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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
 1 
Search results for , issue "Vol 15, No 1 (2026)" : 8 Documents clear
Neuromonitoring on The 3rd Redo Craniotomy for Removal of Infratentorial Tumors Allan, Alma Hepa; Kulsum, Kulsum; Suarjaya, I Putu Pramana; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.744

Abstract

Infratentorial brain tumors such as medulloblastoma have serious neurological implications, particularly in children and adolescents. Re-craniotomy for infratentorial lesions increases the risk of anesthetic complications due to altered anatomy, tissue adhesions, and proximity to vital structures such as the brainstem and cranial nerves. The anesthetic approach must be tailored to support real-time intraoperative monitoring, such as Intraoperative Neurophysiological Monitoring (IONM), to prevent neurological injury. A 16-year-old male with a WHO Grade IV medulloblastoma in the left cerebellum extending to the vermis underwent re-craniotomy tumor removal. The patient presented with balance disturbances, diplopia, and dysphagia. CT scan revealed a solid mass measuring 6.6 × 5.96 × 6.71 cm with peritumoral edema and compression of the fourth ventricle. Anesthetic management included TIVA using propofol TCI Schneider 2–4 mcg/ml, dexmedetomidine 0.2–0.7 mcg/kg/hr, and intermittent rocuronium. The surgery lasted 8 hours and was complicated by cerebral edema managed with mannitol 1 g/kgBW. IONM detected prolonged activation of the left cranial nerve VIII. Intraoperative bleeding reached 1600 ml, managed with 465 ml of PRC. Hemodynamics remained stable with ConnX ranging from 34 to 80. Postoperatively, the patient was admitted to the ICU with mechanical ventilation and continuous sedation. Anesthetic management of infratentorial re-craniotomy requires an individualized approach encompassing hemodynamic stability, neural protection through IONM, and multimodal strategies to prevent postoperative complications. TIVA techniques and ConnX monitoring play an important role in maintaining optimal anesthetic balance and neurological function.
The Use Dexmedetomidine as a Total Intravenous Anesthesia–Propofol Adjuvant for Aneurysm Clipping Sepriwan, Tori; Saleh, Siti Chasnak; Lalenoh, Diana Ch.
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.732

Abstract

Intracranial aneurysm is a cerebrovascular disease with a high mortality rate, particularly in cases of rupture. Aneurysm clipping surgery is one of the definitive management methods; however, it involves significant hemodynamic fluctuations that may lead to intraoperative complications and worsen prognosis. Hemodynamic stability and rapid anesthetic recovery are crucial aspects for the success of this procedure. We report a case of a 57-year-old female with a saccular aneurysm in the right M1 segment of the middle cerebral artery, scheduled for aneurysm clipping surgery. The patient had previously undergone decompressive craniectomy and hematoma evacuation due to non-traumatic intracranial hemorrhage, which was not initially diagnosed as an aneurysm, and showed no significant improvement postoperatively. In anesthetic management, dexmedetomidine was used as an adjuvant to maintain hemodynamic stability and support rapid recovery. Throughout the procedure with TIVA- Propofol, dexmedetomidine effectively maintained stable blood pressure without episodes of hypertension, hypotension, or bradycardia. The patient did not experience significant intraoperative complications, and postoperative recovery was optimal. This emphasizes the critical role of dexmedetomidine within modern anesthetic approaches to the management of intracranial aneurysm cases.
Propofol and Dexmedetomidine potentially maintain BIS, MAP, and BGA in Brain Tumor Patients Ismail, Taufik Suryadi; Kulsum, Kulsum; Khairuddin, Khairuddin; Jamal, Fachrul
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.711

Abstract

Introduction: Brain tumors have a high morbidity and mortality rate in Indonesia. According to data from the Ministry of Health, in 2020 the incidence of brain tumors was around 1.5 percent of all tumor cases. Anesthesia for brain tumor removal surgery has a high risk of postoperative complications such as hypotension, bleeding and intracranial infection. Propofol and dexmedetomidine are often used as anesthetic agents in neurosurgery that affect hemodynamics, depth of anesthesia and blood gas analysis. This study aims to determine the comparative effectiveness of propofol compared to dexmedetomidine on Bispectral Index (BIS), mean arterial pressure (MAP), and blood gas analysis (BGA) in patients undergoing intracranial tumor removal surgery.Subject and Method: This study is an unpaired numerical comparative analytical observational study. A total of 42 participants who met the inclusion and exclusion criteria were randomly assigned into 2 groups, namely the propofol and dexmedetomidine groups. Furthermore, an assessment of mean arterial pressure, BIS, and BGA was carried out.Results: Based on statistical tests using the unpaired T test, it was found that intraoperative MAP was significantly different between the two groups (p0.05), where dexmedetomidine had a more stable MAP. While in BIS and BGA there was no significant difference in the two groups (p0.05) statistically using the Mann Whitney test.Conclusion: Dexmedetomidine has an effect that is not much different compared to propofol in maintaining changes in MAP, BIS and BGA in patients with intracranial tumor removal surgery. 
Anesthetic Management in Patient with Traumatic Brain Injury undergoing Elective Spinal Surgery Soedibjo, Dennis Prakas; Harahap, Mohamad Sofyan; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.728

Abstract

The incidence of traumatic brain injury that concurrent with injuries such us traumatic spinal injuries is relatively high. When considering anesthetic management for patients with acute traumatic brain injury undergoing non-brain surgery procedures, understanding of the implications of traumatic brain injury on anesthesia management is essential for achieving favorable surgical results while minimizing the risk of secondary brain injury to ensure patient safety and optimal outcomes. We report a case of a 25 years old man who presented with decrease of consciousness 3 days prior admission to the hospital after sudden fall in the bathroom. Complaints were accompanied with vomiting, weakness and paresthesia in both bilateral upper extremities and lower extremities. Supportive examination revealed an epidural hematoma at regio frontoparietal sinistra, minimal subdural hematomas at regio anterior falx cerebelli and bilateral tentorium cerebelli, subgaleae hematomas at regio bilateral parietal, with multiple cervical fracture at the C5 level with associated cervical canal narrowing. Due to the minor intracranial bleeding with no significant symptoms for days, patient then scheduled for elective C4-C6 laminectomy and posterior stabilization surgery. Anesthesia management for patient with traumatic brain injury that undergoes non-brain surgery comes with challenges, mainly on how to prevent secondary brain injury and minimizing complications. Comprehensive perioperative planning and vigilant monitoring are essential to ensure patient safety and optimal outcomes
Cerebral Perfusion Pressure in Traumatic Brain Injury: A Dynamic Battlefield of Flow and Pressure Primanov, Rama Mahardika; Putri Maharani, Dinda; Maria Situmorang, Ruth; Indharty, R. R. Suzy; Marolop Pangihutan, Andre
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.668

Abstract

Introduction: Traumatic brain injury (TBI) affects 27-69 million people annually, with over 55 million living with long-term disability. A major management challenge is disruption of cerebral autoregulation, a mechanism that maintains stable cerebral blood flow (CBF) despite systemic pressure changes. Impaired cerebral perfusion pressure (CPP) autoregulation promotes ischemia, edema, and metabolic imbalance, worsening neurological outcomes. Method: This narrative review synthesized literature from PubMed, Google Scholar, ScienceDirect, and the Cochrane Library, focusing on studies from the past decade. Keywords included “cerebral perfusion pressure,” “autoregulation,” “traumatic brain injury,” “TBI,” “mechanism,” “pressure reactivity index,” and “monitoring.” Discussion: TBI-related autoregulation impairment stems from vascular injury, inflammation, and myogenic dysfunction, with patterns ranging from intact to delayed or absent responses. The pressure reactivity index (PRx) enables continuous autoregulation assessment and determination of patient-specific optimal CPP (CPPopt). Observational data link maintaining CPP near CPPopt with better outcomes, while time below CPPopt increases mortality risk. Experimental models identify endothelin-1, ERK1/2, and interleukin-6 as key mediators, with targeted interventions showing potential to preserve reactivity. Conclusion: Integrating mechanistic insights with invasive monitoring and PRx-guided CPP optimization offers a promising, individualized strategy for TBI care, warranting confirmation in large clinical trials.
Ultrasound-Guided Scalp Block as an Anesthetic Technique and Postoperative Analgesia for Awake Cranioplasty in High-Risk Patients Luailiyah, Afridatul datul; Prihatno, M. Mukhlis Rudi; Wicaksono, Nugroho
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.729

Abstract

Cranioplasty is a surgical procedure that restores normal anatomy following craniectomy. Skull bone reconstruction ensures protection and normalizes physiology as well as cerebrospinal fluid dynamics. We present a case of a 37-year-old male following intracerebral hemorrhage (ICH) evacuation via craniotomy. The patient had uncontrolled hypertension and cardiomegaly on chest X-ray, with secondary hemiparesis. Scalp nerve block was employed as an anesthetic technique and for postoperative analgesia. Preoperatively, his heart rate was 70–80 beats/min, blood pressure 158/107 mmHg, and oxygen saturation 100% on room air. Intravenous dexmedetomidine infusion was started (loading dose 1 mcg/kg for 15 minutes, followed by 0.4–0.8 mcg/kg/h) along with 2% lidocaine infusion at 1 mg/kg/h titrated to the desired level of sedation and analgesia. A unilateral (landmark-guided) scalp block was performed using 22 mL of 0.5% levobupivacaine to block the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves. The patient also received intravenous paracetamol 1 g three times daily. Hemodynamics remained stable throughout surgery. The Numeric Rating Scale (NRS) score was 0 at 30 minutes to 6 hours postoperatively, and 1–2 between 8 and 48 hours. Awake regional anesthesia allowed sympathetic tone to remain intact and enabled rapid postoperative neurological assessment. Ultrasound-guided scalp block is an effective alternative anesthetic technique for awake cranioplasty, providing hemodynamic stability, optimal pain control, and faster recovery in high-risk patients
Predictors of Neurosurgical Outcomes in Traumatic Brain Injury: A Study from Banda Aceh, Indonesia Niazie, Azzie; Jasa, Zafrullah Khany; Rahmi, Rahmi; Yusmalinda, Yusmalinda
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.750

Abstract

Introduction: Traumatic brain injury (TBI) remains a major global health challenge and frequently requires neurosurgical intervention. Various clinical, surgical, and systemic factors may influence postoperative morbidity and mortality. This study aimed to identify key predictors of postoperative outcomes in patients with TBI undergoing neurosurgical procedures.Subject and Method: A prospective cohort study was conducted at Dr. Zainoel Abidin General Hospital in Banda Aceh from July to October 2024, involving 48 TBI patients who were selected through total sampling. Statistical analysis using chi-square tests and multiple logistic regression identified significant predictors.Results: We enrolled 48 patients, with an overall postoperative morbidity rate at 58.3%, and the mortality rate was 22.9%. Morbidity was significantly associated with preoperative GCS score (p=0.001), injury-to-surgery time (p=0.039), respiratory (p=0.007), and cardiovascular system (p=0.001). Mortality was significantly associated with preoperative GCS score (p=0.002), surgery duration (p=0.041), respiratory (p=0.041), and cardiovascular system (p=0.004). Multivariate analysis confirmed the preoperative GCS score was the most significant predictor of both morbidity and mortality (p0.05).Conclusion: A low preoperative GCS score is a strong predictor of poor postoperative outcomes in patients with TBI. Optimizing perioperative management may improve clinical outcomes in TBI patients undergoing neurosurgical intervention
Basic Principles of Processed Electroencephalography for Neuroanesthesiologists Pramodana, Bintang; Fuadi, Iwan
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.743

Abstract

Processed electroencephalography (pEEG) has become an integral tool in modern anesthesia and critical care, enhancing the precision of anesthesia depth monitoring, reducing the risk of accidental awareness under general anesthesia (AAGA), and postoperative cognitive issues. Unlike raw EEG, which records cortical electrical activity directly, pEEG applies mathematical and algorithmic analyses, such as spectral analysis and Fourier transformation, to generate numerical indices that are more interpretable for clinicians. Several commercial systems, including the Bispectral Index (BIS), Entropy, Conox, and SedLine, are widely available. For neuroanesthesiologists, understanding core EEG principles and advanced metrics, such as the Density Spectral Array (DSA), Spectral Edge Frequency (SEF), and Burst Suppression Ratio (BSR), is crucial for accurate interpretation. Moreover, recognizing EEG patterns characteristic of various anesthetic agents, including propofol, inhaled agents, dexmedetomidine, ketamine, and opioids, further refines clinical decision-making. Mastery of EEG interpretation ultimately supports better safety, individualized neuroanesthesia practice aligned with the principles of precision medicine

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