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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 3 (2018)" : 8 Documents clear

Pengelolaan Anestesi untuk Eksisi Tumor Intradura Intramedula (IDIM) Setinggi Vertebra Cervical 5-6 dengan Panduan Intraoperative Neurophysiological Monitoring Santosa, Dhania Anindita; Harijono, Bambang; Hamzah, Hamzah; Jasa, Zafrullah Kany; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Eksisi tumor intradura intramedula (IDIM) dengan bantuan intraoperative neurophysiological monitoring (IOM) merupakan suatu teknik pembedahan yang bertujuan agar eksisi tumor dilakukan semaksimal mungkin, dengan meminimalkan defisit neurologis akibat pembedahan. Penanganan anestesi pada eksisi tumor IDIM dengan bantuan IOM ini, seorang ahli anestesi perlu menguasai ilmu dan keterampilan neuroanestesi untuk pembedahan tulang belakang, selain itu juga pemilihan teknik, jenis dan dosis obat yang mendukung pelaksanaan pembedahan dengan IOM ini. Seorang laki-laki usia 52 tahun dengan tumor IDIM setinggi vertebra cervical 56 menjalani pembedahan eksisi tumor dengan bantuan IOM. Pembedahan dilakukan di bawah pengaruh anestesi umum dengan induksi intravena. Laringoskopi dilakukan dengan video laryngoscope. Pembedahan dilakukan dengan panduan IOM, selama anestesi diberikan total intravenous anesthesia tanpa pemberian pelumpuh otot tambahan setelah intubasi. Pembedahan berlangsung selama enam jam dan tumor dapat terangkat seluruhnya. Tantangan selama periode perioperatif adalah penilaian dan persiapan prabedah yang teliti, posisi pasien dan pemilihan teknik anestesi yang tepat.Anesthesia Management for Cervical 5-6 Intradural Intramedullary (IDIM) Tumor under Intraoperative Neurophysiological Monitoring GuidanceExcision of intradural intramedullary (IDIM) tumor using intraoperative neurophysiological monitoring (IOM) is one surgical technique aiming to excise tumor as maximum as possible, with minimum neurological deficit. In anesthesia management for IDIM tumor excision under IOM guidance, an anesthesiologist is required to master neuroanesthesia knowledge and skill, especially for spine surgery. Moreover, understanding the art of anesthesia technique, drug and dose supporting surgery with IOM. A male patient, 52 years old, with IDIM tumor at the level of cervical 5-6th underwent surgery for tumor excision using IOM. Surgery was done under general anesthesia, started with intravenous induction, and intubation was done using video laryngoscope. Surgery was done under IOM guidance, total intravenous anesthesia was implemented and no additional muscle relaxant was given after intubation. Surgery lasted for six hours and tumor was resected completely. Challenges during perioperative period are meticulous preoperative assessment and preparation, patient positioning and appropriate anesthesia technique.

Manajemen Anestesi pada Pasien dengan Akromegali yang Menjalani Prosedur Reseksi Tumor Adenohipofise melalui Pendekatan Sublabial Transphenoidal Hamzah, Hamzah; Farris, Muhammad; Avidar, Yoppie Prim; Rehatta, Nancy Margaritta
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Akromegali merupakan penyakit akibat produksi growth hormone secara berlebihan dan umumya disebabkan oleh adenoma kelenjar hipofisis. Insidensi akromegali pertahunnya mencapai 5 kasus per 1 juta orang dengan prevalensi 60 kasus per 1 juta orang. Manifestasi klinis pada tiap pasien berbeda, tergantung dari kadar dari growth hormone, insulin-like growth factor-1, usia pasien, ukuran tumor, dan keterlambatan diagnosis. Pasien dengan akromegali telah dilaporkan memiliki tingkat mortalitas dan morbiditas yang tinggi, peningkatan angka kematian pada umumnya terkait dengan komplikasi kelainan kardiovaskular, serebrovaskular dan masalah respirasi. Pada kasus ini, seorang laki-laki usia 57 tahun, berat badan 86 kg, dengan PS-ASA II, perawakan khas akromegali dan ditunjang dengan hasil pemeriksaan hormon. Pada pemeriksaan CT-scan ditemukan massa di ruang sella tursica. Pemeriksaan lebih lanjut menunjukkan pembesaran lidah yang menimbulkan kesulitan manajemen jalan nafas dan diklasifikasikan sebagai mallampati kelas II. Pasien akan dilakukan prosedur reseksi tumor adenohipofise melalui pendekatan sublabial transpheonidal dengan anestesi umum. Sebagian besar anestesi untuk operasi pada pasien akromegali membutuhkan perhatian khusus dibandingkan dengan tumor kepala yang lain.Anesthesia Management in Patients with Acromegaly Underlying Adenohipofise Tumor Resection Procedures Through a Transphenoidal Sublabial ApproachAcromegaly and gigantism are clinical abnormalities due to excessive growth hormone production, usually resulted from pituitary adenoma. The incidence of acromegaly is 5 cases per 1 million people per year while the prevalence is 60 cases per 1 million people. Clinical manifestations in each patient is depending on the levels of growth hormone, insulin-like growth factor-1, age of the patient, tumor size and the delay in diagnosis. Increased of morbidity and mortality have been reported in acromegaly patients predominantly caused by complications of cardiovascular, cerebrovascular and respiratory problem. A 57 year old male, 86 kgs, ASA physical status II. His appearance suggested acromegaly, diagnosis then confirmed with hormonal examination and imaging of the pituitary mass. Further examination presented tongue enlargement which cause airway management difficulty and classified as mallampati class II. The patient will undergo adenohipofise tumor resection procedures through a transphenoidal sublabial approach with general anaesthesia. Most of anaesthesia in acromegaly patient surgery require special attention compared with other head tumors.

Perbandingan Status Nutrisi Minggu Pertama pada Pasien Pascacedera Otak Traumatik Sedang dan Berat yang Dirawat di RSUP Dr. Hasan Sadikin Bandung Dinilai dengan Subjective Global Assessment (SGA) Saputra, Tengku Addi; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Penilaian status nutrisi merupakan hal vital untuk menentukan rencana pemberian nutrisi dan memperbaiki luaran pasien dengan cedera otak traumatik (COT). Pada pasien COT terjadi hipermetabolisme, hiperkatabolisme, dan intoleransi glukosa yang dapat mempengaruhi luaran pasien. Penilaian status gizi dilakukan dengan Subjective Global Assessment (SGA). Tujuan penelitian ini adalah untuk membandingkan status nutrisi antara pasien COT sedang dan berat yang dinilai dengan SGA.Subjek dan Metode: Penelitian observasional analitik cross sectional ini dilakukan pada 22 pasien COT yang dirawat di RSUP Dr Hasan Sadikin Bandung sejak November 2016 - Juli 2017, yang dibagi menjadi 2 kelompok, yaitu COT sedang dan berat. Status nutrisi subjek penelitian dinilai dengan SGA selama 7 hari. Analisis data dilakukan dengan Chi Square, Kolmogorof-Smirnof dan Exact Fisher. Hasil: Terdapat perbedaan status nutrisi yang signifikan antara kelompok COT sedang dan berat pada hari perawatan ke-6 dan 7, dimana lebih banyak didapatkan malnutrisi berat pada kelompok COT berat (p0,05).Simpulan: Pada penelitian ini malnutrisi lebih banyak terjadi pada pasien dengan COT berat, disebabkan oleh perlambatan pemberian nutrisi akibat disfungsi gastrointestinal yang terjadi pada pasien COT berat sehingga diperlukan strategi pemberian nutrisi khusus pada kelompok COT berat.Comparison of a One Week Nutritional Status between Moderate and Severe Traumatic Brain Injury Patient in Dr. Hasan Sadikin General Hospital Assessed with Subjective Global Assessment (SGA)Background and Objective: Assessment of nutritional status is vital in determining nutritional plans and improving outcomes of traumatic brain injury (TBI) patients. Hypermetabolism, hypercatabolism, and glucose intolerance occur in patients with TBI can affect its outcome. The used nutritional status assessment is Subjective Global Assessment (SGA). The aim of this study was to compare nutritional status in moderate and severe TBI patients assesed with SGA.Subject and Method: This cross sectional observational analytic study was conducted on 22 TBI patients treated in RSUP DR. Hasan Sadikin Bandung since November 2016 - July 2017, divided into 2 groups, moderate and severe TBI. Assessment of SGA in study subjects was conducted for 7 days. Data was analyzed with Chi Square, Kolmogorof-Smirnof and Exact Fisher test. Results: This study showed a significant difference in nutritional status between moderate and severe TBI groups during the 6th and 7th treatment days, whereas more severe malnutrition was found in the severe TBI group (p 0.05).Conclusion: Compares to patients with moderate TBI, malnutrition is more prevalent in patients with severe TBI, because of delayed of nutrient delivery due to gastrointestinal dysfunction occurring in severe TBI patients requiring specific nutritional strategies in severe TBI group.

Tatalaksana Kraniektomi Dekompresif pada Pasien Cedera Otak Traumatik Berat yang Disertai Peningkatan Tekanan Tinggi Intrakranial Menetap Fitri Sepviyanti Sumardi; Hamzah Hamzah; Sri Rahardjo; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tekanan tinggi intrakranial menetap adalah penyebab kematian terbesar pada pasien dengan cedera kepala traumatik berat. Pada cedera kepala berat, tatalaksana secara konservatif dan operatif dilakukan untuk meminimalisir terjadinya cedera otak sekunder. Peningkatan tekanan intrakranial biasanya disebabkan karena edema otak, hal ini sangat penting dan menentukan hasil luaran pasien/Glasgow outcomes scale (GOS) atau Extended GOS (GOSE). Data klinis menunjukkan bahwa kraniektomi dekompresif menurunkan angka kematian, meningkatkan fungsi pemulihan, menurunkan durasi perawatan di ICU dan meningkatkan hasil luaran berdasarkan Barthel Index Score. Kraniektomi dekompresif sering dilakukan sebagai penyelamatan empiris untuk melindungi kerusakan otak lebih lanjut akibat efek edema dan hipertensi intrakranial menetap. Konsep utama tatalaksana pasien dengan tekanan tinggi intrakanial yang menetap adalah menjaga aliran darah otak dan tekanan perfusi otak.Decompressive Craniectomy Management in Patients with Severe Traumatic Brain Injuries Accompanied by Refractory Intracranial HypertensionRefractory intracranial hypertension is the biggest cause of death in patients with severe traumatic head injury. In severe head injuries, conservative management and surgery are performed to minimize the occurrence of secondary brain injury. The increase in intracranial pressure is usually caused by brain edema, this is very important and determines the outcomes of the Glasgow outcomes scale (GOS) or extended GOS (GOSE). Clinical data show that decompressive craniectomy reduces mortality, improves recovery function, decreases duration of ICU treatment and increases outcome outcomes based on the Barthel Index Score. Decompressive craniectomy is often performed as an empirical salvage to protect further brain damage due to the effects of edema and refractory intracranial hypertension. The main concept of managing patients with refractory intracranial hypertension is to maintain cerebral blood flow and cerebral perfusion pressure.

Gambaran Faktor Risiko Kejadian Stroke di RSHS Bandung Periode Januari 2015 Desember 2016 ; Amalia, Lisda; Suwarman, S
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Stroke merupakan masalah kesehatan di dunia yang menjadi penyebab kematian kedua tertinggi. Epidemiologi pasien stroke berdasarkan faktor risikonya masih sangat bervariasi dan belum ada data yang melaporkan di Jawa Barat. Tujuan penelitian ini adalah untuk mengetahui gambaran faktor risiko kejadian stroke. Subjek dan Metode: Penelitian ini menggunakan studi desain deskriptif dengan rancangan potong lintang. Data diambil secara retrospektif dengan metode total sampling dari rekam medis pasien stroke di bangsal neurologi RSUP Dr. Hasan Sadikin periode Januari 2015Desember 2016 yang memenuhi kriteri inklusi dan eksklusi.Hasil: Didapatkan 1044 subjek terdiri dari 486 laki-laki dan 558 perempuan. Kelompok usia 55-64 tahun (33,3%), pendidikan tamat SD (45,3%), dan tidak bekerja (56,4%) merupakan prevalensi tertinggi dari subjek yang diteliti. Stroke iskemik memiliki prevalensi lebih tinggi dibandingkan stroke perdarahan dengan lokasi sistem karotis lebih tinggi (89,6%) dibandingkan sistem vertebrobasilar (10,4%). Faktor risiko tertinggi yaitu hipertensi. Simpulan: Insidensi pasien stroke lebih tinggi terjadi pada wanita, kelompok usia tua, pendidikan rendah, dan tidak bekerja. Kasus pasien stroke iskemik lebih sering terjadi dibandingkan dengan stroke perdarahan dengan lokasi sistem karotis lebih banyak dibandingkan sistem vertebrobasilar. Hipertensi merupakan faktor risiko paling sering mengakibatkan stroke.Profile of Stroke Risk Factors in Hasan Sadikin General Hospital Bandung During January 2015December 2016Background and Objective: Stroke is an important health issue causing the second most death worldwide. Epidemiology of stroke patients based on risk factors is highly variable without data to report regarding risk factors of stroke in West Java. Aim of this study is to find out profile of stroke risk factor.Subject and Method: This study is a descriptive study with cross section design. Data acquired retrospectively with total sampling method from medical records of stroke patients in Hasan Sadikin General Hospital from January 2015December 2016 that fulfills inclusion criteria and exclusion criteria.Result: Obtained 1044 subjects consisted of 486 males and 558 females. Subjects with age 5564 years old (33.3%), elementary school graduate (45.3%), and no occupation (56.4%) were the highest prevalence of studied subject. Ischaemic stroke had higher prevalence than haemorrhagic stroke with carotid system (89.6%) higher than vertebrobasilar (10.4%). Highest risk factor were hypertension. Conclusion: Incidence of stroke patients are higher in women, older age group, low education, and no occupation. Ischaemic stroke case patients were found more often than haemorrhagic stroke with carotid system more than vertebrobasilar system. Hypertension is the most common risk factor causing stroke.

Anestesi untuk Seksio Sesarea pada Pasien dengan Hipertensi Intrakranial Idiopatik Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Hipertensi intrakranial idiopatik (Idiophatic intracranial hypertension/IIH) atau benign intracranial hypertension atau pseudotumor cerebri adalah kasus jarang dengan penyebab yang tidak diketahui, dan paling sering terlihat pada wanita obes dalam masa reproduktif (19,3/100.000), dan kadang-kadang terjadi pada wanita hamil. Hipertensi intrakranial idiopatik adalah suatu sindroma yang khas dengan adanya peningkatan tekanan intrakranial tanpa hidrocefalus atau lesi massa dengan peningkatan tekanan cairan cerebrospinal dan komposisi cairan serebrospinal yang normal. Kehamilan dan estrogen eksogen dapat memicu IIH atau memperburuknya. Dapat terjadi pada setiap semester kehamilan, dan outcome visual sama seperti wanita tidak hamil dengan IIH. Tidak ada peningkatan keguguran, abortus terapeutikus untuk membatasi perkembangan IIH tidak merupakan indikasi, dan kehamilan selanjutnya tidak meningkatkan risiko kekambuhan. Gambaran klinis sakit kepala dan kehilangan penglihatan dengan adanya papil edema. Tujuan terapi adalah melindungi penglihatan dan memperbaiki keluhan. Terapi medikal umumnya analgesik, kortikosteroid, carbonic anhydrase inhibitors, dan diuretik; bila pengendalian adekuat tidak tercapai maka indikasi dilakukan punksi lumbal untuk mengeluarkan cairan serebrospinal, pengakhiran kehamilan melalai rute yang paling cepat, apakah dilakukan melalui induksi persalinan atau seksio sesarea. Prognosis IIH pada kehamilan baik untuk ibu dan bayi. Anestesi dapat dilakukan dengan spinal anestesia, epidural anestesia, combined spinal epidural atau anestesi umumAnesthesia for Caesarean Section in Patient with Idiopathic Intracranial HypertensionIdiopathic intracranial hypertension (IIH) or benign intracranial hypertension or pseudotumor cerebri is a rare disorder of unknown etiology that is most often seen in obese women of reproductive age (19.3/100,000) and is reported only occasionally during pregnancy. It is a syndrome characterized by increased intracranial pressure without hydrocephalus or mass lession with elevated cerebrospinal fluid (CSF) pressure and normal CSF composition. Both pregnancy and exogenous estrogens are though to promote IIH or worsen it. It can occur in any trisemester during pregnancy, and the visual outcome is the same as for non pregnant patient with IIH. There is no increase in fetal wastage; therapeutic abortion to limit its progression is not indicated, and subsequent pregnancies do not increase the risk of reccurence. Clinically present headache and loss of visions objectifying papil edema. The aim of treatment is to preserve vision and improve symptoms. The usual medical treatment is based on analgesics, corticosteriod, carbonic anhydrase inhibitors, and diuretics; if adequate control is not achieved are indicated lumbar puncture for extracting CSF. Uncontrolled intracranial hypertension required to end the pregnancy by quickest route, either through induction or caesaeran section. The prognosis for IIH in pregnancy is excelent for both mother and baby. Anesthesia can be done with spinal anestheia, epidural anesthesia, combined spinal epidural or general anesthesia

Manajemen Anestesi pada Penderita Sindroma Pfeiffer dengan Posisi Sphinx Halimi, Radian Ahmad; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Sindroma pfeiffer adalah kelainan genetik autosomal dominan berupa fusi prematur tulang kepala dan tubuh lainnya. Operasi rekonstruksi kraniofasial pada pasien dengan sindrom pfeiffer memberikan tantangan tersendiri bagi ahli anestesi. Pada laporan kasus ini, seorang anak perempuan berusia 18 bulan datang ke rumah sakit Hasan Sadikin Bandung dengan keluhan kelainan bentuk kepala sejak lahir. Kelainan tersebut disertai dengan proptosis mata, hipoplasia maksila bilateral, high arc palate, hipotelorisme dan hidrosefalus, namun tidak terdapat riwayat obstruksi jalan nafas. Pasien direncanakan dilakukan prosedur rekonstruksi kraniofasial dan tarsorhaphy dengan posisi modifikasi prone (posisi sphinx). Permasalahan yang terjadi selama operasi adalah obstruksi vena juguler, perdarahan dan kebocoran cairan serebrospinal pascaoperasi. Operasi berlangsung selama 19 jam. Pascaoperasi pasien dirawat di PICU dan dipindahkan ke ruangan perawatan biasa pada hari ke 4. Penanganan perioperatif pasien dengan sindroma pfeiffer yang akan menjalani prosedur operasi kraniofasial membutuhkan penanganan secara multidisiplin dan dibutuhkan pemahaman yang mendalam mengenai fisiologi, potensi permasalahan intraoperasi, resiko dan komplikasi pascaoperasi untuk mencapai hasil luaran yang baikAnesthesia Management in Patients with Pfeiffer Syndrome with Sphinx PositionPfeiffer syndrome is a dominant autosomal genetic disorder characterized by premature fusion of head and other body bones. Craniofacial reconstruction surgery in patients with Pfeiffer syndrome presents a challenge for an anaesthesiologist. This case report discusses about 18 month old girl came to the Hasan Sadikin hospital in Bandung with complaints of clover head shape from birth. The other abnormalities consist of eye proptosis, bilateral maxilla hypophlasia, high arc palate, hypotelorism and hydrocephalus. There was no history of obstructive sleep apneau (OSA). The patient underwent craniofacial vault reconstruction procedure and a tarrsorhaphy with modified prone position (sphinx position). During the operation, there were problems occured such as jugular venous obstruction, bleeding and postoperative cerebrospinal fluid leakage. The procedure takes 19 hours long, and after the operation, the patient admitted to the PICU and being transferred to the ward on day-4. The perioperative treatment of patients undergoing craniofacial surgery requires a multidisciplinary treatment approach, and deep understanding of the physiology, potential intraoperative problems, risks and postoperative complications to achieve better outcomes.

Manajemen Anestesi untuk Awake Craniotomy pada Space Occupying Lesion Lobus Frontalis Kiri Ferdyansyah, Ferry; Harahap, M. Sofyan
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor intrakranial adalah suatu lesi ekspansif yang membentuk massa dalam ruang tengkorak. Kami melaporkan manajemen anestesi pada pasien dengan tumor intrakranial yang menjalani prosedur awake craniotomy. Seorang laki-laki berumur 39 tahun, berat badan 60 kg dengan riwayat epilepsi ditemukan space occupying lession pada lobus frontalis kiri setelah dilakukan CT-scan kepala. Prosedur awake craniotomy untuk pengangkatan tumor dilakukan karena lokasi tumor berada di dekat area Broca. Awake craniotomy dilakukan dengan kombinasi anestesi intravena (i.v) dexmedetomidin dan blok scalp. Premedikasi midazolam 2 mg i.v dan oksigenasi 3 liter/menit nasal diberikan dari awal proses operasi. Pasien diberikan dexmedetomidine loading dose 1 mcg/kgBB dalam 15 menit dan fentanyl 1 mcg/kgBB i.v sebelum dilakukan blok scalp dengan injeksi bupivacain isobarik 0,5% dicampur pehacain 1:1, total 40 ml untuk kedua sisi kepala. Infiltrasi larutan bupivacain-pehacain tambahan diberikan 2,5 ml pada setiap titik pin holder fiksasi kepala dipasang. Pemeliharaan anestesi dijaga dengan infus kontinyu dexmedetomidin 0,5-0,7 mcg/KgBB/jam i.v selama pasien terbangun dan propofol 0,05 0,1 mg/kgBB/menit i.v ditambahkan apabila pasien ditidurkan. Mannitol 1 g/kgBB i.v diberikan 15 menit sebelum duramater dibuka. Proses kraniotomi berjalan 4 jam. Selama operasi berlangsung pasien tidak mengalami perubahan hemodinamik yang signifikan, tekanan darah rata-rata 9569 mmHg, laju nadi 5663 x/mnt, SpO2 100% dengan VAS 0-1. Pasca operasi, pasien stabil dan pindah ke ruangan setelah diobservasi selama 1 jam di ruang pemulihan.Anesthesia Management for Awake Craniotomy on Left Frontal Lobe Solid Occupiying LesionIntracranial tumors are an expansive lesion that forms masses in the skull space. We report anesthesia management in patients with intracranial tumors who undergo awake craniotomy procedures. A 39-year-old male weighing 60 kg with a history of epilepsy found space occupying lession in the left frontal lobe after a head CT scan. The awake craniotomy procedure for removal of the tumor is done because the location of the tumor is near the Broca area. Awake craniotomy is performed with a combination of dexmedetomidine intravenous (i.v) and scalp block. Premedication with 2 mg midazolam i.v and oxygenation of 3 liters / minute nasal was given from the beginning of the surgery. The patient was given dexmedetomidine loading dose of 1 mcg/kg in 15 minutes and fentanyl 1 mcg/kg i.v before scalp block was done with 0.5% isobaric bupivacain injection mixed with 1: 1 Pehacain, a total of 40 ml for both sides of the head. Additional infiltration of bupivacain-pehacain solution was given 2.5 ml at each point the head fixation pin holder was installed. Maintenance of anesthesia is maintained with a continuous infusion of dexmedetomidine 0.5-0.7 mcg/Kg/h i.v as long as the patient is awake and propofol 0.05 - 0.1 mg/kg/minute i.v is added when the patient is put to sleep. Mannitol 1 g/kg i.v is given, 15 minutes before the duramater is opened. The craniotomy process runs 4 hours. During surgery, the patient does not experience significant hemodynamic changes, Mean Blood Pressure is 95-69 mmHg, heart rate 56-63 x/min, SpO2 100% with VAS 0-1. After surgery, the patient was stable and moved to the ward after being observed for 1 hour in the recovery room.

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Agni Susanti

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

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