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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 11, No 1 (2022)" : 8 Documents clear

Manajemen Perioperatif Trepanasi Dekompresi Subdural Hemorrhage (SDH) dengan Hemofilia A Praniarda, Andika Satria; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Haemofilia A is congenital blood disease with female carrier, usualy found in male patient and happened for life. When one coagulation factor is lost or disfunction, coagulation mechanism will be disturbed and the bleeding difficult to stop. In this day, brain injury caused by trauma is the first cause of death in patient with haemophilia. Surgery in intracranial bleeding must be done as much as possible to get better prognosis. Blood evacuation must undergo quickly but very risky for rebleeding. Factor VIII must be given as soon as possible for treatment in severe haemophiliaA patient with acute bleeding. Maintenance anesthesia also include decrease risk of hypertension and tachicardia for minimalize the ongoing bleeding.Male 17thyears old diagnose with brain injury 2x4 caused by subdural hemorrhage (SDH) left frontotemporoparietal region and cerebral edema followed by subfalcine herniation to the right and haemophilia A planned for decompression evacuation of SDH. Patient got factor VIII 4000unit before operation. Intraoperative bledding are 1100cc and get 1940cc of blood product for stabilize the haemodynamic. Post operative was observe in Intensive Care Unit and went for extubation after 8thday after in good condition.Hemofilia adalah kelainan darah bawaan yang serius dengan wanita sebagai pembawa, terutama didapatkan pada pria dan berlangsung sepanjang hidup dimana hemofilia A merupakan tipe hemofilia tersering. Ketika salah satu faktor yang diperlukan untuk pembekuan darah hilang atau memiliki fungsi yang tidak memadai, mekanisme koagulasi yang terganggu menyebabkan perdarahan yang tidak dapat dihentikan. Saat ini, penyebab kematian paling umum di antara pasien hemofilia adalah perdarahan otak karena trauma kepala. Kasus perdarahan intrakranial sebisa mungkin dilakukan tindakan operasi segera untuk mendapatkan prognosis yang lebih baik. Tindakan evakuasi perdarahan harus dikerjakan dalam waktu singkat namun memiliki resiko tinggi terjadinya perdarahan ulang. Pemberian penggantian faktor VIII rekombinan untuk pengobatan perdarahan akut pada pasien hemofilia A berat harus dilakukan segera. Rumatan anestesi juga harus mencakup penurunan resiko hipertensi dan takikardia untuk meminimalkan terjadinya perdarahan. Laki-laki usia 17 tahun dengan diagnosa penurunan kesadaran cedera kepala 2x4 karena perdarahan intracranial subdural hemorrhage (SDH) regio frontotemporoparietal sinistra dan edema cerebri hari ke 4 disertai herniasi subfalcine ke kanan dengan hemofilia A direncanakan tindakan trepanasi dekompresi evakuasi SDH. Pasien mendapatkan injeksi faktor VIII 4000 unit sebelum operasi. Durante operasi perdarahan 1100cc dan mendapat transfusi 1940cc produk darah hingga hemodinamik stabil. Post operatif pasien dilakukan perawatan di ICU selama 8 hari, dilakukan extubasi setelah kondisi membaik.Perioperative Management Trepanation and Decompression Subdural Hemorrhage with Haemophilia AAbstractHaemofilia A is congenital blood disease with female carrier, usualy found in male patient and happened for life. When one coagulation factor is lost or disfunction, coagulation mechanism will be disturbed and the bleeding difficult to stop. In this day, brain injury caused by trauma is the first cause of death in patient with haemophilia. Surgery in intracranial bleeding must be done as much as possible to get better prognosis. Blood evacuation must undergo quickly but very risky for rebleeding. Factor VIII must be given as soon as possible for treatment in severe haemophilia A patient with acute bleeding. Maintenance anesthesia also include decrease risk of hypertension and tachicardia for minimalize the ongoing bleeding. Male 17th years old diagnose with brain injury 2x4 caused by subdural hemorrhage (SDH) left frontotemporoparietal region and cerebral edema followed by subfalcine herniation to the right and haemophilia A planned for decompression evacuation of SDH. Patient got factor VIII 4000unit before operation. Intraoperative bledding are 1100cc and get 1940cc of blood product for stabilize the haemodynamic. Post operative was observe in Intensive Care Unit and went for extubation after 8th day after in good condition.

Penatalaksanaan Anestesi pada Perdarahan Intraserebral dengan Hidrosefalus dan Diabetes Melitus Longdong, Djefri Frederik; Rachman, Iwan Abdul; Bisri, Dewi Yulianti; Sudadi, Sudadi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perdarahan Intraserebral (PIS) adalah ekstravasasi darah yang masuk kedalam parenkim otak, yang dapat berkembang ke ruang ventrikel dan subarahnoid, terjadi spontan dan bukan disebabkan oleh trauma (non traumatis) dan merupakan salah satu penyebab tersering pada pasien yang dirawat di unit perawatan kritis saraf. Kejadian PIS 10-15% dari semua stroke dengan tingkat angka kematian tertinggi dari subtipe stroke dan diperkirakan 60% tidak bertahan lebih dari satu tahun. Kasus: Laki-laki 57 tahun, datang dengan keluhan penurunan kesadaran yang terjadi pada saat mau makan. Pada pemeriksaan didapatkan kesadaran GCS E1M4V1 dengan hemodinamik stabil, dan terdapat hemiplegi sinistra. Pasien diintubasi dan memakai ventilator di ruangan Instalasi Gawat Darurat Disaster sambil menunggu hasil skrining Covid 19 dengan swab polymerase chain reaction (PCR). Pada CT-scan ditemukan adanya PIS 48,93 cc di basal ganglia, capsula eksterna sampai periventrikel lateralis kanan, terjadi distorsi midline sejauh 1 cm ke kiri. Ventrikulomegali disertai perdarahan intraventrikel yang mengisi ventrikel lateralis kanan dan kiri, ventrikel III dan IV. Laboratorium menunjukkan gula darah di atas 200 mg/dl setelah dilakukan koreksi gula darah diputuskan untuk dilakukan tindakan kraniotomi evakuasi segera dengan pemeriksaan penunjang yang cukup. Tindakan kraniotomi evakuasi pada pasien PIS menjadi tantangan bagi seorang anestesi, sehingga diperlukan pengetahuan akan patofisiologi, mortalitas PIS dan tindakan anestesi yang harus dipersiapkan dan dikerjakan dengan tepat.Anesthesia Management in Intracerebral Hemorrhage with Hydrocephalus and Diabetes MellitusAbstractIntracerebral hemorrhage (ICH) is the extravasations of blood into the brain parenchyma, which may develop into ventricular and subarachnoid space, there was spontaneous and not caused by trauma (nontraumatic), and one of the most common cause in patients treated in the neurological critical care unit. ICH represents perhaps 1015% of all strokes with the highest mortality rates of stroke subtypes and about 60% of patients with ICH do not survive beyond one year. Case: a man 57 years, came with complaints of loss of consciousness when he just want to eat. On examination of consciousness obtained GCS E1M4V1 with hemodynamic was stable, there left hemiplegic. Patients is intubated and connected with ventilator at Emergency Room Disaster while waiting for result from PCR. From the CT Scan we found 48,93 cc at basal ganglia, capsula externa until lateral periventricle dextra there is a midline distortion 1 cm to the left. Ventriculomegali with intraventricle hemorrhage wich is fill the lateral ventricle right and left, third ventricular and fourth ventricular. The laboratorium result show the glucose up to 200 mg/dl. After glucose correction, it was decided to evacuate immediately craniotomy action with adequate investigation. Procedure of craniotomy evacuation in ICH patients be a challenge for an anesthesiologist, so knowledge of the pathophysiology, mortality ICH and anesthetic procedure that should be prepared and done properly.

Perbandingan Luaran Klinis pada Pasien Stroke Iskemik Fase Akut dengan Satu atau Lebih Faktor Risiko Hidayat, Faqih; Gamayani, Uni; Wibisono, Yusuf; Berliana, Sobaryati; Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Stroke menurut WHO adalah terjadinya gejala penurunan fungsi neurologis secara tiba-tiba, fokal maupun global, berlangsung lebih dari 24 jam karena gangguan pasokan darah menuju ke otak. Stroke merupakan penyakit multifaktorial penyebab kematian dan disabilitas. Sebagian besar pasien stroke memiliki ? 2 faktor risiko. Tujuan penelitian ini adalah untuk membandingkan gambaran luaran klinis pada pasien stroke iskemik fase akut dengan satu atau lebih faktor risiko.Subjek dan Metode: Penelitian ini merupakan penelitian deskriptif retrospektif pada pasien stroke iskemik fase akut serangan pertama di Departemen Neurologi Rumah Sakit Hasan Sadikin Bandung periode 20152019.Hasil: Terdapat 176 subjek pada penelitian ini, 160 pasien (90,9%) dengan lebih dari satu faktor risiko dan 16 pasien (9,1%) dengan satu jenis faktor risiko. Faktor risiko paling banyak adalah hipertensi sebanyak 147 pasien (83,5%), dislipidemia 91 pasien (51,7%) dan penyakit kardiovaskular 56 orang (31,8%). Penelitian menunjukan luaran klinis yang diukur dengan skor National Institute of Health Stroke Scale (NIHSS) keluar RS pada kelompok lebih dari satu faktor risiko lebih bervariatif dari derajat ringan hingga sangat berat. Sedangkan, pada kelompok dengan satu faktor risiko skor NIHSS cenderung ringan hingga sedang.Simpulan: Pasien dengan lebih dari satu faktor risiko memiliki luaran klinis lebih buruk dibandingan pasien dengan satu faktor risiko.Comparison of The Clinical Outcomes between Single and Multiple Risk Factors in Acute Phase Ischemic Stroke PatientsAbstractBackground and Objective: Stroke according to WHO is a sudden symptom of neurological deficit, focal or global, lasting 24 hours due to disruption of blood supply to the brain. Stroke is a multifactorial disease that causes death and disbility. Most of stroke patients have ?2 risk factors. The aim of this study was to determine the comparison of clinical outcomes between single and multiple risk factor in acute phase ischemic stroke patients.Subjects and Methods: This study was retrospective descriptive study in patient with acute phase ischemic stroke in the Neurology Department Hasan Sadikin Hospital Bandung from 2015-2019.Results: There were 176 subjects in this study, 160 patients (90.9%) with multiple risk factor and 16 patients (9.1%) with single risk factor. The most common risk factors were hypertension in 147 patients (83.5%), dyslipidemia in 91 patients (51.7%) and cardiovascular disease in 56 pasien (31.8%). The study showed that the clinical outcomes as measured by National Institute of Health Stroke Scale (NIHSS) score for hospital discharge in multiple risk factors group varied from mild to very severe. Meanwhile, single risk factor groups the score tends to be mild to moderate.Conclusion: Multiple risk factor patients had a worse clinical outcome than single risk factor patients.

Tatalaksana Vasospasme Serebral Pasca Perdarahan Subarahnoid Widiastuti, Monika; Rahman, Iwan Abdul; Mafiana, Rose -; Jasa, Zafrullah Khany
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Vasospasme cerebral merupakan penyebab morbiditas dan mortalitas utama pada pasien dengan perdarahan subarahonid. Delayed ischemic neurologic deficit yang berhubungan dengan vasospasme serebral menyebabkan kematian pada 50% pasien yang bertahan pada periode awal setelah aneurisma ruptur yang ditangani. Onset vasospasme serebral yang bervariasi, mulai dari 24 jam pasca perdarahan subarahnoid atau subarahcnoid hemorrhage (SAH) sampai dengan 14 hari, patofisiologi vasospasme serebral yang kompleks dan cara diagnosis yang masih kontroversial, turut berkontribusi terhadap morbiditas dan mortalitas yang tinggi pada pasien dengan SAH. Evaluasi ketat selama perawatan di ICU untuk mendeteksi kejadian vasospasme serebral awal sangat penting, setiap gejala neurologis baru yang muncul harus diperiksa dan ditangani secepatnya. Banyak obat-obatan yang diteliti untuk mengatasi vasospasme serebral namun efektifitasnya masih dipertanyakan. Tatalaksana utama yang dulu diketahui adalah dengan melakukan terapi triple H, namun hal ini sudah ditinggalkan. Induced hypertension menjadi satu-satunya bagian dari terapi triple H yang masih digunakan, namun belum banyak dipergunakan secara luas. Oleh karena itu perlu dikaji lebih lanjut bagaimana tatalaksana SAH untuk mencegah luaran yang buruk.Management of Cerebral Vasospasm after Subarachnoid HemorrhageAbstractCerebral vasospasm is the main etiology of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH) patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The variant onset of cerebral vasospasm, start from 24 hours after SAH up to 14 days after, complex pathophysiology, and the diagnosis of vasospasm has still been met with some controversy, contribute to the high morbidity and mortality in these patients. Vigilance evaluation during ICU care to detect cerebral vasospasm as early as posssible is essential, any new onset of neurological symptoms need to be investigated and treated immediately. Many studies reported some agents for the treatment of cerebral vasospasm, however their roles remain uncertain. Triple H therapy was known as a main treatment for vasospasm, however it is no longer applied nowadays. Induced hypertension become the only part of Triple H therapy used yet it is not well recognized. Therefor, there is a need for thorough evaluation regarding treatment of SAH to prevent poor outcomes.

Manajemen N-IOM (Manajemen Neurologi-Intraoperatif) pada Eksisi Tumor Myelum dan Dekompresi Stabilisasi Servikal C2-C6 Rusly, Andri; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Pemantauan neurofisiologis intraoperatif (N-IOM) berkembang menuju standar perawatan untuk meminimalkan risiko cedera jalur saraf selama prosedur bedah saraf. Pentingnya tidak hanya terletak dalam mendiagnosis cedera pada periode perioperatif untuk pasien yang berisiko tinggi serta komplikasi neurologis dari operasi tetapi juga dalam menciptakan kesempatan untuk menyelamatkan jaringan saraf yang berisiko sebelum kerusakan menjadi ireversibel. Operasi pada tulang belakang merupakan salah satu operasi dengan tingkat resiko tinggi untuk mencederai jaringan sehat sekitar, oleh sebab itu teknik anestesi dengan N-IOM akan sangat membantu mengurangi komplikasi durante operasi. Beberapa penelitian sebelumnya meneliti tentang kombinasi yang berbeda dari teknik N-IOM (seperti somatosensory evoked potentials [SEPs], motor evoked potentials [MEPs], direct wave, free- running electromyography). Hasilnya didapatkan bahwa penggunaan N-IOM multimodal untuk operasi tumor sumsum tulang belakang memberikan hasil yang lebih baik daripada penggunaan N-IOM dengan satu teknik. Teknik N-IOM dengan menggunakan sedasi seperti propofol dan dexmedetomidine yang dikombinasikan dengan opioid seperti fentanyl dapat menjaga kedalaman anestesi pasien tanpa mengganggu sinyal N-IOM itu sendiri. Untuk memaksimalkan nilainya, penting tim operasi untuk memiliki pemahaman dasar tentang prinsip-prinsip neuromonitoring dan ahli anestesi untuk memahami bagaimana hal itu dapat dipengaruhi oleh anestesi. Oleh karena itu, diperlukan teknik anestesi yang optimal dimana hemodinamik pasien tetap terjaga selama pembedahan dan monitoring IOM tetap dapat dilakukan.Management N-Iom (Neurology-Intraoperative Management) at Tumor Myelum Exition Decompression and Stabilization Cervical C2-C6AbstractIntraoperative neurophysiological monitoring (IOM) is advancing towards the standard of care for the risk of neural pathway injury during neurosurgical procedures. The importance lies not only in finding a diagnosis in the perioperative period for high-risk patients as well as neurologic complications from surgery but also in creating opportunities to salvage neural tissue before the damage becomes irreversible. Surgery on the spine is one of the operations with a high level of risk for injuring the surrounding health tissue, therefore the anesthetic technique with N-IOM will greatly help reduce complications during surgery. Several previous studies investigated different combinations of N-IOM techniques (such as somatosensory evoked potentials [SEPs], motor evoked potentials [MEPs], direct wave, free-running electromyography). The results showed that the use of multimodal N-IOM for spinal cord tumor surgery gave better results than the use of a single technique N-IOM. N-IOM techniques using sedatives such as Propofol and Dexmedetomidine in combination with Opioids can maintain the depth of anesthesia without interfering with the N-IOM signal itself. To maximize its value, it is important for the operating team to have a basic understanding of the principles of neuromonitoring and the anesthesiologist to understand how it can be affected by anesthesia. Therefore, an optimal anesthetic technique is needed where hemodynamics is maintained during surgery and IOM monitoring can still be performed.

Diagnosis dan Manajemen Anestesi pada Pituitary Apopleksia Tidak Fatal dengan Manifestasi Schizofrenia Cahyadi, Arief; Rachman, Iwan Abdul; Jasa, zafrullah Khany; Mafiana, Rose
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Tumor hipofisis dapat disertai gejala neuropsikiatri. Apopleksia pituitari (AP) merupakan kejadian jarang akibat infark dan perdarahan tumor hipofisis. Pemulihan total masih mungkin terjadi walaupun pada kasus berat dengan terapi pembedahan maupun konservatif. Terapi pembedahan dipilih bila adanya tanda peningkatan intrakranial dengan kondisi klinis dan neurologis yang tidak stabil. Seorang laki laki, umur 36 tahun dengan keluhan gangguan bicara mendadak sehari sebelum masuk RS, dengan riwayat terapi skizofrenia selama 8 bulan. Pasien mengalami penurunan kesadaran dalam perawatan dan didiagnosis tumor hipofisis anterior dengan komponen apopleksia dari CT-scan kepala. Pasca operasi transphenoid urgensi diterapi vasopresin intramuskular akibat poliuria. Penatalaksanaan anestesi pada pembedahan AP tidak berbeda dengan tumor hipofisis lainnya, hanya saja kondisi AP dapat bersifat urgensi. Satu bulan pasca pembedahan, pasien sudah lebih mudah berbicara, mulai beraktifitas fisik, dan halusinasi suara sudah tidak ada. Tatalaksana AP memberikan tantangan dalam manajemennya. Keluhan yang ditemukan dapat berupa halusinasi. Hingga kasus ini dilaporkan, ada satu publikasi kasus AP dengan psikosis akut dan keterlambatan diagnosis masih mungkin terjadi. Kecurigaan gangguan organik tetap perlu dipikirkan pada gangguan neuropsikiatri. Gangguan produksi urin bisa terjadi pasca operasi yang disebabkan beberapa hal sehingga memerlukan pemantauan ketat status hidrasi untuk menghindari morbiditas dan mortalitas yang mungkin terjadi.Anesthesia Management in Urgency Transsphenoidal Tumor Resection with Pituitary Apoplexy Presenting and SchizophreniaAbstractPituitary tumors may be accompanied by neuropsychiatric symptoms. Pituitary Apoplexy (PA) is a rare condition due to infarct or bleeding in pituitary tumors. Complete recovery is still possible even in severe cases with either surgical or conservative therapy. Surgery is a choice if there is evidence of increased intracranial pressure with unstable clinical and neurological conditions. Adult man, 36 yo, with sudden difficulty to speak a day before, with history of schizophrenia since 8 months ago. The patient suffered a decrease in consciousness in hospitalization and was diagnosed with anterior hypophysis tumor with apoplexy by CT-scan results. Post transsphenoidal urgency surgery, the patient was treated with vasopressin IM due to polyuria. Anesthesia management in PA surgery is the same as other pituitary tumor surgery, however, PA can be urgent. One month after surgery, the patient is more easier to talk, start physical activities, and auditory hallucination is not heard again. Management PA had its own challenge. Symptoms can be hallucinations. Until this case was reported, there was one published case of AP with acute psychosis and delay in diagnosis is still possible. Suspicion of organic disorders still needs to be considered in neuropsychiatric disorders. Impaired urine production might occur postoperatively due to several reasons so it requires close monitoring of hydration status to prevent possible morbidity and mortality.

Apa yang Baru dalam Neuroanestesi untuk Cedera Otak Traumatik? Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Konsep dasar Neuroanestesi Neuro Critical Care disebut sebagai ABCDE neuroanestesi. Early Brain Injury (EBI) dahulu dikenal sebagai cedera otak primer. Pada EBI terjadi hilangnya autoregulasi, hilangnya integritas barier darah otak. Adanya Trias Cushing menunjukkan adanya hipertensi intrakranial. Target tekanan darah pada cedera otak traumatik (traumatic brain injury/TBI) adalah hindari tekanan darah sistolik 110 mmHg, pertahankan tekanan perfusi otak (cerebral perfusion pressure/CPP) 60-70 mmHg, target pengaturan PaCO2 adalah normokarbia, PaCO2 3540 mmHg, penggunaan profilaksis phenytoin atau valproate tidak direkomendasikan untuk mencegah late post traumatic seizure (late PTS). Masih perlu menganalisa terapi decompressive craniectomy (DECRA) dibandingkan dengan terapi medikal kontinyu untuk peningkatan tekanan intrakranial (intracranial pressure/ICP) yang refrakter setelah TBI. Anestesi umum untuk pasien dengan TBI berat lebih baik dengan total intravenous anesthesia (TIVA), pemberian cairan harus mempertimbangkan osmolaritas cairan tersebut. Pada konsep yang baru, pada pasien dengan peningkatan ICP, konsentrasi anestetika volatil harus dibatasi sampai 0,5 MAC. Target gula darah adalah normoglikemia. Hipotermi profilaksis atau terapeutik tampaknya tidak memiliki tempat dalam pengelolaan cedera otak berat.What is New in Neuroanesthesia for Traumatic Brain Injury?AbstractThe basic concept of Neuroanesthesia and Neuro Critical Care is referred to as ABCDE neuroanesthesia. Early Brain Injury (EBI) was formerly know as primary brain injury. In EBI, there is loss of autoregulation, loss of integrity of the blood-brain barriere. The presence of Cushings triad indicates the presence of intracranial hypertension. Blood pressure target in traumatic brain injury is to avoid systolic blood pressure less than 110 mmHg, maintain cerebral perfusion pressure (CPP) 60-70 mmHg, target PaCO2 regulation is normocarbia, PaCO2 35-40 mmHg, prophylactic use of phenytoin or valproate is not recommended to prevent late post traumatic seizure (late PTS). Still need to analyse decompressive craniectomy (DECRA) compare with continuous medical therapy for refractory increase in intracranial pressure (ICP) after TBI. General anesthesia for patient with severe TBI is better with total intravenous anesthesia (TIVA), administration of fluids must consider the osmolarity of the fluid. In a new concept in patient with elevated ICP, volatile anesthetic concentaratiom should be limited to 0.5 MAC.Blood glucose target is normoglycemia. Prophylactic and therapeutic hypothermia not recommended for severe traumatic brain injury management.

Karakteristik Klinis dan Status Nutrisi pada Pasien Stroke Fase Akut Amalia, Lisda; Putri, Arviana Adamantina
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Disabilitas yang berat pada stroke meningkatkan risiko terjadinya malnutrisi. Malnutrisi pada pasien stroke dapat disebabkan oleh defisit neurologis dan faktor risiko. Malnutrisi pada stroke meningkatkan morbiditas dan mortalitas. Penelitian ini bertujuan untuk mengetahui karakteristik klinis dan status nutrisi pasien stroke.Subjek dan Metode: Penelitian bersifat deskriptif retrospektif pada pasien stroke yang dirawat di RSUP Hasan Sadikin Bandung pada periode 1 Agustus 2020 hingga 30 September 2020. Status nutrisi dinilai menggunakan Indeks Massa Tubuh (IMT) dan skor Subjective Global Assessment (SGA). IMT dihitung menggunakan kg/m2, dikelompokkan menjadi obesitas (IMT 30), overweight (IMT 25,029,9), normal (IMT 18,524,9) dan underweight (IMT 18,5). Skor SGA 2 termasuk nutrisi baik, dan ?2 tergolong malnutrisi.Hasil: Didapatkan 52 orang pasien stroke yang sebagian besar berjenis kelamin laki-laki (57,7%) dengan rentang usia 3886 tahun (rata-rata 57 tahun), 51,9% mengalami malnutrisi berdasarkan skor SGA, IMT normal dan overweight sebanyak 23 (44,2%) orang, diikuti obesitas (5,7%) dan underweight (5,7%). Ditemukan 71,4% usia ?65 tahun mengalami malnutrisi. Kondisi malnutrisi didominasi pasien stroke infark kardioemboli (63,6%), dengan derajat stroke berat (58,3%), disfagia (59,4%), dengan komorbid infeksi (71,4%) dan stress ulcer (55,6%).Simpulan: Berdasarkan penelitian ini, didapatkan bahwa usia tua , derajat stroke sedang-berat, komorbid infeksi dan stress ulcer akan memiliki kecenderungan malnutrisi sehingga penanganan stroke yang baik dapat menurunkan risiko terjadinya malnutrisi. Kejadian stroke berulang tidak menjadi risiko terjadinya malnutrisi pada penelitian ini.Clinical Characteristics and Nutrition Status in Acute Stroke PatientsAbstractBackground and Objective: Severe disability in stroke increase the risk of malnutrition. Malnutrition in stroke patients can be caused by neurological deficits and risk factors. Malnutrition in stroke increases morbidity and mortality. This study aims to determine the clinical characteristics and nutritional status of stroke patients.Subject and Methods: This study was a retrospective descriptive study of stroke patients who were treated in the Neurology ward of Hasan Sadikin Hospital Bandung from 1 August 2020 to 30 September 2020. Nutritional status was assessed using Body Mass Index (BMI) and Subjective Global Assessment (SGA) scores. BMI was calculated using kg/m2, grouped into obese (BMI 30), overweight (BMI 25.0-29.9), normal (BMI 18.5-24.9) and underweight (BMI 18.5). SGA score 2 is considered as good nutrition, and ?2 is classified as malnutrition.Results: There were 52 stroke patients, most of them were male (57.7%) with an age range of 38-86 years old (mean 57 years), 51.9% were malnourished based on the SGA score, normal BMI and overweight were 23 (44.2%) people, followed by obesity (5.7%) and underweight (5.7%). We also found 71.4% aged ?65 years are malnourished. This condition was dominated by cardioembolic stroke patients (63.6%), with severe stroke (58.3%), dysphagia (59.4%), with comorbid infections (71.4%) and stress ulcers (55.6%).Conclusion: Based on this study, it was found that elderly, moderate-severe stroke, comorbid infections and stress ulcers have a tendency related to malnutrition. Good or better management can/indeed reduce the risk of malnutrition. Stroke history was not a risk for malnutrition in this study.

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Home Page

OAI Link

Editorial Team

Contact

Reviewer

Google Scholar

Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

Phone
+6287722631615

Journal Mail Official
jni@inasnacc.org

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

Location
,

INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

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