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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 8 Documents

Search results for , issue "Vol 10, No 3 (2021)" : 8 Documents clear

Pengelolaan Diabetes Insipidus dengan Cerebral Salt Wasting Syndrome dan Tension Pneumocephalus pada Pasien Pascabedah Eksisi Tumor Pineal Santosa, Dhania A; Rehatta, Nancy Margaretta
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Ketidakseimbangan elektrolit pada pasien pasca bedah saraf sering terjadi dan berpotensi menyebabkan cedera otak sekunder yang dapat memperburuk luaran pasien, sekalipun pembedahan sukses dilaksanakan. Diabetes insipidus merupakan disfungsi hipofisis yang menyebabkan hipernatremia. Kondisis ini sering terjadi pada kelainan hipofisis, namun jarang sebagai akibat tumor pineal. Seorang pasien laki-laki usia 21 tahun dengan diabetes insipidus prabedah menjalani pembedahan kraniotomi dan eksisi tumor pineal. Pada periode pascabedah pasien mengalami episode diabetes insipidus yang dipersulit dengan Cerebral Salt Wasting Syndrome dan Tension Pneumocephalus. Pemantauan ketat akan status volume, kadar gula dan elektrolit darah serta dosis desmopressin yang optimal merupakan kunci keberhasilan penanganan pasien ini sehingga tidak mengalami cedera otak sekunder. Seorang intensivis memegang peranan penting dalam pengelolaan pasien seperti ini terutama terkait patofisiologi kelainan intrakranial dan implikasinya terhadap keseimbangan cairan dan elektrolit.Management of Diabetes Insipidus Complicated by Cerebral Salt Wasting Syndrome and Postoperative Tension Pneumocephalus in a patient who underwent Pineal Tumor RemovalAbstractElectrolyte imbalance is an often incident in patients underwent neurosurgery and it potentially induces secondary brain injury, leading to a worse outcome, despite successful surgery. Diabetes insipidus is a frequent hypernatremic condition, commonly caused by abnormalities in the hypophysis; but rarely happens due to pineal tumor. A 21-year-old male with preoperative diabetes insipidus experienced episodes of diabetes insipidus complicated by cerebral salt wasting syndrome and tension pneumocephalus after a successful pineal tumor removal surgery. Closed observation on volume status, plasma glucose and electrolyte, along with optimal dose of desmopressin were keys of successful postoperative management in this patient in order to avoid the patient from secondary brain injury. An intensivist plays a key role, mainly in the understanding of intracranial pathophysiology and its implications to fluid and electrolyte balance.

Manajemen Low Flow Anesthesia pada Pasien Kraniosinostosis dengan Hipertelorisme yang menjalani Four Box Wall Osteotomy, dan Eksisi Redundant Skin Fronto Nasal Cahyadi, Arief; Bisri, Dewi Yulianti; Harahap, M Sofyan; Gaus, Syaruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Kraniosinostosis merupakan kasus yang didagnosis di tahun pertama kehidupan dan dapat membutuhkan pembedahan pada usia muda. Kraniosinostosis merupakan salah satu bagian dari sindrom hipertelorisme dengan angka kejadian sebesar 20%. Anak laki laki 13 tahun dengan hipertelorisme yang sudah menjalani rangkaian operasi koreksi hipertelorisme sebelumnya. Pasien direncanakan operasi koreksi lanjutan berupa four box wall osteotomy yang merupakan koreksi bagian frontal berupa pelepasan kraniosinostosis di sutura koronal. Risiko perdarahan masif karena anak sudah besar serta operasi panjang menjadi penyulit. Tatalaksana jalan napas memerlukan modifikasi karena deformitas yang ada, penggunaan low flow anestesi untuk membantu menjaga suhu dan mengurangi penggunaan gas anestesi, manajemen cairan intraoperatif berupa kombinasi kebutuhan pemeliharaan dan penggantian perdarahan yang terjadi, serta tatalaksana nyeri pasca operasi pada anak menjadi pertimbangan lain. Penyulit covid-19 terjadi pada pasien sehingga membuat ekstubasi tertunda. Perdarahan masif memerlukan protokol transfusi masif untuk mendukung ketersediaan darah dalam waktu singkat. Produk darah PRC, FFP dan TC harus tersedia karena faktor koagulasi juga perlu diperhatikan. Manajemen anestesi pada hipertelorisme dengan tindakan four box wall osteotomy memerlukan kerja sama baik antara anestesi, bedah saraf, bedah plastik serta ICU anak untuk menurunkan risiko perioperatif termasuk kekhususan covid-19 di era pandemi.Low Flow Anesthesia Management Craniosynostosis Patient with Hypertelorism underwent Four Box Wall Osteotomy and Fronto Nasal Redundant Skin ExcisionAbstractCraniosynostosis is a case that diagnosed in the first year of life and can need surgical in young age. Craniosynostosis is a part of hypertelorism with incidence rate around 20%. Boy, 13 years old with hypertelorism had undergone multiple surgery for correction of hypertelorism before. Patient was planned to advance surgical correction of four box wall osteotomy which consist frontal part correction and part of it is release craniosynostosis in coronal suture. Risk of massive bleeding because patient already in teen age and length of surgery can be prolonged. Difficult airway management due to fascial deformity, use of low flow anesthesia to preserve temperature and reduce inhalation anesthesia usage, intraoperative fluid management in consideration maintenance and replacement blood loss and post operative pain management has become another consideration. Covid-19 as part of problems post operatively being known before extubation made the process is delayed. Massive bleeding needs massive transfusion protocol to speed up blood availability. Blood product such as PRC, FFP and TC should be available because coagulation factor is part of consideration. Anesthesia management in hypertelorism with four box wall osteotomy need good communication between anesthesiologist, neurosurgeon, plastic surgeon and pediatric intensivist to reduce perioperative risk including covid-19 in pandemic era.Key words: Low flow anesthesia management, craniosynostosis, hypertelorism, four box wall osteotomy

Disfungsi Kognitif Post Operatif pada Geriatri Maharani, Nurmala Dewi; Halimi, Radian A; Mafiana, Rose; Gaus, Syaruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Postoperative Cognitive Dysfunction (POCD) adalah gangguan neurokognitif yang ditandai dengan penurunan kinerja kognitif setelah operasi dan anestesi. POCD ditandai dengan gangguan memori, penurunan proses informasi, berkurangnya perhatian, serta perubahan suasana hati dan kepribadian. Insidensi POCD pada pasien lanjut usia ( 60 tahun) sekitar 25,8% dalam tujuh hari setelah operasi dan 10% dalam tiga bulan setelah operasi. Faktor risiko dan etiologi yang menyebabkan POCD dapat dikurangi dengan edukasi pasien yang baik, perawatan pasien, dan sanitasi yang tepat sehingga dapat mencegah kecenderungan gejala POCD pada pasien tersebut. Pemeriksaan dapat dilakukan dengan tes pembelajaran kata, tes pembuatan Jejak, tes ketangkasan manual, dan tes kemampuan untuk mengingat urutan angka. Mini Mental State Examination (MMSE) sebagai tes untuk melakukan skrining demensia. MMSE terkadang digunakan untuk mengukur POCD. MMSE dapat digunakan dalam praktik klinis rutin untuk mengidentifikasi demensia subklinis pra operasi yang akan menempatkan pasien pada risiko yang lebih tinggi untuk berkembang menjadi POCD. Penatalaksanaan pada POCD meliputi dua pendekatan yaitu penegakkan diagnosis secara cepat dan pencegahan gejala POCD. Pencegahan dapat dilakukan dengan mengetahui faktor risiko preoperatif, intraoperatif, dan postoperatif. Pasien dengan POCD persisten mengalami dampak negatif pada kualitas hidup, kinerja memori subjektif, emosional, dan mungkin didapatkan konsekuensi kesehatan seperti demensia dan kematian dini.Post Operative Cognitive Dysfunction among Elderly PatientsAbstractPostoperative Cognitive Dysfunction (POCD) is a neurocognitive disorder characterized by decreased cognitive performance after surgery and anesthesia. POCD is a complication characterized by memory impairment, decreased information processing and reduced attention, accompanied by changes in mood and personality. The incidence of POCD in elderly patients ( 60 years) was approximately 25.8% within seven days after surgery and 10% within three months after surgery. The risk factors and etiology that lead to POCD can be reduced by good patient education, patient care and proper sanitation can prevent the tendency of POCD symptoms in these patients. Examination can be done with the learning test, the word learning test, the tracing test, the manual dexterity test, the ability test to remember a sequence of numbers. Mini Mental Status Examination (MMSE) as a screening test for dementia. MMSE is sometimes used to measure POCD. MMSE can be used in routine clinical practice to identify preoperative subclinical dementia that would put patients at a higher risk of developing POCD. Management in POCD includes two approaches, namely rapid diagnosis and prevention of POCD symptoms. Prevention by knowing the risk factors preoperative, intraoperative and postoperative. In patients with persistent POCD, it has a negative impact on quality of life, subjective memory performance, emotional symptoms, and possible health consequences such as dementia and premature death.

Manajemen Anestesi pada Pasien dengan Tumor Regio Pineal yang Menjalani Kraniotomi Pengangkatan Tumor dengan Posisi Duduk Widiastuti, Monika; Bisri, Dewi Yulianti; Harahap, M Sofyan; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor regio pineal memiliki insiden 0.4-1% dari tumor intracranial. Lokasinya yang dalam, di antara kedua hemisfer otak, berdekatan dengan batang otak dan hipotalamus menjadi tantangan bagi bedah saraf. Operasi dengan supracerebellar approach dalam posisi duduk adalah pilihan terbaik untuk mencapai lokasi. Posisi duduk juga memfasilitasi lapang operasi yang optimal dengan retraksi cerebellum minimal. Posisi duduk membawa tantangan tersendiri untuk dokter anestesi, dengan segala kompleksitas saat memposisikan pasien dan risiko komplikasinya. Venous air embolism adalah pertimbangan utama yang jika tidak terdeteksi dan ditangani dapat menyebabkan kolaps kardiovaskular dalam waktu singkat. Pasien laki-laki berusia 38 tahun datang dengan keluhan nyeri kepala berat dan penglihatan kabur sejak 4 bulan sebelum masuk rumah sakit. Hasil Magnetic Resonance Imaging menunjukkan adanya massa di regio pineal dengan edema perifokal, tanpa deviasi struktur midline. Pasien dilakukan kraniotomi pengangkatan tumor dalam posisi duduk. Operasi berjalan selama 10 jam dengan hemodinamika stabil dan tidak terjadi komplikasi, dalam anestesi umum dengan kombinasi intravena dan inhalasi. Prinsip ABCDE neuroanestesi, posisi duduk dan implikasinya, dan lokasi operasi yang sulit adalah pertimbangan-pertimbangan anestesi yang harus diperhatikan pada pasien ini. Evaluasi preoperasi yang baik, komunikasi dan koordinasi yang baik antara tim bedah dan anestesi sangat diperlukan untuk kelancaran dalam kraniotomi dalam posisi duduk.Anesthetic Management of Patient with Pineal Region Tumor Underwent Craniotomy Tumor Removal in Sitting PositionAbstractIncidence of pineal regio tumor is 0.4-1% of intracranial tumors. Its location which is buried between two cerebral hemispheres, close to brainstem and hypothalamus become a difficult challenge for the neurosurgeon. Surgery with supracerebellar approach in sitting position is the best method to access the lesion. Sitting position also facilitates the optimal visual field with minimal retractions. However, for anesthesiologist, sitting position is challenging since it has its own complexities during positioning the patient and the risk of complications. Venous air embolism is one of the main concern and if not detected early and treated appropriately would leads to cardiovascular collapse instantly. This is a case of a 38-year-old male with chief complaint of severe headache and blurred vision started 4 months before admission. The Magnetic Resonance Imaging showed a pineal region tumor with perifocal edema, without midline deviation. The patient underwent craniotomy tumor removal with sitting position. The procedure lasted for 10 hours and uneventful. The principle of ABCDE neuroanesthesia, sitting position and its implications, and difficult tumor location are some anesthesia considerations for this patient. A thorough preoperative evaluation, good communication and coordination between surgery and anesthesia team are needed for a smooth uneventful procedure performed in sitting position.

Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung Muhafidzah, Novi Fatni; Mansur, Sobaryati; Pranggono, Emmy Hermiyanti; Wibisono, Yusuf; Juli, Cep; Gamayani, Uni; Gunadharma, Suryani; Cahyani, Aih
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Pneumonia adalah komplikasi non neurologis paling sering pada stroke akut (22%) yang meningkatkan angka kematian, lama rawat inap dan biaya perawatan. Perlu dilakukan identifikasi faktor-faktor risiko terjadinya pneumonia salah satunya neurogenic pulmonary edema (NPE) agar dapat dilakukan pencegahan dan intervensi dini. Tujuan penelitian ini untuk mengetahui gambaran faktor-faktor risiko terjadinya pneumonia (termasuk NPE) pada pasien stroke akut di RSUP Dr Hasan Sadikin Bandung.Subjek dan Metode: Deskriptif observasional prospektif, metode consecutive sampling, periode September - Oktober 2019, mengumpulkan data primer pasien stroke akut yaitu derajat keparahan stroke, tipe, lokasi dan ukuran lesi stroke, terapi dan tindakan selama perawatan, komorbiditas (termasuk NPE). Pneumonia ditegakkan berdasarkan kriteria Centers for Disease Control and Prevention (CDC), NPE berdasarkan kriteria Davison.Hasil: 30 orang mengalami pneumonia pada pasien stroke akut (28,30%). Kejadian pneumonia, lebih sering ditemukan pada pemakaian Nasogastric Tube (NGT) (90%), disfagia (64,71%), lokasi infark Sirkulasi Anterior Total (SAT) (61,54%), ukuran infark besar (61,54%), GCS 9-12 (50%) dan NIHSS 16-20 (50%). NPE didapatkan pada 6,60% pasien stroke akut, 54,17% diantaranya menjadi pneumonia.Simpulan: Kejadian pneumonia pada pasien stroke akut lebih banyak ditemukan pada pemakaian NGT, disfagia, stroke infark lokasi SAT, ukuran infark besar, GCS lebih rendah dan derajat keparahan stroke lebih berat.Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital BandungAbstractBackground and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung.Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria.Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia.Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

Tatalaksana Anestesi Posisi Telungkup pada Pasien Pediatrik yang Menjalani Prosedur Reseksi dan Rekonstruksi Human Tail Nur, Alta Ikhsan; Satriyanto, M. Dwi; Harahap, Yustisia Sofirina
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Human tail atau ekor tambahan merupakan malformasi yang tidak biasa dan dibagi menjadi true tails dan pseudotails (lipoma, teratoma, mylomeningocele parasitic fetus). Human tail berhubungan dengan spinal dysraphism. Myelomeningocele (MMC) adalah spinal dysraphism pada medulla spinalis dan isinya mengalami herniasi melalui defek tulang kongenital pada elemen posterior. Tatalaksana pembedahan pada MMC memiliki tantangan tersendiri, tidak hanya pelaksanaan anestesi tetapi juga dalam perawatan perioperatif dan hal ini tergantung kelompok usia pediatrik, komorbid, kelainan sitemik. Tindakan anestesi pada MMC regio lumbosacral dilakukan dengan posisi telungkup. Merubah posisi pasien menjadi posisi telungkup merupakan critical manuver. Komplikasi yang terjadi akibat posisi telungkup yang salah dapat menimbulkan morbiditas dan beberapa kasus menyebabkan mortalitas sehingga anestesi dengan posisi telungkup harus dipahami secara baik untuk menghidari resiko dan komplikasi yang dapat terjadi. Seorang anak perempuan berusia 5 tahun dengan myelomeninocele menjalani prosedur reseksi dan rekontruksi dalam posisi telungkup. Status hemodinamik selama prosedur yang berlangsung 3 jam cukup stabil dengan perdarahan sekitar 10cc. Pasca operasi pasien dirawat 1 hari di PICU dan di ruangan perawatan biasa selama 3 hari.Anesthesia Management for The Prone Position in Pediatric Patients undergoing Human Tail Resection and Reconstruction ProcedureAbstract Human tail or additional tail is an unusual malformation and is divided into true tails and pseudotails (lipoma, teratoma, fetal parasitic mylomeningocele). Human tail is associated with spinal dysraphism. Myelomeningocele is spinal dysraphism in which the spinal cord and its contents herniate through a bone defect. congenital to the posterior element. The surgical management of MMC poses challenges, not only to the implementation of anesthesia but also to provide perioperative care depending on the pediatric age group, comorbid conditions, and associated systemic disorders. Anesthesia for the MMC in the lumbosacral region was performed in the prone position. Changing the patient's position to the prone position is a critical maneuver. Complications that occur due to the wrong prone position can cause morbidity and some cases cause mortality so that anesthesia with the prone position must be well understood to avoid the risks and complications that can occur. A 5 year old girl with myelomeninocele will undergo a resection and reconstruction procedure in a prone position. The hemodynamic status during the procedure which lasted 3 hours was quite stable with a hemorrhage of about 10cc. After surgery, patients were treated for 1 day in PICU and ward for 3 days.

Perbedaan Respon Hemodinamik terhadap Penambahan Clonidin 1 dan 2 mcg/kgbb pada Scalp Block untuk Operasi Kraniotomi Afif, Syarif; Arianto, Tri Ardana; Santosa, Sugeng Budi
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik seperti tekanan darah, tekanan arteri rata-rata (mean arterial pressure/MAP) dan laju nadi terutama pada waktu pemasangan pin, insisi kulit, dan insisi durameter pasien kraniotomi. Adjuvan sering ditambahkan pada anestesi lokal untuk memperkuat dan memperpanjang efek analgesia pada blok saraf tepi. Klonidin memiliki aksi yang sinergis dengan agen lokal anestesi. Dosis yang umum adalah 2 mcg/kgbb. Tujuan penelitian ini untuk mengetahui efektifitas penambahan klonidin 1 mcg/kg dan 2 mcg/kg pada blok scalp sebagai analgetik kraniotomi.Subjek dan Metode: Penelitian pada 30 pasien memenuhi kriteria inklusi. Subyek dibagi tiga kelompok, kelompok I: blok scalp dengan levobupivacain 0,25%, kelompok II: blok scalp ditambah klonidin 1 mcg/kg, dan kelompok III: blok scalp ditambah klonidin 2 mcg/kg. Semua pasien mendapatkan perlakuan anestesi umum sesuai standar kemudian dilakukan penilaian tekanan darah, MAP, laju nadi pada sebelum intubasi, pemasangan pin, insisi kulit dan insisi duramater.Hasil: Ada perbedaan signifikan penambahan klonidin dibandingkan dengan kelompok kontrol terutama pada laju nadi dan diastolik kraniotomi. Klonidin 2 mcg/kgbb pada beberapa waktu menunjukkan perbedaan signifikan dibandingkan dosis klonidin 1 mcg/kgbb. Simpulan: Penambahan klonidin pada blok scalp levobupivakain efektif dalam menjaga respon hemodinamik terutama laju nadi dan tekanan darah diastolik.Differences in Hemodynamic Response to 1 and 2 mcg/kgbw Clonidine Addition to Scalp BlockAbstractBacground and Objective: The addition of a levobupivacaine scalp block is effective in reducing hemodynamic responses such as blood pressure, mean arterial pressure (MAP) and pulse rate, especially when pinning, skin incisions, and durameter incisions in craniotomy. Adjuvants are often added to local anesthetics to enhance and prolong the analgesic effect of peripheral nerve blocks. Clonidine has a synergistic action with local anesthetic agents. Clonidine increases sensory and motor blocks in both peripheral and neuraxial blocks. The common dose is 2 mcg/kgbw. The aim of this study was to determine the effectiveness of adding clonidine 2 mcg/kg and 1 mcg/kg on scalp block as craniotomy analgesic.Subjects and Methods: Study on 30 patients met the inclusion criteria. Subjects were divided into three groups, group I: scalp block with levobupivacain 0.25%, group II: scalp block plus clonidine 1 mcg/kg, group III: scalp block plus clonidine 2mcg/kg. All patients were treated with general anesthesia according to the standard then assessed their blood pressure, MAP, pulse rate before intubation, pinning, skin incision and duramater incision.Results: There was a significant difference in the addition of clonidine with the control group, especially in the pulse and diastolic rates. Clonidine 2 mcg/kg at several times showed a significant difference compared to 1 mcg/kgbb dose.Conclusion: The clonidine addition to scalp block of levobupivacaine was effective in maintening hemodynamic responses, especially pulse rate and diastolic blood pressure.

Penanganan Trigeminocardiac Reflex (TCR) selama Anestesi untuk Bedah Saraf Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Trigeminocardiac reflex (TCR) adalah suatu reflex batang otak unik yang manifest sebagai pertubasi cardio-respiratori negatif. Trigeminocardiac reflex didefinisikan sebagai kejadian tiba-tiba dari disritmia parasimpatetik, hipotensi simpatetik, apnea, atau hipermotilitas gastrik selama stimulasi cabang sensoris dari saraf trigeminal. Secara klinis, TCR telah dilaporkan terjadi pada semua prosedur bedah yang dipersarafi oleh saraf trigeminal. Refleks ini telah dilaporkan terjadi pada operasi skull base (dasar tengkorak), akan tetapi, baru-baru ini, juga berhubungan dengan banyak operasi bedah saraf yang lain, prosedur neurointervensional, juga pada operasi bukan bedah saraf dan pada keadaan tidak dioperasi. Refleks ini menunjukkan perubahan kardiovaskular yang menimbulkan komplikasi katastropik, memperburuk outcome, juga merupakan dilema dalam menegakkan diagnosis. Walaupun terdapat banyak literatur dengan laporan insidensi dan faktor risiko dari TCR, signifikansi fisiologis an fungsi belum sepenuhnya dapat dijelaskan. Sebagai tambahan, ada hal yang kompleks dalam TCR yang memerlukan pengkajian dan klarifikasi. Bila terjadi TCR dapat dilakukan terapi dengan identifikasi dan modifikasi faktor risiko, penilaian kedalaman anestesi, pengobatan profilaksis dengan agen vagolitik atau blok saraf perifer jika terjadi manipulasi saraf perifer, pemantauan kardiovaskular yang cermat selama anestesi, terutama pada mereka yang memiliki faktor risiko TCR, penghentian manipulasi, dan pemberian agen vagolitik dan adrenalin. Karena itu, pada tulisan ini akan disampaikan tentang mekanisme, definisi, patofisiologi, manifestasi, diagnosis dan tatalaksananya.Trigeminocardiac Reflex (TCR) Management during Anesthesia for NeurosurgeryAbstractTrigeminocardiac reflex (TCR) is a unique brain stem reflex that manifests as negative cardio-respiratory perturbations. The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. This reflex is largely reported in skull base surgeries/interventions; however, in recent times, it has been also linked with many neurosurgical, neurointerventional procedures, non-neurosurgical and non-surgical conditions. This reflex presents with many cardiovascular changes that can create catastrophic complications, worse outcome as well as diagnostic dilemmas. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requires examination and clarification. If a CTR occurs, it can risk factor identification and modification, depth of anesthesia assessment, prophylactic treatment with either vagolytic agents or peripheral nerve block in case of peripheral manipulations of the nerve, careful cardiovascular monitoring during anesthesia, especially in those with a risk factor for TCR, treatment of the condition when it occurs: cessation of the manipulation, and administration of vagolytic agents and adrenaline. Therefore, this narrative review intends to elaborate on its mechanisms, definition, pathophysiology, manifestations, diagnosis and management.

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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

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

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