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J Sutawan, Ida Bagus Krisna

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Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

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Manajemen Anestesi Reseksi Tumor Cerebello-pontine Angle Vestibular Schwannoma dengan Posisi Lateral Suarjaya, I Putu Pramana; Paramartha, Bagus; J Sutawan, Ida Bagus Krisna; Panji, I Putu Agus Surya
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor Cerebello-pontine angle (CPA) adalah tumor yang paling sering terjadi di daerah fossa posterior, dan berkisar 5-10 % dari seluruh kasus tumor intrakranial. Sebagian besar tumor CPA adalah tumor jinak, 85% diantaranya merupakan vestibular schwannoma (neuroma akustik). Terapi pilihan untuk tumor CPA vestibular schwannoma dengan gejala adalah tindakan pembedahan. Kraniotomi dengan posisi lateral penuh pada reseksi vestibular schwannoma yang berlangsung lama memberikan tantangan karena potensi terjadinya ketidaksesuaian ventilasi-perfusi dan atelektasis paru sisi bawah. Seorang pasien perempuan, usia 25 tahun, dengan gangguan pendengaran, gangguan keseimbangan, kelemahan separuh badan kiri, mengalami kesulitan menelan dan pada pemeriksaan magnetic resonance imaging (MRI) didapatkan lesi padat di cerebelo-pontine angle dengan ukuran 5,6 x 5 x 4.5 cm yang meluas hingga internal auditory canal dan didiagnosa sebagai tumor cerebro-pontine angle vestibular schwannoma sinistra. Pasien menjalani pembedahan dengan anestesi umum intubasi endotrakeal, posisi lateral kanan penuh, yang berlangsung selama 6 jam 40 menit. Target dari pengelolaan anestesi pada tindakan pembedahan tumor vestibular schwannoma adalah memfasilitasi lapangan pembedahan yang ideal dan melakukan proteksi serebral untuk mencegah cedera sekunder dengan mempertahankan tekanan perfusi serebral, menghindari instabilitas hemodinamik, memungkinkan dilakukannya pemantauan neurologi intraoperatif, deteksi dini dan pengelolaan segera bila terjadi komplikasi pembedahan.Anesthesia Management of Cerebello-pontine Angle Tumor Vestibular Schwannoma Resection in Lateral PositionAbstractCerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannoma (acoustic neuromas). The preferred treatment for symptomatic vestibular schwannoma has been surgical excision. Craniotomy for vestibular schwannoma resections in lateral position gave better surgical field exposure, but also posed increased risk of ventilation-perfusion mismatch and atelectasis of the dependent lung in lengthy surgery. A 25 years old woman, with loss of hearing function, disturbed sense of balance, left hemiplegia, difficulties to swallow, on magnetic resonance imaging (MRI) examination had solid lesion in the cerebello-pontine angle size 5,6 cm x 5 cm x 4.5 cm which is diagnosed as Cerebello-pontine angle vestibular schwannoma sinistra. Patient underwent surgical resection in right lateral position under general anesthesia and the surgical resection performed in 6 hour 40 minutes. The goals of anesthetic management in vestibular schwannoma tumor resection are to facilitate ideal surgical condition and provide brain protection by maintaining cerebral perfusion pressure, avoid hemodynamic instability, enable intraoperative neuro-monitoring and ensure the early detection and prompt management of potential complications.

Penatalaksanaan Anestesi Tindakan Bedah Endoskopi Evakuasi Perdarahan Intraserebral karena Stroke Hemoragik Suarjaya, I Putu Pramana; J Sutawan, Ida Bagus Krisna; Sugiharso, Muhammad Aris
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Penatalaksanaan utama perdarahan intraserebral di daerah supratentorial adalah manajemen konservatif dengan penatalaksanaan optimal tekanan darah, penatalaksanaan komplikasi seperti pencegahan kejang, tromboemboli dan peningkatan tekanan intrakranial. Pembedahan untuk evakuasi perdarahan dilakukan bila terjadi penambahan bermakna volume perdarahan intraserebral yang meningkatkan morbiditas dan mortalitas. Prosedur neuroendoskopi saat ini menjadi pilihan karena pendekatan yang invasif minimal dan tingkat keberhasilan yang tinggi, insiden komplikasi lebih rendah, proteksi jaringan otak lebih baik, dan cedera yang berhubungan dengan teknik pembedahan lebih rendah dibanding kraniotomi terbuka. Pasien laki-laki, 44 tahun, obesitas dengan indeks massa tubuh 36,73 kg/m2, riwayat hipertensi, mengalami penurunan kesadaran dan lumpuh separo badan yang terjadi secara tiba-tiba. Pasien dirawat secara konservatif dan mengalami perbaikan sampai kesadaran pulih penuh, dengan gejala sisa hemiparese sinistra dan paresis nervus VII supranuklear sinistra. Pada hari keempatbelas perawatan, pasien didapatkan mengalami penambahan volume perdarahan intraserebral yang bermakna dan dilakukan operasi endoskopi evakuasi perdarahan intraserebral. Manajemen anestesi untuk pasien stroke hemoragik dengan riwayat hipertensi yang menjalani pembedahan neuroendoskopi merupakan tantangan untuk dokter anestesi selama periode perioperatif untuk mampu menyediakan kondisi operasi yang optimal, melakukan upaya proteksi jaringan otak dan menjamin pasien pulih segera dengan baik.Anesthetics Management for Endoscopic Evacuation of Intracerebral Hemorrhage due to Hemorrhagic StrokeAbstractMedical conservative treatment is a mainstay of supratentorial intracerebral hemorrhage management, which include blood pressure and increased intracranial pressure management, as well as seizure and thromboembolic prevention. Surgical intervention is an option if the intracerebral hematoma is expanding significantly and increase morbidity and mortality. Neuroendoscopic procedure is an attractive option which is less invasive and also provides high hemorrhage evacuation rate, low incidence of complication, better protection of brain tissue, and fever surgery-related injuries compared to open craniotomy. In this report, we presented a case of a man 44 years old, obese with body mass index of 36.73 kg/m2, hypertensive, who suffered from intracerebral hemorrhage and underwent endoscopic intracerebral blood clot evacuation. Medical management was done and the patient regained full consciousness, with left hemiparesis and the left supranuclear nerve VII sequelae. Due to the expanding volume of the hematoma, the patient underwent endoscopic surgical blood clot evacuation. Minimally invasive intracerebral blood clot evacuation of expanding hemorrhagic stroke in patient gives the anesthesiologist enormous challenge during the perioperative periods to provide optimal surgical conditions, performing brain protection, and ensure patients have early excellent recovery.

Kejadian dan Manajemen Nyeri Pascaoperasi Bedah Saraf Pediatri di RSUP Prof. I.G.N.G. Ngoerah Denpasar Suarjaya, I Putu Pramana; Muliadi, Win; Hengky, Hengky; Santo, Budi; Yani, Jancolin Yani; Chandra, Steven Okta; J Sutawan, Ida Bagus Krisna
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.544

Latar Belakang dan Tujuan: Nyeri pascaoperasi sangat penting dalam upaya pemulihan dini pascaoperasi. Penelitian observasional ini bertujuan untuk mengetahui kejadian dan manajemen nyeri pascaoperasi bedah saraf pada populasi pediatri di RSUP Prof. I.G.N.G. Ngoerah Denpasar.Subjek dan Metode: Pasien pediatri yang menjalani operasi bedah saraf dilakukan pencatatan data demografis, regimen analgetik pascaoperasi dan penilaian derajat nyeri saat berada di ruang pemulihan, jam ke-6, 12, 24, dan 48 pascaoperasi. Uji Wilcoxon digunakan untuk menilai kemaknaan penurunan derajat nyeri pascaoperasi.Hasil: Penelitian ini yang dilakukan pada 37 pasien pediatri pascaoperasi bedah saraf mendapatkan rerata usia pasien 91 bulan, sebagian besar laki-laki, rerata berat badan 28 kilogram, rerata tinggi badan 115 sentimeter, paling banyak dengan diagnosis hidrosefalus komunikans, paling banyak dilakukan operasi ventrikulo-peritoneal shunt, dengan rerata durasi operasi 165 menit, serta paling banyak dengan teknik anestesi umum. Uji statistik Wilcoxon mendapatkan penurunan bermakna (p0,05) derajat nyeri pasien pediatri pascaoperasi seiring waktu saat berada di ruang pemulihan, jam ke-6, 12, 24, dan 48 pascaoperasi.Simpulan: Manajemen nyeri pascaoperasi bedah saraf pediatri pada subyek penelitian telah berjalan baik, tidak didapatkan adanya pasien mengalami nyeri sedang dan berat pascaoperasi, walaupun modalitas manajemen nyeri yang digunakan beragam.Incidence and Post-Operative Pain Management on PediatricPatients Underwent Neurosurgery at Prof. I.G.N.G. Ngoerah Hospital DenpasarAbstractBackground and Objective: Postoperative pain management is important for early recovery after surgery. This observational study aims to determine the incidence and management of postoperative pain in pediatrics underwent neurosurgery at Prof. I.G.N.G. Ngoerah General Hospital Denpasar.Subject and Methods: Demographic data, postoperative analgesic regimen, and pain score while in the recovery room, on the 6th, 12th, 24th, and 48th hours postoperative were recorded. The decreased in pain score analyzed by Wilcoxon signed-rank test with significant value p0.05 Results: This study which included 37 pediatric patients whom underwent neurosurgery, found patients have average age of 91 months, mostly male, average weight of 28 kilograms, average height of 115 centimeters, with most diagnosis were communicating hydrocephalus, the most performed surgery were ventriculoperitoneal shunt, with average operating time of 165 minutes, and with most anesthetic techniques used were general anesthesia. The Wilcoxon statistical test found a significant (p0.05) decreased in the postoperative level of pain over the time from in the recovery room, on the 6th, 12th, 24th, and 48th hours postoperative.Conclusion: Postoperative pain management in pediatric patients underwent neurosurgery at Prof. I.G.N.G. Ngoerah Hospital, Denpasar was acceptable. There was no subject experiencing moderate and severe postoperative pain.

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