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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 6, No 2 (2017)" : 7 Documents clear

Transcranial Doppler Ultrasonography: Diagnosis dan Monitoring Non Invasif pada Neuroanesthesia dan Neurointesive Care Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Transcranial Doppler (TCD) adalah pemeriksaan ultrasonografi yang telah digunakan secara luas dibidang neuroanestesi dan perawatan intensif. Pada bidang perawatan intensif neurologi, pemeriksaan TCD sangat berguna untuk evaluasi dan monitoring perubahan sirkulasi pembuluh darah penting di otak, seperti arteri serebri media (middle cerebral artery-MCA), arteri serebri anterior (anterior cerebral artery-ACA), arteri carotis interna (internal carotid artery-ICA) cabang terminalis, arteri cerebri posterior (posterior cerebral artery-PCA), arteri vertebralis dan arteri basilaris. Selain kecepatan aliran, pemeriksaan ini juga dapat digunakan untuk evaluasi perubahan diameter pembuluh darah. TCD digunakan untuk pemeriksaan penunjang diagnostik perdarahan subarachnoid, monitoring vasospasme dan deteksi peningkatan tekanan intrakranial (TIK), evaluasi hemodinamik cerebral pada kasus trauma kepala, serta sebagai alat bantu penentuan kasus kematian otak. Pada tindakan pembedahan saraf atau neurosurgery, TCD sangat berguna dalam deteksi dini adanya mikroemboli.Transcranial Doppler Ultrasonography: Diagnosis and Monitoring non Invasive in Neuroanesth and Neurointensive CareTranscranial Doppler (TCD) is ultrasound examination which is already widely used in the field of neuroanesthesia and intensive care. In the field of neurology intensive care, TCD examination is very useful for the evaluation and monitoring of significant changes in the circulation of main cerebral blood vessels, such as the middle cerebral artery (MCA), anterior cerebral artery (ACA), terminal branches of internal carotid artery (ICA), posterior cerebral artery (PCA) , the vertebral artery and the basilar artery. In addition to the flow velocity, the examination can also be used to evaluate changes in the diameter of blood vessels. TCD is used for diagnostic investigation of subarachnoid hemorrhage, vasospasm monitoring and detection of elevated intracranial pressure (ICP), evaluation of cerebral hemodynamics changes in cases of head injury, as well as aids for determination of brain death cases. In neurosurgery, TCD is very useful in the early detection of microemboli.

Tatalaksana Anestesi pada Bedah Minimal Invasif Deep Brain Stimulation (DBS) Fithrah, Bona Akhmad; Fuadi, Iwan; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Otak adalah organ terpenting dalam tubuh manusia. Pada neuroanestesi otak ini dimanipulasi dengan berbagai obat hingga dapat dilakukan pembedahan pada otak itu sendiri. Saat ini berkembang berbagai prosedur bedah syaraf yang bersifat minimal invasif. Dengan hadirnya pembedahan minimal ini diharapkan keluaran bedah syaraf semakin baik dan komplikasi minimal. Salah satu prosedur bedah minimal invasif adalah Deep Brain stimulation (DBS). Prosedur ini memiliki beberapa hal yang harus dipertimbangkan yang bila tidak diperhatikan maka akan menyulitkan operator dan anestesi sendiri. Hal terpenting dari prosedur ini adalah keakuratan untuk menempatkan electrode pada nuclei yang akan dilakukan stimulasi. Anestesi hadir untuk memfasilitasi prosedur minimal invasif ini. Target anestesi pada bedah syaraf minimal invasif tetap sama yaitu perfusi otak yang adekuat. Dan untuk mencapai perfusi otak yang adekuat ini tetap memerlukan persiapan pasien yang baik. Teknik anestesi yang dilakukan berbeda dengan anestesi rutin bedah syaraf. Tekhnik yang umum dikerjakan saat ini adalah monitored anesthesia care dengan local anesthesia, conscious sedation dan anestesi umum. Setiap tekhnik ini memiliki keuntungan, kerugian, pemilihan obat anestesi dan dapat disesuaikan dengan kondisi rumah sakit. DBS sendiri setelah ditanamkan memiliki standar keamanan tersendiri yang harus dipatuhi agar tetap bekerja dengan baik. DBS saat ini dapat ditawarkan sebagai terapi alternatif bagi pasien parkinson yang gagal dengan terapi medikamentosa.Anesthesia for Minimally Invasive Surgery Deep Brain Stimulation (DBS)Brain is the important part from human body. In neuroanesthesia brain is manipulated so surgery can conduct in the brain itsef. Nowadays there are several minimally invasive neurosurgery procedure. What we expect from the minimally invasive surgery is the outcome will be better and or with minimal complication. One of the minimally invasive procedure is Deep Brain Stimulation (DBS). This procedure have some concern to considered if not would complicate the surgeon and the anesthesiologist. Anesthesia come to facilitate this minimally invasive neurosurgery. The goal of anesthesia attending this minimal invasive procedure still the same with routine neurosurgery. which is to make sure adequate cerebral perfusion pressure. Anesthesia procedure litle bit different with common neurosurgery. Anesthesia procedure that recommend nowadays are monitored anesthesia care with local anesthesia, conscious sedation and general anesthesia. All the procedure have advantages and disadvantages, anesthesia drug chosen and customizing with hospital condition. After implanted DBS has certain procedure to be followed if not would endanger or destroyed the DBS itself. Nowadays DBS can be offered as an alternative therapy for the patients which failed with medical therapy.

Peranan Index of Consciousness (IoC) dalam Tatalaksana Total Intravenous Anesthesia pada Operasi Mikrovaskular Dekompresi Sumardi, Fitri Sepviyanti; Fuadi, Iwan; Rahardjo, Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perkembangan ilmu pengetahuan dan tehnik operasi bedah saraf ini berbanding lurus dengan kemajuan keilmuan anestesi. Tatalaksana anestesi sangat mempengaruhi kualitas hidup dan kesehatan pasien pascabedah. Seorang laki-laki 58 tahun dengan diagnosis trigeminal neuralgia sinistra, berat badan 60 kg dan tinggi badan 165 cm. Pasien mengeluh nyeri wajah sebelah kiri yang terkadang disertai nyeri kepala. Riwayat hipertensi dan penyakit penyerta lain disangkal. Riwayat konsumsi obat-obatan seperti carbamazepine disangkal. Dilakukan induksi anestesi umum dengan tehnik total intravenous anesthesia (TIVA) menggunakan teknik target controlled infuse (TCI): propofol, dexmetomidine, fentanyl dan rocuronium, sebagai alat pantau/monitoring digunakan index of consciousness (IoC), lama operasi 2 jam dan lama pasien teranestesi 2 jam 30 menit. Pascabedah pasien dirawat di ICU selama 1 hari, lalu dipindahkan ke ruang rawat inap dan pulang ke rumah pada hari ke-6 perawatan. Mikrovaskular dekompresi merupakan operasi bedah otak yang minimal invasif menuntut para ahli anestesi untuk bertanggung jawab menyokong pascabedah yang lebih optimal, sehingga pasien cepat bangun dan penilaian neurokognitif dilakukan sedini mungkin. Penggunaan IoC sebagai alat pantau pasien/monitoring selama diberikan anestesi TIVA sangatlah berguna. Hal ini bertujuan untuk mencegah timbulnya pasien tetap sadar selama operasi berlangsung, dengan melihat kedalaman anestesi yang diberikan, agar tidak terjadi kekurangan atau kelebihan dosis obat-obatan anestesi yang diberikan.The role of index of consciousness (IoC) Total Intravenous Anesthesia Management for Microvascular Decompression SurgeryThe development of science and engineering neurosurgical operation is directly proportional to the scientific advancement of anesthesia. Management of anesthesia greatly affect quality of life and health of patients postoperatively. A man 58 years old with a diagnosis of the left trigeminal neuralgia, weighing 60 kg and height 165 cm. Patients complain of pain left face is sometimes accompanied by headache. A history of hypertension and other comorbidities denied. A history of consumption of drugs such as carbamazepine denied. Induction of general anesthesia with TIVA technique using TCI: propofol, dexmetomidine, fentanyl and rocuronium, as a means of monitoring / monitoring use IoC (index of consciousness), long operating time of 2 hours and anesthetized patients 2 hours 30 minutes. Postoperative patients admitted to the ICU for 1 day, and then transferred to the wards and go home on the 6th day of treatment. Microvascular decompression is a brain surgery less invasive and requires minimal bleeding anesthesiologists responsible for more optimal postoperative support, so patients quickly get up and neurocognitive assessment done as early as possible. The use IoC as a tool to monitor patients during anesthesia TIVA, its very useful. It aims to prevent the patient awareness during surgery, to see the depth of anesthesia is given, in order to avoid under- or overdosing anesthesia agents.

Tight Brain pada Anestesi Awake Craniotomy dengan Dexmedetomidine Riyadh Firdaus; Dewi Yulianti Bisri; Siti Chasnak Saleh; A. Hmendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Anestesi pada awake craniotomy dilakukan dengan menggunakan salah satu atau kombinasi dari teknik scalp block, sedasi dengan propofol dan dexmedetomidine. Teknik ini memfasilitasi awake craniotomy sehingga pemetaan intraoperatif fungsi korteks elokuen yang memfasilitasi reseksi tumor secara radikal. Kebutuhan pemetaan korteks adalah untuk menggambarkan fungsi otak antara lain bicara, sensorik dan motorik dengan tujuan mempertahankan selama dilakukan reseksi. Obat yang diberikan harus dapat memberikan level sedasi dan analgesia yang adekuat untuk mengangkat tulang tetapi tidak mempengaruhi tes fungsional dan elektrokortikografi. Prosedur ini sama dengan kraniotomi standar dengan perbedaan pasien sadar penuh selama pemetaan korteks dan reseksi tumor. Dexmedetomidine adalah suatu agonis adrenoreseptor α-2 spesifik dengan efek sedatif, analgetik, anesthetic sparing effect, efek proteksi otak, tidak adiksi, tidak menekan respirasi dan pasien mudah dibangunkan. Wanita, 54 tahun dengan keluhan utama kejang berulang sejak 3 hari yang lalu. Berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang pasien didiagnosis tumor lobus frontal kanan. Pasien dilakukan pengangkatan tumor dengan teknik awake craniotomy. Pasien dilakukan scalp block, sedasi dengan propofol dan dexmedetomidine. Saat operasi berlangsung didapatkan kondisi tight brain. Dexmedetomidine dipertimbangkan sebagai salah satu faktor yang mempengaruhi relaksasi otak selama operasi. Lama operasi kurang lebih 5 jam. Pascaoperasi pasien dirawat di HCU.Tight Brain on Awake Craniotomy Anesthesia with DexmedetomidineAnesthesia in awake craniotomy is done using scalp block, propofol sedation, dexmedetomidine sedation or a combination of the three. This technique facilitate awake craniotomy such that intraoperative mapping of eloquent cortical function can be done in radical tumor resection. The need for cortical mapping is to describe and maintain brain function such as speaking, sensoric and motoric function throughout the resection process. The drug given must be able to provide adequate sedation and analgesia for bone removal but do not interfere with the result of function test and electrocorticography. This procedure is similar to other craniotomy, however the patient is alert during cortical mapping and tumor resection and is able to speak after tumor is resected. Dexmedetomidine is an alpha 2 adrenoreceptor agonist with specific effects such as sedation, analgesia, anesthetic sparing, cerebral protection, non addictive, does not suppress respiration, comfortable and easy to recover from. A case of 54 years old female with chief complaint of recurrent seizure in the last 3 days prior to admission is described. Based on history and examination, patient is diagnosed with right frontal lobe tumor. Patient underwent tumor resection using awake craniotomy technique. Scalp block combined with propofol and dexmedetomidine sedation was done. During the surgery, tight brain was encountered. Dexmedetomidine was evaluated as one of the factors that influence the brain relaxation throughout surgery. The Surgery took 5 hours, post surgery patient is observed in HCU.

Efek Proteksi Otak Metamizol Intravena Sebagai Farmakologik Hipotermi Terhadap Suhu Inti Dan Kadar Interleukin-6 Pada Pasien Cedera Kepala Berat Muhammad Erias; Ruli Herman Sitanggang; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Cedera kepala berat merupakan salah satu penyebab mortalitas dan morbiditas bagi pasien pasca trauma. Sirkulasi sitokin interleukin-6 (IL-6) pada cedera kepala berat dan proteksi otak dalam pengaturan suhu berhubungan dengan hasil luaran berupa morbiditas dan mortalitas. Tujuan dari penelitian ini mengkaji efek proteksi otak metamizol intravena sebagai farmakologik hipotermi terhadap suhu inti dan kadar interleukin pada cedera otak traumatik. Subjek dan Metode: Penelitian merupakan penelitian tersamar acak ganda yang dilakukan pada 30 pasien dewasa dengan cedera kepala berat yang dikelompokkan menjadi dua kelompok yaitu kelompok kontrol dan kelompok metamizol (M). Kelompok M diberikan metamizol intravena 15 mg/kgbb setiap 8 jam selama 72 jam. Data yang dicatat adalah suhu membran timpani setiap 8 jam dan kadar IL-6 setiap 24 jam selama 72 jam. Penelitian dilakukan selama bulan Juli sampai Agustus 2016 dan hasil penelitian diuji statistik menggunakan uji t berpasangan, uji Mann-Whitney, Uji Chi-square dan uji Fisher's Exact. Hasil: Penelitian menunjukkan bahwa nilai IL-6 pada kelompok M 244,20±93,07, lebih rendah dari kelompok K 375,20±152,62 dengan nilai p=0,006 pada jam ke-48 dan pada jam ke-72 dengan kadar IL-6 197,20±76,03 dan nilai p=0,008 sehingga bermakna secara statistik (p0,05). Subjek pada kelompok M juga menunjukkan suhu tubuh yang lebih rendah secara keseluruhan dan bermakna secara statistik (p0,01). Simpulan: Metamizole mempunyai efek proteksi otak dan mempunyai kegunaan sebagai farmakologik hipotermi pada cedera kepala traumatik.Effect Brain Protection Metamizol Intravenous as Pharmacalogic Hypothermia to Core Temperature and Interleukin-6 Level in Severe Traumatic Brain InjuryBackground and Objective: Severe traumatic brain injury (TBI) is one of the major cause of morbidity and mortality in trauma. Circulating interleukin-6 (IL-6) and neuroprotection from temperature has a strong relation with improve outcome. The aim of this study is to evaluate the brain protection properties of intravenous metamizole as a hypothermic pharmacologic in reducting IL-6 and core temperature regulation on severe TBI. Subject and Method: This is a randomized controlled trial to 30 adult pasien with severe TBI which was distributed into two groups which was control group (K) and metamizole group(M). The M grup was given 15 mg/kgbw of intravenous metamizole every 8 hours for 72 hours. Core temperature from the tympnic membrane every 8 hours and IL-6 every 24 hours was noted for 72 hours. This studi was conducted from July to August 2016 and the data was then analyzed statistically using the paire t test, Mann-Whitney test, Chi-Square test and Fishers’s Exact test. Result: Shows that IL-6 on the M group was 244.20±93.07 which was lower than the K group at 375.20±152.62 with p=0.006 on the 48th hour and on the 72nd hour with IL-6 at 197.20±76.03 with p=0.008 which is statistically significant (p0.005) and also shows lower temperature at every recording with p0.01. Conclusion: Metamizole has brain protecting properties in reducing circulating IL-6 and has uses as a hypothermic agent in severe TBI.

Insidensi Hipoksemia dan Hipotensi pada Cedera Otak Traumatik di RSUP Dr. Hasan Sadikin Bandung Tahun 2015 Arif, Izhar Muhammad; Usman, Hermin Aminah; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Cedera otak traumatik (COT) merupakan kasus cedera dengan prevalensi ketiga terbesar diantara cedera bagian tubuh lain (16,8%) di Indonesia. Hipotensi dan hipoksemia adalah prediktor luaran COT yang dapat dikontrol. Penelitian ini bertujuan untuk mengetahui insidensi hipotensi dan hipoksemia pada pasien COT., yang masuk di unit Gawat Darurat Rumah Sakit Dr. Hasan Sadikin.Subjek dan Metode: Penelitian ini berupa deskriptif kuantitatif. Data diambil secara retrospektif dari rekam medis pasien dengan diagnosis COT yang masuk ke Unit Gawat Darurat RSUP Dr. Hasan Sadikin periode 1 Januari 201531 Desember 2015. Sampel diambil secara total sampling, kemudian diklasifikasikan berdasarkan usia, jenis kelamin, etiologi cedera, tingkat COT, saturasi oksigen, dan tekanan darah pasien.Hasil: Didapatkan 669 sampel penelitian. Rata-rata umur sampel adalah 29 tahun dengan jumlah terbanyak di kelompok umur 1524 tahun (30,3%). Kejadian pada laki-laki (71,2%) lebih tinggi dibandingkan perempuan (28,8%). COT paling banyak disebabkan oleh kecelakaan lalulintas (KLL) (68,9%). Terdapat 78 (11,7%) kasus COT berat. Pasien COT yang mengalami hipotensi dan hipoksemia sebanyak 50 orang (7,5%), dan angka kejadian hipotensi dan hipoksemia paling tinggi terdapat pada pasien COT berat (66%). Simpulan: Proporsi kejadian hipoksemia dan hipotensi paling banyak terjadi pada COT berat dengan etiologi KLL.Hypoxaemia and Hypotension Incidence of Traumatic Brain Injury in Dr. Hasan Sadikin Hospital Bandung in 2015Background and Objectives: Traumatic brain injury (TBI) is a case with the third highest prevalence among other injuries (16,8%) in Indonesia. Hypotension and hypoxaemia are TBI outcome predictors which can be controlled. This research aims to find out the incidence of hypotension and hypoxaemia in TBI patients.Subjects and Method: This descriptive quantitative research collected the data retrospectively from the medical record of COT patients who were admitted to Emergency Room (ER) Dr. Hasan Sadikin Public General Hospital in 1 January 31 December 2015. Samples were collected with total sampling technique, and classified based on age, gender, etiology, TBI severity level, oxygen saturation, and blood pressure of the patients.Results: 669 samples were collected. Age average of the samples was 29 years with the highest age group frequency being 15-24 years (30,3%). There were more male patients (71,2%) compared to the female ones (28,8%). The most common cause of TBI was traffic accidents (68,9%). There were 78 (11,7%) severe TBI cases. There were 50 (7,5%) TBI patients with hypoxaemia and hypotension, and the most hypotension and hypoxaemia cases were in severe TBI patients (66%).Conclusion: The proportion of hypoxaemia and hypotension incidence was the highest in severe TBI patients due to traffic accidents.

Penatalaksanaan Anestesi pada Reseksi Tumor Batang Otak Krisna J. Sutawan, Ida Bagus; Bisri, Dewi Yulianti; Saleh, Siti Chasnak; Wargahadibrata, A. Himendra
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Batang otak adalah komponen dari fossa posterior, oleh karena itu penatalaksanaan anestesi pada reseksi tumor di batang otak tentunya mengikuti prinsip-prinsip umum penatalaksanaan anestesi pada fossa posterior ditambah dengan perhatian khusus terhadap komplikasi yang mungkin terjadi pada saat melakukan manipulasi pada batang otak. Seorang laki-laki 41 tahun dengan tumor batang otak mengeluh adanya pengelihatan ganda, rasa tebal dan nyeri pada wajah serta gangguan menelan, pada MRI ditemukan lesi difus batas tidak tegas di daerah pons sampai mid brain, curiga tumor otak primer (low grade tumor), nervus optikus dan kiasma optikum kanan kiri tampak normal. Pasien berhasil dianestesi dengan baik digunakan TCI- propofol monitoring standar ditambah monitoring invasif artery line dan pemasangan kateter vena sentral, intraoperatif pasien mengalami episode hipotensi tekanan darah (70/40 mmHg) dan bradikardia, (laju nadi 35 x/menit), oksigen 50%, fentanyl sevofluran dan rekuronium, digunakan akibat manipulasi pada batang otak. Postoperatif pasien dirawat di ICU dan diextubasi 12 jam kemudian.Anesthesia Management in Brain Steam Tumor ResectionBrain steam is a component of fossa posterior, ther fore anesthesia management for brain steam tumor resection should follow the general rule for anesthesia management of fossa posterior and a special concern for complication that could happen when brain steam is manipulated. Forty one year old male with a brain steam tumor complain a double vision, numbness and pain on the face, and swallowing problem, MRI show diffuse lesion on the pons to mid brain, suspect primary brain tumor (low grade tumor), nervus opticus and chiasma opticum are normal. Patient has been anesthesied well using TCI propofol, oxygen 50%, fentanyl, sevoflurane and rocuronium using invasive monitoring artery line and central venous catheter (CVC) in addition to standart monitoring. Intraoperatifly patient going through a hypotensive episode (blood pressure 70/40 mmHg) and bradycardia (heart rate 35x/minute that caused by manipulation on the brain steam. Postoperatifly patient is in the ICU and extubated on next 12 hours.

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Home Page

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Editorial Team

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Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

Phone +6287722631615

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

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Abstract

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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
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INDONESIA