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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 7 Documents

Search results for , issue "Vol 5, No 3 (2016)" : 7 Documents clear

Perdarahan Berulang Pascakraniotomi pada Pasien Cedera Kepala Ringan Fithrah, Bona Akhmad; Oetoro, Bambang J.; Umar, Nazaruddin; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Kraniotomi adalah prosedur pembedahan yang digunakan untuk mengangkat tumor untuk memperbaiki lesi vascular atau menurunkan tekanan intrakranial. Salah satu komplikasi dari prosedur ini adalah terjadinya perdarahan hingga harus dilakukan pembedahan kembali. Cedera kepala ringan memiliki angka kejadian sekitar 8090% dari seluruh cedera kepala dan memiliki angka kematian sekitar 0,1% itu terjadi disebabkan oleh perdarahan intra cerebral yang terlewat. Seorang laki laki usia 47 tahun, berat badan 106 kg dirujuk dari rumah sakit kecil setelah terpelesat saat turun dari angkutan umum. Pasien tidak sadarkan diri dan saat tersadar sudah di instalasi gawat darurat. Hemodinamik pasien baik,GCS E4M6V5, telah dilakukan CT scan dan tidak didapatkan perdarahan apapun. Pasien dua hari di ruang rawat dan terus mengeluh sakit kepala yang bertambah. Dilakukan CT scan ulang dan didapatkan perdarahan intracerebral. Dilakukan tindakan kraniotomi evakuasi hematom dan pasca operasi pasien dirawat di ICU. Dua hari di ICU pasien kembali mengalami penurunan kesadaran dan pada CT scan didapatkan kembali perdarahan pada tempat yang sama. Dilakukan kembali kraniotomi evakuasi hematom dan pasca tindakan pasien dirawat di ICU. Dengan pengawasan yang baik dan tindakan yang cepat cedera kepala ringan yang mengalami perdarahan intracerebral dapat diatasi dengan baik dan tidak menjadi suatu kematianRecurrent Post Craniotomy Hemorrhage in Patient with Mild Head InjuryCraniotomy is a procedure performed to remove brain tumor, repair vascular lesion or relieve intracranial pressure. Sometimes complication arise that need re-do craniotomy. Incidence mild traumatic brain injury 8090%from all traumatic brain injury and has mortality 0,1% related with missed intra-cranial hemorrhage. Patient, 47 years old, body weight 106 kgs referred from smaller hospital after slipped and falling down from the bus. Patient said he had unconscious for several minutes. Patient had already had CT scan and no bleeding at all. Patient stayed in the ward for two days and keep complaining severe headache. CT scan conduct again and the result said there were intracranial hemorrhage. Craniotomy evacuation hemorrhage performed and after operation patient stayed in the ICU. Two days in the ICU patient had decreased of consciousness. CT scan immediately performed and there was another intracranial hemorrhage in the same place with bigger volume. Re-do craniotomy evacuation hemorrhage performed again. With a good monitoring in the room/ICU, a fast diagnostic and craniotomy this patient wouldnt become a mortality case

Penatalaksanaan Perioperatif Cedera Kepala Traumatik yang Terlambat P, Alexander Samuel; Umar, Nazaruddin; Saleh, Siti Chasnak; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala traumatik merupakan salah satu pembunuh pada usia dewasa muda di seluruh dunia. Permasalahan yang sering timbul selain pasien dengan cedera kepala yang tidak dibawa ke rumah sakit, terkadang juga diagnostik yang dilakukan pada awal perjalanan penyakit tidak menunjukkan adanya masalah. Yang sering terlupakan adalah patologi cedera kepala tidaklah berhenti, namun dapat terus berlangsung. Laki-laki dengan berat badan 50 tahun dengan tinggi badan 172 cm BB 82kg dibawa ke Unit gawat darurat, menurut keluarga,pasien ditemukan dalam keadaan mata lebam di dalam rumah, tampak sakit kepala dan muntah-muntah di rumah sejak 18 jam sebelum masuk Rumah Sakit tanpa jelas mekanisme traumanya. Kesadaran GCS E34 M6 V5 pemeriksaan pupil kanan dan kiri 2mm isokor, kelopak mata kanan tampak jejas, TD tekanan darah 135/85, frekuensi nadi 5060x. Dari CT scan ditemukan adanya EDH pada daerah frontal-parietal dan ICH multipel. Dilakukan operasi darurat untuk evakuasi hematom, intra operatif terjadi perdarahan, pasca operasi pasien dirawat di ICU dengan sedasi propofol 5mg/kg/jam. Penatalaksanaan cedera kepala yang terlambat dan tidak adekuat dapat memberikan hasil yang kurang baik.Perioperative Management in Delayed Traumatic Brain InjuryTraumatic brain injury is one of the leading cause of death worldwide. Problems with these patient with traumatic brain injury was not administered to the hospital, sometimes from the diagnostic done in the early course of the disease does not indicate a problem. What is often forgotten is the course of the disease head injury did not stop, keep continue. Male weighing 50 years with a body height of 172 cm BB 82kg brought to emergency department , according to the family, the patient was found with bluish eyes in the house, severe headache and vomiting at home since 18 hours before entering the Hospital without obvious trauma mechanism. GCS was E3-4 M6 V5 pupillary examination 2mm isokor right and left, looked right eyelid injury, blood pressure 135/85, heart rate 50-60x. CT scans reveal any EDH in the frontal-parietal and multiple ICH. The neurosurgeon decide to performed emergency surgery, intraoperative major bleeding, postoperative patients admitted to the ICU with propofol sedation 5mg / kg / hour. Management of head injury late unhandled include rapid evaluation, resuscitation, surgery and intensive therapy management gives good outcome

Krisis Tiroid Pascakraniotomi Mikro pada Makroadenoma Hipofise disertai Akromegali Yasmine Kartika Putri; M. Sofyan Harahap
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor Hipofise sering terjadi pada dewasa dan mewakili 10% tumor intrakranial. Akromegali adalah sindrom klinik yang disebabkan oleh produksi hormon pertumbuhan yang berlebihan dan diketahui sebagai penyakit yang jarang, yang ditandai oleh sekresi yang berlebihan hormon pertumbuhan (GH, growth hormone) dan faktor pertumbuhan seperti insulin (IGF-1/Insulin Growth Factor-1). Insiden keseluruhan akromegali diperkirakan mencapai 3 sampai 5 kasus baru per juta populasi. Akromegali dapat muncul bersamaan dengan gangguan tiroid. Lini pertama pengobatan untuk akromegali adalah operasi transsphenoidal. Manajemen perioperatif operasi hipofise membutuhkan penanganan oleh tim bedah saraf, neuroanaesthesiologists dan ahli endokrin. Semua pasien dengan adenoma hipofise memerlukan evaluasi endokrin menyeluruh pada periode pre-operatif dan di follow-up saat periode post-operatif. Seorang wanita 50 tahun masuk Rumah Sakit dengan keluhan kedua tangan dan kaki membesar, telapak kaki menebal dan bengkok, rahang dan hidung membesar. Riwayat pengobatan hipertiroid ± 3 tahun. Dari pemeriksaan magnetic resonance imaging (MRI) kepala dengan kontras didapatkan makroadenoma hipofise. Pasien menjalani prosedur operasi craniotomi mikro transsphenoidal. Pasca operasi pasien dirawat di ICU dan mengalami perburukan dan pada akhirnya meninggal di hari kedua perawatan ICU oleh karena krisis tiroid.Thyroid Crisis Post Microcraniotomy of Macroadenoma Pituitary Accompanied AcromegalyPituitary tumors are common in adults and represents 10% of intracranial tumors. Acromegaly is a clinical syndrome caused by the production of excess growth hormone and it is known as a rare disease, which is characterized by excessive secretion of growth hormone (GH) and growth factors such as insulin (IGF-1, Insulin Growth Factor-1). The overall incidence of acromegaly is estimated at 3 to 5 new cases per million population. Acromegaly can coexist with thyroid disorders. First-line treatment for acromegaly is transsphenoidal surgery. Perioperative management of pituitary surgery requires treatment by a team of neurosurgeons, neuroanaesthesiologists and endocrinologists. All patients with pituitary adenoma requires a thorough pre -operative endocrine evaluation and a follow- up in post- operative period. A 50 years old woman entered a hospital with complaints of swollen both hands and feet, thicken and crooked foot, enlarging of jaw and nose. She had a history of ± 3 years hyperthyroid treatment. Magnetic resonance imaging (MRI) examination of the head with the contrast obtained macroadenoma pituitary. Patiens underwent micro- surgery procedures of craniotomi transsphenoidal. Post-surgery, Patient being observed in the ICU and her condition was deteriorated and she eventually died on the second day due to thyroid crisis.

Perbandingan antara Sevofluran dan Isofluran terhadap Gangguan Fungsi Kognitif Pascabedah Tumor Otak menggunakan Mini Mental State Examination (MMSE Wullur, Caroline; Redjeki, Ike Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Pasien dengan tumor otak sering mengalami gangguan fungsi kognitif yang berdampak terhadap fungsi fisik, psikologis, sosial, dan vokasional. Post operative cognitive dysfunction (POCD) adalah ganggguan kognitif pascabedah yang paling sering terjadi. Anestesi umum yang digunakan dapat berpengaruh terhadap gangguan fungsi kognitif. Anestetika inhalasi sevofluran dan isofluran merupakan anestetika inhalasi yang paling sering digunakan untuk prosedur kraniotomi tumor otak. Tujuan penelitian adalah untuk mengetahui perbandingan efek antara sevofluran dan isofluran terhadap fungsi kognitif pascabedah tumor otak.Subjek dan Metode: eksperimental acak terkontrol buta tunggal melibatkan 44 pasien dengan tumor otak yang menjalani kraniotomi tumor otak pada bulan April?Oktober 2015. Data dianalisis dengan uji-t tidak berpasangan, Chi kuadrat, Mann Whitney dan Komolgorov Smirnov, nilai p0,05 dianggap bermakna. Fungsi kognitif diukur menggunakan uji mini mental state examination (MMSE) yang dinilai saat pre-operatif dan pascabedah pada jam ke 6, 12, 18, 24, 48, 72, 96, dan 120. Hasil penelitian menunjukkan MMSE pascabedah pada kelompok anestetika inhalasi sevofluran lebih tinggi dibanding dengan isofluran pada 6, 12, 18, 18, 24, 48 dan 72 jam pascabedah dengan perbedaan bermakna (p0,05).Simpulan: Anestetik inhalasi sevofluran menimbulkan gangguan fungsi kognitif pascabedah yang lebih ringan dibanding dengan isofluran pada pasien yang menjalani kraniotomi tumor otak.Comparison between Sevoflurane and Isoflurane on Cognitive Dysfunction Post Craniotomy Tumor Removal assessed using Mini Mental State Examination (MMSE)Background and Objective: Patients with brain tumor often experience cognitive dysfunction that may have an impact on physical functioning, psychology, social and vocacional functioning. Post operative cognitive dysfunction (POCD) is the most common post surgical cognitive dysfunction. General anaesthesia may have an impact on POCD. Sevofluran and isoflurane are the two most commonly used inhaled anaesthetic agents for craniotomy tumor removal. The aim of this study is to compare the effects between sevoflurane and isoflurane on cognitive functions after brain tumor surgery.Subject and Method: This is a randomized controlled trial involving 44 ASA II patients who underwent craniotomy tumor removal under general anaesthesia between period of April?October 2015. Statistical analysis using unpaired t-test, Chi Square, Mann Whitney and Komolgorov Smirnov test with p0,05 as statistically significant. Cognitive function was assessed using mini mental state examination (MMSE) preoperatively and postoperatively at 6, 12, 18, 24, 48, 72, 96 and 120 hour postoperative. Result: shows that postoperative MMSE was higher in sevoflurane group compared to isoflurane on 6, 12, 18, 24, 48, 72 hours postoperatively with statistical significance (p0,05). Conclusion: Inhaled anaesthetic agent sevoflurane causes less postoperative cognitive disturbance compared to isoflurane on patients undergoing craniotomy tumor removal.

Manajemen Cairan dan Elektrolit pada Pasien Cedera Kepala Aulyan Syah, Bau Indah; Gaus, Syafruddin; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Manajemen pasien cedera kepala harus selalu difokuskan pada penatalaksanaan cedera primer dan cedera sekunder. Pemeliharaan perfusi serebral dan pencegahan hipertensi intrakranial yang mencakup pemeliharaan osmolalitas merupakan bagian penting dalam tatalaksana cairan dan elektrolit pasien cedera kepala, terutama bila diduga sawar darah otak tidak intak. Pemberian dan jenis cairan harus mempertimbangkan ketidakmampuan otak pasien dalam mengatasi perubahan volume dan osmolalitas seluler dan peningkatan konsumsi oksigen serebral. Target tekanan perfusi serebral antara 5070 mmHg. Pemilihan jenis cairan pada cedera kepala masih kontroversi, karena baik koloid maupun kristaloid dianggap memiliki efek samping yang sama beratnya terhadap otak yang cedera. Dari penelitian SAFE (Saline and Albumin Fluid Evaluation) ditemukan luaran mortalitas-28 hari yang lebih tinggi pada pasien yang menerima koloid (albumin 4%) dibanding yang menerima kristaloid (salin isotonik). Sifat hipotonis albuminlah (osmolalitas 260 mOsml/kg) yang membahayakan pasien cedera kepala, bukan karena sifat koloidnya. Rekomendasi terkini menganjurkan penggunaan larutan isotonik seperti NaCl 0,9%. Penanganan hipertensi intrakranial pada cedera kepala juga sering melibatkan terapi hiperosmolar, dan yang paling dominan adalah mannitol yang dianjurkan hanya untuk jangka pendek dan pada sawar darah otak yang intak, serta dalam cakupan osmolaritas darah 300310 mOsm/l. Selain mannitol, salin hipertonik dapat menjadi alternatif, namun harus dihindari bila kadar natrium serum lebih dari 160 mmol/L.Fluid and Electrolyte Management in Head Injury PatientTreatment for head trauma patients should always be focused on the management of the primary and secondary trauma. Maintaining cerebral perfusion and preventing intracranial hypertension, which include maintaining cerebral osmolality, is part of the crucial fluid and electrolyte management for patients with head injury, particularly when the blood brain barrier is assumed to be no longer intact. Fluid administration and the type of the fluids given should carefully account the patient brain capability to adjust to volume change and cellular osmolality, and to an increase in cerebral oxygen consumtion. Target of cerebral perfusion pressure in the range of 50-70 mmHg. The preference fluid for patients with head injury remains controversial, because either colloid or crystalloid fluids are both believed to be equally detrimental in side effects. However, SAFE (Saline and Albumin Fluid Evaluation) research revealed 28 days mortality outcome higher among patients receiving colloid (4% albumin) compared to those receiving crystalloid (Isotonic saline). It was the hypotonisity of the albumin (osmolality 260 mOsml/kg) that was harmful in nature for the patients brain, instead of its colloid characteristics. Recent updates recommend using isotonic solution such NaCl 0.9%. Intracranial hypertension management in head injury cases is frequently combined with hyperosmolar therapy, which dominantly using mannitol which is recommended limited to certain circumstances: short period of administration, intact condition of blood brain barrier, and with osmolarity coverage in range of 300-310 mOsml/L. As alternative, hypertonic saline can also be used, hence should be avoided when sodium serum concentration is higher than 160 mmol/L.

Efek perbedaan Volume Tidal Ventilasi Mekanik Selama Operasi terhadap Rasio PaO2/FiO2 Pascakraniotomi Elektif Aditianingsih, Dita; Sedono, Rudyanto; Baktiar, Yoshua
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang: Kraniotomi elektif memiliki insidens komplikasi paru pascaoperasi (25%) dan mortalitas (10%) yang tinggi; insiden ini lebih rendah pada pemakaian volume tidal rendah sebagai teknik proteksi paru. Penelitian ini meneliti efek volume tidal 6 mL/kg dan 10 mL/kg terhadap rasio PaO2/FiO2(sebagai parameter keparahan cedera paru) pascaoperasi pada kraniotomi elektif.Subjek dan Metode: Setelah mendapat izin Komite Etik FKUI/Rumah Sakit Cipto Mangukusumo dan konsen pasien, dilakukan uji klinis acak pada 52 pasien kraniotomi elektif yang dirandomisasi ke dalam 2 kelompok: ventilasi mekanik selama operasi dengan volume tidal 6 mL/kg (VT6) atau 10 mL/kg (VT10), lalu dilakukan analisis gas darah.Hasil: Rasio PaO2/FiO2 kelompok VT-6 dan VT10 secara berurutan: pada 1 jam pascainduksi 413,7 113,4 mmHg dan 401,5 106,3 mmHg (p0.05); pada akhir operasi, 466,6 94,6 mmHg dan 471,1 89,0 mmHg (p0.05), pada 24 jam pascainduksi, 418,8 108,8 mmHg dan 448,5 119,6 mmHg (p0.05); pada 48 jam pascainduksi, 414,9 88,1 mmHg dan 402,5 100,7 mmHg (p0.05 ). Tidak ada perbedaan signifikan insiden mortalitas dan komplikasi paru dan ekstraparu diantara dua kelompok.Simpulan: Tidak ada perbedaan signifikan antara volume tidal 6 ml/kg dan 10 ml/kg terhadap ratio PaO2/FiO2 pada pasien kraniotomi elektif.The Effect of Different Tidal Volume against Postoperative PaO2/FiO2 Ratio in Elective Craniotomy PatientsBackground: Elective craniotomy is associated with a high incidence of postoperative pulmonary complications/PPC (25%) and mortality (10%); in which these incidence went down with the administration of low tidal volume. This study investigated the effect of low tidal volume in intraoperative PaO2/FiO2 ratio in elective craniotomy patients.Subject and Methods: After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients,a randomized controlled trialwas done to 52 elective craniotomy patients. Subjects were ventilated with tidal volume 6 mL/kg (VT6) or 10 mL/kg (VT10) intraoperatively, then blood gas analyses wereperformed.Results: PaO2/FiO2 ratio of VT6 and VT10 respectively: at 1 hour postinduction, 413.7 113.4 mmHg and 401.5 106.3 mmHg (p0.05); at end of surgery, 466.6 94.6 mmHg and 471.1 89.0 mmHg (p0.05); at 24 hours postinduction, 418.8 108.8 and 448.5 119.6 mmHg (p0.05); at 48 hours postinduction, 414.9 88.1 mmHg and 402.5 100.7 mmHg (p0.05). There were no significant differences on mortality, lung and extralung complications observed between both groupsConclusions: There were no significant difference between tidal volume 6 ml/kg and 10 ml/kg against intraoperative PaO2/FiO2 ratio in elective craniotomy patients.

Ambang Hemoglobin pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

WHO mendefinisikan anemia bila konsentrasi Hb12g/dL pada wanita dan 13 g/dL pada laki-laki. Anemia merupakan salah satu komplikasi medikal yang paling sering pada pasien sakit kritis, termasuk pasien dengan kelainan neurologik. Kira-kira 2/3 pasien mempunyai kadar Hb12 g/dL pada saat masuk ke ICU, dan kemudian terjadi penurunan 0,5 g/dl/hari. Transfusi PRC memelihara hematokrit dan kapasitas pembawa oksigen, tapi dihubungkan dengan peningkatan resiko infeksi, gagal multiorgan termasuk gagal nafas, kejadian tromboembolik, dan kematian. Penelitian telah menunjukkan bahwa untuk kebanyakan pasien sakit kritis, tidak ada keuntungan untuk mempertahankan konsentrasi hemogloblin yang lebih tinggi.Disamping penemuan pada pasien sakit kritis, diketahui bahwa konsentrasi Hb serendah 7 g/dL tidak dapat ditolerir pada pasien dengan cedera otak traumatik berat maka indikasi transfusi bila Hb7g/dL. Penelitian telah menunjukkan tidak ada perbedaan dalam mortalitas atau mendukung suatu hubungan antara transfusi dengan lebih buruknya outcome. Mempertahankan konsentrasi Hb sekitar 9-10g/dL adalah suatu strategi terapi yang telah lama dilakukan untuk memperbaiki oksigenasi otak pada pasien dengan cedera otak traumatik. Kemungkinan efek menguntungkan lain dari mempertahankan konsentrasi Hb yang lebih tinggi adalah untuk menghindari peningkatan tekanan intrakranial yang dipicu oleh anemia dan untuk memberikan tekanan darah yang lebih tinggi serta tekanan perfusi otak yang lebih baik. Simpulan adalah anemia berat dan transfusi RBC bisa mempunyai pengaruh pada outcome klinis, transfusi restriksif aman dan sering dianjurkan, indikasi transfusi bukan dari kadar Hb tapi dari sinyal otak misalnya brain tissue oxygen tension dan regional cerebral oxygen saturation.Hemogloblin Treshold in Traumatic Brain InjuryWHO defined anemia as a Hb concentration 12 gr/dL in women and 13 g/dL in men. Anemia is one of the most common medical complication in critically ill patient, including patient with neurologic disorder. About 2/3 patient have Hb concentration 12 g/dL at the time of ICU admission with subsequent decrement of about 0.5 g/dL per day. PRC transfusion improve hematocrit and oxygen carrying capacity, but have correlation with increase infection risk, multiorgan failure including respiratory failure, thromboembolic event and death. The study show that for common critically ill patient, no benefit to keep Hb concentration in higher level. Beside in critically ill patient, Hb concentratrion as low as 7 g/dL can be tolerir in severe traumatic brain injury and indication for transfusion if Hb7g/dL. Study show that no different in mortality or support a relation between transfusion and worst outcome. Keeping Hb concentration arround 910g/dL is a strategy therapy to improve brain oxygenation in traumatic brain injury patient. The possibility othe advantageus in higher Hb concentration is to avoid increase ICP cause by anemia and to increase blood pressure and better cerebral perfusion pressure.The conclusion is severe anemia and RBC transfusion have some effect in clinical outcome, restrictive transfusion safe and advisable, transfusion indication not only from Hb level but from brain signaling ec brain tissue oxygen tension and regional cerebral oxygen saturation.

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Contact Name Agni Susanti

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Editorial Address Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

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Agni Susanti

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jurnalneuroanestesi@gmail.com

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+6287722631615

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jni@inasnacc.org

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Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

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INDONESIA