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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 10 Documents

Search results for , issue "Vol 1, No 2 (2012)" : 10 Documents clear

Tatalaksana Anestesi Pada Posisi Telungkup untuk Laminektomi Pengangkatan Tumor Satriyanto, M. Dwi; Harahap, M. Sofyan; Oetoro, Bambang J.; Wargahadibrata, A. Hmendra; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tindakan anestesi dengan posisi telungkup sering diperlukan guna memfasilitasi akses operasi pada berbagai tindakan bedah termasuk bedah saraf, antara lain pada tindakan pembedahan tulang belakang. Selain perubahan fisiologis, dapat juga terjadi beberapa komplikasi pada posisi telungkup yang harus mendapat perhatian khusus, sehingga diperlukan pemahaman yang baik akan masalah ini. Kasus: Telah dilakukan laminektomi guna pengangkatan tumor intra-ekstradura setinggi vertebra lumbal 4 sampai sakrum 2 dalam posisi telungkup pada seorang pasien laki-laki berusia 18 tahun. Pengaturan posisi dari telentang ke telungkup prabedah maupun pengembalian posisi dari telungkup ke telentang pascabedah, mendapat perhatian khusus. Status hemodinamik selama tindakan anestesi berlangsung dengan baik. Pascabedah, pasien di observasi di ruang pulih selama beberapa jam, kemudian dipindahkan ke ruang rawat setelah skor modifikasi dari Aldrete mencapai 10.Anesthesia Management In Prone Position For Laminectomy Tumor RemovalAnesthesia procedure in the prone position was often necessary in order to facilitate access to a variety of surgical operations, including neurosurgery among others, the spine surgery. In addition to physiological changes, some complications can also occur in the prone position that should receive special attention, so it requires a good understanding of this issue. Case: Laminectomy was being done for removal of the tumor intra-ekstradura at 4th lumbar vertebra to 2nd sacrum vertebra in the prone position in a male patient aged 18 years. Arrangement of the supine position to prone position preoperative and return to the supine position of the postoperative, gets special attention. emodynamic status during anesthesia procedure was progressing well. Postoperative, patients in the observation in the recovery room for several hours, then transferred to the ward after modified Aldrete score reached 10.

Reaktif Oksigen Spesies Pada Cedera Otak Traumatik Suarjaya, I Putu Pramana; Bisri, Tatang; Wargahadibrata, A. Himendra
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatik menyebabkan mortalitas dan morbiditas karena terjadinya cedera primer yang diikuti oleh cedera sekunder. Cedera sekunder yang terjadi meliputi peningkatan asam amino eksitatif, ketidak seimbangan ion, penurunan kadar ATP, aktivasi enzim proteolitik dan stres oksidatif yang akan menyebabkan terjadinya disfungsi neuron sampai kematian neuron. Terdapat kaitan erat antara beratnya stres oksidatif yang terjadi dengan beratnya cedera otak yang terjadi, sebagai akibat terganggunya hemostasis kalsium, gangguan pembentukan energi dan meningkatnya proses peroksidasi lipid. Pada telaah ini didiskusikan bagaimana stres oksidatif yang terjadi pada cedera otak traumatik, dan pengaruhnya pada proses pathologi sedera otak traumatik.Reactive Oxygen Species in Traumatic Brain InjuryTraumatic Brain Injury (TBI) morbidity and mortality are due to primary and secondary injury. Primary injury is due to mechanical forces during the trauma process and secondary injury is subsequent process following the primary impact. This secondary injury processes involving increased excitatory amino acids, ionic imbalance, decreased ATP level, unusual proteolytic enzyme activity, and oxidative stress which contibute to delayed neuronal dysfunction and neuronal death. The mammalian brain is vulnerable to oxidative stress because of the high oxygen consumption needed for maintaining neuronal ion homoeostasis during the propagation of action potentials.There is a close relationship between degree of oxidative stress and severity of brain insults, which results from a perturbation of calcium homeostasis, energy metabolism, and increased lipid peroxidation. In this review we discuss oxidative stress during traumatic brain injury, and its implication on pathology of traumatic brain injury.

Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi Of Fallot Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tetralogi of Fallot (TOF), pertama kali diperkenalkan pada tahun 1888 oleh seorang dokter dari Prancis yang bernama Etienne-Louis Arthur Fallot. Tetralogi of Fallot (TOF) merupakan salah satu jenis cacat jantung bawaan sianotik yang paling banyak diketemukan. Tetralogi of Fallot (TOF) memiliki empat kelainan yaitu: (1) stenosis infundibulum pulmonari, (2) Ventricular Septal Defect (VSD), (3) overidding aorta, dan (4) hipertrofi ventrikel kanan. Pasien dengan penyakit kongenital jantung sianotik (right to left shunt) memiliki resiko terjadinya abses otak. Penyakit jantung sianotik terhitung sekitar 12.8-69,4% dari semua kasus abses otak dan insidensi tertinggi terjadi pada anak-anak. Kami melaporkan seorang anak laki-laki berusia 8 tahun, berat badan 16 kg dengan abses otak multiple yang disertai dengan cacat jantung bawaan sianotik Tetralogi of Fallot (TOF) yang akan dilakukan aspirasi abses. Pasien datang dengan suhu tubuh 39oC, GCS 13, Tekanan darah 90/50 mmHg, nadi 120 x/menit, SpO2 90% dengan simple mask 6 L/menit. Hasil lab menunjukan Hb14gr%, Hematokrit 41%, thrombosit 250.000/mm3. PT/aPTT 13,2/26,9. Sudah terpasang infus dari UGD, selanjutnya diberikan premedikasi midazolam 1 mg intravena, induksi dengan propofol, fentanyl, vecuronium, rumatan anestesi dengan oksigenudara, sevoflurane. 12 Jurnal Neuroanestesia Indonesia Operasi berlangsung selama 1,5 jam, pemberian cairan dengan target normovolume, pascaoperasi dirawat di neurointensive care unit selama 3 hari. Puasa prabedah harus diperhitungkan sebaik-baiknya karena pasien harus tetap terhidrasi dengan baik. Pasien TOF dengan polisitemia, apabila terjadi dehidrasi akan meningkatkan viskositas dan sludging. Pasien ini sudah terhidrasi dengan baik dan cairan pengganti puasa diberikan melalui infus. Pasien harus dalam keadaan tenang dan rileks. Pasien diberikan premedikasi midazolam intravena. Premedikasi dengan suntikan intramuskuler harus dihindari karena kecemasan dan stress dapat menyebabkan tet spell. Premedikasi berat juga harus dihindari karena adanya depresi nafas yang menimbulkan hiperkarbia dapat meningkatkan Pulmonary Vascular Resistance (PVR) dan menimbulkan peningkatan shunting dari kanan ke kiri. Aspirasi abses serebri tidak dapat dilakukan dengan anestesi lokal karena akan meningkatkan kecemasan, tekanan darah pasien. Anestesi harus dilakukan dengan anestesi umum. Pengelolaan perioperatif pasien TOF yang dilakukan operasi ditempat lain (bukan operasi TOFnya) memerlukan pemahaman tentang patofisiologik TOF dan teknik neuroanestesi untuk mendapatkan outcome yang baik.Anesthesia Management For Brain Abscess Drainage Patient With Tetralogy Of FallotTetralogy of Fallot (TOF) was first described in 1888 by a French physician named Etienne-Louis Arthur Fallot. Tetralogy of Fallot (TOF) is one type of cyanotic congenital heart defect most widely found. Tetralogy of Fallot (TOF) has four abnormalities: (1) pulmonary infundibulum stenosis, (2) VSD (Ventricular Septal Defect), (3) overriding aorta, and (4) right ventricular hypertrophy. Patients with congenital cyanotic heart disease (right to left shunt) have a risk of brain abscess. The incidences of cyanotic heart disease is about 12.8-69,4% of all cases of brain abscess and the highest incidence occurs in children. We reported an 8-years old 16-kg boy with multiple brain abscesses accompanied with cyanotic congenital heart defect Tetralogy of Fallot (TOF) and whom abscess aspiration would be performed. Patients was present with body temperature 39oC, GCS 13, blood pressure 90/50 mmHg, pulse 120 beats/min, SpO2 90% with a simple mask using oxygenation of 6 L/min. Lab results showed Hb 14gr%, hematocrit 41%, platelet count 250.000/mm3, PT /aPTT: 13.2/26.9. Patient was mounted infusion from the emergency ward (ER), given 1 mg intravenous midazolam premedication, induction with propofol, fentanyl, vecuronium, maintenance with oxygen-air anesthesia and sevoflurane. The operation lasted for 1.5 hours, the infusion targeted to normal volume, postoperative care was given in the neurointensive care unit for 3 days. Pre-surgical fasting plan plays an important role because the patient must remains well hydrated. TOF patients with polycythemia when dehydrated, will increase the viscosity and sludging events. This patient was well hydrated and fasting replacement fluid therapy was given intravenously. Patients should be in a state of calm and relaxed. Patient was given intravenous midazolam premedication. Premedication with intramuscular injections should be avoided, since anxiety and stress may lead to "tet" spell. Heavy premedication should also be avoided because of respiratory depression leading to hypercarbia can increase the Pulmonary Vascular Resistance (PVR) and precipitate increased shunting from right to the left. Cerebral abscess aspiration can not be performed under local anesthesia because it increases the anxiety and the patient's blood pressure. Anesthesia should be performed under general anesthesia. Management of perioperative TOF patients who will underwent surgery elsewhere (not for TOF) requires deep understanding on TOF pathophysiology and neuro-anesthesia techniques to get a good outcome

Anestesi Untuk Pasien dengan Perdarahan Intrasereberal yang Dilakukan Kraniektomi Dekompresi Darurat Sasongko, Himawan; Harahap, M. Sofyan
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perdarahan intraserebral (intracerebral hemorrhage/ICH) adalah penyakit yang cukup sering terjadi, dan dapat diklasifikasikan menjadi dua berdasar sudut pandang, yaitu anatomis dan etiologis. Secara etiologis, dapat dibedakan menjadi perdarahan primer atau sekunder. Kraniektomi dekompresi akan menurunkan TIK secara cepat dan menetap serta menghindari terjadinya herniasi otak. Posisi telungkup atau tengkurap yang dilakukan pada pasien selama tindakan anestesi akan berhubungan dengan perubahan fisiologis maupun komplikasi yang dapat timbul terhadap pasien. Seorang wanita usia 49 tahun dengan perdarahan intraserebelum, yang akan dilakukan tindakan darurat kraniektomi dekompresi. Premedikasi yang diberikan adalah midazolam dan ondansetron. Induksi anestesi menggunakan propofol, fentanyl dan vekuronium. Pemeliharaan anestesi dengan sevofluran 1,5-2,0 vol%, oksigen dan vekuronium. Semua tindakan ini bertujuan untuk proteksi otak. Selama pembedahan dilakukan pemantauan tekanan darah, laju nadi, saturasi O2 dan elektrokardiografi. Pembedahan dilakukan pada posisi tengkurap. Selama 120 menit pembedahan, hemodinamik stabil. Pascaoperasi, pasien diekstubasi dan dikirim ke High Care Unit (HCU). Selama pengelolaan di HCU, hemodinamik stabil dan setelah 2 hari perawatan, pasien dipindahkan ke bangsal perawatan biasa. Salah satu cara untuk menangani pasien dengan perdarahan intrasereberal akibat trauma adalah dengan kraniektomi dekompresi. Tujuannya adalah untuk menurunkan tekanan intrakranial dan mencegah terjadinya herniasi otak. Evaluasi perioperasi dan perhatian yang baik sebelum, selama dan sesudah pembedahan, akan menghasilkan kondisi yang baik dengan angka kesakitan dan kematian yang minimal.Anesthesia for Patient with Intracereberal Hemorrhage Underwent Decompressive Craniectomy EmergencyIntracerebral hemorrhage (ICH) is a common disease, and can be classified by anatomical or etiological aspect. According to etiological aspects can be differenced by primary or secondary hemorrhages. Decompessive craniectomy will decreased intracranial pressure at once and prevent brain herniation. Prone position patient during anaesthesia is associated with physiological changes and also with number of complications. A forty nine years old female with intracereberal hemorrhage, undergone emergency decompressive craniectomy. Premedication with midazolam and ondancetron was given. Induction of anesthesia used propofol, fentanyl, and vecuronium. Maintenance of anesthesia used oxygen, sevoflurane 1.5-2.0 vol% and rocuronium. All this maneuver is for brain protection. Monitoring of BP, HR, SpO2 and ECG was done. During 120 minutes of surgery, hemodynamic was stable. Post operation, patient was extubated and admitted to High Care Unit (HCU). During management in HCU, hemodynamic was stable and after 2 days, patient moved to the ward. Decompressive craniectomy is one methode to handle patient with intracereberal hemorrhage. The purpose is to decreased intracranial pressure and prevent brain herniation. Perioperative evaluation and good attention before procedure, will produce outcome with minimal adverse effect and less mortality.

Disfungsi Kognitif Pascaoperasi Pada Pasien Operasi Elektif Lucky Andriyanto; W Wijoto; Nancy Margereta Rehatta
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Latar Belakang dan Tujuan: Disfungsi kognitif pascaoperasi (DKPO) sering terjadi dan menjadi masalah serius karena dapat menurunkan kualitas hidup pasien yang menjalani pembedahan dan meningkatkan beban pembiayaan kesehatan. Tujuan penelitian ini adalah untuk mengetahui angka kejadian DKPO pada pasien yang menjalani operasi elektif di RSU dr. Sutomo dan menganalisa faktor-faktor yang mempengaruhinya. Subjek dan Metode: Penelitian ini melibatkan 50 orang sampel berusia 40 tahun atau lebih yang menjalani pembedahan lebih dari dua jam. Dilakukan serangkaian pemeriksaan fungsi kognitif praoperasi dan tujuh hari pascaoperasi. Domain kognitif yang diukur adalah atensi dan memori. Faktor yang diduga mempengaruhi kejadian DKPO dalam penelitian ini adalah usia, tingkat pendidikan dan durasi operasi. Hasil: Tujuh hari pascaoperasi 30% sampel mengalami gangguan atensi, 36% sampel mengalami gangguan memori dan 52% sampel mengalami disfungsi kognitif pascaoperasi. Pemeriksaan kognitif yang mengalami penurunan bermakna adalah digit repetition test, immediate recall, dan paired associate learning. Analisa logistik regresi variabel usia (p=0,798), tingkat pendidikan (p=0,921) dan durasi operasi (p=0,811) terhadap kejadian DKPO menunjukkan hubungan yang tidak bermakna. Namun bila dianalisa pada masing masing kelompok usia tampak bahwa persentase pasien yang mengalami DKPO konsisten lebih tinggi pada usia  50 tahun, tingkat pendidikan  6 tahun dan durasi operasi  180 menitSimpulan: Kejadian disfungsi kognitif pada pasien yang menjalani operasi elektif di RSU dr. Sutomo cukup tinggi. Faktor usia, tingkat pendidikan dan durasi operasi tampaknya mempengaruhi kejadian DKPO meskipun secara statistik tidak signifikan.Postoperative Cognitive Dysfunction In Elective Surgical PatientBackground and Objective: Post operative cognitive dysfunction (POCD) is a common and becoming a serious problem since it can impair the quality of life of the patient who underwent surgery and increase the burden of health cost. In this study, author wanted to know the incidence of POCD among patients undergoing elective surgery patients in dr. Sutomo hospital and examine the risk factors.Method: The study involved a sample of fifty people aged 40 years or older who underwent surgery more than two hours. Conducted a series of cognitive function tests pre-surgery and seven days post-surgery. Cognitive domain that measured were attention and memory. Factors that thought to affect the incidence of POCD in this study were age, educational level and duration of surgery.Result: After 7 days post surgery 30 % of patients had attention decline, 36 % patients had memory decline and 52 % had post operative cognitive decline. Cognitve function test that decrease significantly are digit repetition test, immediate recall, and paired associate learning. Regression logistic analysis for age (p = 0.798), education level (p = 0.921) and duration of surgery (p = 0.811) on the incidence POCD showed no significant relationship. However, when analyzed in each group of age, the results would show that the percentage of patients experiencing POCD was consistently higher in the age of 50 years or older, education level of 6 years or less and duration of surgery of 180 minutes or longer.Conclusion: The incidence of cognitive dysfunction in patients undergoing elective surgery in dr. Sutomo hospital was considered high. Age, education level and duration of surgery appeared to influence the incidence of POCD although not statistically significant.

Penanganan Edema Serebri Berat dan Herniasi Serebri pada Cedera Kepala Traumatik Agus Baratha Suyasa; Sri Rahardjo
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.vol1i2.93

Cedera kepala traumatik merupakan salah satu kondisi yang mengancam jiwa secara serius pada korban kecelakaan, dan merupakan penyebab utama kecacatan dan kematian pada dewasa dan anak-anak. Subdural hematom merupakan lesi fokal intrakranial yang paling sering dijumpai, sekitar 24% dari pasien yang mengalami cedera kepala berat tertutup. Edema serebral sering ditemui pada praktek klinis dan merupakan penyebab utama morbiditas dan mortalitas pada pasien sakit kritis serta pasien bedah saraf yang mengalami cedera otak akut. Herniasi serebri adalah suatu keadaan emergensi, dimana tujuan terapi adalah menyelamatkan jiwa pasien. Prognosis sangat tergantung di bagian mana herniasi terjadi. Kematian pasti terjadi jika herniasi tidak ditangani. Seorang wanita 27 thn dengan subdural hematom frontotemporoparietal D, edema serebri berat dan herniasi serebri, dengan riwayat tidak sadar setelah terjatuh dari motor karena ditabrak. Rencana dilakukan craniotomi evakuasi clot dan dekompresi. Saat pasien tiba, assesmen ditegakan, intubasi segera dilakukan untuk menguasai jalan nafas dan memberikan oksigenasi yang adekuat, resusitasi cairan serta manitol diberikan untuk mengendalikan kenaikan tekanan intrakranial. Operasi dilakukan dengan anestesi umum, menggunakan ETT No 7,5, ventilasi kendali. Dekompresi lambung dengan NGT no 16. Premedikasi dengan midazolam 2 mg. Co induksi menggunakan fentanyl 100 μg, induksi dengan propofol 100 mg. Lidocain 1,5 mg /KgBB diberikan 3 menit sebelum intubasi. Fasilitas intubasi dengan vekuronium 0,1 mg / KgBB. Pemeliharaan anestesi dengan O2 + N2O + Sevofluran. Propofol diberikan kontinyu 4-6 mg/kgBB/jam, vekuronium 6mg /jam. Operasi berlangsung selama 3 jam, evakuasi clot di regio frontotemporoparietal kanan, setelah dilakukan evakuasi clot, terjadi reperfusi ke daerah yang tadinya terdapat clot, sehingga terjadi pembengkakan otak (bulging) yang tidak dapat dikendalikan dengan hiperventilasi, manitol maupun pemberian furosemid. Diputuskan untuk melakukan dekompresi kraniektomi. Selama operasi hemodinamik relatif stabil, tekanan darah sistolik berkisar 100-130 mmHg, tekanan darah diastolik 60-90mmHg, laju nadi (HR) 87-110 x/mnt, SaO2 99-100 %, etCO2 25-30. Pascabedah pasien di rawat di ICU, ventilasi kontrol dengan ventilator, sedasi penuh. Sembilan hari kemudian pasien meninggal. Disfungsi neurologis dan kematian pada cedera otak traumatik (TBI) berhubungan dengan (a) cedera otak itu sendiri, (b) koma yang berkepanjangan dan komplikasinya, (c) infeksi karena luka terbuka atau patah tulang dasar tengkorak, (d) hidrocephalus karena SAH, dan (e) peningkatan TIK. Tekanan intrakranial yang sangat tinggi (TIK) dapat menyebabkan terjadinya herniasi serebri yang dapat berakibat fatal bahkan kematian.Management of Severe Cerebral Edema and Cerebral Herniation in Traumatic Brain InjuryTraumatic brain injury is one of life-threatening condition to victims of serious accidents, and is the leading cause of disability and death in adults and children. Subdural hematoma is a focal intracranial lesions are most common, about 24% of patients with severe closed head injury. Oedema cerebral commonly encountered in clinical practice and is a major cause of morbidity and mortality in critically ill patients and neurosurgical patients experiencing acute brain injury. Cerebral herniation is a state of emergency, where the therapeutic goal is to save patients' lives. Prognosis greatly depends on where the herniation occurs. Deaths would occur if the herniation is not addressed. A 27 years old woman with a subdural hematoma frontotemporoparietal D, severe edema cerebral and cerebral herniation, with a history of unconscious after falling from the motor due to being hit. Plans for craniotomi clot evacuation and decompression. When the patient arrived, the assessment is being established, immediate intubation for airway control and provide adequate oxygenation, fluid resuscitation and mannitol administered to control the rise in intracranial pressure. Operations performed in general anesthesia, using ETT No 7,5, controlled ventilation. Stomach decompression with NGT No.16. Premedication with midazolam 2 mg. Co induction using fentanyl 100 mg, induction with propofol 100 mg. Lidocain 1.5 mg / kg administered 3 minutes before intubation. Vekuronium 0.1 mg / kg for intubation fascilitation. Maintenance of anesthesia with O2 + N2O + sevoflurane. Given a continuous propofol 4-6 mg / kg / hour, vekuronium 6mg / hour. The operation lasted for 3 hours, clot evacuation in the region frontotemporoparietal right, after the evacuation of clot, occurs reperfusion to the area that had contained clot, resulting in swelling of the brain (bulging) that can not be controlled by hyperventilation, mannitol and furosemide administration. It was decided to perform craniectomy decompression. The hemodynamics relatively stable during the operation, systolic blood pressure range 100-130 mmHg, diastolic blood pressure 60-90mmHg, pulse rate (HR) 87-110 x / mnt, SaO2 99-100%, 25-30 EtCO2. Postoperative care of patients in the ICU, with ventilator control ventilation, full sedation. Nine days later the patient died. Neurological dysfunction and mortality in traumatic brain injury (TBI) are associated with (a) injury to the brain itself, (b) a prolonged coma and its complications, (c) infection of open wounds or fractures of the skull base, (d) hidrocephalus because of SAH, and (e) an increase in ICP. Very high intracranial pressure (ICP) can lead to cerebral herniation which can be fatal even death

Penatalaksanaan Anestesi Untuk Kliping Ruptur Aneurisma Serebral Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Aneurisma cerebral merupakan suatu kelainan vaskuler intraserebral, dengan angka kejadian sekitar 5% dari jumlah populasi pada usia 45-60 tahun. Perdarahan subarachnoid (Subarachnoid Hemorrhage /SAH) merupakan gejala serius dari aneurisma yang ruptur dengan angka kejadian berkisar antara 10-15 kasus per 100.000 populasi. Aneurisma yang pecah ulang atau iskemia merupakan masalah utama pada pengelolaan perioperatif pasien dengan aneurisma serebral. Seorang wanita berusia 73 tahun, berat badan 80 kg dengan aneurisma sakuler dari arteri vertebralis kanan bagian proksimal dari arteri sereberal posterior inferior (Posterior Inferior Cereberal Artery /PICA) dengan gambaran SAH, GCS 7, tekanan darah 200/160 mmHg, nadi 100 x/ menit, respirasi 18 x/permenit dengan Kriteria Hunt and Hess III-IV. Dilakukan intubasi dan penanganan tekanan darah di Unit Gawat Darurat dan pasien dirawat di ICU. Di ICU pasien diventilasi, dengan sedasi propofol 1 mg/kgBB/jam, diberikan perdipine 0,5 mg/kg BB/menit, dan pasien dapat diekstubasi hari ke-10 setelah perawatan di ICU. Operasi dilakukan pada perawatan hari ke 17, dengan keadaan prabedah GCS 13, tekanan darah 160/80 mmHg, nadi 90 x/menit, respirasi 14 x/menit SpO2 100% dengan binasal canul, dan direncanakan dilakukan kliping aneurisma. Dipasang alat pantau tekanan darah non-invasif, EKG, SpO2, dan urine kateter. Pasien tanpa premedikasi, induksi dengan propofol, fentanyl, lidokain, dan fasilitas intubasi dengan rocuronium 0,9 mg/kg BB. Rumatan anestesi dengan Sevofluran - Oksigen 40% - propofol kontinyu 1-3 mg/kg/jam - vecuronium 0,1 mg/kgBB/jam. Pemasangan arteri line setelah induksi anestesi. Untuk pengaturan tekanan darah sebelum dan saat kliping temporari dan permanen dengan nitrogliserin titrasi. Pascabedah pasien dipindahkan ke ICU, tidak diekstubasi, dan dilakukan ventilasi mekanis selama 24 jam, dan dirawat selama 12 hari, dengan mendapatkan terapi hipertensi dengan menaikkan tekanan darah maksimal 20% dari nilai dasar. Pasien di pindahkan ke ruangan GCS 15, Tekanan darah 140/90 mmHg, Nadi 80x/menit, respirasi 12x/menit SpO2 100%. Komplikasi pada post operasi aneurisma adalah hidrocephalus, rebleeding, kejang dan vasospasme. Adanya penurunan kesadaran pascabedah terutama disebabkan karena menurunnya aliran darah otak akibat vasospasme. Pencegahan dan penanganan kemungkinan terjadinya komplikasi ini dapat memperbaiki luaran pasien. Penatalaksaanaan preoperasi, intraoperatif dan postoperatif yang benar dapat memperbaiki luaran pasien.Anesthesia Management For Clipping Cerebral Aneurysm RuptureCerebralaneurysm is considered an intra cerebrovascular structural dysfunction, with the incidence rate around 5% of total 45-60 years of age population. Subarachnoid Hemorrhage (SAH) is considered a serious symptom of ruptured aneurysm and the incidence rate is around 10-15 cases per 100.000 human population. Re-ruptured or ischemia are the main problems in perioperative management of patient with cerebral aneurysm. A 73-year-80 kg BW female with saculler aneurysm on the right vertebral artery proximal to Posterior Inferior Cereberal Artery (PICA) and the appearance of subarachnoid haemorrhage (SAH), GCS 7, blood pressure 200/160 mmHg, heart rate 100 beats/minute, respiration rate 18 beats/minute with the Hunt and Hess Criteria III-IV was admitted to the hospital. Performed intubation and hypertension management at the emergency ward and the patient was treated at the ICU. At the ICU, the patient was on ventilator, sedated using propofol 1 mg/kgBW/hr, perdipine 0,5 mg/kgBW/minute, and the patient was extubated on the day-10 after ICU treatment. The surgery was performed on the day-17, and the presurgery descriptions were GCS 13, blood pressure 160/80 mmHg, heart rate 90 beats/minute, respiration rate 14 beats/minute, SpO2 100% with oxygenation using binasal canule, and the patient was scheduled for aneurysm clipping. A non-invasive monitor was installed for blood pressure, ECG, SpO2 and urine foley catheter was also installed. The patient was without premedication, inducted using propofol, fentanyl, lidocain, and facilitate intubation with rocuronium 0,9 mg/kgBW. Anesthetic maintenance using Sevoflurane - oxygen 40% - propofol continuously 1-3 mg/kgBW/hr - vecuronium 0,1 mg/kgBW/hr. Installation of arterial line was performed right after anesthetic induction. Nitrogliserin titration was used to manage blood pressure before and during temporary and permanent clipping. After surgery, the patient was transferred to ICU, unextubated, and was on mechanical ventilator for 24 hr, being treated for 12 days, and received hypertension therapy by increasing the blood pressure 20% maximum from the baseline. The patient was then transferred to the inpatient ward at GCS 15, blood pressure 140/90 mmHg, heart rate 80 beats/minute, respiration rate 12 beats/minute, and SpO2 100%. Complications that may occur at the post aneurysm surgery were hidrocephalus, re-bleeding, seizure and vasospasm. The awareness decline post surgery may due to the decreasing of intra cerebral blood circulation due to vasospasm. Anticipation and management the possibility of those complications may determine the patients outcome. The correct management of pre-surgery, intrasurgery and post surgery will improve the patient outcome as well.

Penanganan Anestesi pada Cedera Otak Traumatik Lalenoh, Diana Christine; Sudjito, M. H; Suryono, Bambang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatik (COT) atau Traumatic Brain Injury (TBI) merupakan masalah besar di dunia karena mortalitas dan morbiditas yang tinggi. Di Amerika setiap tahun cedera kepala terjadi pada 600.000 orang. Di Jerman sekitar 17,6% dari seluruh kasus trauma adalah cedera otak traumatik dan paling sering menyebabkan kematian (26%). Dilaporkan penanganan anestesi pada seorang pasien laki-laki 19 tahun, dengan berat badan 65 kg dengan diagnosa adanya epidural hematoma (EDH), ICH regio frontotemporalis sinistra, ICH regio temporalis dekstra, dan fraktur linear os temporal sinistra. Dilakukan kraniniotomi untuk pengambilan bekuan darah.Tekanan darah saat masuk kamar operasi 110/70 mmHg, laju nadi 98 kali /menit, laju napas 24 kali /menit, suhu badan 37,50 C, dan GCS E1V3M5. Pasien diinduksi dengan Fentanyl 100 ?g, Propofol 100 mg, fasilitas intubasi dengan Rocuronium 40 mg, Lidokain 70 mg, dan pemeliharaan dengan Isofluran dan Oksigen serta Propofol kontinyu, dan penambahan fentanyl dan rokuronium intermiten. Operasi berlangsung selama empat jam, kemudian dipindahkan ke ICU. Setelah dirawat selama 2 hari di ICU, pasien kemudian dipindahkan ke ruangan dengan GCS pasca operasi E3V5M6. Pengelolaan anestesi untuk perdarahan otak karena cedera otak traumatik membutuhkan suatu pengertian mengenai patofisiologi dari peningkatan tekanan intrakranial, tekanan perfusi otak. Resusitasi otak perioperatif secara farmakologik dan non-farmakologik adalah sangat penting untuk mencegah terjadinya cedera otak sekunder.Anesthesia Management in Traumatic Brain InjuryTraumatic Brain Injury (TBI) is a big problem in the world because of high mortality and morbidity. TBI burdens approximately 600,000 people every year in USA. Head injuries are found in 17.6% of all trauma in-patients and are the most common cause of death after injury (26.6%) in German. Here we report anesthetic management in male, 19 yrs old, 65 kgs body wieght, diagnose was Epidural Haematome (EDH), left frontotemporal intracranial haemorrhage (ICH), right temporal ICH, and linear fracture of left temporal bone. He was undergoing craniotomy procedure to evacuate blood clot. Blood pressure was 110/70 mmHg, HR 98 x / m, RR 24 x /m ,core temperature 37,50 C. GCS E1 V3 M5. Induction of anesthesia was with Fentanyl 100 ?g, Propofol 100 mg. Intubation with Rocuronium 40 mg, Lidocaine 70 mg, and maintenance with Isofluran and oxygen with intermittent Propofol, Fentanyl, and Rocuronium. After undergoing 4 hours anesthesia for craniotomy was ended, patient transfer to ICU. After 2 days patient was transfer to ward with GCS score E3V5M6. Anesthesia managementi in intracranial bleeding ec TBI is very important for understand intracranial hypertension pathophysiology, cerebral perfusion pressure. Basic brain rescucitation perioperatively with pharmacological and non pharmacological strategies is very important in TBI to prevent secondary brain injury.

Perioperatif Anestesi Pada Kraniotomi Penderita Cedera Otak Berat Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatik (TBI) merupakan penyebab kematian dan kecacatan pada penderita, apabila tidak mendapatkan pertolongan yang cepat dan tepat. Diperlukan peran seorang ahli anestesi dalam hal penanganan, yang dimulai sejak pra rumah sakit sampai perawatan neuro intensif. Standar terapi cedera otak traumatik selalu mengalami kemajuan dari tahun ke tahun, yang diharapkan bisa mencapai hasil yang maksimal dalam menangani kasus trauma kepala. Seorang laki-laki, usia 37 tahun, berat badan 75 kg, tinggi badan 170 cm. Penderita rujukan dari rumah sakit di kabupaten dengan diagnosa cedera otak berat. Mulai dari kejadian sampai masuk kamar operasi membutuhkan waktu 12 jam. Terjadi penurunan GCS dari 11 (3,3,5) ke 8 (2,2,4) kemudian 7 (1,2,4) dan dilakukan intubasi di ruang resusitasi, sebelum masuk kamar operasi. Dilakukan kraniotomi selama 7 jam untuk evakuasi hematoma subdural. Setelah operasi, dilakukan monitoring tekanan intrakranial (ICP) dan tindakan untuk terapi hipertensi intrakranial. Hari ketiga post operasi dilakukan tracheostomi. Hari ke lima post operasi, GCS 2,X,5 (dengan tracheostomi) dan penderita alih rawat ke bangsal. Penanganan penderita cedera otak traumatik seharusnya sudah dilakukan di tempat kejadian trauma dan berkesinambungan sampai perawatan intensif. Dengan adanya petugas trauma care yang terlatih di setiap daerah, diharapkan tidak terjadi keterlambatan dalam penanganan penderita yang juga akan berdampak pada hasil akhir penderita. Pemilihan obat anestesi disesuaikan dengan situasi dan kondisi penderita, termasuk kondisi rumah sakit. Semua itu mempunyai tujuan utama untuk mencegah kerusakan sekunder, serta diharapkan akan mengurangi mortalitas dan kecacatan penderita trauma.Perioperative Anesthesia In Craniotomy For Severe Traumatic Brain InjuryTraumatic brain injury (TBI) is a major cause of death and dissability in patient, if it doesnt get any therapy quickly and accurately. Anesthesiologist is important in case to handling the therapy from the accident site until in the neuro intensive care. A standard therapy in TBI is always moving forward by years, that is expected to achieve maximal results in that case. A man, 37 years old, weight 75 kg, height 170 cm. This patient was referral from another hospital in counties with severe head injury. Takes 12 hours, from the accident event until the patient arrive in the operating room. GCS is continues to drop from 11( 3,3,5) to 8 (2,2,4) and became 7 (1,2,4) then the intubation is taking place in the resuscitation room, before the patient get into the operation room. Craniotomy was done in 7 hours to evacuate subdural hematoma. After surgery, ICP monitoring and intracranial hypertension therapy was taken. In the 3rd day after surgery, tracheostomy was given to the patient. In the 5th day after main surgery, GCS is 2, X, 5 (with tracheostomy) and move to ward. The treatments of patient with TBI should taken on the site of accident until the patient in intensive care unit. A trained emergency staff in every region is expected in patient management effectively, that can affect in final results. The selection of anesthesia agent is depends on both patient and hospital, condition and circumstances. All of it, has a primary purpose to prevent secondary damage and expected to reduce mortality and disability in patients.

Pengelolaan Perioperatif Anestesi pada Pasien dengan Pembedahan Hipofisis Surgery Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Pengelolaan perioperatif pada pasien yang menjalani pembedahan kelenjar hipofisis bervariasi sesuai dengan ukuran lesi hipofisis, jenis lesi, metode pembedahan yang digunakan serta fungsi endokrin yang ideal pra-pembedahan. Permasalahan tertentu pada kebanyakan pasien berhubungan dengan kondisi hipersekresi hormon primer serta komplikasi yang menyertainya. Hal ini disebabkan karena tidak adanya metode yang terbaik untuk semua pasien yang menjalani proses pembedahan. Kelenjar hipofisis terletak didasar tulang tengkorak, didalam sella turcica, tepat dibelakang chiasma optica. Kelenjar ini dibagi menjadi dua bagian, yaitu; pars anterior (adenohipofisis) dengan area 75% yang merupakan bagian paling besar, dan pars posterior (neurohipofisis) yang menyatu dengan hipotalamus. Kelenjar ini mensekresi hormon yang juga dikontrol oleh hipotalamus secara hormonal impuls nervus. Tumor hipofisis pada umumnya berasal dari daerah anterior hipofisis, bersifat jinak dan secara gambaran histologis menyerupai kelenjar hipofisis yang normal. Diperlukan adanya serangkaian pemeriksaan awal sebelum dilakukan tindakan bedah pada pasien. Pengelolaan anestesi pada saat proses pembedahan, disesuaikan dengan teknik pembedahan yang dilakukan. Hal lain yang juga tidak kalah pentingnya adalah monitoring kondisi pascabedah pada neurointensive care yang terkait dengan komplikasi dan metode penggantian hormon sementara setelah tindakan bedah dilakukan. Pemahaman mengenai penilaian pra operasi, tata laksana intra operatif, komplikasi yang mungkin terjadi, teknik pembedahan dan cara-cara pencegahan komplikasi, merupakan dasar keberhasilan perawatan pasien perioperatif sehingga mencegah morbiditas dan mortalitas.Perioperative Management Anesthesia on Patients Undergoing PituitaryPerioperative management on patients undergoing pituitary surgery is varies according to the size of pituitary lesion, type of lesion, surgical method used and the ideal preoperative function of endocrine. Specific problems in most patients relate to primary hormonal hypersecretion conditions and its complications. It cause by the absence of best methods for all patients undergoing this kind of surgery. Pituitary glands lie on the floor of the skulls bone, in sella turcica, right behind the chiasma optica. This glands was divided into two parts, pars anterior (adenohypophyse), its about 75% which is the biggest part of it, and the pars posterior (neurohypophyse) that fused with hypothalamus. This gland secretes hormone that controlled impuls nervus by the hypothalamus. In general, pituitary tumor was came from pars anterior, benign adenoma and histoligically same with a normal glands. A series of initial evaluation is required before the surgery take to the patients. Anesthesia management in the surgery is adapted to its technique. The other things that is equally important is post operative monitoring in neurointensive care, according to complications and transient hormone replacement method after the surgery. The understanding of preoperative assessment, intraoperative management, potential complication, surgical methods and several ways to prevent complications are the fundamental for successful perioperative patients care to prevent morbidity and mortality.

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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

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