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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 10, No 1 (2021)" : 9 Documents clear

Manajemen Anestesia pada Evakuasi Epidural Haemorrhage (EDH) dengan Pendarahan Masif Huda, Nurul; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Cedera otak traumatik menjadi penyebab dari mortalitas dan morbiditas di seluruh dunia. Epidural Haemorrhage (EDH) merupakan salah satu bentuk cedera otak traumatik dimana waktu adalah indikator yang harus diperhatikan dalam tatalaksananya. Fokus utama selama penatalaksanaan kasus cedera otak traumatik adalah stabilisasi pasien dan mengendalikan tekanan intrakranial, serta mempertahankan oksigenasi dan perfusi otak. Selanjutnya dilakukan dekompresi dengan pembedahan. Evakuasi dan kontrol perdarahan harus dikerjakan dalam waktu singkat untuk menghindari cedera lebih lanjut. Praktik neuroanastesi, sebagai penunjang dalam tatalaksana cedera otak traumatik, sering diasosiasikan dengan kejadian kehilangan darah yang mengakibatkan kondisi anemia selama periode intra operatif dan pasca operatif. Meskipun anemia berkorelasi dengan hasil akhir yang buruk pada pasien cedera otak, transfusi sel darah merah untuk mengoreksi kondisi anemia juga berkorelasi dengan hasil akhir yang buruk pada pasien. Masih belum ada rekomendasi yang jelas mengenai pemberian transfusi, apakah restriksi atau masif, terkait dengan manfaat yang diberikan. Pasien laki-laki, usia 51 tahun dengan keluhan penurunan kesadaran dan muntah-muntah, rujukan dari rumah sakit sebelumnya dengan diagnosis cedera kepala sedang 225 dengan EDH temporoparietal 96cc, midline shift 11mm ke kanan, edema serebri. Selama durante operasi terjadi perdarahan masif yang mengganggu status hemodinamik sehingga diberikan transfusi komponen darah sampai didapatkan status hemodinamik yang stabil. Pada perawatan pasca operasi di ICU, kondisi pasien relatif baik.Blood Transfusion Management for Epidural Haemorrhage (EDH) Evacuation with Massive BleedingAbstractTraumatic brain injury causes mortality and morbidity worldwide. Epidural Haemorrhage (EDH) is a form of head injury where time is an indicator that must be considered in its management. The main focus during traumatic brain injury management is patient stabilization and control of intracranial pressure, as well as maintaining brain oxygenation and perfusion. Subsequently, surgical decompression was performed. Evacuation and bleeding control should be done in a short time to avoid further injury. The practice of neuroanesthesia, as a support in the management of traumatic brain injuries, is often associated with blood loss that results in anemia during the intraoperative and postoperative periods. Although anemia correlates with poor outcome in brain-injured patients, red blood cell transfusion to correct anemia also correlates with poor outcome in patients. There are still no clear recommendations regarding the administration of transfusions, whether restrictive or massive, regarding the benefits provided. Male patient, age 51 years with complaints of decreased consciousness and vomiting, referred from the previous hospital with a diagnosis of moderate head injury 225 with 96cc temporoparietal EDH, 11mm midline shift to the right, and cerebral edema. During the operation period, there was massive bleeding that interfered with the hemodynamic status so that blood components were transfused until a stable hemodynamic status was obtained. In postoperative care in the ICU, the patient is relatively in good condition.

Gangguan Tidur pada Pasien Stroke Fase Akut Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Stroke adalah suatu kondisi ketika seseorang terkena defisit neurologis secara tiba-tiba yang disebabkan oleh adanya gangguan pada pembuluh darah otak. Sekitar 2177% dari pasien stroke memiliki gangguan tidur yang terjadi setelah stroke. Siklus tidur diatur oleh otak dan stroke dapat menyebabkan gangguan tidur karena kelainan yang dapat terjadi pada struktur otak yang mengatur tidur. Post Stroke Sleep Disoder (PSSD) merupakan gejala tersering setelah stroke. Gangguan tidur setelah stroke meliputi Sleep Disordered Breathing (SDB), insomnia, circadian rhythm sleep disturbance, hipersomnia, parasomnia dan sleep-related movement disorder. Tidur memiliki banyak manfaat, salah satunya adalah restorasi fungsi fisik dan mental, konsolidasi memori dan meningkatkan kemampuan belajar dari seseorang baik secara motorik maupun sensorik. Penelitian lain pun menunjukkan adanya korelasi antara waktu tidur elektrografik dan fungsi kognitif dari pasien stroke pada masa pemulihan. Sebuah penelitian percobaan lain pula mengindikasikan bahwa gangguan tidur dapat meningkatkan ekspresi dari neurocan, yaitu gen yang menghambat pertumbuhan saraf. Gangguan tidur pada pasien stroke dapat menurunkan efisiensi dan efektifitas dari rehabilitasi stroke.Sleep Disorders in Acute Phase Stroke PatientsAbstractStroke is a condition when a person has a sudden neurological deficit caused by a disruption in the blood vessels of the brain. About 21-77% of stroke patients have sleep disorders that occur after a stroke. The sleep cycle is regulated by the brain and strokes can cause sleep disturbances due to abnormalities that can occur in the brain structures that regulate sleep. Post Stroke Sleep Disoder (PSSD) is the most common symptom after stroke. Sleep disorders after stroke include Sleep Disordered Breathing (SDB), insomnia, circadian rhythm sleep disturbance, hypersomnia, parasomnia and sleep-related movement disorders. Sleep has many benefits, one of which is the restoration of physical and mental functions, the consolidation of memory and improving the learning ability of a person both motorically and sensitively. Other studies have also shown a correlation between electrographic sleep time and cognitive function of stroke patients during recovery. Another experimental study also indicated that sleep disorders can increase the expression of neurocans, which are genes that inhibit nerve growth. Sleep disorders in stroke patients can reduce the efficiency and effectiveness of stroke rehabilitation

Pengaruh Gangguan Tidur dan Peranan Sitokin terhadap Luaran Stroke Iskemik Djajasasmita, Daswara
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Stroke merupakan penyebab kematian kedua di dunia. Sebanyak 15,4% dari seluruh kematian di Indonesia disebabkan oleh stroke. Prevalensi penyakit stroke meningkat dari tahun ke tahun dan akan menimbulkan masalah di bidang kesehatan. Salah satu faktor yang dapat memperburuk penyakit stroke, diantaranya adalah gangguan tidur. Tujuan penulisan artikel ini adalah untuk mengetahui hubungan antara gangguan tidur dan pengaruh sitokin terhadap luaran stroke iskemik. Stroke iskemik akibat aterosklerotik dengan adanya hipoksia pada neuron akan memicu pelepasan sitokin, termasuk tumor necrosis factor-alpha (TNF-?) dan interleukin-10 (IL-10) dari neuron dan sel glial. Sitokin juga berpengaruh terhadap pola tidur seperti nerve growth factor (NGF) menginduksi non-rapid eye movement sleep (NREM) dan rapid eye movement sleep (REM). Gangguan tidur terutama sleep apnea mempunyai risiko yang lebih besar terhadap kejadian stroke atau risiko kematian oleh sebab apapun. Proses yang terjadi pada stroke iskemik akut menimbulkan respon inflamasi, proses inflamasi ini seperti pedang bermata dua karena di satu sisi menimbulkan kerusakan yang lebih luas, namun di sisi lain dapat bertindak membantu perbaikan. Peningkatan produksi sitokin seperti interleukin-10 (IL-10), IL-6, dan C-reactive protein (CRP) akan menimbulkan luaran yang buruk pada penderita stroke.The Effect of Sleep Disturbances and The Role of Cytokines on The Outcome of StrokeAbstractStroke is the second cause of death in the world. As many as 15.4% of all deaths in Indonesia are caused by strokes. The prevalence of stroke increases from year to year and will cause problems in the health sector. One of the factors can exacerbate stroke, including sleep disturbances. The aim of this article is to examine the relationship between sleep disturbances and the effect of cytokines on ischemic stroke outcome. Ischemic stroke due to atherosclerosis in the presence of hypoxia in neuron will result in the release of cytokines, including tumor necrosis factor-alpha (TNF-?) and interleukin-10 (IL-10) from neurons and glial cells. Cytokines also influence sleep patterns such as nerve growth factor (NGF) inducing non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). Sleep disorders, especially sleep apnea, have a greater risk of stroke or risk of death for any cause. The process that occurs in acute ischemic stroke causes an inflammatory response, this inflammatory process is like a double-edged sword because on the one hand it causes more extensive damage, but on the other hand it can act help repair. Increased production of cytokines such as interleukin-10 (IL-10), IL-6, and C-reactive protein (CRP) will lead to poor outcomein stroke patients.

Korelasi antara Skor Intracerebral Hemorrhage (ICH) dengan Mortalitas Pasien Perdarahan Intraserebral di RSUD Ulin Banjarmasin Awanis, Marini; Sikumbang, Kenanga Marwan; Asnawati, Asnawati
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Perdarahan intraserebral (PIS) merupakan kejadian medis yang meningkatkan angka kematian dan kecacatan tinggi. Secara teori, mortalitas PIS dapat diprediksi dengan menggunakan komponen skor Intracerebral Hemorrhage (ICH). Tujuan penelitian ini untuk mengetahui bagaimana korelasi antara skor ICH dengan mortalitas pasien PIS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sebanyak 53 sampel didapatkan secara consecutive sampling. Data hasil penelitian diuji dengan uji Regresi Logistik.Hasil: Dalam penelitian ini pasien skor ICH 0 meninggal sebanyak 15%, 36% skor ICH 1, 71% skor ICH 2, 86% skor ICH 3 dan 100% skor ICH 4 dan 5. Hasil analisis data penelitian ini, diperoleh OR = 0,02; 0,06; 0,3 untuk masing-masing skor ICH 1, 2 dan ?3; dengan p=0,001. Simpulan: Terdapat korelasi yang sangat signifikan dan hubungan positif antara skor ICH dengan mortalitas pasien PIS di RSUD Ulin Banjarmasin, sebagai prediktor independen.Correlation between ICH Score with ICH Patients Mortality at Ulin General Hospital BanjarmasinAbstractBackground and Objective: Intracerebral hemorrhage (ICH) is the medical events that increases the mortality and disability. Theoretically, mortality can be predict by ICH scores components. The purpose of this study is to determine the correlation between ICH scores and mortality of ICH patients in Ulin General Hospital Banjarmasin. Subject and Method: This research is an analytic observational with cross sectional approach. A total of 53 samples were obtained by consecutive. Data analysis of this study used the Logistic Regression test.Result: In this study, it was found that patients with ICH score 0 died 15%, 36% score 1, 71% score 2, 86% score 3 and 100% score 4 and 5. Data analysis of this study showing OR= 0,02; 0,06; 0,3 for ICH score 1, 2 and ?3 respectively; with p=0,001. Conclusion: There is a very significant correlation and enough positive relationship between the ICH score and mortality of ICH patients in Ulin General Hospital Banjarmasin, as independent predictor.

Penggunaan Remifentanil pada Pasien Pediatrik dengan Meningokel yang Dilakukan Tindakan Eksisi Meningokel Sikumbang, Kenanga Marwan; Lahdimawan, Ardik
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Meningokel adalah kondisi kegagalan fusi selubung saraf medulla spinalis yang umum ditemui pada pasien pediatrik. Koreksi meningokel dilakukan dalam posisi prone yang memerlukan tatalaksana anestesi yang hati-hati. Fisiologi neonatus dan infant berbeda dengan orang dewasa, karena fungsi fisiologis system organ masih imatur dan menyebabkan safety margin terbatas, sehingga pilihan obat adalah yang metabolismenya tidak tergantung pada fungsi hati dan ginjal normal. Dalam bidang neuroanestesi pediatrik, penggunaan remifentanil semakin luas, karena onset cepat, efek analgesik poten dan eliminasi cepat. Seorang bayi laki-laki, usia 7 bulan dengan berat badan 7 kg, diagnosis meningokel lumbosacral dilakukan tindakan eksisi meningokel. Pasien diberikan remifentanil 1 mcg/kgbb selama 1 menit dilanjutkan dengan remifentanil kontinyus 0.05-1mcg/kgbb/mnt. Induksi dengan propofol, diberikan atracurium sebelum intubasi. Selama operasi kondisi stabil, tidak terjadi episode bradikardi dan pascaoperasi pasien langsung diekstubasi. Penggunaan remifentanil menjadi pilihan karena onset cepat, efek analgesik poten, eliminasi cepat dan memberikan stabilitas hemodinamik selama operasi. Operasi dengan posisi prone pada pasien pediatrik memerlukan kehati-hatian terutama saat memposisikan pasien, dimana harus yakin pipa ett tidak mengalami dislokasi atau kinking, mencegah efek penekanan pada mata dan pencegahan terjadinya neuropati perioperatif. Pemakaian remifentanil pada kasus ini memberikan stabilitas hemodinamik yang baik dan pulih sadar yang cepat.Using Remifentanyl For Pediatrik Patient With Meningocele Underwent Meningocelectomy Under General AnesthesiaAbstractMeningocele is failure of the neural tube to close during first trimester pregnancy which is the most common conditions in pediatrik patient. Correction is performed under prone position with carefull anesthestic procedure. The physiology of neonates and infants are different from that of adults. Immaturity of their vital organ systems narrows the safety margin of perioperative management including anesthesia. Remifentanil is becoming increasingly popular for this purpose. Remifentanil has favorable characteristics for anesthesia in neonates such as rapid onset, potent analgesic effect, and rapid elimination. A baby boy 7 months old, 7 kg, with meningocele lumbosacral underwent meningocelectomy. The patient was given remifentanil 1 mcg/kgbw/iv in one minute and continuous 0.05-0.1 mcg/kgbw/mnt. Induction with propofol iv, atracurium before intubation. Stability hemodynamic during the operation, no episode of bradycardia and patient extubated early after the operation. Remifentanil is an ultra-short-acting opioid, with rapid onset, produces profound analgesia, rapid offset and good stability of hemodynamic during the operation. The operations are carried out prone, careful positioning is paramount to avoid complications like dislodging or kinking of the endotracheal tube, corneal abrasion or perioperative neuropathy. Using remifentanyl in this case report given good hemodynamic stability dan rapid emergence.

Hubungan Jumlah Leukosit dan C-Reactive Protein (CRP) dengan Luaran Pasien Cedera Otak Traumatik (COT) berdasarkan Skor Glasgow Coma Scale (GCS) di RSUD Ulin Banjarmasin Maulana, Irvan; Sikumbang, Kenanga M.; Asnawati, Asnawati
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Latar Belakang dan Tujuan: Tingkat keparahan dari cedera otak traumatik (COT) dapat dinilai menggunakan Glasgow Coma Scale (GCS). Saat terjadi cedera kepala, tubuh akan melepaskan berbagai mediator inflamasi, leukosit dan penanda radang yaitu C-Reactive Protein (CRP). Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara jumlah leukosit dan CRP dengan luaran pasien COT berdasarkan skor GCS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian menggunakan studi desain observasional analitik dengan rancangan potong lintang. Data diambil secara consecutive sampling. Hasil: Didapatkan 45 subjek dengan hasil rerata jumlah leukosit dan kadar CRP tertinggi ada pada pasien COT berat diikuti dengan COT sedang dan COT ringan. Pada hari ke-7, didapatkan 41 pasien dengan luaran yang baik dan 4 pasien dengan luaran yang buruk. Analisis menggunakan uji korelasi Spearman menunjukan terdapat hubungan antara jumlah leukosit (p=0,004; r=0,424) dan CRP dengan luaran pasien COT (p=0,043; r=0,361). Simpulan: Terdapat hubungan antara jumlah leukosit dan kadar CRP dengan luaran pasien COT berdasarkan skor GCSAssociation of Leukocyte Count and C-Reactive Protein (CRP) Levels with Traumatic Brain Injury (TBI) Patient Outcome based on Glasgow Coma Scale (GCS) Score in Ulin General Hospital BanjarmasinAbstractBackground and Objective: The severity of traumatic brain injury (TBI) can be assessed using the Glasgow Coma Scale (GCS). When head injury occurs, the body releases various inflammatory mediators, leukocytes and inflammatory markers, namely c-reactive protein (CRP). The purpose of this study was to determine whether there is a correlation between the leukocyte count and CRP levels with the outcome of TBI patients based on GCS scores in Ulin Hospital Banjarmasin. Subject and Method: This research is an analytic observational with cross-sectional approach. Data acquired with consecutive sampling method. Result: We Obtained 45 subjects with the highest mean of leukocytes count and the highest CRP levels in patients with severe TBI followed by moderate TBI and mild TBI. On the 7th day, 41 patients had good outcome and 4 patients had bad outcome. Analysis using the Spearman correlation test showed that there was a relationship between the leukocyte count (p = 0.004; r = 0.424) and CRP levels with the outcome of TBI patients (p = 0.043; r = 0.361).Conclusion: It was concluded that there is a correlation between leukocyte count and CRP levels with the outcome of TBI patients based on GCS scores

Manajemen Neuroanestesi pada Operasi Carotid Endarterectomy: Pasien dengan Riwayat Stroke Berulang Bangun, Chrismas Gideon; Irina, RR. Sinta; Bisri, Dewi Yulianti; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Carotid endarterectomy (CEA) adalah prosedur bedah yang dilakukan untuk memulihkan aliran darah karotis dan mengurangi kejadian stroke embolik dan trombotik. Walaupun merupakan prosedur preventif, CEA membawa risiko komplikasi perioperatif: neurologik dan kardiak. Komplikasi mayor CEA adalah stroke intra dan postoperatif, infark miokard, dan kematian. Untuk mengurangi angka kejadian stroke intraoperatif maka dikembangkan teknologi monitoring intraoperatif salah satunya dengan elektroensefalogram (EEG). Pada kasus ini pasien laki-laki, 62 tahun, dengan riwayat stroke iskemik berulang dan kelemahan tungkai kiri direncanakan untuk CEA dengan anestesi umum. Ahli bedah memutuskan untuk menggunakan shunt secara selektif dengan menilai monitoring EEG saat dilakukan clamping. Akhirnya shunt tidak jadi dilakukan, operasi berjalan selama 6 jam, diwarnai dengan gejolak hemodinamik yang sering terjadi pada pasien dengan penyakit karotis akibat gangguan baroreseptor. Dengan penanganan anestesi yang cermat selama dan sesudah operasi, operasi berhasil dilakukan, dan hasil postoperasi kekuatan motorik kaki kiri meningkat dari 2 ke 4.Management Neuroanesthesia for Carotid Endarterectomy: Patients with a History of Recurrent StrokeAbstractCarotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.

Pertimbangan Anestesi Perioperatif untuk Pasien Bedah Saraf dengan Covid-19 Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Coronavirus yang baru, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pertamakali timbul di Wuhan, Provinsi Hubei Cina, pada bulan Desember 2019, dan menyebar dengan cepat ke seluruh dunia ke lebih dari 190 negara. Pasien harus ditapis untuk covid-19 menggunakan kombinasi riwayat penyakit, computed tomography (CT) dada, dan pemeriksaan real time quantitative polymerase chain reaction (RT-qPCR) bergantung kebijakan institusinya. Keluhan neurologis seperti dizziness, headache, hypogeusia dan hyposmia, sering (36%) pada pasien covid-19. Encefalopati dan perubahan status mental juga terjadi pada pasien yang telah terinfeksi dengan virus SARS-CoV-2. Penyakit serebrovaskuler lebih sering pada covid-19 yang berat; acute ischemic stroke telah dilaporkan pada 5,7% dan gangguan kesadaran pada 15% pasien. Tindakan pembedahan rutin kranial dan spinal aman untuk dilakukan. Operasi endoscopic endonasal tidak aman dan harus dihindari. Ekstubasi setelah anestesi umum bila memungkinkan dilakukan di ruangan tekanan negatif, personil tetap memakai alat pelindung diri (APD) level 3. Harus dihindari pasien batuk saat ekstubasi. Setelah ekstubasi, pasang oksigen binasal, dan pasien harus memakai masker bedah dan aliran oksigen tinggi harus dihindari (berikan 6L/menit) untuk menghindari terjadinya aerosolisasiPerioperative Anesthesia Consideration for Neurosurgical patients with Covid-19AbstractThe novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province China, in December 2019, and spread fast to all the world more than 190 countries. Patients should be screened for covid-19 using a combination of history, computed tomography (CT) chest, and real time quantitative polymerase chain reaction (RT-qPCR) testing depending on institutional policies. Neurological symptom as dizziness, headache, hypogeusia and hyposmia, common (36%) at covid-19 patient. Encephalopaty and changed mental status exist in patient infected by SARS-CoV-2 virus. Cerebrovascular diseases more in severe covid-19; acute ischemic stroke had reported in 5.7% and altered level of consciousnes in 15% patient. Surgical measuremet cranial and spinal rutine is safe, endoscopic endonasal surgery not safe and must be avoided. Extubation after general anesthesia if possible do air negative pressure room, and personil still use personal protection equipment (PPE) level 3. Must be avoid patient cough during extubation. After extubation, give oxygen nasal canule, surgical mask, and high flow oxygen (give 6 L/min) avoided given the risk of aerosolization

Fungsional Makroadenoma Hipofisis dengan Manifestasi Akromegali dan Komplikasi Diabetes Insipidus Pascaoperasi Krisna J. Sutawan, Ida Bagus; Suarjaya, I Putu Pramana; Kumaat, Garry D. Chrysogonus
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Akromegali sebagai manifestasi klinis dari fungsional makroadenoma hipofisis adalah suatu kasus yang jarang terjadi. Laki-laki 28 tahun dikonsulkan dengan space occupying lesion serebri suprasellar dengan differensial diagnosis meningoma atau adenoma yang akan dilakukan reseksi tumor. Pada pemeriksaan preoperasi didapatkan pasien dengan tanda-tanda yang mengarah ke akromegali seperti rahang yang lebih menonjol, ukuran hidung, lidah, dan tangan yang relatif lebih besar dari orang normal namun tanpa gejala obstructive sleep apnea. Intraoperasi pasien berhasil diintubasi dengan video laringoskop dengan persiapan fiber optik. Pasca-operatif pasien mengalami diabetes insipidus dan dipindahkan ke ruangan dari ICU pada hari ke tujuh pasca-operatif pada saat sudah bebas dari vasopressin. Ada beberapa hal yang harus dipertimbangkan pada penatalaksanaan pasien dengan makroadenoma hipofisis, seperti penatalaksanaan jalan nafas jika terjadi akromegali dan komplikasi diabetes insipidus pacaoperasiFunctional Pituitary Macroadenoma with Acromegaly and Complications of Postoperative Diabetes InsipidusAbstractAcromegaly as a clinical manifestation of functional pituitary macroadenoma is a rare case. A 28-year-old male was consulted with a space occupying suprasellar cerebral lesion with a differential diagnosis of meningioma or adenoma which would require tumor resection. On the pre-operative examination, it was found that patients with signs and symptom of acromegaly such as a more prominent jaw, the size of the nose, tongue, and hands were relatively larger than normal people but without symptoms of obstructive sleep apnea. Intraoperatively, the patient was successfully intubated with a video laryngoscope with a fiber optic preparation. Post-operatively the patient developed diabetes insipidus and was transferred to the room from ICU on the seventh postoperative day when she was free of vasopressin. There are several things that should be considered during the perioperative management of patients with pituitary macroadenoma, such as airway management if there is acromegaly and diabetes insipidus as a postoperative complication.

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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

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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