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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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Penyakit Serebrovaskuler pada Preeklampsia Yulianti Bisri, Dewi; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 7 No 1 (2024): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v7i1.175

Preeklamsia, penyakit hipertensi yang mempengaruhi 5% hingga 8% kehamilan, adalah gangguan multisistem, dengan disfungsi pembuluh darah menjadi pusat penyakit. Pembuluh darah otak ibu sangat rentan terhadap efek samping preeklampsia. Komplikasi serebrovaskular jangka pendek dan jangka panjang dari preeklampsi termasuk sindrom ensefalopati reversibel posterior (posterior reversible encephalopathy syndrome/PRES), sindrom vasokonstriksi serebral reversibel (reversible cerebral vasoconstriction syndrome/RCVS), stroke hemoragik dan iskemik, penyakit vasokonstriksi serebral, dan demensia vaskular. Gangguan serebrovaskular akut, termasuk PRES, RCVS, stroke iskemik dan hemoragik, dan trombosis sinus vena serebral (cerebral venous sinus thrombosis/CVST), adalah komplikasi preeklampsia yang ditakuti yang dapat mengakibatkan kecacatan ibu permanen atau kematian. Risiko penyakit serebrovaskular akut pada kehamilan yang dipersulit oleh preeklampsi sebesar 1 dari 500 persalinan; sebagai perbandingan, risiko keseluruhan penyakit serebrovaskular akut terkait kehamilan adalah ≈30 per 100.000 persalinan. PRES adalah sindrom edema vasogenik dan kerusakan sawar darah otak, yang mempengaruhi struktur kortikal dan subkortikal dan semua daerah otak. Ada kecenderungan pada lobus parietal dan oksipital, kadang-kadang mengakibatkan gangguan penglihatan atau kebutaan kortikal. Hadir dengan keluhan sakit kepala thunderclap yang parah, RCVS menyebabkan vasospasme arteri sirkulus Willisi dan dapat dikaitkan dengan stroke iskemik dan subarachnoid hemorrhagic (SAH) nonaneurisma, biasanya di atas convexitas serebral.

Anestesi untuk Seksio Sesarea Elektif Pasien dengan Morbid Obesitas, Preeklampsia dan Asma Bronkial Yulianti Bisri, Dewi; Zaka Anwary, Army; Soefviana, Stefi Berlian; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 7 No 2 (2024): Juli
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v7i2.187

Obesitas telah berkembang sebagai faktor risiko utama dan sering sebagai komplikasi pada kehamilan berupa hipertensi, diabetes melitus gestasional, seksio sesarea, dan infeksi pascapersalinan dan pascaoperasi, insiden emboli paru dan perdarahan postpartum primer. Preeklampsia mempengaruhi 2% hingga 8% dari semua kehamilan merupakan gangguan kehamilan spesifik yang mengakibatkan hipertensi dan disfungsi multiorgan dan menetap setelah persalinan serta merupakan penyebab utama kematian ibu di seluruh dunia. Seorang wanita, 41 tahun, G4P1A2, berat badan 135 kg, tinggi badan 161 cm, BMI 52,1 kg/m2, obese kelas III, bekas seksio sesarea satu kali 15 tahun yang lalu, lingkar leher 51 cm, jarak thyromental lebih dari 3 jari, skor Mallampati 2, wheezing positif pada kedua lapang paru akan dilakukan seksio sesarea karena preeklampsi. Obat-obatan yang dikonsumsi adalah acetylsalicylic acid yang dihentikan 1 hari yang lalu, nifedipin, metildopa, salbutamol spray. Induksi anestesi dengan propofol, pelumpuh otot dengan atracurium, dan rumatan anestesi dengan N2O/O2 sevofluran. Dilahirkan bayi perempuan dengan berat badan 2,2 kg, panjang badan 44 cm, APGAR score 1 menit 6 dan 5 menit 9. Diberikan metilergometrin 0,2 mg intravena dan 0,2 mg intramuskuler dan oksitosin 20 IU dilarutkan dalam 500 mL RL. Linier analog score (LAS score) 6-7-8. Total perdarahan 600 mL. Lama operasi 90 menit. Selesai operasi, ibu bisa diekstubasi.

Gravida 7 para 4 abortus 2 (G7P4A2) for multiple repeat caesarean section: general or neuroaxial anesthesia Dewi Yulianti Bisri; Tatang Bisri
ACTA Medical Health Sciences Vol. 2 No. 1 (2023): ACTA Medical Health Sciences
Publisher : ACTA Medical Health Sciences

Show Abstract | Download Original | Original Source | Check in Google Scholar

A caesarean section (CS) is a surgical procedure that has several risks, such as uterine rupture, infection, bleeding, thrombosis, and damage to the bladder, ureters, or intestines. Compared to primary CS, multiple repeat caesarean sections (MRCS) are associated with additional risks, including placenta previa, abnormal placental invasion, difficulty in surgical dissection, longer surgeries, and greater amounts of bleeding. A woman, age 40 years, G7P4A2, gravida aterm, weight 64.4 kg, height 150 cm, Mallampati score 1, open mouth >3 cm, thyromental distance > 3 fingers, neck circumference 33 cm, former caesarean section 4 times, would have her caesarean section and sterilization at Melinda Woman Hospital Bandung-Indonesia. A caesarean section was performed under general anesthesia, induction with propofol, atracurium, and sevoflurane, and maintenance anesthesia with N2O/O2-sevoflurane. Induction-delivery time: 16 minutes, uterine incision 50 seconds, baby born with 1-minute Apgar score was 9 and 5-minute Apgar score was 10. Analgetic fentanyl is given after birth at a dose of 1.5 mcg/kgBw intravenously. There were no caesarean-section complications. Postoperatively, the patient was treated in the wards. Due to concerns about heavy bleeding, which would require massive transfusions, anesthesia was performed under general anesthesia due to the fact that massive transfusions make patient uncomfortable because of various complications of massive transfusion DOI : 10.35990/amhs.v2n1.p38-45 REFERENCE Cook JR, Jarvis S, Knight M, Dhanjal MK. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG. 2013;120(1):85–91. doi:10.1111/1471-0528.12010. [PubMed][Google Scholar] Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more? 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Experience in elective caesarean section under general anesthesia in more than 5000 patients at Melinda Women Hospital Bandung-Indonesia. OAMJMS. 2023. Shah RK, Ansari S, Musthaq R, Shah P, Shrestha R, Deep JG. Primary caesarean section among multiparous pregnant women visiting a tertiary care centre: a descriptive cross-sectional study. J Nepal Med Assoc. 2022;60(254):848-52. Aryasa T, Sari AR, Marwoto. Aliran darah uteroplacenta. In: Bisri DY, Uyun Y, Soewondo BS, Wahjoeningsih S, Bisri T, eds. Obstetri Anesthesia & Critical Care. Subkomisi Pendidikan Subspesialis Obsteri KATI, September 2021, 55. Alchalabi HA, Amarin ZO, Badria LF, Zayed FF. Does the number of previous caesarean deliveries affect maternal outcome and complication rates? Mediterr Health J. 2007 May-Jun;13(3):544-50. Gasim T, Al Jama FE, Rahman MS, Rahman J. Multiple repeat caesarean sections: operative difficulties, maternal complications and outcome. J Reprod Med. 2013;58(7-8):312–318. 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Penatalaksanaan Anestesi pada Perdarahan Intraserebral dengan Hidrosefalus dan Diabetes Melitus Longdong, Djefri Frederik; Rachman, Iwan Abdul; Bisri, Dewi Yulianti; Sudadi, Sudadi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Perdarahan Intraserebral (PIS) adalah ekstravasasi darah yang masuk kedalam parenkim otak, yang dapat berkembang ke ruang ventrikel dan subarahnoid, terjadi spontan dan bukan disebabkan oleh trauma (non traumatis) dan merupakan salah satu penyebab tersering pada pasien yang dirawat di unit perawatan kritis saraf. Kejadian PIS 10-15% dari semua stroke dengan tingkat angka kematian tertinggi dari subtipe stroke dan diperkirakan 60% tidak bertahan lebih dari satu tahun. Kasus: Laki-laki 57 tahun, datang dengan keluhan penurunan kesadaran yang terjadi pada saat mau makan. Pada pemeriksaan didapatkan kesadaran GCS E1M4V1 dengan hemodinamik stabil, dan terdapat hemiplegi sinistra. Pasien diintubasi dan memakai ventilator di ruangan Instalasi Gawat Darurat Disaster sambil menunggu hasil skrining Covid 19 dengan swab polymerase chain reaction (PCR). Pada CT-scan ditemukan adanya PIS 48,93 cc di basal ganglia, capsula eksterna sampai periventrikel lateralis kanan, terjadi distorsi midline sejauh 1 cm ke kiri. Ventrikulomegali disertai perdarahan intraventrikel yang mengisi ventrikel lateralis kanan dan kiri, ventrikel III dan IV. Laboratorium menunjukkan gula darah di atas 200 mg/dl setelah dilakukan koreksi gula darah diputuskan untuk dilakukan tindakan kraniotomi evakuasi segera dengan pemeriksaan penunjang yang cukup. Tindakan kraniotomi evakuasi pada pasien PIS menjadi tantangan bagi seorang anestesi, sehingga diperlukan pengetahuan akan patofisiologi, mortalitas PIS dan tindakan anestesi yang harus dipersiapkan dan dikerjakan dengan tepat.Anesthesia Management in Intracerebral Hemorrhage with Hydrocephalus and Diabetes MellitusAbstractIntracerebral hemorrhage (ICH) is the extravasations of blood into the brain parenchyma, which may develop into ventricular and subarachnoid space, there was spontaneous and not caused by trauma (nontraumatic), and one of the most common cause in patients treated in the neurological critical care unit. ICH represents perhaps 1015% of all strokes with the highest mortality rates of stroke subtypes and about 60% of patients with ICH do not survive beyond one year. Case: a man 57 years, came with complaints of loss of consciousness when he just want to eat. On examination of consciousness obtained GCS E1M4V1 with hemodynamic was stable, there left hemiplegic. Patients is intubated and connected with ventilator at Emergency Room Disaster while waiting for result from PCR. From the CT Scan we found 48,93 cc at basal ganglia, capsula externa until lateral periventricle dextra there is a midline distortion 1 cm to the left. Ventriculomegali with intraventricle hemorrhage wich is fill the lateral ventricle right and left, third ventricular and fourth ventricular. The laboratorium result show the glucose up to 200 mg/dl. After glucose correction, it was decided to evacuate immediately craniotomy action with adequate investigation. Procedure of craniotomy evacuation in ICH patients be a challenge for an anesthesiologist, so knowledge of the pathophysiology, mortality ICH and anesthetic procedure that should be prepared and done properly.

Tatalaksana Kejang Intraoperatif pada Operasi Glioma dengan Tehnik Awake Craniotomy Sutaniyasa, I Gede; Firdaus, Riyadh; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.558

Tehnik Awake Craniotomy (AC) untuk reseksi tumor glioma di area eloquent, menjadi pilihan untuk menghindari gangguan neurologis dan kognitif pascabedah. Perempuan, 34 tahun, diagnosa tumor intra-axial (high grade glioma), dengan keluhan kejang fokal pada tangan kiri sejak 4 bulan sebelumnya. Pemeriksaan MRI kepala dengan kontras ditemukan massa supratentorial intra-axial mengesankan suatu primary malignant brain tumor (high grade glioma). Dilakukan operasi AC dengan Monitored Consciuos Sedation (MCS), menggunakan dexmedetomidine dan scalps block. Selama operasi pasien mengalami 3 kali kejang, dari kejang fokal sampai kejang umum. Lama operasi 4 jam, reseksi tumor lebih dari 60%, operasi selesai karena pasien mengalami gangguan fungsi motorik pada ekstremitas atas dan bawah kiri. Pascabedah di rawat di ICU selama 2 hari, mengalami satu kali kejang pascabedah, dengan hemiparese sinistra grade 3. Kejang merupakan salah satu komplikasi yang paling sering dilaporkan pada prosedur AC. Kejang intraoperatif bisa menggagalkan AC, diganti ke anestesi umum dengan intubasi atau pemasangan laryngeal mask airway (LMA), dan kejang saat AC dikaitkan dengan meningkatnya morbiditas dan lama perawatan di rumah sakit Pemilihan pasien yang tepat, dukungan psikologis perioperatif, tim anestesi dan bedah yang berpengalaman memegang peranan penting dalam keberhasilan operasi dengan prosedur AC.Management of Intraoperative Seizures during Awake Craniotomy in Glioma Tumors AbstractThe Awake Craniotomy (AC) technique for resection of glioma tumors in the eloquent area is performed, while preserving neurological and cognitive functioning. Female, 34 years old, diagnosed with an intra-axial tumor (high-grade glioma), with complaints of focal seizures in the left hand since 4 months before. Head MRI examination with contrast found a supratentorial intra-axial mass suggesting a primary malignant brain tumor (high-grade glioma). AC surgery was performed with monitored conscious sedation (MCS), using dexmedetomidine and scalp blocks. During the operation, the patient had three seizures, ranging from focal seizures to generalized seizures. Operation time was 4 hours, tumor resection was more than 60%, and the operation was completed because the patient had impaired motor function in the left upper and lower extremities. Postoperatively, he was treated in the ICU for 2 days and experienced one postoperative seizure with grade 3 left hemiparesis. Seizure is one of the most commonly reported complications associated with awake craniotomy. Intraoperative seizure resulted in AC failures, requiring intubation or laryngeal mask airway change to to general anesthesia, and seizures during AC were associated with increased neurological short-term morbidity and a longer length of hospital stay. Selection of the right patient, perioperative psychological support, an experienced anesthetic and surgical team play an important role in the success of surgery with AC procedures.

Hubungan Strok dengan Gagal Ginjal Kronis: Laporan Kasus Bisri, Dewi Yulianti; Utama, M Lucky
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.534

Masalah ginjal dapat meningkatkan risiko gangguan otak. Para peneliti menemukan hubungan yang kuat antara fungsi ginjal yang buruk dan penurunan aliran darah ke otak, semakin besar penurunan fungsi ginjal. Seorang laki-laki, 47 tahun, BB 50 kg, dengan diagnosis tumor ginjal sinistra end stage renal disease (ESRD), disertai infark lakunar cerebral, efusi pleura sinistra dan asma bronkial yang akan dilakukan nefrektomi. Riwayat hemodialisa rutin sejak 8 bulan, stroke infark 2 bulan lalu tanpa disertai kelemahan anggota gerak, asma bronkial terakhir serangan 1 tahun lalu. Induksi dengan fentanyl, propofol, atracurium, intubasi dengan pipa endotrahea no. 7,5 spiral, dan rumatan anestesi dengan sevoflurane 23 vol%, oksigen/N2O 50%, posisi flank. Operasi berlangsung selama 3 jam, dengan total perdarahan 2000 cc, pasien mendapatkan transfusi 1 PRC (189cc), cairan kristaloid 1000 cc, koloid 500cc. Dilakukan pemasangan chest tube thoracostomy (CTT) setelah pasien teranastesi. Dilakukan ektubasi di kamar operasi dan dipindahkan ke ruangan ICU, dirawat selama 2 hari sebelum dipindahkan ke ruang perawatan biasa. Gagal ginjal adalah faktor risiko untuk strok, yang merupakan penyebab utama morbiditas dan mortalitas. Risiko strok 530 kali lebih tinggi pada pasien dengan chronic kidney disease (CKD), terutama pada dialisis. Case fatality rate juga lebih tinggi mencapai hampir 90%. Oleh karena itu, penting untuk memahami faktor-faktor yang mempengaruhi strok pada populasi yang rentan ini untuk menerapkan strategi pencegahan dengan lebih baik.Relationship of Stroke with Chronic Renal Failure: Case ReportAbstractKidney problems can increase the risk of brain disorders. The researchers found a strong link between poor kidney function and decreased blood flow to the brain, resulting in a greater decrease in kidney function. A male, 47 years old, BW 50 kg, with a diagnosis of sinistra kidney tumor with end stage renal disease (ESRD), cerebral lacunar infarction, pleural effusion sinistra, asthma to be performed nephrectomy. History of routine hemodialysis since 8 months, stroke infarction 2 months ago without accompanied limb weakness, asthma with last exacerbation occurred 1 months ago. Induction with fentanyl, propofol, atracurium, intubation with endotracheal tube no. 7.5 spiral, and maintenance anesthesia with sevoflurane 2-3 vol% with 50% oxygen/N2O with the flank position. The operation lasted for 3 hours, with a total bleeding of 2000 cc, the patient got a transfusion of 1 PRC (189cc), crystalloid fluid 1000 cc, colloidal 500cc. Chest tube thoracostomy (CTT) installation is carried out after the patient is anesthetized. The patient was extubated in the operating room and transferred to the ICU and was care for 2 days before being transferred to the ward. Renal failure is a risk factor for stroke, which is the leading cause of morbidity and mortality. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. The case fatality rate is also higher, reaching almost 90%. Therefore, it is important to understand the factors that influence stroke in this vulnerable population in order to better implement prevention strategies.

Hipotensi Berat Intraoperatif Tiba-Tiba saat Kraniotomi Pengangkatan Meningioma Bisri, Dewi Yulianti; Habibi, Muhammad; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.550

Tekanan darah adalah perkalian cardiac output (CO) dengan systemic vascular resistance (SVR) dan CO ditentukan oleh stroke volume dan frekuensi denyut jantung. Seorang wanita usia 61 tahun, berat badan 49 kg, tinggi badan 154 cm, datang di rumah sakit Santosa Bandung Central dengan keluhan benjolan pada bagian belakang kepala sejak 3 tahun lalu dan semakin lama semakin bertambah besar. Tidak terdapat tanda-tanda peningkatan tekanan intrakranial dan defisit neurologis lainnya, di diagnosa meningioma dengan hipertensi, dilakukan pengangkatan tumor dalam posisi telungkup. Induksi dengan propofol, fentanyl, vecuronium bromida, lidokain, rumatan anestesi dengan sevofluran-oksigen/udara dan propofol serta vecuronium kontinyu. Intraoperatif terjadi 2 kali penurunan tekanan darah yang terjadi tiba-tiba, bradikardia dan desaturasi. Diberikan cairan dengan ringerfundin, gelofusin 1 L, darah Pack Red Cell (PRC) 2 unit, sulfas atropin, efedrin dan dilanjutkan dengan norepinephrine. Pascabedah dirawat 1 hari di Intensive Care Unit (ICU) dan kemudian 1 hari lagi di High Care Unit (HCU), kemudian pindah ke ruang perawatan biasa dan dirawat selama 3 hari sebelum dipulangkan dari rumahsakit. Penurunan tekanan darah hebat disertai bradikardia berat dan desaturasi tidak mungkin disebabkan karena perdarahan, tapi lebih mungkin dihubungkan dengan gangguan pada jantung. Terapi yang dilakukan dengan mengembalikan parameter tersebut ke nilai fisiologis sesegera mungkin. Sebagai simpulan, penurunan tekanan darah tiba-tiba disertai bradikardia dan desaturasi kemungkinan disebabkan karena terjadinya Bezold-Jarisch Reflexes (BJR).Sudden Intraoperative Severe Hypotension during Craniotomy of Meningioma RemovalAbstractBlood pressure is the multiplication of cardiac output (CO) with systemic vascular resistance (SVR) and CO determined by stroke volume and heart rate frequency. A 61-year-old woman, weight 49 kg, height 154 cm, came to Santosa Hospital Bandung Central in with complaints of a lump on the back of the head that has gotten bigger since 3 years ago and the longer it gets bigger. There were no signs of increased intracranial pressure and other neurological deficits, diagnosed with meningioma with hypertension, tumor removal was carried out in a prone position. Induction with propofol, fentanyl, vecuronium bromide, lidocaine, anesthetic treatment with sevoflurane-oxygen/air and propofol and continuous vecuronium. Intraoperative suddenly occurs 2 times decrease in blood pressure, bradycardia and desaturation. Given liquid with ringerfundin, gelofusin 1 L, blood pack red cells (PRC) 2 units, sulfas atropine, ephedrine and continued with norepinephrine. Post-dissected treated 1 day in the Intensive Care Unit (ICU) and then another 1 day in the High Care Unit (HCU), then moved to the ward and was treated for 3 days before being discharged from the hospital. Severe drops in blood pressure accompanied by severe bradycardia and desaturation are unlikely to be caused by bleeding, but are more likely to be associated with heart disorders. Therapy is carried out by returning these parameters to physiological values as soon as possible. As conclusion, a sudden drop in blood pressure accompanied by bradycardia and desaturation may be due to the occurrence of Bezold-Jarisch Reflexes (BJR).

Perioperative Management Patients with Meningioma C1-2 Bisri, Dewi Yulianti; Indrayani, Ratih Rizki; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.587

Removal of spinal meningiomas in cervical 1 and 2 has several problems, especially regarding the respiratory and cardiovascular systems. A woman, 33 years old, admit Santosa Bandung Central Hospital with complaints of weakness in her left hand and both legs since 4 months ago. Weight 50 kg, height 155 cm, blood pressure 146/102 mmHg, pulse rate 105 x/min, temperature 36.50C, SpO2 98% with room air. At diagnosis of cervical myelopathy due to space occupying lesion (SOL) intradural meningioma suspect. Induction of anesthesia with fentanyl 100 mcg, propofol 60 mg, rocuronium 40 mg, ventilated with 100% oxygen and sevoflurane 3 vol% (1.5 MAC), before laryngoscopy-intubation repeated half the initial dose of propofol. The patient is intubated in an in-line position. Anesthesia maintenance with sevoflurane 1 vol%, oxygen: air 50%, dexmedetomidine continuous 0.4 mcg/kg per hour, and continuous rocuronium 10 mcg/kgBW/min. Ventilation is controlled with a tidal volume of 360 ml, frequency 14 times/min. Then the patient is positioned in the prone position. Post-surgery is admitted to the ICU and day 5 the patient can be discharged from the hospital. The effects of C12 spinal cord tumors can affect the respiratory and cardiovascular systems. Surgical trauma can aggravate the injury before recovery occurs, so it is necessary to do ventilation assistance and cardiovascular support before recovery.

Apa yang Baru dalam Neuroanestesi untuk Cedera Otak Traumatik? Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Konsep dasar Neuroanestesi Neuro Critical Care disebut sebagai ABCDE neuroanestesi. Early Brain Injury (EBI) dahulu dikenal sebagai cedera otak primer. Pada EBI terjadi hilangnya autoregulasi, hilangnya integritas barier darah otak. Adanya Trias Cushing menunjukkan adanya hipertensi intrakranial. Target tekanan darah pada cedera otak traumatik (traumatic brain injury/TBI) adalah hindari tekanan darah sistolik 110 mmHg, pertahankan tekanan perfusi otak (cerebral perfusion pressure/CPP) 60-70 mmHg, target pengaturan PaCO2 adalah normokarbia, PaCO2 3540 mmHg, penggunaan profilaksis phenytoin atau valproate tidak direkomendasikan untuk mencegah late post traumatic seizure (late PTS). Masih perlu menganalisa terapi decompressive craniectomy (DECRA) dibandingkan dengan terapi medikal kontinyu untuk peningkatan tekanan intrakranial (intracranial pressure/ICP) yang refrakter setelah TBI. Anestesi umum untuk pasien dengan TBI berat lebih baik dengan total intravenous anesthesia (TIVA), pemberian cairan harus mempertimbangkan osmolaritas cairan tersebut. Pada konsep yang baru, pada pasien dengan peningkatan ICP, konsentrasi anestetika volatil harus dibatasi sampai 0,5 MAC. Target gula darah adalah normoglikemia. Hipotermi profilaksis atau terapeutik tampaknya tidak memiliki tempat dalam pengelolaan cedera otak berat.What is New in Neuroanesthesia for Traumatic Brain Injury?AbstractThe basic concept of Neuroanesthesia and Neuro Critical Care is referred to as ABCDE neuroanesthesia. Early Brain Injury (EBI) was formerly know as primary brain injury. In EBI, there is loss of autoregulation, loss of integrity of the blood-brain barriere. The presence of Cushings triad indicates the presence of intracranial hypertension. Blood pressure target in traumatic brain injury is to avoid systolic blood pressure less than 110 mmHg, maintain cerebral perfusion pressure (CPP) 60-70 mmHg, target PaCO2 regulation is normocarbia, PaCO2 35-40 mmHg, prophylactic use of phenytoin or valproate is not recommended to prevent late post traumatic seizure (late PTS). Still need to analyse decompressive craniectomy (DECRA) compare with continuous medical therapy for refractory increase in intracranial pressure (ICP) after TBI. General anesthesia for patient with severe TBI is better with total intravenous anesthesia (TIVA), administration of fluids must consider the osmolarity of the fluid. In a new concept in patient with elevated ICP, volatile anesthetic concentaratiom should be limited to 0.5 MAC.Blood glucose target is normoglycemia. Prophylactic and therapeutic hypothermia not recommended for severe traumatic brain injury management.

Tatalaksana Anestesi Pasien Adenoma Hipofisis dengan Riwayat Hipotiroid Maharani, Nurmala Dewi; Bisri, Dewi Yulianti; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Adenoma hipofisis merupakan tumor otak dengan gejala klinis tergantung hormon yang dihasilkan oleh sel tumor, ukuran, dan invasi lokal. Perempuan 50 tahun dengan adenoma hipofisis dengan riwayat hipotiroid. Pada pemeriksaan prabedah GCS E4M6V5, tekanan darah 114/76 mmHg, denyut nadi 81x/menit, pernafasan 18x/menit, dan saturasi 99%. Pada pemeriksaan fisik berat badan dan visus mata kanan menurun. Pemeriksaan fungsi tiroid kesan hipotiroid, lalu pasien diterapi levotiroksin natrium 100 g perhari tablet selama 14 hari sampai dengan eutiroid. Tatalaksana lanjutan yang dilakukan adalah kraniotomi reseksi adenoma hipofisis. Premedikasi hidrokortison 100 mg dan midazolam 0,1mg/kgbb intravena. Induksi propofol 1 mg/kgbb, fentanyl 2g/kgbb, rocuronium 1 mg/kgbb, lidokain 1 mg/kgbb dan propofol pengulangan dosis 0,5 mg/kgbb. Manitol diberikan 0,5 mg/kgbb dan dexamethason 10 mg. Rumatan anestesi sevoflurane 0,5% dan propofol 50100 g/kgbb/menit. Pasca operasi pasien di ICU diberikan dexmedetomidine 0,2 g/kgbb/jam dan suplemen steroid H-1 diberikan 25 mg hidrokortison setiap 12 jam. Pada H-2 diberikan 20 mg hidrokortison pagi hari dan 10 mg sore hari kemudian dapat dihentikan. Pasien dirawat di ICU 3 hari sebelum pindah ruang rawat biasa. Manajemen perioperatif adenoma hipofisis dengan riwayat hipotiroid adalah mengoptimalkan pra operasi pasien sehingga pasien mencapai eutiroid, menjaga stabilitas hemodinamik, mengoptimalkan oksigenasi serebral, mencegah serta mengatasi komplikasi.Anesthesia Management of Patient with Pituitary Adenoma with Hystory of HypothyroidismAbstractPituitary adenoma is a brain tumor has clinical symptoms depending on hormones produced by tumor cells, size, and local invasion. A 50-year-old woman with pituitary adenoma with history of hypothyroidism. On preoperative, GCS E4M6V5, blood pressure was 114/76 mmHg, pulse was 81x/minute, respiration was 18x/minute, and saturation was 99%. On physical examination, body weight and the visual acuity in the right eye decreased. Examination of thyroid function suggests hypothyroidism before surgery, patient was treated with levothyroxine sodium 100 g per day tablets for 14 days until euthyroid. The next treatment was resection craniotomy of the pituitary adenoma. Premedicated with hydrocortisone 100 mg and midazolam 0.1 mg/kg body weight. Induction propofol 1 mg/kg body weight, fentanyl 2 g/kg body weight, rocuronium 1 mg/kg body weight, lidocaine 1 mg/kg body weight and repeated doses of 0.5 mg/kg body weight propofol. Mannitol was given 0.5 mg/kgbw and dexamethasone 10 mg. Maintenance anesthesia with sevoflurane 0.5% and propofol 50-100 g/kgbw/min. Postoperative the patient in the ICU was given dexmedetomidine 0.2 g/kgbw/hour and steroid supplement day-1 was given 25 mg hydrocortisone every 12 hours. On day-2, 20 mg of hydrocortisone in the morning and 10 mg in the evening, then can be discontinued. The patient was admitted to the ICU for 3 days before moving to the ward. Perioperative management of pituitary adenoma with a history of hypothyroidism is optimizing preoperatively the patient reaches euthyroid, maintaining hemodynamics, optimizing cerebral oxygenation, preventing and treatment if there are complications.

Co-Authors A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Hmendra Wargahadibrata Achmad Adam, Achmad Adriman, Silmi Adriman, Silmi Ahmado Oktaria Alifahna, Muhammad Rezanda Alifan Wijaya 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 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 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 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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