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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 2, No 2 (2013)" : 8 Documents clear

Penatalaksanaan Anestesi pada Pasien dengan Sindroma Apert yang Dilakukan Suturektomi Rachman, Iwan Abdul; Fuadi, Iwan; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Sindroma Apert adalah suatu gangguan genetik yang ditandai dengan penggabungan tulang yang terlalu dini (kraniosinostosis). Penggabungan dini tersebut menghambat pertumbuhan normal tulang dan mempengaruhi pertumbuhan bentuk kepala dan wajah. Penggabungan dini tulang kepala dapat mempengaruhi perkembangan otak bahkan menyebabkan peningkatan tekanan intrakranial, dan pada sindroma Apert juga didapatkan penggabungan beberapa jari tangan dan kaki (sindaktili). Seorang anak berusia 2 tahun dengan sindroma Apert. Tanda klinis peningkatan tekanan intrakranial belum didapatkan sehingga operasi dijadwalkan terencana dan pasien dirawat terlebih dahulu di ruangan. Kemungkinan kesulitan untuk intubasi dengan laringoskopi diantisipasi dengan persiapan intubasi menggunakan optik fiber dan trakeostomi. Pasien diberikan premedikasi midazolam 0,5 mg intravena pada saat pasien akan dibawa ke kamar operasi. Dilakukan anestesi umum, induksi menggunakan propofol 30 mg, fentanil 30 ?g diberikan 3 menit sebelum intubasi. Fasilitas intubasi dengan vekuronium 2 mg, pemeliharaan anestesi dengan N2O/O2 dan Sevofluran. Vekuronium diberikan 1 mg /jam. Ventilasi kendali menggunakan ETT no. 5,0. Operasi berlangsung selama 6 jam dengan posisi pasien terlentang. Hemodinamik selama operasi relatif stabil, tekanan darah sistolik berkisar 90-110 mmHg, tekanan darah diastolik 50-70 mmHg, laju nadi (HR) 87-110 x/mnt, SaO2 99-100 %. Setelah operasi berakhir pasien bernafas spontan adekuat dan dilakukan ekstubasi di kamar operasi. Pasca operasi pasien di rawat di PICU hingga hari ke-4 pasien dipindahkan ke ruangan. Gangguan penggabungan tulang kepala yang terlalu dini dapat menyebabkan gangguan pertumbuhan bentuk kepala, otak dan gangguan pendengaran dan penglihatan. Selain itu juga dapat menyebabkan terjadinya peningkatan tekanan intrakranial. Koreksi segera dengan melakukan suturektomi dan dekompresi dapat mencegah kemungkinan-kemungkinan tersebut.Anaesthetic management of patient with Apert syndrome which undergo suturectomy Apert syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. Early fusion of the skull bones also affects the development of the brain and even can increased the intracranial pressure. In apert syndrome there was also fusion of fingers and toes (syndactyly). A 2 years old child with Apert syndrome which undergo suturectomy and decompression. The clinical signs of raised intracranial pressure in this patient has not been obtained yet so the surgery was done as scheduled . Difficulties to perform intubation with direct laryngoscopy were anticipated through the use of fiber optic and preparation of tracheostomy. Patient has been given premedication using midazolam 0,5 mg given intravenously before his admission to the operating room. The surgery is performed with general anesthesia using propofol 30 mg then fentanyl 30mcg, 3 minutes before intubation. Vecuronium 2mg was given to facilitates intubation. Maintenance of anesthesia with Nitroons/O2 sevoflurane and Vecuronium 1mg/hour. Ventilation was controlled by using ETT no 5.0. Patient was in supine position, and it last for 6 hours. There was relatively stable hemodynamics, systolic blood pressure range 90-110 mmHg, diastolic blood pressure 50-70 mmHg, pulse rate 87-110x/minutes, SaO2 99-100%. After the operation, there was adequate spontaneous breathing so extubation was performed in the operating room, then he was referred to PICU. On day 4 patient was moved to the room. Premature fusion of skull bones will cause growth disorders of the head, brain, and hearing and vision impairment. It also can cause increased intracranial pressure. Immediate correction by suturectomy and decompression can prevent this possibility.

Anestesia pada Tindakan Dekompresi Foramen Magnum pada Pasien dengan Malformasi Arnold Chiari Umar, Nazaruddin; Prabowo, Haryo; Hamdi, Tasrif
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Malformasi Arnold Chiari tipe 1 adalah pergeseran tonsil serebellum kearah kaudal kanalis spinalis tulang belakang servikal melalui foramen magnum. Siringomielia adalah gangguan degeneratif progresif yang ditandai dengan amiotropi brakhial dan kehilangan fungsi sensorik dan secara patologi dengan kavitasi bagian sentral dari medula spinalis, siringomielia pada malformasi Chiari terjadi antara level servikalis 46. Seorang laki-laki usia 29 tahun datang dengan riwayat nyeri tumpul di kedua lengan atas. Dalam perjalanannya setelah 2 tahun terjadi atropi thenar dan hipothenar dan kehilangan kemampuan motorik pada kedua lengan atas. Pemeriksaan neurologis menunjukkan gangguan sensorik pada lengan kanan dan lengan kiri. Pencitraan MRI menunjukkan herniasi tonsil ke foramen magnum dan siringomielia dari medula oblongata ke level T4. Laporan kasus ini adalah kasus langka seorang laki-laki dengan malformasi Arnold Chiari tipe 1 dengan manifestasi lambat dan siringomielia yang sukses menjalani prosedur operasi dekompresi foramen magnum dengan teknik anestesi umum.Anesthesia for Foramen Magnum Decompression in Patient with Arnold Chiari Malformation The Arnold Chiari malformation type I (Chiari malformation) is a caudal displacement of the cerebellar tonsils into the cervical spinal canal through the foramen magnum. Syringomyelia is a chronic progressive degenerative disorder characterized clinically by brachial amyotrophy and segmental sensory loss of dissociated type, and pathologicaly by cavitation of the central parts of the spinal cord, syringomyelia is often associated with Chiari Malformation type I and is commonly seen between the C-4 and C-6 levels. A 29-year-male had experienced a history of dull pain in her both arm for 2 years. Additionally, after two years hipothenar and thenar muscle became atropi and the patient lossing his upper extremity motorik ability. The neurological examination revealed sensory disturbances in his right arm,and left arm. MRI showed cerebellar tonsillar herniation into the foramen magnum and syringomyelia from the medulla oblongata to the T4 level. This report is a very rare case of an middle age male with late-onset Arnold Chiari malformation type I and syringomyelia that was successfully undergo foramen magnum decompression under general anesthesia.

Angka Kejadian dan Outcome Cedera Otak di RS. Hasan Sadikin Bandung Tahun 2008-2010 Zamzami, Nyiemas Moya; Fuadi, Iwan; Nawawi, A. Muthalib
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Latar Belakang dan Tujuan: Cedera otak traumatik (COT) merupakan salah satu masalah kesehatan di dunia terutama negara berkembang dengan angka kematian yang tinggi pada dewasa muda. Tujuan penelitian ini adalah untuk mengetahui jumlah angka kejadian COT dan karakteristiknya di RS. Hasan Sadikin (RSHS) Bandung.Subjek dan Metode: Penelitian deskriptif retrospektif dengan subyek pasien COT di Instalansi Gawat Darurat RSHS pada tahun 2008-2010. Pengambilan sampel dilakukan memakai data status pasien dan data elektronik catatan medis. Data dicatat dan dikelompokan sesuai dengan variabel karakteristik, outcome, serta dihitung CFR.Hasil: Angka kejadian COT selama 3 tahun di RSHS 3578 kasus, data yang berhasil dicatat sebanyak 2836 kasus, data yang tidak lengkap 483, dan data yang hilang 259, dengan CFR 3,5%. Kejadian COT ringan 1641 kasus, COT sedang 1086 kasus, COT berat 109 kasus. Kejadian pada laki-laki (79,8%) lebih tinggi dibandingkan perempuan (20,2%) dan tertinggi pada 18-45 tahun. Kecelakaan kendaraan roda dua adalah penyebab utama COT pada pasien RSHS. Jumlah terbanyak yang dilakukan operasi adalah fraktur depres dan cedera otak sedang. Interval waktu kedatangan di IGD sampai dimulainya operasi lebih dari 6 jam sebanyak 410 kejadian (60%) dan 273 kejadian (40%) memerlukan waktu operasi kurang dari 6 jam. Outcome pada pasien COT ringan adalah baik yaitu sebesar 94,7%, sedangkan outcome buruk dijumpai pada COT sedang sebesar 5,3%.Simpulan: Insidensi dan mortalitas COT di RSHS masih sangat tinggi dan tertinggi pada laki-laki, terjadi pada kelompok usia remaja sampai dewasa muda. Penyebab utama COT karena kecelakaan kendaraan roda dua dan mayoritas outcome pascaoperasi baik.Incidence and Outcome of Head Injury at Hasan Sadikin Hospital Bandung 2008-2010 Background and Objective: Traumatic brain injury (TBI) is one of the health problems in the world, especially in developing countries with high mortality rates in young adults. The purpose of this study was to determine the amount of TBI incidence and characteristics at Hasan Sadikin Hospital (RSHS) BandungSubject and Method: This research method is descriptive retrospective subject all patients with TBI at the emergency room RSHS in 2008 to 2010. Sampling was conducted using patient status data and electronic data of medical records. Data were recorded and classified in accordance with variable characteristics, outcome and Case Fatality Rate was calculated.Results: The incidence of TBI in 3 years at the RSHS is 3578 cases. Completed data attained were 2836 cases, with incomplete data in 483 cases and missing data in 259 cases with CFR 3.5%. The incidence of mild head injury were 1641 cases, moderate head injury were 1086 cases and 109 cases of severe head injury and CFR 3.5%. Incidence of TBI occurred in men was 79.8% which was higher compared to female 20.2%, with the age group of 18-45 years old was the highest. Majority were motorcycle accidents as the leading cause of TBI, and the most frequent diagnosis was depressed fracture have surgery. The most cases that underwent surgery were patients with moderate TBI. The more than 6 hours interval from emergency admission to surgery were recorded in 419 cases (60%) and 6 hours interval in 273 cases (40%). Good outcome were recorded in the mild TBI 94.7%, but poor outcome were recorded in moderate TBI as many as 5.3%, 90 Jurnal Neuroanestesia IndonesiaConclusion: The incidence and mortality rate of TBI at RSHS was still very high. TBI occured mostly in men and in adolescent to young adult age group. The cause of head trauma was high due to motorcycle accidents, but most of the cases had a good outcome.

Pascaoperasi Bedah Saraf: Kapan Ekstubasi, Kapan Ventilasi? Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Prinsip dasar tujuan anestesi pada bedah saraf adalah memudahkan pemeriksaan neurologik dini. Pemulihan yang cepat dari neuroanestesia dan ekstubasi dini sangat diinginkan pada semua kasus karena memungkinkan pemantauan klinis yang merupakan hal penting untuk mendeteksi komplikasi pascabedah. Ekstubasi trakea harus dilakukan dengan hati-hati serta mempertimbangkan risiko dan keuntungannya, yaitu: terlalu cepat sadar dari anestesi dapat memperburuk edema atau perdarahan otak sebagai akibat dari hipertensi berat dan ekstubasi pada pasien yang belum sadar penuh dapat menyebabkan hiperkapnia dan aspirasi. Setelah operasi yang tidak sulit, pasien biasanya pulih dari anestesi dengan perubahan metabolik dan hemodinamik minimal. Dengan demikian pemulihan dini dan ekstubasi di kamar operasi adalah metode yang lebih disukai apabila kesadaran prabedah relatif normal dan pembedahan tidak pada daerah otak yang penting atau manipulasi yang luas. Pada pembedahan yang sulit dan pasien tidak stabil, risiko ekstubasi dini harus dipertimbangkan keuntungannya. Namun selalu memungkinkan untuk membangunkan pasien tanpa ekstubasi untuk evaluasi neurologik dini yang diikuti dengan pemulihan anestesi dan ekstubasi yang tertunda. Jika ada keraguan apakah pasien akan diekstubasi, sedasi selama 1-2 jam memberikan waktu untuk mengoreksi hemodinamik dan gangguan metabolik. Pemulihan keadaran yang ditunda dan ekstubasi yang kemudian dilakukan di unit perawatan intensif (UPI) direkomendasikan untuk memperoleh stabilitas kardiovaskuler setelah prosedur intrakranial major. Tersedianya anestetika dan analgesia intravena dengan mula dan lama kerja sangat singkat dan obat-obat penghambat adrenergik telah memungkinkan untuk pulih sadar segera setelah pembedahan intrakranial. Pemantauan hemodinamik dan respirasi yang ketat adalah wajib dilakukan pada semua kasus dan skor GCS 8 telah ditetapkan sebagai prediktor berhasilnya ekstubasi.Postoperative Neurosurgery: When Extubation, When Ventilation? The principal elements to anesthetics goal to neurosurgery is facilitate an early neurologic assessment. Early recovery from neuroanesthesia and extubation to desirable to most cases because it allows clinical monitoring of the patients, which is essential to detect postoperative complications. Extubation of the trachea must be carefully considered in terms of risk and benefit that is: too rapid an emergence from anesthesia may lead to worsening of cerebral edema or cerebral hemorrhages as result of severe hypertension and extubation of a patient who not fully conscious may promote hypercapnia and aspiration. After uncomplicated surgery, patients generally recover from anesthesia with minimal metabolic and hemodynamic changes. Thus, early recovery and extubation in the operating room is the preferred method when the preoperative state of consciousness is relative normal and surgery does not involve critical brain areas or extensive manipulation. In the complicated or unstable patient, the risk of early extubation may outweigh the benefits. It is, however, often possible to perform a brief awakening of the patient without extubation to allow early neurological evaluation, followed by delayed emergence and extubation. If there is any doubt as to whether the patient should be extubated, a 1- to 2-hour sedation period allow time to correct hemodynamic and metabolic disturbances. A delayed emergence and later extubation in the intensive care unit (ICU) might be recommended to achieve better cardiovascular stability after major intracranial procedures. The availability of ultrashort intravenous anesthetic and analgetic agents and adrenergic blocking agents has added to the flexibility in the immediate emergence period after intracranial surgery. Close hemodynamic and respiratory monitoring are mandatory in all cases and GCS score 8 established a cutoff associated with a likelihood of successful extubation.

Peran Protease Calpains pada Neurotrauma MM Rudi Prihatno; Sudadi Sudadi
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Cedera otak traumatik merupakan kejadian yang dapat berakibat fatal bila tidak mendapatkan penatalaksanaan yang adekuat. Penatalaksanaan tersebut dapat berupa terapi medikamentosa ataupun intervensional non-farmakologik seperti pemberian oksigen dengan ventilasi mekanik, tindakan pembedahan, dan lain sebagainya. Hal terpenting yang paling baik dilakukan adalah penatalaksanaan awal pasca kejadian, dimana proses-proses metabolik di otak sangat mempengaruhi hasil akhir dari kondisi seluler otak. Salah satu yang menjadi pertimbangan adalah penatalaksanaan pencegahan pemburukan dampak cedera otak traumatik dengan intervensi yang memanfaatkan jalur-jalur iskemik yang sudah diketahui, salah satunya adalah protease calpain The Role of Calpains Protease in Neurotrauma Traumatic brain injury is an event that can be fatal if not get an adequate management. Treatment may be either medical therapy or interventional non-pharmacological, such as providing oxygen with mechanical ventilation, surgery, and so forth. The most important thing is best done early post-incident management, in which metabolic processes in the brain greatly affect the outcome of the condition of the brain cell. One of the consideration is the impact of deterioration prevention treatment of traumatic brain injury with interventions that harness ischemic pathways already known, one of which is the protease calpain.

Pengaruh Pemberian Propofol Intravena terhadap Ekspresi Kaspase 3 Hipokampus pada Mencit Balb/C dengan Cedera Kepala Yani, Yusri; Arianto, Ardana Tri; Sudjito, M.H
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Latar Belakang dan Tujuan: Cedera kepala masih menjadi penyebab utama kecacatan dan kematian. Dalam cedera kepala terjadi proses biomolekuler dan biokimiawi patologik yang dapat menyebabkan nekrosis maupun apoptosis melalui aktivasi kaspase 3. Propofol obat anestesi intravena mempunyai mekanisme neuroproteksi dengan pengaturan pada kaspase 3. Tujuan penelitian ini adalah meneliti keefektifan pemberian propofol 10 mg/kgbb, 25 mg/kgbb dan 50 mg/kgbb terhadap ekspresi kaspase 3 pada mencit balb/c dengan cedera kepala.Subjek dan Metode: Penelitian eksperimental laboratorik dengan desain randomized controlled trial group pada 32 ekor mencit Balb/c yang disuntik propofol intravena. Mencit dibagi menjadi 4 kelompok secara random, yaitu kelompok K1 sebagai kontrol. Semua kelompok diberi perlakuan cedera kepala dengan metode weight drop dan kemudian diberi propofol 10 mg; 25 mg; 50 mg/kgBB intravena untuk kelompok K2, K3, K4. Pemeriksaan aktivasi kaspase 3 menggunakan pengecatan khusus immunohistokimia setelah 6 jam pemberian propofol. Hasil dinilai dengan SPSS 19 dengan derajat kemaknaan p0,05.Hasil: Rata-rata persentase ekspresi kaspase 3: K1=4,08, K2= 2,95, K3= 2,52, K4=1,77. Perhitungan statistik dari semua kelompok menunjukkan signifikan (P=0,000). Perbandingan antar kelompok menujukkan: K1-K2 (p=000), K1-K3 (p=0,000), K1-K4 (p=0,000), K2-K4 (p=0,000), K3-K4 (p=0,000), sedangkan antara K2-K3 tidak ada perbedaan signifikan (P=0,232).Simpulan: Pemberian propofol 10,25,50 mg/kgbb menunjukkan hasil yang signifikan menghambat ekspresi kaspase 3 aktif dibandingkan dengan kontrol pada mencit yang diberi cedera kepala. Dari penelitian ini dapat ditarik simpulan bahwa pemberian propofol dosis 50 mg/kgbb merupakan dosis yang efektif untuk menurunkan ekspresi kaspase 3 aktif pada mencit dengan cedera kepalaThe Effect of Propofol Intravena to Expression of Caspase 3 in Hipocampus Mice Balb/C with Brain Injury Background and Objective: Head injury is a leading cause of disability and death. In head injury occurs biomolecular and biochemical processes that can lead to pathologic necrosis or apoptosis through the expression of caspase 3. Propofol an intravenous anesthetic drug has neuroprotective mechanism by setting the caspase 3. The objective of the research is to identify effect of propofol 10 mg/kg,25 mg/kg, and 50 mg/kg dose toward activation caspase 3 in Balb/c mice hipocampus with brain injury.Subject and Methods: This is a laboratory setting experiment with randomized post test only controlled group design. Thirty two balb/c mice makes head injury by given of weight drop and intravenous propofol. The mice were given the same procedure weight drop and intravenous propofol 10,25,50 mg/kg 6 hours after injury for the K2, K3, K4 group respectively. Activation of caspase 3 was studied by immunohistochemistry method 6 hours after intravenous propofol administration. Data was analized using Kruskal Wallis Test, cross-tabulation chi square, one way ANOVA and processed by SPSS program. Result: Means expression of caspase 3: K1= 4.08; K2 = 2.95; K3 =2.52; K4 = 1.77. The statistic result test among all groups show significant differences (p=0.000). The comparation of groups that have significant 82 Jurnal Neuroanestesia Indonesia outcome are: K1-K2 (p=0.00), K1-K3 (p=0.000), K1-K4 (p=0.000), K2-K4 (p=0.000), K3-K4 (p=0.000).There is no significant difference between K2-K3 (p=0.232). Conclusion: Administration of propofol 10, 25, 50 mg/kg intravenous after traumatic head injury show significant difference in hipocampus caspase 3 activation compared to control, group. From this research, we can also conclude that administering propofol in 50 mg is the effective dose to lowering expression of caspase 3 to mice, with given brain injury.

Tatalaksana Anestesi pada Laminektomi Komplek karena Hernia Nukleus Pulposus L15 Roosiati, Betty
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Hernia nukleus pulposus (HNP) lumbalis sering terjadi, dengan angka kejadian 2% dari populasi umum. Skiatika yang berasal HNP lumbal sering menimbulkan nyeri radikular dari kaki pada populasi pekerja dewasa. Pengaturan posisi pasien, posisi prone, selain untuk mendapatkan akses yang optimal untuk ahli bedah, dapat mempengaruhi waktu pulih, morbiditas dan mortalitas. Umumnya pasien geriatri lebih sensitif terhadap anestetika. Untuk mendapatkan efek klinik yang diharapkan pada orang tua diperlukan obat-obatan lebih sedikit, dan efeknya sering memanjang. Secara umum, operasi pada pasien geriatri, harus didapatkan pemulihan yang cepat dan hindari penurunan fungsi organ. Wanita 61 tahun mengalami nyeri punggung bawah dan parestesia. Kesadaran GCS 15, berat badan 50 kg, tekanan darah 120/80 mmHg, laju jantung 80x/menit. Foto torak: pembesaran jantung yang ringan, CTR50%, peningkatan sekret bronkovaskular. Monitor EKG didapatkan amplitudo QR yang rendah, QT memanjang, kemungkinan penyakit jantung iskemik. Laboratorium dalam batas normal. Pada MRI: HNP L12345. Operasi dilakukan dalam posisi prone selama 9 jam. Tidak ada kesulitan dalam tata laksana anestesi, selama operasi kardiovaskular stabil, tekanan darah antara 105/55130/70 mmHg dan laju jantung 7780 x/menit. Tidak terjadi komplikasi pascabedah.Anesthetic Management of Complex Laminectomy Due To Lumbar Disc Herniation L1 5 A lumbar disk herniation is very common, occuring in 2% of the general population. Sciatica, resulting from a herniated lumbar disk, is the most common cause of radicular leg pain in the adult working population. Important setting patient's position, prone position, in addition to gain optimal access for the surgeon, can affect recovery time, morbidity and mortality. Generally, geriatric patients are more sensitive to anesthetic. To obtain the expected clinical effect usually in elderly ussually need fewer drugs, and the effect is often prolonged. Generally in geriatric patients, have obtained a rapid recovery and avoid decreasing organs function decline. Women 61 years of experience lower back pain and paresthesias. GCS 15, weight 50 kgs, blood pressure 120/80 mmHg, heart rate 80x/menit. Thorax photo: mild cardiac enlargement, CTR50%, increase in bronchovascular. Secretions QR ECG reveal a low amplitude, QT prolonged, with the possibility of ischemic heart disease. Laboratories within normal limits. On MRI: HNP L12345. Surgery performed in prone position for 9 hours. Anesthesia was uneventful stable cardiovascular,with blood pressure between 105/55 - 130/70 mmHg and heart rate of 77-80x/ min. No postoperative complications occurred

Dexmedetomidine sebagai Terapi Ajuvan untuk Operasi Tumor Fossa Posterior pada Bayi Umar, Nazaruddin; Silalahi, David
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Dexmedetomidine, agonis reseptor ?2 adrenergik-memberikan efek "sedasi kooperatif," ansiolitik, dan analgesia tanpa depresi pernafasan, efek simpatolitik dan antinosisepsi memungkinkan untuk stabilitas hemodinamik perioperatif. Kasus ini akan membahas neurofarmakologi dan neurofisiologi dari ?2-adrenergik agonis dan penerapan dexmedetomidine sebagai ajuvan. Bayi 1 tahun,10 kg, didiagnosa hidrosefalus obstruktif oleh adanya tumor di regio fossa posterior (yang telah menjalani 3 kali revisi VP-shunt), GCS10: E4V2M4, tekanan darah 90/40mmHg, laju nadi 150 x/menit, laju nafas 30 x/menit, suhu 36,8C, akan menjalani kraniektomi untuk pengangkatan tumor di regio fossa posterior pada posisi prone. Monitor non-invasif (tekanan darah, denyut jantung, SpO2, EKG, Kapnograph dan kateter urin). Premedikasi dengan midazolam 0,5 mg intravena. Induksi anestesi dengan ajuvan dexmedetomidine. Pemeliharaan anestesi dengan oksigen/udara, sevoflurane 0,6-1,0%, infus kontinyu dexmedetomidine dan pemberian selimut penghangat 370C. Pemantauan ketat dilakukan di ICU anak (PICU) dengan ventilasi mekanik dan diekstubasi pada esok pagi. Setelah hari ke-10 rawatan di PICU, pasien dipindahkan ke ruangan tanpa komplikasi neurologis perioperatif (GCS 12: E4V3M5). Manajemen, evaluasi serta pencegahan yang tepat terhadap kemungkinan komplikasi yang terjadi dapat meningkatkan luaran pasien.Dexmedetomidine as Ajuvant Therapy for Infant Undergoing Posterior Fossa Surgery Dexmedetomidine, an ?2-adrenergic receptor agonist offers a unique cooperative sedation, anxiolysis, analgesia without respiratory depression, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments both for neurosurgical stimulation and emergence phase of anesthesia. One year infant, 10 kgs, admitted with loss of consciousness and head enlargement since 2 months of age, diagnosed obstructive hydrocephalus due to posterior fossa tumor and had underwent three VP-shunt revision surgeries. Preoperative with GCS8 E4V1M3, blood pressure 90/40mmHg, heart rate 150 beats/minute, respiratory rate 30/minute, temperature 36.8C, underwent craniectomy tumor removal for posterior fossa tumor in prone position. Premedication with midazolam 0.5 mg intravenous. Induction of anesthesia with ajuvant dexmedetomidine. Maintenance of anesthesia used oxygen/air with sevoflurane 0,6-1,0%, continuous infusion of dexmedetomidine, insertion of subclavian central vein cannulation and temperature preservation with warm blanket set to 370C. Post operation, patient was mechanically ventilated and monitored in Pediatric Intensive Care Unit (PICU) and extubated on the next morning. During in PICU, hemodynamic was stable and no worsening complication of neurologic deficit (GCS11 E4V3M5). After 10 days, patient moved to ward. The proper management, evaluation and prevention the possibility of these complications may improve patient outcome

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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