Laksono, Buyung Hartiyo
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia

Published : 26 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 26 Documents
Search

Anestesi untuk Pengangkatan Meningioma Suprasella dengan Pendekatan Supraorbita Hadinata, Yudi; Isngadi, M.; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (316.681 KB) | DOI: 10.24244/jni.vol2i3.158

Abstract

Anestesi pada kasus meningioma memiliki beberapa hal yang harus diperhatikan. Otak merupakan jaringan yang tertutup oleh tulang kranium dan memiliki jaringan pembuluh darah yang banyak sehingga beresiko untuk terjadinya pendarahan dan edema. Kondisi jaringan otak yang rileks dibutuhkan ketika akan dilakukan operasi otak melalui insisi kecil supraorbita. Tanpa penanganan anestesi yang baik maka ahli bedah saraf akan kesulitan untuk melakukan pendekatan pada tumor dan meningkatkan resiko edema otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien wanita usia 44 tahun datang dengan keluhan nyeri kepala hebat dan pusing dirasakan sejak 8 bulan sebelum masuk rumahsakit, mengalami periode kejang selama 12 menit, terjadi kurang lebih 1x/bulan, penglihatan pada mata kanan buram. Pasien didiagnosa dengan meningioma suprasellar, dan direncanakan dilakukan pembedahan dengan pendekatan subfrontal. Status fisik ASA 3 dengan riwayat asma, riwayat sepsis karena pneumonia dan infeksi saluran kemih, riwayat Steven Johnson karena phenytoin, leukositosis 10.570, defisit neurologis. Pasien dilakukan tindakan anestesi umum dengan intubasi. Induksi dengan midazolam, fentanyl, lidokain, propofol, dan vecuronium. Operasi dengan pendekatan supraorbita berlangsung selama 10 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif (Intensive Care Unit/ICU) selama 2 hari sebelum pindah ruangan. Kontrol faktor fisiologi dan perlakuan anestesi yang dilakukan selama operasi memiliki pengaruh kepada jaringan otak. Lebih lanjut lagi, seorang dokter anestesi harus memiliki pengetahuan tentang berbagai macam efek obat untuk mencapai hal tersebut dan mengetahui kondisi premorbid pasien yang dapat mempengaruhinya.Anesthesia Management for Suprasella Meningioma Removal with Supraorbital Approach Anesthesia for meningioma presents special considerations. The brain is enclosed in a rigid skull and the brain is a highly vascular organ presenting potential for massive perioperative hemorrhage and edema. A slack brain is necessary when treating neoplastic lesions through the small supraorbital approach. Without optimal anesthesia care, the neurosurgeon can not reach the operative site and the risk of brain edema due to extensive brain manipulation is increased. This case reports a 44 years old woman with severe headache and dizziness for 8 months prior to admission she suffers from 12 minutes periods of seizure once a month, and experienced a blured vision on her right eye. She was diagnosed with suprasellar meningioma, which will be removed with supraorbital surgical approach. ASA 3rd was confirmed with history of status asthmaticus, septic condition due to pneumonia and urinary tract infection, history of Steven-Johnson syndrome due to phenytoin, leucocytosis of a count of 10.570, and neurological deficits general anesthesia was performed. Induction of anesthesia was done using midazolam, fentanyl, lidocaine, propofol and vecuronium. The surgery for meningioma was conducted within 10 hours. Patient was managed in the Intensive Care Unit post operatively for 2 days prior to ward transfer. Physiologic and anesthetics factors controlled by the anesthesiologist have profound effects on the brain. Furthermore, anesthesiologists are required knowledge of the effects of various drugs on the issues mentioned above and patient conditions.
Tehnik Proteksi Otak pada Pembedahan Non Neurosurgery (Radical Neck Dissection) dengan Premorbid Space Occupying Lesion (SOL) dan Infark Serebri Laksono, Buyung Hartiyo; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2391.959 KB) | DOI: 10.24244/jni.vol3i3.144

Abstract

Insidensi kasus tumor dengan metastase otak berkisar antara 100.000 sampai 170.000 pertahun. Metastase otak bersifat multiple dengan 80% terletak pada hemis ferserebri. Pendesakan akibat lesi tersebut mengakibatkan gangguan neurologis dan peningkatan tekanan intrakranial (TIK). Seorang laki-laki, 62 tahun dengan tumor sub mandibula direncanakan radical neck dissection. Pada pasien didapatkan proses metastase pada serebri dan cerebropontine angle disertai infark serebri daerah pons dan otak tengah. Defisit neurologis berupa kelemahan ekstremitas kanan dan disartria. Preoperatif diberikan kortikosteroid untuk menurunkan edema perifokal. Tatalaksana anestesi dengan prinsip tehnik proteksi otak, dilakukan induksi kombinasi dengan midazolam, fentanyl, lidokain, propofol dan rocuronium. Kontrol ventilasi target paCO2 3035 mmHg. Pemeliharaan anestesi dengan kombinasi sevofluran dan propofol. Pembedahan berjalan 7 jam, temperature selama pembedahan 3536 C dan MAP dijaga 70 mmHg. Dilakukan ekstubasi, setelah menilai status neurologis dan hemodinamik, difasilitasi dengan lidokain. Pascabedah tidak didapatkan perburukan defisit neurologis. Pasien dirawat di ICU selama 2 hari kemudian ke ruangan dengan perbaikan status neurologis. Tehnik proteksi otak bertujuan mencegah cedera sekunder dari SOL dan iskemia. Tindakan anestesi dan pembedahan dapat menambah perburukan cedera sekunder. Penatalaksanaan anestesi yang baik dengan prinsip proteksi otak akan menghasilkan outcome pembedahan sesuai yang diharapkan. Brain Protection Technique in Non Neurosurgical Procedure (Radical Neck Dissection) on a Patient with Space Occupying Lession (SOL) and Cerebral InfarctionThe incidence of tumors with brain metastases ranged from 100,000 to 170,000 per year. Brain metastases are multiple with 80% of lesion located on the cerebral hemispheres. These lesions could cause neurological disorders and increase intracranial pressure (ICP). A 62 years old male, diagnosed with sub mandibular tumour was scheduled for radical neck dissection. From preoperative evaluation he hadcerebral metastasis at the cerebrum and cerebro-pontine angle with cerebral infarction at pons and middle brain regions. Neurological deficits were weakness of the right limband dysarthria. The patient received corticosteroids pre-operatively to reduce perifocal edema. Anesthesia management was given using brain protection principles. Induction was done by using midazolam, fentanyl, lidocaine, propofol and rocuronium. Ventilation was controlled with a target PaCO2 of 3035 mmHg. Sevoflurane and propofol was given as anesthesia maintenance. Surgery was done for 7 hrs, temperature was 3536 C during surgery and MAP was maintained 70 mmHg. Extubation was done after assessing the neurologic and hemodynamic status,facilitated with lidocaine. There was no worsening of neurologic deficits post surgery. Patients was managed in the ICU for 2 days and transferred to ward with increased neurological state. The technique of brain protection aims to prevent further process of secondary injury from SOL and ischemia. Anesthesia and surgery itself could increase the progression of secondary injury. Anesthesia management usingbrain protection principles will provide better outcomes as expected.
Pembedahan Tumor Cerebellopontine Angle: Tehnik Proteksi Otak, Pengawasan Sistem Kardiorespirasi dan Efek Manipulasi Posisi True Lateral Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3849.096 KB) | DOI: 10.24244/jni.v8i3.217

Abstract

Tumor cerebellopontine angle (CPA) merupakan jenis neoplasma terbanyak yang ditemukan di fossa posterior. Wanita 32 tahun dengan diagnosa CPA tumor dilakukan pembedahan trepanasi reseksi. Posisi pembedahan true lateral. Tehnik anestesi proteksi otak menggunakan kombinasi total intra vena (TIVA) dan inhalasi. Dilakukan pemasangan pengawasan invasif untuk memantau perubahan sistem kardiorespirasi selama pembedahan. Dilakukan pencegahan dan pemantauan terhadap akibat dari posisi pembedahan. Hasil dari pembedahan didapatkan pengurangan skala nyeri dan peningkatan fungsi neurologis. Tindakan pembedahan pada tumor di daerah CPA merupakan tindakan pembedahan yang sulit dan dapat menimbulkan komplikasi yang fatal. Pengelolaan anestesi untuk tindakan bedah fossa posterior memerlukan pertimbangan yang matang dan sudah ditentukan sebelum dilakukan anestesi. Persiapan pada pasien dengan lesi fossa posterior adalah evaluasi prabedah, premedikasi, induksi, posisi durante, pengelolaan anestesi dan monitoring. Manipulasi selama pembedahan pada batang otak dan saraf kranialis akan menimbulkan akibat pada sistem kardiorespirasi dan dapat fatal. Posisi true lateral mempunyai resiko tersendiri terhadap pasien selama dan pascapembedahan, hal tersebut harus menjadi perhatian khusus oleh ahli anestesi. Anestesi mempunyai peranan yang sangat penting dalam manajemen secara keseluruhan pada pasien ini untuk memberikan manajemen proteksi otak yang maksimal selama pembedahan sehingga memperoleh hasil akhir pembedahan yang sukses.Cerebellopontine Angle Tumor Surgery: Brain Protection Techniques, Cardiorespiratory System Monitoring and True Lateral Position Manipulation EffectsAbstractCerebellopontine angle (CPA) tumors are the most common neoplasm found in the posterior fossa. A 32-year-old woman diagnosed with CPA tumor underwent resection. The surgery position is true lateral. Brain protection anesthetic techniques use total intravenous (TIVA)-inhalation combination. Invasive monitoring is performed to monitor the cardiorespiratory system during surgery. Prevention and monitoring are done to manage the effect of surgical position. There is a reduction in pain scale and increased neurological function after the surgery. CPA tumor surgery is a difficult procedure and potentially cause fatal complications. The anesthesia management for posterior fossa surgery must be determined before anesthesia. The surgery preparation for posterior fossa lesions-patients consists of surgery evaluation, premedication, induction, durante position, anesthesia management, and monitoring. The brainstem and cranial nerve surgery cause a fatal complication in the cardiorespiratory system. The true lateral position impact the patients' condition during and after surgery. Anesthesia is important to provide maximum brain protection and successful surgery.
Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray Laksono, Buyung Hartiyo; Hartono, Ruddi; Tamam, Abdul Rasyid; Jaya, Wiwi
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.01

Abstract

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units.Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test.Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters.Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.
Perioperative Management of Neuroanesthesia in Patients with Supratentorial Tumors Who Have Excised Tumors Using Neuroprotection Technique and Total Intravenous Anesthesia Aditiarso, Candra; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol. 5 No. 2 (2024): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.02.04

Abstract

Background: Neuroanesthesia management presents a unique challenge for anesthesiologists. They must provide an optimal surgical condition without worsening the patient's neurological deficits. Therefore, we need drugs with neuroprotective abilities. This case report explains the perioperative management of neuroanesthesia in patients with supratentorial tumors who have excised tumors using a neuroprotection technique and total intravenous anesthesia (TIVA).Case: A 43-year-old female patient with space-occupying process cerebri with the differential diagnosis of meningioma frontotemporal dextra, post trepanation frontal sinistra tumor excision, edema cerebri, and hydrocephalus on ventriculoperitoneal shunt. On physical examination, Glasgow coma scale E3M6Vaphasia, aphasia and left hemiparesis were found. She underwent a tumor excision procedure with total intravenous anesthesia modified with neuroprotection techniques and total intravenous anesthesia techniques using 300 mg thiopental, 2 mg midazolam, 150 µg fentanyl, 80 mg lidocaine, and 50 mg rocuronium. Intraoperative anesthesia management was carried out by administering propofol 50 mg/hour, fentanyl 50 µg/hour, and atracurium 15 mg/hour.Conclusion: Total intravenous anesthesia is a complete general anesthesia method used in all intravenous agents, where the benefits of this method are used in neurosurgery, including accelerating the patient's return from the effects of anesthesia, faster recovery of cognitive function, as well as reducing intracranial pressure and the risk of ischemia.
Tatalaksana Anestesi pada Prosedur Minimal Invasive Neurosurgery: Kasus Perdarahan Intraserebral Traumatika Laksono, Buyung Hartiyo; Suarjaya, I Putu Pramana; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2321.139 KB) | DOI: 10.24244/jni.vol5i2.68

Abstract

Traumatic brain injury (TBI) menyumbang 70% kematian akibat trauma. Penyebab yang tersering adalah kecelakaan lalu lintas 49%. Tehnik minimal invasif cukup berkembang pada beberapa dekade ini, demikian juga pada bidang bedah saraf. Tujuan utama tatalaksana anestesia adalah immobilisasi intraoperatif, stabilitas kardiovaskuler, minimal komplikasi pascaoperasi, fasilitasi intraoperatif neurologi monitoring, kolaborasi tatalaksana peningkatan tekanan intrakranial (TIK) dan rapid emergence untuk pemeriksaan neurologis dini. Kasus laki-laki 50 tahun dengan perdarahan intraserebral (ICH) direncanakan operasi minimal invasive neuroendoscopy evakuasi hematom. Posisi selama operasi adalah true lateral yang juga menjadi perhatian tersendiri. Komplikasi akibat posisi harus dihindari karena rentan mempengaruhi luaran operasi. Operasi berjalan selama 3 jam dengan luaran optimal. Beberapa masalah penting menjadi perhatian khusus selama operasi dan pascaoperasi. Prinsip tatalaksana anestesi pada minimal invasif yang harus dicapai adalah pemeriksaan dan perencanaan preoperatif yang baik, kontrol hemodinamik serebral untuk menjamin tekanan perfusi otak (cerebral perfusion presure/CPP) optimal, immobilisasi penuh, dan dapat dilakukan rapid emergence untuk menilai status neurologis. Komunikasi antara operator dan ahli anestesi penting untuk keberhasilan kasus ini.Anesthesia Management in Minimally Invasive Neurosurgery Procedure: Traumatic Intracerebral Hemorrhage CaseTraumatic brain injury (TBI) accounted for 70% of deaths from trauma. The most common causes of traffic accidents is 49%. Minimally invasive techniques sufficiently developed in the past few decades, as well as in the field of neurosurgery. The main objective is the treatment of immobilization intraoperative anesthesia, cardiovascular stability, minimal postoperative complications, facilitating intraoperative neurological monitoring, collaborative management of an increase in intracranial pressure (ICP) and the rapid emergence of early neurological examination. The case of a man 50 years with intracerebral hemorrhage (ICH) minimally invasive surgery neuroendoscopy planned evacuation of hematoma. Position during operation is true lateral is also a concern in itself. Complications due to the position should be avoided because it is vulnerable affect the outcome of the operation. Operations run for 3 hours with optimal outcomes. Some important issue is of particular concern during surgery and postoperatively. Procedural principle in minimally invasive anesthesia to be achieved is the examination and good preoperative planning, cerebral hemodynamic control to ensure optimal cerebral perfussion pressure (CPP), full immobilization, and can do rapid emergence to assess the neurological status. Communication between the operator and the anesthetist is important to the success of this case.