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Tatalaksana Vasospasme Serebral Pasca Perdarahan Subarahnoid Widiastuti, Monika; Rahman, Iwan Abdul; Mafiana, Rose -; Jasa, Zafrullah Khany
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Vasospasme cerebral merupakan penyebab morbiditas dan mortalitas utama pada pasien dengan perdarahan subarahonid. Delayed ischemic neurologic deficit yang berhubungan dengan vasospasme serebral menyebabkan kematian pada 50% pasien yang bertahan pada periode awal setelah aneurisma ruptur yang ditangani. Onset vasospasme serebral yang bervariasi, mulai dari 24 jam pasca perdarahan subarahnoid atau subarahcnoid hemorrhage (SAH) sampai dengan 14 hari, patofisiologi vasospasme serebral yang kompleks dan cara diagnosis yang masih kontroversial, turut berkontribusi terhadap morbiditas dan mortalitas yang tinggi pada pasien dengan SAH. Evaluasi ketat selama perawatan di ICU untuk mendeteksi kejadian vasospasme serebral awal sangat penting, setiap gejala neurologis baru yang muncul harus diperiksa dan ditangani secepatnya. Banyak obat-obatan yang diteliti untuk mengatasi vasospasme serebral namun efektifitasnya masih dipertanyakan. Tatalaksana utama yang dulu diketahui adalah dengan melakukan terapi triple H, namun hal ini sudah ditinggalkan. Induced hypertension menjadi satu-satunya bagian dari terapi triple H yang masih digunakan, namun belum banyak dipergunakan secara luas. Oleh karena itu perlu dikaji lebih lanjut bagaimana tatalaksana SAH untuk mencegah luaran yang buruk.Management of Cerebral Vasospasm after Subarachnoid HemorrhageAbstractCerebral vasospasm is the main etiology of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH) patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The variant onset of cerebral vasospasm, start from 24 hours after SAH up to 14 days after, complex pathophysiology, and the diagnosis of vasospasm has still been met with some controversy, contribute to the high morbidity and mortality in these patients. Vigilance evaluation during ICU care to detect cerebral vasospasm as early as posssible is essential, any new onset of neurological symptoms need to be investigated and treated immediately. Many studies reported some agents for the treatment of cerebral vasospasm, however their roles remain uncertain. Triple H therapy was known as a main treatment for vasospasm, however it is no longer applied nowadays. Induced hypertension become the only part of Triple H therapy used yet it is not well recognized. Therefor, there is a need for thorough evaluation regarding treatment of SAH to prevent poor outcomes.

Diagnosis dan Manajemen Anestesi pada Pituitary Apopleksia Tidak Fatal dengan Manifestasi Schizofrenia Cahyadi, Arief; Rachman, Iwan Abdul; Jasa, zafrullah Khany; Mafiana, Rose
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor hipofisis dapat disertai gejala neuropsikiatri. Apopleksia pituitari (AP) merupakan kejadian jarang akibat infark dan perdarahan tumor hipofisis. Pemulihan total masih mungkin terjadi walaupun pada kasus berat dengan terapi pembedahan maupun konservatif. Terapi pembedahan dipilih bila adanya tanda peningkatan intrakranial dengan kondisi klinis dan neurologis yang tidak stabil. Seorang laki laki, umur 36 tahun dengan keluhan gangguan bicara mendadak sehari sebelum masuk RS, dengan riwayat terapi skizofrenia selama 8 bulan. Pasien mengalami penurunan kesadaran dalam perawatan dan didiagnosis tumor hipofisis anterior dengan komponen apopleksia dari CT-scan kepala. Pasca operasi transphenoid urgensi diterapi vasopresin intramuskular akibat poliuria. Penatalaksanaan anestesi pada pembedahan AP tidak berbeda dengan tumor hipofisis lainnya, hanya saja kondisi AP dapat bersifat urgensi. Satu bulan pasca pembedahan, pasien sudah lebih mudah berbicara, mulai beraktifitas fisik, dan halusinasi suara sudah tidak ada. Tatalaksana AP memberikan tantangan dalam manajemennya. Keluhan yang ditemukan dapat berupa halusinasi. Hingga kasus ini dilaporkan, ada satu publikasi kasus AP dengan psikosis akut dan keterlambatan diagnosis masih mungkin terjadi. Kecurigaan gangguan organik tetap perlu dipikirkan pada gangguan neuropsikiatri. Gangguan produksi urin bisa terjadi pasca operasi yang disebabkan beberapa hal sehingga memerlukan pemantauan ketat status hidrasi untuk menghindari morbiditas dan mortalitas yang mungkin terjadi.Anesthesia Management in Urgency Transsphenoidal Tumor Resection with Pituitary Apoplexy Presenting and SchizophreniaAbstractPituitary tumors may be accompanied by neuropsychiatric symptoms. Pituitary Apoplexy (PA) is a rare condition due to infarct or bleeding in pituitary tumors. Complete recovery is still possible even in severe cases with either surgical or conservative therapy. Surgery is a choice if there is evidence of increased intracranial pressure with unstable clinical and neurological conditions. Adult man, 36 yo, with sudden difficulty to speak a day before, with history of schizophrenia since 8 months ago. The patient suffered a decrease in consciousness in hospitalization and was diagnosed with anterior hypophysis tumor with apoplexy by CT-scan results. Post transsphenoidal urgency surgery, the patient was treated with vasopressin IM due to polyuria. Anesthesia management in PA surgery is the same as other pituitary tumor surgery, however, PA can be urgent. One month after surgery, the patient is more easier to talk, start physical activities, and auditory hallucination is not heard again. Management PA had its own challenge. Symptoms can be hallucinations. Until this case was reported, there was one published case of AP with acute psychosis and delay in diagnosis is still possible. Suspicion of organic disorders still needs to be considered in neuropsychiatric disorders. Impaired urine production might occur postoperatively due to several reasons so it requires close monitoring of hydration status to prevent possible morbidity and mortality.

Manajemen Anestesi pada Pasien dengan Tetraparese yang dilakukan Reseksi Tumor Cervikal Ekstradural (C1-3) Jasa, Zafrullah Khany; Utami, Niken Asri; Arief, Hafizh
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (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.v11i1.462

Tumor ekstradural servikal merupakan salah satu tumor yang jarang dijumpai dan dapat menimbulkan permasalahan neurologis yang progresif. Defisit neurologis pada pasien usia produktif sangat berpengaruh terhadap kualitas hidup pasien. Tatalaksana pembedahan dilakukan bertujuan mengurangi nyeri, perbaikan kondisi neurologis, serta meningkatkan kualitas hidup pasien. Perempuan 25 tahun mengalami tetraparese yang progresif sejak 2 bulan sebelum masuk ke rumah sakit, MRI menunjukkan massa ekstradural yang menekan medula spinalis setinggi level vertebra servikalis 13. Pasien dilakukan operasi dengan prinsip neuroanestesi. Pascaoperasi, fungsi kekuatan motorik mengalami perbaikan yang signifikan. Telah dilakukan operasi pengangkatan tumor ekstradural pada pasien wanita dewasa dengan perdarahan 850 cc dan terjadi peningkatan fungsi motorik pada kedua ekstrremitas superior dan inferior pascaoperasi. Diperlukan manajemen perioperatif yang baik pada pasien dengan tumor spinal terutama pada daerah servikal. Antisipasi perdarahan dan trauma medula spinalis iatrogenik yang dapat selama tindakan operatif berlangsung. Evaluasi neurologis dan rehabilitasi pada pasien dilakukan dengan melibatkan tim multidisiplin. Tumor ekstradural merupakan salah satu jenis tumor spinal dengan yang bila dilakukan tindakan bedah saraf pada waktu yang tepat dan perioperatif anestesi yang baik dapat memperbaiki fungsi neuorologis dan luaran pascaoperasi.Anesthesia Management of Patient with Tetraparese underwent Cervical Extradural Tumor (C1-3)AbstractCervical extradural tumor is one of the rare tumors and can cause progressive neurological problems. Neurological deficit in productive age greatly affects the patient's quality of life. Surgical management is carried out with the aim of reducing pain, improving neurological conditions, and improving the patient's quality of life. A 25-year-old woman had progressive tetraparesis since 2 months prior to admission, MRI showed an extradural mass compressing the spinal cord at the level of the C1-3. The surgery was performed under the principles of neuroanaesthesia. On postoperative assessment, motor strength function has improved significantly. A extradural tumor patient was excision by operation with 850 mm bleeds and good recovery with improvement motoric function in all extremities Good perioperative management is needed in patients with spinal tumors, especially patient with tumors on the cervical levels. The anticipation of iatrogenic spinal cord trauma and bleeding has to be maintained during the surgery. Neurological evaluation and rehabilitation of patients is carried out by involving a multidisciplinary team. Spinal cord tumour with excise in neurosurgery at the right time and good perioperative neuroanesthesia will good outcome and improve neurologicals deficit.

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)
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.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).

Assessment of serum electrolytes, nutritional status, and oxygen saturation among athletic Senior High School students Muhammad, Insyirah; Dimiati, Herlina; Jasa, Zafrullah Khany
AcTion: Aceh Nutrition Journal Vol 10, No 2 (2025): June
Publisher : Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30867/action.v10i2.2447

Adolescent athletes have a higher risk of dehydration than adult athletes do. This increased risk results from the greater absorption of environmental heat and heightened body heat, which affects electrolyte balance and oxygen saturation. This study aimed to analyze electrolyte values and oxygen saturation in students at SMA Keberbakatan Aceh in 2024 using an observational analytical approach with a cross-sectional design. A total of 43 respondents were selected for this study. The intensity of physical exercise was assessed using the International Physical Activity Questionnaire (IPAQ) score, of which two respondents had hyponatremia, 40 had normal sodium levels, and one respondent had hypernatremia related to the intensity of physical exercise (p= 0,381). Potassium levels were not significantly affected, as all 43 respondents had normal potassium levels (p= 0,740). Regarding chloride levels, one respondent had hypochloremia, 40 had normal levels, and two had hyperchloremia. While previous results showed no effect, exercise intensity was found to have a significant influence on respondents’ nutritional status (p= 0,034). All respondents maintained levels within normal limits in the assessment of oxygen saturation. Conclusion: Physical exercise intensity had no significant effect on serum electrolytes or oxygen saturation levels. However, a significant relationship was observed between the physical exercise intensity and nutritional status.

Comparison of Fentanyl and Tramadol on Pain Sensitivity in Rat Model of Traumatic Barin Injury Deswita, Rinda; Jasa, Zafrullah Khany; Rahmi, Rahmi
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Background:Â Traumatic Brain Injury (TBI) is intracranial tissue damage caused by mechanical processes originating from outside that cause structurally and functionally brain damage. After TBI, these animals often exhibit exaggerated responses to otherwise mild pain stimuli, a condition mimicking chronic pain observed in human TBI patients.Methods:Â This laboratory experimental study used a pretest-posttest control group design. A traumatic brain injury (TBI) rat model was created using the Feeney weight drop method. Rats received intravenous fentanyl or tramadol every 8 hours for three days. Pain thresholds were measured before and at 1, 6, 24, and 72 hours, and 7 days after TBI.Results:Â Pain sensitivity peaked at 6 and 24 hours post-trauma, with the control group showing a significant drop in Von Frey test scores. In contrast, the fentanyl and tramadol groups showed gradual improvement from 6 hours, with stable recovery by 72 hours. By day 7, both treatment groups returned to near-baseline sensitivity, while the control group remained impaired. Statistical analysis showed a significant difference between control and intervention groups (p < 0.05).Â Conclusion:Â Both fentanyl and tramadol improved pain sensitivity in the early phase after TBI and restored thresholds close to baseline state before TBI while the control group did not.Â Â

Perbandingan Capaian Kedalaman Anestesi dengan Konduksi Ketamin dan Fentanyl pada Anestesi Umum di RSUD Dr. Zainoel Abidin Banda Aceh Burhanuddin, Burhanuddin; Jasa, Zafrullah Khany; Rahmi, Rahmi
Jurnal Anestesi Perioperatif Vol 13, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v13n2.4457

Kedalaman anestesi yang memadai untuk mencegah komplikasi intraoperatif, termasuk intraoperative awareness. Ketamin dan merupakan obat koinduksi yang umum digunakan, namun keduanya memiliki profil hemodinamik dan efek terhadap kedalaman anestesi yang berbeda. Penelitian ini bertujuan membandingkan efek koinduksi ketamin dan fentanil terhadap kedalaman anestesi dan stabilitas hemodinamik menggunakan bispectral index score (BIS). Penelitian merupakan uji klinis acak tersamar tunggal terhadap 44 pasien yang menjalani anestesi umum di RSUD dr. Zainoel Abidin Banda Aceh periode April–Mei 2025. Subjek dibagi menjadi dua kelompok, yaitu ketamin 0,5kg/BB (n=22) dan fentanil 2 μg/kgBB (n=22). Parameter BIS, tekanan darah diastol, sistol laju jantung, laju napas dan SpO2 diukur pada menit ke-0, 5, 10, 15, dan 20 pascainduksi. Hasil menunjukkan bahwa ketamin menurunkan BIS lebih cepat dan lebih dalam, dengan perbedaan bermakna signifikan pada menit ke-5 (p=0,002), 15 dan 20 (p<0,001). Ketamin juga mempertahankan tekanan darah lebih stabil, sedangkan fentanil meningkatkan laju jantung lebih tinggi pada menit ke-10 (p=0,032). Tidak terdapat perbedaan bermakna pada laju napas dan SpO2. Ketamin lebih unggul dalam mencapai kedalaman anestesi yang cepat dan stabil secara hemodinamik, dibanding dengan fentanil.

A Descriptive Study of Knowledge, Attitude, and Awareness of Basic Life Support Among the Students of the Faculty of Veterinary Medicine Jasa, Zafrullah Khany; Putra, Teuku Romi Imansyah; Al-Mathari, Alif; Farhana, Rika; Zulkifli, Baidillah
The International Journal of Tropical Veterinary and Biomedical Research Vol 8, No 2 (2023): Vol. 8 (2) November 2023
Publisher : The Faculty of Veterinary Medicine of Syiah Kuala University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21157/ijtvbr.v8i2.35835

Basic life support (BLS) is a first-aid measure performed to restore vital organ functions in cardiac or respiratory arrest patients. This research was conducted on the students of the Veterinary Medicine Faculty in the 2018th and 2019th entry years from November 15th 30th, 2021. This study was a descriptive observational study using a cross-sectional research design. Two hundred two respondents in this study were selected by stratified random sampling. Data from respondents were collected using an online questionnaire via Google Forms. The results of this study indicated that most respondents were 20 years old (46.5%), female (65.8%), and the number of respondents from each generation was the same. The data analysis of the respondents' basic life support showed that they possessed a minimal level of knowledge (60.9%), good attitude (66.8%), and good awareness (56.9%). According to these findings, most students had positive attitudes and awareness of basic life support. The aspect of knowledge about basic life support practices among these students falls into the poor category; therefore, there is a need to step up the socialization and training process.

Optimizing pediatric anesthesia: A randomized controlled trial comparing oral gabapentin and lorazepam on intubation-induced hemodynamic responses Munawar, Emil; Riswandi; Jasa, Zafrullah Khany
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 16, No 3, (2025)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol16.Iss3.art7

Background: Endotracheal intubation in pediatric patients undergoing elective surgery can trigger hemodynamic response, including increased blood pressure and heart rate, due to sympathetic stimulation. Premedication is required to attenuate these responses. However, the comparative effectiveness of gabapentin and lorazepam remains to be investigated.Objectives: This study aims to evaluate and compare the effects of gabapentin and lorazepam premedication on blood pressure and heart rate during tracheal intubation in pediatric patients.Methods: This randomized controlled clinical trial involved 64 pediatric patients undergoing elective surgery. They were divided into two groups: the gabapentin group (15 mg/kg) and the lorazepam group (0.025 mg/kg). Hemodynamic parameters were measured before and after intubation. Results: The study results showed that the gabapentin group had lower systolic blood pressure, diastolic blood pressure, and mean arterial pressure (MAP) compared to the lorazepam group after intubation (p<0.05). Gabapentin was also more effective in maintaining blood pressure stability than lorazepam, while both groups showed comparable heart rate parameters (p > 0.05).Conclusion: Gabapentin premedication is more effective in suppressing the surge in blood pressure caused by intubation than lorazepam, while lorazepam is more significant in reducing heart rate. Overall, gabapentin may be a more optimal premedication option for maintaining hemodynamic stability in pediatric patients undergoing elective surgery.

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