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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 363 Documents

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Anestesi pada Operasi Reseksi Avm Otak Wibowo, Kuncoro; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Manajemen anestesi pada arteriovenous malformation ( AVM ) menghadirkan tantangan yang besar karena pemahaman dan kompleksitas patofiologi yang belum di pahami dengan jelas. Kemajuan alat alat diagnostic seperti CT scan atau MRI akan meningkatkan insiden penemuan AVM dalam masyarakat kita. Walaupun tehnologi pembedahan sudah semakin maju tetapi angka morbiditas dan mortalitas pada pasien AVM tetap tinggi.Terapi pada pasien AVM sangat tergantung pada ukuran diameter AVM dan lokasinya. Manajemen anestesi mencakup persiapan preoperative yang baik, induksi yang tidak menimbulkan gejolak kardiovaskular, pemilihan obat obatan dan cairan intraoperasi maupun perawatan pasca operasi. Manajemen anestesi untuk AVM yang akan menjalani operasi stereotactic radiosurgey maupun diagnostic mempunyai konsekuensi penanganan anestesi yang berbeda. Post operasi pemahaman penanganan pasien selama di ICU juga merupakan tantangan tersendiri.Anesthesia for Brain Avm Resection Management of anesthesia in arteriovenous malformation (AVM) presents a great challenge due to the complexity of understanding and pathophysiology that has not been clearly understood. Progress diagnostic tools such as CT scan or MRI will increase the incidence of AVM discovery in our society. Although the technology is more advanced surgery but morbidity and mortality in patients with AVM remains high. Management therapy of AVM patients is highly dependent on the size of the diameter of the AVM and its location. Anesthetic management includes preoperative preparation, smooth induction, cardiovascular stability, choosing of drugs and fluids intraoperative and postoperative care. Management of anesthesia for the AVM to be undergoing stereotactic surgery and diagnostic radiosurgey have different consequences in anesthetic management. Understanding postoperative management during the ICU is also a challenge.

Monitoring Anesthesia Care Menggunakan Target Control Infusion Propofol pada Evacuasi SDH Spontan dengan Kelainan Jantung Krisna J. Sutawan, Ida Bagus; Oetoro, Bambang J; Rasman, Marsudi
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
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Pasien SDH spontan yang berhubungan dengan pengobatan warfarin biasanya memberikan keluaran yang baik setelah dilakukan evakuasi hematom SDH, namun biasanya pasien disertai oleh penyakit-penyakit penyerta yang memberikan tantangan pada saat penaganan anestesi. Monitoring Anasthesia Care (MAC) dengan Target Controlled Infusion (TCI) Propofol dibandingkan dengan bolus manual dihubungkan dengan peningkatan stabilitas hemodinamik dan penurunan dari efek penekanan jalan nafas dan respirasi. Seorang pasien geriatri dengan SDH spontan subkronik, riwayat penggunaan warfarin dan penyakit penyerta atrial fibrilasi, gagal jantung kronik serta hipertiroid dikeluhkan dengan penurunan kesadaran. GCS 13, pupil 3mm/2mm, reflek cahaya menurun, tekanan darah 140/90 dengan nadi irreguler 100x/mnt, murmur positif. CT-scan kepala, SDH frontotemporoparietal dextra dengan herniasi 1,62 cm ke kiri dan herniasi transtentorial. Echocardiografi, gobal hipokinetik, MR berat, PR sedang, TR berat dengan ejeksi fraksi 36%. Pembedahan difasilitasi dengan MAC menggunakan TCI propofol model Schnider yang ditingkatkan secara bertahap sampai skala ramsay 5, dan setelah dilakukan sclap blok, sedasi diturunkan sampai skala ramsay 3-4 untuk meminimalisir penekanan jalan nafas dan respirasi. MAC menggunaan kombinasi bolus fentanyl dengan TCI propofol ditambah premedikasi midazolam dan obat adjuvant klonidin, dapat memfasilitasi dengan baik tindakan evakuasi SDH spontan dengan borrhole. Induksi TCI propofol yang dilakukan dengan model Schnider dengan jalan meningkatkan effect sitenya (Ce) secara bertahap dapat memberikan keadaan hemodinamik yang stabil dan penekanan jalan nafas serta respirasi yang minimal.Monitoring Anesthesia Care using Target Control Infusion Propofol for Evacuation of Spontaneous SDH with Heart ProblemWarfarin associated spontaneous SDH patient usually have a good outcome following evacuation of SDH hematoma, however this kind of patient usually have underlying disease that become a challange for the anesthesia management. Monitoring Anasthesia Care (MAC) using Propofol Target Controlled Infusion (TCI) compare to manual bolus, associated with better hemodinamic stabilitas and less respiration/airway deppresion. A geriatic, warfarin associated subchronic spontaneous SDH patient is complained having decrease of conciousness. The patient with underlying disease of atrial fibrilaton, Chronic heart failure and hypertyroidism. GCS 13, pupil 3mm/2mm, decrease pupil reflex, blood pressure 140/90 with irregular pulse 100x/minute, murmur (+). Brain CT-Scan, SDH frontotemporoparietal dextra, with herniation to the left 1,62 cm and transtentorial herniation. Echocardiogrphy, global hypokinetic, MR severe, PR severe, TR severe with ejection fraction 36%. Surgery is fasilitated by MAC using Schiner model TCI propofol with slowly increasing dose to achieved ramsay lever 5. After the sugeon done with their sclap block, the dose is decreased up till ramsay level 3-4 is achived. The purpose is to minimalized respiratori and airway deppresion. MAC using combination of fentanyl bolus and TCI propofol with premedication midazolam and klonidin, can be use nicely to fasilitated an SDH spontan evacuation by borrhole. Induction of TCI propofol using Schiner model, in which the effect site (Ce) is slowly increased can give an hemodinamic stability and minimal airway/respiration deppresion.

Pascaoperasi Bedah Saraf: Kapan Ekstubasi, Kapan Ventilasi? Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Prinsip dasar tujuan anestesi pada bedah saraf adalah memudahkan pemeriksaan neurologik dini. Pemulihan yang cepat dari neuroanestesia dan ekstubasi dini sangat diinginkan pada semua kasus karena memungkinkan pemantauan klinis yang merupakan hal penting untuk mendeteksi komplikasi pascabedah. Ekstubasi trakea harus dilakukan dengan hati-hati serta mempertimbangkan risiko dan keuntungannya, yaitu: terlalu cepat sadar dari anestesi dapat memperburuk edema atau perdarahan otak sebagai akibat dari hipertensi berat dan ekstubasi pada pasien yang belum sadar penuh dapat menyebabkan hiperkapnia dan aspirasi. Setelah operasi yang tidak sulit, pasien biasanya pulih dari anestesi dengan perubahan metabolik dan hemodinamik minimal. Dengan demikian pemulihan dini dan ekstubasi di kamar operasi adalah metode yang lebih disukai apabila kesadaran prabedah relatif normal dan pembedahan tidak pada daerah otak yang penting atau manipulasi yang luas. Pada pembedahan yang sulit dan pasien tidak stabil, risiko ekstubasi dini harus dipertimbangkan keuntungannya. Namun selalu memungkinkan untuk membangunkan pasien tanpa ekstubasi untuk evaluasi neurologik dini yang diikuti dengan pemulihan anestesi dan ekstubasi yang tertunda. Jika ada keraguan apakah pasien akan diekstubasi, sedasi selama 1-2 jam memberikan waktu untuk mengoreksi hemodinamik dan gangguan metabolik. Pemulihan keadaran yang ditunda dan ekstubasi yang kemudian dilakukan di unit perawatan intensif (UPI) direkomendasikan untuk memperoleh stabilitas kardiovaskuler setelah prosedur intrakranial major. Tersedianya anestetika dan analgesia intravena dengan mula dan lama kerja sangat singkat dan obat-obat penghambat adrenergik telah memungkinkan untuk pulih sadar segera setelah pembedahan intrakranial. Pemantauan hemodinamik dan respirasi yang ketat adalah wajib dilakukan pada semua kasus dan skor GCS 8 telah ditetapkan sebagai prediktor berhasilnya ekstubasi.Postoperative Neurosurgery: When Extubation, When Ventilation? The principal elements to anesthetics goal to neurosurgery is facilitate an early neurologic assessment. Early recovery from neuroanesthesia and extubation to desirable to most cases because it allows clinical monitoring of the patients, which is essential to detect postoperative complications. Extubation of the trachea must be carefully considered in terms of risk and benefit that is: too rapid an emergence from anesthesia may lead to worsening of cerebral edema or cerebral hemorrhages as result of severe hypertension and extubation of a patient who not fully conscious may promote hypercapnia and aspiration. After uncomplicated surgery, patients generally recover from anesthesia with minimal metabolic and hemodynamic changes. Thus, early recovery and extubation in the operating room is the preferred method when the preoperative state of consciousness is relative normal and surgery does not involve critical brain areas or extensive manipulation. In the complicated or unstable patient, the risk of early extubation may outweigh the benefits. It is, however, often possible to perform a brief awakening of the patient without extubation to allow early neurological evaluation, followed by delayed emergence and extubation. If there is any doubt as to whether the patient should be extubated, a 1- to 2-hour sedation period allow time to correct hemodynamic and metabolic disturbances. A delayed emergence and later extubation in the intensive care unit (ICU) might be recommended to achieve better cardiovascular stability after major intracranial procedures. The availability of ultrashort intravenous anesthetic and analgetic agents and adrenergic blocking agents has added to the flexibility in the immediate emergence period after intracranial surgery. Close hemodynamic and respiratory monitoring are mandatory in all cases and GCS score 8 established a cutoff associated with a likelihood of successful extubation.

Penanganan Anestesi pada Operasi Atlas Meningioma Susanto, Yunita; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
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Angka kejadian spinal meningioma di Amerika adalah 25 % dari seluruh tumor di regio spinal dan empat kali lebih banyak muncul pada perempuan usia lebih dari 40 tahun dibandingkan pada laki-laki. Delapan puluh persen terjadi di daerah vertebra thorakal, 15% di cervikal, 3% di lumbal dan 2% di foramen magnum. Seorang wanita berusia 42 tahun, GCS 15 dengan diagnosa atlas meningioma, yang dilakukan operasi laminectomu untuk pengangkatan tumor. Pasien mengeluh kesemutan mulai dari tangan kiri diikuti tangan kanan, kaki kiri diikuti kaki kanan sejak 10 bulan yang lalu. Sejak 2 bulan yang lalu pasien mengeluh lemas bila berjalan yang disertai kelemahan kedua tangan, disertai keterbatasan gerak dari leher, tidak ada gangguan berkemih dan defekasi. Intubasi dilakukan dengan cara inline position, operasi berlangsung selama 7 jam dengan total perdarahan 650 cc, rumatan anestesi menggunakan isofluran 0,81 vol%, dexmedetomidine 0,20,7 mcg/kgbb/jam dan vecuronium 1 mcg/kgbb/mnt. Pascaoperasi pasien tidak diekstubasi, dirawat Neurosurgery Critical Care Unit (NCCU), pernafasan dibantu mesin bantu nafas dengan mode Synchronized Intermittent Mandatory Ventilation (SIMV) dan baru diekstubasi 12 jam pascaoperasi. Tiga hari pascaoperasi pasien dipindahkan ke ruangan dengan GCS 15 dan keadaaan hemodinamik stabil.Anesthesia Management in Atlas Meningioma SurgeryThe incidence rate of spinal meningioma in the US is 25% of all tumors in the spinal region and appears four times more in women aged over 40 years old than in men. Eighty percent occurs in the thoracal, 15% in the cervical, 3% in the lumbar and 2% in the foramen magnum. This is a case of a 42-year-old woman with GCS 15 who was diagnosed with high cervical meningioma underwent laminectomy tumor removal. Patient experienced numbness on the left referring to the right hand and left referring to the right hand foot since 10 months ago. Since 2 months ago the patient experienced limp with weakness on both hands and limited neck motion. Patients had no disturbance in micturition and defecation. Intubation was done by inline position while the surgery lasted for 7 hours with 650cc bleeding. Anesthesia was maintained using isoflurane 0.8-1 vol %, dexmedetomidine 0.2-0.7 mcg/kg/h and vecuronium 1 mcg/kg/mnt. After surgery, the patient was not extubated and admitted to NCCU (Neurosurgery Critical Care Unit) with ventilator-mode SIMV (Synchronized Intermittent Mandatory Ventilation). Extubation was performed 12 hours postoperative. Three days after surgery patient was transferred to inpatient ward with GCS 15 and stable hemodynamic status.

Pembedahan Tumor Cerebellopontine Angle: Tehnik Proteksi Otak, Pengawasan Sistem Kardiorespirasi dan Efek Manipulasi Posisi True Lateral Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
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Tumor cerebellopontine angle (CPA) merupakan jenis neoplasma terbanyak yang ditemukan di fossa posterior. Wanita 32 tahun dengan diagnosa CPA tumor dilakukan pembedahan trepanasi reseksi. Posisi pembedahan true lateral. Tehnik anestesi proteksi otak menggunakan kombinasi total intra vena (TIVA) dan inhalasi. Dilakukan pemasangan pengawasan invasif untuk memantau perubahan sistem kardiorespirasi selama pembedahan. Dilakukan pencegahan dan pemantauan terhadap akibat dari posisi pembedahan. Hasil dari pembedahan didapatkan pengurangan skala nyeri dan peningkatan fungsi neurologis. Tindakan pembedahan pada tumor di daerah CPA merupakan tindakan pembedahan yang sulit dan dapat menimbulkan komplikasi yang fatal. Pengelolaan anestesi untuk tindakan bedah fossa posterior memerlukan pertimbangan yang matang dan sudah ditentukan sebelum dilakukan anestesi. Persiapan pada pasien dengan lesi fossa posterior adalah evaluasi prabedah, premedikasi, induksi, posisi durante, pengelolaan anestesi dan monitoring. Manipulasi selama pembedahan pada batang otak dan saraf kranialis akan menimbulkan akibat pada sistem kardiorespirasi dan dapat fatal. Posisi true lateral mempunyai resiko tersendiri terhadap pasien selama dan pascapembedahan, hal tersebut harus menjadi perhatian khusus oleh ahli anestesi. Anestesi mempunyai peranan yang sangat penting dalam manajemen secara keseluruhan pada pasien ini untuk memberikan manajemen proteksi otak yang maksimal selama pembedahan sehingga memperoleh hasil akhir pembedahan yang sukses.Cerebellopontine Angle Tumor Surgery: Brain Protection Techniques, Cardiorespiratory System Monitoring and True Lateral Position Manipulation EffectsAbstractCerebellopontine angle (CPA) tumors are the most common neoplasm found in the posterior fossa. A 32-year-old woman diagnosed with CPA tumor underwent resection. The surgery position is true lateral. Brain protection anesthetic techniques use total intravenous (TIVA)-inhalation combination. Invasive monitoring is performed to monitor the cardiorespiratory system during surgery. Prevention and monitoring are done to manage the effect of surgical position. There is a reduction in pain scale and increased neurological function after the surgery. CPA tumor surgery is a difficult procedure and potentially cause fatal complications. The anesthesia management for posterior fossa surgery must be determined before anesthesia. The surgery preparation for posterior fossa lesions-patients consists of surgery evaluation, premedication, induction, durante position, anesthesia management, and monitoring. The brainstem and cranial nerve surgery cause a fatal complication in the cardiorespiratory system. The true lateral position impact the patients' condition during and after surgery. Anesthesia is important to provide maximum brain protection and successful surgery.

Penatalaksanaan Perioperatif pada Bedah Dekompresi Mikrovaskular: Sajian Kasus Serial Firdaus, Riyadh; Suarjaya, I Putu Pramana; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
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Dekompresi mikrovaskular (microvascular decompression/MVD) adalah terapi definitif dari spasme hemifasial, yakni suatu gangguan gerakan neuromuskular wajah. Spasme ini ditandai dengan kontraksi involunter berulang pada otat yang diinervasi oleh N. fasialis (N.VII) akibat penekanan oleh arteri, tumor atau kelainan vaskular lainnya. Prevalensinya mencapai 911 kasus per 100.000 populasi sehat, dan paling sering terjadi pada usia 4060 tahun. Meskipun bukaan operasi MVD kecil yaitu di sekitar retroaurikula tetapi teknik anestesi-nya menggunakan prinsip-prinsip pembedahan fossa posterior. Bukaan lapangan operasi yang baik, kewaspadaan terhadap rangsangan ke batang otak maupun nervus kranialis dan kewaspadaan terhadap penurunan perfusi otak merupakan pilar-pilar utama tatalaksana anestesia pada MVD. Disajikan empat kasus spasme hemifasial dengan keadaan khusus. Kasus pertama operasi dilakukan pada pasien geriatri, pasien kedua dengan riwayat hipertensi, pasien ketiga dengan leher pendek dan asma, pasien terakhir dengan diabetes mellitus serta hipertensi. Pemantauan kestabilan hemodinamik, kedalaman anestesia dan relaksasi otot merupakan aspek penting yang menyertai tata laksana anestesi pada kasus ini.Perioperative Management in Microvascular Decompression Surgery: Case Series ReportMicrovascular decompression (MVD) is the definitive surgery for hemifacial spasm. The symptoms is described as a repetitive involuntary muscle contraction which innervated by N.fascialis caused by compression of the nervus by enlarged artery, tumor or vascular malformation. Its happened to 9-11 people from 100.000 population, especially in 4th to 6th decades. Although MVD operation only need small opening in retroauricula area but it still use posterior fossa operation principles. They are sufficient work field, awareness of impulse to brain stem and cranial nerves, and decrease of cerebral perfusion pressure. We present four cases of hemifacial spasm, with variety of considerations. The first case was a geriatric patient, the second was with history of hypertension, the third patient has short neck and also history of hypetension and asthma and the last is with diabetes mellitus and history of hypertension. Hemodynamic monitoring, deepness of anesthesia and adequate muscle relaxation is important parameter of anasthetical management of these cases.

Penatalaksanaan Anestesi pada Seksio Sesarea Penderita HIV/AIDS dengan Space Occupying Lession (SOL) Rose Mafiana; Yusmein Uyun
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
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Kehamilan mempunyai dampak terhadap perubahan anatomi, fisiologi, farmakologi dan psikis pada sang ibu sehingga seksio sesarea pada ibu hamil merupakan tantangan tersendiri untuk spesialis anestesiologi, karena pertimbangannya terhadap keselamatan ibu dan anak. Apabila kehamilan disertai dengan penyulit yang lain, maka kondisi ini akan semakin kompleks. Kasus ini mengemukakan ibu hamil penderita HIV/AIDS dengan penyulit Space Occupying Lession (SOL), pertimbangan seksio sesarea dilakukan sebagai terminasi kehamilan untuk mengurangi paparan Maternal to Child Transmission (MTCT) terhadap anak yang dilahirkan. Pertimbangan pemilihan tehnik anestesinya berdasarkan fisiologi kehamilan, patofisiologi HIV/AIDS, efek samping obat Anti Viral (ARV), interaksi obat ARV dengan obat anestesi, komplikasi HIV/AIDS pada otak berupa SOL yang berhubungan dengan peningkatan TIK, dampak infeksius penyakot ini kepada lingkungannya serta antisipasi terhadap medis/paramedic yang ikut menangani tindakan terminasi. Pada penderita ini kami lakukan tehnik anestesi edpidural dengan bupivacaine 0,5 % sebagai bfasilitas anestesi selama seksio sesarea. Pascaoperasi dilanjutkan nyeri melalui kateter epiduralnya.Anesthesia Management of Sectio Caesaria HIV/AIDS Patient with Space Occupying Lession (SOL)Sectio caesarea on prenatal vidual have challenge in anaesthesia because influence safety mothers and children. Pregnancy to changes anatomy, physiology, pharmacology and psychology on the mother moreover that’s can accompanied by another complications, and make change this increasingly complex. In this case was pregnant mothers HIV/AIDS sufferes with a complication space occupying lesion (SOL). Sectio caesaria done to termination of pregnancy to reduce exposure transmission against children born gord loan-to- maternal child transmission (MCTC), Consideration of anestesinya technique based on pregnancy, physiology, pahtopfisiologi HIV/AIDS, adverse side effects anti retro viral (ARV) and interaction with medicine. Anaethetic complication SOL in HIV/AIDS in the brain associated with increased intracranial pressure. The impact of infectious disease that contaminate the environment and anticipations for medical paramedics / anaesthetic to prevent its. We did the patient with ep[idural anaethetic technique and used bupivacaine 0.5 % as facilitate anesthesia during section caesaria. Postoperaive continued pain releave through her catheter epidural.

Tatalaksana Cerebral Venous Sinus Thrombosis dengan Alkoholik dan Perdarahan Intraserebral Fitri Sepviyanti Sumardi; Rose Mafiana; Eri Surachman
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
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Cerebral venous sinus thrombosis (CVST) adalah suatu sindrom seperti stroke, angka kejadiannya sangat jarang, sehingga dapat menjadi dilema bagi dokter di instalasi gawat darurat dalam menegakkan diagnosis. Seorang lelaki 25 tahun, 50 kg, tinggi badan 165 cm, mengeluh lemah anggota badan sebelah kanan sejak 12 jam sebelum masuk rumah sakit. Keluhan disertai dengan sukar berbicara. Satu hari sebelum masuk rumah sakit, pasien mabuk-mabukan dan mengalami muntah-muntah ± 3–5 x/hari. Riwayat kejang, konsumsi obat-obatan dan trauma sebelumnya disangkal. Tidak ada riwayat demam, hipertensi, diabetes mellitus dan penyakit penyerta lainnya. Dilakukan dekompresi evakuasi perdarahan sebagai tindakan penyelamatan jiwa setelah pasien terehidrasi, operasi dilakukan dalam anestesi umum. Lama operasi selama 2 jam dan lama pasien teranestesi 2 jam 15 menit. Pasien dirawat di ICU selama 2 hari, lalu dipindahkan ke ruang HCU. Pada hari ke-5 pascabedah mulai diberikan enoxaparin sodium 50 mg subcutan selama 6 hari. Lalu pasien dipindahkan ke ruang rawat inap dan pulang ke rumah pada hari ke-15 perawatan. Target pencapaian utama pada pasien CVST adalah untuk rekanalisasi penyumbatan, menjaga venous return, mengurangi risiko hipertensi vena, infark serebral dan emboli paru. Algoritma tatalaksana pasien CVST terkadang harus disesuaikan dengan kondisi klinis pasien saat tiba di rumah sakit. Pemberian low-weightmoleculer heparin (LWMH) tetap diberikan selama tidak terjadi peningkatan tekanan darah yang bermaknaCerebral Venous Sinus Thrombosis Management with Alkoholic and Intracerebral HemorrhageCerebral venous sinus thrombosis (CVST) is a syndrome similar a stroke, the incidence is very rare, so it can be a dilemma for doctors at emergency departments to make the diagnosis. A 25 year old male weighing 50 kg and height 165 cm. Patients complained of right limb wekness since 12 hours before admission. Complaints are accompanied by difficulty speaking. One day before entering the hospital, the patient got drunk and experienced vomiting ± 3–5 times a day. History of seizures, previous consumption of drugs and trauma was denied. No history of fever, hypertension, diabetes mellitus and other comorbidities. Decompression by hematoma evacuation was performed as a life-saving action after the patient was hydrated, surgery was performed under general anesthesia. Operation duration was 2 hours and anesthesia duration was 2 hours 15 minutes. The patient was admitted to the ICU for 2 days, then transferred to the HCU room. On the 5th day post-surgery patient got 50 mg subcutaneous enoxaparin for 6 days. Then the patient was transferred to the ward and returned home on the 15th day of treatment. The main achievement targets in CVST patients were for clotting recanalization, maintaining venous return, reducing the risk of venous hypertension, cerebral infarction and pulmonary embolism. The CVST patient management algorithm sometimes has to be adjusted to the patient's clinical condition upon arrival at the hospital. Provision of LWMH is still given as long as the blood pressure does not increase significantly.

Manajemen Anestesi untuk Reseksi Tumor Pineal Body dengan Posisi Duduk Agus Baratha Suyasa
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perkembangan teknik operasi mikro yang semakin baik serta perkembangan neuroanesthesia dan critical care yang semakin canggih membuat reseksi tumor yang agresif menjadi pilihan untuk manajemen tumor regio pineal dan ventrikel III. Seorang laki laki 49 tahun dengan tumor pineal body pasca Ventriculo-Peritoneal shunt, akan dilakukan operasi kraniotomi reseksi tumor dengan posisi duduk. Pasien mengeluh nyeri kepala hebat, berkurang dengan obat tetapi sering kambuh. Sejak Maret 2013 penglihatan kabur, sempoyongan, mual muntah, dan telinga terasa berdenging. Operasi dilakukan dengan posisi duduk dalam anestesi umum, menggunakan pipa endotrakeal (ETT) no.7,5 non kinking, ventilasi kendali. Pipa nasogastrik (NGT) no.16 dipasang untuk dekompresi. Premedikasi dengan midazolam 2 mg iv, deksametason 20 mg iv. Koinduksi menggunakan fentanyl 100 μg iv, induksi dengan propofol 200 mg iv. Fasilitas intubasi dengan rokuronium 0,9 mg/KgBB. Pemeliharaan anestesi dengan O2 + air + sevofluran dengan fraksi oksigen 50%. Propofol kontinyu 100–200 mg/jam, vekuronium 6mg/jam. Monitoring tanda vital (tekanan darah, nadi, SaO2, elektrokardiografi), etCO2, arteri line dan kateter vena sentral (CVC). Reseksi tumor dilakukan selama 6 jam. Selama operasi hemodinamik relatif stabil, tekanan darah sistolik berkisar 90–110 mmHg, tekanan darah diastolik 60-80mmHg, laju nadi 50–70 x/mnt, SaO2 99–100 %, etCO2 30 mmHg. Pascaoperasi pasien masih dengan ventilasi kontrol di rawat di ruang perawatan intensif. Berbagai pendekatan bedah telah dikemukakan untuk tumor ventrikel III posterior dan regio pineal. Pilihan pendekatan dipengaruhi oleh lokasi tumor, temuan patologi, dan kenyamanan dokter bedah serta pertimbangan resiko komplikasi. Management of Anesthesia for Pineal Body Tumor Resection in the Sitting Position The development of micro-surgery techniques are advancing and the development of neuroanesthesia and critical care are growing increasingly sophisticated making aggressive tumor resection as an option for the management of tumors located in the pineal and third ventricle region. A 49 years old male with a pineal body tumor after Ventriculo-Peritoneal shunt, underwent a craniotomy tumor resection surgery conducted in a sitting position. The patient complained of severe headache which was reduced by drugs, however relapsed again. Blurred vision, staggering, nausea, vomiting, ringing in the ears, were experienced in March 2013. Surgery performed with general anesthesia in the sitting position, using non kinking endotracheal tube size 7.5 under controlled ventilation. Nasogastric tube no.16 was inserted for decompression. Premedication with midazolam 2 mg iv, dexamethasone 20 mg iv. Co induction using fentanyl 100 mcg iv, induced with propofol 200 mg iv. Facilities intubation with rocuronium 0.9 mg/KgBW. Maintenance of anesthesia with sevoflurane + O2 + air with oxygen fraction 50%. Continuous propofol 100–200 mg/hour, and vekuronium 6 mg/h were given. Monitoring vital signs (BP, HR, SaO2, ECG), etCO2, arterial line and CVC. Tumor resection was performed in 6 hours. Relatively stable hemodynamics during surgery, systolic blood pressure ranged within 90–110 mmHg, diastolic blood pressure of 60-80 mmHg, heart rate 50–70 x/min, SaO2 99–100%, etCO2 30 mmHg. Postoperatively the patient was managed in the ICU under controlled ventilation. Various surgical approaches have been put forward for the posterior third ventricular tumor and pineal region. Choice of approach is influenced by the location of the tumor, pathological findings, surgeon comfort and risk of complications

Profil Kadar Natrium Serum pada Pemberian Manitol 20% dan Natrium Laktat Hipertonik Intravena pada Tikus Jantan Wistar Pamillian, Niko; Sudadi, Sudadi
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Penggunaan cairan hiperosmoler dalam waktu lama berpengaruh terhadap peningkatan natrium serum. Natrium laktat hipertonik sebagai cairan baru berbasis natrium belum memiliki evidence base yang menyatakan bahwa penggunaan jangka panjang aman pada peningkatan tekanan intrakranial (TIK).Tujuan penelitian ini adalah untuk mengetahui pengaruh pemberian natrium laktat hipertonik terhadap perubahan natrium pada tikus wistar jantan dibandingkan dengan manitolSubjek dan Metode: Penelitian ini adalah penelitian laboratorik eksperimental pada hewan coba menggunakan rancangan simple random sampling. Didapatkan 36 tikus wistar jantan dengan usia dan berat badan 14,220,43 minggu dan 301,5625,10gr pada kelompok A dan 14,170,38 minggu dan 277,6118,85gr pada kelompok B. Manitol atau natrium laktat hipertonik diberikan selama 5 hari dan dinilai perubahan kadar natrium pasca pemberianHasil: Perubahan kadar natrium tertinggi pada kelompok natrium laktat hipertonik dibandingkan manitol terjadi pada hari pertama dibandingkan kadar natrium sebelum perlakuan, sebelum perlakuan 5,064,25 dan setelah perlakuan 5,672,96 mEq/L ( p= 0,222) dan perubahan terendah didapatkan pada hari ketiga dibandingkan hari kedua (0,223,51 vs 0,222,29 mEq/L) (p=0,568). Rerata tertinggi pada kelompok natrium laktat hipertonik dibandingkan manitol adalah 147,833,35 vs 147,833,35 mEq/L dan rerata terendah adalah 145,83 2,07 vs 146,06 2,92. Simpulan: Pada penelitian hewan coba ini pemberian natrium laktat hipertonik dan manitol akan meningkatkan kadar natrium secara bermakna dibandingkan sebelum perlakuan, tetapi tidak diikuti dengan perubahan yang bermakna pada hari pertama sampai dengan hari kelima.Profile of Serum Sodium Levels on Intravenous Administrations of 20% Mannitol and Hypertonic Sodium Lactate in Male Wistar RatsAbstractBackground and Objective: Prolonged use of hyperosmolar solution associated with mortality. Hypertonic sodium lactate as a new sodium-based solution does not yet have an evidence base that states that long-term use is safe in increasing ICP. Knowing the effect of hypertonic sodium lactate on alterations sodium level in male wistar rats compared to mannitolSubject and Method: This research is an animal experimental laboratory study using a simple random sampling design.Thirtysix male wistar rats were obtained with age and body weight 14.220.43 weeks and 301.5625.10gr in the group A and 14.170.38 weeks and 277.6118.85gr in the group B. Both groups were given hypertonic sodium lactate or mannitol for 5 days and assessed on changes sodium level after administration.Results: The highest alterations sodium levels in the hypertonic sodium lactate group compared to mannitol occurred on the first day 5.064.25 compared to sodium levels before treatment 5.672.96 mEq / L (p = 0.222) and the lowest changes were obtained at the third day compared to the second day (0.223.51 vs 0.222.29 mEq / L) (p = 0.568). The highest mean in the hypertonic sodium lactate group compared to mannitol was 147.833.35 vs 147.833.35 mEq / L and the lowest mean was 145.832.07 vs 146.062.92.Conclusion: In this experimental animal study, hypertonic sodium lactate and mannitol increased sodium levels significantly compared to before treatment, but were not followed by significant changes on the first day to the fifth day.

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Home Page

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Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

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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

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INDONESIA