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Agni Susanti
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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
Articles 8 Documents
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Search results for , issue "Vol 13, No 3 (2024)" : 8 Documents clear
Comparison of Changes in Cortisol Values Before and After Administration of a Combination of Continuous Fentanyl and Paracetamol Drip in Post-Craniotomy Patients in ICU of Haji Adam Malik General Hospital Medan Etania, Cassandra; Irina, Rr Sinta; Ihsan, Muhammad
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.593

Abstract

Introduction: Post-craniotomy surgical pain can trigger an inflammatory response and release various stress response mediators. Prolonged stress response to pain can increase cortisol secretion which will eventually be resulted in cortisol dysfunction and widespread inflammation. Opioids have been shown to provide pain management after craniotomy. Fentanyl is a commonly used opioid analgesic to manage postoperative pain. The addition of paracetamol is often used as multimodal analgesia which aims to reduce postoperative pain and to minimize the stress response that occurs. The aim of the study was to obtain a comparison of changes in cortisol values before and after the administration of a combination of continuous fentanyl and paracetamol in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan. Subject and Methods: This research design used a cross sectional test with pretest and posttest design, with primary data sources obtained directly from examinations on patients in the ICU. This study involved 15 post-craniotomy patients in the ICU with mechanical ventilation. The cortisol levels in the patients blood were checked before and after administration continuous fentanyl and paracetamol drip. Results: There was a decrease in cortisol levels after being given a combination of continuous fentanyl and paracetamol drip in post-craniotomy patients by 18% with a p-value of 0.001 (p
Tetralogy Scalp Block Anesthesia without Opioid for Anesthetic Management in Children Undergoing Frontal Reconstruction Mahendratama, Muhammad Riza; Prihatno, M. Mukhlis Rudi; Wicaksono, Nugroho
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.640

Abstract

Traumatic brain injury (TBI) is one of the leading causes of death in developing countries, especially Indonesia. The incidence of TBI in Indonesia between 6% and 12% and has a mortality rate of 25% to 37%. Treatment of traumatic brain injury is done as soon as possible to improve quality of life and prevent further damage to brain cell and function. A 13-year-old child sustained mild traumatic brain injury and frontal fracture due to a fall from a motorcycle. The patient underwent frontal reconstruction in the operating room. The surgery was performed under regional anesthesia using a scalp block with an ultrasound device and without using opioid drugs. The surgery lasted about two hours without hemodynamic disturbances. The post-surgery Visual Analogue Scale (VAS) was 2-3. The patient was observed in the regular ward for four days and discharged without any disability. Scalp block was chosen to enhances analgesic quality without opioid, reduce requirement of ICU as well as hospitalization time, and save treatment costs. Opioids may cause respiratory and gastrointestinal depression and Postoperative Nausea and Vomiting (PONV).
Anesthetic Management of Craniotomy for Supratentorial Tumor Resection in a Patient with Femoral-Popliteal Deep Vein Thrombosis: Case Report Saputra, Tengku Addi; Halimi, Radian Ahmad; Hamzah, Hamzah
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.606

Abstract

Patients with brain tumors are highly susceptible to venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Approximately 2030% of those with intracranial tumors experience VTE, with factors such as neurological deficits, tissue factor secretion, genetic predispositions, advanced age, and hypertension contributing to the risk. In this case, a 61year woman with Space Occupying Lesion (SOL) Supratentorial at Midfrontal, Hypertension Stage II, Diabetes Mellitus (DM) type 2, and femoral-popliteal DVT undergoes craniotomy in general anesthesia. A thorough preoperative assessment is carried out to increase the success of anesthesia, including Doppler ultrasound assessment, administering anticoagulants up to 24 hours before surgery, and monitoring platelet levels and coagulation profiles. Managing VTE in these patients typically involves anticoagulants, thrombolytics, and thrombectomy tailored to the clinical situation. However, the use of anticoagulants, like heparin, poses a risk of severe bleeding during surgical procedures such as craniotomy. A craniotomy is associated with an increased risk of VTE due to endothelial damage, thromboplastin release, and post-operative immobilization, all contributing to Virchows Triad (venous stasis, endothelial injury, and hypercoagulability). Anesthesiologists must provide meticulous perioperative care, incorporating preoperative and post-operative anticoagulant prophylaxis and being aware of intraoperative bleeding. While VTE is recognized as a common post-operative complication, its impact during surgery and the strategies needed to mitigate related risks are still underexplored. Understanding and addressing these challenges are essential, particularly in patients undergoing craniotomy for intracranial tumors, to improve surgical outcomes and reduce mortality.
Tetralogy of Fallot with Sepsis Induced Coagulopathy in Case of Spontaneous Intracerebral Haemorrhage & Subarachnoid Haemorrhage Emas, Bagas; Winarso, Achmad Wahib Wahju; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.614

Abstract

Congenital heart disease is the most common cause of stroke in some children. A child aged 5 years 9 months came with complaints of decreased consciousness and shortness of breath, weight 23 kg and height 140 cm, blood pressure 140/95 mmHg, pulse 52x/minute, axillary temperature 36.7oC, respiratory rate 44x/minute and obtained SpO2 62%78% using a nasal cannula. The patient was diagnosed with Tetralogy of Fallot through echocardiography but it was not corrected, Intracerebral Haemorrhage & Subarachnoid Haemorrhage were discovered on a CT scan, and sepsis induced coagulopathy through other supporting examinations. Children with congenital heart disease (CHD) are more susceptible to infection, this occurs because there is an increased risk for children with congenital heart disease to experience severe complications due to common infections such as sepsis. Sepsis itself will cause a coagulopathy disorder called sepsis induced coagulopathy (SIC) whose mechanism is also based on sepsis. Each of tetralogy of Fallot and Sepsis induced coagulopathy have mutually supporting roles in the mechanism of intracerebral haemorrhage. Most ICHs are caused by hypertension, arteriovenous malformation (AVM), and aneurysm. The patient experiences left ventricular dilatation, this can cause a long-term condition of hypertension. Through the SIC mechanism it can cause systemic inflammation and vascular injury caused by mass production of inflammatory cytokines and their release into the circulation causing excessive activation of the clotting process, impaired fibrinolysis, and suppression of anticoagulant mechanisms which can cause endothelial dysfunction and thrombus formation.
Optic Nerve Pilocytic Astrocytoma in a Pediatric Patient: A Case Report Pramantara, I Made Stepanus Biondi; Niryana, I Wayan; Sista Satyarsa, Agung Bagus Sista; Golden, Nyoman; Mahadewa, Tjokorda Gede Bagus; Maliawan, Sri; Suarjaya, I Putu Pramana
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.594

Abstract

Pilocytic astrocytoma is a type of low-grade glioma that can develop in any part of the central nervous system. It primarily affects individuals in the pediatric and young adult age groups. Optic nerve pilocytic astrocytoma is an uncommon, gradually developing type of brain tumor known as a glioma. It is categorized as a grade I tumor by the World Health Organization (WHO). We aim to report rare optic nerve pilocytic astrocytomas and discuss their clinical findings and interconnection with the current literature. A 7-year-old male patient exhibited left-sided eye proptosis and complete loss of vision. A magnetic resonance imaging (MRI) performed before surgery showed the presence of a tumor in the left eye socket. The mass has a spherical shape and smooth boundaries, resulting in the compression of the left optic tract from behind. The left optic tract appears darker on T1-weighted images and brighter on T2-weighted images. On contrast administration, there is heterogenous contrast enhancement. A total resection of the mass was performed. Histopathology results show pilocytic astrocytoma (WHO Grade I). Optic nerve pilocytic astrocytoma is a tumor that can affect the optic nerve pathway. Early diagnosis and multidisciplinary team management are required. Treatment must be individualized, and the options include chemotherapy, radiotherapy, and surgical intervention. Surgery is only recommended in cases of painful or disfiguring proptosis and exposure keratopathy in eyes with severe vision impairment.
Levetiracetam as an Alternative to Phenytoin for Prophylactic Use in Post-Traumatic Seizures: a Literature Review Nagatri, Gabriela; Situmorang, Dicky Arjuna; Ramoti, Natanael; Siahaan, Andre Marolop Pangihutan; Indharty, Rr. Suzy; Tandean, Steven
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.622

Abstract

Traumatic brain injury (TBI) is a common concern for the causes of disability and mortality and it can cause post-traumatic seizure (PTS). Currently, Brain Trauma Foundation (BTF) recommends phenytoin (PHY) as early PTS prophylaxis for patients with severe TBI. The two most common drugs prescribed for PTS are levetiracetam (LEV) and PHY. However, PHY displays a wide array of disadvantages. LEV appears as a better alternative to PHY because of its easier administration, the absence of need for drug level monitoring, lower drug-drug interaction, and better side-effects profile. It is due to the linear elimination kinetics LEV had in comparison to PHY that have zero order pharmacokinetics. Theoretically, LEV is better than PHY. But according to prior studies, LEV and PHY have comparable efficacy at preventing PTS in the early stages. Furthermore, the current evidence is insufficient to definitely recommend LEV over PHY in terms of effectiveness and adverse effects. This study aimed to analyze levetiracetam as an alternative to phenytoin for prophylactic use in post-traumatic seizure.
Analysis of Mortality Risk in Stroke Patients for Optimizing Stroke Services Amalia, Lisda; Islami, Aditya
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.569

Abstract

Introduction: The high mortality rate due to stroke causes a burden on health services, so it is essential to optimize stroke services. Mortality is one of the parameters used to assess stroke services. Hasan Sadikin General Hospital, as a stroke service support hospital, should carry out comprehensive service development, one of which is through continuous evaluation regarding the mortality rate of stroke patients being treated. This study aims to analyze the description of mortality in stroke patients at Hasan Sadikin General Bandung, Indonesia. Subject and Methods: The study used a retrospective analytic method for stroke patients in the Neurology ward from January to April 2023. The patients were divided into two groups: those who died and those who returned home with improvement. Data were taken from medical records regarding age, onset, length of stay, NIHSS, initial leukocytes, NLR, and complications. The data were then analyzed using the Mann-Whitney correlation test. Results: From this study showed that 22 patients died, and 70 patients were discharged with improvement. There were no statistically significant differences (p>0.05) in the variables of age, onset, and length of stay in the two groups. There were statistically significant differences (p
Case Report: Postoperative Complication Epidural Haematoma after Brain Tumor Resection Sikumbang, Kenanga Marwan; Juniarti, Ayu; Febria, Aswin; Susatya, Arif Budiman; Susianto, Oky
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.602

Abstract

Postoperative intracranial haemorrhage is one of the most dangerous complications in cranial surgery, especially epidural haematoma although it is very rare with an incidence of 1.0%. The exact mechanism of occurrence is still unknown and with appropriate treatment can result in a good outcome. A 34-year-old female, 63 kg, who lost consciousness after extubation following resection of a meningioma in the parietooccipital region. In the recovery room, the patient regained consciousness and was transferred to the ICU for observation. The patient suddenly lost consciousness after 30 minutes in the ICU, reintubation was performed and a CT scan of the head showed an epidural hematoma after tumour resection. An emergency decompressive craniotomy was performed, with total intravenous anaesthesia (TIVA) combination of remifentanil 0.1 mcg/kg/min and thiopental 2 mg/kg/h, The operation lasted for one hour. The patient was admitted to the intensive care unit (ICU) for seven days under mechanical ventilation. The patient was extubated on the eighth day and transferred to the ward on the following day. There are several causes of epidural hematoma after brain tumour resection, namely sudden decrease in ICP, massive CSF drainage, uneven ICP distribution, coagulopathy factors, and excessive pin fixation. Excessive loss of CSF during surgery causes displacement of the brain and creates negative pressure in the remote area. In this case, it is suspected that the sudden decrease in ICP caused traction on the meningeal blood vessels, so that the negative pressure made the dura pulled and caused extradural haematoma. Conclusion: Postoperative epidural haematoma is a serious and relatively rare complication but if treated promptly, will result in a favourable outcome.

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