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Tatalaksana Anestesi pada Prosedur Minimal Invasive Neurosurgery: Kasus Perdarahan Intraserebral Traumatika Laksono, Buyung Hartiyo; Suarjaya, I Putu Pramana; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2321.139 KB) | DOI: 10.24244/jni.vol5i2.68

Abstract

Traumatic brain injury (TBI) menyumbang 70% kematian akibat trauma. Penyebab yang tersering adalah kecelakaan lalu lintas 49%. Tehnik minimal invasif cukup berkembang pada beberapa dekade ini, demikian juga pada bidang bedah saraf. Tujuan utama tatalaksana anestesia adalah immobilisasi intraoperatif, stabilitas kardiovaskuler, minimal komplikasi pascaoperasi, fasilitasi intraoperatif neurologi monitoring, kolaborasi tatalaksana peningkatan tekanan intrakranial (TIK) dan rapid emergence untuk pemeriksaan neurologis dini. Kasus laki-laki 50 tahun dengan perdarahan intraserebral (ICH) direncanakan operasi minimal invasive neuroendoscopy evakuasi hematom. Posisi selama operasi adalah true lateral yang juga menjadi perhatian tersendiri. Komplikasi akibat posisi harus dihindari karena rentan mempengaruhi luaran operasi. Operasi berjalan selama 3 jam dengan luaran optimal. Beberapa masalah penting menjadi perhatian khusus selama operasi dan pascaoperasi. Prinsip tatalaksana anestesi pada minimal invasif yang harus dicapai adalah pemeriksaan dan perencanaan preoperatif yang baik, kontrol hemodinamik serebral untuk menjamin tekanan perfusi otak (cerebral perfusion presure/CPP) optimal, immobilisasi penuh, dan dapat dilakukan rapid emergence untuk menilai status neurologis. Komunikasi antara operator dan ahli anestesi penting untuk keberhasilan kasus ini.Anesthesia Management in Minimally Invasive Neurosurgery Procedure: Traumatic Intracerebral Hemorrhage CaseTraumatic brain injury (TBI) accounted for 70% of deaths from trauma. The most common causes of traffic accidents is 49%. Minimally invasive techniques sufficiently developed in the past few decades, as well as in the field of neurosurgery. The main objective is the treatment of immobilization intraoperative anesthesia, cardiovascular stability, minimal postoperative complications, facilitating intraoperative neurological monitoring, collaborative management of an increase in intracranial pressure (ICP) and the rapid emergence of early neurological examination. The case of a man 50 years with intracerebral hemorrhage (ICH) minimally invasive surgery neuroendoscopy planned evacuation of hematoma. Position during operation is true lateral is also a concern in itself. Complications due to the position should be avoided because it is vulnerable affect the outcome of the operation. Operations run for 3 hours with optimal outcomes. Some important issue is of particular concern during surgery and postoperatively. Procedural principle in minimally invasive anesthesia to be achieved is the examination and good preoperative planning, cerebral hemodynamic control to ensure optimal cerebral perfussion pressure (CPP), full immobilization, and can do rapid emergence to assess the neurological status. Communication between the operator and the anesthetist is important to the success of this case.
Penatalaksanaan Perioperatif pada Bedah Dekompresi Mikrovaskular: Sajian Kasus Serial Firdaus, Riyadh; Suarjaya, I Putu Pramana; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3523.249 KB) | DOI: 10.24244/jni.vol5i1.56

Abstract

Dekompresi mikrovaskular (microvascular decompression/MVD) adalah terapi definitif dari spasme hemifasial, yakni suatu gangguan gerakan neuromuskular wajah. Spasme ini ditandai dengan kontraksi involunter berulang pada otat yang diinervasi oleh N. fasialis (N.VII) akibat penekanan oleh arteri, tumor atau kelainan vaskular lainnya. Prevalensinya mencapai 911 kasus per 100.000 populasi sehat, dan paling sering terjadi pada usia 4060 tahun. Meskipun bukaan operasi MVD kecil yaitu di sekitar retroaurikula tetapi teknik anestesi-nya menggunakan prinsip-prinsip pembedahan fossa posterior. Bukaan lapangan operasi yang baik, kewaspadaan terhadap rangsangan ke batang otak maupun nervus kranialis dan kewaspadaan terhadap penurunan perfusi otak merupakan pilar-pilar utama tatalaksana anestesia pada MVD. Disajikan empat kasus spasme hemifasial dengan keadaan khusus. Kasus pertama operasi dilakukan pada pasien geriatri, pasien kedua dengan riwayat hipertensi, pasien ketiga dengan leher pendek dan asma, pasien terakhir dengan diabetes mellitus serta hipertensi. Pemantauan kestabilan hemodinamik, kedalaman anestesia dan relaksasi otot merupakan aspek penting yang menyertai tata laksana anestesi pada kasus ini.Perioperative Management in Microvascular Decompression Surgery: Case Series ReportMicrovascular decompression (MVD) is the definitive surgery for hemifacial spasm. The symptoms is described as a repetitive involuntary muscle contraction which innervated by N.fascialis caused by compression of the nervus by enlarged artery, tumor or vascular malformation. Its happened to 9-11 people from 100.000 population, especially in 4th to 6th decades. Although MVD operation only need small opening in retroauricula area but it still use posterior fossa operation principles. They are sufficient work field, awareness of impulse to brain stem and cranial nerves, and decrease of cerebral perfusion pressure. We present four cases of hemifacial spasm, with variety of considerations. The first case was a geriatric patient, the second was with history of hypertension, the third patient has short neck and also history of hypetension and asthma and the last is with diabetes mellitus and history of hypertension. Hemodynamic monitoring, deepness of anesthesia and adequate muscle relaxation is important parameter of anasthetical management of these cases.
Co-Authors A Himendra Wargahadibrata Adi Hidayat Adi, Erman Noor Adriman, Silmi Adriman, Silmi Afra, Syeda Maria Ahmad Agnesha, Fahmi Ambarini, Ronia Anindita, Triatma Arief, Budi Arshad, Muhammad Aulyan Syah, Bau Indah Aulyan Syah, Bau Indah Ayu, Rifana Bambang Suryono, Bambang Bestari, Viqy Esha Bhirowo Yudo Pratomo Bijaksana, Gena Bimarso, Wahyono Budianti, Nugrahaeni Calcarina Fitriani Retno Wisudarti Chamsudi, Danie Hayam Mada Christanto, Sandhi Christanto, Sandhi Dewi Yulianti Bisri Dian Artanti Arubusman, Dian Artanti Diana Lalenoh Dinar Dewi Kania Edhie Budi Setiawan, Edhie Budi Fachrial, Peppy Fadhil, Dimas Nu’man Faturachman, Muhammad Rafli Firdaus, Riyadh Firdaus, Riyadh Fithrah, Bona Akhmad Fithrah, Bona Akhmad Fitri Sepviyanti Sumardi Francis Tantri, Francis Fuadi, I Fuadi, I Gunawan, Fanny Hamzah, Hanzah Handayani, Sri Hartono, Pinter Herlambang, Panji Hisam, Muhammad Yusuf Ida Bagus Krisna Jaya Sutawan Ikhwandi, Arif Indrawan, Rully Isngadi Iwan Abdul Rachman Jasa, Zafrullah Kany Jasa, Zafrullah Kany Kadarisman, Muh Laksono, Buyung Hartiyo Lalenh, Diana C. Larasati, Kinanthi Lisda Amalia Liza, Helda Luky Adrianto Mahmud Mahmud Malisan, Johny Mangastuti, Rebecca Sidhapramudita Manurung, Laurensius Muhammad Thamrin Mulyono Narohito, Yosapat Parningotan Nasution, Syahrial Nur, Muhammad Ikhwan Nuryawan, Iwan Oetoro, Bambang J. Oetoro, Bambang J. P, Inggita Dyah Parhusip, Veronica Permatasari, Endah Permatasari, Endah Prasadja Ricardianto, Prasadja Prasetya, Sandie Prayunanto A.N, Eko Purbanuara Parlindungan Sitorus Purwa Saputra, Datep Purwanto, Erfien Puspita, Amelia Tri Putra, Bina Putri, Dini Handayani Putu Pramana Suarjaya Radian Ahmad Halimi Ratih Kumala Fajar Apsari Restu S, Meta Rini, Isworo Ruddy Suwandi Rudita, Muhammad Rumpoko, Triaji Mudo Saleh, Siti Chasnak Saleh, Siti Chasnak Santoso, Arief Hariyadi Sectio, Devin Igel Septika, Rafidya Indah Setiandari, Kristina Setyarto, Aries Siti Helmyati Siti Maemunah Soeboer, Deni Achmad Solihah Sari Rahayu Subekti, Bambang Eko Subekti, Bambang Eko Sudadi Sudadi Sudadi Suhalis, Adenan Suharso, Pamungkas Hary Sujarwanto Sujarwanto, Sujarwanto Sulam, Munyati Sunartejo, Bayu Suyasa, Agus Baratha Suyasa, Agus Baratha Syafruddin Gaus Tatang Bisri Taufik Perdana Budiman, Bambang Tjahya Aryasa Widiastuti, Monika - Winarso, Achmad Wahib Wahju Winarso, Achmad Wahib Wahju Wrgahadibrata, A Himendra Yana Tatiana, Yana Yosiyanto, Robi Yunita Widyastuti Yusmein Uyun Zaki, Wildan Arsyad