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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 3 (2013)" : 8 Documents clear

Mannitol untuk Hipertensi Intrakranial pada Cedera Otak Traumatik: apakah masih diperlukan? Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Angka kejadian cedera otak traumatika (COT) masih cukup tinggi berkisar 1,4 juta pertahun dengan angka kematian 1520%. Peningkatan tekanan intrakranial (TIK) sangat sering terjadi setelah COT yang dihubungkan dengan angka mortalitas dan morbiditas. Terapi hipertensi intrakranial harus dimulai bila tekanan intrakranial 20 mmHg atau lebih, karena makin tinggi kenaikan tekanan intrakranial makin tinggi mortalitas. Komplikasi peningkatan TIK adalah terjadinya iskemia dan herniasi otak. Pada guideline terapi hipertensi intrakranial dikenal first-tier therapy dan second-tier therapy. First-tier therapy adalah drenase cairan serebrospinalis, hiperventilasi sedang mencapai PaCO2 3035 mmHg, dan pemberian osmotik diuretik mannitol. Mannitol mampu menurunkan volume otak dan TIK, mengurangi viskositas darah, meningkatkan aliran darah otak, sehingga akan memperbaiki pasokan oksigen. Peningkatan deformabilitas eritrosit akan membantu menurunkan TIK. Akan tetapi, Cochrane systematic review menemukan tidak cukup data untuk membuat rekomendasi penggunaan mannitol untuk pengelolaan pasien cedera otak traumatik.Terapi diuretik dengan mannitol 0,251 g/kg diinfuskan dalam waktu lebih dari 10 menit sampai 20 menit dan diulang setiap 36 jam. Osmolaritas plasma harus dipantau dan tidak boleh lebih dari 320 mOsm/L. Efek akan dimulai pada menit ke 1530 setelah pemberian dan menetap 90 menit sampai 6 jam. Simpulannya adalah karena dari guideline Brain Trauma Foundation yang menyebutkan bahwa mannitol digunakan untuk first-tier therapy, maka pada pekerjaan sehari-hari dalam mengelola pasien cedera kepala berat dengan hipertensi intrakranial kita tetap memberikan terapi mannitol. Mannitol for Intracranial Hypertension in Traumatic Brain Injury: is it still needed? The incidence of traumatic brain injury (TBI) remains high, about 1.4 million per year with a mortality rate of 1520%. Increased intracranial pressure (ICP) is very common after TBI. Increased ICP is associated with incidence of mortality and morbidity. Intracranial hypertension therapy should be initiated when the ICP is 20 mmHg or more, as higher increase in ICP will increase mortality. Complications of elevated ICP include brain ischemia and brain herniation. Intracranial hypertension treatment guidelines include first-tier and second-tier therapy. First-tier therapy is cerebrospinal fluid drainage, hyperventilation, achieving PaCO2 3035 mmHg, and osmotic diuretic: mannitol administration. Mannitol can reduce brain volume and ICP, reduce blood viscosity, improve cerebral blood flow, therefore improving the supply of oxygen. Increased erythrocyte deformability will help to reduce ICP. However, the Cochrane systematic review found insufficient data to make recommendations on the use of mannitol for the management of TBI patients. Diuretic therapy with mannitol 0.25 to 1g/kg infused in just over 10 minutes to 20 minutes and repeated every 36 hours. Plasma osmolarity should be monitored and should not be more than 320 mOsm/L. Effect will begin 1530 minutes after administration and settled 90 minutes to 6 hours. Brain Trauma Foundation guidelines states that mannitol is used as first-tier therapy, therefore we administer manitol as part of management of patients with severe head injury with intracranial hypertension.

Tatalaksana Anestesi Perioperatif pada Pasien dengan Perdarahan Intraserebral Spontan akibat Hipertensi Emergensi: Serial Kasus Panduwaty, Lira; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Perdarahan intraserebral (PIS) mempunyai angka morbiditas dan mortalitas yang tinggi. Hanya 20% individu yang bertahan dari penyakit ini dapat hidup dalam 6 bulan. Masih terdapat kontroversi dalam tatalaksana PIS, seperti meregulasi tekanan darah, mencegah perluasan hematoma, edema otak, dan mempertahankan perfusi serebral. Tujuan penelitian ini adalah untuk membahas prosedur tatalaksana perioperatif PIS dengan hipertensi emergensi. Subjek dan Metode: Penelitian serial kasus dari 3 kasus dengan gangguan kesadaran (skor GCS ?14), didiagnosa PIS, akan dilakukan kraniotomi evakuasi hematoma. Dilakukan pengelolaan tekanan darah prabedah dengan target tekanan darah rata-rata (TAR) 125130 mmHg. Induksi dengan fentanyl 3 ug/kg, propofol 2,5 mg/kg, vecuronium 0,1 mg/kg, lidokain 1,5 mg/kg dan rumatan anestesi dengan O2, air, isoflurane 11,5 vol%. Hasil: Pascabedah 2 kasus dirawat di ICU selama 23 hari dan satu kasus dirawat di neurocritical care unit (NCCU) selama 3 hari dan terdapat perbaikan GCS menjadi 15. Setelah itu dipindahkan ke ruangan dan mendapat perawatan selama 57 hari, dan dipulangkan setelah 715 hari. Simpulan: Masih ada kontroversi tentang terapi PIS yang optimal terutama dalam pengendalian tekanan darah. Tekanan darah yang tinggi dapat menimbulkan hematoma, tapi penurunan tekanan darah dapat menimbulkan penurunan perfusi otak. The Intensive Blood Pressure Reduction of Acute Cerebral Hemorrhage Trial (INTERACT) menemukan bahwa penurunan tekanan darah yang segera akan mengurangi resiko perluasan perdarahan tapi tidak mempunyai efek pada outcome, akan tetapi, pada ke 3 kasus tersebut menurunkan tekanan darah dalam waktu kurang dari 24 jam memberikan hasil yang baik. Perioperative Anesthesia Management in Patients with Spontaneous Intracerebral Haemorrhage (ICH) et causa Hypertensive Emergency: A Case Series Background and Objectives: Intracerebral hemorrhage (ICH) have a high rate of morbidity and mortality. Only 20% of individuals who survive ICH are independent at 6 months. Many issues need to be considered for the optimal management of ICH, such as blood pressure (BP) control, prevention of hematoma growth, containing brain edema, and preserving cerebral perfusion. The objective of this case series is to report perioperative management procedure for ICH with hypertensive emergency.Subject and Methods: A serial case study of three patients with decrease consciousness (score GCS ?14), ICH, were planned for craniotomy evacuation. Perioperative management of BP has been done to a targetted mean arterial pressure (TAR) of 125130 mmHg. Induction with fentanyl 3 ug/kg, propofol 2.5 mg/kg, vecuronium 0.1 mg/kg, lidocaine 1.5 mg/kg and maintain of anesthesia with O2, air, isoflurane 11.5 vol%. Results: Two patients were admitted to the ICU post-operatively for 23 days, one patient were admitted to the Neuro Critical Care Unit (NCCU) for three days, and had improvements of consciousness (GCS 15), then transferred to the ward for another 57 days, and finally discharged after 715 days. Conclusion: There are still controversies in the treatment of ICH, especially in the control of BP. High BP can lead to hematoma, but decrease in BP can reduce cerebral perfusion. The Intensive Blood Pressure Reduction of Acute Cerebral Hemorrhage Trial (INTERACT) found that early intensive BP management reduced the risk of hematoma expansion but had no effect on outcomes. However in all three cases above, a reduction in BP within 24 hours have provided good results.

Implikasi Anestesi Pasien Cedera Kepala Traumatik dengan Penyakit Jantung Bawaan (PJB) Sianotik: Masalah Hiperviskositas Darah Suyasa, Agus Baratha; Umar, Nazaruddin; Oetoro, Bambang J.
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
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Saat ini banyak penderita penyakit jantung bawaan (PJB) yang mampu bertahan sampai dewasa (1525%). Penderita PJB memiliki anatomi serta fisiologi yang kompleks dan spesifik dengan morbiditas dan mortalitas perioperatif yang tinggi. Anak-anak dengan PJB meningkatkan resiko henti jantung serta mortalitas 30 hari setelah pembedahan mayor maupun minor dibandingkan dengan anak-anak yang sehat. Cedera otak traumatik merupakan salah satu kondisi yang mengancam jiwa dan merupakan penyebab utama kecacatan serta kematian pada dewasa dan anak-anak. Edema serebral sering ditemui dalam praktek klinis serta dapat menimbulkan masalah besar termasuk iskemia serebral, yang memperburuk aliran darah otak regional dan global, pergeseran kompartemen intrakranial akibat peningkatan tekanan intrakranial (TIK) sehingga menekan struktur vital otak. PJB sianotik memiliki kadar hematokrit yang meningkat dan diasumsikan berhubungan dengan resiko trombosis serebral dan stroke. Peningkatan massa sel darah merah dicurigai sebagai penyebab sindroma hiperviskositas dimana kadar hematokrit selanjutnya menjadi faktor resiko tejadinya infark serebral. Terdapat hubungan yang signifikan antara aliran darah otak dan kadar hematokrit namun belum jelas dinyatakan dalam literatur berapa batas kadar hematokrit, dan kriteria untuk dilakukan phlebotomi. Namun beberapa argumentasi menyatakan polisitemia (kadar hematokrit 60%) memiliki efek yang merugikan dan harus diturunkan dengan phlebotomi karena kompensasi yang berlebihan akan mengganggu aliran darah regional serta aliran darah serebralAnesthesia Implication in a Traumatic Brain Injury Patient with Cyanotic Congenital Heart Disease (CHD): Blood hyperviscosity problem Many patients with congenital heart disease (CHD) survive to adulthood period (1525%). Patients with CHD have a complex and specific anatomy and physiology with high perioperative morbidity and mortality. Children with congenital heart disease have an increased risk of cardiac arrest and 30 days mortality after both major and minor surgeries compared to healthy children. Traumatic brain injury is one of a life-threatening conditions which is the leading cause of disability and death in both adults and children. Cerebral edema is commonly encountered in clinical practice which have potential to cause major problems including cerebral ischemia, which was worsen the regional and global cerebral blood flow, intracranial compartment shift due to an increase in intracranial pressure (ICP) therefore pressing the vital structures of the brain. Cyanotic congenital heart disease patients have an increased hematocrit levels and this is assumed to be related to the risk of cerebral thrombosis and stroke. Increased red blood cell mass is suspected as the cause of hyperviscosity syndrome in which the hematocrit levels is a further risk factor for cerebral infarction is a significant relationship between cerebral blood flow and hematocrit levels. However the haematocrit unit and criterias for phlebotomy has not been explicitly stated in the literature. Some arguments stated that polycythemia (hematocrit levels 60%) had an adverse effect and should be reduced by phlebotomi as excessive compensation would disrupt the regional blood flow and cerebral blood flow.

Manajemen Anestesi untuk Reseksi Tumor Pineal Body dengan Posisi Duduk Agus Baratha Suyasa
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
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Perkembangan teknik operasi mikro yang semakin baik serta perkembangan neuroanesthesia dan critical care yang semakin canggih membuat reseksi tumor yang agresif menjadi pilihan untuk manajemen tumor regio pineal dan ventrikel III. Seorang laki laki 49 tahun dengan tumor pineal body pasca Ventriculo-Peritoneal shunt, akan dilakukan operasi kraniotomi reseksi tumor dengan posisi duduk. Pasien mengeluh nyeri kepala hebat, berkurang dengan obat tetapi sering kambuh. Sejak Maret 2013 penglihatan kabur, sempoyongan, mual muntah, dan telinga terasa berdenging. Operasi dilakukan dengan posisi duduk dalam anestesi umum, menggunakan pipa endotrakeal (ETT) no.7,5 non kinking, ventilasi kendali. Pipa nasogastrik (NGT) no.16 dipasang untuk dekompresi. Premedikasi dengan midazolam 2 mg iv, deksametason 20 mg iv. Koinduksi menggunakan fentanyl 100 μg iv, induksi dengan propofol 200 mg iv. Fasilitas intubasi dengan rokuronium 0,9 mg/KgBB. Pemeliharaan anestesi dengan O2 + air + sevofluran dengan fraksi oksigen 50%. Propofol kontinyu 100–200 mg/jam, vekuronium 6mg/jam. Monitoring tanda vital (tekanan darah, nadi, SaO2, elektrokardiografi), etCO2, arteri line dan kateter vena sentral (CVC). Reseksi tumor dilakukan selama 6 jam. Selama operasi hemodinamik relatif stabil, tekanan darah sistolik berkisar 90–110 mmHg, tekanan darah diastolik 60-80mmHg, laju nadi 50–70 x/mnt, SaO2 99–100 %, etCO2 30 mmHg. Pascaoperasi pasien masih dengan ventilasi kontrol di rawat di ruang perawatan intensif. Berbagai pendekatan bedah telah dikemukakan untuk tumor ventrikel III posterior dan regio pineal. Pilihan pendekatan dipengaruhi oleh lokasi tumor, temuan patologi, dan kenyamanan dokter bedah serta pertimbangan resiko komplikasi. Management of Anesthesia for Pineal Body Tumor Resection in the Sitting Position The development of micro-surgery techniques are advancing and the development of neuroanesthesia and critical care are growing increasingly sophisticated making aggressive tumor resection as an option for the management of tumors located in the pineal and third ventricle region. A 49 years old male with a pineal body tumor after Ventriculo-Peritoneal shunt, underwent a craniotomy tumor resection surgery conducted in a sitting position. The patient complained of severe headache which was reduced by drugs, however relapsed again. Blurred vision, staggering, nausea, vomiting, ringing in the ears, were experienced in March 2013. Surgery performed with general anesthesia in the sitting position, using non kinking endotracheal tube size 7.5 under controlled ventilation. Nasogastric tube no.16 was inserted for decompression. Premedication with midazolam 2 mg iv, dexamethasone 20 mg iv. Co induction using fentanyl 100 mcg iv, induced with propofol 200 mg iv. Facilities intubation with rocuronium 0.9 mg/KgBW. Maintenance of anesthesia with sevoflurane + O2 + air with oxygen fraction 50%. Continuous propofol 100–200 mg/hour, and vekuronium 6 mg/h were given. Monitoring vital signs (BP, HR, SaO2, ECG), etCO2, arterial line and CVC. Tumor resection was performed in 6 hours. Relatively stable hemodynamics during surgery, systolic blood pressure ranged within 90–110 mmHg, diastolic blood pressure of 60-80 mmHg, heart rate 50–70 x/min, SaO2 99–100%, etCO2 30 mmHg. Postoperatively the patient was managed in the ICU under controlled ventilation. Various surgical approaches have been put forward for the posterior third ventricular tumor and pineal region. Choice of approach is influenced by the location of the tumor, pathological findings, surgeon comfort and risk of complications

Barbiturat dan Obat Pelumpuh Otot: Masih Bermanfaat untuk Menangani Hipertensi Intrakranial? M. Sofyan Harahap
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
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Hipertensi intrakranial dapat menyebabkan cedera otak sekunder dan meningkatkan morbiditas serta mortalitas. Untuk mempertahankan tekanan intrakranial agar senantiasa dalam batas normal, maka cairan serebrospinal dan darah mempunyai kemampuan untuk mengurangi volume intrakranial sampai 30%. Hipertensi intrakranial didefinisikan sebagai tekanan intrakranial di atas 20 mmHg yang menetap lebih dari 20 menit pada dewasa. Pada otak yang sedang mengalami proses patologis, autoregulasi akan terganggu dan interaksi antara tekanan arteri rata-rata (mean arterial pressure/MAP) dan aliran darah otak sangat bergantung pada derajat kerusakan yang ada. Perubahan MAP akan mengakibatkan perubahan aliran darah otak (ADO) walaupun MAP masih pada rentang normal. Pengelolaan hipertensi intrakranial terdiri dari terapi umum yaitu optimalisasi drenase vena serebral, pengelolaan jalan nafas, sedasi dan analgesia, mengatasi demam, mengelola hipertensi, anemia dan mencegah kejang. Terapi spesifik adalah pemberian sedasi dan paralisis, terapi hiperosmolar, hiperventilasi, koma barbiturat, hipotermia dan pemberian steroid (hanya untuk tumor otak). Tiopental menurunkan ADO dan metabolisme otak yang setara dengan keadaan isoelektrik pada rekaman electro encephalo graphy (EEG). Pelumpuh otot menghambat kontraksi otot sehingga akan mengurangi kebutuhan energi, mengurangi produksi CO2, memperbaiki perfusi otak, dan mempertahankan TIK Barbiturates and Neuromuscular Blocking Agent: Still Valuable to Treat Intracranial Hypertension? Intracranial hypertension may cause secondary brain injury and have the potential to increase morbidity and mortality. In keeping the intracranial pressure within normal limit, cerebrospinal liquor and also the blood have the ability to reduce intracranial volume to 30%. Intracranial hypertension is defined as intracranial pressure above 20 mmHg for more than 20 min in adult patients. During the pathological process caused by various aetiologies, autoregulation process is impaired and interaction between mean arterial pressure (MAP) and cerebral blood flow will depend on the severity of impairement. Meaning that changes of mean arterial pressure within normal autoregulation range will influence the cerebral blood flow accordingly. Management of Intracranial hypertension consist of general and specific approaches. General approach includes optimal cerebral venous drainage, airway management, sedation and analgesia, fever, anemia and hypertension treatment and seizure prevention. Specific approach includes paralysis and sedation, hyperosmolar therapy, hyperventilation, barbiturate coma, hypothermia and steroid for tumor cases only. Tiopental decreases CBF and cerebral metabolism which is equivalent to an isoelectric electro encephalo graphy (EEG). Muscle relaxant prevents muscle contraction therefore reducing energy consumption, CO2 production, improve cerebral perfusion, and maintain ICP.

Anestesi untuk Pengangkatan Meningioma Suprasella dengan Pendekatan Supraorbita Hadinata, Yudi; Isngadi, M.; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Anestesi pada kasus meningioma memiliki beberapa hal yang harus diperhatikan. Otak merupakan jaringan yang tertutup oleh tulang kranium dan memiliki jaringan pembuluh darah yang banyak sehingga beresiko untuk terjadinya pendarahan dan edema. Kondisi jaringan otak yang rileks dibutuhkan ketika akan dilakukan operasi otak melalui insisi kecil supraorbita. Tanpa penanganan anestesi yang baik maka ahli bedah saraf akan kesulitan untuk melakukan pendekatan pada tumor dan meningkatkan resiko edema otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien wanita usia 44 tahun datang dengan keluhan nyeri kepala hebat dan pusing dirasakan sejak 8 bulan sebelum masuk rumahsakit, mengalami periode kejang selama 12 menit, terjadi kurang lebih 1x/bulan, penglihatan pada mata kanan buram. Pasien didiagnosa dengan meningioma suprasellar, dan direncanakan dilakukan pembedahan dengan pendekatan subfrontal. Status fisik ASA 3 dengan riwayat asma, riwayat sepsis karena pneumonia dan infeksi saluran kemih, riwayat Steven Johnson karena phenytoin, leukositosis 10.570, defisit neurologis. Pasien dilakukan tindakan anestesi umum dengan intubasi. Induksi dengan midazolam, fentanyl, lidokain, propofol, dan vecuronium. Operasi dengan pendekatan supraorbita berlangsung selama 10 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif (Intensive Care Unit/ICU) selama 2 hari sebelum pindah ruangan. Kontrol faktor fisiologi dan perlakuan anestesi yang dilakukan selama operasi memiliki pengaruh kepada jaringan otak. Lebih lanjut lagi, seorang dokter anestesi harus memiliki pengetahuan tentang berbagai macam efek obat untuk mencapai hal tersebut dan mengetahui kondisi premorbid pasien yang dapat mempengaruhinya.Anesthesia Management for Suprasella Meningioma Removal with Supraorbital Approach Anesthesia for meningioma presents special considerations. The brain is enclosed in a rigid skull and the brain is a highly vascular organ presenting potential for massive perioperative hemorrhage and edema. A slack brain is necessary when treating neoplastic lesions through the small supraorbital approach. Without optimal anesthesia care, the neurosurgeon can not reach the operative site and the risk of brain edema due to extensive brain manipulation is increased. This case reports a 44 years old woman with severe headache and dizziness for 8 months prior to admission she suffers from 12 minutes periods of seizure once a month, and experienced a blured vision on her right eye. She was diagnosed with suprasellar meningioma, which will be removed with supraorbital surgical approach. ASA 3rd was confirmed with history of status asthmaticus, septic condition due to pneumonia and urinary tract infection, history of Steven-Johnson syndrome due to phenytoin, leucocytosis of a count of 10.570, and neurological deficits general anesthesia was performed. Induction of anesthesia was done using midazolam, fentanyl, lidocaine, propofol and vecuronium. The surgery for meningioma was conducted within 10 hours. Patient was managed in the Intensive Care Unit post operatively for 2 days prior to ward transfer. Physiologic and anesthetics factors controlled by the anesthesiologist have profound effects on the brain. Furthermore, anesthesiologists are required knowledge of the effects of various drugs on the issues mentioned above and patient conditions.

Pemanjangan Ventilasi Mekanik di Intensive Care Unit (ICU) pada Pasien dengan Tumor Glioma Batang Otak yang menjalani Kraniotomi Pengangkatan Tumor Halimi, Radian Ahmad; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Kekerapan glioma batang otak mencapai 1020% dari semua tumor primer sistem saraf pusat dan biasanya terdiagnosa pada usia muda. Pada penanganan perioperatif perlu dipertimbangkan cara pengangkatan tumornya, pemakaian steroid perioperatif, perencanaan ventilasi mekanik pascabedah dan fisioterapi. Seorang anak berumur 11 tahun dengan diagnosa tumor batang otak, mengeluh tidak dapat berdiri, penglihatan ganda, afasia, gangguan menelan. Pasien telah menggunakan kortikosteroid dalam waktu yang lama. Dilakukan operasi pengangkatan massa tumor otak dengan lama operasi 10 jam. Pascabedah terjadi pemanjangan ventilasi mekanik, Ventilator Associated Pneumonia (VAP) pada hari ke-4 dan perdarahan lambung pada hari ke-6 di ICU. Teknik operasi sulit karena tumor berada di daerah yang sangat dekat dengan pusat pernapasan dan hemodinamik. Diperlukan perencanaan yang matang mengenai penilaian kondisi pasien saat preoperatif, pemantauan hemodinamik dan tekanan intrakranial, strategi perlindungan terhadap lambung, perencanaan ventilasi mekanik, penilaian cepat perlunya trakheostomi, pemberian antibiotik untuk meningkatkan keluaran yang lebih baik. Prolonged Mechanical Ventilation on Postcraniotomy Tumor Removal on Brainstem Glioma in the Intensive Care Unit Brain stem glioma makes 1020% of primary central nervous system tumor and is diagnosed primarily in children. In perioperative management, approach of tumor removal, steroid usage, mechanical ventilation planning, good nursing care, and physioterapy, should be considered. The aim of this case report is to discuss complications that may occur with prolonged mechanical ventilation after surgery. An 11-year old boy, diagnosed with brain tumor, was admitted to hospital due to inability to stand, double-vision, aphasia, swallowing disorder, with longterm corticosteroid treatment. He underwent a brain tumor removal surgery. Surgery was conducted within 10 hours. After the surgery, he had prolonged mechanical ventilation in ICU. On the fourth day, he suffered from ventilator associated pneumonia (VAP) and gastrointestinal bleeding on the sixth day care in ICU. Patient presented to hospital with late onset symptoms of his condition. Operation technique was difficult as the tumor is located within close proximity to the breathing and haemodynamic centers. There are necessity for detailed perioperative assessment and planning, hemodynamic and intracranial pressure monitoring, gastric protection strategy, mechanichal ventilation planning, quick assessment of tracheostomy installment need and usage of proper antibiotic for a better outcome.

Pemberian Salin Hipertonik 3% Selama Kraniotomi pada Pasien dengan Cedera Otak Traumatik Memberikan Relaksasi Otak yang Lebih Baik Dibandingkan dengan Manitol 20% Damayanthi, Made Ayu; Sinardja, I Ketut
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Manitol telah dipakai secara luas sebagai pilihan osmoterapi untuk menurunkan masa otak baik itu akibat cedera otak maupun tumor. Beberapa penelitian menyebutkan bahwa salin hipertonik sama efektifnya bahkan lebih baik dalam menurunkan tekanan intrakranial maupun menurunkan masa otak intraoperatif. Penelitian ini bertujuan untuk menilai kondisi relaksasi otak setelah pemberian salin hipertonik 3% dibandingkan dengan manitol 20% selama kraniotomi pada pasien dengan cedera otak traumatik. Subyek dan Metode: Empat puluh dua pasien dengan cedera otak traumatik yang memenuhi kriteria eligibilitas diikutsertakan dalam penelitian uji klinik prospektif ini. Keempatpuluhdua pasien dibagi menjadi dua kelompok, kelompok A menerima 5 mL/kgBB salin hipertonik 3% dan kelompok B menerima 5 mL/kgBB mannitol 20% yang diberikan saat insisi kulit kepala selama 15 menit. Pada saat pembukaan duramater, dokter bedah saraf menilai relaksasi otak berdasarkan skala empat poin, selanjutnya data relaksasi otak dibagi menjadi data dikotom (favorable dan unfavorable). Analisis statistik dilakukan uji chi-kuadrat dan nilai p0,05 dianggap signifikan. Hasil: Kondisi otak favorable didapatkan pada 19 pasien (90,5%) pada kelompok A dan 13 pasien (61,9%) pada kelompok B. Analisis statistik menyebutkan kondisi relaksasi otak setelah pemberian salin hipertonik 3% bermakna lebih baik dibandingkan dengan manitol 20% (uji chi-kuadrat), nilai p0,05). Simpulan: Pemberian salin hipertonik 3% selama kraniotomi pada pasien dengan cedera otak traumatik memberikan relaksasi otak yang lebih baik dibandingkan manitol 20% Hypertonic Saline 3% Provide a Better Brain Relaxation During Craniotomy in Patients with Traumatic Brain Injury Compared to Mannitol 20% Background and Objective: Mannitol has been widely used as an osmotherapy agent to reduce brain mass caused either by brain injury or tumor. Many studies argued that hypertonic saline is as effective or even better in reducing intracranial pressure and intraoperative brain mass. The purpose of this study was to evaluate brain relaxation after administration of hypertonic saline 3% compared to mannitol 20% during craniotomy in patients with traumatic brain injury.Material and Methods: Forty two patients who met the eligibility criteria were enrolled into this prospective clinical trial. Patients were randomized into two groups, group A received 5 mL/kg of hypertonic saline 3% and group B received 5 mL/kg of mannitol 20% at scalp incision, infused in 15 minutes. After opening duramater, neurosurgeon assessed brain relaxation on four-point scale. Data were dichotomized into two points (favorable and unfavorable) and analyzed by chi-square test, p-value less than 0.05 was considered significant. Results: Favorable brain were observed in 19 patients (90.5%) in group A and 13 patients (61,9%) in group B. Statistical analysis showed that brain relaxation after administration of hypertonic saline 3% was significantly better compared to mannitol 20% (chi-square test, p-value less than 0.05). Conclusion: The present study demonstrated that administration of hypertonic saline 3% provides better brain relaxation during craniotomy in patients with traumatic brain injury compared to mannitol 20%.

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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

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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