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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 9 Documents

Search results for , issue "Vol 4, No 1 (2015)" : 9 Documents clear

Penanganan Anestesi pada Operasi Olfactory Groove Meningioma Adriman, Silmi; Bisri, Dewi Yulianti; Rahardjo, Sri; Wargahadibrata, A Himendra
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Angka kejadian Olfactory Groove Meningioma adalah 1015% dari total meningioma yang terjadi di intrakranial, dimana tumor ini berasal dari basis cranii anterior. Manifestasi klinis berupa penurunan penciuman akibat terjepitnya saraf olfaktori dan apabila tumor cukup besar dan menekan saraf optikus, pasien akan mengalami penurunan penglihatan, bahkan buta. Pada kasus ini dilaporkan seorang wanita berusia 38 tahun, GCS 15 dengan diagnosis olfactory groove meningioma akan dilakukan operasi kraniotomi untuk pengangkatan tumor. Pasien datang dengan keluhan tidak bisa melihat dan tidak bisa mencium bebauan. Hasil CT Scan menunjukkan gambaran hiperdens berbentuk enhancing lesion pada regio frontal. Pasien dilakukan tindakan anestesi umum dengan intubasi. Induksi dengan propofol, fentanyl, lidokain dan vecuronium. Pengelolaan cairan perioperatif dengan ringerfundin, manitol dan furosemid. Pembedahan dilakukan selama 6 jam. Pasca bedah, pasien dirawat di Unit Perawatan Intensif (Intensive Care Unit/ ICU) selama 2 hari sebelum pindah ruangan.Anesthesia Management for Olfactory Groove Meningioma RemovalOlfactory Groove Meningioma, a type of meningioma is primarily derived from anterior cranial base, manifest in approximatelly 10-15% of meningioma cases. Clinical manifestations include smelling disorder and blurred vision or even cause blindness due to compression of the tumor to the optic nerve. This case reported a 38 years old woman with GCS 15 and diagnosed with olfactory groove meningioma, planned for a craniotomy tumor removal under general anesthesia. She was admitted to hospital due to blurred vision and smelling disorder. Computed Tomography (CT) scan showed a enhancing lesion in the frontal region. Induction of anesthesia was done using propofol, fentanyl, lidocaine and vecuronium. Ringerfundin, manitol and furosemide were used for perioperative fluid management. The surgery was conducted for 6 hours. Patient was managed in the Intensive Care Unit post operatively for 2 days prior to ward transfer

Interaksi Otak-Paru pada Neurocritical Care Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Pasien cedera otak traumatik (COT) berat merupakan kasus trauma yang paling sering masuk ke ruang terapi intensif dan kemudian terjadi multiple organ dysfunction dengan morbiditas dan mortalitas yang tinggi. Disfungsi neurologik berat dihubungkan dengan terjadinya edema paru dan cedera paru yang akan memperburuk outcome, dapat terjadi pada cedera otak traumatik, subarachnoid hemorrhage, status epileptikus, dan mati otak. Ventilasi mekanis yang sering digunakan dalam pengelolaan pasien sakit kritis, juga dapat memicu respons paru dan organ lain termasuk otak akibat terjadinya inflamasi. Pengaruh dari paru ke otak terlihat bahwa kebanyakan pasien yang selamat dari acute respiratory distress syndrome (ARDS) menunjukkan kemunduran kognitif yang menetap saat dipulangkan. Mekanisme yang mendasarinya belum diketahui, tapi hiperglikemia, hipotensi dan hipoksia/hipoksemia di ICU secara nyata berkorelasi dengan outcome neurologik yang tidak baik tersebut. Sebaliknya, pengaruh dari otak ke paru terlihat bahwa sepertiga dari pasien COT terjadi acute lung injury (ALI), yang memperburuk outcome, tapi penyebabnya belum jelas, namun kemungkinan mekanismenya antara lain neurogenic lung/pulmonary edema, mediator inflamasi, infeksi nosokomial, dan efek buruk dari terapi neuroproteksi. Neurogenic pulmonary edema merupakan komplikasi cedera SSP yang telah dikenal dengan baik akibat pelepasan katekolamine masif. Sebagai simpulan pada pasien dengan cedera otak dan gagal nafas akut, pencegahan dari cedera otak iskemik dan penggunaan strategi proteksi paru yang hati-hati merupakan hal yang utama. Sejak cross-talk antara otak dan paru diketahui dapat terjadi melalui berbagai jalur yang berbeda, pengendalian variabel fisiologis merupakan hal penting untuk proteksi otak.Brain-Lung Interaction in Neurocritical CareSevere traumatic brain injury patient is one of the most frequent traumatic cases admitted to intensive care unit (ICU) and develop multiple organ dysfunction with high rate of morbidity and mortality. Severe neurological dysfunction associated with pulmonary edema and pulmonary injury which can further worsen clinical outcome has been observed in traumatic brain injury, subarachnoid hemorrhage, status epilepticus, and in brain death cases. Mechanical ventilation that is commonly used in the management of critically ill patients can also trigger pulmonary and other organs responses including the brain, in relation to the inflammation caused. The effect from lung to the brain can be seen by the fact that many acute respiratory distress syndrome (ARDS) survivors showed a persistent cognitive deterioration when discharge. The underlying mechanisms remains unknow, but hyperglycemia, hypotension and hypoxia/hypoxemia in ICU are significantly correlated with this unfavorable neurological outcome. On the other hand, the effect from brain to the lung can be seen by the fact that one-third of acute brain injury patients develop acute lung injury (ALI), that worsen the clinical outcome, but the cause remaining obscure. The possible mechanisms include neurogenic lung edema, inflammatory mediators, nosocomial infection, and the adverse effect of neuroprotective therapy. Neurogenic pulmonary edema is a well-recognized complication of central nervous system insult attributed to a massive catecholamine release. As conclusion in patient with brain injury and acute lung injury, prevention of inadvertent ischemic brain insult and the use of protective lung strategies are mandatory. Since the cross-talk between the brain and lungs may occurs through different pathway, greater control of physiological variables might be important to protect the brain.

Penatalaksanaan Perioperatif Cedera Kepala Traumatik Berat dengan Tanda Cushing Basuki, Wahyu Sunaryo; Suryono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala traumatik merupakan masalah utama kesehatan dan sosial ekonomi, penyebab kematian dan kecacatan di seluruh dunia. Meskipun ada cara diagnosis yang canggih dan penatalaksanaan yang mutakhir, prognosis pasien cedera kepala traumatik masih tetap jelek. Derajat keparahan cedera primer merupakan faktor utama yang menentukan luaran; sedangkan cedera sekunder karena hipotensi, hipoksemia, hiperkarbia, hiperglikemia, dan hipoglikemia setelah cedera awal menyebabkan kerusakan lebih lanjut dari jaringan otak dan memperjelek luarannya. Cedera kepala traumatik berat adalah cedera kepala dengan glasgow coma scale score antara 3 sampai 8. Tanda Cushing adalah tanda kenaikan tekanan intrakranial yang tinggi dan tanda herniasi. Penatalaksanaan cedera kepala difokuskan pada pengelolaan dan pencegahan cedera sekunder. Seorang wanita 54 tahun, berat badan 50 kg, tinggi badan 155 cm dibawa ke unit gawat darurat rujukan dari rumah sakit lain karena kecelakaan lalu lintas, jatuh dari sepeda motor. Dilakukan resusitasi dan stabilisasi; jalan nafas bebas; laju nafas 1016x/menit; tekanan darah 180/100 mmHg; laju nadi 5055x/menit; skor GCS E2M2V1; pupil kiri dan kanan isokor 3 mm, reaksi cahaya lambat. Pemeriksaan CT-Scan menunjukkan perdarahan intraserebral frontal basal kanan, ukuran 7,5 x 4,4 x 2,2 cm, perkiraan volume 40 cc, dan perdarahan kiri kecil; perdarahan subarahnoid mengisi sulkus temporal kanan; midline shift ke kiri 2,6 mm; dan edema serebri luas. Segera dilakukan kraniotomi evakuasi perdarahan untuk menyelamatkan pasien. Penatalaksanaan cedera kepala perioperatif meliputi evaluasi yang cepat, resusitasi pembedahan dini, dan tatalaksana terapi intensif dapat memperbaiki luaran penderita cedera kepalaPerioperative Management of Severe Brain Injury with Cushings SignTraumatic brain injury (TBI) is a major health and socioeconomic problem, as well as a common cause of death and disabilty worldwide. Despite modern diagnostic tools and advancement in the treatment, prognosis of TBI patients remains poor. Severity of primary injury is the determining factor of outcome in TBI. Secondary injury, caused by hypotension, hypoxemia, hypercarbia, hyperglycemia, and hypoglycemia, following primary injury can cause further brain damage and worsen patients outcome. Severe TBI is brain injury with Glasgow Coma Scale score (GCS) of 3 to 8. Cushings sign is a sign of high intracranial pressure and herniation. Management of TBI is focused on managing and preventing secondary injury. A 54 years-old female patient (50 kg, 155 cm) was admitted ro the emergency unit due to motorcycle accident. Upon resuscitation and stabilization, the airway was secured, respiratory rate 10-16 times/minute, blood pressure 180/100 mmHg, pulse 50-55 beats/minute, and GCS E2M2V1. Pupils were isochoric, with 3 mm diameter. Direct light reflex was slow. CT-scan revealed a 40 cc right frontobasal intracranial hemorrhage with a size of 7.5 x 4.4 x 2.2 cm3; subarachnoid hemorrhage was occupying the right temporal sulcus; 2.6 mm midline shift to the left; and extensive cerebral edema. Craniotomy for evacuation of intracranial hematoma was performed. Perioperative managements including rapid evaluation, early surgical resuscitation, and intensive care can improve patients outcome.

Korelasi antara Tipe Hematoma Intrakranial dengan Kejadian dan Beratnya Post Traumatic Headache (PTH) Halimi, Radian Ahmad; Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Keluhan sakit kepala setelah cedera otak traumatik (COT) disebut sebagai Post Traumatic Headache (PTH), yang dapat terjadi setelah cedera otak ringan, sedang atau berat. Tujuan penelitian ini untuk menemukan korelasi antara tipe hematoma intrakranial dengan kejadian dan beratnya PTH.Subjek dan Metode: Penelitian observasional cohort prospektif pada 31 pasien, umur1359 tahun, laki-laki dan perempuan, yang mengalami COT ringan atau sedang. Pengambilan sampel secara consequetive sampling. Parameter yang dicatat adalah umur, jenis kelamin, berta badan, Glasgow Coma Scale (GCS), tipe hematoma intrakranial, kejadian PTH dan beratnya PTH dengan menggunakan skor numeric rating scale (NRS). Analisis korelasi linier dengan dua variable dengan analisis korelasi Spearman. Korelasi dianggap signifikan bila koefisien korelasi (R) 0,4 dan p0,05.Hasil: Seratus persen pasien subdural hematoma (SDH) dan Intracerebral Hematoma (ICH) mengalami post traumatic headache dan hanya 70,6% pada pasien EDH. Pasien dengan depressed fractur tanpa perdarahan intrakranial mengalami PTH sebanyak 33,3%.Simpulan: Perdarahan yang terjadi dibawah duramater menunjukkan kejadian PTH yang paling tinggi.The Correlation between Type of Intracranial Hematoma with The Incidence and Severity of Post Traumatic Headache (PTH)Background and Objective: Headache occurs after Traumatic Brain Injury (TBI) is known as Post Traumatic Headache (PTH), which could manifest after a mild, moderate, or severe head injury. The aim of this study is to evaluate the correlation between type of intracranial hematoma with the incidence and severity of PTH.Subject and Method: This prospective observational cohort study was performed in 31 patients aged from 1359 years old with mild or moderate TBI usig a consequetive sampling retrieval. Parameters recorded in this study were age, gender, weight, GCS, type of hematoma intracranial, the incidence of PTH, and severity of pain of PTH using the numeric rating score (NRS) score. Linear correlation analysis of two variables was calculated using Spearman correlation analysis. The correlation is significant if the correlation coefficient (R) 0.4 and p 0.05.Result: One hundred percent of subdural hematoma (SDH) and intracerebral hematoma (ICH) patients were experienced PTH and only 70,6% in epidural hematoma (EDH) patients. PTH also found in 33.3% of patient with depressed fracture without intracranial bleeding.Conclusion: Hematoma under duramater causes the highest incidence of PTH

Tatalaksana Anestesi pada Microvascular Decompression (MVD) Bau Indah Aulyan Syah; Siti Chasnak Saleh; Sri Rahardjo
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Microvascular decompression (MVD) nervus kranialis merupakan salah satu terapi untuk trigeminal neuralgia, spasme hemifacialis, dan neuralgia glosspharyngeal. Seorang wanita 52 tahun masuk ke rumah sakit dengan keluhan utama kedutan pada wajah sebelah kiri selama 17 tahun dan telah berobat ke beberapa dokter, termasuk suntikan botoks, namun hasilnya tidak memuaskan. Pemeriksaan MRI otak menunjukkan persilangan arteri cerebellaris anterior inferior (AICA) kiri dengan N. VII di daerah entry zone. Hal ini dapat menyebabkan TIC fasialis kiri. Pasien ini didiagnosis dengan spasme hemifasialis sinistra dan akan menjalani prosedur MVD. Pasien dianestesi dengan teknik anestesi umum intubasi endotrakea dengan menerapkan prinsip-prinsip neuroanestesia. Pada pasien ini tidak ditemukan tanda-tanda peningkatan tekanan intrakranial, namun dalam memfasilitasi pembedahan untuk dekompressi saraf yang tertekan, sangat penting untuk menurunkan volume otak. Karena itu, diterapkan beberapa metode, seperti hiperventilasi volunter, pemberian mannitol 20% 150mL dengan mempertahankan batas autoregulasi. Kombinasi anestesi inhalasi (sevofluran 0,6-1,5%) dan intravena (propofol kontinyu 60–100mg/jam), relaksasi dengan vecuronium kontinyu 2,5–4,5mg/jam. Cairan rumatan dipilih ringer fundin 400ml dan NaCl 0,9% 500ml melalui 2 jalur intravena. Operasi berjalan selama 2 jam, pendarahan sebanyak 150mL, urin 1000mL dilakukan ekstubasi segera setelah operasi selesai. Pasca anestesi, pernapasan dan hemodinamik stabil dan adekuat. Pemeriksaan neurologis di ruang pemulihan didapatkan kedutan menghilang Anesthesia Management for Microvascular Decompression (MVD)Microvascular decompression (MVD) cranial nerves as a therapy for trigeminal neuralgia, hemifacial spasm, and glosso pharyngeal neuralgia. A 52 years old female, came to the hospital due to the twitching on the left side of her face. She had been experiencing the twitching for over 17 years, had been treated by several doctors, including Botox injection, but with no satisfying outcome. MRI examination showed intercrossing of the left anterior inferior cerebellar artery (AICA) with the seventh cranial nerve in the area of entry zone. The condition caused the left facial TIC. She was diagnosed with left hemifacial spasm and planned for a MVD procedure. The patient was anesthetized with endotracheal intubation under general anesthesia using neuroanesthesia principles. There was no sign of increased intracranial pressure. Nevertheless, it is importance to facilitate the nerve decompression procedure by reducing the brain volume that can be perform with several methods, such as voluntary hyperventilation, administering mannitol 20% 150 mL while maintaining the autoregulation level. Combination of inhalation (sevofluran 0,6-1,5%) and intravenous anesthesia (propofol continuously 60–100mg/hour) was chosen, relaxation was obtained with continuous vecuronium 2,5-4,5mg/hr. Maintenance of intravenous fluids were Ringer fundin 400ml and NaCl 0,9% 500ml delivered via two intravenous routes. The operation was last for 2 hours, the amount of bleeding was 150 mL, and the urine was 1000 mL. The patient was extubated immediately after the operation. Breathing and hemodynamic post anesthesia were both stable and adequate. Neurological examination in the recovery room revealed no more twitching observed.

Tatalaksana Anestesi pada Pendarahan Intraserebral Spontan Non Trauma M. Dwi Satriyanto; Siti Chasnak Saleh
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Pendarahan Intraserebral (PIS) adalah ekstravasasi darah yang masuk kedalam parenkim otak, yang dapat berkembang ke ruang ventrikel dan subarahnoid, yang terjadi secara spontan dan bukan disebabkan oleh trauma (non traumatis) dan salah satu penyebab tersering pada pasien yang dirawat di unit perawatan kritis saraf. Kejadian PIS berkisar 10–15% dari semua stroke dengan angka kematian tertinggi tingkat dari subtipe stroke dan diperkirakan 60% tidak bertahan lebih dari satu tahun. Laki-laki 18 tahun, datang dengan keluhan penurunan kesadaran setelah sebelumnya merasakan lemas pada anggota gerak kanan yang terjadi tiba-tiba saat mengendarai kendaraan. Pada pemeriksaan didapatkan kesadaran GCS E3M5V2 dengan hemodinamik cukup stabil, dan terdapat hemiplegi dextra. Pasien dirawat di perawatan intensif selama 4 hari, karena kesadaran menurun menjadi E2M4V2 maka dilakukan MSCT ulangan, dan ditemukan PIS bertambah (kurang lebih 30cc) dibandingkan dengan MSCT sebelumnya dengan midline shift lebih dari 5mm. Diputuskan untuk dilakukan tindakan kraniotomi evakuasi segera dengan pemeriksaan penunjang yang cukup. Tindakan kraniotomi evakuasi pada pasien PIS menjadi tantangan bagi seorang spesialis anestesiologi, sehingga diperlukan pengetahuan akan patofisiologi, mortalitas PIS dan tindakan anestesi yang harus dipersiapkan dan dikerjakan dengan tepat. Anesthesia Management in Spontaneous-Non Traumatic Intracerebral HemorrhageIntracerebral hemorrhage (ICH) is the extravasations of blood into the brain parenchyma, which may develop into ventricular and subarachnoid space, that occurs spontaneously and not caused by trauma (non-traumatic), and one of the most common causes in patients treated in the neurological critical care unit. ICH represents approximately 10–15% of all strokes with the highest mortality rates of all stroke subtypes and about 60% of patients with ICH may not survive within the first year. A 18 years old male with loss of consciousness after suffering from sudden right limb weakness while driving a vehicle. On examination, the level of consciousness (GCS) was E3M5V2 with stable hemodynamic and right hemiplegia. Patients was managed in intensive care unit (ICU) for 4 (four) days, and because of the decreasing level of consciousness to E2M4V2, the MSCt test was performed and the result revealed an ICH (approximately 30cc) compared to the previous MSCt with more than 5mm midline shift. Immediate craniotomy evacuation was then performed. Craniotomy evacuation in ICH patients is challenging for an anesthesiologist.Therefor, require a thorough understanding of the pathophysiology as well as mortality of ICH and anesthetic management should be prepared and done properly.

Kerusakan Barier Pertahanan Alamiah: Sawar Darah Otak Arianto, Ardana Tri; Sudjito, M. H
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Sawar Darah Otak (SDO) adalah struktur membran yang secara primer memisahkan serta memfiltrasi darah ataupun zat dari sirkulasi sistemik yang masuk ke dalam sirkulasi otak. Sawar Darah Otak merupakan penghalang fisik antara pembuluh darah lokal dan sebagian besar dari sistem saraf pusat itu sendiri, dan tempat berhentinya zat makromolekul. Konsep Sawar Darah Otak pertama kali diperkenalkan oleh Paul Ehrlich. Paul Ehrlich menemukan bahwa injeksi intravena perwarna ke dalam aliran darah meninggalkan noda pada seluruh jaringan di sebagian besar organ kecuali otak. Pada trauma kerusakan sawar darah otak banyak diakibatkan oleh rusaknya integritas membrane sawar darah otak dan pada tumor disebabkan oleh peningkatan permeabilitas sawar darah otak akibat invasi sel tumor. Pada keadaan trauma, disfungsi sawar darah otak dapat terjadi secara cepat ataupun lambat, gangguan dari kompleks tight junction dan integritas membran menghasilkan peningkatan permeabilitas seluler. Sedangkan tumor otak dapat menyebabkan peningkatan permeabilitas sawar darah otak, pembengkakan jaringan sekitar tumor, dan terjadi absorpsi serta pengeluaran cairan dan protein dengan cairan serebrospinal di ventrikel. Terapi kortikosteroid menurunkan ekspresi dari vascular endothelial growth factor (VEGF) yang diproduksi edema yang terikat dengan sel endotel. Pengelolaan perioperatif penting untuk mengetahui hal-hal yang berkaitan tentang sawar darah otak dikarenakan kompleksitas dari anatomi, fisiologi, fungsi transpor sampai hubungan antara sawar darah otak dengan gangguan neurologis seperti yang terdapat pada kasus cedera otak traumatik dan tumor otak.Disruption of Natural Defense Barrier: Blood-Brain BarriereThe blood brain Barrier (BBB) is a structural membrane that separates and filters blood and subtances that enters the cntral nervous system from systemic circulation. It is a physical barrier between the local blood vessels and most parts of the central nervous system itself, and the flow of macro substances. The concept of the blood brain barrier was first introduced by Paul Ehrlich. He found that intravenous injection of dyes into the bloodstream stained all the tissues in most organs except the brain. In traumatic brain injury, vascular disruption causes damage to integrity of the membrane BBB while in case of tumor, there's an increase of permeability due to tumor cell invasion. In traumatic brain injury , the onset of BBB dysfunction can be immediate or delayed, increased cellular permeability is the result of thr damage of the tight junction complex and membrane integrity. Brain tumor can increase the permeability of BBB edema in the surrounding area, and cause absorption and excretion of cerebrospinal fluid and protein in to the ventricel. Corticosteroid therapy can reduce the expression of vascular endothelial growth factor (VEGF) in the edematous endothelial cells. Perioperative mamagemrnt requires comprehensive knowledge of the complexity of blood brain barrier's anatomy, physiology, transport function, and the relation between BBB with neurologic dysfunctions which are commonly seen in traumatic brain injury and tumor.

Penatalaksanaan Perioperatif Hipofisektomi Transsphenoidal: Pendekatan Endoskopik Endonasal Christanto, Sandhi; Suryono, Bambang; Bisri, Tatang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor kelenjar hipofisa sering dijumpai dan mewakili kurang lebih 10% dari semua neoplasma otak yang terdiagnosa. Meski tersedia terapi medis, pendekatan pembedahan menjadi lebih sering dilakukan. Pendekatan transsphenoidal endonasal endoskopik dipilih karena memiliki keuntungan untuk mencapai regio sella secara cepat dengan resiko kerusakan otak dan komplikasi pascabedah yang minimal. Pengetahuan dan keahlian dokter anestesi tentang pembedahan endoskopik basis kranii dibutuhkan untuk memenuhi kriteria dalam menyediakan keadaan anestesi yang aman, yang akan memainkan peran penting dalam menghasilkan luaran yang diharapkan. Seorang wanita 25 tahun dibawa ke rumah sakit dengan penurunan kesadaran pasca seksio sesarea. Pada pemeriksaan ditemukan edema otak, dan hidrosephalus yang kemudian dilakukan pintas ventrikuloperitoneal. Pemeriksaan lebih lanjut didapatkan massa kistik suprasellar dan pembedahan hipofisektomi transsphenoidal melalui jalur endonasal endoskopik dipilih sebagai pendekatan surgikal. Pasien dengan kelainan hipofisa serta pendekatan pembedahan endoskopik memberikan tantangan tersendiri bagi dokter anestesi. Peralatan endoskopik berteknologi tinggi, pertimbangan intraoperatif yang berhubungan dengan tehnik ini, membutuhkan pengelolaan anestesi yang baik selama periode perioperatif, sehingga dokter anestesi dapat memberikan anestesi yang aman selama prosedur pembedahan dan memberi kontribusi besar bagi keberhasilan dan kemajuan pembedahan endoskopik basis kranii.Perioperative Management of Transsphenoidal Hypophysectomy: Endoscopic Endonasal ApproachPituitary gland tumor represents 10% of all brain neoplasms. Although medical therapy is available, surgical approach becomes commonly performed. The transsphenoidal via endoscopic endonasal is preferred because it has advantage of rapid access to the sella region with minimal traumatic risk to the brain as well as post-operative complications. The highly advance technology, the position of neurosurgeon when performing the surgery and other intraoperative consideration present a unique challenge which require a thorough understanding and the skill of anesthesia management that is tailored to the needs of safe anesthesia for this technique. A 25 years old woman was admitted to hospital following a decreased in level of conciousness after sectio cesarea and found to have edema cerebri and hydrocephalus. Ventricular peritoneal shunt was performed immediately. Further examination revealed a cystic mass in suprasellar region and transsphenoidal hypophysectomy via endonasal endoscopic route was chosen as surgical approach. Patient with pituitary disease and endoscopic method present challenges to the anesthesiologist. High technology equipment and techniques, as well as other intraoperative considerations mandate the skillfulness of anesthesia management throughout the perioperative periode. Those considerations will ensure the neuroanestesiologist for a safe anesthesia and continue to make contributions to the development of full endoscopic skull base surgery.

Terapi Hipotermia pada Stroke Hemoragik Aulyan Syah, Bau Indah; Fuadi, I; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Terapi antipiretik merupakan salah satu terapi yang dianjurkan untuk pasien stroke karena peningkatan suhu tubuh dianggap berhubungan dengan luaran neurologis yang buruk. Namun demikian, belum ada rekomendasi yang paling tepat untuk kontrol demam baik secara farmakologi maupun mekanik akibat kurangnya temuan klinik.Saat ini, hipotermi terapeutik dianggap satu-satunya metode neuroprotektif yang sukses dalam meningkatkan luaran pasien stroke iskemik. Istilah neuroprotektif disini mengacu pada memelihara atau melindungi cedera saraf yang reversibel agar tidak rusak atau mengalami kematian sel. Metode hipotermi dianggap berpengaruh terhadap sejumlah jalur patofisiologi stroke. Pada penelitian in vitro, hipotermi mencegah edema serebral dan kerusakan sawar darah otak. Selain itu, mencegah aktivasi mikroglia, produksi radikal bebas, dan pelepasan neurotransmitter eksitotoksik serta asam laktat dan piruvat. Selain itu, cerebral metabolic rate (CMR), apoptosis dan respon inflamasi lokal juga berkurang. Hipotermi otak secara lokal dilaporkan menurunkan ekspresi gen interleukin-1b dan pembentukan edema vasogenik pada model perdarahan intraserebrial binatang. Hipotermi terapeutik dianggap lebih efektif bila dimulai lebih awal setelah onset gejala. Durasi hipotermia yang lebih lama juga memiliki efek neuroprotektif persisten dalam jangka waktu lama. Namun demikian, terapi hipotermia memiliki beberapa komplikasi terhadap jantung, paru-paru, immunologi, hematologi, dan metabolik. Komplikasi yang paling sering dilaporkan adalah pneumonia, bradikardi, aritmia, dan trombositopenia. Evaluasi efektivitas hipotermia sulit dievaluasi pada pasien yang tersedasi karena pemeriksaan neurologis harian seringkali membingungkan.Hypothermia Therapy in Hemorrhagic StrokeAntipyretic is among one of the suggested therapies for stroke patients. The reason is because increase in body temperature is considered related to bad neurological outcomes. However, there is no best recommendation available for controlling the temperature, neither pharmacologically nor mechanically due to less clinical practices findings available. Currently, therapeutic hypothermia is considered as the one and only successful neuroprotective in enhancing the ischemic strokes patients outcomes. The term neuroprotective refers to protecting or conserving various types of reversible neurological injuries from damage or further cell impairment. In vitro studies showed hypothermia prevent cerebral edema and blood brain barrier damage, as well as successfully proven effective in preventing microglia activation, free radical production, and release of exotoxic neurotransmitters, lactic acid and piruvate. In addition, cerebral metabolite rate (CMR), apoptosis, and local inflammatory response are also decreased. Local brain hypothermia is reported could lowering the 1b-interleukin gen expression and establishment of vasogenic edema among animal models with intracerebral hemorrhage. Therapeutic hypothermia is considered highly effective when initiated early in subsequent to the symptom onset. Longer duration of cooling is related to a more persistent neuroprotective effect in long periode. Despite its effectiveness, therapeutic hypothermia could generate several complications affecting the heart, lung, immunology, hepatology and metabolic states. The most common complications are pneumonia, bradicardia, arrhythmia, and thrombocytopenia. Evaluation to the effectiveness of hypothermia is difficult to measure in sedated patients due to difficulty in defining the patients neurological states on day to day bases

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Reviewer

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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

Location
,

INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

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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

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