (nilai p = 0,026). Kurva ROC menunjukkan bahwa PLR merupakan prediktor terkuat dibandingkan dengan kedua rasio lainnya (area di bawah kurva ROC = 0,674, sensitivitas = 0,874, spesifisitas = 0,56, sesuai dengan nilai batas = 120,09). Ketika kelompok pasien dibagi berdasarkan kuartil PLR, analisis Kaplan-Meier menunjukkan kelangsungan hidup yang jauh lebih buruk pada kelompok dengan kuartil PLR terendah (< 120,09) dibandingkan dengan kelompok kuartil lainnya. Nilai PLR yang lebih rendah dikaitkan dengan tingkat kematian yang lebih tinggi pada pasien dewasa dengan COT sedang hingga berat, menunjukkan potensi penggunaan PLR dalam stratifikasi risiko yang memerlukan validasi lebih lanjut.
THE EFFECTIVENESS OF POSTOPERATIVE PERICAPSULAR NERVE GROUP ANALGESIA BLOCK IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENT WITH REGIONAL ANESTHESIA SUBARACHNOID BLOCK I Gede Prima Julianto; I Made Gede Widnyana; Kadek Agus Heryana Putra; I Ketut Wibawa Nada; I Gusti Ngurah Mahaalit Aribawa; Ida Bagus Krisna Jaya Sutawan; Made Wiryana; Tjokorda Gde Agung Senapathi
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 1 (2024): APRIL 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i1.27258

Abstract

Penggunaan blok saraf kelompok perikapsular (PENG) dapat menjadi alternatif analgesia post-operatif yang efektif untuk Penggantian Sendi Panggul Total, dengan komplikasi rendah. Penelitian ini bertujuan untuk menentukan efektivitas analgesia blok PENG terhadap tingkat nyeri, jumlah konsumsi opioid dalam 24, 48, dan 72 jam serta analgesia post-operatif THR di Rumah Sakit Prof. Dr. I. G. N. G. Ngoerah Denpasar. Penelitian ini adalah studi eksperimental dengan desain uji acak terkontrol buta tunggal yang dilakukan di ruang operasi Instalasi Bedah Sentral Rumah Sakit Prof. Dr. I. G. N. G Ngoerah, Denpasar. Uji perbandingan rata-rata menggunakan uji Mann-Whitney jika distribusi data tidak normal. Seluruh proses analisis data di atas menggunakan perangkat lunak statistik SPSS 26. Ada 48 subjek yang menjalani THR dan dibagi menjadi 2 kelompok. Ada perbedaan yang signifikan secara statistik antara kelompok-kelompok tersebut. Berdasarkan hasil analisis non-parametrik, NRS saat istirahat dan bergerak di kelompok perlakuan lebih rendah daripada kontrol dengan nilai p <0,001. Jumlah opioid yang diperoleh memiliki nilai p <0,001 dalam 24 jam pertama, 48 jam, dan 72 jam. Durasi efek ditemukan lebih lama pada kelompok PENG dibandingkan dengan kontrol (p <0,001). Pemberian blok PENG selama prosedur THR menghasilkan NRS yang lebih rendah pada 24 jam, penggunaan opioid yang lebih rendah pada 24 jam, 48 jam, dan 72 jam pascaoperatif, dan durasi efek bebas nyeri yang lebih lama.
ANESTHESIA MANAGEMENT IN MODIFIED PARK BENCH POSITION IN NEUROSURGERY : A CASE REPORT Wanda, Aprilia; Suarjaya, I Putu Pramana; Widnyana, Made Gede; Sutawan, IB Krisna Jaya; Ryalino, Christopher
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 8 No. 2 (2024): AGUSTUS 2024
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v8i2.31222

Abstract

The modified park bench position enhances surgical exposure while minimizing brainstem manipulation but poses significant anesthetic challenges. This case report aimed to describe the author’s anesthesia management in a modified park bench position for neurosurgery. A 39-year-old woman presented with intermittent headaches, nausea, and vomiting for three months, alongside vision deterioration. She denied loss of consciousness, seizures, weight loss, or trauma. Examination revealed typical vital signs, neurological function, and musculoskeletal integrity. Supporting tests showed elevated SGOT levels and a primary malignant brain tumor with suspected hemorrhage and surrounding vasogenic edema. She underwent craniotomy after fasting and standard anesthesia preparation. An arterial line, premedication, and intubation were administered, followed by five-hour surgery in the modified park bench position. Postoperatively, pain was managed with fentanyl, paracetamol, and ibuprofen. She was monitored in the ICU for seven days and discharged on the eighth postoperative day. In summary, managing primary malignant brain tumors like glioblastoma requires thorough preoperative assessment, precise anesthesia planning, and vigilant intraoperative monitoring for patient safety and successful outcomes. The collaborative effort of neurosurgery and anesthesia teams and postoperative care is vital for patient recovery and underscores the importance of comprehensive perioperative management.
Anesthesia Management of Space-Occupying Lesion in the Pontine Region due to Brainstem Glioma in a Pediatric Patient: a Case Report Yustisia, Putu Ngurah Krisna Denta; Sutawan, Ida Bagus Krisna Jaya; Senapathi, Tjokorda Gde Agung; Kurniyanta, I Putu
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v9i11.16937

Abstract

A space-occupying lesion (SOL) in the pontine region of the medulla oblongata, often suspected as a brainstem glioma, poses a complex diagnostic challenge. Brainstem gliomas, primarily diffuse intrinsic, afflict all age groups with a median survival of about 12 months, influenced by tumor characteristics. Comprehensive preoperative evaluation is essential to assess the patient's health status and identify potential complications, guiding optimal anesthesia management. This case report aimed to describe the author's anesthesia technique for managing patients with SOL in the pontine region of the medulla oblongata, focusing on those with suspected brainstem gliomas. A four-year-old girl weighing 20 kilograms presented with sudden left-sided weakness, difficulty swallowing, headaches, and speech difficulties. Examination revealed right cranial nerve paresis and decreased left extremity strength. MRI showed a pontine glioma. Surgery preparation included fasting, fluid calculation, and medication readiness. Anesthesia induction involved midazolam premedication, propofol induction, and remifentanil for intubation. Monitoring included EtCO2 and oxygen saturation maintenance. Intraoperatively, target-controlled infusion (TCI) propofol and compressed air sustained oxygenation. Paracetamol and tranexamic acid were administered. The surgery lasted five hours in the left lateral decubitus position. Postoperative analgesia included fentanyl and oral paracetamol. The patient spent seven days in the PICU on a ventilator before discharge on the eighth day. In summary, the case of the four-year-old girl with left-sided weakness and difficulty swallowing, diagnosed with pontine glioma, showcases the intricate multidisciplinary approach essential in pediatric neurosurgery.
Co-Authors Anak Agung Ngurah Aryawangsa Christopher Ryalino Cynthia Dewi Sinardja Dewi Yulianti Bisri Diana Lalenoh Eka Nantha Kusuma, Putu EM, Tjahya Aryasa Erwin Pradian Gde Agung Senapathi, Tjokorda Gede Semarawima, Gede Haithami, Guntur Mu Ammar Hendra Santoso Hendrikus Gede Surya Adhi Putra I Gede Catur Wira Natanagara I Gede Prima Julianto I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit I Gusti Ngurah Mahaalit Aribawa I Ketut Sinardja I Ketut Wibawa Nada I Made Gede Widnyana I Wayan Aryabiantara, I Wayan IGNA Putra Arimbawa, IGNA Putra Johanes, Kevin Paul Junaedi, Made Darma Kadek Agus Heryana Putra Kadek Agus Heryana Putra, Kadek Agus Ketut Dewi Kumara Wati Ketut Semara Jaya, Ketut Semara Ketut Yudi Arparitna, Ketut Yudi Komang Ayu Witarini Kurniyanta, I Putu Made Agus Kresna Sucandra, Made Agus Kresna Made Wiryana Mulyadi, Win Oetoro, Bambang J Oetoro, Bambang J. Parami, Pontisomayaa Pontisomaya Parami Pragra, Maria Preicilia Putu Agus Surya Panji Putu Ayunda Trisnia Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Putu Pramana Suarjaya Rasman, Marsudi Ratumasa, Marilaeta Cindryani Ra Richard Richard Saleh, Siti Chasnak Siti Chasnak Saleh Sri Rahardjo Sucandra, MA Kresna Supradnyana, I Nyoman Novi Syafruddin Gaus Tatang Bisri Tatang Bisri Tinni T. Maskoen Tinni T. Maskoen Tjahya Aryasa Tjokorda Gde Agung Senapathi Wanda, Aprilia Wargahadibrata, A. Hmendra Yustisia, Putu Ngurah Krisna Denta