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Jurnal Neuroanestesi Indonesia

jni
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Published by Indonesian Society of Neuroanesthesia & Critical Care

ISSN : 20889674 EISSN : 24602302 DOI : https://doi.org/10.24244/jni

Core Subject : Health, Science, Education,

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

Editor of the magazine Journal of Neuroanestesi Indonesia receives neuroscientific articles in the form of research reports, case reports, literature review, either clinically or to the biomolecular level, as well as letters to the editor. Manuscript under consideration that may be uploaded is a full text of article which has not been published in other national magazines. The manuscript which has been published in proceedings of scientific meetings is acceptable with written permission from the organizers. Our motto as written in orphanet: www.orpha.net is that medicine in progress, perhaps new knowledge, every patient is unique, perhaps the diagnostic is wrong, so that by reading JNI we will be faced with appropriate knowledge of the above motto. This journal is published every 4 months with 8-10 articles (February, June, October) by Indonesian Society of Neuroanesthesia & Critical Care (INA-SNACC). INA-SNACC is associtation of Neuroanesthesia Consultant Anesthesiology and Critical Care (SpAnKNA) and trainees who are following the NACC education. After becoming a Specialist Anesthesiology (SpAn), a SpAn will take another (two) years for NACC education and training in addition to learning from teachers in Indonesia KNA trainee receive education of teachers/ experts in the field of NACC from Singapore.

Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine

Articles 9 Documents

Search results for , issue "Vol 1, No 1 (2012)" : 9 Documents clear

Manajemen Anestesia pada Anak dengan Nasofrontal Meningoencephalocele dan Hydrocephalus Non-Communicant Wohon, Erfprinsi; Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Meningoencephalocele adalah defek kongenital yang sangat jarang, tapi insidennya tinggi di Asia Tenggara, termasuk di Indonesia. Penderita dengan nasofrontal meningoencephalocele memerlukan koreksi pembedahan sedini mungkin karena adanya kelainan bentuk wajah, gangguan pandangan, bertambahnya ukuran meningoencephalocele disebabkan bertambahnya prolaps cerebri dan risiko infeksi. Dalam laporan ini kami presentasikan kasus seorang bayi 9 bulan dengan meningoencephalocele naso-orbital dan hydrocephalus non communican yang menjalani operasi VP shunt dan eksisi cele. Adanya massa tersebut, baik meningoencephalocele nasofrontal atau frontoethmoidal maupun occipital, menimbulkan kesulitan bagi ahli anestesi mulai saat induksi, pemeliharaan anestesi dan pasca operasinya. Menjadi tantangan bagi ahli anestesi dalam pengelolaan meningoencephalocele, dimana sebagian besar penderitanya adalah anak-anak yang mempunyai kesulitan tersendiri, termasuk mengamankan jalan nafas dengan intubasi dan adanya massa yang akan mempersulit ventilasi saat induksi, adanya massa pada nasofrontal serta nasoethmoidal yang berhubungan dengan komplikasinya dan penilaian yang tepat terhadap perdarahan dan hipotermia.Anesthesia Management for A child with Nasofrontal Meningoencephalocele and Hydrocephalus Non CommunicantMeningoencephaloceles are very rare congenital malformations in the world that have a high incidence in the population of Southeast Asia, include in Indonesia. Children with nasofrontal meningoencephaloceles should have surgical correction as early as possible because of the facial dysmorphia, impairment of binocular vision, increasing size of the meningoencephalocele caused by increasing brain prolapse, and risk of infection of the central nervous system. In this report, we presented a case of a 9 months-old baby girl with nasofrontal meningoencephalocele and hydrocephalus non communican, posted for VP shunt (ventriculo-peritoneal shunt) and cele excision. Because of the mass, nasofrontal or frontoethmoidal and occipital meningoencephalocele leads the anaesthetist to problems since the preoperative visit, time of induction, maintenance of anaesthesia during the operation until post operative care. Anaesthetic challenges in management of meningoencephalocele, which most of the patients are children, include ventilation, intubation and securing the airway with intubation with the mass in nasofrontal and nasoethmoidal with its associated complications and accurate assessment of bloodloss and prevention of hypothermia.

Penatalaksanaan Anestesi untuk Tindakan Anterior Cervical Dissection Fussion pada Pasien dengan Fraktur Kompresi Vertebra Servikalis 5 Suyasa, Agus Baratha; Wargahadibrata, A. Himendra
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Kasus trauma masih merupakan penyebab kematian terbesar di dunia. Di Amerika lebih dari 90.000 orang meninggal setiap tahunnya karena kasus trauma, yang paling sering karena kecelakaan kendaraan bermotor dan kasus kekerasan. Diperkirakan 20% dari korban tersebut mengalami trauma multipel dan juga mengalami cedera medula spinalis. Sekitar 55% cedera pada tulang belakang terjadi pada daerah servikal dan diperkirakan 5% dari penderita cedera kepala juga mengalami cedera pada tulang belakang. Seorang laki-laki 21 tahun akan dilakukan operasi Anterior Cervical Dissection Fussion (ACDF) karena mengalami cedera medula spinalis lesi inkomplit Frankle C karena fraktur kompresi vertebra servikalis 5. Tujuh hari sebelum masuk rumah sakit penderita jatuh dari atap rumah. Keluhan utama 2 Jurnal Neuroanestesia Indonesia yang dirasakan tangan dan kaki tidak dapat digerakan. Operasi dilakukan dengan anestesi umum, menggunakan pipa endrotrakeal no 7,5, dengan ventilasi kendali. In line position saat melakukan laringoskopi intubasi. Premedikasi dengan fentanyl 100 _g, lidokain 1,5 mg/KgBB 3 menit sebelum intubasi, induksi dengan propofol 100 mg. Fasilitas intubasi menggunakan atrakurium 0,5 mg/KgBB. Pemeliharaan anestesi dengan O2, N2O, Isofluran serta propofol kontinyu 100 mg /jam. Selama operasi hemodinamik stabil, tekanan darah sistolik 90-125 mmHg, tekanan darah diastolik 42-78 mmHg, laju nadi 62-82 x/mnt dan SpO2 99%. Ekstubasi dilakukan di kamar operasi segera setelah operasi selesai. Post operasi pasien dirawat di NCCU. Struktur anatomi tulang servikal yang tipis sangat memudahkan terjadinya fraktur, sehingga medula spinalis pun sangat mudah mengalami cedera. Jaringan saraf dapat mengalami cedera akibat peregangan, kompresi maupun laserasi. Disrupsi fisikal pada medula spinalis dapat menyebabkan kehilangan fungsi secara komplit dan irreversibel. Prinsip utama penatalaksanaan penderita dengan cedera medula spinalis pada fraktur tulang belakang adalah tidak memperburuk cedera medula spinalis yang sudah terjadi serta melakukan proteksi terhadap medula spinalis baik secara mekanik maupun kimiawi. Mempertahankan aliran darah medula spinalis dan mencegah edema pada medula spinalis merupakan salah satu prinsip penting dalam proteksi medula spinalis dan memperbaiki outcome pasien. Assesmen awal terhadap pasien yang mengalami fraktur tulang servikal selalu dimulai dari airway, breathing, circulation dan kemudian resusitasi dilakukan secara simultan. Ekstensi dan traksi axial yang berlebihan harus dihindari. Stabilisasi dapat dilakukan dengan pemasangan servikal collar atau manual in line pada saat laringoskopi intubasi. Perhatikan komplikasi syok spinal dan cedera medula spinalis. Pemilihan obat-obat anestesi yang memiliki efek proteksi terhadap medula spinalis.Anesthetic Management for Anterior Cervical Dissection Fusion Procedure in Patient with Compression Fracture of the 5th Cervical SpineTrauma is still the most cause of death in the world. In America more than 90,000 people die because of trauma, mostly traffic accident and violence. Around 20% of the victim had multiple trauma and spinal cord injury. Around 55 % patient of spine injury was located at cervical part and 5% of patientwith head injury should have spine injury. A male, 21 years old, with spinal cord injury incomplete lesion Frankle C because of compression fracture of the 5th cervical spine undergone ACDF (Anterior Cervical Dissection Fusion) procedure. Seven days before enter the hospital, the patient has fell down from the roof. He was unable to move his hands and legs. The procedure was perform in general anesthesia, using ETT No 7,5, controlled ventilation. In line position while performed laringoscopy intubations. Fentanyl 100 ?g intravenous, lidocain 1,5 mg/Kg 3 minutes before intubations has used as premedications. Induction of anesthesia was performed with propofol 100mg and atracurium 0,5mg/Kg for intubations facilitation. Maintenance of anesthesia was used O2, N2O, Isoflurane and Propofol 100 mg/hour. During the operation, haemodynamic remain stable, systolic blood pressure 90 125 mmHg, diastolic blood pressure 42-78 mmHg, heart rate 62-82 bpm and SaO2 99 %. The patient was extubated in the operating theatre after the end of surgery. Post operative patient was transferred to the NCCU. Anatomic structure of the cervical spine are thin, these make them vulnerable to injury. The spinal cord is vulnerable also when fracture of the spine occur. Spinal cord and the neuronal tissue may injure from stretching, compression and laceration. Physical disruption of spinal cord can cause the complete and irreversible loss of function. The main principle in manage spine fracture do not worsen the existing spinal cord injury by protecting the spinal cord mechanically and chemically. Maintain the spinal cord blood flow and prevent the edema may improve the patient outcome. Early assessment for spine fracture including airway, breathing and circulation must be done, and resuscitation performed simultaneously. Excessive extension or axial traction must be avoided. Stabilization of the spine can be done by cervical collar or manual in line position during intubations. Prevent the spinal shock complication and further spinal cord injury. Use the anesthetic agent which has the spinal cord protection effect.

Keberhasilan Resuitasi Jantung Paru Otak (RJPO) dengan Posisi Telungkup pada Pada Pasien Pediatrik saat Pengangkatan Tumor Infratentorial Satriyanto, M. Dwi; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Tumor infratentorial merupakan tumor yang paling sering ditemukan pada anak-anak dengan gejala klinis antara lain ataksia, kelainan saraf kranial, muntah, sakit kepala, penurunan kesadaran, dan hidrosefalus. Umumnya tumor infratentorial memerlukan tindakan bedah. Kasus seorang anak laki-laki 3 tahun dengan tumor infratentorial yang mendesak ventrikel IV, dilakukan tindakan craniotomy tumor removal dengan posisi telungkup. Saat tumor diangkat terjadi perdarahan dan menyebabkan perubahan hemodinamik sampai henti jantung yang berlangsung sangat cepat, kemudian operasi dan seluruh obat anestesi dihentikan, dilakukan Resusitasi Jantung Paru Otak (RJPO) dalam posisi telungkup dengan pemberian obat resusitasi (adrenalin dan sulfas atropin), dan melakukan pengisian intravaskuler volume (pemberian cairan dan darah), setelah dilakukan RJPO selama 10 menit hemodinamik kembali stabil. Tindakan operasi dilanjutkan untuk menutup luka operasi. Post operasi pasien di rawat di ICU dengan ventilasi mekanik (propofol dan vecuronium kontinu), pada hari ke 3 dilakukan operasi kembali untuk menyempurnakan operasi yang telah dilakukan. Post operasi pasien dirawat kembali di ICU, selama perawatan hemodinamik stabil, hari ke 4 pasien sadar dengan sequele motorik pada sisi tubuh sebelah kiri. Pada operasi pengangkatan tumor infratentorial, salah satu risiko yang dapat terjadi yaitu perdarahan masif selama operasi yang dapat mempengaruhi hemodinamik. Diperlukan persiapan dan pengawasan ketat selama operasi. Pada kasus ini, RJPO tetap dapat dilakukan pada posisi yang terbatas (posisi telungkup).Successfully of Cardio Pulmonary Cerbral Resuscitation (CPCR) in Prone Position on Pediatric Patient during Infratentorial Tumor SurgeryInfratentorial tumor is more frequent in children, with sign and symptom of ataxia, cranial nerve disorder, vomiting, headache, decrease of consciousness level and hydrocephalus. Infratentorial tumor usually requires surgical removal. Case report of a 3 year old boy with infratentorial tumor, which depressed the 4th ventricle, undergone craniotomy tumor removal with prone position. When tumor was removed, massive bleeding occurred and caused sudden change in hemodynamic and cardiac arrest. The operation and anesthetic agents were discontinued, followed by Cardio Pulmonary Cerebral Resuscitation (CPCR) in prone position with resuscitation drugs (i.e adrenalin and sulfas atropin), as well as blood and fluids to replace the intravascular volume. After approximately 10 minutes of CPCR, hemodynamic was stable. Operation was continued to close operation wound. Post operation, patient was admitted to ICU and being treated with mechanical ventilation under sedation with continues propofol and vecuronium. On the 3rd day, re-operation was conducted to establish the previous operation as planned. The patient was admitted to the ICU post operatively. During management in ICU, hemodynamic was stable and the patient woke up on the 4th day with motoric squele on his left body side. In conducting an infratentorial tumor removal, an anesthesiologist should be aware for the risk of massive bleeding durante operation which could manipulate hemodynamic. There for special preparation and tight monitoring are required during the operation. In this case, CPCR can be done in limited position (prone position).

Manajemen Perioperatif Epidural Hemorrhage Akibat Cedera Otak Traumatik I Putu Pramana Suarjaya; A. Himendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Epidural hemorrhage (EDH) adalah perdarahan yang terjadi pada ruang epidural, biasanya terjadi pada fossa kranii media karena adanya laserasi arteri meningea media, walaupun bisa juga terjadi pada fossa anterior ataupun posterior. Bentuknya biasanya lentikuler dan dibatasi oleh garis sutura di mana lapisan perikranial dura melekat ke kranium. Secara klasik, pasien EDH memiliki lucid interval, yakni periode adanya kesadaran yang jernih sebelum terjadinya penurunan kesadaran. Gejala klinis sebagai akibat dari hematoma intrakranial seperti EDH, terutama tergantung pada besarnya volume dan kecepatan hematoma ini terbentuk. Bila hematoma terbentuk dengan cepat, terjadi peningkatan tekanan intrakranial (TIK) yang akan menimbulkan perburukan neurologis sampai dapat mengancam kehidupan. Pengelolaan perioperatif pasien dengan cedera otak traumatik yang mengalami EDH bertujuan mempertahankan perfusi dan oksigenasi otak, mengendalikan TIK serta dekompresi dan evakuasi perdarahan dengan pembedahan pada sebagian kasus. Kami membahas manajemen perioperatif pada 2 orang pasien, seorang anak dan seorang remaja yang mengalami EDH karena cedera otak traumatik yang menjalani kraniotomi emergensi untuk evakuasi perdarahannya. EDH sangat penting untuk cepat didiagnosa, karena bila terdeteksi segera dan dilakukan evakuasi perdarahan, biasanya hasilnya baik dengan mortalitas kurang dari 10%. Evakuasi dan kontrol perdarahan segera sangat penting untuk keselamatan pasien dan menghindari cedera neurologis yang permanen.Perioperative Management of Epidural Hemorrhage Due to Traumatic Brain InjuryEpidural hemorrhages (EDH) are bleeding in epidural space, usually occur in the middle cranial fossa via laceration of the middle meningeal artery, although they can also occur in the anterior and osterior fossae. They are usually lenticular shaped and are bounded by suture lines where the pericranial ayer of dura attaches to the skull. Classically patients suffered from EDH experience a lucid interval which is a period of intact consciousness prior to deterioration.Clinical symptom of intracranial hematoma such as EDH, mainly depend on volume and rate the hematoma formed. If the intracranial hematoma formed rapidly, there will be a sudden rise on ICP which led to neurologic deterioration that could be deleterious. Perioperative management of intracranial hematoma such as EDH is to maintain brain perfusion and oxygenation, control the ICP, and surgical decompression in some cases. We are scussing perioperative management of two cases suffered from EDH due to traumatic brain injury who underwent emergency craniotomy for clott evacuation.These are important injuries to identify;if detected early they are usually associated with good outcome and have a mortality of less than 10%. Early bleeding control and hematoma evacuation are very important to patient safety and avoid any permanent neurologic injury.

Anestesia untuk Operasi Syringomyelia C2-7 dengan Penyulit Obesitsas Mellitus Tipe II Betty Roosiati; Bambang J. Oetoro
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Syringomyelia refers to the cystic cavitation of the spinal cord. Two main forms of syringomyelia have been described: communicating syringomyelia and non communicating syringomyelia. In communicating syringomyelia, there is primary dilatation of the central canal that is often associated with abnormalities at the foramen magnum such as tonsillar herniation (Chiari malformation) and basal arachnoiditis. In non communicating syringomyelia, a cyst arieses within the cord substance itself and does not communicate with the central canal or subarachnoid space. This patients is clasified as communicating syringomyelia due to Chiari malformation. Obesity and diabetes mellitus type II as comorbid in this case. The surgery was done under general anesthesia, prone position uneventfull.Anethesia for C2-7 Syringomyelia Surgery with Comorbid Obesity and Diabetes Mellitus Type IISyringomyelia adalah kista pada medulla spinalis. Ada dua bentuk utama dari syringomyelia yaitu communicating syringomyelia dan non communicating syringomyelia. Communicating syringomyelia adalah dilatasi primer dari kanalis sentralis dan sering berhubungan dengan abnormalitas pada foramen magnum, misal herniasi tonsillar (Chiari Malformasi) dan arachnoiditis basal. Non communicating syringomyelia, kista berasal dari medulla spinalis dan tidak berhubungan dengan kanalis sentralis atau ruang subarachnoid. Pasien ini termasuk golongan communicating syringomyelia karena adanya Chiari malformasi. Obesitas dan diabetes mellitus tipe II sebagai comorbid. Operasi dilakukan dengan anestesi umum dalam posisi prone.

Anestesia untuk Kraniotomi Tumor Supratentorial Lalenoh, Diana Christine; Lalenoh, Hermanus; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Tumor supratentorial tersering pada orang dewasa adalah glioma (36%), meningioma (32.1%), dan adenoma pituitary (8.4%). Sekitar separuh dari tumor tersebut adalah ganas. Mayoritas tumor tumor tersebut (80%) adalah supratentorial. Untuk seluruh tumor primer, rata-rata usia terdeteksi adanya tumor otak adalah 57 tahun. Angka pasti insidens metastase tumor otak tidak diketahui namun diperkirakan cukup rendah. Dari sekitar 25% pasien yang meninggal karena kanker, ditemukan adanya metastase dari tumor sistem saraf pusat (SSP) pada otopsi. Ada lima sumber keganasan yang sering metastase ke otak yaitu kanker payudara, kanker kolorektal, kanker paru, dan melanoma. Enam persen dari pasien dengan komplikasi tersebut muncul dalam 1 tahun setelah terdeteksi adanya tumor primer. Lima jenis kanker tersebut yang sering menyebabkan metastase otak pada sekitar 37.000 kasus di Amerika Serikat. Jurnal Neuroanestesia Indonesia 17 Dilaporkan keberhasilan penanganan anestesi pada seorang pasien, wanita 56 tahun, dengan berat badan 65 kg. Pasien tersebut didiagnosis sebagai Space Occupaying Lession (SOL) kanan DD/Meningioma. Pasien dilakukan operasi kraniotomi untuk pengeluaran tumor. Tekanan darah saat masuk kamar operasi 176/100 mmHg, laju nadi 98 kali / menit, laju napas 20 kali / menit, suhu badan 370 C, dan GCS E4V5M6. Pasien diinduksi dengan Fentanyl 100 ?g, Propofol 100 mg, fasilitas intubasi dengan Rocuronium 40 mg, Lidokain 70 mg, dan pemeliharaan dengan Sevofluran dan Oksigen serta Propofol kontinyu, dan penambahan fentanyl dan rokuronium intermiten. Infus terpasang dua jalur. Operasi berlangsung selama tujuh jam dua puluh menit. Dengan terpasang nasal kanul dan oksigen 3 liter/menit, pasien dipindahkan ke ICU. Pasien dirawat selama satu hari di ICU, kemudian dipindahkan ke ruangan. Setelah lima hari pasien dirawat di ruangan kemudian pasien dipulangkan dan rawat jalan dengan dokter bedah saraf. Anestesi untuk tumor supratentorial membutuhkan suatu pengertian mengenai patofisiologi dari penekanan tekanan intrakranial (TIK) lokal maupun secara keseluruhan; pengaturan dan pemeliharaan perfusi intraserebral; bagaimana menghindari akibat pengaruh sekunder dari sistemik terhadap otak. Persiapan perioperatif yang cermat dan terstruktur sangat penting pada penanganan anestesi untuk tumor supratentorial, yang meliputi persiapan pasien preoperasi, persiapan kelengkapan obat, alat, dan monitoring, serta perencanaan pelaksanaan anestesi sampai dengan pananganan pasca operasi.Anesthesia For Craniotomy Supratentorial TumorThe common supratentorial tumors in adults are glioma (36%), meningioma (32.1%), and adenoma pituitary (8.4%). Approximately half of these tumors are malignant. The majority of them ( 80%) are supratentorial. For the entire primary tumor, the average age when a brain tumor was detected is 57 years old. The exact number of metastatic brain tumor incidence is unknown, but it is assumed quite low. The existence of metastatic tumor of the central nervous system (SSP) is found at the autopsy of around 25% of patients who died of cancer. There are five sources of malignancy which often cause metastasis to the brain, namely breast cancer, colorectal cancer, lung cancer, and melanoma. In six percent of patients, these complications appeared within a year after the primary tumor is detected. These five cancers frequently cause the brain metastases in approximately 37.000 cases in the United States. It is reported the successful handling of anesthesia on a woman 56 years old, weighing 65 kg. This patient was diagnosed with Space Occupying Lession (SOL) right DD / Meningioma. Craniotomy surgery was performed for tumor expenditure. At the time she entered the operating room, her blood pressure was 176/100 mmHg, pulse rate beats / minute, respiratory rate 20 times / minute, body temperature of 37o C, and GCS E4V5M6. She was induced with Fentanyl 100 mg, 100 mg Propofol; intubation facilities are Rocuronium 40 mg, Lidocaine 70 mg, maintenance with Inhalan Sevoflurane and Oxygen, along with continuous Propofol, the addition of Fentanyl and intermittent Rocuronium. Infusion was attached in two pathways.The surgery lasted seven hours and twenty minutes. With nasal cannula and oxygen 3 liters / minute attached, the patient was transferred to ICU. She was treated for one day in ICU, before moved into a ward. After stay in the ward for five days, she was discharged and became an outpatient of neurosurgeon. Anesthesia for supratentorial tumor requires an understanding of pathophysiology of intracranial pressure (ICP) suppression locally and entirely; setting up and maintenance of intracerebral perfusion; how to avoid secondary effects of a systemic effect on the brain. Accurate and structured perioperative preparation is critical for handling of anesthesia for supratentorial tumors, which includes the preparation of the patient pre-surgery, completeness preparation of drugs, devices, and monitoring, as well as planning the implementation of the anesthesia until post-surgery tendance.

Strategi untuk Mencegah Aspirasi Isi Lambung pada Operasi Cedera Otak Otak Traumatika Emergensi Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Pengelolaan pasien emergensi memiliki tantangan tersendiri bagi anestesiologis. Resiko terjadinya aspirasi isi lambung sangat besar pada pasien emergensi. Angka kejadian aspirasi isi lambung pada pasien emergensi berkisar antara 0,7-4% yang dapat berakibat kematian. Disfungsi gastrointestinal sering terjadi pada pasien dengan cedera otak traumatika. Lebih dari 50% pasien dengan cedera kepala berat tidak mentoleransi enteral feeding. Intoleransi ini manifest dengan adanya muntah, distensi abdominal, pelambatan pengosongan lambung, refluks oesofageal dan penurunan peristaltik intestinal, yang menunjukkan bahwa disfungsi gastrointestinal adalah fenomena yang umum setelah cedera otak traumatika. Puasa merupakan pencegahan yang efektif untuk mengurangi terjadinya resiko aspirasi isi lambung, namun pada kasus emergensi sulit untuk dilaksanakan. Berbagai upaya yang dapat dilakukan pada pasien emergensi untuk mengurangi angka kejadian aspirasi adalah: a) pemberian obat-obatan tertentu sebelum dilakukannya anestesi: histamine 2-reseptor antagonis (ranitidine, cimetidine), proton pump inhibitor (omeprazole), antacid (sodium citrate, magnesium trisilicate) dan antiemetic (ondansentrone), b) posisi kepala yang lebih tinggi dari tubuh 30-45o, c) rapid sequence induction dengan sellick maneuver, d) pemasangan pipa naso atau orogastric dan aspirasi isi lambung. Rapid sequence induction tidak memberi kesempatan untuk mencegah kenaikan tekanan darah saat laringoskopi dan intubasi, padahal untuk pasien dengan kelainan serebral termasuk cedera otak traumatika, harus dihindari lonjakan tekanan darah yang akan meningkatkan tekanan intrakranial. Aspirasi isi lambung merupakan komplikasi anestesi yang mungkin terjadi pada periode perioperatif khususnya pada pasien emergensi. Pengelolaan yang adekuat mampu untuk mengurangi terjadinya resiko aspirasi.Strategy to Prevent Gastric Content Aspiration in Emergency Traumatic Brain Injury SurgeryManagement of an emergency patients has a particular challenge for an anesthesiologist. The risk of pulmonary aspiration from gastric content is very high in emergency cases. The incidence of gastric aspiration in emergency cases is approximately 0.7-4% which could lead to death. Gastrointestinal dysfunction frequently occurs in patients with traumatic brain injury (TBI). More than 50% patients with severe head injuries could not tolerate enteral feedings. This intolerance is manifested by vomiting, abdominal distention, delayed gastric emptying, esophageal reflux and decreased intestinal peristalsis, indicating that gastrointestinal dysfunction is a common phenomenon following TBI. Fasting is an effective manouver to reduce the incidence of gastric aspiration, but in emergency cases is rather difficult to establish that manouver. Several manouvers to reduce aspiration incidence are: a) to administer drugs prior to induction: histamine 2-reseptor antagonist (ranitidine, cimetidine), proton pump inhibitor (omeprazole), antacid (sodium citrate, magnesium trisilicate) and antiemetic (ondansentrone), b) head up position of 30-45o, c) rapid sequence induction with sellick manouver, d) insert naso or orogastric tube and aspirate gastric content. By using rapid sequence induction there would be not enough time to avoid the increase in blood pressure during laryngoscopy-intubation, whereas for patient with cerebral disorder including traumatic brain injury, increased blood pressure should be avoided because this will lead to increase intracranial pressure. Gastric content aspiration is one of anesthesia complication during perioperative periode especially in emergency cases. Adequate managment can reduce the incidency of aspiration.

Pengelolan Perioperatif Stroke Hemoragik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Stroke hemoragik merupakan penyakit yang mengerikan dan hanya 30% pasien bertahan hidup dalam 6 bulan setelah kejadian. Penyebab umum dari perdarahan intrakranial adalah subarachnoidhemorrhage (SAH) dari aneurisma, perdarahan dari arteriovenous malformation (AVM), atau perdarahan intraserebral. Perdarahan intraserebral sering dihubungkan dengan hipertensi, terapi antikoagulan atau koagulopati lainnya, kecanduan obat dan alkohol, neoplasma, atau angiopati amiloid. Mortalitas dalam 30 hari sebesar 50%. Outcome untuk stroke hemoragik lebih buruk bila dibandingkan dengan stroke iskemik dimana mortalitas hanya sekitar 10-30%. Stroke hemoragik khas dengan adanya sakit kepala, mual, muntah, kejang dan defisit neurologik fokal yang lebih besar. Hematoma dapat menyebabkan letargi, stupor dan koma. Disfungsi neurologik dapat terjadi dari rentang sakit kepala sampai koma. Pengelolaan dini difokuskan pada : 1) pengelolaan hemodinamik dan jantung, 2) jalan nafas dan ventilasi, 3) evaluasi fungsi neurologik dan kebutuhan pemantauan tekanan intrakranial atau drainase ventrikel atau keduanya.Perioperative Management of Hemorrhage StrokeHemorrhagic stroke is devastating disease and only 30% patients survive in 6 months after event. The common cause of intracranial hemorrhage are subarachnoid hemorrhage (SAH) from aneurysm, bleeding from arteriovenous malformation (AVM) or intracerebral hemorrhage. Intracerebral hemorrhage common correlation with hypertension, anticoagulant therapy, or other coagulopathi, drug and alcohol addict, neoplasm, or amyloid angiopathi. Mortality in 30 days is 50%. Outcome for hemorrhagic stroke worst than ischemic stroke with mortality arround 10-30%. Hemorrhagic stroke typically presents with headache, nausea, and vomiting as well as seizure and focal neurological deficits. Neurological dysfunction variated between headache untill coma. Early treatment focused on: 1) hemodynamic and cardiac, 2) airway and ventilation, 3) neurological function evaluation and the needed intracranial pressure monitoring or ventricular drainage or both.

Anestesia untuk Corpus Callosotomy Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Corpus Callosotomy sering dilakukan pada anak-anak dengan drop attacks atau atonic seizure,pada anak tersebut secara tiba-tiba tonus otot hilang/ lemas, yang akan menyebabkan anak jatuh kelantai saat berjalan. Juga dilakukan pada seseorang dengan kejang tonic-klonic menyeluruh yang tidak terkontrol dengan terapi obat-obatan, atau Grandmal epilepsi, atau dengan massive jerkingmovement. Seorang anak laki-laki, umur 2,5 tahun, dengan keluhan utama: kejang, 810 kali setiap hari, sejak penderita umur 4 bulan. Sudah mendapat terapi dari poliklinik syaraf, kejang hanya berkurang. Dipersiapkan operasi dengan pemeriksaan laboratorium lengkap, pemeriksaan penunjang, pemeriksaan EEG dan MRI. Dilakukan Corpus Callosotomy, post operasi dirawat di ICU selama 2 hari, kemudian pindah ruangan, dan selanjutnya pulang. Intensitas kejang berkurang. Penanganan pada penderita ini terdapat masalah khusus yaitu masalah anestesia pada anak-anak dan masalah neuroanestesia. Memerlukan persiapan operasi yang khusus sehingga dapat menentukan fokus epilepsI dengan tepat dan terapi operasi yang tepat pula.Anesthesia for Corpus CallosotomyCorpus callosotomy is most often performed for children with drop attacks, or atonic seizure, in which a sudden loss of muscle tone cuases the child fall to the floor. It also performed in people with uncontrolled generalized tonic-clonic, or grand mal, or with massive jerking movement. A 2.5 year-old boys for corpus callosotomy indicated for the treatment of intractable epilepsi. With chief complaint frequent seizure since 4 month old and frequent convulsion 810 time per day. Preparing pre operative must be complete including Electroencephalogram and Magnetic Resonance Image (MRI) for detection focal epilepsi. Post operative periode in ICU and than go to ward two day latter. Intensity of seizure decreased more than pre operative condition. Management this patient need serious attention, special cases for children anesthesia and neuroanesthesia. It also need to special prepare for this patient, until to found good outcome.

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Agni Susanti

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Abstract

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Abstract

Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

Phone +6287722631615

Journal Mail Official jni@inasnacc.org

Editorial Address Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

Location , INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

Phone
+6287722631615

Journal Mail Official
jni@inasnacc.org

Editorial Address
Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

Location
,

INDONESIA