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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 9, No 3 (2020)" : 8 Documents clear

Awake Endospine Disektomi pada Pasien Lumbar Spinal Stenosis karena Hernia Nucleus Pulposus Laras, Nuzulul Widyadining; Sasongko, Himawan
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Lumbar spinal stenosis (LSS) merupakan gejala penyakit yang berhubungan dengan berkurangnya ukuran canalis spinalis vertebra lumbal menyebabkan penekanan saraf yang terletak di dalamnya. Berdasar penyebabnya dibagi jadi dua, kongenital dan degeneratif. Pasien dapat merasakan fase nyeri yang tidak dapat diprediksi dan juga fase stabil tanpa nyeri. Salah satu contoh LSS degeneratif adalah pembengkakan diskus intervertebralis atau HNP. Penyakit HNP merupakan salah satu penyebab dari nyeri punggung bawah dan merupakan salah satu masalah kesehatan yang utama. Prevalensi HNP berkisar antara 12 % dari populasi. Terapi yang dilakukan salah satunya endospine disektomi. Operasi ini dapat dikerjakan dengan general anestesia (GA) atau neuroaksial anestesia (spinal, epidural). GA lebih dipilih karena lebih aman dari komplikasi gangguan jalur nafas. Deksmedetomidine memiliki efek sedasi tanpa risiko depresi respirasi serta memiliki efek analgesi dapat digunakan untuk metode awake endospine pada disektomi. Pada penulisan ini, dilakukan pemilihan teknik anestesi awake untuk mengakomodasi operator untuk menilai respon nyeri dan fungsi motorik pasien saat operasi.Awake Endospine Dissectomy in Patient with Lumbar Spine Stenosis caused by Hernia Nucleus PulposusAbstractLumbar spinal stenosis (LSS) are symptoms from degradation canalis spinalis vertebraes size which pressured nerve inside it. Based on its cause, there are two types of LSS, congenital and degenerative. The patient can experience an unpredictable pain phase as well as a stable phase without pain. Bulging of intervertebralis disc or HNP is one of degenerative LSS. HNP disease is one of the causes of low back pain and is a major health problem. HNP prevalention is 1-2 % from population. One of therapy use to medicate LSS is endospine discectomy. This operation done with general anesthesia (GA) or neuroaxial anesthesia (spinal, epidural). GA preferably used because it caused less side effect like airway obstruction or neural injury. Dexmedetomidine has a sedative effect without the risk of respiratory depression and has an analgesic effect. It can be used to awake endospine methods in dissectomy. In this case report, the writer did awake endospine method to accommodate operator so they could know level of pain and motoric function of patient durante operation.

Hubungan antara Skor GCS dengan Skor NRS PTH Akut pada Pasien COT di RSUD Ulin Banjarmasin Nur Alaina, Ilma Fi Ahsani; Sikumbang, Kenanga M.; Asnawati, Asnawati
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Cedera otak traumatik (COT) dapat dinilai menggunakan skor Glasgow Coma Scale (GCS). Adanya mekanisme cedera sekunder yang berkembang dalam beberapa hari menjadi faktor pencetus munculnya keluhan Post Traumatic Headache (PTH) akut. Keparahan nyeri yang dikeluhkan pada pasien PTH dapat dinilai berdasarkan skor Numeric Rating Scale (NRS). Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara skor GCS dengan skor NRS PTH akut pada pasien COT di RSUD Ulin BanjarmasinSubjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional dengan 40 sampel diperoleh secara consecutive sampling dan sebanyak 36 pasien (90%) mengeluhkan PTH akut. Analisis data penelitian ini menggunakan uji one-way anova.Hasil: Hasil penelitian menunjukkan nilai p=0,558 pada pasien COT yang dilakukan tataksana operatif dan p=0,732 pada tatalaksana konservatif.Simpulan: Dapat disimpulkan bahwa tidak terdapat hubungan antara skor GCS dengan skor NRS PTH akut pada pasien COT di RSUD Ulin Banjarmasin.Associations between GCS Score and NRS Score of Acute PTH in TBI Patients at Ulin General Hospital BanjarmasinAbstractBackground and Objective: Traumatic brain injury (TBI) is an alteration in brain function caused by external physical forces that its severity can be assessed using the Glasgow Coma Scale (GCS) score. The secondary injury can develop in a few days and may trigger the appearance of acute Post Traumatic Headache (PTH). The severity of PTH can be assessed using the Numeric Rating Scale (NRS) score. The purpose of this study was to determine whether there is an association between GCS score and NRS score of acute PTH in TBI patients at Ulin General Hospital Banjarmasin.Subject and Methods: This study used an analytic observational method with cross sectional approach. A total of 40 samples were obtained with a distribution of 36 patients (90%) complained acute PTH.Results: Data analysis in this study using the one-way anova test showed p value = 0,558 on patients with operative management and p value = 0,732 on conservative management.Conclusion: It can be concluded that there is no association between GCS score with NRS score of acute PTH in TBI patients at Ulin General Hospital Banjarmasin.

Manajemen Perioperatif Gejala Ekstrapiramidal (EPS) pada Hidrocephalus Tekanan Normal (NPH) Lestari, Ni Putu Dharmi; Suyasa, Agus Baratha
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Gejala ekstrapiramidal (EPS) merupakan gangguan gerak akibat efek samping obat penghambat reseptor dopamin. Gejala-gejala EPS antara lain dystonia, akathisia, dan parkinson. Gejala EPS pada kasus ini ditemukan pada hidrocephalus tekanan normal (NPH) yang tidak mengkonsumsi obat penghambat reseptor dopamin. Hidrocephalus tekanan normal adalah hidrocephalus yang tidak bersamaan dengan peninggian tekanan intrakranial (TIK). Melaporkan kasus laki-laki 57 tahun dengan penurunan kesadaran dan gejala ekstrapiramidal serta Normo pressure hydrocephalus (NPH), dilakukan operasi VP Shunt. Operasi dilakukan dengan anestesi umum, menggunakan ETT no 7,5 non kinking, ventilasi kendali. Premedikasi diberikan midazolam 2 mg iv, Co induksi dengan oxycodon 10 mg iv. Induksi dengan propofol 150 mg iv, fasilitas intubasi dengan rokuronium 30 mg iv, pemeliharaan dengan O2 : Air (50 : 50), sevofluran, propofol kontinyu 100 mg/jam, rokuronium 20 mg/jam.Hemodinamik stabil, TDS 130150 mmHg, TDD 8090 mmHg, HR 5070 x/menit, saturasi O2 99100%, etCO2 3537. Pasca operasi pasien dirawat di ruang intensif (ICU) untuk pemantauan tekanan darah dan gejala ekstrapiramidal. Tujuan utama penanganan seharusnya tidak semata-mata untuk penanganan gejala akut EPS namun juga penanganan penyakit dasar penyebab EPS terkait morbiditas serta menjaga kualitas hidup. Manajemen multidisiplin (bedah saraf, saraf, anestesi intensif dan rehabilitasi medis) dibutuhkan untuk hasil jangka panjang yang lebih baik.Perioperative Management Extrapyramidal Symptoms (EPS) in Normo Pressure Hydrocephalus (NPH)AbstractExtrapyramidal symptoms (EPS) are movement disorders due to side effects of dopamine receptor blocking agents. Symptoms of EPS include dystonia, akathisia, and parkinsonism. Symptoms of EPS in this case are found in normal pressure hydrocephalus (NPH) which does not consume dopamine receptor blocking drugs. Normal pressure hydrocephalus is hydrocephalus which does not coincide with intracranial pressure (ICT) elevation. Reported a case of a 57-year-old male with decreased consciousness and extrapyramidal symptoms and Normo pressure hydrocephalus (NPH), a V-P Shunt operation was performed. The operation was carried out under general anesthesia, using a non-kinking ETT no. 7.5, controlled ventilation. Premedication given midazolam 2 mg iv, Co induction with oxycodon 10 mg iv. Induction with propofol 150 mg iv, intubation facilities with rocketuronium 30 mg iv, maintenance with O2: Air (50: 50), sevoflurane, propofol continuous 100 mg/hour, rokuronium 20 mg/hour. Stable hemodynamics, SBP 130150 mmHg, DBP 8090 mmHg, HR 5070 x/min, O2 saturation 99100%, etCO2 3537. After surgery the patient was treated in the intensive care unit (ICU) for monitoring blood pressure and extrapyramidal symptoms. The main goal of treatment should not be solely for the treatment of acute symptoms of EPS but also for the management of basic disease causing EPS related to morbidity and maintaining quality of life. Multidisciplinary management (neurosurgery, neurosurgery, intensive anesthesia and medical rehabilitation) are needed for better long-term results.

Anestesi untuk Kraniotomi Evakuasi Perdarahan Intraserebral pada Pasien Cedera Otak Traumatik dengan Tetralogy of Fallot Santosa, Dhania A; Hamzah, Hamzah
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Penyakit jantung bawaan (PJB) merupakan salah satu penyakit bawaan yang paling sering terjadi, yaitu sekitar 8 dari 1000 kelahiran hidup. Sekitar 85% dari pasien dengan PJB diharapkan bertahan hidup sampai dengan usia dewasa di Amerika Serikat. Penanganan cedera otak traumatik dengan PJB memerlukan pemahaman patofisiologi PJB dengan teknik neuroanestesi yang baik. Seorang laki-laki usia 17 tahun mengalami kecelakaan lalu lintas dan didiagnosis dengan cedera otak traumatik sedang, perdarahan intraserebral (ICH) dan perdarahan epidural (EDH) serta edema serebri dengan komorbiditas PJB sianotik Tetralogy of Fallot, dilakukan pembedahan darurat kraniotomi evakuasi ICH. Pembedahan dilakukan dengan anestesi umum intubasi endotrakeal dan berjalan selama kurang lebih tiga jam. Tantangan selama anestesi dan pembedahan adalah mempertahankan hantaran oksigen optimal, menghindari peningkatan kebutuhan oksigen dan mencegah pelepasan katekolamin yang dapat memicu terjadinya hypercyanotic tet spell. Pascabedah pasien dirawat di Ruang Observasi Intensif dengan bantuan ventilator dan dilakukan ekstubasi pada sore hari pertama pascabedah. Pasien kemudian dirawat di Ruangan dan dipulangkan pada hari ke-14 pascabedahAnesthesia Management for Craniotomy for Intracerebral Hemorrhage Evacuation in Traumatic Brain Injury Patient with Tetralogy of FallotAbstractCongenital heart disease (CHD) is one of the leading congenital disease with the incidence of 8 patients of 1000 livebirth. Around 85% of patients with CHD is expected to reach adult age in United States of America. Management of traumatic brain injury in patients with CHD requires combination of fine understanding on pathophysiology of CHD and neuroanesthesia technique. A male patient, 17 years of age had a motor vehicle accident and was diagnosed with moderate traumatic brain injury, intracerebral hemorrhage, epidural hemorrhage and cerebral edema with Tetralogy of Fallot, underwent an emergency craniotomy for ICH evacuation. Surgery was done under general anesthesia and lasted for approximately 3 hours. Challenges during anesthesia and surgery include maintaining optimal oxygen delivery, avoiding increase in oxygen demand and preventing catecholamine release which may trigger hypercyanotic tet spell. Patient was observed and ventilator supported in Intensive Observation Ward and was extubated at the same post surgery day. Patient was then observed in the Ward and sent home on the 14th day after the incident.

Pengelolaan Neuroanestesi pada Pasien dengan Pentalogy of Fallot Putra, Eka Satrio; Suryandari, Retno; Purwoko, Purwoko; Arianto, Ardana Tri
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Pentalogy of Fallot (POF) salah satu jenis cacat jantung bawaan sianotik langka yang berpotensi tinggi komplikasi abses cerebri. Abses cerebri sering dijumpai pada kelainan jantung sianotik karena terjadinya hipoksia kronis dan yang kedua adalah hiperviskositas karena berkurangnya aliran mikrosirkulasi ke otak. Kami melaporkan seorang anak laki-laki berusia 6 tahun, berat badan 14 kg dengan abses otak multiple yang disertai dengan Pentalogy of Fallot (POF) yang akan dilakukan kraniotomi evakuasi abses. Pemeriksaan fisik preoperatif didapatkan GCS E4V5M6, SpO2 preductal 88%, post ductal 84 % dalam posisi supine. Pada sistem kardiovaskular didapatkan bunyi jantung I-II regular, bising sistolik terkuat di parasternal kiri ICS 3 grade 3, clubbing finger. Nilai hemoglobin 14,4gr%, hematokrit 43%, leukositosis 13,200/mm Tujuan anestesi pada penyakit jantung sianotik POF adalah menjaga curah jantung dengan mempertahankan denyut jantung, kontraktilitas juga preload, mencegah peningkatan rasio PVR:SVR serta menghindari hipersianosis akibat peningkatan mendadak kebutuhan oksigen sistemik. Pilihan agen anestesi harus didasarkan pada fisiologi pasien dan tujuan menyeimbangkan aliran darah paru dan sistemik. Rehidrasi yang adekuat sebelum induksi dan penggunaan diuretik manitol dapat dipertimbangkan mengingat hiperviskositas menurunkan pengiriman oksigen ke otak. Peningkatan TIK dari ketamine dapat dikurangi dengan hiperventilasi, kombinasi dengan benzodiazepin dan dengan pencegahan hipercapnia. Maka dari itu monitoring end tidal CO2 (ETCO2) perlu diperhatikan. Pengelolaan perioperatif pasien POF pada kasus evakuasi abses cerebri pada anak laki- laki usia 6 tahun pada laporan berikut ini menuliskan pentingnya pemahaman akan patofisiologi POF dan teknik neuroanestesi untuk mendapatkan luaran yang baik.Neuroanesthesia on Patient with Pentalogy of FallotAbstractPentalogy of Fallot (POF) is a rare type of cyanotic congenital heart defect with high risk of having cerebral abscesses as one of its complications. Cerebral abscesses are often found in cyanotic heart disease due to chronic hypoxia and hyperviscosity reduced microcirculatory flow to the brain. We report a 6-year-old boy, 14 kg body weight with multiple brain abscesses accompanied by Pentalogy of Fallot (POF) who undergone a craniotomy to evacuate the abscess. Preoperative physical examination found GCS E4V5M6, other vital signs within normal limits, preductal oxygen saturation 88%, post ductal oxygen saturation in supine position 84%. The I-II heart sounds are regular with grade 3 systolic murmur in the left parasternal third intercostal space and clubbing finger was found. The laboratory shows a hemoglobin value of 14.4gr%, hematocrit of 43%, leukocytosis 13,200/mm. The goal of anesthesia in cyanotic heart disease is to maintain cardiac output by stabilize heart rate, contractility as well as preload, prevent the increase of PVR:SVR ratio and avoid hypercyanotic due to sudden increase in systemic oxygen demand. The choice of anesthetic agent must be based on the patient's physiology. Adequate rehydration before induction and use of mannitol diuretics can be considered to reduce hyperviscosity that decrease oxygen delivery to the brain. Increased intracranial pressure from ketamine can be reduced by hyperventilation, in conjunction to benzodiazepines and prevention of hypercapnia. Therefore, monitoring end tidal CO2 (ETCO2) needs to be done. This case report delineating the perioperative management of a 6 years old boy with POF underwent evacuation of cerebral abscesses, will highlight the importance of understanding the pathophysiology of POF and neuroanesthesia techniques in order to receive a good outcome.

Efek Perbedaan Ventilasi Mekanik Positive End Expiratory Pressure (PEEP) Low dan Moderate terhadap Rasio PaO2/FiO2 Pascabedah pada Kraniotomi Elektif Rizki, Muhammad; Harahap, M. Sofyan; Wicaksono, Satrio Adi
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Kraniotomi elektif memiliki kejadian komplikasi paru pascaoperasi (25%) dan mortalitas (10%) yang tinggi. Penelitian ini berusaha mengetahui efek Positive End Expiratory Pressure (PEEP) 5 cmH2O and 8 cmH2O terhadap rasio PaO2/FiO2 pascaoperasi pada kraniotomi elektifSubjek dan Metode: Uji klinis acak ini dilakukan di satu rumah sakit pendidikan di Indonesia. Lima puluh dua pasien kraniotomi elektif (usia 17-55 tahun, lama bedah 4 jam, paru normal) dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik perioperatif dengan low Positive End Expiratory Pressure ( PEEP) (5 cmH2O) atau moderate PEEP (8 cmH2O). Hipotesis penelitian ini adalah rasio PaO2/FiO2 kelompok moderate PEEP lebih tinggi dibandingkan low PEEP. Analisis gas darah dilakukan pada 24 jam pasca induksi Hasil: Penelitian ini tidak menunjukkan perubahan yang signifikan rasio PaO2/FiO2 antara kelompok low PEEP dan moderate PEEP. Rasio PaO2/FiO2 kelompok low PEEP dan moderate PEEP secara berurutan adalah: pada 24 jam pasca induksi, 429,34 72,25 mmHg dan 458,59 71,11mmHg (p =0,147).Simpulan: Perbandingan low PEEP dan moderate PEEP pada ventilasi mekanik perioperatif tidak menghasilkan perbedaan nilai rasio PaO2/FiO2yang signifikan pada 24 jam pasca induksi.The Differential Effect of Low and Moderate Positive End Expiratory Pressure (PEEP) Mechanical Ventilation to Postoperative PaO2/FiO2 Ratio in Elective CraniotomyAbstractBackground and Objective: Elective craniotomy is associated with high incidence of postoperative pulmonary complications (PPC, 25%) and mortality (10%). We determined to study the effect of Positive End Expiratory Pressure (PEEP) 5 cmH2O and 8 cmH2O to postoperative PaO2 / FiO2 ratio (PF ratio) in elective craniotomy.Subject and Methods: This randomized clinical trial was at a university hospital in Indonesia. Fifty two elective craniotomy patients (ages 1755 years, surgical duration 4 hours, normal lung) were randomized into 2 intervention groups: perioperative mechanical ventilation with low PEEP (5 cmH2O) or moderate PEEP (8 cmH2O). The hypothesis of this study is that the ratio of PaO2 / FiO2 in the moderate PEEP group is higher than low PEEP. Blood gas analysis was performed 24 hours post induction.Results: This study did not show a significant difference in the PaO2/FiO2 ratio between the low PEEP and moderate PEEP groups. The PaO2 / FiO2 ratios of the low PEEP and moderate PEEP groups were respectively: at 24 hours post induction, 429.34 72.25 mmHg and 458.59 71.11mmHg (p = 0.147). Conclusions: Comparison of low PEEP and moderate PEEP in perioperative mechanical ventilation did not result in a significant difference in the value of the PaO2/FiO2 ratio at 24 hours post induction

FOUR Score sebagai Alternatif dalam Menilai Derajat Keparahan dan Memprediksi Mortalitas pada Pasien Cedera Otak Traumatik yang Diintubasi Airlangga, Prananda Surya; Hamzah, Hamzah; Santosa, Dhania Anindita; Subiantoro, Andri
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Skala yang mengukur koma yang ideal seharusnya bersifat linear, reliabel, valid, dan mudah digunakan. Berbagai macam skala telah dikembangkan dan divalidasi untuk mengevaluasi tingkat kesadaran secara cepat, derajat penyakit, dan prognosis terhadap morbiditas maupun mortalitas. Glasgow Coma Scale (GCS) merupakan alat pemeriksaan tingkat kesadaran yang paling sering digunakan dan dijadikan gold standard, namun GCS mempunyai keterbatasan karena pasien yang diintubasi tidak dapat dinilai komponen verbal. Full Outline of UnResponsiveness (FOUR) score dikembangkan untuk mengatasi berbagai keterbatasan GCS. Pemeriksaan FOUR score adalah skala penilaian klinis dalam penilaian pasien dengan gangguan tingkat kesadaran. FOUR score lebih sederhana dan memberikan informasi yang lebih baik, terutama pada pasien cedera otak traumatik yang diintubasi. Hasil penelitian menunjukkan bahwa GCS dan FOUR score memiliki nilai prediksi yang tinggi tidak hanya kematian pada pasien trauma tetapi juga luaran pada pasien yang dipulangkan. Studi multicentre menunjukkan FOUR score dan GCS tidak berbeda dalam memprediksi kematian di rumah sakit. Studi tersebut menyarankan bahwa FOUR score dapat menjadi alat diagnostik yang lebih baik untuk menilai refleks batang otak dan pola pernapasan. Namun penelitian lain didapatkan juga hasil yang bertentangan antara GCS dan FOUR score dalam prediksi luaran pasien. Adanya kontradiksi tersebut menunjukkan perlunya dilakukan lebih banyak studi. Oleh karena itu, telaah literatur ini dilakukan dengan tujuan untuk membandingkan skor GCS dan FOUR dalam memprediksi mortalitas pasien trauma.FOUR Score as an Alternative in Assessing the Degree of Severity and Predicting Mortality in Intubated Traumatic Brain Injury PatientsAbstractThe ideal consciousness scoring scale must be linear, reliable, valid, and user-friendly. There is a need to develop and validate a scale to quickly evaluate the level of consciousness, the severity of the disease, and the prognosis of morbidity and mortality. Glasgow Coma Scale (GCS) is the most commonly used tool to assess the level of consciousness and is considered the gold standard. However, GCS has several limitations, such as inability to evaluate verbal components in intubated patients. To overcome these challenges, researchers developed the Full Outline of UnResponsiveness (FOUR) score. FOUR scores is a clinical grading scale to assess the altered state of consciousness. FOUR scores is simpler and able to provide better information, especially in intubated-traumatic brain injury (TBI) patients. Some studies showed that GCS and FOUR scores have the high predictive value in predicting not only the mortality of trauma patients but also the outcome of discharged patients. A multicentre study showed that FOUR scores and GCS do not differ in predicting inpatient mortality. This study suggested that the FOUR scores could be a better diagnostic tool for assessing brainstem reflexes and breathing patterns. Unfortunately, some studies have found conflicting results between GCS and FOUR scores in predicting patient outcomes. These contradictions suggest the need to conduct more studies. Therefore, this literature review will compare GCS and FOUR scores in predicting mortality of TBI patients.

Perdarahan Gastrointestinal pada Stroke Iskemik Akut: Sebuah Tinjauan Pustaka Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perdarahan gastrointestinal pada stroke iskemik akut disebabkan oleh proses neuroinflamasi pada sel otak yang mengalami iskemik. Edema otak yang terjadi pada pasien stroke iskemik akut mempengaruhi hipotalamus dan batang otak. Keterlibatan nukleus vagal pada batang otak menyebabkan peningkatan stimulasi dari vagus serta berkurangnya inhibisi vagus. Proses neuroinflamasi tersebut mempengaruhi sistem saraf parasimpatis menyebabkan hiperaktivitas vagal sehingga terjadi peningkatan pelepasan gastrin yang meningkatkan produksi asam lambung. Perdarahan gastrointestinal pada pasien stroke iskemik akut mengakibatkan penghentian atau penundaan terapi antiplatelet atau antikoagulan sehingga terjadi keadaan prokoagulasi, menyebabkan lebih mudah terjadi trombosis sehingga meningkatkan risiko stroke ulang dan luaran klinis yang buruk. Beberapa penelitian perdarahan gastrointestinal pada pasien stroke iskemik akut mempunyai prognosis yang kurang baik terhadap luaran. Luaran tersebut antara lain perburukan defisit neurologis, kematian di rumah sakit, dan memperpanjang lama perawatan.Gastrointestinal Bleeding in Acute Ischemic Stroke: A Literature ReviewAbstractGastrointestinal bleeding in acute ischemic stroke is caused by the process of neuroinflamation in ischemic brain cells. Brain edema that occurs in acute ischemic stroke patients affects the hypothalamus and brainstem. Involvement of the vagal nucleus in the brainstem results in increased stimulation of the vagus and reduced inhibition of the vagus. The neuroinflamation process affects the parasympathetic nervous system causing vagal hyperactivity resulting in an increase in gastrin release which increases gastric acid production. Gastrointestinal bleeding in patients with acute ischemic stroke results in the cessation or delay of antiplatelet or anticoagulant therapy, resulting in a procoagulatory state, making thrombosis easier, thereby increasing the risk of repeated strokes and poor clinical outcomes. Several studies of gastrointestinal bleeding in patients with acute ischemic stroke have a poor prognosis for outcomes. These outcomes include worsening neurological deficits, hospital deaths, and prolonged treatment.

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jni@inasnacc.org

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

Location
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INDONESIA