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Penerapan Enhanced Recovery after Surgery (ERAS) pada Bedah Saraf Firdaus, Riyadh; Permana, Affan Priyambodo; Sugianto, Astrid Indrafebrina; Theresia, Sandy
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3040.941 KB) | DOI: 10.24244/jni.v10i2.326

Abstract

Enhanced recovery after surgery atau ERAS adalah suatu protokol perawatan perioperasi terstandar multidisiplin pada pasien bedah yang bertujuan untuk meminimalkan stres perioperasi sehingga menghasilkan luaran yang lebih baik. Protokol ERAS tersusun dari berbagai komponen perawatan yang terbukti mendukung pemulihan dan/atau menghindari komplikasi pascaoperasi. Komponen-komponen tersebut mengikutsertakan ahli bedah, ahli anestesi, perawat, farmasi, ahli gizi yang terlibat dalam perawatan pasien sehingga memberikan perbaikan yang lebih baik. Protokol ERAS tersusun dari berbagai komponen perawatan dari mulai praoperasi (konseling, pemberian nutrisi, pengelolaan kebiasaan, trombofilaksis, persiapan daerah operasi dan profilaksis antimikroba), intraoperasi (teknik anestesi, manajemen anestesi, analgesia, manajemen cairan, pengaturan suhu, teknik pembedahan) hingga pascaoperasi (kejadian post-operative nausea and vomiting (PONV), drainase urin, asupan nutrisi, mobilisasi dini). Penerapan ERAS menunjukkan hasil yang baik, dapat diterapkan, dan memberikan keuntungan bagi pasien bedah saraf. Walau demikian, protokol ERAS dalam bedah saraf masih sangat terbatas dan memerlukan penelitian lebih lanjut mengikuti berbagai jenis tindakan/operasi dan keadaan pasien yang berbeda-beda.Implementation of Enhanced Recovery after Surgery (ERAS) in NeurosurgeryAbstractEnhanced recovery after surgery (ERAS) is a multidisciplinary standardized perioperative treatment protocol in surgical patients that aims to minimize perioperative stress and result in better outcomes. The ERAS protocol is composed of various components of care that have been shown to support recovery and/or avoid postoperative complications. These components include surgeons, anesthesiologists, nurses, pharmacists, nutritionists who are involved in patient care to provide better improvements. The ERAS protocol is composed of various components of preoperative care (counseling, nutrition, lifestyle management, thromboprophylaxis, preparation of the surgical area and antimicrobial prophylaxis), intraoperative care (anesthetic technique, anesthesia management, analgesia, fluid management, temperature regulation, surgical technique) and postoperative care (PONV management, urinary drainage, nutritional intake, early mobilization). Implementation of ERAS is applicable and shows good results along with the benefits for patients undergoing neurosurgery. However, ERAS in neurosurgery is still very limited and requires further research following different types of procedures / operations and different patient conditions.
Rekomendasi Sistem Stroke Pendekatan 8D dalam Penanganan Stroke Iskemik Akut Permana, Affan Priyambodo; Nafisah, Zharifah Fauziyyah; Mesiano, Taufik; Yunus, Reyhan Eddy; Sulistio, Septo; Habib, Hadiki; Mulyana, Radi Muharris; Albar, Imamul Aziz
Majalah Kedokteran Indonesia Vol 71 No 1 (2021): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.71.1-2021-162

Abstract

Stroke is the leading cause of death in Indonesia and leading cause of long-termdisability in the world. Ischemic stroke include 85% of all stroke cases. Ischemic stroke is caused by thromboembolic blockage or arterial stenotic by atherosclerotic plaque. Current practice shows that ischemic stroke can be treated. Treatment using intravenous thrombolytic (IV-tPA) and mechanical thrombectomy will provide better outcomes for the patient. It can be achieved when treated kurang dari 4.5 hours since onset for IV-tPA and kurang dari 6-24 hours for large vessel occlusions using mechanical thrombectomy. However, only a small number of patients can achieve this treatment due to lack of society knowledge about the sign and symptoms, transportation problems, and the stroke management system that has not been well established. Every one minute stroke patient is left untreated, 1.9 millions neurons in the brain are dead. An integrated management of the stroke system can provide better outcomes, lower the length-of-stay of the patients in hospital and reduce the cost spent for treatment. One system that is recommended for managing stroke cases is 8D that consist of detection, dispatch, delivery, door, data, decision, drug/device, and disposition. This system will help health care providers to collaborate through a multidisciplinary system for managing acute ischemic stroke cases comprehensively so that stroke patients can get proper handling and better outcomes.