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Jurnal Neuroanestesi Indonesia
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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Perbandingan Status Nutrisi Pasien Stroke Iskemik Pertama dan Ulang di RSUP Dr. Hasan Sadikin Bandung Khairunnisa, Shafa Ayu; Amalia, Lisda; Fatimah, Siti Nur
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.444

Abstract

Latar Belakang dan Tujuan: Stroke memiliki manifestasi klinis yang dapat menyebabkan rendahnya asupan nutrisi. Pasien stroke juga dapat mengalami stroke ulang. Penelitian ini bertujuan untuk mengetahui perbandingan status nutrisi pasien stroke iskemik pertama dan ulang berdasarkan Indeks Massa Tubuh (IMT) dan Penilaian Global Subjektif (PGS).Subjek dan Metode: Penelitian ini merupakan analitik komparatif dari data rekam medis pasien stroke iskemik pertama dan ulang di RSUP Dr. Hasan Sadikin Bandung periode 2018?2019. Metode pemilihan sampel dengan sampling konsekutif, sampel sebanyak 118 pasien untuk masing-masing kelompok. Analisis data nominal dengan uji Fishers Exact, data ordinal dan numerik dengan uji Mann Whitney. Hasil: Total 236 subjek pada kedua kelompok yang terdiri dari 130 pria dan 106 wanita dengan rata-rata usia 56,614,6 dan 61,811,4 tahun, mayoritas memiliki faktor risiko hipertensi. Berdasarkan IMT, mayoritas pasien dalam kategori normal dan obesitas pada strok iskemik pertama (33,05%) dan obesitas pada strok iskemik ulang (37,39%, p0,05). Kategori PGS B 64,41% dan 66,95% pada strok iskemik pertama dan ulang (p0,05).Simpulan: Tidak terdapat perbedaan yang signifikan secara statistika pada status nutrisi pasien stroke iskemik pertama dan ulang berdasarkan PGS dan IMT, namun secara proporsi pasien stroke iskemik ulang memiliki status nutrisi yang lebih buruk. Mayoritas pasien stroke iskemik mengalami obesitas, berlawanan dengan PGS yang menunjukkan pasien mengalami malnutrisi ringan-sedangComparison of Nutritional Status between First and Recurrent Ischemic Stroke Patients in Dr. Hasan Sadikin Central General Hospital BandungAbstractBackground and Objective: Stroke has various clinical manifestations that can cause low nutritional intake. Stroke patients can also experience recurrent stroke. This study aims to determine the comparison of nutritional status in patients with first and recurrent ischemic stroke based on Body Mass Index (BMI) and Subjective Global Assessment (SGA).Subject and Methods: This study is a comparative analysis of the medical records of patients with first and recurrent ischemic stroke at RSUP Dr. Hasan Sadikin Bandung period 2018?2019. The sample selection method was carried out by consecutive sampling with 118 patients for each group. Data analysis for nominal data was tested by Fishers exact test, for ordinal and numerical data tested by Mann Whitney test. Result: A total of 236 subjects in both groups of first and recurrent ischemic stroke patients consisting of 130 men and 106 women with an average age of 56,6414,60 and 61,7511,36 years, and the majority had risk factors for hypertension. Based on BMI, the majority of ischemic stroke patients were categorized as normal and obese in the first (33,05%) and obese in recurrent ischemic stroke (37,39%), p0,05. SGA B rating (64,41% in the first and 66,95% in the recurrent ischemic stroke), p0,05.Conclusion: There was no statistically significant difference in the nutritional status of first and recurrent ischemic stroke patients based on SGA and BMI, but the proportion of recurrent ischemic stroke patients had worse nutritional status. The majority of ischemic stroke patients are obese, in contrast to the SGA which shows that patients are mildly-moderately malnourished
Penatalaksanaan Anestesi Neonatus yang Menjalani Pembedahan Koreksi Giant Unruptured Occipital Meningoencephalocele Suarjaya, I Putu Pramana; Kharisma, Chau Febriani; Sutawan, IB Krisna Krisna Jaya
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.527

Abstract

Meningoencephalocele adalah kelainan kongenital, duramater dan kranium tidak menutup sempurna sehingga sebagian jaringan intrakranial berada di luar kranium terbungkus kantong cele. Manajemen jalan nafas neonatus, memberikan tantangan karena anatomi jalan nafas yang khusus, fungsi organ pernafasan yang terbatas serta perbandingan ukuran kepala dan badan yang ekstrim. Meningoencephalocele oksipital akan menambah tingkat kesulitan tindakan intubasi serta kontrol jalan nafas saat tindakan anestesi dan pembedahan. Pasien lakilaki, usia sembilan hari, dengan benjolan di oksipital berukuran 17x12x8 cm menjalani reseksi meningoencephalocele. Induksi anestesi dilakukan dengan inhalasi sevofluran, rokuronium untuk fasilitas laringoskopi intubasi dengan videolaringoskop pada posisi terlentang dengan bantalan donat sesuai dengan bentuk dan ukuran cele. Videolaringoskop dipilih karena visualisasi lebih optimal tanpa memerlukan ekstensi dan manipulasi berlebih dibanding laringoskop konvensional sehingga intubasi bisa dilakukan dalam posisi terlentang. Tindakan anestesi dan pembedahan berlangsung selama 2 jam 15 menit. Pascaoperasi pasien dirawat di ruang rawat intensif neonatus, ekstubasi 24 jam pascaoperasi dan diperbolehkan pulang pada hari kesepuluh. Tantangan terbesar pada anestesi reseksi meningoencephalocele oksipital adalah mengamankan jalan nafas sambil memastikan keutuhan kantong cele saat dilakukan manipulasi jalan nafas dan perubahan posisi selama pembedahan.Airway Management for NeonatesUnderwent Giant Unruptured Occipital Meningoencephalocele ResectionAbstractMeningoencephalocele is a rare congenital abnormality where duramater and cranium failed to close completely, leaving part of intracranial tissues outside the cranium wrapped in a sac. Neonates airway management, pose many challenges due to immaturity of airway anatomy, limited respiratory organ reserve and extreme head-to-body ratios. Occipital meningoencephalocele will also complicate the intubation and airway control during anesthesia and surgery. A nine days old male patient with an occipital lump measuring 17x12x8 cm underwent meningoencephalocele resection. Induction of anesthesia was performed by sevoflurane inhalation, rocuronium to facilitate videolaryngoscopy and intubation in supine position, supported by doughnut-shape pads which fits the size of the cele. Videolaryngoscope was chosen because it provides optimal visualization without hyperextension and over manipulation than conventional laryngoscope, therefore intubation can be done in supine position. Anesthesia and surgery duration was 2 hours and 15 minutes. The patient was treated in the neonatal intensive care unit after surgery, extubated 24 hours later, and discharged home 10 days after surgery. The greatest challenge in anesthesia management for occipital meningoencephalocele resection is securing the airway while ensuring the sac is not ruptured during airway manipulation and positional changes during anesthesia and surgery.
Kelainan Neurologi akibat Kondisi Hiperkoagulasi pada Pasien Coronavirus Disease-19 Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.452

Abstract

Koagulopati merupakan salah satu manifestasi klinis dari Coronavirus Disease of 2019 (Covid-19) berat, dan menyebabkan buruknya prognosis penyakit. Manifestasi klinis dari Covid-19 memiliki spektrum yang luas, yaitu asimtomatik, gejala ringan tidak spesifik (demam, batuk kering, diare), pneumonia ringan, pneumonia berat (dispnea, takipnea, dan pertukaran gas terganggu), sindrom gangguan pernapasan akut (Acute Respiratory Distress Syndrome/ARDS), koagulasi intravaskular diseminata (Disseminated Intravascular Coagulation/DIC), sepsis, dan sindrom disfungsi multiorgan multipel. Pasien Covid-19 mengalami keadaan inflamasi berat yang menyebabkan peningkatan aktivasi kaskade koagulasi, peningkatan trombin, dan keadaan hiperkoagulasi sehingga meningkatkan risiko terjadi trombosis di pembuluh darah otak maupun medulla spinalis. Keadaan seperti usia tua, merokok, hipertensi, diabetes, penyakit kardiovaskular, penyakit paru obstruktif kronik, dan keganasan dapat meningkatkan risiko pasien mengalami derajat Covid-19 yang lebih berat dan mortalitas yang lebih tinggi. Keberadaan komplikasi Covid-19 seperti trombosis dapat mempengaruhi prognosis dan angka mortalitas pasien.Neurological Disorder Related Hypercoagulable Condition after Coronavirus Disease-19AbstractCoagulopathy is one of the clinical manifestations of severe Coronavirus Disease of 2019 (Covid-19), and causes a poor prognosis of the disease. The clinical manifestations of Covid-19 have a broad spectrum, namely asymptomatic, non-specific mild symptoms (fever, dry cough, diarrhea), mild pneumonia, severe pneumonia (dyspnea, tachypnea, and impaired gas exchange), acute respiratory distress syndrome (Acute Respiratory Syndrome). Distress Syndrome/ARDS), Disseminated Intravascular Coagulation (DIC), sepsis, and multiple multiorgan dysfunction syndrome. Covid-19 patients experience a severe inflammatory state that causes an increase in the activation of the coagulation cascade, an increase in thrombin, and a hypercoagulable state, thereby increasing the risk of thrombosis in the blood vessels of the brain and spinal cord. Conditions such as old age, smoking, hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and malignancy can increase a patient's risk of experiencing a more severe degree of COVID-19 and higher mortality. The presence of Covid-19 complications such as thrombosis can affect the patient's prognosis and mortality
Manajemen Anestesi pada Pasien dengan Tetraparese yang dilakukan Reseksi Tumor Cervikal Ekstradural (C1-3) Jasa, Zafrullah Khany; Utami, Niken Asri; Arief, Hafizh
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v11i1.462

Abstract

Tumor ekstradural servikal merupakan salah satu tumor yang jarang dijumpai dan dapat menimbulkan permasalahan neurologis yang progresif. Defisit neurologis pada pasien usia produktif sangat berpengaruh terhadap kualitas hidup pasien. Tatalaksana pembedahan dilakukan bertujuan mengurangi nyeri, perbaikan kondisi neurologis, serta meningkatkan kualitas hidup pasien. Perempuan 25 tahun mengalami tetraparese yang progresif sejak 2 bulan sebelum masuk ke rumah sakit, MRI menunjukkan massa ekstradural yang menekan medula spinalis setinggi level vertebra servikalis 13. Pasien dilakukan operasi dengan prinsip neuroanestesi. Pascaoperasi, fungsi kekuatan motorik mengalami perbaikan yang signifikan. Telah dilakukan operasi pengangkatan tumor ekstradural pada pasien wanita dewasa dengan perdarahan 850 cc dan terjadi peningkatan fungsi motorik pada kedua ekstrremitas superior dan inferior pascaoperasi. Diperlukan manajemen perioperatif yang baik pada pasien dengan tumor spinal terutama pada daerah servikal. Antisipasi perdarahan dan trauma medula spinalis iatrogenik yang dapat selama tindakan operatif berlangsung. Evaluasi neurologis dan rehabilitasi pada pasien dilakukan dengan melibatkan tim multidisiplin. Tumor ekstradural merupakan salah satu jenis tumor spinal dengan yang bila dilakukan tindakan bedah saraf pada waktu yang tepat dan perioperatif anestesi yang baik dapat memperbaiki fungsi neuorologis dan luaran pascaoperasi.Anesthesia Management of Patient with Tetraparese underwent Cervical Extradural Tumor (C1-3)AbstractCervical extradural tumor is one of the rare tumors and can cause progressive neurological problems. Neurological deficit in productive age greatly affects the patient's quality of life. Surgical management is carried out with the aim of reducing pain, improving neurological conditions, and improving the patient's quality of life. A 25-year-old woman had progressive tetraparesis since 2 months prior to admission, MRI showed an extradural mass compressing the spinal cord at the level of the C1-3. The surgery was performed under the principles of neuroanaesthesia. On postoperative assessment, motor strength function has improved significantly. A extradural tumor patient was excision by operation with 850 mm bleeds and good recovery with improvement motoric function in all extremities Good perioperative management is needed in patients with spinal tumors, especially patient with tumors on the cervical levels. The anticipation of iatrogenic spinal cord trauma and bleeding has to be maintained during the surgery. Neurological evaluation and rehabilitation of patients is carried out by involving a multidisciplinary team. Spinal cord tumour with excise in neurosurgery at the right time and good perioperative neuroanesthesia will good outcome and improve neurologicals deficit.
Tantangan dalam Menjaga Cerebral Perfusion Pressure (CPP) yang Aman pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.531

Abstract

Tekanan perfusi serebral (cerebral perfusion pressure/CPP) adalah gradien tekanan yang mendorong pengiriman oksigen ke jaringan serebral, perbedaan antara tekanan arteri rata-rata (MAP) dan tekanan intrakranial (ICP), CPP = MAP-CVP atau CPP = MAP ICP jika ICPCVP. Tekanan perfusi serebral harus dipertahankan dalam rentang yang sempit karena tekanan yang terlalu rendah dapat menyebabkan jaringan otak menjadi iskemik, dan bila terlalu tinggi dapat meningkatkan tekanan intrakranial. Tekanan perfusi serebral yang aman adalah antara 60-80 mmHg, tetapi nilai-nilai ini dapat bergeser ke kiri atau kanan tergantung pada fisiologi individu pasien. Karena CPP adalah ukuran yang dihitung, MAP dan ICP harus diukur secara bersamaan, paling sering dengan cara invasif. Ketika terjadi cedera otak, kapiler serebral bisa menjadi "bocor" atau lebih permeabel terhadap air. Selain itu, pembuluh darah serebral dapat melebar dalam respon terhadap cedera jaringan otak, hipoksemia, hiperkarbia, asidosis, atau hipotensi. Jika tekanan darah meningkat, peningkatan CPP dapat menyebabkan peningkatan aliran darah serebral. Tujuan yang disarankan dari CPP berdasarkan pedoman dari Brain Trauma Foundation adalah 50-70 mmHg. Menargetkan CPP tinggi 70 mmHg belum terbukti bermanfaat pada pasien dengan cedera otak traumatik dan dikaitkan dengan peningkatan risiko sindrom gangguan pernapasan akut (ARDS).Challenges in Maintaining Safe Cerebral Perfusion Pressure (CPP) in Traumatic Brain InjuryAbstractCerebral perfusion pressure (CPP) is the net pressure gradient that drives oxygen delivery to cerebral tissue. It is the difference between the mean arterial pressure (MAP) and the intracranial pressure (ICP), CPP = MAP-CVP or CPP =MAP ICP if ICPCVP. Cerebral perfusion pressure must be maintained within narrow limits because too litle pressure could cause brain tissue become ischemic, and too much could raise intracranial pressure. The normal range lies between 60 and 80 mmHg, but these values can shift to the left or right depending on individual patient physiology. As CPP is a calculated measure, MAP and ICP must be measured simultaneously, most commonly by invasive means. When brain injury occurs, cerebral capillaries can become leaky or more permeable to water. In addition, cerebral blood vessels may dilate in respons to brain tissue injury, hypoxemia, hypercarbia, acidosis, or hypotension. If blood pressure becomes elevated, the increased CPP can lead to increased cerebral blood flow. The recommended goal of CPP per the Brain Trauma Foundation (BTF) guideline is 50-70 mmHg. Targeting high CPP 70 mmHg has not been shown to be beneficial in patient with traumatic brain injury and is associated with an increased risk of acute respiratory distress syndrome (ARDS).
Mortalitas Pasien Cedera Kepala Berat Berdasarkan Nilai Mean Arterial Pressure di RSUD Ulin Banjarmasin Januari 2018 Oktober 2021 Abidin, Zainal; Wibowo, Rama Anshori Putra; Illiandri, Oski; Gunawan, Steven; Husair, Ahmad; Sikumbang, Kenanga Marwan
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.529

Abstract

Latar Belakang dan Tujuan: Cedera kepala berat (CKB) memiliki angka kejadian sekitar 10% dari total cedera kepala, dengan angka mortalitas yang sangat tinggi. Nilai mean arterial pressure (MAP) dapat mempengaruhi mortalitas pasien karena gangguan perfusi otak. Penelitian ini bertujuan mengetahui mortalitas pasien CKB berdasarkan nilai MAP di RSUD Ulin Banjarmasi dari Januari 2018 Oktober 2021. Subjek dan Metode: Penelitian ini merupakan studi deskriptif retrospektif berupa pengambilan data rekam medik dengan teknik purposive sampling. Hasil: Sebanyak 51 pasien terdiagnosis CKB, meninggal sebanyak 72.5% dan hidup sebanyak 27.5%, Nilai MAP 50 mmHg kematian 100%, nilai MAP 150 mmHg kematian sebesar 77%. Rentang nilai MAP 50-150 mmHg memberikan angka kematian sebesar 62%. Nilai MAP pasien cedera kepala mempengaruhi angka kematian akibat gangguan tekanan perfusi otak yang tergantung pada tekanan intrakranial (TIK) dan MAP. Sirkulasi darah ke otak dipengaruhi oleh MAP. Tekanan perfusi otak yang adekuat mampu menurunkan angka mortalitas dan meningkatkan luaran hidup pasien.Simpulan: Nilai MAP mempengaruhi angka kematian pasien CKBMortality Severe Head Injury Patients Based on Mean Arterial Pressure at Ulin Hospital Banjarmasin Since Januari 2018-Oktober 2021AbstractBackground and Objective: Severe head injury has an incidence of about 10% of total head injuries, severe head injury has the highest mortality rate. In head injury patients, Mean arterial pressure (MAP) value can affect the patient's mortality rate related to brain perfusion. This research aims to know mortality of severe head injury patients based on the mean arterial pressure at Ulin Hospital Banjarmasin in January 2018 October 2021 period.Subject and Method: This research was retrospective descriptive study, with collected data from medical records using purposive sampling technique. Result: The results showed from 51 people diagnosed with severe head injury, death 72.5% and alive 27.5%. Mortality rate 100% with MAP 50 mmHg, 77% with MAP 150 mmHg. And in MAP 50-150 mmHg mortality rate about 62%. Measurement of MAP in patient with severe head injury affect the mortality rate related to brain perfusion which depends on intracranial pressure (ICP) and MAP. Mean arterial pressure affect cerebral blood flow. Adequate brain perfusion are factors to decrease mortality and increase survival outcome.Conclusion: mean arterial pressure affect mortality rate in patient with severe head injury
Masalah Respirasi pada Penderita Cedera Medula Spinalis Servikal Hermawan, Freddy; Harahap, Mohamad Sofyan
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.504

Abstract

Masalah pada sistem respirasi merupakan komplikasi yang sering menyebabkan morbiditas dan mortalitas pada pasien dengan Spinal Cord Injury (SCI) baik pada fase akut maupun kronik. Hal tersebut disebabkan adanya kelumpuhan otot-otot inspirasi dan ekspirasi yang motor neuronnya berasal dari nervus spinalis C3C5, melemahnya refleks batuk dan stagnansi sekret. Cedera tulang belakang servikal dapat terjadi baik langsung maupun tidak langsung, dapat menyebabkan defisit neurologis ataupun kematian. Cedera medula spinalis servikal terjadi 23% dari seluruh kejadian cedera dan 8,2% dari semua cedera yang menyebabkan kematian. Pada artikel ini disajikan kasus pasien dengan SCI setinggi C3C6, pasien menjalani operasi laminektomi dekompresi. Pascaoperasi pasien dirawat di ICU dikontrol menggunakan ventilator dengan mode Synchronized Intermittent Mandatory Ventilation (SIMV). Setelah pasien diekstubasi, saturasi turun, dari pemeriksaan fisik didapatkan ronkhi minimal, pasien didiagnosis dengan Hospital-Acquired Pneumonia (HAP) dan sepsis. Saturasi pasien membaik menjadi 99% setelah direintubasi disertai dengan program nebul combivent dan bisolvon 20 tetes/6 jam. Weaning ventilator pada pasien ditunda. Pasien diberikan vancomysin dan meropenem sebagai antibiotik definitif setelah dilakukan kultur bakteri.Respiration Problems in Cervical Spine Injury PatientsAbstractRespiratory complications associated with spinal cord injury (SCI) are the most important cause of morbidity and mortality in both the acute phase and a long-term perspective. This is due to paralysis of the inspiratory and expiratory muscles whose motor neurons originate from the C3C5 spinal nerves, weakened cough reflexes and stagnation of secretions. Cervical spinal cord injuries can occur directly or inderectly that can cause neurological disorder or death. Cervical injuries occur 23% of all cedera events and 8,2% of all cederas that cause of death. In this article, we present a case of a patient with SCI at C3C6, a patient undergoing decompressive laminectomy surgery. Postoperation, the patient was treated in the ICU controlled using a ventilator with Synchronized Intermittent Mandatory Ventilation (SIMV) mode. After the patient was extubated, the saturation dropped, on physical examination, there were minimal rhonchi, the patient was diagnosed with Hospital-Acquired Pneumonia (HAP) and sepsis. Patient saturation improved to 99% after reintubation accompanied by nebul combivent program and bisolvon 20 drops every 6 hours. Ventilator weaning in patient was delayed. The patient was given vancomycin and meropenem as definitive antibiotics after bacterial culture was performed.
Hubungan Strok dengan Gagal Ginjal Kronis: Laporan Kasus Bisri, Dewi Yulianti; Utama, M Lucky
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.534

Abstract

Masalah ginjal dapat meningkatkan risiko gangguan otak. Para peneliti menemukan hubungan yang kuat antara fungsi ginjal yang buruk dan penurunan aliran darah ke otak, semakin besar penurunan fungsi ginjal. Seorang laki-laki, 47 tahun, BB 50 kg, dengan diagnosis tumor ginjal sinistra end stage renal disease (ESRD), disertai infark lakunar cerebral, efusi pleura sinistra dan asma bronkial yang akan dilakukan nefrektomi. Riwayat hemodialisa rutin sejak 8 bulan, stroke infark 2 bulan lalu tanpa disertai kelemahan anggota gerak, asma bronkial terakhir serangan 1 tahun lalu. Induksi dengan fentanyl, propofol, atracurium, intubasi dengan pipa endotrahea no. 7,5 spiral, dan rumatan anestesi dengan sevoflurane 23 vol%, oksigen/N2O 50%, posisi flank. Operasi berlangsung selama 3 jam, dengan total perdarahan 2000 cc, pasien mendapatkan transfusi 1 PRC (189cc), cairan kristaloid 1000 cc, koloid 500cc. Dilakukan pemasangan chest tube thoracostomy (CTT) setelah pasien teranastesi. Dilakukan ektubasi di kamar operasi dan dipindahkan ke ruangan ICU, dirawat selama 2 hari sebelum dipindahkan ke ruang perawatan biasa. Gagal ginjal adalah faktor risiko untuk strok, yang merupakan penyebab utama morbiditas dan mortalitas. Risiko strok 530 kali lebih tinggi pada pasien dengan chronic kidney disease (CKD), terutama pada dialisis. Case fatality rate juga lebih tinggi mencapai hampir 90%. Oleh karena itu, penting untuk memahami faktor-faktor yang mempengaruhi strok pada populasi yang rentan ini untuk menerapkan strategi pencegahan dengan lebih baik.Relationship of Stroke with Chronic Renal Failure: Case ReportAbstractKidney problems can increase the risk of brain disorders. The researchers found a strong link between poor kidney function and decreased blood flow to the brain, resulting in a greater decrease in kidney function. A male, 47 years old, BW 50 kg, with a diagnosis of sinistra kidney tumor with end stage renal disease (ESRD), cerebral lacunar infarction, pleural effusion sinistra, asthma to be performed nephrectomy. History of routine hemodialysis since 8 months, stroke infarction 2 months ago without accompanied limb weakness, asthma with last exacerbation occurred 1 months ago. Induction with fentanyl, propofol, atracurium, intubation with endotracheal tube no. 7.5 spiral, and maintenance anesthesia with sevoflurane 2-3 vol% with 50% oxygen/N2O with the flank position. The operation lasted for 3 hours, with a total bleeding of 2000 cc, the patient got a transfusion of 1 PRC (189cc), crystalloid fluid 1000 cc, colloidal 500cc. Chest tube thoracostomy (CTT) installation is carried out after the patient is anesthetized. The patient was extubated in the operating room and transferred to the ICU and was care for 2 days before being transferred to the ward. Renal failure is a risk factor for stroke, which is the leading cause of morbidity and mortality. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. The case fatality rate is also higher, reaching almost 90%. Therefore, it is important to understand the factors that influence stroke in this vulnerable population in order to better implement prevention strategies.

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