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Dewi Yulianti Bisri
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung
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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Tantangan dalam Menjaga Cerebral Perfusion Pressure (CPP) yang Aman pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
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.v12i1.531

Abstract

Tekanan perfusi serebral (cerebral perfusion pressure/CPP) adalah gradien tekanan yang mendorong pengiriman oksigen ke jaringan serebral, perbedaan antara tekanan arteri rata-rata (MAP) dan tekanan intrakranial (ICP), CPP = MAP-CVP atau CPP = MAP ICP jika ICPCVP. Tekanan perfusi serebral harus dipertahankan dalam rentang yang sempit karena tekanan yang terlalu rendah dapat menyebabkan jaringan otak menjadi iskemik, dan bila terlalu tinggi dapat meningkatkan tekanan intrakranial. Tekanan perfusi serebral yang aman adalah antara 60-80 mmHg, tetapi nilai-nilai ini dapat bergeser ke kiri atau kanan tergantung pada fisiologi individu pasien. Karena CPP adalah ukuran yang dihitung, MAP dan ICP harus diukur secara bersamaan, paling sering dengan cara invasif. Ketika terjadi cedera otak, kapiler serebral bisa menjadi "bocor" atau lebih permeabel terhadap air. Selain itu, pembuluh darah serebral dapat melebar dalam respon terhadap cedera jaringan otak, hipoksemia, hiperkarbia, asidosis, atau hipotensi. Jika tekanan darah meningkat, peningkatan CPP dapat menyebabkan peningkatan aliran darah serebral. Tujuan yang disarankan dari CPP berdasarkan pedoman dari Brain Trauma Foundation adalah 50-70 mmHg. Menargetkan CPP tinggi 70 mmHg belum terbukti bermanfaat pada pasien dengan cedera otak traumatik dan dikaitkan dengan peningkatan risiko sindrom gangguan pernapasan akut (ARDS).Challenges in Maintaining Safe Cerebral Perfusion Pressure (CPP) in Traumatic Brain InjuryAbstractCerebral perfusion pressure (CPP) is the net pressure gradient that drives oxygen delivery to cerebral tissue. It is the difference between the mean arterial pressure (MAP) and the intracranial pressure (ICP), CPP = MAP-CVP or CPP =MAP ICP if ICPCVP. Cerebral perfusion pressure must be maintained within narrow limits because too litle pressure could cause brain tissue become ischemic, and too much could raise intracranial pressure. The normal range lies between 60 and 80 mmHg, but these values can shift to the left or right depending on individual patient physiology. As CPP is a calculated measure, MAP and ICP must be measured simultaneously, most commonly by invasive means. When brain injury occurs, cerebral capillaries can become leaky or more permeable to water. In addition, cerebral blood vessels may dilate in respons to brain tissue injury, hypoxemia, hypercarbia, acidosis, or hypotension. If blood pressure becomes elevated, the increased CPP can lead to increased cerebral blood flow. The recommended goal of CPP per the Brain Trauma Foundation (BTF) guideline is 50-70 mmHg. Targeting high CPP 70 mmHg has not been shown to be beneficial in patient with traumatic brain injury and is associated with an increased risk of acute respiratory distress syndrome (ARDS).
Sindrom Hiperperfusi Serebral Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 11, No 3 (2022)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v11i3.514

Abstract

Sindrom hiperperfusi serebral (cerebral hyperperfusion syndrome/CHS) adalah kondisi yang relatif jarang terjadi setelah endarterektomi karotis (carotidenarterectomy/CEA) atau stenting arteri karotis (carotid artery stenting/CAS) tetapi berpotensi dapat dicegah. Empat kriteria berikut untuk mendefinisikan CHS pasca-CEA: (1) Kejadian dalam waktu 30 hari pasca-CEA; (2) Fitur klinik seperti onset baru sakit kepala, kejang, hemiparesis, dan skala koma glasgow (GCS) 15 atau fitur radiologis termasuk edema serebral atau perdarahan intraserebral (ICH); (3) Bukti hiperperfusi (didefinisikan sebagai aliran darah serebral [CBF] 100% dari nilai perioperatif) pada studi pencitraan atau tekanan darah sistolik 180 mmHg; dan (4) Tidak ada bukti iskemia serebral baru, oklusi karotis pasca operasi dan penyebab metabolik atau farmakologis. Faktor kunci pada patofisiologi CHS adalah gangguan autoregulasi dan disfungsi baroreseptor, hipertensi kronis, mikroangiopati dan sawar darah otak, pembentukan radikal bebas, derajat beratnya carotid stenosis kronis dan sirkulasi kolateral. Faktor kunci dalam pencegahan dan pengobatan CHS adalah pengendalian tekanan darah, waktu dilakukan operasi karotid, obat-obat anestesi yang digunakan. Penggunaan profilaksis obat anti-epilepsi tidak dianjurkan. Bukti tentang penggunaan salin hipertonik dan manitol tidak kuat tetapi dapat diberikan jika pasien mengalami edema serebral, kortikosteroid dan barbiturat tidak diindikasikan. Hiperventilasi dan sedasi dapat diberikan jika pasien mengalami edema serebral
Konsep GHOST- CAP untuk Proteksi Otak Perioperatif pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (463.3 KB) | DOI: 10.24244/jni.v11i2.472

Abstract

Kerusakan otak adalah cedera yang menyebabkan rusak atau memburuknya sel otak yang disebabkan oleh berbagai kondisi seperti trauma kepala, pasokan oksigen yang tidak memadai, infeksi atau perdarahan intrakranial. Proteksi otak adalah intervensi terapeutik preemptif untuk memperbaiki outcome neurologik pada pasien yang berisiko terjadinya iskemi serebral, sedangkan resusitasi otak merujuk ke intervensi terapeutik yang dimulai setelah terjadinya iskemi. Targetnya adalah terapi iskemi dan mengurangi cedera neuron. Kerusakan otak perioperatif adalah salah satu komplikasi merugikan yang paling serius dari operasi dan anestesi, mengakibatkan defisit neurologis baru pasca operasi. Konsep GHOST-CAP, yang merupakan akronim dari Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure dan PaCO2, digunakan pada periode pascaoperatif. G: target level glukosa antara 80 dan 180?mg/dL. H: hemoglobin, ambang batas 79g/dL. O: oksigen, targetkan SpO2 antara 94 dan 97%. S: konsentrasi sodium mempengaruhi volume otak, kadar sodium hingga 155?mEq/L dapat ditoleransi. T: temperatur diatur untuk mengoptimalkan fungsi seluler, tetapi suhu inti ?38,0C harus dihindari. C: kenyamanan pasien (comfort), termasuk kontrol nyeri, agitasi, kecemasan, dan menggigil. A: tekanan darah arteri adalah penentu utama aliran darah otak (CBF), pertahankan tekanan arteri rata-rata (MAP) 80?mmHg dan tekanan perfusi otak (CPP) 60?mmHg. P: perubahan akut PaCO2 menyebabkan perubahan CBF, maka PaCO2 tidak boleh kurang dari 35 mmHg. Tulisan ini mengkaji konsep GHOST-CAP untuk proteksi otak perioperatif, apakah cukup memadai atau harus ditambah.GHOST-CAP Concept for Perioperative Brain Protection in Traumatic Brain InjuryAbstractBrain damage is an injury that causes damage or worsening of brain cells caused by various conditions such as head trauma, inadequate oxygen supply, infection or intracranial hemorrhage. Brain protection is a preemptive measure of therapeutic interventions to improve neurological outcomes in patients at risk of cerebral ischemic, while brain resuscitation refers to therapeutic interventions that begin after the occurrence of ischemic. The target is ischemic therapy and reducing neuronal injury. Perioperative brain damage is one of the most serious adverse complications of surgery and anesthesia, resulting in new postoperative neurological deficits. The concept of GHOST-CAP, an acronym for Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure and PaCO2, can be used in the postoperative period. G: The target level of glucose is between 80 and 180 mg/dL. H: hemoglobin threshold is 7-9 g/dL. O: oxygen, target SpO2 between 94 and 97%. S: Sodium concentration affects brain volume, sodium levels up to 155 mEq/L are tolerable. T: temperatures regulated to optimize cellular function, but core temperatures 38.0C should be avoided. C: patient comfort, including pain control, agitation, anxiety, and chills. A: Arterial blood pressure is the main determinant of cerebral blood flow (CBF), maintaining an mean arterial pressure (MAP) of 80 mmHg and cerebral perfusion pressure (CPP) of 60 mmHg. P: Acute changes in PaCO2 cause CBF changes, PaCO2 not to be less than 35 mmHg. This paper examines the GHOST-CAP concept for perioperative brain protection, whether adequate or should be supplemented
Managemen Anestesi untuk Seksio Sesarea dengan Strok Maternal Hemoragik Bisri, Dewi Yulianti; Lalenoh, Diana C
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.v12i2.547

Abstract

Strok adalah penyebab utama ketiga morbiditas dan mortalitas di banyak negara maju. Penyakit serebrovaskular selama kehamilan dapat diakibatkan oleh tiga mekanisme utamaperdarahan, infark arteri, dan trombosis vena. Strok maternal bisa berupa iskemik atau hemoragik. Strok iskemik merupakan stroke yang umum terjadi disebabkan oleh hilangnya pasokan darah ke area otak. Strok hemoragik disebabkan oleh pendarahan ke otak akibat pecahnya pembuluh darah. Seksio sesarea atau intervensi bedah saraf yang harus diprioritaskan atau dilakukan secara bersamaan adalah masalah penting, sama seperti keputusan untuk menggunakan anestesi umum atau spinal dan epidural ketika akan dilakukan seksio sesarea. Teknik anestesi yang digunakan harus dibuat dengan mempertimbangkan risiko ibu secara keseluruhan. Hiperventilasi untuk mengurangi tekanan intrakranial (ICP) harus dijaga dalam kisaran 2530 mmHg karena kisaran normal PaCO2 selama kehamilan menurun menjadi 30-32 mmHg akibat peningkatan ventilasi dan progesteron. Selain itu, anestesi dalam yang berlebihan harus dihindari untuk mencegah ketidakstabilan hemodinamik. Penggunaan manitol untuk mengendalikan ICP, mempunyai risiko dehidrasi janin; sementara laporan lain menunjukkan bahwa 0,2 hingga 0,5mg/kg manitol tidak berpengaruh secara signifikan terhadap keseimbangan cairan janin. Pertimbangan khusus diperlukan untuk wanita dengan preeklampsia. Anestesi umum untuk seksio sesarea dikaitkan dengan peningkatan risiko strok jika dibandingkan dengan anestesi neuraksial pada wanita preeklamptik. Terlepas dari status preeklamptik ibu, pemeliharaan oksigenasi yang memadai dan stabilitas hemodinamik penting untuk keselamatan ibu dan janin.Anesthesia Management for Cesarean Section with Maternal Hemorrhagic StrokeAbstractStroke is the third leading cause of morbidity and mortality in many developed countries. Cerebrovascular disease during pregnancy can result from three main mechanismsbleeding, arterial infarction, and venous thrombosis. Maternal stroke can be either ischemic or hemorrhagic. Ischemic stroke is a common stroke caused by loss of blood supply to an area of the brain. Hemorrhagic stroke is caused by bleeding into the brain due to rupture of a blood vessel. Cesarean section or neurosurgical intervention should be prioritized or performed simultaneously is an important issue, as is the decision to use general anesthesia or spinal and epidural when a cesarean section is performed. The anesthesia technique used should be made taking into account the overall maternal risk. Hyperventilation to reduce intracranial pressure (ICP) should be kept in the range of 25-30 mmHg because the normal range of PaCO2 during pregnancy decreases to 30-32 mmHg due to increased ventilation and progesterone. The use of mannitol to control ICP, there are associated risks of fetal dehydration; While other reports show that 0.2 to 0.5mg/kg of mannitol has no significant effect on fetal fluid balance. Special consideration is needed for women with preeclampsia. General anesthesia for cesarean section is associated with an increased risk of stroke when compared to neuraxial anesthesia in preeclampsic women. Regardless of maternal preeclampic status, maintenance of adequate oxygenation and hemodynamic stability is important for maternal and fetal safety.
Thiopental-Dexmedetomidine as Adjuvant Anesthesia for Craniotomy Tumor Removal: A Case Report Bisri, Dewi Yulianti; Nuryanda, Dian; Alifahna, Muhammad Rezanda; Bisri, Tatang
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.v13i2.595

Abstract

Brain tumor surgery requires special anesthesia to get a slack brain and perform perioperative brain protection. The selected anesthetic drugs and adjuvants have the ability of anesthesia sparring effect and have a brain protective effect. Not many have done the combination of thiopental adjuvant with dexmedetomidine. The purpose of this case report is to see the effect of the combination of thiopental with dexmedetomidine as an adjuvant anesthesia on hemodynamics and slack brain and successful removal of brain tumors. A woman, 32 years old, with meningiomas had surgery to remove a brain tumor at Santosa Bandung Central Hospital. Preoperative examination showed blood lab results within normal limits, the presence of large meningioma and midline shift. Induction of anesthesia with thiopental 5 mg/kgBW, rocuronium bromide 0.9 mg/kgBW, fentanyl 3 mcg/kg and anesthetic maintenance with sevoflurane below 1.5 MAC, oxygen/air, continuous rocuronium 0.5 mg/kgBW/hour, thiopental and continuous dexmedetomidine. The anesthetic adjuvant used was thiopental 1-3 mg/kg/hour and continuous dexmedetomidine 0.40.7 mcg/kg/hour. A slack brain is obtained, and 90% of the tumor could be removed, and transfused during surgery 4 units pack red cells (PRC), crystalloid liquid as much as 2,500 cc, and colloidal fluid as much as 2,000 cc. The length of surgery is 11 hours. Post-surgery was treated in the ICU for 5 days, then moved to the ward for 2 days then the patient could be discharged from the hospital. The use of thiopental and dexmedetomidine continuously can produce slack brain and almost the entire tumor can be removed.
Monitoring End-Tidal CO2 pada Wanita Hamil: Fokus pada Keselamatan Pasien Yulianti Bisri, Dewi; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 7 No 3 (2024): November
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.v7i3.195

Abstract

Pada seksio sesarea, keselamatan pasien adalah menjaga keselamatan ibu dan bayi. Anestesi untuk seksio sesarea dapat dilakukan dengan anestesi umum, anestesi neuraxial atau gabungan spinal-epidural. Keuntungan dari anestesi umum termasuk induksi cepat, keandalan, reproduktifitas, pengendalian, menghindari hipotensi. Sedangkan kelemahan anestesi umum meliputi kemungkinan aspirasi ibu, masalah penatalaksanaan jalan napas, narkotisasi neonatus, dan awarenes ibu. Efek anestesi umum pada bayi adalah karena penyebab fisiologis dan farmakologis. Penyebab fisiologis meliputi hipoventilasi ibu, hiperventilasi ibu dan pengaruh perpanjangan waktu induction-delivery dan uterine incission-delivery yang mempengaruhi aliran darah uteroplacental, sedangkan penyebab farmakologis adalah obat induksi anestesi, obat blokade neuromuskuler, konsentrasi oksigen rendah, N2O dan anestesi inhalasi. Masalah manajemen jalan napas adalah masalah terbesar karena mungkin jalan napas yang sulit pada wanita hamil mengingat adanya kenaikan berat badan dan lingkar leher, leher relatif pendek, dan buah dada membesar. Hipoventilasi akan mengurangi ketegangan oksigen pada ibu dan pada gilirannya akan menyebabkan perubahan asam-basa neonatal atau depresi biokimia. Hiperventilasi ibu juga dapat menimbulkan potensi bahaya pada janin selama anestesi umum dengan mengurangi tekanan oksigen janin. Kesimpulannya, pemasangan kapnograf pada ibu hamil yang dilakukan dengan seksio sesarea dengan anestesi umum mutlak diperlukan untuk memeriksa keberhasilan intubasi dan menentukan end-tidal CO2.
Tetralogy of Fallot with Sepsis Induced Coagulopathy in Case of Spontaneous Intracerebral Haemorrhage & Subarachnoid Haemorrhage Emas, Bagas; Winarso, Achmad Wahib Wahju; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.614

Abstract

Congenital heart disease is the most common cause of stroke in some children. A child aged 5 years 9 months came with complaints of decreased consciousness and shortness of breath, weight 23 kg and height 140 cm, blood pressure 140/95 mmHg, pulse 52x/minute, axillary temperature 36.7oC, respiratory rate 44x/minute and obtained SpO2 62%78% using a nasal cannula. The patient was diagnosed with Tetralogy of Fallot through echocardiography but it was not corrected, Intracerebral Haemorrhage & Subarachnoid Haemorrhage were discovered on a CT scan, and sepsis induced coagulopathy through other supporting examinations. Children with congenital heart disease (CHD) are more susceptible to infection, this occurs because there is an increased risk for children with congenital heart disease to experience severe complications due to common infections such as sepsis. Sepsis itself will cause a coagulopathy disorder called sepsis induced coagulopathy (SIC) whose mechanism is also based on sepsis. Each of tetralogy of Fallot and Sepsis induced coagulopathy have mutually supporting roles in the mechanism of intracerebral haemorrhage. Most ICHs are caused by hypertension, arteriovenous malformation (AVM), and aneurysm. The patient experiences left ventricular dilatation, this can cause a long-term condition of hypertension. Through the SIC mechanism it can cause systemic inflammation and vascular injury caused by mass production of inflammatory cytokines and their release into the circulation causing excessive activation of the clotting process, impaired fibrinolysis, and suppression of anticoagulant mechanisms which can cause endothelial dysfunction and thrombus formation.
Preeklampsia dan Risiko Penyakit Kardiovaskuler di Masa Depan Yulianti Bisri, Dewi; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 8 No 1 (2025): 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.v8i1.194

Abstract

Preeklampsia adalah gangguan kehamilan spesifik yang mengakibatkan hipertensi dan disfungsi multiorgan, merupakan penyebab utama kematian ibu di seluruh dunia dan mempengaruhi 2% hingga 8% dari semua kehamilan. Didefinisikan sebagai timbulnya hipertensi setelah kehamilan 20 minggu dengan proteinuria, disfungsi organ, atau disfungsi uteroplacental. Ada bukti bahwa efek ini bertahan setelah bayi dilahirkan. Menurut American College of Obstetricians and Gynecologists, faktor risiko untuk terjadi preeklampsia adalah obesitas, hipertensi kronis, diabetes mellitus, penyakit ginjal kronis, preeklampsia sebelumnya, lupus eritematosus sistemik, usia >40 tahun, primiparitas, kehamilan ganda, fertilisasi in vitro, dan riwayat keluarga preeklampsia. Preeklampsia dikaitkan dengan insiden di masa depan untuk peningkatan kejadian gagal jantung 4 kali lipat dan peningkatan risiko penyakit jantung koroner, stroke, dan kematian karena jantung koroner atau penyakit kardiovaskular 2 kali lipat. Pre-eklampsia terkait dengan risiko serangan jantung empat kali lipat lebih tinggi dalam satu dekade setelah melahirkan. Oleh karena itu, penting dilakukan pemantauan faktor risiko kardiovaskular seumur hidup pada wanita dengan riwayat preeklampsia.
Kehilangan Penglihatan Pascabedah Laminektomi dalam Posisi Prone Sumardi, Fitri Sepviyanti; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (238.038 KB) | DOI: 10.24244/jni.vol1i4.193

Abstract

Kehilangan penglihatan pascabedah nonocular sangatlah jarang, akan tetapi, harus dipertimbangkan sebagai komplikasi pascabedah yang tidak diinginkan. Kehilangan penglihatan unilateral atau bilateral secara tiba-tiba yang terjadi pascaanestesia umum telah dilaporkan dan dihubungkan dengan berbagai sebab diantaranya syok haemorhagik, hipotensi, hipotermia, kelainan koagulopathi, trauma langsung, emboli, dan penekanan pada bola mata yang berlangsung lama. Kasus: seorang laki-laki berusia 60 tahun dengan diagnosis radiculopathi setinggi L4 e.c protunded disc L4-5 dan L5-S1 yang menjalani laminektomi dalam anestesi umum. Terjadi komplikasi pascabedah berupa kehilangan penglihatan yang disertai opthalmoplegi total akibat oklusi arteri retina sentralis, sindroma kompartemen orbita akut, dan pseudotumor tipe miositis.Visual Loss after Prone Lumbar Spine SurgeryVisual loss after nonocular surgery is a rare but devastating postoperative complication. Sudden unilateral or bilateral visual loss occurring after general anesthesia has been reported and attributed to various causes including haemorrhagic shock, hypotension, hypothermia, coagulopathic disorders, direct trauma, embolism, and prolonged compression of the eyes. Case: a man, 60 years-old with diagnosis radiculopathy in level L4 e.c. protunded disc L4-5 and L5-S1 who required laminectomy in general anesthesia. An unusual complication of visual loss with total opthalmoplegy was caused by central retina artery occlusion, acute ischemic orbital compartement syndrome, and pseudotumor type myositis.
Opioid-Free Anesthesia Technique for Anterior Cervical Discectomy and Fusion (ACDF): Anesthesia Management Cobis, Albinus Yunus; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.660

Abstract

Anterior cervical discectomy and fusion (ACDF) is a safe and effective surgical procedure to treat cervical spine pathology. ACDF treats Cervical Spondylotic Myelopathy (CSM), where degeneration of the cervical vertebrae compresses the spinal cord, causing sensory, motor, reflex, and bowel function impairment. The use of opioids can have unpleasant effects, hence opioid-free anaesthesia techniques were developed as a strategy to reduce this risk. A man, 62 years old, complained of weakness in the upper limbs until it was difficult to move the hands. Supportive examination revealed cervical myeloradiculopathy due to multiple hernia nucleus pulposus (HNP). Management of opioid-free anaesthesia techniques using multimodal analgesics. During the operation, haemodynamics were relatively stable. Extubation was performed in the operating room and then the patient was transferred to the intensive care unit. The choice of opioid-free anaesthesia technique in the case was to provide multimodal using specific agents that have anaesthetic or analgesic properties. Opioid-free anaesthesia methods that support the Enhanced Recovery after Surgery (ERAS) concept are considered highly beneficial in accelerating recovery time, reducing length and cost of treatment and minimizing opioid-related unpleasant risks. The opioid-free anaesthetic technique in this case report demonstrates the feasibility and benefits of opioid-free anaesthesia in effective pain management and minimizing opioid-related risks, especially in ACDF surgical procedures. This technique is in line with the ERAS protocol.
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