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All Journal Jurnal Anestesiologi Indonesia Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Majalah Anestesia dan Critical Care Jurnal Anestesi Obstetri Indonesia Interdisciplinary Social Studies Jurnal Neuroanestesi Indonesia International Journal of Health Science and Technology Acta Medical and Health Sciences (AMHS)

Dewi Yulianti Bisri

Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin Bandung

Author-ID : 508250

Humanities Biochemistry, Genetics & Molecular Biology Education Engineering Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi Of Fallot Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Tetralogi of Fallot (TOF), pertama kali diperkenalkan pada tahun 1888 oleh seorang dokter dari Prancis yang bernama Etienne-Louis Arthur Fallot. Tetralogi of Fallot (TOF) merupakan salah satu jenis cacat jantung bawaan sianotik yang paling banyak diketemukan. Tetralogi of Fallot (TOF) memiliki empat kelainan yaitu: (1) stenosis infundibulum pulmonari, (2) Ventricular Septal Defect (VSD), (3) overidding aorta, dan (4) hipertrofi ventrikel kanan. Pasien dengan penyakit kongenital jantung sianotik (right to left shunt) memiliki resiko terjadinya abses otak. Penyakit jantung sianotik terhitung sekitar 12.8-69,4% dari semua kasus abses otak dan insidensi tertinggi terjadi pada anak-anak. Kami melaporkan seorang anak laki-laki berusia 8 tahun, berat badan 16 kg dengan abses otak multiple yang disertai dengan cacat jantung bawaan sianotik Tetralogi of Fallot (TOF) yang akan dilakukan aspirasi abses. Pasien datang dengan suhu tubuh 39oC, GCS 13, Tekanan darah 90/50 mmHg, nadi 120 x/menit, SpO2 90% dengan simple mask 6 L/menit. Hasil lab menunjukan Hb14gr%, Hematokrit 41%, thrombosit 250.000/mm3. PT/aPTT 13,2/26,9. Sudah terpasang infus dari UGD, selanjutnya diberikan premedikasi midazolam 1 mg intravena, induksi dengan propofol, fentanyl, vecuronium, rumatan anestesi dengan oksigenudara, sevoflurane. 12 Jurnal Neuroanestesia Indonesia Operasi berlangsung selama 1,5 jam, pemberian cairan dengan target normovolume, pascaoperasi dirawat di neurointensive care unit selama 3 hari. Puasa prabedah harus diperhitungkan sebaik-baiknya karena pasien harus tetap terhidrasi dengan baik. Pasien TOF dengan polisitemia, apabila terjadi dehidrasi akan meningkatkan viskositas dan sludging. Pasien ini sudah terhidrasi dengan baik dan cairan pengganti puasa diberikan melalui infus. Pasien harus dalam keadaan tenang dan rileks. Pasien diberikan premedikasi midazolam intravena. Premedikasi dengan suntikan intramuskuler harus dihindari karena kecemasan dan stress dapat menyebabkan tet spell. Premedikasi berat juga harus dihindari karena adanya depresi nafas yang menimbulkan hiperkarbia dapat meningkatkan Pulmonary Vascular Resistance (PVR) dan menimbulkan peningkatan shunting dari kanan ke kiri. Aspirasi abses serebri tidak dapat dilakukan dengan anestesi lokal karena akan meningkatkan kecemasan, tekanan darah pasien. Anestesi harus dilakukan dengan anestesi umum. Pengelolaan perioperatif pasien TOF yang dilakukan operasi ditempat lain (bukan operasi TOFnya) memerlukan pemahaman tentang patofisiologik TOF dan teknik neuroanestesi untuk mendapatkan outcome yang baik.Anesthesia Management For Brain Abscess Drainage Patient With Tetralogy Of FallotTetralogy of Fallot (TOF) was first described in 1888 by a French physician named Etienne-Louis Arthur Fallot. Tetralogy of Fallot (TOF) is one type of cyanotic congenital heart defect most widely found. Tetralogy of Fallot (TOF) has four abnormalities: (1) pulmonary infundibulum stenosis, (2) VSD (Ventricular Septal Defect), (3) overriding aorta, and (4) right ventricular hypertrophy. Patients with congenital cyanotic heart disease (right to left shunt) have a risk of brain abscess. The incidences of cyanotic heart disease is about 12.8-69,4% of all cases of brain abscess and the highest incidence occurs in children. We reported an 8-years old 16-kg boy with multiple brain abscesses accompanied with cyanotic congenital heart defect Tetralogy of Fallot (TOF) and whom abscess aspiration would be performed. Patients was present with body temperature 39oC, GCS 13, blood pressure 90/50 mmHg, pulse 120 beats/min, SpO2 90% with a simple mask using oxygenation of 6 L/min. Lab results showed Hb 14gr%, hematocrit 41%, platelet count 250.000/mm3, PT /aPTT: 13.2/26.9. Patient was mounted infusion from the emergency ward (ER), given 1 mg intravenous midazolam premedication, induction with propofol, fentanyl, vecuronium, maintenance with oxygen-air anesthesia and sevoflurane. The operation lasted for 1.5 hours, the infusion targeted to normal volume, postoperative care was given in the neurointensive care unit for 3 days. Pre-surgical fasting plan plays an important role because the patient must remains well hydrated. TOF patients with polycythemia when dehydrated, will increase the viscosity and sludging events. This patient was well hydrated and fasting replacement fluid therapy was given intravenously. Patients should be in a state of calm and relaxed. Patient was given intravenous midazolam premedication. Premedication with intramuscular injections should be avoided, since anxiety and stress may lead to "tet" spell. Heavy premedication should also be avoided because of respiratory depression leading to hypercarbia can increase the Pulmonary Vascular Resistance (PVR) and precipitate increased shunting from right to the left. Cerebral abscess aspiration can not be performed under local anesthesia because it increases the anxiety and the patient's blood pressure. Anesthesia should be performed under general anesthesia. Management of perioperative TOF patients who will underwent surgery elsewhere (not for TOF) requires deep understanding on TOF pathophysiology and neuro-anesthesia techniques to get a good outcome

Pengelolaan Perioperatif Anestesi Perdarahan Intraserebral karena Stroke Perdarahan dan Luarannya Basuki, Wahyu Sunaryo; Bisri, Dewi Yulianti; Oetoro, Bambang J.; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
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Perdarahan intraserebral masih merupakan penyebab kematian dan kecacatan yang tinggi. Angka kejadiannya berkisar 1030 % kasus per 100.000, dengan angka kematian mencapai 62% dan hanya 20% yang bisa bertahan hidup secara fungsional dalam 6 bulan dari onset. Penyebab dari perdarahan intraserebral adalah hipertensi. Pengelolaan perioperatif meliputi pencegahan bertambahnya hematom dan edema, pengelolaan tekanan darah, mencegah naiknya ICP dan mempertahankan tekanan perfusi otak. Seorang laki-laki dibawa ke rumah sakit karena lemah anggota gerak kanan atas dan bawah dan tidak bisa bicara sejak 2 jam sebelumnya. Dari anamnesa didapat riwayat hipertensi dalam 5 tahun terakhir dan mendapat obat bisoprolol. Dari pemeriksaan didapatkan kesadaran dengan GCS E4 M5Vx, hemiplegi dekstra dan afasia, tekanan darah 180/105 mmHg. Pasien di rawat diruangan intermediate di ICU. Pada hari kedua karena ada penurunan kesadaran dengan GCS E3 M4 Vx serta penambahan hematoma menjadi 87 cc dibanding MRI sebelumnya diputuskan segera dilakukan kraniotomi evakuasi. Tindakan ini memerlukan pengetahuan yang baik mengenai pengelolaan perioperatif pasien dengan perdarahan intraserebral karena hipertensi dari seorang ahli Anestesiologi sehingga mendapat luaran yang baik.Anesthetic Perioperative Management of Intracerebral Hemorrhage and its OutcomeIntracerebral hemorrhage (ICH) has high mortality and morbidity rates. Its incidence is 10-30%, with a mortality rate of 62%. Only 20% of patients survive functionally within six months from time of onset. The cause of ICH is hypertension. Perioperative management of ICH includes blood pressure control, prevention of hematoma enlargement and edema, prevention of ICP increase and maintenance of cerebral perfusion pressure. A male patient was brought to the hospital due to weakness of the left extremities and inability to speak since two hours before admission. Patient had had hypertension for the last five years and was on bisoprolol. Physical examination revealed GCS E4M5Vx, left hemiplegia, aphasia, and blood pressure 180/105 mmHg. Patient was admitted to intermediate ward in the intensive care unit. On day-2, due to further decrease in consciousness (GCS E3M4Vx) and increase in hematoma volume to 87 cc, craniotomy for evacuation was indicated. This procedure requires good understanding of perioperative management of ICH by an anesthesiologist to produce favorable outcome.

Pengaruh Asam Traneksamat Intravena terhadap Jumlah Perdarahan Intraoperatif dan Kebutuhan Transfusi pada Operasi Meningioma Sutanto, Sigit; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
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Latar Belakang dan Tujuan: Meningioma merupakan tumor otak yang berisiko tinggi terjadi perdarahan pada reseksi massa. Penelitian dengan rancangan double blind RCT dilakukan pada 40 subjek meningioma di RSUP Dr Hasan Sadikin Bandung dengan tujuan melihat pengaruh asam traneksamat (TXA) dalam mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi. Subjek dan Metode: Subjek penelitian dibagi dua kelompok, kelompok A diberikan asam traneksamat intravena 20 mg/kg dalam NaCl 0,9% 100 mL dan kelompok B diberikan NaCl 0,9% 100 mL sebelum insisi. Data hemodinamik, jumlah cairan, jumlah transfusi dan jumlah perdarahan intraoperatif dicatat per jam. Dilakukan pemeriksaan kadar Hb, Ht dan faktor pembekuan pascaoperasi dan 24 jam pascaoperasi. Data hasil penelitian diuji secara statistik menggunakan uji t tidak berpasangan dan uji Mann-Whitney. Hasil: Perdarahan intraoperatif (1008,51327,192 vs 1347539,120 ml; p=0,021), kebutuhan pada transfusi packed red cell (PRC) intraoperatif (89,30152,970 ml vs 306,85224,631 ml; p=0,003), kebutuhan transfusi PRC 24 jam pasca operasi (88,50153,014 ml vs 212,00212,505 ml; p=0,028) pada kelompok A secara signifikan lebih kecil dari kelompok B.Simpulan: Asam traneksamat 20 mg/kg yang diberikan intravena sebelum insisi dapat mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi pada operasi tumor otak suspek meningioma.Effects of Intravenous Tranexamic Acid on Blood Loss and Transfusion Requirements in Tumor Removal Surgery of Suspected MeningiomaBackground and objective: Meningiomas are highly vascular brain neoplasms that often associated with substantial blood loss. This experimental, double-blind RCT conducted in Dr. Hasan Sadikin Hospital, enrolled 40 subjects with intracranial meningioma underwent surgical excision. The objective of this study is to see the effect of tranexamic acid (TXA) in reducing bleeding and transfusion requirementsSubjects and Method: Subjects divided into two groups, group A received tranexamic acid 20 mg/kg body weight in 100 mL normal saline, and group B received 100 mL normal saline before incision. Intraoperative hemodynamics, amount of fluid, transfusions, and blood loss were recorded hourly. Hemoglobin, hematocrit, and coagulation factors measured in postoperative, and subjects were followed up for the first 24 hours to record transfusion requirements and laboratorium work up. We analyzed the data using t-test and Mann-Whitney test. Results: Intraoperative blood loss (1008,51327,192 vs 1347539,120 ml; p=0,021), intraoperative packed red cell (PRC) transfusion requirement (89,30152,970 ml vs 306,85224,631 ml, p=0,003), PRC transfusion requirement in first 24 hours postoperative (88,50153,014 ml vs 212,00212,505 ml, p=0,028) in group A significantly less than group B Conclusions: Administration of intravenous tranexamic acid 20 mg/kg before incision can reduce intraoperative blood loss and transfusion requirement in patients underwent surgical excision of meningioma

Perbandingan Status Nutrisi Minggu Pertama pada Pasien Pascacedera Otak Traumatik Sedang dan Berat yang Dirawat di RSUP Dr. Hasan Sadikin Bandung Dinilai dengan Subjective Global Assessment (SGA) Saputra, Tengku Addi; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
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Latar Belakang dan Tujuan: Penilaian status nutrisi merupakan hal vital untuk menentukan rencana pemberian nutrisi dan memperbaiki luaran pasien dengan cedera otak traumatik (COT). Pada pasien COT terjadi hipermetabolisme, hiperkatabolisme, dan intoleransi glukosa yang dapat mempengaruhi luaran pasien. Penilaian status gizi dilakukan dengan Subjective Global Assessment (SGA). Tujuan penelitian ini adalah untuk membandingkan status nutrisi antara pasien COT sedang dan berat yang dinilai dengan SGA.Subjek dan Metode: Penelitian observasional analitik cross sectional ini dilakukan pada 22 pasien COT yang dirawat di RSUP Dr Hasan Sadikin Bandung sejak November 2016 - Juli 2017, yang dibagi menjadi 2 kelompok, yaitu COT sedang dan berat. Status nutrisi subjek penelitian dinilai dengan SGA selama 7 hari. Analisis data dilakukan dengan Chi Square, Kolmogorof-Smirnof dan Exact Fisher. Hasil: Terdapat perbedaan status nutrisi yang signifikan antara kelompok COT sedang dan berat pada hari perawatan ke-6 dan 7, dimana lebih banyak didapatkan malnutrisi berat pada kelompok COT berat (p0,05).Simpulan: Pada penelitian ini malnutrisi lebih banyak terjadi pada pasien dengan COT berat, disebabkan oleh perlambatan pemberian nutrisi akibat disfungsi gastrointestinal yang terjadi pada pasien COT berat sehingga diperlukan strategi pemberian nutrisi khusus pada kelompok COT berat.Comparison of a One Week Nutritional Status between Moderate and Severe Traumatic Brain Injury Patient in Dr. Hasan Sadikin General Hospital Assessed with Subjective Global Assessment (SGA)Background and Objective: Assessment of nutritional status is vital in determining nutritional plans and improving outcomes of traumatic brain injury (TBI) patients. Hypermetabolism, hypercatabolism, and glucose intolerance occur in patients with TBI can affect its outcome. The used nutritional status assessment is Subjective Global Assessment (SGA). The aim of this study was to compare nutritional status in moderate and severe TBI patients assesed with SGA.Subject and Method: This cross sectional observational analytic study was conducted on 22 TBI patients treated in RSUP DR. Hasan Sadikin Bandung since November 2016 - July 2017, divided into 2 groups, moderate and severe TBI. Assessment of SGA in study subjects was conducted for 7 days. Data was analyzed with Chi Square, Kolmogorof-Smirnof and Exact Fisher test. Results: This study showed a significant difference in nutritional status between moderate and severe TBI groups during the 6th and 7th treatment days, whereas more severe malnutrition was found in the severe TBI group (p 0.05).Conclusion: Compares to patients with moderate TBI, malnutrition is more prevalent in patients with severe TBI, because of delayed of nutrient delivery due to gastrointestinal dysfunction occurring in severe TBI patients requiring specific nutritional strategies in severe TBI group.

Pencegahan dan Pengobatan Disfungsi Kognitif setelah Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
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Kognisi adalah proses untuk mengetahui atau berpikir, memilih, mengerti, mengingat, dan menggunakan informasi. Gangguan kognitif adalah gangguan dalam melakukan perhatian dan konsentrasi, proses dan mengerti informasi, ingatan, komunikasi, perencanaan, organisasi, pemikiran, pemecahan masalah dan pengambilan keputusan, mengendalikan rangsangan dan hasrat. Lebih dari 50.000 orang meninggal setiap tahun akibat cedera otak traumatik (COT) dan 70.00090.000 mengalami kecatatan permanen di USA. Walaupun pasien dengan COT sedang, secara fisik mengalami pemulihan penuh, tapi sering mengalami perubahan tingkah laku jangka lama yang mempengaruhi pekerjaan, cara hidup, dan keluarganya. Setelah COT yang lebih berat, gangguan kognitif merupakan masalah paling umum dan memberikan kontribusi lebih daripada gangguan fisik. Luasnya defisit kognitif ditunjukkan oleh 1) beratnya diffuse axonal injury (DAI) yang ditunjukkan lamanya posttraumatic amnesia (PTA), luasnya atropi umum, dan 2) lokasi, dalamnya, dan volume lesi serebral fokal. Terapi difokuskan pada rehabilitasi neurokognisi. Sampai saat ini tidak ada terapi untuk cedera otak primer dan terapi yang dilakukan adalah mengurangi cedera sekunder yang dipicu oleh cedera primer. Jadi secara umum tetap menggunakan ABCDE neuroanestesi/neuroresusitasi dan secara khusus dengan pemberian infus lidokain, natrium laktat hipertonik, obat kholinergic, catecholaminergic, tricyclic antidepressants.Prevention and Management of Cognitive Dysfunction after TBICognition is the act of knowing or thinking process. It includes the ability to choose, understand, remember and use information. Cognition function disorder includes disturbances in accessing and optimizing attention and concentration, processing and understanding information, memory, communication, planning, organizing, and assembling, reasoning, problem-solving, decision-making, and judgment, controlling impulses, desires and being patient. More than 50,000 people die from traumatic brain injury (TBI) each year and other 70,00090,000 people are permanently disabled in the US. Even individuals with moderate head injuries who appear to be physically fully recovered, often have long lasting behavioral sequelae, which in turn affects the individuals occupation, lifestyle and interaction with family members. After a more severe injury, cognitive function disorder is considered more common compared to physical impairment. The extent of cognitive function deficit after TBI is reflected by a number of factors 1) the severity of diffuse axonal injury, as indicated by the length of post traumatic amnesia (PTA), the extent of generalized atrophy; and 2) the location, depth, and volume of focal cerebral lesions. Therapy is focused to neuro cognitive rehabilitation. Until now, there is no specific therapy for primary brain injury and commonly applied therapy is focused on reducing secondary brain injury. In general, the ABCDE of neuroanesthesia/neuroresuscitation is still commonly used, and in specific case, the need to administration of lidocaine infusion, sodium lactate hyperosmolar, cholinergic, catecholaminergic, and tricyclic antidepressants.

Insidensi Tumor Supratentorial berdasarkan Jenis dan Letaknya di RSUP Dr. Hasan Sadikin Tahun 20122013 M, Mutivanya Inez; Bisri, Dewi Yulianti; Adam, Achmad
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Latar Belakang dan Tujuan: Tumor otak adalah kumpulan sel tidak normal pada otak yang bermultiplikasi dan dapat menyebabkan kerusakan pada jaringan sekitarnya dan organ-organ terkait. Tumor supratentorial adalah tumor otak yang terletak superior terhadap tentorium serebeli. Tentorium serebeli adalah lapisan dural yang memisahkan lobus oksipital pada otak besar dengan otak kecil. Tumor supratentorial adalah 33% dari total tumor otak. Penelitian ini bertujuan untuk menggambarkan angka kejadian tumor supratentorial berdasarkan jenis dan letak tumor.Subjek dan Metode: Objek penelitian adalah rekam medis pasien dengan diagnosis tumor supratentorial yang masuk ke Rumah Sakit Hasan Sadikin Bandung pada Januari 2012 hingga Desember 2013. Penelitian ini merupakan penelitian deskriptif memakai rancangan studi kasus. Data dibagi kedalam kelompok sesuai dengan jenis dan letak tumor kemudian dilihat karakteristiknya.Hasil: Terdapat 494 pasien tumor supratentorial tapi hanya ada 168 yang memiliki informasi lengkap. Berdasarkan jenisnya, tumor dikelompokkan secara garis besar menjadi glioma (14,88%), tumor kranial dan paraspinal (0,60%), tumor meningen (70,24%), tumor pada region sella (10,12%) dan tumor metastasis (4,17%). Berdasarkan letaknya, secara garis besar tumor terletak di sisi kanan (35,12%), sisi kiri (36,90%), region sellar (13,69%), sisi tengah (4,16%) dan bilateral (10,12%)Simpulan: Jenis tumor supratentorial terbanyak adalah meningioma dan lokasi tumor supratentorial paling banyak adalah pada sisi kiri otak secara umum, atau pada lobus frontal secara spesifik.Incidence of Supratentorial Tumor based on Types and Locations of Tumor in Hasan Sadikin Hospital Year 20122013Background and Objective: Brain tumor is a group of abnormal cells in the brain which multiplies and causes damage to the surrounding tissues and related organs. Supratentorial tumor is a brain tumor which is located at superior of tentorium cerebelli. Tentorium cerebelli is the dural layer which separates the occipital lobe of cerebrum with the cerebellum. Thirty three percent of brain tumor is supratentorial tumor. This study was aimed to observe the prevalence of supratentorial tumor based on the type and location of the tumor.Subject and Method: The objects of the study were the medical records of patients diagnosed with supratentorial tumor whom admitted to Dr. Hasan Sadikin General Hospital Bandung from January 2012 until December 2013. This study was a case- descriptive study and data was divided into groups based on type and location of the tumor and then analyzed based on the characteristics.Result: There were 494 patients with supra tentarial tumor, but only 168 patients had complete infomation. Based on the type, tumors were categorized generally into glioma (14.88%), cranial and paraspinal tumor (0.60%), meningeal tumor (70.24%), sellar region tumor (10.12%) and metastatic tumor (4.17%). Based on the location in the brain, tumors were located generally in the right side (35.12%), left side (36.90%), sellar region (13.69%), middle (4.16%) and bilateral (10.12%).Conclusion: The most common type of supratentorial tumor is meningioma and most common location of supratentorial tumor is in the left side of the brain, particularly in the frontal lobe.

Manajemen Pasien Stroke Perdarahan Spontan dengan Komorbid Penyakit Paru Obstruktif Kronik yang Terjadi Bronkhospasme Intraoperasi Halimi, Radian Ahmad; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Stroke perdarahan spontan dan penyakit paru obstruktif kronik (chronic obstructive pulmonary disease/COPD) merupakan dua penyakit yang memiliki angka morbiditas dan mortalitas yang paling tinggi di dunia. Kondisi COPD akan meningkatkan resiko terjadinya stroke, selain itu dapat mengakibatkan terjadinya hipoksemia dan hiperkapnia. Seorang pria berusia 62 tahun datang ke unit gawat darurat karena mengalami penurunan kesadaran dan tidak dapat menggerakkan anggota tubuh sebelah kiri sejak 1 hari, pasien memiliki riwayat hipertensi namun tidak rutin meminum obat, pasien memiliki riwayat sering sesak, dan berdasarkan pemeriksaan fisik didapatkan kondisi barrel chest. Berdasarkan pemeriksaan CT-scan kepala didapatkan perdarahan intrakranial spontan pada basal ganglia sinistra. Pasien dilakukan tindakan kraniotomi evakuasi, namun 2 jam setelah dilakukan induksi anestesi terjadi kondisi desaturasi, hiperkapnia, peningkatan tekanan jalan nafas, dan ditemukan wheezing pada kedua lapang paru, kemudian diberikan terapi farmakologis dan non farmakologis untuk mengatasi kondisi bronkospasme. Pascabedah dilakukan pemanjangan ventilasi mekanik hingga pasien memenuhi kriteria untuk dilakukan ekstubasi. Penanganan pasien stroke dengan komorbid COPD membutuhkan pemahaman yang lebih mendalam mengenai interaksi otak dengan fungsi pernafasan akibat perubahan fisiologi dan patofisiologi pasien COPD.Management of Spontaneous Intracranial haemorhage with Comorbids Chronic Obstructive Pulmonary Disease Occurring Intraoperative BronchospasmAbstractStroke and chronic obstructive pulmonary disease (COPD) are the two diseases that have the highest morbidity and mortality rates in the world. COPD conditions will increase the risk of stroke, but it can lead to hypoxemia and hypercapnia. A 62-year-old man came to the emergency room because of a decreased consciousness and was unable to move the left limb since 1 day, the patient had a history of hypertension but did not regularly take medication, the patient had a history of frequent tightness, and based on physical examination was obtained barrel chest condition. Based on a head CT scan, spontaneous intracranial hemorrhage occurs in the left basal ganglia. Evacuation craniotomy was performed, but 2 hours after anesthesia induction occurred conditions of desaturation, hypercapnia, increased airway pressure, and wheezing was found in both lung fields, then given pharmacological and non-pharmacological therapy to overcome the condition of bronchospasm. After surgery, lengthening of mechanical ventilation is done until the patient meets the criteria for extubation. The treatment of stroke patients with co-morbid COPD requires a deeper understanding of brain interactions with respiratory function due to changes in physiology and pathophysiology of COPD patients.

Penanganan Anestesi pada Operasi Atlas Meningioma Susanto, Yunita; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
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Angka kejadian spinal meningioma di Amerika adalah 25 % dari seluruh tumor di regio spinal dan empat kali lebih banyak muncul pada perempuan usia lebih dari 40 tahun dibandingkan pada laki-laki. Delapan puluh persen terjadi di daerah vertebra thorakal, 15% di cervikal, 3% di lumbal dan 2% di foramen magnum. Seorang wanita berusia 42 tahun, GCS 15 dengan diagnosa atlas meningioma, yang dilakukan operasi laminectomu untuk pengangkatan tumor. Pasien mengeluh kesemutan mulai dari tangan kiri diikuti tangan kanan, kaki kiri diikuti kaki kanan sejak 10 bulan yang lalu. Sejak 2 bulan yang lalu pasien mengeluh lemas bila berjalan yang disertai kelemahan kedua tangan, disertai keterbatasan gerak dari leher, tidak ada gangguan berkemih dan defekasi. Intubasi dilakukan dengan cara inline position, operasi berlangsung selama 7 jam dengan total perdarahan 650 cc, rumatan anestesi menggunakan isofluran 0,81 vol%, dexmedetomidine 0,20,7 mcg/kgbb/jam dan vecuronium 1 mcg/kgbb/mnt. Pascaoperasi pasien tidak diekstubasi, dirawat Neurosurgery Critical Care Unit (NCCU), pernafasan dibantu mesin bantu nafas dengan mode Synchronized Intermittent Mandatory Ventilation (SIMV) dan baru diekstubasi 12 jam pascaoperasi. Tiga hari pascaoperasi pasien dipindahkan ke ruangan dengan GCS 15 dan keadaaan hemodinamik stabil.Anesthesia Management in Atlas Meningioma SurgeryThe incidence rate of spinal meningioma in the US is 25% of all tumors in the spinal region and appears four times more in women aged over 40 years old than in men. Eighty percent occurs in the thoracal, 15% in the cervical, 3% in the lumbar and 2% in the foramen magnum. This is a case of a 42-year-old woman with GCS 15 who was diagnosed with high cervical meningioma underwent laminectomy tumor removal. Patient experienced numbness on the left referring to the right hand and left referring to the right hand foot since 10 months ago. Since 2 months ago the patient experienced limp with weakness on both hands and limited neck motion. Patients had no disturbance in micturition and defecation. Intubation was done by inline position while the surgery lasted for 7 hours with 650cc bleeding. Anesthesia was maintained using isoflurane 0.8-1 vol %, dexmedetomidine 0.2-0.7 mcg/kg/h and vecuronium 1 mcg/kg/mnt. After surgery, the patient was not extubated and admitted to NCCU (Neurosurgery Critical Care Unit) with ventilator-mode SIMV (Synchronized Intermittent Mandatory Ventilation). Extubation was performed 12 hours postoperative. Three days after surgery patient was transferred to inpatient ward with GCS 15 and stable hemodynamic status.

Tatakelola Ventilasi Mekanik pada Pengangkatan Tumor Metastasis Ekstradura Torakal dengan Teknik Anestesi Satu Paru dan Posisi Lateral Dekubitus Putri, Dini Handayani; Bisri, Dewi Yulianti; Fuadi, Iwan; Harahap, M Sofyan
Jurnal Neuroanestesi Indonesia Vol 9, No 1 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Spinal adalah lokasi yang paling umum untuk metastasis tulang. Metastasis spine dapat menyebabkan nyeri, ketidakstabilan tulang belakang dan cedera neurologis lainnya. Pada operasi tumor spinal metastasis pendekatan pembedahan menjadi hal penting baik bagi ahli bedah saraf maupun neuroanestesi. Pada kasus ini laki-laki 60 tahun dengan tumor ekstradura metastasis torakal akan menjalani operasi pengangkatan tumor dan stabilisasi dengan pendekatan posterolateralextracavity untuk mendapat akses yang optimal ke bagian ventral spinal bagian torakal atas. Pasien di induksi dengan fentanil 200 mcg dan propofol 100 mg, fasilitasi intubasi dengan rocuronium 50 mg dan pemasangan double lumen tube kiri, posisi lateral dekubitus. Ketika dilakukan ventilasi satu paru pasien mengalami kejadian desaturasi oksigen sampai 93%, dilakukan penyesuaian mode ventilator sebagai penanganannya. Pascaoperasi pasien tidak diekstubasi dan menjalani perawatan diruangan intensif selama dua hari dan dipulangkan pada hari ke 13. Tatakelola kasus ini difokuskan pada penilaian preoperatif, pengaruh posisi lateral dekubitus dan teknik anestesi satu paru terhadap fungsi respirasi dan kardiovaskular. Risiko hipoksemia akibat ketidaksesuaian ventilasi / perfusi yang menyebabkan gangguan oksigenisasi dan perfusi terhadap otak dan medulla spinalis, sehingga diperlukan tatakelola ventilasi mekanik, monitoring intraoperasi yang berhubungan dengan kaidah-kaidah neuroproteksi terhadap otak dan medulla spinalis.Management of Mechanical Ventilation in the Removal of Thoracal Extradura Metastatic Tumors with One Lung Anesthesia Technique in Decubitus Lateral PositionAbstractThe spine is the most common location for bone metastases. Spine metastases can cause pain, spinal instability and other neurological injuries. In spinal metastatic tumor surgery a surgical approach is important for both neurosurgeons and neuroanesthesiologists. In this case, a 60-year-old man with a thoracic metastatic extradura tumor would undergo tumor removal and stabilization with the posterolateralextracavity approach to obtain optimal access to the ventral spinal ventral region. Patients were induced with 200 mcg fentanyl and propofol 100 mg, facilitation of intubation with 50 mg rocuronium and installation of the left double lumen tube, lateral decubitus position. When one lung is ventilated, the patient experiences an oxygen desaturation event of up to 93%, adjusting the ventilator mode as a treatment. Postoperatively the patient was not extubated and underwent intensive care for two days and was discharged on day 13. The case management focused on preoperative assessment, the influence of lateral decubitus position and one-pulmonary anesthetic technique on respiration and cardiovascular function. The risk of hypoxemia due to ventilation / perfusion mismatches that cause oxygenisation and perfusion disorders of the brain and spinal cord, so that management of mechanical ventilation, intraoperative monitoring associated with neuroprotection rules of the brain and spinal cord.

Anesthesia Management of Patients with Redo Craniotomy: Cases of Supratentorial Recidive Tumors Bisri, Dewi Yulianti; Septiani, Gusti Ayu Pitria; Limawan, Michaela Arshanty; Bisri, Tatang
Interdisciplinary Social Studies Vol. 2 No. 8 (2023): Special Issue
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/iss.v2i8.450

Background: Compared to non-surgical therapies, redo craniotomy is linked to improved neurological state and a lower mortality rate. But it also carries a higher price tag and complication risk. Aim: The researchers would like to discover anesthesia management of patients with redo craniotomy in patients with supratentorial recidive tumors. Method: The researchers used the case study method. Two cases of redo craniotomy performed at the Santosa Hospital Bandung Central Indonesia are presented. The first case involved a 24-year-old male with a supraorbital tumor, GCS 15, and the second case involved a 43-year-old woman with meningiomas, GCS 15. The first patient underwent redo craniotomy six (6) months after the first operation, while the second patient underwent the procedure three (3) months after the first operation. These patients were subjected to anesthesia using the same techniques and anesthetic drugs. patients were positioned in a neutral position with 20-30 degree head up, voluntary hyperventilated, and adequate anxiolytics. Findings: The bleeding volume of the patients was 800 mL for the first patient and 1,000 mL for the second, and the fluid balance was maintained using the ringerfundin balance solution. The durations of the operation of the first and second patients were 4 and 6.5 hours, respectively. Postoperatively, patients were treated in the ICU for one day under mechanical ventilation and were transferred to the ward after extubation. Better intraoperative care, improved surgical skills, surgical equipment, and better intensive care support are likely to improve outcomes in patients with redo craniotomy.

Co-Authors A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Hmendra Wargahadibrata Achmad Adam Adriman, Silmi Adriman, Silmi Ahmado Oktaria Alifahna, Muhammad Rezanda Alifan Wijaya Alkadia Alfasha Andy Hutariyus Anwar, Tabihul Arief Cahyadi Arif, Izhar Muhammad Arif, Izhar Muhammad Arna Fransisca Arshad, Muhammad Ayu Rosema Sari Bangun, Chrismas Gideon Basuki, Wahyu Sunaryo Basuki, Wahyu Sunaryo Boesoirie, M. Adli Boesoirie, M. Adli Budiana Rismawan Cecep Eli Kosasih Cobis, Albinus Yunus Daneswara, Andika Deni Nugraha Dhany Budipratama Doddy Tavianto Emas, Bagas Eri Surahman Firdaus, Riyadh Firdaus, Riyadh Fitri Sepviyanti Sumardi Fitri Sepviyanti Sumardi Gaus, Syaruddin Giovanni, Cindy Giovanni, Cindy Hana Nur Ramila Harahap, M Sofyan Hengki Saputra Munthe Hermin Aminah Usman Ida Bagus Krisna Jaya Sutawan Ike Sri Redjeki Indrayani, Ratih Rizki Indria Sari Iqbal Pramukti Irina, Rr. Sinta Iwan Abdul Rachman Iwan Fuadi Jasa, Zafrullah Khany Krisna J. Sutawan, Ida Bagus Lalenoh, Diana C Limawan, Michaela Arshanty Lira Panduwaty Lisda Amalia Longdong, Djefri Frederik M, Mutivanya Inez M, Mutivanya Inez M. Sofyan Harahap Maharani, Mutivanya Inez Maharani, Nurmala Dewi Mangastuti, Rebecca Sidhapramudita Mangastuti, Rebecca Sidhapramudita Michaela Arshanty Limawan Mirza Oktavian Muhammad Habibi Nataputra, Mario Nopian Hidayat Nugroho, Andy Nuryanda, Dian Oetoro, Bambang J. Oetoro, Bambang J. Okky Harsono Oktaria, Ahmado Permatasari, Endah Permatasari, Endah Putri, Dini Handayani Putri, Dini Handayani Radian Ahmad Halimi Rasman, Marsudi Rasman, Marsudi Renaldy Sobarna Riki Punisada Riyadh Firdaus Robert Sihombing Ruli Herman Sitanggang Saleh, Siti Chasnak Saleh, Siti Chasnak Saputra, Tengku Addi Saputra, Tengku Addi SATRIYAS ILYAS Septiani, Gusti Ayu Pitria Sihombing, Robert Siti Chasnak Saleh Soefviana, Stefi Berlian Sri Rahardjo Sugiyanto, Endy Susanto, Yunita Susanto, Yunita Sutaniyasa, I Gede Sutanto, Sigit Sutanto, Sigit Suwarman Suwarman Syafruddin Gaus Syahpikal Sahana Syifa, Nadia Syifa, Nadia Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Uhud, Akhyar Nur Umar, Nazaruddin Utama, M Lucky Wargahadibrata, A. Hmendra Wargahadibrata, A. Hmendra Widiastuti, Monika Winarso, Achmad Wahib Wahju Wullur, Caroline Wullur, Caroline Yuanda Rizawan Putra Yusmein Uyun Zaka Anwary, Army

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