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Penanganan Ventilasi Pascaoperasi pada Penderita Tumor Intradural Ekstradural Medula Spinalis Servikal 1-3: Sebuah Laporan Kasus Syahril, Chandra Patrya Putra; Tri C, Rizky Rahmad; Anindita, Eliezer Iswara; Harahap, M Sofyan
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.572

Pendahuluan: Reseksi bedah tumor sumsum tulang belakang dapat menimbulkan tantangan yang signifikan dalam manajemen jalan napas. Sebagian besar pasien yang menjalani reseksi tumor sumsum tulang belakang dikelola melalui intubasi endotrakeal, nafas kendali selama operasi, dan bantuan ventilasi pascabedah. Kasus: Perempuan 43 tahun datang dengan mengeluh nyeri leher belakang dirasakan menjalar sampai dengan kedua telapak kanan terutama sisi kiri, kemudian pasien mengeluh kelemahan semua anggota gerak yang dirasakan sepanjang hari dan membuatnya kesulitan untuk beraktivitas sehari-hari. Rasa kesemutan dirasakan dari kedua ujung jari kaki hingga ke leher depan. Pasien menjalani operasi kraniotomi far lateral approach sisi kiri dan eksisi tumor, operasi berlangsung selama 7 jam 30 menit dengan hemodinamik yang stabil selama anestesi dan pembedahan. Pascaoperasi dilakukan bantuan pernapasan dengan ventilator di ICU dan dilakukan pengecekan laboratorium darah rutin, blood gas arterial (BGA) dan elektrolit. Setelah hari ke dua pipa endotrkeal dapat dilepas dan pasien kembali ke ruangan biasa. Pasien pulang pada hari kelima dan kontrol rawat jalan. Diskusi: Manajemen anestesi pada kasus tumor medula spinalis servikal, membutuhkan perhatian khusus, terutama bantuan ventilasi pasca operasi. Dengan pemantauan yang baik dan penyesuaian ventilasi sesuai kebutuhan, pasien dapat segera disapih dari ventilator. Kesimpulan: Penatalaksanaan anestesi pada pasien yang menjalani operasi tumor sumsum tulang belakang bersifat kompleks. Diperlukan pemahaman lengkap tentang jenis tumor, lokasi, dan efek massa dalam manajemen ventilasi pada pasien paska operasi tumor medulla spinalis.Postoperative Ventilation Management in Patients with Cervical Spinal Cord Intradural and Extradural Tumors 1-3 : a Case ReportAbstractIntroduction : Surgical resection of spinal cord tumors can pose significant challenges in airway management. Most patients undergoing spinal cord tumor resection are managed via endotracheal intubation, controlled ventilation during surgery and post operative ventilation support. Case: A 43 year old woman came in complaining of back neck pain that spread to both right palms, especially the left side, then the patient complained of weakness in all limbs felt throughout the day and making it difficult for her to carry out daily activities. A tingling sensation is felt from the tips of the toes to the front of the neck. The patient underwent a left-sided far lateral approach craniotomy and tumor excision, the operation lasted 7 hours 30 minutes with stable hemodynamics during anesthesia and surgery. Post-operatively, ventilation was supported with a ventilator in the ICU and laboratory checks were carried out including routine blood, arterial blood gas (BGA) and electrolytes. After the second day the endotrcheal tube can be removed and the patient returns to the normal room. The patient went home on the fifth day and was outpatient control. Discussion: Anesthetic management in cases of cervical spinal cord tumors requires special attention, especially postoperative ventilation assistance. With good monitoring and ventilation adjustments as needed, patients can be quickly weaned from the ventilator. Conclusion: Anesthetic management in patients undergoing surgery for spinal cord tumors is complex. A complete understanding of tumor type, location, and mass effect is needed in ventilation management in post-operative spinal cord tumor patients.

Dexmedetomidine Administration does not Affect Electrocorticography Reading during Epilepsy Focal Removal Surgery Nauli, Anggarian Oloan; Harahap, M Sofyan
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.591

Epilepsy prevalent across all ages and genders, making it one of the most widespread neurologic disorder. Worldwide, 20-40% of epilepsy patients are refractory or resistant to oral anti-epileptic drugs, requiring surgery to treat their seizures. The use of electrocorticography (ECoG) can help determine the focus of epilepsy and requires anaesthetic drugs that do not affect the electroencephalography (EEG) readings during surgery. The aim of this case was to study the effect of using dexmedetomidine (DEX) as additional to maintenance anesthesia in epileptic craniotomy surgery with ECoG. A 28-year-old man came to the hospital with complaints of recurrent seizures, generalized tonic-clonic type seizures that lasted 2-3 minutes, was unconscious during the seizure, fell asleep afterwards, and recurred 2-3 times a day. The patient had suffered from epilepsy since 4 years ago. Physical and supporting examinations were within normal limits. Head MSCT examination with contrast suspected oligodendroglioma. The patient was administered dexmetomidine while underwent epilepsy craniotomy surgery with ECoG to remove the tumor which was suspected to be the epileptic focus. The choice of anesthetic agent in epilepsy craniotomy, especially when involving ECoG modalities, requires special consideration to improve intraoperative quality and postoperative outcomes. Propofol is the most widely used induction agent. However, these agents have anticonvulsant effects and activate non-specific spike waves in large areas of the brain. This has the potential to interfere with spike wave monitoring with ECoG. The use of dexmedetomidine has been shown to produce a stable hemodynamic effect and does not affect the ECoG readings. The use of DEX as an adjuvant in anesthesia maintenance does not inhibit spike waves during surgery, so ECoG can be used effectively for anesthesia in craniotomy operations with ECoG

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.

Kombinasi Dexmedetomidine Sevoflurane 0,5 MAC pada Bedah Mikro Reseksi Malformasi Arteri-Vena Tjahyanto, Adhy; Samdani, Ibnu Siena; Harahap, M Sofyan
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
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Malformasi arterivena (MAV) merupakan kasus yang jarang terjadi, terutama pada usia muda (40 tahun). Usaha untuk menjaga kestabilan hemodinamik dan pencegahan perdarahan masif selama reseksi bedah mikro MAV adalah hal yang harus dikuasai oleh seorang ahli anestesi. Total Intra Venous Anesthesia dengan propofol masih populer untuk mengendalikan tekanan intrakranial karena mudah dititrasi dan agen kerja cepat (baik onset maupun durasi). Penilaian status neurologis umum segera setelah anestesi dihentikan juga termasuk komponen penting dalam pembedahan mikro reseksi MAV otak. Pada kasus ini, dilaporkan seorang wanita berusia 20 tahun yang mengalami penurunan kesadaran dan hemiparesis sinistra mendadak. Hasil angiografi otak menunjukan adanya MAV di lobus frontal dekstra. Tindakan reseksi MAV dilakukan dengan pembedahan mikro. Setelah 5-menit-preoksigenasi dilakukan, induksi anestesi menggunakan propofol, fentanil, rocuronium, dan sevoflurane. Sepuluh detik proses intubasi tidaklah menimbulkan gejolak hemodinamik. Pembedahan berlangsung lancar dengan kombinasi dexmedetomidine-sevoflurane 0,5MAC. Hemodinamik pasien pasca-anestesi stabil dan tanpa lesi neurologis baru.A Combination of Dexmedetomidine Sevoflurane 0.5MAC in Microsurgical Resection of Arteriovenous Malformation: a Case ReportAbstractArterio-venous malformation (AVM) is a rare case, particularly among young patients (40 years old). Maintaining haemodynamic stability and anticipating massive haemorrhage during micro surgery resection of AVM are fundamental for an anaesthetist. Total Intra Venous Anesthesia using propofol is still popular to control intracranial pressure as it is easily titrated and fast acting agent (both in onset and duration). Moreover, general neuruologic evaluation soon after anesthesia terminated is an integral important component of microsurgery of brain MAV. In this case report: a 20-year-old woman suddenly lost her consciousness and left-sided motors strength. Brain angiographic revealed an AVM in right frontal lobe. Microsurgery of brain AVM resection was performed. After 5-minute-preoxygenation, anaesthetic induction was performed by using propofol, fentanyl, rocuronium, and sevoflurane. The surgery went successfully using a combination of dexmedetomidine-sevoflurane 0.5MAC. Post-anaesthesia hemodynamic of this patient was in stable and without new neurologic deficit afterward.

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

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

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