Putu Pramana Suarjaya
Faculty Of Medicine Anesthesiology & Therapy Intensif Universitas Udayana Denpasar

Published : 62 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Dexmedetomidine as Adjuvant in Scalp Nerve Block for Craniotomy: A Double-Blind Randomized Clinical Trial Eka Nantha Kusuma, Putu; I Putu Pramana Suarjaya; Parami, Pontisomaya; IGAG Utara Hartawan; I Gusti Ngurah Mahaalit; I Putu Kurniyanta; Ida Bagus Krisna Jaya Sutawan; Sudiantara, Putu Herdita; I Made Gede Widnyana; Gde Agung Senapathi, Tjokorda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/q23wyc88

Abstract

Introduction: Scalp nerve block (SNB) is an effective adjunct for attenuating hemodynamic responses and reducing postoperative pain in craniotomy. Dexmedetomidine (DEX), with its analgesic and anti-inflammatory properties, may enhance the quality of SNB. This study evaluated the effects of adding DEX to SNB on hemodynamic stability, postoperative pain, inflammatory response, and analgesic duration in craniotomy patients. Methods: A double-blind, parallel-group randomized clinical trial was conducted on 36 adult patients undergoing elective craniotomy (July–September 2025) at a tertiary hospital Denpasar. Participants received SNB using 0.375% ropivacaine (20 mL) with or without DEX 1 µg/kg under standardized general anesthesia. Outcomes included mean arterial pressure (MAP), Visual Analog Scale (VAS) scores at 12 and 24 hours, neutrophil-to-lymphocyte ratio (ΔNLR), and time to first rescue analgesic (TTFAR). Statistical analyses used mixed ANOVA and Mann–Whitney U tests. Ethical approval number was 2159/UN14.2.2.VII.14/LT/2025. Results: MAP was significantly lower in the DEX group at 10 minutes (Δ = 4.89 mmHg; 95% CI 1.62–8.16), 20 minutes (Δ = 4.83; 95% CI 1.57–8.10), 30 minutes (Δ = 3.67; 95% CI 0.40–6.94), and upon PACU arrival (Δ = 3.72; 95% CI 0.45–6.99) (all p < 0.05). Median VAS scores were significantly lower with DEX at 12 hours (1.50 vs 3.00; p < 0.001) and 24 hours (1.00 vs 2.00; p < 0.001). ΔNLR was reduced in the DEX group (−0.56 vs 3.08; p = 0.004). TTFAR was markedly prolonged (554 vs 257 minutes; p < 0.001). No adverse events were reported. Conclusion: Dexmedetomidine added to scalp nerve block enhances hemodynamic stability, reduces postoperative pain for up to 24 hours, suppresses early systemic inflammation, and prolongs analgesic duration in craniotomy without observed complications. DEX–SNB represents a beneficial component of multimodal analgesia in neuroanesthesia and may support enhanced recovery pathways
Neuromonitoring on The 3rd Redo Craniotomy for Removal of Infratentorial Tumors Allan, Alma Hepa; Kulsum, Kulsum; Suarjaya, I Putu Pramana; Bisri, Tatang
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.v15i1.744

Abstract

Infratentorial brain tumors such as medulloblastoma have serious neurological implications, particularly in children and adolescents. Re-craniotomy for infratentorial lesions increases the risk of anesthetic complications due to altered anatomy, tissue adhesions, and proximity to vital structures such as the brainstem and cranial nerves. The anesthetic approach must be tailored to support real-time intraoperative monitoring, such as Intraoperative Neurophysiological Monitoring (IONM), to prevent neurological injury. A 16-year-old male with a WHO Grade IV medulloblastoma in the left cerebellum extending to the vermis underwent re-craniotomy tumor removal. The patient presented with balance disturbances, diplopia, and dysphagia. CT scan revealed a solid mass measuring 6.6 × 5.96 × 6.71 cm with peritumoral edema and compression of the fourth ventricle. Anesthetic management included TIVA using propofol TCI Schneider 2–4 mcg/ml, dexmedetomidine 0.2–0.7 mcg/kg/hr, and intermittent rocuronium. The surgery lasted 8 hours and was complicated by cerebral edema managed with mannitol 1 g/kgBW. IONM detected prolonged activation of the left cranial nerve VIII. Intraoperative bleeding reached 1600 ml, managed with 465 ml of PRC. Hemodynamics remained stable with ConnX ranging from 34 to 80. Postoperatively, the patient was admitted to the ICU with mechanical ventilation and continuous sedation. Anesthetic management of infratentorial re-craniotomy requires an individualized approach encompassing hemodynamic stability, neural protection through IONM, and multimodal strategies to prevent postoperative complications. TIVA techniques and ConnX monitoring play an important role in maintaining optimal anesthetic balance and neurological function.
Co-Authors A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Himendra Wargahadibrata Adi, Made Septyana Parama Adinda Putra Pradhana Adityawarma, Anak Agung Ngurah Agung Harawikrama Agung Bagus S. Satyarsa Aldy, Aldy Allan, Alma Hepa Andika Metrisiawan Aryasa EM, Tjahya Aulyan Syah, Bau Indah Aulyan Syah, Bau Indah Brillyan Jehosua Toar Budiarta, Gede Chandra, Steven Okta Christanto, Sandhi Christanto, Sandhi Christopher Ryalino Christopher, Michael Chriswidarma, Dewa Gede Cynthia Dewi Sinardja D.H., Asterina Damayanti, Elok Demoina, I Gede Patria Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Eka Nantha Kusuma, Putu Eric Makmur, Eric Firdaus, Riyadh Firdaus, Riyadh Gd. Harry Kurnia Prawedana Gde Agung Senapathi, Tjokorda Giovanni, Malvin Hartawan, IGAG Utara Hendrikus Gede Surya Adhi Putra Hengky Hengky, Hengky I Gede Catur Wira Natanagara I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit I Ketut Sinardja I Made Gede Widnyana I Made Stepanus Biondi Pramantara I Putu Agus Surya Panji I Wayan Ade Punarbawa I Wayan Niryana I Wayan Suranadi I. D. G. Tresna Rismantara Ida Bagus Alit Saputra Ida Bagus Krisna Jaya Sutawan J Sutawan, Ida Bagus Krisna J. Sutawan, IB Krisna J. Sutawan, Ida Bagus Krisna Jeanne, Bianca Jimmy Wongkar Johanes, Kevin Paul Juwita, Nova Kadek Agus Heryana Putra, Kadek Agus Katipana, Madyline Victorya Ketut Yudi Arparitna, Ketut Yudi Khamandanu, Kadek Fabrian Kharisma, Chau Febriani Krisna J. Sutawan, Ida Bagus Krisnayanti, Ida Ayu Arie Kulsum Kulsum, Kulsum Kumaat, Garry D. Chrysogonus Kurniawan Komala, Tomas Ari Kurniawan Komala, Tomas Ari Kurniyanta, I Putu Kusuma, Oscar Indra Laksono, Buyung Hartiyo Lauren, Christopher Made Septyana Parama Adi Made Wiryana Marilaeta Cindryani Lolobali, Marilaeta Cindryani MD, Burhan MD, Patricia Michael Humianto Muhammad Aris Sugiharso, Muhammad Aris Muliadi, Win Mulyadi, Win Narakusuma, Fajar Ni Made Supradnyawati, Ni Made Ni Putu Wardani Nova Juwita Nyoman Golden Paramartha, Bagus Patricia, Yoshie Permatasari, Endah Permatasari, Endah Pontisomaya Parami Prabowo, Pratama Yulius Pranata, I Made Harry Pratana, Yolanda Jenny Purwanto, Osmond Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Ratu, Tiffani Richard Richard Saleh, Siti Chasnak Saleh, Siti Chasnak Santo, Budi Sidabutar, Beny Pratama Sidemen, IGP Sukrana Sista Satyarsa, Agung Bagus Sista Soerodjotanojo, Simson Samuel Sri Maliawan Sri Rahardjo Suastika, I Gede Juli Sucandra, I Made Agus Kresna Supradnyana, I Nyoman Novi Suranadi , I Wayan Sutawan, IB Krisna Krisna Jaya Taopan, Damatus Try Hartanto Tatang Bisri Tini, Kumara Tirta, Ian Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa Virayanti, Luh Putu Diah Wanda, Aprilia Wargahadibrata, A. Hmendra Widyana, I Made Gede Wiryawan, I Nyoman Wisnu Wardhana Wundiawan, Kristian Felix Yani, Jancolin Yani