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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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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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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

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.

Pressure Reactivity Index (PRx): A Concept to Optimize Cerebral Perfusion Pressure in Traumatic Brain Injury Uhud, Akhyar Nur; Bisri, Dewi Yulianti; Jasa, Zafrullah Khany; Bisri, Tatang
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.v14i2.693

Two common factors contributing to poorer outcomes in TBI patients are high intracranial pressure (ICP) and low cerebral perfusion pressure (CPP). These two factors constitute a vicious circle that will have a negative impact on TBI patients. An increase in ICP will cause a decrease in CPP, while a reduction in CPP will cause ischemia, which will worsen the high ICP. However, increasing the CPP by increasing MAP will not help the situation; in fact, it may worsen the impact due to impairment of cerebral autoregulation (CA). Therefore, it is critical to manage TBI patients with an ideal CPP. Pressure reactivity index (PRx) is a measurement of the linear relationship between the mean arterial pressure (MAP) and ICP. A positive correlation between ICP and MAP indicates an impairment of CA, which suggests a suboptimal CPP value. The basis of PRx theory is that the rise, because of the presence of CA, an increase in MAP should not be followed by the rise in ICP because there is a compensatory effect in the form of a decrease in cerebral blood volume, so that ICP does not increase. That being said, this mechanism will not work when the limit of autoregulation is exceeded. Based on PRx and CPP, an optimal CPP could be obtained by using a U-shaped curve. The outcomes of TBI patients can be enhanced by treating them according to their optimal CPP (CPPopt).

Managemen Anestesia Spinal untuk Seksio Sesarea Wanita Hamil dengan Morbid Obesitas dan Preeklampsi Berat Yulianti Bisri, Dewi; Bisri, Tatang
Jurnal Anestesi Obstetri Indonesia Vol 8 No 2 (2025): 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.v8i2.221

Seksio sesarea mempunyai berbagai masalah dengan harus mempertimbangkan keselamatan ibu dan bayi. Preeklampsi merupakan penyulit kehamilan. Obesitas juga merupakan penyulit kehamilan. Penyulit preeclampsi dan obesitas dapat mempengaruhi seluruh organ tubuh dan bukan saja pada masa kehamilan dan post partum, akan tetapi, juga beberapa bulan-tahun setelah selesai masa nifas. Seorang perempuan umur 28 tahun dengan G1P0A0 mengalami hipertensi sejak umur kehamilan 20 minggu, berat badan sekarang 107 kg, tinggi badan 167 cm, BMI 38,36 kg/m2, sedangkan berat badan waktu diketahui positip hamil sekitar 70 kg. Obat yang diberikan preoperasi adalah methyldopa 3 x 250 mg per oral dan di high care unit (HCU) diberikan nicardipin intravena 3,4 mL/jam (2 ampul nicardipin dilarutkan dengan NaCl 0,9% menjadi 50 mL). Anestesi dilakukan dengan spinal anestesi, tusukan setinggi L4-L5 dengan jarum 27G, memakai obat bupivacain 0,5% hiperbarik 2cc, fentanyl 0,5 cc dan morfin 0,05 mg. Bayi lahir dengan berat badan 2,2 kg, panjang badan 46 cm. Apgar score 1 menit 8 dan 5 menit 9. Kontraksi uterus diukur dengan linear analog scale (LAS) dan hasilnya 8-9. Selama operasi diberikan nicardipin 10 mL/jam. Pascabedah pasien dirawat kembali di HCU, dengan nicardipin 10 mL/jam. Analgetic pascabedah dengan meperidin 100 mg dan dexketoprofen 100 mg dalam 500 mL untuk 24 jam dengan hasil VAS 2

Manajemen Anestesi pada Pasien dengan Tumor Regio Pineal yang Menjalani Kraniotomi Pengangkatan Tumor dengan Posisi Duduk Widiastuti, Monika; Bisri, Dewi Yulianti; Harahap, M Sofyan; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor regio pineal memiliki insiden 0.4-1% dari tumor intracranial. Lokasinya yang dalam, di antara kedua hemisfer otak, berdekatan dengan batang otak dan hipotalamus menjadi tantangan bagi bedah saraf. Operasi dengan supracerebellar approach dalam posisi duduk adalah pilihan terbaik untuk mencapai lokasi. Posisi duduk juga memfasilitasi lapang operasi yang optimal dengan retraksi cerebellum minimal. Posisi duduk membawa tantangan tersendiri untuk dokter anestesi, dengan segala kompleksitas saat memposisikan pasien dan risiko komplikasinya. Venous air embolism adalah pertimbangan utama yang jika tidak terdeteksi dan ditangani dapat menyebabkan kolaps kardiovaskular dalam waktu singkat. Pasien laki-laki berusia 38 tahun datang dengan keluhan nyeri kepala berat dan penglihatan kabur sejak 4 bulan sebelum masuk rumah sakit. Hasil Magnetic Resonance Imaging menunjukkan adanya massa di regio pineal dengan edema perifokal, tanpa deviasi struktur midline. Pasien dilakukan kraniotomi pengangkatan tumor dalam posisi duduk. Operasi berjalan selama 10 jam dengan hemodinamika stabil dan tidak terjadi komplikasi, dalam anestesi umum dengan kombinasi intravena dan inhalasi. Prinsip ABCDE neuroanestesi, posisi duduk dan implikasinya, dan lokasi operasi yang sulit adalah pertimbangan-pertimbangan anestesi yang harus diperhatikan pada pasien ini. Evaluasi preoperasi yang baik, komunikasi dan koordinasi yang baik antara tim bedah dan anestesi sangat diperlukan untuk kelancaran dalam kraniotomi dalam posisi duduk.Anesthetic Management of Patient with Pineal Region Tumor Underwent Craniotomy Tumor Removal in Sitting PositionAbstractIncidence of pineal regio tumor is 0.4-1% of intracranial tumors. Its location which is buried between two cerebral hemispheres, close to brainstem and hypothalamus become a difficult challenge for the neurosurgeon. Surgery with supracerebellar approach in sitting position is the best method to access the lesion. Sitting position also facilitates the optimal visual field with minimal retractions. However, for anesthesiologist, sitting position is challenging since it has its own complexities during positioning the patient and the risk of complications. Venous air embolism is one of the main concern and if not detected early and treated appropriately would leads to cardiovascular collapse instantly. This is a case of a 38-year-old male with chief complaint of severe headache and blurred vision started 4 months before admission. The Magnetic Resonance Imaging showed a pineal region tumor with perifocal edema, without midline deviation. The patient underwent craniotomy tumor removal with sitting position. The procedure lasted for 10 hours and uneventful. The principle of ABCDE neuroanesthesia, sitting position and its implications, and difficult tumor location are some anesthesia considerations for this patient. A thorough preoperative evaluation, good communication and coordination between surgery and anesthesia team are needed for a smooth uneventful procedure performed in sitting position.

Pengelolaan Anestesi pada Pasien yang dilakukan Eksisi Tumor Medula Spinalis Servikal 2-3 dengan Ventrikel Ekstra Sistole Maharani, Nurmala Dewi; Rachman, Iwan Abdul; Bisri, Dewi Yulianti; Sudadi, Sudadi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
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Penyakit yang mengakibatkan kompresi medulla spinalis dapat mengakibatkan iritasi pada sistem saraf otonom. Hiperinervasi saraf simpatis berisiko tinggi pada aritmia ditandai adanya perubahan pada elektrokardiografi, yakni perubahan durasi gelombang P, durasi QRS, depresi segmen ST, interval puncak gelombang T dan ventrikel ekstrasistol. Laki- laki 52 tahun dengan tumor intra-ektramedullar pada area cervikalis 2-3 dengan tetraparesis dan ventrikel ektrasistol dilakukan wide eksisi tumor dan stabilisasi posterior. Pemeriksaan fisik nadi 90 x/menit teraba tidak teratur. Elektrokardiogarfi (EKG) didapatkan hasil irama irreguler 82 x/menit, ventrikel ektrasistol 10 x/menit. Echocardiography menunjukkan disfungsi diastolik grade 3 preserved LV function. Sebelum operasi pasien diberikan terapi ventrikel ektrasistol dengan menggunakan analgetik dan amiodaron 150 mg (10 mL) pada 10 menit pertama, dilanjutkan dengan 360 mg (200 mg) untuk 6 jam selanjutnya, 540 mg untuk 18 jam berikutnya dan analgetik. Induksi anestesi dilakukan dengan midazolam 3 mg, fentanyl 200 mcg, lidokain 60 mg, propofol 100 mg, dan atricurium 30 mg serta intubasi manual in-line. Dilakukan pemasangan arteri line dan kateter vena sentral setelahnya pasien diposisikan prone. Pembedahan berlangsung 6 jam. Pasien dirawat di ICU 2 hari sebelum pindah ruang rawat biasa. Pemberian amiodarone sendiri dapat dipertimbangkan pada ventrikel ekstrasistol maligna yang memerlukan tatalaksana segera dengan pertimbangan hemodinamik pasien dalam keadaan stabil.Anesthesia Management for Cervical 2-3 Spinal Cord Tumor with Ventricles ExtrasystoleAbstractCompression of the spinal cord can cause irritation to the autonomic nervous system. Hyperinervation of sympathetic nerves at high risk for arrhythmias characterized by electrocardiographic results in changes in P-wave duration, QRS duration, ST-segment depression, T-wave peak interval, and ventricular extrasystole. A 52-year-old male with an intra-extramedullar tumor in cervical 2-3, tetraparesis, dysrhythmias, and ventricular extrasystole bigemini. Wide excision of tumor and posterior stabilization would be performed. The pulse was 90x/minute palpable irregularly. Electrocardiography examination revealed irregular rhythm 82 x/minute and ventricular extrasystole 10 x/minute. Echocardiography showed grade 3 diastolic dysfunction with preserved LV function. Before the procedure, the patient was given management for the dysrhythmia and ventricular extrasystole with analgetics and amiodaron 150mg (10ml) in the first 10 minutes followed by 360mg (200mg) for the next 6 hours, 540mg for the next 18 hours and analgetics. General anesthesia carried out with midazolam 3mg, fentanyl 200mcg, lidocaine 60mg, propofol 100mg, and atricurium 30mg, with manual intubation in-line. After arterial line and central venous catheter insertion, the patient was placed in the prone position. Surgery lasted for approximately 6 hours. The patient was treated in the ICU for 2 days before moving to the usual ward. Amiodarone can be considered in ventricular extrasystole requiring immediate treatment with stable hemodynamic.

Manajemen Neuroanestesi pada Operasi Carotid Endarterectomy: Pasien dengan Riwayat Stroke Berulang Bangun, Chrismas Gideon; Irina, RR. Sinta; Bisri, Dewi Yulianti; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Carotid endarterectomy (CEA) adalah prosedur bedah yang dilakukan untuk memulihkan aliran darah karotis dan mengurangi kejadian stroke embolik dan trombotik. Walaupun merupakan prosedur preventif, CEA membawa risiko komplikasi perioperatif: neurologik dan kardiak. Komplikasi mayor CEA adalah stroke intra dan postoperatif, infark miokard, dan kematian. Untuk mengurangi angka kejadian stroke intraoperatif maka dikembangkan teknologi monitoring intraoperatif salah satunya dengan elektroensefalogram (EEG). Pada kasus ini pasien laki-laki, 62 tahun, dengan riwayat stroke iskemik berulang dan kelemahan tungkai kiri direncanakan untuk CEA dengan anestesi umum. Ahli bedah memutuskan untuk menggunakan shunt secara selektif dengan menilai monitoring EEG saat dilakukan clamping. Akhirnya shunt tidak jadi dilakukan, operasi berjalan selama 6 jam, diwarnai dengan gejolak hemodinamik yang sering terjadi pada pasien dengan penyakit karotis akibat gangguan baroreseptor. Dengan penanganan anestesi yang cermat selama dan sesudah operasi, operasi berhasil dilakukan, dan hasil postoperasi kekuatan motorik kaki kiri meningkat dari 2 ke 4.Management Neuroanesthesia for Carotid Endarterectomy: Patients with a History of Recurrent StrokeAbstractCarotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.

Pertimbangan Anestesi Perioperatif untuk Pasien Bedah Saraf dengan Covid-19 Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Coronavirus yang baru, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pertamakali timbul di Wuhan, Provinsi Hubei Cina, pada bulan Desember 2019, dan menyebar dengan cepat ke seluruh dunia ke lebih dari 190 negara. Pasien harus ditapis untuk covid-19 menggunakan kombinasi riwayat penyakit, computed tomography (CT) dada, dan pemeriksaan real time quantitative polymerase chain reaction (RT-qPCR) bergantung kebijakan institusinya. Keluhan neurologis seperti dizziness, headache, hypogeusia dan hyposmia, sering (36%) pada pasien covid-19. Encefalopati dan perubahan status mental juga terjadi pada pasien yang telah terinfeksi dengan virus SARS-CoV-2. Penyakit serebrovaskuler lebih sering pada covid-19 yang berat; acute ischemic stroke telah dilaporkan pada 5,7% dan gangguan kesadaran pada 15% pasien. Tindakan pembedahan rutin kranial dan spinal aman untuk dilakukan. Operasi endoscopic endonasal tidak aman dan harus dihindari. Ekstubasi setelah anestesi umum bila memungkinkan dilakukan di ruangan tekanan negatif, personil tetap memakai alat pelindung diri (APD) level 3. Harus dihindari pasien batuk saat ekstubasi. Setelah ekstubasi, pasang oksigen binasal, dan pasien harus memakai masker bedah dan aliran oksigen tinggi harus dihindari (berikan 6L/menit) untuk menghindari terjadinya aerosolisasiPerioperative Anesthesia Consideration for Neurosurgical patients with Covid-19AbstractThe novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province China, in December 2019, and spread fast to all the world more than 190 countries. Patients should be screened for covid-19 using a combination of history, computed tomography (CT) chest, and real time quantitative polymerase chain reaction (RT-qPCR) testing depending on institutional policies. Neurological symptom as dizziness, headache, hypogeusia and hyposmia, common (36%) at covid-19 patient. Encephalopaty and changed mental status exist in patient infected by SARS-CoV-2 virus. Cerebrovascular diseases more in severe covid-19; acute ischemic stroke had reported in 5.7% and altered level of consciousnes in 15% patient. Surgical measuremet cranial and spinal rutine is safe, endoscopic endonasal surgery not safe and must be avoided. Extubation after general anesthesia if possible do air negative pressure room, and personil still use personal protection equipment (PPE) level 3. Must be avoid patient cough during extubation. After extubation, give oxygen nasal canule, surgical mask, and high flow oxygen (give 6 L/min) avoided given the risk of aerosolization

Penanganan Trigeminocardiac Reflex (TCR) selama Anestesi untuk Bedah Saraf Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Trigeminocardiac reflex (TCR) adalah suatu reflex batang otak unik yang manifest sebagai pertubasi cardio-respiratori negatif. Trigeminocardiac reflex didefinisikan sebagai kejadian tiba-tiba dari disritmia parasimpatetik, hipotensi simpatetik, apnea, atau hipermotilitas gastrik selama stimulasi cabang sensoris dari saraf trigeminal. Secara klinis, TCR telah dilaporkan terjadi pada semua prosedur bedah yang dipersarafi oleh saraf trigeminal. Refleks ini telah dilaporkan terjadi pada operasi skull base (dasar tengkorak), akan tetapi, baru-baru ini, juga berhubungan dengan banyak operasi bedah saraf yang lain, prosedur neurointervensional, juga pada operasi bukan bedah saraf dan pada keadaan tidak dioperasi. Refleks ini menunjukkan perubahan kardiovaskular yang menimbulkan komplikasi katastropik, memperburuk outcome, juga merupakan dilema dalam menegakkan diagnosis. Walaupun terdapat banyak literatur dengan laporan insidensi dan faktor risiko dari TCR, signifikansi fisiologis an fungsi belum sepenuhnya dapat dijelaskan. Sebagai tambahan, ada hal yang kompleks dalam TCR yang memerlukan pengkajian dan klarifikasi. Bila terjadi TCR dapat dilakukan terapi dengan identifikasi dan modifikasi faktor risiko, penilaian kedalaman anestesi, pengobatan profilaksis dengan agen vagolitik atau blok saraf perifer jika terjadi manipulasi saraf perifer, pemantauan kardiovaskular yang cermat selama anestesi, terutama pada mereka yang memiliki faktor risiko TCR, penghentian manipulasi, dan pemberian agen vagolitik dan adrenalin. Karena itu, pada tulisan ini akan disampaikan tentang mekanisme, definisi, patofisiologi, manifestasi, diagnosis dan tatalaksananya.Trigeminocardiac Reflex (TCR) Management during Anesthesia for NeurosurgeryAbstractTrigeminocardiac reflex (TCR) is a unique brain stem reflex that manifests as negative cardio-respiratory perturbations. The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. This reflex is largely reported in skull base surgeries/interventions; however, in recent times, it has been also linked with many neurosurgical, neurointerventional procedures, non-neurosurgical and non-surgical conditions. This reflex presents with many cardiovascular changes that can create catastrophic complications, worse outcome as well as diagnostic dilemmas. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requires examination and clarification. If a CTR occurs, it can risk factor identification and modification, depth of anesthesia assessment, prophylactic treatment with either vagolytic agents or peripheral nerve block in case of peripheral manipulations of the nerve, careful cardiovascular monitoring during anesthesia, especially in those with a risk factor for TCR, treatment of the condition when it occurs: cessation of the manipulation, and administration of vagolytic agents and adrenaline. Therefore, this narrative review intends to elaborate on its mechanisms, definition, pathophysiology, manifestations, diagnosis and management.

Manajemen Low Flow Anesthesia pada Pasien Kraniosinostosis dengan Hipertelorisme yang menjalani Four Box Wall Osteotomy, dan Eksisi Redundant Skin Fronto Nasal Cahyadi, Arief; Bisri, Dewi Yulianti; Harahap, M Sofyan; Gaus, Syaruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Kraniosinostosis merupakan kasus yang didagnosis di tahun pertama kehidupan dan dapat membutuhkan pembedahan pada usia muda. Kraniosinostosis merupakan salah satu bagian dari sindrom hipertelorisme dengan angka kejadian sebesar 20%. Anak laki laki 13 tahun dengan hipertelorisme yang sudah menjalani rangkaian operasi koreksi hipertelorisme sebelumnya. Pasien direncanakan operasi koreksi lanjutan berupa four box wall osteotomy yang merupakan koreksi bagian frontal berupa pelepasan kraniosinostosis di sutura koronal. Risiko perdarahan masif karena anak sudah besar serta operasi panjang menjadi penyulit. Tatalaksana jalan napas memerlukan modifikasi karena deformitas yang ada, penggunaan low flow anestesi untuk membantu menjaga suhu dan mengurangi penggunaan gas anestesi, manajemen cairan intraoperatif berupa kombinasi kebutuhan pemeliharaan dan penggantian perdarahan yang terjadi, serta tatalaksana nyeri pasca operasi pada anak menjadi pertimbangan lain. Penyulit covid-19 terjadi pada pasien sehingga membuat ekstubasi tertunda. Perdarahan masif memerlukan protokol transfusi masif untuk mendukung ketersediaan darah dalam waktu singkat. Produk darah PRC, FFP dan TC harus tersedia karena faktor koagulasi juga perlu diperhatikan. Manajemen anestesi pada hipertelorisme dengan tindakan four box wall osteotomy memerlukan kerja sama baik antara anestesi, bedah saraf, bedah plastik serta ICU anak untuk menurunkan risiko perioperatif termasuk kekhususan covid-19 di era pandemi.Low Flow Anesthesia Management Craniosynostosis Patient with Hypertelorism underwent Four Box Wall Osteotomy and Fronto Nasal Redundant Skin ExcisionAbstractCraniosynostosis is a case that diagnosed in the first year of life and can need surgical in young age. Craniosynostosis is a part of hypertelorism with incidence rate around 20%. Boy, 13 years old with hypertelorism had undergone multiple surgery for correction of hypertelorism before. Patient was planned to advance surgical correction of four box wall osteotomy which consist frontal part correction and part of it is release craniosynostosis in coronal suture. Risk of massive bleeding because patient already in teen age and length of surgery can be prolonged. Difficult airway management due to fascial deformity, use of low flow anesthesia to preserve temperature and reduce inhalation anesthesia usage, intraoperative fluid management in consideration maintenance and replacement blood loss and post operative pain management has become another consideration. Covid-19 as part of problems post operatively being known before extubation made the process is delayed. Massive bleeding needs massive transfusion protocol to speed up blood availability. Blood product such as PRC, FFP and TC should be available because coagulation factor is part of consideration. Anesthesia management in hypertelorism with four box wall osteotomy need good communication between anesthesiologist, neurosurgeon, plastic surgeon and pediatric intensivist to reduce perioperative risk including covid-19 in pandemic era.Key words: Low flow anesthesia management, craniosynostosis, hypertelorism, four box wall osteotomy

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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