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All Journal 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 Kliping Ruptur Aneurisma Serebral Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Aneurisma cerebral merupakan suatu kelainan vaskuler intraserebral, dengan angka kejadian sekitar 5% dari jumlah populasi pada usia 45-60 tahun. Perdarahan subarachnoid (Subarachnoid Hemorrhage /SAH) merupakan gejala serius dari aneurisma yang ruptur dengan angka kejadian berkisar antara 10-15 kasus per 100.000 populasi. Aneurisma yang pecah ulang atau iskemia merupakan masalah utama pada pengelolaan perioperatif pasien dengan aneurisma serebral. Seorang wanita berusia 73 tahun, berat badan 80 kg dengan aneurisma sakuler dari arteri vertebralis kanan bagian proksimal dari arteri sereberal posterior inferior (Posterior Inferior Cereberal Artery /PICA) dengan gambaran SAH, GCS 7, tekanan darah 200/160 mmHg, nadi 100 x/ menit, respirasi 18 x/permenit dengan Kriteria Hunt and Hess III-IV. Dilakukan intubasi dan penanganan tekanan darah di Unit Gawat Darurat dan pasien dirawat di ICU. Di ICU pasien diventilasi, dengan sedasi propofol 1 mg/kgBB/jam, diberikan perdipine 0,5 mg/kg BB/menit, dan pasien dapat diekstubasi hari ke-10 setelah perawatan di ICU. Operasi dilakukan pada perawatan hari ke 17, dengan keadaan prabedah GCS 13, tekanan darah 160/80 mmHg, nadi 90 x/menit, respirasi 14 x/menit SpO2 100% dengan binasal canul, dan direncanakan dilakukan kliping aneurisma. Dipasang alat pantau tekanan darah non-invasif, EKG, SpO2, dan urine kateter. Pasien tanpa premedikasi, induksi dengan propofol, fentanyl, lidokain, dan fasilitas intubasi dengan rocuronium 0,9 mg/kg BB. Rumatan anestesi dengan Sevofluran - Oksigen 40% - propofol kontinyu 1-3 mg/kg/jam - vecuronium 0,1 mg/kgBB/jam. Pemasangan arteri line setelah induksi anestesi. Untuk pengaturan tekanan darah sebelum dan saat kliping temporari dan permanen dengan nitrogliserin titrasi. Pascabedah pasien dipindahkan ke ICU, tidak diekstubasi, dan dilakukan ventilasi mekanis selama 24 jam, dan dirawat selama 12 hari, dengan mendapatkan terapi hipertensi dengan menaikkan tekanan darah maksimal 20% dari nilai dasar. Pasien di pindahkan ke ruangan GCS 15, Tekanan darah 140/90 mmHg, Nadi 80x/menit, respirasi 12x/menit SpO2 100%. Komplikasi pada post operasi aneurisma adalah hidrocephalus, rebleeding, kejang dan vasospasme. Adanya penurunan kesadaran pascabedah terutama disebabkan karena menurunnya aliran darah otak akibat vasospasme. Pencegahan dan penanganan kemungkinan terjadinya komplikasi ini dapat memperbaiki luaran pasien. Penatalaksaanaan preoperasi, intraoperatif dan postoperatif yang benar dapat memperbaiki luaran pasien.Anesthesia Management For Clipping Cerebral Aneurysm RuptureCerebralaneurysm is considered an intra cerebrovascular structural dysfunction, with the incidence rate around 5% of total 45-60 years of age population. Subarachnoid Hemorrhage (SAH) is considered a serious symptom of ruptured aneurysm and the incidence rate is around 10-15 cases per 100.000 human population. Re-ruptured or ischemia are the main problems in perioperative management of patient with cerebral aneurysm. A 73-year-80 kg BW female with saculler aneurysm on the right vertebral artery proximal to Posterior Inferior Cereberal Artery (PICA) and the appearance of subarachnoid haemorrhage (SAH), GCS 7, blood pressure 200/160 mmHg, heart rate 100 beats/minute, respiration rate 18 beats/minute with the Hunt and Hess Criteria III-IV was admitted to the hospital. Performed intubation and hypertension management at the emergency ward and the patient was treated at the ICU. At the ICU, the patient was on ventilator, sedated using propofol 1 mg/kgBW/hr, perdipine 0,5 mg/kgBW/minute, and the patient was extubated on the day-10 after ICU treatment. The surgery was performed on the day-17, and the presurgery descriptions were GCS 13, blood pressure 160/80 mmHg, heart rate 90 beats/minute, respiration rate 14 beats/minute, SpO2 100% with oxygenation using binasal canule, and the patient was scheduled for aneurysm clipping. A non-invasive monitor was installed for blood pressure, ECG, SpO2 and urine foley catheter was also installed. The patient was without premedication, inducted using propofol, fentanyl, lidocain, and facilitate intubation with rocuronium 0,9 mg/kgBW. Anesthetic maintenance using Sevoflurane - oxygen 40% - propofol continuously 1-3 mg/kgBW/hr - vecuronium 0,1 mg/kgBW/hr. Installation of arterial line was performed right after anesthetic induction. Nitrogliserin titration was used to manage blood pressure before and during temporary and permanent clipping. After surgery, the patient was transferred to ICU, unextubated, and was on mechanical ventilator for 24 hr, being treated for 12 days, and received hypertension therapy by increasing the blood pressure 20% maximum from the baseline. The patient was then transferred to the inpatient ward at GCS 15, blood pressure 140/90 mmHg, heart rate 80 beats/minute, respiration rate 12 beats/minute, and SpO2 100%. Complications that may occur at the post aneurysm surgery were hidrocephalus, re-bleeding, seizure and vasospasm. The awareness decline post surgery may due to the decreasing of intra cerebral blood circulation due to vasospasm. Anticipation and management the possibility of those complications may determine the patients outcome. The correct management of pre-surgery, intrasurgery and post surgery will improve the patient outcome as well.

Penatalaksanaan Anestesi pada Pasien dengan Tumor Supratentorial Berukuran Besar Suspek Konveksitas Meningioma Wullur, Caroline; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Penatalaksanaan anestesi untuk kasus meningioma memiliki beberapa hal khusus yang penting untuk dilaksanakan. Jaringan otak tertutup oleh tulang kranium. Karena hubungan kontinu dari aliran darah dan volume jaringan otak, maka resiko perdarahan dan edema sangat tinggi. Tanpa pendekatan anestesi yang tepat, maka dapat meningkatkan resiko edema dan perdarahan otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien berusia 35 tahun dengan keluhan nyeri kepala di daerah frontal disertai dengan penurunan penglihatan sejak 1 tahun sebelum masuk rumah sakit. Pasien tidak pernah mengalami kejang ataupun penurunan kesadaran. Pasien didiagnosa dengan tumor supratentorial ec suspek conveksitas meningioma yang direncanakan dilakukan pembedahan kraniotomi untuk pengangkatan tumor. Status fisik ASA 2 dengan defisit neurologis. Pasien dilakukan dengan anestesi umum dengan intubasi. Induksi dengan fentanil, propofol dan vecuronium. Operasi berlangsung selama 7,5 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif selama 2 hari sebelum pindah ke ruangan. Perlakuan anestesi dan pengaturan faktor fisiologi mempunyai dampak yang besar terhadap jaringan otak. Dokter anestesi harus mempunyai pengetahuan mengenai efek obat dan manipulasi lainnya untuk mencapai hasil operasi yang baik.Anaesthetic Management of a Patient with Large Supratentorial Brain Tumor Suspected Convexity MeningiomaAnesthesia for meningioma cases has several specific important considerations. The brain is enclosed in a rigid skull. Brain tissue is highly vascularized therefore the risk of bleeding and edema are very high. Without the correct anaesthetic approach, the risk of bleeding and edema due to surgical manipulation may be increased. This phenomenon may have negative impact since the visual of surgical field will be limited. In this case, we reported a 35-year old female patient with severe headache at the frontal region accompanied with visual impairment since 1 year prior to hospital admittance. This patient was never experienced any seizures or inconsiousness. Patient was diagnosed with supratentorial tumor caused by suspect of convexity meningioma and was planned tumor removal craniotomy. ASA II physical status with neurological deficit. The patient was on general anaesthesia with intubation. Induction was performed using fentanyl, propofol and vecuronium while continuous propofol and vecuronium were used for maintenance. The surgery lasted for 7.5 hours. After surgery, the patient was treated in the Intensive Care Unit for 2 days prior to inpatient ward transfer. Anaesthetic management and physiological factors control have a positive impact on the brain tissue. Anaesthesiologist must have the comprehensive knowledge on drug effects and other manipulations to achieve positive result of a surgery.

Penanganan Anestesi Wanita Hamil untuk Kraniotomi Emergensi Hematoma Subdural Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Trauma selama kehamilan, termasuk cedera kepala, adalah penyebab morbiditas dan kematian ibu akibat kecelakaan dan merupakan 6%-7% penyulit dari keseluruhan kehamilan dan pengelolaan pasien harus multidisiplin. Spesialis anestesiologi harus memahami perubahan fisiologi pada wanita hamil, implikasinya, dan risiko khusus pemberian anestesi selama kehamilan sehingga dapat dibuat perencaan penanganannya. Perubahan fisiologi yang unik dari kehamilan, terutama sistem kardiovaskuler, mempunyai keuntungan dan kerugian setelah trauma. Kami melaporkan seorang pasien, umur 28 tahun, dengan umur kehamilam 27-28 minggu masuk ke departemen emergensi akibat kecelakaan sepeda motor dengan Glasgow Coma Scale (GCS) E1M4Vt, tekanan darah 130/70 mmHg, laju nadi 72 x/menit, laju nafas 16 x/menit, telah diintubasi dengan pipa endotrakhea no.6.5, pupil isokor, refleks cahaya positif, laju jantung fetus 140-144 x/menit, dan hasil CT-scan menunjukkan adanya subdural hematoma temporoparietal kanan. Anestesia endotrakheal dengan isofluran, oksigen/udara dengan monitor standar dan Doppler untuk memantau laju jantung fetus. Tujuan utama intervensi bedah saraf pada wanita hamil adalah adalah untuk kelangsungan hidup ibu dan anak. Sasaran utama penanganan anestesi untuk wanita hamil yang tidak dilakukan operasi obstetri adalah mempertahankan perfusi uteroplasenta. Peranan tim multidisiplin dalam penanganan pasien parturien dengan risiko tinggi tidak dapat diremehkanAnesthetic Management of Pregnant Woman for Emergency Craniotomy Subdural Hematoma Trauma during pregnancy, including head injury, is the leading cause of accidental maternal death and morbidity, and complicates 6%-7% of all pregnancies which requires multidisciplinary patients management. The anesthesiologist must understand the physiological changes of pregnancy, their implications, and the specific risks of anesthesia during pregnancy, so that the best anesthetic approach can be performed. The unique physiologic changes of pregnancy, particularly on the cardiovascular system, are both have advantage and disadvantage after acute traumatic injury. We reported a 28 years old parturient patient at 27-28 weeks of pregnancy who was admitted to emergency department due to motorcycle accident with Glasgow Coma Scale (GCS) of E1M4Vt, Blood Pressure 130/70 mmHg, Heart Rate 72 x/minute, Respiratory Rate 16 x/minute.The patient was already intubated using an endotracheal tube no.6.5, the pupils were equal, round and still reactive to light stimulation, fetal heart rate (FHR) was 140-144 x/minute, and head computed tomography scan showed right temporoparietal subdural hematoma. Endotracheal anesthesia was given with isoflurane, oxygen/air, with implementation of standard monitors and Doppler for FHR. The main aim of a neurosurgical intervention in a pregnant woman is to preserve the viability of both the mother and the infant. The main goal in the management of anesthesia for pregnant woman undergoing a non-obstetric surgery is to maintain the uteroplacental perfusion. The role of a multidisciplinary team in the care of high risk parturient patients cannot be avoided.

The Management of Peritumoral Brain Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.586

Brain edema is classified into four main types: vasogenic, cellular, osmotic, and interstitial. These types may be triggered by various conditions, such as head injuries, vascular ischemia, intracranial lesions, and obstructive hydrocephalus. Several factors are associated with the development of (the swelling of the brain including tumors, physical injuries, insufficient oxygen supply (hypoxia), infections, disruption in metabolism, or acute hypertension. Vasogenic brain edema, the most prevalent form of brain edema, is characterized by a blood- brain barrier (BBB) disorder. When the BBB is compromised, ions and proteins move more easily into the extravascular space, creating an osmotic effect that fluid into the brain’s interstitium. In brain tumors, cerebral edema occurs due to leakage of plasma into the parenchyma caused by impaired function of cerebral capillaries. Management of brain edema focuses on two key strategies: preventing further damage caused by the increased fluid in the brain, and addressing the underlying cause of the edema. Corticosteroids are frequently used as a primary therapy for this condition. While low-dose corticosteroids are preferred to minimize serious adverse effects such as myopathy or diabetes, higher doses of dexamethasone-sometimes along with osmotherapy (e.g. mannitol) or surgical interventions- may be necessary in emergency situations. Careful tapering of corticosteroids is essential to prevent dependence or withdrawal symptoms. New therapies, such as vascular endothelial growth factor receptor inhibitors and corticotropin-releasing factor, require additional clinical evaluation. A thorough understanding of pathophysiology of brain edema is crucial for optimizing the treatment strategies both before and after surgical procedures.

Interaksi Otak-Paru pada Neurocritical Care Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Pasien cedera otak traumatik (COT) berat merupakan kasus trauma yang paling sering masuk ke ruang terapi intensif dan kemudian terjadi multiple organ dysfunction dengan morbiditas dan mortalitas yang tinggi. Disfungsi neurologik berat dihubungkan dengan terjadinya edema paru dan cedera paru yang akan memperburuk outcome, dapat terjadi pada cedera otak traumatik, subarachnoid hemorrhage, status epileptikus, dan mati otak. Ventilasi mekanis yang sering digunakan dalam pengelolaan pasien sakit kritis, juga dapat memicu respons paru dan organ lain termasuk otak akibat terjadinya inflamasi. Pengaruh dari paru ke otak terlihat bahwa kebanyakan pasien yang selamat dari acute respiratory distress syndrome (ARDS) menunjukkan kemunduran kognitif yang menetap saat dipulangkan. Mekanisme yang mendasarinya belum diketahui, tapi hiperglikemia, hipotensi dan hipoksia/hipoksemia di ICU secara nyata berkorelasi dengan outcome neurologik yang tidak baik tersebut. Sebaliknya, pengaruh dari otak ke paru terlihat bahwa sepertiga dari pasien COT terjadi acute lung injury (ALI), yang memperburuk outcome, tapi penyebabnya belum jelas, namun kemungkinan mekanismenya antara lain neurogenic lung/pulmonary edema, mediator inflamasi, infeksi nosokomial, dan efek buruk dari terapi neuroproteksi. Neurogenic pulmonary edema merupakan komplikasi cedera SSP yang telah dikenal dengan baik akibat pelepasan katekolamine masif. Sebagai simpulan pada pasien dengan cedera otak dan gagal nafas akut, pencegahan dari cedera otak iskemik dan penggunaan strategi proteksi paru yang hati-hati merupakan hal yang utama. Sejak cross-talk antara otak dan paru diketahui dapat terjadi melalui berbagai jalur yang berbeda, pengendalian variabel fisiologis merupakan hal penting untuk proteksi otak.Brain-Lung Interaction in Neurocritical CareSevere traumatic brain injury patient is one of the most frequent traumatic cases admitted to intensive care unit (ICU) and develop multiple organ dysfunction with high rate of morbidity and mortality. Severe neurological dysfunction associated with pulmonary edema and pulmonary injury which can further worsen clinical outcome has been observed in traumatic brain injury, subarachnoid hemorrhage, status epilepticus, and in brain death cases. Mechanical ventilation that is commonly used in the management of critically ill patients can also trigger pulmonary and other organs responses including the brain, in relation to the inflammation caused. The effect from lung to the brain can be seen by the fact that many acute respiratory distress syndrome (ARDS) survivors showed a persistent cognitive deterioration when discharge. The underlying mechanisms remains unknow, but hyperglycemia, hypotension and hypoxia/hypoxemia in ICU are significantly correlated with this unfavorable neurological outcome. On the other hand, the effect from brain to the lung can be seen by the fact that one-third of acute brain injury patients develop acute lung injury (ALI), that worsen the clinical outcome, but the cause remaining obscure. The possible mechanisms include neurogenic lung edema, inflammatory mediators, nosocomial infection, and the adverse effect of neuroprotective therapy. Neurogenic pulmonary edema is a well-recognized complication of central nervous system insult attributed to a massive catecholamine release. As conclusion in patient with brain injury and acute lung injury, prevention of inadvertent ischemic brain insult and the use of protective lung strategies are mandatory. Since the cross-talk between the brain and lungs may occurs through different pathway, greater control of physiological variables might be important to protect the brain.

Kemoterapi pada Pasien Operasi Tumor Otak Metastasis: Apa Implikasi Anestesinya? Putri, Dini Handayani; Bisri, Dewi Yulianti; Rasman, Marsudi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor otak metastasis adalah salah satu jenis keganasan intrakranial yang paling umum di temukan pada dewasa. Di Amerika Serikat sendiri tumor otak metastasis mencapai 150.000 170.000 kasus pertahun. Lebih dari 50% tumor otak metastasis terletak di supratentorial, dapat memberikan gejala neurologis, sangat bergantung akan jumlah lesi, ukuran lesi, serta ukuran dari edema vasogenik yang terjadi dan menekan jaringan otak sekitarnya. Lima sumber paling umum dari tumor otak metastasis adalah payudara, colorectal, ginjal, jantung dan melanoma. Dari keseluruhan pasien dengan tumor otak akibat metastasis 8 14% akan menjalani operasi pengangkatan tumor dengan beberapa pertimbangan seperti didapatkan tanda tanda kegawatdaruratan neurologis, ukuran massa yang besar, jenis tumor primer, grade tumor, lokasi tumor, resiko, komplikasi operasi dan Karnofsky Performance Score (KPS). Pasien tumor otak metastasis tentunya datang dengan dengan riwayat tumor ganas pada organ tubuh lainnya dan telah menjalani kemoterapi sebagai terapi. Pasien dengan riwayat kemoterapi memerlukan perhatian khusus karena selain membunuh sel kanker, kemoterapi dapat memberi efek toksik pada sistem organ, baik efek jangka pendek maupun efek jangka panjang, sehingga di perlukaan tatalaksana perioperatif yang seksama pada operasi tumor otak metastasis agar didapatkan hasil luaran yang baik.Chemotherapy In Patients with Metastatic Brain Tumor Surgery: What are the Implications of Anesthesia?Metastatic brain tumor is one of the most common types of intracranial malignancies found in adults. In the United States alone metastatic brain tumors attain. 150,000 - 170,000 cases per year. Metastatic brain tumor of more than 50% is located in the supratentorial, may provide neurological symptoms, highly dependent on the number of lesions, the size of the lesion, as well as the size of the vasogenic edema that occurs and suppress the surrounding brain tissue. The five most common sources of metastatic brain tumors are breast, colorectal, kidney heart and melanoma. Of all patients with brain tumors due to metastasis 8 to 14% will undergo tumor removal surgery with some considerations such as the emergence of signs of neurological emergency, large mass size, type of primary tumor, tumor grade, tumor location, risk complication of surgery, and Karnofsky performance score (KPS). Patients with metastatic brain tumors certainly come with a history of malignant tumors in other organs and have undergone chemotherapy as therapy. Patients with a history of chemotherapy require special attention because in addition to killing cancer cells, chemotherapy can have a toxic effect on the organ system, both short-term and long-term effects, so a careful perioperatif treatment in patients with brain tumor metastasis surgery is mandatory in order to obtain good results.

Hipotermia untuk Proteksi Otak Bisri, Dewi Yulianti; Oetoro, Bambang J.; Harahap, M. Sofyan; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Proteksi otak adalah serangkaian tindakan yang dilakukan untuk mencegah atau mengurangi kerusakan sel-sel otak yang diakibatkan oleh keadaan iskemi. Iskemia adalah gangguan hemodinamik yang akan menyebabkan penurunan aliran darah otak sampai suatu tingkat yang akan menyebabkan kerusakan otak yang ireversibel. Iskemi serebral dan atau hipoksia dapat terjadi sebagai konsekuensi dari syok, stenosis atau oklusi pembuluh darah, vasospasme, neurotrauma, dan henti jantung. Hipotermia dibagi menjadi hipotermia ringan (33-36OC), hipotermia sedang (28-32OC), hipotermia dalam (11-20OC), profound (6-10OC), dan ultraprofound (5OC).Teknik hipotermia di bagi kedalam 3 fase yaitu: fase induksi, fase rumatan dan fase rewarming. Teknik hipotermia yang dianjurkan adalah hipotermia ringan hingga sedang dan penggunaannya segera setelah cedera otak traumatika dan tidak lebih dari 72 jam. Hipotermia dapat mempengaruhi sistem kardiovaskuler, sistem respirasi, infeksi dan fungsi saluran cerna, sistem ginjal, asam basa dan hematologi. Efek hipotermia sebagai proteksi adalah efek terhadap metabolism dan aliran darah otak, excitotoxicitas, oxidative stress dan apoptosis, inflamasi, blood-brain barrier (BBB), permeabilitas pembuluh darah dan pembentukan edema, dan terhadap mekanisme ketahanan hidup sel. Mekanisme proteksi otak dengan hipotermi belum sepenuhnya dimengerti dengan jelas, hanya sebagian saja diketahui bagaimana mekanismenya. Rewarming adalah proses pemulihan temperatur ini ke temperatur inti normal. Rewarming harus dilakukan sangat pelahan untuk mengurangi kejadian komplikasi seperti hipertemia, hiperkalemia dan kerusakan sel.Hypothermia for Brain ProtectionCerebral protection is the preemptive use of theurapeutic intervention to avoid or decrease neurologic damage cause by ischemia. Ischemia is defined as perfussion insufficient to the level will be cause irreversible brain damage. Cerebral ischemia and or hypoxia as consequency of shock, stenosis or vascular occlusion, vasospasm, neurotrauma, and cardiac arrest. Hypothermia were divided into mild hypothermia (33-36OC), hypothermia was (28-32oC), hypothermia in the (11-20oC), profound (6-10C), and ultraprofound (5oC). Hypothermia technique is classified into 3 phases namely: an induction phase, maintenance phase and the phase of rewarming. The recommended technique of hypothermia is mild to moderate hypothermia and its use soon after brain injury traumatika and not more than 72 hours. Hypothermia can affect the cardiovascular system, respiratory system, gastrointestinal tract infections and function, renal system, acid-base and hematologic. Effect of hypothermia as brain protective are effect on cerebral blood flow and metabolism, on excitotoxicity, oxidative stress and apoptosis, inflammation, blood-brain barrier (BBB), permeability of blood vessels and form of edema, and the mechanisms of cell survival. Mechanism of brain hypothermia protection as a whole is not clearly known mechanism, only in part be obvious how mthe mechanism. Rewarming is the core body temperature returns to normal core body temperature. Rewarming should be done very slowly to reduce the incidence of complication as hyperthermia, hyperkalemia and cell damage.

Tatalaksana Anestesi Perioperatif pada Pasien dengan Perdarahan Intraserebral Spontan akibat Hipertensi Emergensi: Serial Kasus Panduwaty, Lira; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
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Latar Belakang dan Tujuan: Perdarahan intraserebral (PIS) mempunyai angka morbiditas dan mortalitas yang tinggi. Hanya 20% individu yang bertahan dari penyakit ini dapat hidup dalam 6 bulan. Masih terdapat kontroversi dalam tatalaksana PIS, seperti meregulasi tekanan darah, mencegah perluasan hematoma, edema otak, dan mempertahankan perfusi serebral. Tujuan penelitian ini adalah untuk membahas prosedur tatalaksana perioperatif PIS dengan hipertensi emergensi. Subjek dan Metode: Penelitian serial kasus dari 3 kasus dengan gangguan kesadaran (skor GCS ?14), didiagnosa PIS, akan dilakukan kraniotomi evakuasi hematoma. Dilakukan pengelolaan tekanan darah prabedah dengan target tekanan darah rata-rata (TAR) 125130 mmHg. Induksi dengan fentanyl 3 ug/kg, propofol 2,5 mg/kg, vecuronium 0,1 mg/kg, lidokain 1,5 mg/kg dan rumatan anestesi dengan O2, air, isoflurane 11,5 vol%. Hasil: Pascabedah 2 kasus dirawat di ICU selama 23 hari dan satu kasus dirawat di neurocritical care unit (NCCU) selama 3 hari dan terdapat perbaikan GCS menjadi 15. Setelah itu dipindahkan ke ruangan dan mendapat perawatan selama 57 hari, dan dipulangkan setelah 715 hari. Simpulan: Masih ada kontroversi tentang terapi PIS yang optimal terutama dalam pengendalian tekanan darah. Tekanan darah yang tinggi dapat menimbulkan hematoma, tapi penurunan tekanan darah dapat menimbulkan penurunan perfusi otak. The Intensive Blood Pressure Reduction of Acute Cerebral Hemorrhage Trial (INTERACT) menemukan bahwa penurunan tekanan darah yang segera akan mengurangi resiko perluasan perdarahan tapi tidak mempunyai efek pada outcome, akan tetapi, pada ke 3 kasus tersebut menurunkan tekanan darah dalam waktu kurang dari 24 jam memberikan hasil yang baik. Perioperative Anesthesia Management in Patients with Spontaneous Intracerebral Haemorrhage (ICH) et causa Hypertensive Emergency: A Case Series Background and Objectives: Intracerebral hemorrhage (ICH) have a high rate of morbidity and mortality. Only 20% of individuals who survive ICH are independent at 6 months. Many issues need to be considered for the optimal management of ICH, such as blood pressure (BP) control, prevention of hematoma growth, containing brain edema, and preserving cerebral perfusion. The objective of this case series is to report perioperative management procedure for ICH with hypertensive emergency.Subject and Methods: A serial case study of three patients with decrease consciousness (score GCS ?14), ICH, were planned for craniotomy evacuation. Perioperative management of BP has been done to a targetted mean arterial pressure (TAR) of 125130 mmHg. Induction with fentanyl 3 ug/kg, propofol 2.5 mg/kg, vecuronium 0.1 mg/kg, lidocaine 1.5 mg/kg and maintain of anesthesia with O2, air, isoflurane 11.5 vol%. Results: Two patients were admitted to the ICU post-operatively for 23 days, one patient were admitted to the Neuro Critical Care Unit (NCCU) for three days, and had improvements of consciousness (GCS 15), then transferred to the ward for another 57 days, and finally discharged after 715 days. Conclusion: There are still controversies in the treatment of ICH, especially in the control of BP. High BP can lead to hematoma, but decrease in BP can reduce cerebral perfusion. The Intensive Blood Pressure Reduction of Acute Cerebral Hemorrhage Trial (INTERACT) found that early intensive BP management reduced the risk of hematoma expansion but had no effect on outcomes. However in all three cases above, a reduction in BP within 24 hours have provided good results.

Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi Of Fallot Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

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)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

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.

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 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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