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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 7, No 2 (2018)" : 8 Documents clear

Perbandingan Antara Fentanil 2 μg/kgBB/jam dan Scalp Block Terhadap Peningkatan Hemodinamik dan Kadar Glukosa Darah Sewaktu Saat Pemasangan Pin Kepala Pada Kraniotomi Robert Sihombing; Dewi Yulianti Bisri; Ruli Herman Sitanggang
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Opioid dosis tinggi efektif memblokade nyeri pada operasi kraniotomi namun memiliki efek yang tidak diinginkan. Alternatif lain menggunakan teknik scalp block dikombinasikan dengan anestesi umum. Tujuan penelitian ini untuk membandingkan hemodinamik dan kadar glukosa darah sewaktu (GDS) antara fentanil 2 μg/kgBB/jam dan scalp block saat pemasangan pin kepala pada kraniotomi pengangkatan tumor elektif dengan anestesi umum. Subjek dan Metode: Penelitian ini dilakukan pada 28 pasien yang direncanakan pembedahan tumor otak elektif. Subjek penelitian dibagi menjadi dua kelompok: scalp block dan kelompok fentanil 2 μg/kgBB/jam. Tekanan arteri rerata, laju nadi dan kadar GDS intraoperatif dinilai dan dianalisis menggunakan uji-t berpasangan dan Chi-square.Hasil: MAP dan laju nadi antara kedua grup memiliki perbedaan signifikan (p0,05). Kelompok fentanil memiliki MAP dan laju nadi lebih tinggi dibanding dengan kelompok scalp block. Namun perbandingan kadar GDS antara kedua kelompok tidak menunjukkan hasil yang signifikan (p0,05).Simpulan: Scalp block lebih efektif dalam mengurangi peningkatan hemodinamik namun sama efektif dengan fentanil 2 μg/kgBB/jam dalam mengurangi peningkatan kadar GDS pada pasien yang menjalani operasi kraniotomi pengangkatan tumor elektif.Comparison Between Fentanyl 2 μg/kg/hr and Scalp Block of Hemodynamic Improvement and Blood Glucose Levels During Head Pin Installment in CraniotomyBackground and Objective: High dose opioids is one of the most effective techniques for blocking pain in craniotomy surgery but it has undesirable effect. Other alternative to overcome pain in craniotomy is using a scalp block technique in combination with general anesthesia. The aim of this study was to compare the increase of hemodynamic and blood glucose levels (BGL) between fentanyl 2 μg/kgBW/hr and scalp block during head pin installment in craniotomy surgery.Subject and Method: Twenty eight patients undergoing elective craniotomy tumor removal surgery were enrolled in the study. The patients were divided into two groups: scalp block and fentanyl 2 μg/kgBW/hr. Intraoperative mean arterial pressure (MAP), heart rate (HR) and BGL were recorded, and analyzed by paired t-test and Chisquare.Result: MAP and HR showed significant differences between groups (p0,05), wherein fentanyl group had higher MAP and HR than scalp block group. However, BGL during head pin installment did not show significant results between the two groups (p 0,05).Conclusion: Scalp block is more effective than fentanyl 2 μg/kgBW/hr in reducing increased of hemodynamic but equally effective with fentanyl in reducing increased of BGL during head pin installment in craniotomy tumor removal.

Trombosis Vena Otak Marwan, Kenanga; Jasa, Zafrullah Kany; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Trombosis vena otak (TVO) adalah trombosis pada vena otak dan sinus mayor duramater. Faktor resiko terjadinya TVO meliputi faktor genetik trombofilia dan penggunaan kontrasepsi hormonal. Manifestasi klinis TVO sangat bervariasi. Timbulnya gejala dan tanda bersifat akut, subakut, atau kronis. Empat sindrom utama yang muncul: hipertensi intrakranial terisolasi, kelainan neurologis fokal, kejang, dan ensefalopati. Sindrom ini dapat muncul dalam kombinasi atau terisolasi tergantung pada luas dan lokasi TVO. Tatalaksana fase akut dari TVO berfokus pada antikoagulan, manajemen dari sekuele seperti kejang, peningkatan tekanan intrakranial, dan infark vena.2 Penyebab utama kematian pasien TVO selama fase akut adalah herniasi transtentorial yang kebanyakan disebabkan karena perdarahan vena. Mayoritas pasien mengalami penyembuhan parsial dan sekitar 10% mengalami defisit neurologis permanen hingga 12 pasien terjadi pada bulan ketiga) dan akan terbatas setelahnya. Rekurensi dari TVO termasuk jarang (2,8%).Cerebral Venous ThrombosisCerebral venous thrombosis is a condition of thrombosis in cerebral veins and major sinus duramater. Risk factor of cerebral venous thrombosis include genetic factor like thrombophylia and hormonal contraception. There are variations in clinical manifestation of cerebral venous thrombosis. The sign and symptom could be divided into acute, subacute or chronic onset. There are 4 syndroms of clinical manifestations of cerebral venous thrombosis: isolated intracranial hypertension, focal neurologic deficits, seizure, and encephalopathy. The focus of treatment in cerebral venous thrombosis is anticoagulant therapy, sequele of seizure, to treat intracranial hypertension and venous infract. The main cause of death patient with acute onset cerebral venous thrombosis is transtentorial herniation due to venous bleeding. Partial recovery happens in mostly patient with cerebral venous thrombosis anda about 10% had permanent neurologic deficits untill 12 moths. Recanalisation occurs in the first month after cerebral venous thrmbosis (84% patient in the third month) and limited after that. Cerebral venous thrombosis recurrency is rare (2,8%).

Kadar Hemoglobin, Jumlah Perdarahan dan Transfusi pada Pasien yang Menjalani Operasi Tumor Otak di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung Tahun 20152016 Ningsih, Diana Fitria; Suwarman, Suwarman; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Operasi tumor otak berhubungan erat dengan risiko perdarahan dalam jumlah besar yang dapat menyebabkan anemia. Efek klinis anemia dapat diperbaiki dengan pemberian transfusi darah. Transfusi diberikan dengan target level Hemoglobin (Hb) antara 9 sampai 10 gr/dL. Tujuan penelitian ini adalah untuk mengetahui gambaran kadar Hb dan hematokrit prabedah dan pascabedah, jumlah perdarahan serta pemberian transfusi darah pada pasien yang menjalani operasi tumor otak di RSUP Dr. Hasan Sadikin Bandung periode Juni 2015 sampai dengan Juni 2016.Subjek dan Metode: Penelitian ini merupakan penelitian deskriptif observasional yang dilakukan secara retrospektif terhadap 126 objek penelitian yang diambil di bagian rekam medis.Hasil dan Simpulan: Penelitian ini memperoleh hasil kadar Hb prabedah rata-rata sebesar 13,231,35 gr/dL dan hematokrit prabedah rata-rata sebesar 39,193,54%. Kadar Hb pascabedah 9 gr/dL sebanyak 15 pasien, Hb 910 gr/dL sebanyak 6 pasien dan Hb 10 gr/dL sebanyak 105 pasien. Hematokrit pascabedah rata-rata sebesar 34,036,03%. Jumlah perdarahan rata-rata sebesar 11591032,66cc. Transfusi yang diberikan pada 56 pasien terdiri atas PRC dengan jumlah rata-rata sebesar 365,81258,70cc, FFP rata-rata sebesar 425,45274,78cc dan WB 250cc.Hemoglobin Levels, Blood Loss and Transfusionin Patients Underwent Brain Tumor Surgery atDr. Hasan Sadikin Bandung General Hospital During 20152016Background and Objective: Brain tumor surgery is closely related to the risk of numerous bleeding that can cause the patient to be in an anemic condition. The clinical effects of anemia can be improved by administered blood transfusions. Transfusion can be administered with target Hemoglobin (Hb) level between 9 to 10 gr/dL.The purpose of this study was to describe of preoperative and postoperative levels of Hb and hematocrit, blood loss and how blood transfusion administered in patients undergoing brain tumor surgery at Dr. Hasan Sadikin Bandung during June 2015 to June 2016.Subject and Method: This is a descriptive observational study with retrospective approach to 126 objects taken at medical records.Result and Conclusion: The average of preoperative Hb level was 13,231,350 gr/dL and the average of preoperative hematocrit level was 39,193,54%. Number of patients with postoperative Hb level 9 gr/dL were 15 patients, Hb 9-10 gr/dL were 6 patients and Hb10 gr/dL were 105 patients. The average of postoperative Ht were 34,036,032%. The rate of blood loss was 11591032,66cc. The rate of transfusions administered to 56 patients was pack red cell 365,81258,70cc, fresh frozen plasma 425,45274,78cc and whole blood 250cc.

Ventilasi Mekanik yang Memanjang pada Pasien Cedera Otak Traumatik Berat dengan Kejang Pascatrauma Rr Sinta Irina; Bambang J Oetoro; Syafruddin Gaus
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala trauma masih merupakan masalah di seluruh dunia karena masih merupakan salah satu penyebab utama kematian dan kecacatan pada anak-anak dan dewasa. Akibat cedera primer bisa terjadi cedera sekunder yang akan mempengaruhi hasil luaran. Kejang merupakan salah satu komplikasi dari cedera kepala trauma berat. Kejadian kejang, demam, infeksi paru merupakan cedera sekunder yang akan mempengaruhi hasil luaran. Seorang laki-laki, 24 tahun, 50 kg dirujuk dari RSUD dengan penurunan kesadaran GCS E1M2V1, dari hasil scan kepala didapatkan perdarahan intraserebral di frontal kanan/kiri dan parietal kanan, perdurahan subdural, perdarahan subarachnoid dan oedema serebri. Pasien segera diintubasi di UGD dan direncanakan evakuasi perdarahan dan dekompresi craniektomi. Setelah perawatan ke-2 pasien mengalami kejang yang cukup sering dan durasi lama sehingga proses penyapihan dari ventilator terhambat. Dan salah satu komplikasi pemakaian ventilator 48-72 jam adalah ventilator-associated pneumonia (VAP). Diberikan terapi antibiotik sesuai kultur dan penanganan bagi pemulihan paru. Pasien bisa lepas dari ventilator walaupun masih terpasang dengan tracheostomy.Prolonged of Mechanical Ventilation at Intensive Care Unit (ICU) in Patients with Severe Traumatic Head Injury with Post Traumatic SeizuresTraumatic head injury is still a worldwide problem as it is still one of the leading causes of death and disability in children and adults. As a result of a primary injury, a secondary injury will affect the outcome. Seizures are one of the complications of severe trauma head injury. Occurrence of seizures, fever, lung infections is a secondary injury that will affect the outcome. A man, 24 years old, 50 kg was referred from the RSUD with decreased awareness of GCS E1M2V1, from head scans obtained intracerebral hemorrhage on the right and left frontal and right parietal, subdural suburural, subarachnoid hemorrhage and cerebral edema. Patients are immediately intubated in the ER and planned evacuation of bleeding and craniectomy decompression. After the 2nd treatment the patient experienced frequent seizures and long duration so that the weaning process of the ventilator is inhibited. And one of the complications of ventilator use 48-72 hours is VAP (ventilator-associated pneumonia). Given appropriate antibiotic therapy for culture and treatment for lung recovery. Patients can escape from the ventilator although still attached with tracheostomy.

Fast Track Anesthesia untuk Prosedur Kraniotomi Evakuasi Hematom karena Stroke Hemoragik Bona Akhmad Fithrah; Bambang Suryono; Siti Chasnak Saleh; Himendra Warga Dibrata
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Fast tract anesthesia pertama kali dikenalkan pada periode 1990 dengan maksud untuk untuk mencegah kerusakan multi organ, komplikasi dan berujung pada masa pemulihan yang cepat. Dengan masa pemulihan yang cepat diharapkan akan mengurangi penggunaan ruang rawat intensif dan masa tinggal di rumah sakit yang lebih pendek. Prosedur fast tract bukan sekedar ekstubasi cepat tapi juga bagaimana mengelola pasien secara efektif dan efisien anestesi dalam periode perioperatif. Kondisi preoperatif yang baik. Penggunaan obat obatan kerja pendek-menengah dan prosedur yang singkat sangat menentukan kesuksesan fast track anesthesia. Akan kami laporkan suatu kasus perdarahan intrakranial, laki laki 60 th masuk ke IGD dengan keluhan sakit kepala berat, pasien dengan riwayat hipertensi tidak terkontrol, diabetes mellitus dan stroke non hemoragik sebelumnya tahun 2013. GCS masuk E3M6Vapasia. Tekanan darah 180/110 mmHg saat masuk. Dari CT scan kepala didapatkan perdarahan intracrebri pada lokasi temporoparietal kiri. Dilakukan prosedur evakuasi hematom segera. Gejolak hemodinamik saat laringoskopi direk dicegah dengan menggunakan lidokain intravena. Saat intraoperatif dilakukan teknik balans anestesi antara intravenous anestesi dengan gas anestesi. Analgetik diberikan intermitten dan relaksan diberikan secara kontinyu. MAP dipertahankan sekitar 90-110. Gula darah diperiksa setiap jam dan dipertahankan dengan drip insulin. Hemodinamik intraoperatif relatif stabil. Prosedur evakuasi hematom dilakukan selama tiga jam. Dengan pertimbangan kesadaran preoperatif yang baik, prosedur yang tidak terlalu lama, hemodinamik stabil selama operasi, udem jaringan otak yang minimal tidak ada kerusakan jaringan yang berat maka dilakukan ekstubasi dan pasca operasi pasien dirawat di HCU. Pasien dirawat selama dua hari di HCU dan hari ke delapan pasien sudah keluar dari rumah sakitFast Track Anesthesia untuk Prosedur Kraniotomi Evakuasi Hematom karena Stroke HemoragikFast tract anesthesia first time introduced in early 1990 with aim to prevent multi organ failure, complication and speedy recovery. With a quick recovery will reduce intensive care unit usage and reduce length of stay in the hospital. Fast tract anesthesia not just early extubation but also how to manage with effective and efficient anesthesia during perioperative. Good preoperative condition, using short acting drug and short procedure will determinate the successful of fast tract anesthesia. Here we report an intracerebral hemorrhage with fast tract anesthesia. Men, 60 yo attended to the ER with complaining severe headache. Patient with uncontrolled hypertension, diabettes mellitus and stroke non hemorahic in 2013. GCS when admission E3M6Vaphasia and blood pressure 180/110 mmHg. CT scan said intracerebri hemmorhage at left temporoparietal. Evacuation hematom performed urgently. Hemodinamic unstability during laringoscopy direct prevent with lidocaine intravenous. Anesthesia performed with balamnce anesthesia using intravenous and inhaled anesthesia. Analgetic intermitten, muscle relaxant given continuosly. MAP controlled 90-110. Blood glucose check every one hour and stabilized using insulin. During operation hemodynamic relatively stable. Procedur completed after three hours. Considering preoperatif awareness still good, not too long procedur, hemodynamic stable, and minimal brain edema or other brain tissue damaged patient extubated and transport to High care unit.patient was observed in the HCU for two days and after eight days stayed in the hospital patient can go back home.

Penanganan Cedera Kepala Berat disertai Intoksikasi Alkohol Akut dengan Panduan Transcranial Doppler Paskaoperasi Krisna J. Sutawan, Ida Bagus; Gaus, Syafruddin; Oetoro, Bambang J.
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala yang disertai dengan intoksikasi alkohol akut memerlukan suatu perhatian khusus selain karena nilai GCS yang digunakan untuk menggolongkan derajat beratny cedera kepala penilaiannya dipengaruhi oleh intoksikasi alkohol, juga karena pengaruh alkohol pada susunan saraf pusat. Transcranial doppler (TCD) dapat digunakan secara noninvasif untuk mengevaluasi aliran darah ke otak, tekanan intrakranial dan tekanan perfusi serebri. Panduan TCD membantu dalam pengambilan keputusan pada perawatan pascaoperasi. Seorang laki-laki 23 tahun dengan GCS E1V2M4, dari foto CT-scan didapatkan subdural hematoma lobustemporoparietal kanan yang menyempitkan sisterna ventrikel lateralis kanan dan deviasi midline sejauh 0,54 cm ke kiri. Pasien ditangani sesuai dengan standar prosedure operasional cedera kepala berat, operasi evakuasi hematoma dan kranietomi berjalan dengan lancar. Dua belas jam pascaoperasi pada pemeriksaan TCD didapatkan aliran darah dan tekanan intrakranial normal, sehingga pasien diextubasi dengan GCS 15 hanya dalam waktu 18 jam pascaoperasi.Management of Severe Head Injuri with Alcohol Intoxication guided by Pascaoperatif Transcranial DopplerHead injury associated with alcholol intoxication needs special concideration, not only because GCS which is used to classifying the severity of head injury is affected by alcohol intoxication, but also because of the effect of alcohol to the central nervous system. Transcranial doppler (TCD) can be used noninvasifly to evaluate cerebral blood flow, intracranial pressure and cerebral perfusion pressure. TCD guidance helps in decision making on postoperative management. Twenty three years old male, GCS E1V2M4 , on a CT-scan image there is a subdural right lobustemporoparietal hematoma constricting the right ventricular lateral system and a midline deviation of 0.54 cm to the left. Patient was managed according to standart operational procedure for severe head injury, hematoma evacuation and craniectomy procedures went smoothly. Twelve hours postoperative, from TCD examination obtained normal blood flow and intracranial pressure, so patients were extubated with GCS 15 in just 18 hours postoperatively.

Pengelolaan Hipertensi Intrakranial yang Membandel pada Cedera Otak Traumatik Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
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Hipertensi intrakranial yang membandel (intractable/refracter/malignant intracranial hypertension) didefinisikan sebagai peningkatan tekanan intrakranial (intracranial pressure/ICP) lebih dari 25 mmHg selama 30 menit, 30 mmHg selama 15 menit, atau 40 mmHg selama 1 menit. Definisi lain adalah peningkatan ICP sebagai peningkatan spontan ICP 20 mmHg selama 15 menit dalam periode 1 jam meskipun telah dilakukan intervensi first-tier secara optimal atau ICP 25 mmHg untuk 1-12 jam. Hipertensi intrakranial adalah kelainan yang dapat berakibat fatal. Mortalitas tertinggi dari hipertensi intrakranial terlihat pada pasien dengan cedera kepala berat, yang mana peningkatan ICP sangat ekstrim dan sering membandel terhadap terapi. Masalah utama peningkatan ICP adalah iskemia dan herniasi.Tindakan untuk terapi hipertensi intrakranial adalah pasang monitor ICP, pertahankan cerebral perfusion pressure (CPP) 50-70 mmHg, first-tier therapy dan second-tier therapy. Indikasi pemasangan monitor ICP adalah 1) abnormal CT scan dan skor GCS 3-8 setelah dilakukan resusitasi yang adekuat untuk syok dan hipoksia, 2) normal CT scan dan skor GCS 3-8 disertai dengan 2 atau lebih hal-hal berikut: umur 40 tahun, posturing, atau tekanan darah sistolik 90 mmHg. Terapi untuk menurunkan ICP dimulai pada level ICP 20-25 mmHg. First-tier therapy untuk terapi peningkatan tekanan intrakranial adalah: 1) CSF drainase melalui kateter intraventricular, 2) diuresis dengan mannitol, 0,25-1,5 g/kg berikan lebih 10 menit, 3) moderate hiperventilasi.Bila tekanan intrakranial membandel terhadap first-tier therapy (intractable) lakukan second-tier therapy yaitu hiperventilasi untuk mencapai PaCO2 30 mmHg (dianjurkan memasang monitor SJO2, AVDO2, dan/atau CBF), dosis tinggi terapi barbiturat, hipotermia, terapi hipertensif, dekompresif kraniektomi.The Management of Intractable Intracranial Hypertension in Traumatic Brain InjuryIntractable intracranial hypertension (refractory/malignant intracranial hypertension) defined as intracranial pressure (ICP) that exceed 25 mmHg for 30 minutes, 30 mmHg for 15 minutes, or 40 mmHg for 1 minute. Other definition are refractory elevation in ICP as a spontaneous increase ICP 20 mmHg during 15 minutes within a 1 hour period despite optimized first-tier intervention or ICP 25 mmHg for 1-12 hour. Intracranial hypertension is a potentially fatal disorder. The highest mortality from intracranial hypertension is seen in patient with severe head injury, in whom elevations in intracranial pressure are extreme and frequency resistant to treatment. Main problem of increased intracranial pressure (ICP) are ischemia and herniation.Treatment of intracranial hypertension includes insert ICP monitor, maintenance CPP 50-70 mmHg, first-tier therapy and second-tier therapy. Indication for insertion of an ICP monitor include 1) an abnormal CT scan and a GCS score of 3 to 8 after adequate resuscitation of shock and hypoxia, 2) normal CT scan and a GCS of 3 to 8 accompanied by two or more the following at admitted hospital: age 40 years, posturing, or systolic blood pressure of 90 mmHg. Treatment to decrease ICP usually initated at ICP level of 20-25 mmHg. The aim is to maintain CPP 50-70 mmHg. First-tier therapy involves the following: 1) incremental CSF drainage via an intraventricular catheter, 2) diuresis with mannitol, 0.25-1.5 g/kg over 10 minutes, 3) moderate hyperventilation. If intracranial hypertension intractable to first-tier therapy, do second-tier therapy: hyperventilation to achieved PaCO2 30 mmHg (SJO2, AVDO2, and/or CBF monitoring is recommended), high dose barbiturate therapy, consider hypothermia, consider hypertensive therapy, consider decompressive craniectomy.

Dexmedetomidine dan Natrium Laktat Hipertonik pada Bedah Transfenoid Makroadenoma Hipofisis dengan Hiponatremia Prihatno, MM. Rudi; Setiawan, Agus Budi
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Makroadenoma hipofisis merupakan salah satu tumor sellar yang banyak ditemukan di Indonesia. Tumor Sellar memiliki variabilitas histologis yang besar dan mewakili sekitar 10 - 15% dari semua neoplasma intrakranial, dari adenoma hipofisis yang ada mewakili 95% lesi dan merupakan penyebab sekitar 25% dari semua reseksi bedah untuk tumor susunan saraf pusat (SSP). Salah satu tatalaksana makroadenoma hipofisis adalah dengan melakukan upaya intervensi melalui pendekatan transsfenoid. Seorang laki-laki berusia 64 tahun yang mengalami kecelakaan dan menjalani tindakan pembedahan ortopedi. Pasca dilakukan prosedur bedah ortopedi, pasien dirawat di ruang rawat intensif selama 16 hari karena mengalami gangguan ketidakseimbangan elektrolit berkepanjangan, serta didiagnosa menderita tumor di area hipofisisis setelah menjalani pemeriksaan CT-scan. Pasien kemudian direncanakan dilakukan pembedahan melalui pendekatan transphenoid. Pembedahan berlangsung selama 360 menit. Selama pembedahan kondisi hemodinamik stabil, penggunaan opioid minimal dan pasien pulih sadar dengan cepat. Pasien di rawat di ruang perawatan intensif selama 24 jam dan dipindahkan ke ruang perawatan umum. Keluhan yang menyertai pasien pascaoperasi adalah gangguan bernafas melalui hidung kanan dan pusing. Tidak ada gangguan keseimbangan elektrolit yang berlebihan pasca operasi. Penggunaan dexmedetomidine sebagai ajuvan anestesi inhalasi akan mengurangi penggunaan opioid, sedangkan cairan natrium laktat hipertonik pada kasus ini sebagai upaya untuk mempertahankan keseimbangan elektrolit serta membantu dalam proses pembedahan.Dexmedetomidine and Hypertonic Sodium Lactate in Surgical Transphenoid Macroadenoma Hypophyse with HyponatremiaMacroadenoma pituitary is one of the most common sellar tumors found in Indonesia. Sellar tumors have great histologic variability and represent about 10-15% of all intracranial neoplasms, of existing pituitary adenomas representing 95% of lesions and account for about 25% of all surgical resections for CNS tumors. One of the management of pituitary macroadenoma is by making intervention through transsphenoid approach. A 64-year-old man who had an accident and underwent orthopedic surgery. After orthopedic surgery, the patient was admitted to the intensive care unit for 16 days due to prolonged electrolyte imbalance, and was diagnosed with a tumor in the pituitary area after undergoing a CT scan. The patient then planned surgery through a transphenoid approach. Surgery procedure lasted for 360 minutes. During surgicall, patient in stable hemodynamic conditions, minimal opioid use and the patient recovers consciously quickly. The patient was admitted to the intensive care unit for 24 hours and transferred to the general ward. Complaints that accompany the patient are breathing problems through the right nose and dizziness. There is no electrolyte excessive imbalance postoperative. The use of dexmedetomidine as an adjuvant of inhaled anesthesia will reduce the opioids requirement, while hypertonic lactic sodium liquid in this case as an attempt to maintain electrolyte balance and assist in the process of surgery.

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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