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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

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Penatalaksanaan Anestesia pada Pasien Cretin dengan Hipopituitarisme Sekunder Akibat Kraniofaringioma Rahardjo, Theresia Monica; Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Kraniofaringioma adalah tumor sela dan parasela, yang merupakan 6-10% tumor otak pada anak-anak. Gejala umum merupakan tanda peningkatan tekanan intrakranial, seperti sakit kepala, muntah dan gangguan penglihatan. Disfungsi endokrin yang nyata merupakan gambaran umum kraniofaringioma akibat lokasi tumor terhadap kelenjar hipotalamus dan pituitari. Fisik pendek ditemukan pada 50-86% pasien dengan laju pertumbuhan subnormal dan pubertas yang terlambat. Seorang laki-laki, umur 20 tahun, pasien kretin dengan hipopituitarisme sekunder menjalanicraniotomy tumor removal dan penempatan omaya shunt. Dia memiliki riwayat sakit kepala sejak 13 tahun yang lalu disertai dengan gangguan penglihatan yang dimulai dari mata kiri dan saat ini dia buta. Dia juga menderita kegagalan pertumbuhan dan pubertas yang terhambat, memiliki fisik seorang anak laki-laki, dengan tinggi badan 140 cm dan berat badan 40 kg. Dia memiliki TSHs yang meningkat dengan T3 dan fT4 yang normal, LH dan FSH yang menurun, prolaktin yang normal, hormon pertumbuhan yang normal rendah dan kortisol yang menurun. Teknik anestesia yang digunakan adalah anestesia umum. Induksi dengan fentanyl, pentotal, lidocaine dan vecuronium dengan kombinasi N2O/O2 dan isoflurane. Rumatan anestesi dengan isoflurane dan kombinasi O2/udara. Pernapasan pasien dikontrol dengan dosis inkremental vecuronium untuk mempertahankan relaksasi. Mannitol dan furosemide diberikan untuk menurunkan tekanan intrakranial. Operasi berlangsung selama 5 jam. Setelah 5 hari di ICU, pasien dapat kembali keruangannya di Kemuning. Masalah pasien ini adalah peningkatan tekanan intrakranial, disfungsi endokrin dan kemungkinan kesulitan jalan napas akibat bentuk tubuh yang kecil. Kortikosteroid sebagai terapi penggantian hormonal diberikan sebelum operasi. Dosis obat anestesi disesuaikan dengan berat badan. Intubasi menggunakan laryngoscope blade dan endotracheal tube dengan ukuran lebih kecil. Selama operasi dihindari pemakaian nitrous oxide, digunakan konsentrasi rendah anestesi inhalasi dan penggunaan dominan anestesi intravena. Pemantauan post operatif dilakukan di ICU dengan memperhatikan kemungkinan komplikasi hormonal seperti diabetes insipidus dan hiponatremia selain pengelolaan nyeri post operatif. Pasien dengan penyakit pituitari, dalam kasus ini kraniofaringioma, disertai dengan disfungsi endokrin dan pertumbuhan abnormal, membutuhkan penatalaksanaan preoperatif, intraoperatif dan postoperatif yang sangat teliti. Kerjasama yang baik antara bagian anestesi, bedah dan endokrinologi dapat menurunkan morbiditas dan mortalitas pada penyakit ini.Anesthesia Management In Cretin Patient With Hypopitutarism Secondary Of CraniopharyngiomaCraniopharyngioma is a sellar and parasellar tumor, which accounts to 6-10% of childhood brain tumors. Common symptoms are signs of increase intracranial pressure, like headache, vomiting and visual dysfunction. A significant endocrine dysfunction is an usual feature of craniopharyngioma due to the proximity of the tumor to hypothalamus and pituitary gland. Short statue found in 50-86% patient with subnormal growth rates and delayed puberty. A male, 20 yrs cretin patient with hypopituitarism secondary of craniopharyngioma had a craniotomy tumor removal and placement of omaya shunt. He had a history of headache since 13 yrs ago accompanied by visual disturbance, started from his left eye, now he is totally blind. He also suffered from growth failure and delayed puberty, has a physic of a boy regardless his age as 20 yrs old adult, with height 140 cm and weight 40 kg. He has an elevated TSHs but normal T3 and fT4, a decreased LH and FSH, a normal prolactin, a normal but low growth hormon and a decreased cortisol. Anesthetic technique used was general anesthesia. Induction was done with fentanyl, pentotal, lidocaine and vecuronium with a mixture of N2O/O2 and isoflurane. Anesthesia was maintained with isoflurane and a mixture of O2/air. Patient was in controlled breathing with an incremental dose of vecuronium to maintaine the relaxation. Mannitol and furosemide were given to reduce intracranial pressure. The procedure took about 5 hours. After 5 days ICU stayed, the patient was referred back to his room at Kemuning. The problems in this patient are a raised of intracranial pressure, an endocrine dysfunction and a possibility of airway difficulty related to his short statue. Corticosteroid as hormone replacement therapy was given before the operation. Based on his short statue, induction dose of anesthetic agents were adjusted and smaller laryngoscope blade and endotracheal tube were used for intubation. Avoidance of nitrous oxide, low concentration of volatile agent and dominant used of intravenous anesthetic agent were applied during the operation. Post operative monitoring was done in ICU with specific concern of hormone complications like diabetes insipidus and hyponatremia beside post operative pain control. Patient with pituitary disease, in this case craniopharyngioma, accompanied by endocrine dysfunction and abnormal growth, need a very careful treatment from preoperative, intraoperative to postoperative period. A good management and cooperation between anesthesiologist, surgeon and endocrinologist can reduce the morbidity and mortality in this kind of disease.

Penatalaksanaan Cedera Otak pada Anak AR, Muhammad; Umar, Nazaruddin; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Trauma kepala (TBI) pada anak merupakan suatu problem khusus dalam neuroanestesi. Terdapat perbedaan anatomi, fisiologi dan fisikososial, disamping otak anak yang sedang mengalami perkembangan/pertumbuhan. Bila terjadi trauma akan menyebabkan angka mortalitas dan morbilitas serta angka kecatatan yang lebih tinggi, yang sangat berpengaruh pada perkembangan anak. Patah tulang kepala, perdarahan epidural, subdural dan intracerebral, edema otak akan menimbulkan gangguan pertumbuhan dan berefek pada organ-organ lain. Seorang anak laki-laki, 4 tahun 10 bulan, datang ke RS dengan mengalami penurunan kesadaran setelah terjatuh dari kendaraan karena kecelakaan lalu lintas. Datang ke rumah sakit lebih kurang 6 jam setelah kecelakaan, sebelumnya dirawat di rumah sakit terdekat. Pada pemeriksaan didapat GCS 10, pupil isokor 2/2mm, reflek cahaya +/+, hemodinamik dalam batas normal, anemia (+). Setelah dilakukan pemeriksaan fisik dan pemeriksaan tambahan didiagnosa kerusakan otak karena trauma (GCS 10) + didapatkan fraktur terbuka tulang frontoparietal kanan + fraktur tulang frontal kiri kontusio hemorrhagik + anemia. Dilakukan operasi debridemen dan koreksi fragmen tulang yang patah dengan bantuan anestesi umum. Pascabedah pasien di rawat di ICU dengan kesadaran meningkat, keadaan membaik. Kemudian pasien di pulangkan setelah 15 hari perawatan. Penanganan anestesi pada trauma kepala anak mempunyai problem khusus yang berbeda dengan dewasa, maka perlu pemahaman tentang anatomi, fisiologi dan psikologi yang baik dalam persiapan dan penatalaksanaan yang khusus sehingga dapat mencegah atau mengurangi kemungkinan terjadinya penyulit-penyulit post operasi.Management of Brain Trauma in Children AbstractHead trauma (TBI) in children is a particular problem in neuroanestesi. There are differences in anatomy, physiology and psychosocial, as well as children who are experiencing brain development / growth. In the event of trauma will cause mortality and morbidity and a higher rate, which is very influential in the development of children. Skull fracture, epidural hemorrhage, subdural and intracerebral, brain edema may lead to an effect on growth and other organ. A boy, 4 years 10 months, admitted to hospital with the experience a decrease in consciousness after falling from a vehicle due to traffic accidents. Come to the hospital approximately 6 hours after the accident, previously treated in nearly hospitals. On examination 10 obtained GCS, pupillary light reflex isocoor 2/2mm + / +, hemodynamics in the normal range, anemia (+). After a physical examination and was diagnosed with an additional examination brain damage due to trauma (GCS 10) + obtained frontoparietal bone fracture open fracture of the right frontal bone fracture + left + contusio hemorrhagic + anemia. Surgical debridement and correction of the broken bone fragments under general anesthesia. Post surgery patients cared for in ICUs with increased awareness, things got better. Then the patient at discharge after 15 days. Anesthesia management in head trauma the child has special problems that are different from adults. It is necessary to an understanding of the anatomy, physiology and psychology are both in preparation and stylists specifically so as to prevent or reduce the likelihood of postsurgery complications.

Membran Sel Neuron dan Sawar Darah Otak sebagai Struktur Proteksi Otak Mafiana, Rose; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Otak adalah organ vital tubuh yang rentan untuk rusak. Mempunyai kebutuhan oksigen yang tinggi, sangat tergantung terhadap glukosa, mempunyai kecepatan metabolisme yang tinggi, tetapi mempunyai daya adaptasi yang rendah terhadap cedera serta sangat sulit beregenerasi. Cedara pada sel otak (neuron) adalah suatu kondisi yang serius yang dapat menyebabkan disfungsi dan kematian sel otak. Kebutuhan otak yang tinggi akan oksigen dan glikogen secara konstan adalah untuk memproduksi energi tubuh berupa adenosine-5-triposphate (ATP) yang berguna untuk mempertahankan kehidupannya. Injuri sel dapat mengganggu metabolisme tersebut, mengurangi produksi ATP, menurunkan cadangan ATP dan menyebabkan proses glikolisis dan penggunaan laktat tubuh sebagai sumber energi metabolisme. Kondisi patologis ini memicu untuk terjadinya kerusakan sampai kematian sel melalui jalur nekrosis maupun apoptosis. Oleh karena itu otak dilindungi oleh membran sel dan sistem pembuluh darah otak yang bersifat spesifik, yang disebut sawar darah otak.Membrane Neuronal Cell and Blood Brain Barriere as Structure Brain Protection The brain is the body's vital organs are susceptible to damage. Have a high oxygen demand, is highly dependent on glucose, has a high metabolic rate, but have low adaptability of the injury and it is very difficult to egeneration. Injury on brain cells (neurons) is a serious condition because of risk for dysfunction and cells death. The brain needs for oxygen and glycogen constanly to produce the body's energy in the form of adenosine-5'-triposphate (ATP) which is useful for maintaining life. Injury can interfere with the metabolism of these cells, reducing the production of ATP, reducing ATP reserves and cause glycolysis process in the body and the use of lactate as an energy source metabolisme. This pathological condition for the occurrence of damage cell and trigger to cell death through necrosis or apoptosis process. Therefore, the protective structure cell membran and cerebral vascular system such as special, the vascular structure is blood brain barrier.

Cedera Kepala Berat Pada Pasien Hamil M. Zafrullah Arifin; Subrady Leo SS; Firman Priguna T
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Latar Belakang dan Tujuan: Cedera kepala pada wanita dengan kehamilan dapat meningkatkan resiko morbiditas dan mortalitas bagi ibu dan janinnya. Komplikasi yang dapat terjadi antara lain kematian ibu, syok, perdarahan intrauterin, kematian janin intrauterin, trauma janin, abruptio placenta, ruptur uterin. Penyebab tersering dari trauma tersebut antara lain kecelakaan lalulintas, terjatuh dari ketinggian, kekerasan dalam rumah tangga, dan luka tembak. Banyak penilaian dan penanganan yang unik untuk kasus ini, meskipun evaluasi awal dan resusitasi sasaran utama untuk menyelamatkan ibu. Setelah keadaan ibu stabil baru dilakukan evaluasi dan penilaian dari janin. Monitoring tokokardiografi, pemeriksaan ultrasound, CT-Scan kepala dapat dilakukan disertai dengan tindakan kraniotomi dan atau seksio sesarea. Subjek dan Metode: Penelitian observasional dari tahun 2008-2012, serial kasus, pada wanita hamil yang mengalami cedera kepala berat dan dilakukan operasi untuk evakuasi hematoma. Hasil: Selama 3 tahun terakhir telah dilakukan tindakan pembedahan untuk penderita cedera kepala dengan kehamilan sebanyak 3 kasus, dua diantaranya disertai dengan seksio sesarea. Simpulan: Kasus cedera kepala pada wanita dengan kehamilan tergolong jarang dan penanganan dini multidisiplin pada cedera kepala berat pada kehamilan dapat menurunkan risiko morbiditas dan mortalitas untuk ibu dan janin Severe Head Injury in Pregnant Patients Background and Objective: Head injury in pregnancy can increase the risks of mortality and morbidity, both for the mother and fetus. Common complications are including death, shock, intrauterine bleeding, intrauterine fetal death, fetal trauma, placental abruptio and, uterine rupture. Motor vehicle accident, falls, assault and gun shot wound are the primary cause of injury. Treatment and recognition of this cases are unique, even though the main target are early evaluation and resuscitation of the mother and afterward, the fetus. Tococardiography monitoring, ultrasound, and head CT Scan can be perform with or without craniotomy and caesarean section.Subject and Method: An observasional study taken from the year of 2008-2012, a serial case report in pregnant women with severe head injury undergoing operation for evacuation of hematoma.Result: During the last 3 years, three patients had underwent surgery for head injury with two of them underwent a sectio caesarean procedure.Conclusion: The incidence of head injury in pregnant women is considered very rare and an early multidiciplinary management for head injury in pregnancy can decrease the risk of morbidity and mortality for both the mother and the fetus.

Penatalaksanaan Anestesi untuk Tumor Neuroendokrin Syafruddin Gaus; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Tumor neuroendokrin sering ditemukan pada orang dewasa dengan angka kejadian 10%-15% dari seluruh neoplasma intrakranial dan tertinggi pada dekade ke 4 sampai ke 6 kehidupan. Penderita dengan tumor neuroendokrin mempunyai tantangan yang unik untuk dokter ahli anestesi karena peranan yang penting kelenjar hipofise pada sistem endokrin.Tantangan ini mulai saat pemeriksaan prabedah dan berlanjut selama operasi serta periode pascabedah. Banyak teknik anestesi dan obat anestesi yang dapat diberikan pada pembedahan tumor neuroendokrin. Pemilihan obat anestesi tergantung pada penyakit komorbititas penderita dan riwayat anestesi sebelumnya. Apabila diinginkan penderita cepat sadar untuk segera dilakukan pemeriksaan neurologik maka dapat digunakan obat-obat yang cepat dieliminasi (misalnya propofol dan remifentanil) atau anestetika inhalasi dengan kelarutan dalam darah yang rendah (misalnya sevofluran) merupakan pilihan yang rasional. Keberhasilan pembedahan dan penatalaksaan anestesi pada penderita tumor neuroendokrin memerlukan pendekatan multidisiplin dan sangat tergantung pada kualitas perawatan perioperatif. Anesthesia Management for Neuroendocrine TumorNeuroendocrine tumor is commonly in adult patient with incidence 10-15% in all of intracranial neoplasm and highest at 4th-6th of life decade. Patients with neuroendocrine tumor have an unique challange for anesthesiologist because the important role of pituitary gland in endocrine system. The challange came during preoperative, intraoperative and postoperative periode. Many of anesthesia technique and anesthetics can use for neuroendocrine tumors surgery. The choice of anesthetics depend on comorbid diseases and history of anesthesia previously. If needed fast emergens for neurological evaluation, it can be use drug with fast elimination (ex propofol and remifentanil) or inhalation anesthetic with low coefficient partition (ex sevoflurane) is rational choice. The successful surgery and anesthesia management for neuroendocrine patient need multidisipline approach and depend on the quality of postoperative care.

Penanganan Anestesi Wanita Hamil untuk Kraniotomi Emergensi Hematoma Subdural Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Trauma selama kehamilan, termasuk cedera kepala, adalah penyebab morbiditas dan kematian ibu akibat kecelakaan dan merupakan 6%-7% penyulit dari keseluruhan kehamilan dan pengelolaan pasien harus multidisiplin. Spesialis anestesiologi harus memahami perubahan fisiologi pada wanita hamil, implikasinya, dan risiko khusus pemberian anestesi selama kehamilan sehingga dapat dibuat perencaan penanganannya. Perubahan fisiologi yang unik dari kehamilan, terutama sistem kardiovaskuler, mempunyai keuntungan dan kerugian setelah trauma. Kami melaporkan seorang pasien, umur 28 tahun, dengan umur kehamilam 27-28 minggu masuk ke departemen emergensi akibat kecelakaan sepeda motor dengan Glasgow Coma Scale (GCS) E1M4Vt, tekanan darah 130/70 mmHg, laju nadi 72 x/menit, laju nafas 16 x/menit, telah diintubasi dengan pipa endotrakhea no.6.5, pupil isokor, refleks cahaya positif, laju jantung fetus 140-144 x/menit, dan hasil CT-scan menunjukkan adanya subdural hematoma temporoparietal kanan. Anestesia endotrakheal dengan isofluran, oksigen/udara dengan monitor standar dan Doppler untuk memantau laju jantung fetus. Tujuan utama intervensi bedah saraf pada wanita hamil adalah adalah untuk kelangsungan hidup ibu dan anak. Sasaran utama penanganan anestesi untuk wanita hamil yang tidak dilakukan operasi obstetri adalah mempertahankan perfusi uteroplasenta. Peranan tim multidisiplin dalam penanganan pasien parturien dengan risiko tinggi tidak dapat diremehkanAnesthetic Management of Pregnant Woman for Emergency Craniotomy Subdural Hematoma Trauma during pregnancy, including head injury, is the leading cause of accidental maternal death and morbidity, and complicates 6%-7% of all pregnancies which requires multidisciplinary patients management. The anesthesiologist must understand the physiological changes of pregnancy, their implications, and the specific risks of anesthesia during pregnancy, so that the best anesthetic approach can be performed. The unique physiologic changes of pregnancy, particularly on the cardiovascular system, are both have advantage and disadvantage after acute traumatic injury. We reported a 28 years old parturient patient at 27-28 weeks of pregnancy who was admitted to emergency department due to motorcycle accident with Glasgow Coma Scale (GCS) of E1M4Vt, Blood Pressure 130/70 mmHg, Heart Rate 72 x/minute, Respiratory Rate 16 x/minute.The patient was already intubated using an endotracheal tube no.6.5, the pupils were equal, round and still reactive to light stimulation, fetal heart rate (FHR) was 140-144 x/minute, and head computed tomography scan showed right temporoparietal subdural hematoma. Endotracheal anesthesia was given with isoflurane, oxygen/air, with implementation of standard monitors and Doppler for FHR. The main aim of a neurosurgical intervention in a pregnant woman is to preserve the viability of both the mother and the infant. The main goal in the management of anesthesia for pregnant woman undergoing a non-obstetric surgery is to maintain the uteroplacental perfusion. The role of a multidisciplinary team in the care of high risk parturient patients cannot be avoided.

Luaran Pasien Dengan Perdarahan Intraserebral dan Intraventrikular yang Dilakukan Vp-Shunt Emergensi Jasa, Zafrullah Kany; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Perdarahan intraventrikuler dan intraserebral merupakan kejadian akut yang dapat timbul spontan terutama akibat hipertensi dan aneurisma yang pecah atau oleh karena cedera kepala akibat trauma. Pada keadaan akut tindakan yang dilakukan dapat berupa pemberian obat-obatan ataupun tindakan pembedahan. Tindakan pembedahan yang dilakukan bertujuan untuk mengurangi tekanan intrakranial yang meningkat mendadak dan mengeluarkan hematoma untuk segera memperbaiki gangguan fungsi dan mencegah kerusakan neurologis lebih berat. Tindakan ini diharapkan dapat menurunkan tekanan intrakranial serta mengurangi resiko timbulnya hidrosefalus akibat tersumbatnya sistem ventrikel di otak sebagai salah satu kompilkasi dari perdarahan intrakranial.Subjek dan Metode: Telah dilakukan tindakan pemasangan Ventrikulo-Peritoneal Shunt (VP-Shunt) pada 8 orang pasien yang mengalami perdarahan intraventrikuler atau perdarahan intraserebral oleh karena stroke dan trauma dalam 72 jam pertama setelah timbulnya gejala. Dilakukan perbandingan terhadap GCS awal sebelum operasi dan 72 jam setelah operasi serta luaran terhadap pasien terebut.Hasil: Didapatkan bahwa 6 orang pasien (75%) terjadi peningkatan GCS setelah pemasangan VP-Shunt. Dari pasien yang mengalami perbaikan GCS didapatkan selanjutnya 4 orang (50%) dipulangkan dan 4 pasien meninggal selama perawatan karena komplikasi.Simpulan: Tindakan VP-Shunt pada keadaat akut terhadap pasien perdarahan intraventrikuler dan intraserebral diduga dapat memperbaiki tingkat kesadaran meskipun luaran pasien tidak menunjukkan perbedaan bermaknaOutcome of Patients with Intracerebral and Intraventricular Haemorrhage After an Emergency Vp-Shunt Insertion Background and Objective: Intraventricular and intracerebral haemorrhage is an acute condition that can occurs spontaneously due to hypertension or rupture of aneurism, and also can be occurs as a result from brain damage caused by trauma. Management in this acute condition can be done by either giving particular drugs or through surgical procedures. The aim of surgical procedure is to reduce a sudden increase of intracranial pressure as well as to evacuate hematome, in order to prevent functional neurology disturbance and damage. By performing this management, intracranial pressure is expected to decrease, and to reduce the risk of hydrocephalus resulted from an occlusion in brain ventricular system as one of the complication of intracranial haemorrhage.Subject and Method: Ventriculo-Peritoneal Shunt (VP-Shunt) was inserted during the first 72 hours after the event in 8 patients with intraventricular and intracerebral haemorrhage due to stroke and trauma. Level of consciousness was assessed, by comparing the pre-operative and 72 hours post-operative using Glasgow Coma Scale (GCS), and the patient outcome was also assessed.Result: Six (75%) patients showed an increase GCS after VP-Shunt insertion, with 4 of them can be discharged from the hospital, whilst 4 patients died due to other complications.Conclusion: VP-Shunt insertion in acute condition in patients with intraventricular and intracerebral haemorrhage is considered to be useful in accelerating the level of consciousness, even though the overall outcome of the patients is not significantly different.

Penggunaan Dexmedetomidin pada Neurotrauma Prihatno, MM Rudi; Lian, Abdul; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Penggunaan dexmedetomidin dalam neurotrauma masih terpecah antara yang setuju dan tidak setuju. Permasalahan ketidaksetujuan adalah dari sisi penilaian terhadap kesadaran pasien, sedangkan yang menyetujui pemberian dexmedetomidin lebih cenderung digunakan sebagai sedasi dan juga efeknya sebagai protektor otak. Permasalahan tersebut diatas dapat dijadikan pertimbangan oleh ahli anestesi dalam penatalaksanaan neurotrauma dengan tetap mempertimbangkan kondisi fisik dan kesadaran pasien dengan harapan agar keselamatan pasien tetap terjaga dengan baik dan tidak memperburuk kondisi pasien.The Use of Dexmedetomidine on Neurotrauma The use of dexmedetomidine in Neurotrauma still divided between the agree and disagree. Disagreement is the issue of the assessment of patient awareness, while approving the provision of dexmedetomidine were more likely to be used as a sedative and also its effect as a brain protector. The problems mentioned above can be considered by an anesthesiologist in the management of Neurotrauma while considering the physical condition and consciousness of the patient with the expectation that patient safety is maintained properly and not worsen the patient's condition.

Peran Neuro Critical Care Pada Tata Laksana Pasien Cedera Aksonal Difus Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera aksonal difus (Diffuse Axonal Injury / DAI) adalah keadaan penderita dengan kehilangan kesadaran, lebih dari 6 jam pada cedera otak traumatik berat dan tanpa lesi masa intrakranial. Berdasar lama kondisi koma pada pasien, DAI dibagi menjadi 3 kategori, kelas I (ringan), kelas II (sedang), kelas III (berat). Bila tidak ditangani dengan cepat dan tepat, kemungkinan pasien akan mengalami cacat permanen dan tetap dalam kondisi vegetative. Peran Neuro Anestesi dan Critical Care adalah untuk menangani penderita, dimulai dari tempat kejadian trauma hingga perawatan neurointensif. Seorang wanita, umur 18 tahun, berat badan 50 kg, tinggi 165 cm. Mengalami kecelakaan sepeda motor, kemudian penderita pingsan mulai dari tempat kejadian sampai dibawa ke rumah sakit. Dilakukan monitoring tekanan intrakranial (ICP) dan perawatan cedera otak traumatik berat pada umumnya. Pada hari ke 4 setelah trauma, penderita mulai sadar, dapat diperintah dan dengan nilai Glasgow Outcomes Scale (GOS): 3 (cacat parah). DAI terjadi karena cedera otak berat setelah trauma sehingga menyebabkan penurunan kesadaran tanpa adanya lesi masa intrakranial maupun iskemik. Bermacam-macam teori dikemukakan mengenai terjadinya DAI. Penatalaksanaan DAI tidak ada yang khusus, dilaksanakan penanganan seperti pada cedera otak traumatik umumnya, hanya diperlukan pencegahan cedera sekunder dan mempertahankan tekanan intrakranial (ICP) dalam kondisi normal. Prognosa tergantung dari jenis DAI yang terjadi.The Role Of Neurocritical Care On Diffuse Axonal Injury Management Diffuse Axonal Injury (DAI) is a state of long-time unconsciousness, more than 6 hours in severe traumatic brain injury and without mass lesions of intracranial. According to how long the patient still in coma condition, DAI is divided into 3 categories, grade I (mild), grade II (moderate), grade III (severe). If this condition not addressed quickly and accurately, the patient may will get a permanent disability and still in a vegetative state condition. The importance of Neuro-anesthesiologist and Critical Care is to take care of the patient, from the trauma site until in the neurointensive care. A woman, 18 years old, weight 50 kg, height 165 cm. She had a motorcycle accident and unconscious from the trauma site until she got into the hospital. Intra Cranial Pressure (ICP) Monitoring and a treatment of traumatic brain injury in general was performes. On the 4th day after trauma, the patient began to understand the command that was given and the GOS (Glasgow Outcomes Scale) is 3 (severe disability). DAI occurs due to severe brain injury after trauma resulting in impairment of consciousness with the absence of intracranial mass lesions and also ischemia. The various theories bring to the surface regarding the occurrence of DAI. The management in DAI is nothing specials, it contains the treatment in traumatic brain injury in general, the prevention of secondary injury and maintain ICP in normal condition is essentials. The prognosis is depends on the type DAI that was occurs.

Subdural Hematom dengan Atrial Fibrilasi dan Penyakit Jantung Hipertensi Suyasa, Agus Baratha; Sudadi, Sudadi
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

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. Atrial Fibrilasi (AF) menyebabkan 6-24% kejadian stroke iskemik serta dapat terjadi kematian secara tiba-tiba karena gagal jantung. Seorang wanita 63 th dengan subdural hematom temporoparietal D, atrial fibrilasi dan penyakit jantung hipertensi, dengan riwayat jatuh dari motor, pingsan, mual dan nyeri kepala hebat. Rencana dilakukan kraniotomi evakuasi clot dan reposisi fiksasi fraktur. Operasi dilakukan dengan anestesi umum, menggunakan ETT No 7,5, ventilasi kendali. NGT no.16 dipasang untuk dekompresi. Premedikasi dengan midazolam 2 mg. Lidocain 1,5 mg /KgBB 3 menit sebelum intubasi. Co induksi menggunakan fentanyl 100 ?g, induksi dengan propofol 100 mg. Fasilitas intubasi dengan vekuronium 0,1 mg / KgBB. Pemeliharaan anestesi menggunakan O2 + N2O + Sevofluran. Propofol di berikan kontinyu 100 mg/jam, Vekuronium 6mg /jam, Digoksin drip 0,25mg/24 jam. Operasi dilakukan selama 4 jam. Selama operasi hemodinamik relatif stabil, tekanan darah sistolik 130-150 mmHg, tekanan darah diastolik 70-90mmHg, laju nadi (HR) 90-110 x/mnt ireguler, SaO2 99-100 %, EtCO2 30-33. Ekstubasi tidak dilakukan dikamar operasi karena terdapat VES bigemini dan rapid ventricular respons terhadap AF, pasien kemudian dibawa ke ICU. Penurunan oksigenasi jaringan otak merupakan akibat dari dampak fisiologis pada sistem tubuh. Hipertensi, aritmia, hiperglikemi, hipertermi dan hipernatremi dapat muncul akibat sympathetic storming. Aritmia yang sering muncul adalah bradikardi, denyut ektopik, denyut ireguler, atrial fibrilasi dan supraventrikuler takikardi. Aritmia harus segera ditangani jika mengancam kehidupan, dan menyebabkan instabilitas hemodinamik serta hipoksia serebral, baik karena infark miokard maupun thromboemboli (AF dan SVT). Persiapan yang baik sebelum pembedahan yaitu oksigenasi, stabilisasi respirasi dan kardiovaskuler termasuk terapi aritmia, serta status cairan yang adekuat akan memberikan hasil yang lebih baik.Subdural Hematom in Patient with Atrial Fibrilation and Hypertensive Heart DiseaseTraumatic Brain Injury (TBI) is one of the serious life-threatening condition in trauma victim, and as the major cause of disability and death in adult and children. Subdural hematoma is the most often focal intracranial lesion found, with the incidence of 24% in close head injury cases. Approximatelly 6-24% of Atrial Fibrilation (AF) contributes to ischemic stroke and sudden death because of heart failure. We reported a 63 years old female, diagnosed with subdural hematoma of the right temporoparietal, atrial fibrillation and hypertensive heart disease, who arrivde at the hospital with history of unconsciousness, and severe headache due to motor vehicle accident, and undergone a craniotomy clot evacuation and reposition fixation of the fractured bones. The procedure was performed under general anesthesia, using ETT No 7,5., controlled ventilation. NGT no 16 was inserted for gastric decompression. Two mg of Midazolam and 1,5 mg/KgBW of lidocain given intravenously 3 minutes prior to intubations was used as premedications, 100 ?g intravenou Fentanyl,was given as co induction. Induction anesthesia was performed using 100mg propofol and 0,1mg/KgBW vecuronium to facilitate intubations. Maintenance of anesthesia was obtained using O2, N2O, sevoflorane, continuous drip of 100 mg/hour propofol, 6mg/hour vecuronium,and 0,25mg/24hours of digoxin continuous drip was given. The procedure was done in 4 hours. During the operation, haemodynamic remained stable with SBP 130 150 mmHg, DBP 70-90 mmHg, HR 90-110 bpm irregular and SaO2 99-100 %. EtCO2 level was 30-33. The patient was not extubated by end of surgery, because ECG monitor showed VES bigemini and rapid ventricular response of AF. The patient was directly transferred to the ICU after the procedure. Decreased in brain tissue oxygenation is the physiological impact of body system. Hypertension, arrhythmia, hyperglycemia, hyperthermia and hypernatremia can occur due to sympathetic storm. The most common arrhythmias that could occur are bradycardia, ectopic beat, irregular beat, atrial fibrillation and supraventricular tachycardia. Arrhythmias due to myocardial infarction or thromboemboli (AF and SVT) must be treated immediately when considered as a life threatening condition which provokes a hemodynamic instability and cerebral hypoxia Optimal pre-operative management including oxygenation, cardiorespiration stabilization, arrhythmia managemen and, adequate fluid status, will improve the outcome.

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Home Page

OAI Link

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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

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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