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Dexmedetomidine as Neuroanesthesia Management in Patient with Meningioma Craniotomy Kumoro, Mohammad Aji; Prihatno, MM Rudi; Kartinofan, Aditya Pradana
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.v13i2.592

Meningiomas are the type of tumour that grows from the protective membranes of the brain, which line both the brain and spinal cord. The incidence rate of meningioma between females and males is 2:1 and tt is a fairly common neurosurgical case at Margono Soekarjo General Hospital Purwokerto. Dexmedetomidine is the drug of choice used for sedation and analgesia. In various literature, it is said that the use of dexmedetomidine will reduce hemodynamic fluctuations during surgery. A 49-year-old man was hospitalized because of cephalgia and hemiparesis of his left extremity. Computed tomography scan revealed a solid tumour at parietooccipitalis region, lobulated, measuring 7,2 x 7,1 x 4,4 cm, and an increase in intracranial pressure. General anesthesia was administered, beginning with premedication using sufentanil for analgesia, followed by induction with thiopental, and rocuronium for muscle relaxation to facilitate intubation. Dexmedetomidine is an attractive option available for anesthesiologist for maintaining general anesthesia. In this surgical procedure to remove an intracranial tumor, appropriate induction and monitoring of the patient's condition during surgery is required to prevent the risk of increasing intracranial pressure. Dexmedetomidine reduces cerebral blood flow, decreases intracranial pressure, reduces the rate of cerebral oxygen metabolism, and maintains cerebral perfusion pressure. Good management of neuroanesthesia supports the maintenance of hemodynamic stability and leads to better outcomes in craniotomy surgery. Dexmedetomidine has benefits on maintenance of anaesthesia in neurosurgical procedures.

PERBEDAAN KARAKTERISTIK PEKERJA DAN BIOMARKER PAPARAN LINGKUNGAN KERJA PADA PEKERJA BENGKEL LAS DAN KANTOR Nendyah Roestijawati; MM Rudi Prihatno; M. Zaenuri Syamsu Hidayat; Yudhi Wibowo; Diah Krisnansari
Biomedika Vol 15, No 2 (2023): Biomedika Agustus 2023
Publisher : Universitas Muhammadiyah Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23917/biomedika.v15i2.3313

ABSTRACT Occupational diseases are caused by the interaction of workers, workload, and work environment factors. This study aims to determine the correlation of worker factors with biomarkers of occupational exposure MT1a, GSTp1, and PSA. The research design used was comparative cross-sectional. The research subjects were 30 welding workers and 30 administrative office employees who were taken by purposive sampling. The variables studied were worker factors such as age and BMI, levels of the enzyme GSTp1, MT1a and PSA. Measurement of GSTp1, MT1a, and PSA in blood was performed using the sandwich ELISA method. Data analysis was performed using the Mann-Whitney test. The results of the study found that there were significant differences in age, BMI, and PSA levels in the two groups. There is no differences in GSTp1 and MT1a level between groups. We concluded that the PSA levels of the group of office workers were higher than those of the group of welding workshop workers, perhaps because the average age was older. ABSTRAK Penyakit akibat kerja disebabkan oleh adanya interaksi faktor pekerja, pekerjaan dan lingkungan kerja. Penelitian bertujuan mengetahui perbedaan karakteristik dan biomarker paparan lingkungan kerja seperti: MT1a, GSTp1 dan PSA antara pekerja bengkel las dan pekerja kantor administrasi. Desain penelitian yang digunakan adalah cross sectional. Subyek penelitian adalah 30 orang pekerja bengkel las dan 30 orang pekerja kantor administrasi yang diambil secara purposive sampling. Variabel yang diteliti adalah factor pekerja berupa usia dan IMT, kadar enzim GSTp1, MT1a dan PSA. Pengukuran GSTp1, MT1a dan PSA dalam darah dilakukan menggunakan metode ELISA sandwich. Analisis data dilakukan dengan uji Mann-Whitney. Hasil penelitian menunjukkan adanya perbedaan signifikan usia, IMT dan kadar PSA pada kedua kelompok, dan tidak ada perbedaan signifikan kadar GSTp1 dan MT1a antara kelompok. Kesimpulannya bahwa kadar PSA kelompok pekerja kantor lebih tinggi dibandingkan kelompok pekerja bengkel las, dimungkinkan karena rerata usia yang lebih tua.

Effect of Centella Asiatica (L.) Extract on Serum Levels of IL-6 and IL-10 in Traumatic Brain Injury Rat Nurafia, Sindy; Prihatno, MM Rudi; Novrial, Dody; Nafiisah, Nafiisah
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.611

Introduction: Traumatic brain injury (TBI) represents a major global health burden, because it is the foremost causes of death, particularly in young adults. Elevated IL-6 and IL-10 serum levels in severe TBI have been identified as an early indicator of unfavorable clinical outcomes. Pegagan (Centella asiatica (L.)) has antioxidant, neuroprotective, neurogenerative, anti-inflammatory properties. Our goal of this study was to find out what happened to IL-6 and IL-10 levels in blood of the TBI rat model when they were given pegagan extract (Centella asiatica (L.)). Subject and Method: experimental research design. For 3 days, there were 4 groups of male Wistar strain rats (Rattus norvegicus) subjects, consisting of three treatment groups (pegagan extract doses of 300 mg/kgBW, 500 mg/kgBW, and 1000 mg/kgBW) and one control group. On the 4th day, blood was taken, and we continued to examine IL-6 and IL-10 serum levels by ELISA. Result: A dose-dependent and significant increase of IL-6 and IL-10 serum levels was observed in the treatment groups compared with control group. Conclusion: In TBI rat model, administration of pegagan (Centella asiatica (L.)) extract increases IL-6 and IL-10 levels.

Penggunaan Dexmedetomidin pada Neurotrauma Prihatno, MM Rudi; Lian, Abdul; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Penggunaan dexmedetomidin dalam neurotrauma masih terpecah antara yang setuju dan tidak setuju. Permasalahan ketidaksetujuan adalah dari sisi penilaian terhadap kesadaran pasien, sedangkan yang menyetujui pemberian dexmedetomidin lebih cenderung digunakan sebagai sedasi dan juga efeknya sebagai protektor otak. Permasalahan tersebut diatas dapat dijadikan pertimbangan oleh ahli anestesi dalam penatalaksanaan neurotrauma dengan tetap mempertimbangkan kondisi fisik dan kesadaran pasien dengan harapan agar keselamatan pasien tetap terjaga dengan baik dan tidak memperburuk kondisi pasien.The Use of Dexmedetomidine on Neurotrauma The use of dexmedetomidine in Neurotrauma still divided between the agree and disagree. Disagreement is the issue of the assessment of patient awareness, while approving the provision of dexmedetomidine were more likely to be used as a sedative and also its effect as a brain protector. The problems mentioned above can be considered by an anesthesiologist in the management of Neurotrauma while considering the physical condition and consciousness of the patient with the expectation that patient safety is maintained properly and not worsen the patient's condition.

Penurunan Kadar Glutamat pada Cedera Otak Traumatik Pascapemberian Agonis Adrenoseptor Alpha-2 Dexmedetomidin sebagai Indikator Proteksi Otak Prihatno, MM Rudi; Harahap, M. Sofyan; Akbar, Ieva B; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Latar Belakang dan Tujuan: Dexmedetomidin untuk kasus-kasus neurotrauma masih kontroversi, antara yang setuju dan menolak. Dexmedetomidin sebagai agonis adrenoseptor ?2 memiliki beberapa keuntungan dalam kaitannya dengan kemampuannya sebagai neuroprotektan. Penelitian ini bertujuan untuk mengkaji efek neuroproteksi dari dexmedetomidin yang dilihat dari pengaruhnya terhadap penurunan kadar glutamat.Subjek dan Metode Penelitian single blind randomized controlled trial dilakukan pada 16 orang yang datang ke IGD RSUD Prof. Dr. Margono Soekarjo dengan cedera otak traumatik dengan GCS ?8 pada MeiDesember 2013. Subjek dibagi dalam 2 kelompok yaitu kelompok dexmedetomidin dan NaCl 0,9%. Pembedahan dilakukan dalam rentang waktu 9 jam pascatrauma. Pemeriksaan kadar glutamat dengan menggunakan metode ELISA. Analisis data menggunakan uji-t dan uji Mann-Whitney.Hasil: Kelompok yang mendapatkan dexmedetomidin menunjukkan bahwa pemberian dexmedetomidin 0,4 ?g/kgBB/jam secara kontinyu, menunjukkan penurunan kadar glutamat yang diukur mulai dari awal perlakuan hingga jam ke-24 sebanyak 27,9% (p=0,025), dari jam ke-24 hingga jam-72 sebanyak 9,6% (p=0,208), serta dari awal perlakuan hingga jam ke-72 sebanyak 57,1% (p=0,036). Kelompok yang tidak mendapatkan dexmedetomidin mengalami peningkatan kadar glutamat.Simpulan: Pemberian dexmedetomidin 0,4 ?g/kgBB/jam dapat menurunkan kadar glutamat pada pasien cedera otak traumatik dengan GCS ? 8.Decreased Level of Glutamate after Administration of Dexmedetomidine (Alpha-2 Adrenoreceptor Agonist) as Neuroprotective Indicator in Traumatic Brain InjuryBackground and Objective: The usage of Dexmedetomidine in neurotrauma cases is still controversial, between the pros and cons. Dexmedetomidine as ?2-adrenoceptor agonist has several benefits in concomitant with its properties as neuroprotector. This study aims to evaluate the neuroprotection effect of dexmedetomidine based on the decline in glutamate level.Subject and Method: This single blind randomized controlled trial was done in 16 TBI patients with GCS ? 8, recruited from May-December 2013. Subjects were equally divided into 2 groups: dexmedetomidine and 0.9% NaCl group. Surgery was performed within 9 hours post TBI. Glutamate level was examined using ELISA method. Data were analyzed using t-test and Mann-Whitney test.Result: This study showed that glutamate levels in patient who received continuous intravenous dexmedetomidine 0.4 mcg / kg / h were decreased, starting from baseline to 24 h (27.9%, p=0.025), 24 to 72 h (9.6%, p= 0.208) and baseline to 72 h (57.1%, p= 0.036). All patients in NaCl 0.9% group experienced an increase in glutamate level.Conclusion: Administration of dexmedetomidine 0.4 mcg/kg/h in TBI patient with GCS ? 8 could decrease glutamate level.

Defisit Neurologis Iskemik Tertunda pada Perdarahan Subaraknoid akibat Rupture Aneurisma yang dilakukan Tindakan Coiling Rahmatisa, Dimas; Prihatno, MM Rudi
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Stroke dapat terjadi akibat terhentinya aliran darah ke otak, yang terjadi secara mendadak. Penyebab terbanyak stroke adalah berkurangnya pasokan darah ke otak (stroke iskemik). Penyebab stroke lainnya adalah perdarahan (stroke hemoragik). Perdarahan subaraknoid (SAH) biasanya dapat terjadi baik karena ruptur aneurisma, atau karena trauma. Perempuan, 46 tahun dengan GCS 14 (E4M6V4) dengan hipertensi tidak terkontrol mengalami nyeri kepala hebat. Dari pemeriksaan CT scan memperlihatkan adanya perdarahan subaraknoid dan edema sereberi. Pasien ini dilakukan tindakan coiling aneurisma cito dengan anestesia umum. Pasca coiling pasien dirawat di ruang intensive care unit (ICU). Pasca perawatan 1 hari di ICU, pasien dipindahkan ke ruang high care unit (HCU), dengan kondisi stabil. Penurunan kesadaran mulai terjadi saat perawatan hari kedua, sempat dilakukan pemasangan lumbar drain pada hari ketiga, untuk membantu mengurangi hidrosefalus dan juga menurunkan tekanan intra kranial. Pada perawatan hari ketigabelas kesadaran menurun drastis menjadi E1M1V1, pasien dipindahkan ke ruang ICU, dan meninggal esok harinya. Penurunan kesadaran pasca coiling diakibatkan oleh peningkatan tekanan intra kranial, yang pada kasus ini disebabkan oleh edema sereberi luas. Early Brain Injury ditambah dengan adanya vasopasme menyebabkan terjadinya delayed ischemic neurological deficit. Terapi yang sudah dikerjakan baik farmakologis maupun non farmakologis, tetap tidak bisa memperbaiki keadaan pasien.Delayed Ischemic Neurological Defisit (DIND) Pasca Coiling Subarachnoid Hemorrhage (SAH) e.c Ruptur AneurismaAbstractStroke can occur due to the cessation of blood flow to the brain, which occurs suddenly. The most common cause of stroke is reduced blood supply to the brain (ischemic stroke). Another cause of stroke is bleeding in the brain (hemorrhagic stroke). Subarachnoid hemorrhage (SAH) usually results from ruptured aneurysms or because of trauma. Women, 46 years old with GCS 14 (E4M6V4) with uncontrolled hypertension experienced severe headache since 2 days before admitted to the hospital. The CT scan examination showed subarachnoid hemorrhage and edema of the brain. This patient then performed emergency coiling of aneurysm with general anesthesia. During the procedure the patient is in stable condition. Post coiling the patient was sent to the ICU room. After 1 day in ICU, the patient was transferred to high care unit (HCU) room, with stable condition. Decreased of consciousness began to occur during the second day of treatment, had done lumbar drain installation on the third day, to help reduce the hydrocephalus and also improve intra-cranial pressure. On the thirteenth day care GCS was decrease suddenly to E1M1V1, the patient was transferred to the ICU room, the next day the patient was declared dead. The decrease of consciousness post coiling results from an increase in intra-cranial pressure, which in this case is due to severe brain edema. Earlu brain injury along with the occurence of vasospasm lead to delayed ischemic neurological deficit. Pharmacological and non-pharmacological therapy had been given to the patient still couldnt improve the patient condition

Cardiac Arrest Intra Operatif Pada Neuroanestesi Pediatrik Prihatno, MM Rudi; Manulima, Teguh
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
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Henti jantung (cardiac arrest) intra operatif merupakan penyulit yang paling menakutkan selama pembedahan berlangsung, terutama pada kasus-kasus bedah saraf pediatrik, dikarenakan akan berpengaruh pada luaran operasi dan dampak jangka panjang yang ditimbulkannya. Resiko yang lebih berat adalah kematian di meja operasi. Seorang anak perempuan 10 bulan dibawa ke RSUD Prof. Dr. Margono Soekarjo oleh orangtuanya dengan keluhan kelemahan anggota gerak sebelah kiri sejak 1 bulan sebelumnya. Pasien rujukan dari salahsatu rumahsakit daerah. Setelah dilakukan tindakan pemeriksaan penunjang, maka disimpulkan dengan diagnosa sementara primitive neuroectoderm tumor (PNET). Pasien direncanakan untuk dilakukan tindakan opeasi bedah saraf elektif. Tindakan anestesi bedah saraf berlangsung selama 180 menit. Selama berlangsungnya operasi pasien mengalami henti jantung (cardiac arrest) pada menit ke-120. Kemudian dilakukan tindakan resusitasi kardiopulmoner. Pasien merespon resusitasi dengan baik. Pasien pasca operasi dibawa ke ruang perawatan intensif. Pasien dirawat di ruang perawatan intensif selama 6 hari, dirawat di ruang bedah saraf selama 4 hari, dan dipulangkan pada hari ke-10 pasca operasi.Intraoperative Cardiac Arrest in Pediatric NeuroanesthesiaIntra-operative cardiac arrest is the most frightening complication during surgery, especially in cases of pediatric neurosurgery, because it will affect the outcome of the operation and the long-term effects it causes. A more severe risk is death at the operating table. A 10-month-old girl was brought to the RSUD Prof. Dr. Margono Soekarjo by his parents with complaints of weakness in the left limb since 1 month before. Patient referral from one regional hospital. After carrying out investigative actions, it is concluded with a provisional diagnosis of primitive neuroectoderm tumor (PNET). Patients are planned for elective neurosurgery surgery. The neurosurgical anesthetic procedure lasts 180 minutes. During the operation, the patient experiences cardiac arrest (cardiac arrest) in the 120th minute. Then cardiopulmonary resuscitation is performed. Patients respond to resuscitation. Postoperative taken to intensive care. The patient was treated in the intensive care room for 6 days, was admitted to the neurosurgical room for 4 days, and sent home on the 10th day postoperatively.

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