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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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Tatalaksana Anestesi pada Direct Clipping Aneurisma Otak Buyung Hartiyo Laksono; Nazaruddin Umar; Marsudi Rasman
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Perdarahan subarachnoid (SAH) yang diakibatkan oleh pecahnya aneurisma otak menyumbang sekitar 85% dari kejadian SAH non traumatik. Insidensi sekitar 8–10 per 100.000 penduduk per tahun atau sekitar (0,008%). Rangkaian tatalaksana kasus SAH mempengaruhi outcome dari hasil terapi, mulai dari pertolongan pertama pada prehospital, transportasi, diagnosis awal, manajemen kegawatdaruratan dini, tindakan neuroradiologi intervensi ataupun pembedahan dan perawatan intensif pasca tindakan definitif. Pada laporan kasus ini, pasien wanita usia 65 tahun, berat badan 50 kg dengan diagnosa SAH hari ke 18 karena pecahnya aneurisma arteri serebri media disertai defisit neurologis ringan. Pembedahan dilakukan tindakan kraniotomi direct clipping aneurisma. Prinsip anestesi yang dilakukan adalah pemeliharaan homeostasis dan Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP) yang efektif, tindakan pencegahan peningkatan tekanan intrakranial (Intracranial Pressure-ICP), pembengkakan otak dan manajemen vasospasme serebral. Operasi berjalan 6 jam dan dilakukan rapid emergence. Outcome pembedahan sesuai yang diharapkan. 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. Anesthetic Management in Direct Clipping Cerebral AneurysmaSubarachnoid hemorrhage (SAH) caused by rupture of a brain aneurysm accounts for about 85% of the incidence of non-traumatic SAH. The incidence is approximately 8-10 per 100,000 populations per year, or about (0.008%). The management of SAH affects the outcome, ranging from first aid in Prehospital, transportation, early diagnosis, early emergency management, neuroradiology action or surgical interventions and intensive therapy after definitive care. In this case report, a 65 years old female, 50 kgs, diagnosised with SAH day 18 due to middle cerebral artery aneurysm rupture with mild neurological deficits. Craniotomy was performed using direct aneurysm clipping. The anesthesia principle is to maintain adequate homeostasis and effective Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP), preventing increase in ICP, brain swelling and management of cerebral vasospasm. The operation was done in 6 hours with rapid emergence. The outcome of surgery was as expected. Anesthesia has a very important role in the overall management of these patients to provide optimal brain protection management during surgery in obtaining successful outcome.

Korelasi antara Skor Intracerebral Hemorrhage (ICH) dengan Mortalitas Pasien Perdarahan Intraserebral di RSUD Ulin Banjarmasin Awanis, Marini; Sikumbang, Kenanga Marwan; Asnawati, Asnawati
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Latar Belakang dan Tujuan: Perdarahan intraserebral (PIS) merupakan kejadian medis yang meningkatkan angka kematian dan kecacatan tinggi. Secara teori, mortalitas PIS dapat diprediksi dengan menggunakan komponen skor Intracerebral Hemorrhage (ICH). Tujuan penelitian ini untuk mengetahui bagaimana korelasi antara skor ICH dengan mortalitas pasien PIS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sebanyak 53 sampel didapatkan secara consecutive sampling. Data hasil penelitian diuji dengan uji Regresi Logistik.Hasil: Dalam penelitian ini pasien skor ICH 0 meninggal sebanyak 15%, 36% skor ICH 1, 71% skor ICH 2, 86% skor ICH 3 dan 100% skor ICH 4 dan 5. Hasil analisis data penelitian ini, diperoleh OR = 0,02; 0,06; 0,3 untuk masing-masing skor ICH 1, 2 dan ?3; dengan p=0,001. Simpulan: Terdapat korelasi yang sangat signifikan dan hubungan positif antara skor ICH dengan mortalitas pasien PIS di RSUD Ulin Banjarmasin, sebagai prediktor independen.Correlation between ICH Score with ICH Patients Mortality at Ulin General Hospital BanjarmasinAbstractBackground and Objective: Intracerebral hemorrhage (ICH) is the medical events that increases the mortality and disability. Theoretically, mortality can be predict by ICH scores components. The purpose of this study is to determine the correlation between ICH scores and mortality of ICH patients in Ulin General Hospital Banjarmasin. Subject and Method: This research is an analytic observational with cross sectional approach. A total of 53 samples were obtained by consecutive. Data analysis of this study used the Logistic Regression test.Result: In this study, it was found that patients with ICH score 0 died 15%, 36% score 1, 71% score 2, 86% score 3 and 100% score 4 and 5. Data analysis of this study showing OR= 0,02; 0,06; 0,3 for ICH score 1, 2 and ?3 respectively; with p=0,001. Conclusion: There is a very significant correlation and enough positive relationship between the ICH score and mortality of ICH patients in Ulin General Hospital Banjarmasin, as independent predictor.

Disfungsi Kognitif Pascaoperasi Pada Pasien Operasi Elektif Lucky Andriyanto; W Wijoto; Nancy Margereta Rehatta
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Latar Belakang dan Tujuan: Disfungsi kognitif pascaoperasi (DKPO) sering terjadi dan menjadi masalah serius karena dapat menurunkan kualitas hidup pasien yang menjalani pembedahan dan meningkatkan beban pembiayaan kesehatan. Tujuan penelitian ini adalah untuk mengetahui angka kejadian DKPO pada pasien yang menjalani operasi elektif di RSU dr. Sutomo dan menganalisa faktor-faktor yang mempengaruhinya. Subjek dan Metode: Penelitian ini melibatkan 50 orang sampel berusia 40 tahun atau lebih yang menjalani pembedahan lebih dari dua jam. Dilakukan serangkaian pemeriksaan fungsi kognitif praoperasi dan tujuh hari pascaoperasi. Domain kognitif yang diukur adalah atensi dan memori. Faktor yang diduga mempengaruhi kejadian DKPO dalam penelitian ini adalah usia, tingkat pendidikan dan durasi operasi. Hasil: Tujuh hari pascaoperasi 30% sampel mengalami gangguan atensi, 36% sampel mengalami gangguan memori dan 52% sampel mengalami disfungsi kognitif pascaoperasi. Pemeriksaan kognitif yang mengalami penurunan bermakna adalah digit repetition test, immediate recall, dan paired associate learning. Analisa logistik regresi variabel usia (p=0,798), tingkat pendidikan (p=0,921) dan durasi operasi (p=0,811) terhadap kejadian DKPO menunjukkan hubungan yang tidak bermakna. Namun bila dianalisa pada masing masing kelompok usia tampak bahwa persentase pasien yang mengalami DKPO konsisten lebih tinggi pada usia  50 tahun, tingkat pendidikan  6 tahun dan durasi operasi  180 menitSimpulan: Kejadian disfungsi kognitif pada pasien yang menjalani operasi elektif di RSU dr. Sutomo cukup tinggi. Faktor usia, tingkat pendidikan dan durasi operasi tampaknya mempengaruhi kejadian DKPO meskipun secara statistik tidak signifikan.Postoperative Cognitive Dysfunction In Elective Surgical PatientBackground and Objective: Post operative cognitive dysfunction (POCD) is a common and becoming a serious problem since it can impair the quality of life of the patient who underwent surgery and increase the burden of health cost. In this study, author wanted to know the incidence of POCD among patients undergoing elective surgery patients in dr. Sutomo hospital and examine the risk factors.Method: The study involved a sample of fifty people aged 40 years or older who underwent surgery more than two hours. Conducted a series of cognitive function tests pre-surgery and seven days post-surgery. Cognitive domain that measured were attention and memory. Factors that thought to affect the incidence of POCD in this study were age, educational level and duration of surgery.Result: After 7 days post surgery 30 % of patients had attention decline, 36 % patients had memory decline and 52 % had post operative cognitive decline. Cognitve function test that decrease significantly are digit repetition test, immediate recall, and paired associate learning. Regression logistic analysis for age (p = 0.798), education level (p = 0.921) and duration of surgery (p = 0.811) on the incidence POCD showed no significant relationship. However, when analyzed in each group of age, the results would show that the percentage of patients experiencing POCD was consistently higher in the age of 50 years or older, education level of 6 years or less and duration of surgery of 180 minutes or longer.Conclusion: The incidence of cognitive dysfunction in patients undergoing elective surgery in dr. Sutomo hospital was considered high. Age, education level and duration of surgery appeared to influence the incidence of POCD although not statistically significant.

Hematoma Subdural pada Bayi dengan Acquired Prothrombine Complex Deficiency (Apcd) Syndrome Di Rs. Hasan Sadikin Dari Juli 2010 Sampai Februari 2011 Fitri Sepviyanti Sumardi; Dewi Yulianti Bisri; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Latar Belakang dan Tujuan: Acquired Prothrombine Complex Deficiency (APCD) adalah salah satu penyakit serius bayi, menyebabkan tingkat kematian yang tinggi, dan gejala sisa neurologis permanen pada penderita dengan hematoma subdural (SDH). Beberapa penelitian menyatakan tentang hubungan APCD dengan tingginya prevalensi menggunakan minuman ramuan tradisional disertai pembatasan asupan makanan pada ibu menyusui. Kadar Vitamin K2MK4 pada air susu ibu (ASI) yang menggunakan minuman ramuan tradisional ditemukan lebih rendah dari dibandingkan ASI dari ibu yang tidak menggunakan minuman ramuan tradisional.Subyek dan Metode: Enam kasus bayi dengan diagnosis SDH spontan karena APCD, ditinjau dari Juli 2010 sampai Februari 2011 di RS Hasan Sadikin Bandung. Data diambil meliputi anamnesis, pemeriksaan fisik, hasil CT-scan, hasil laboratorium, manajemen dan temuan selama pembedahan serta setelah pembedahan.Hasil: Semua enam bayi menunjukkan bukti memiliki riwayat, tanda dan gejala, dan gangguan perdarahan yang menuju kearah SDH karena APCD. Manajemen pada seluruh kasus di atas termasuk evaluasi awal CT scan, pengobatan intervensi APCD dan bedah menghasilkan hasil keluaran yang baik pada pasca pembedahan dan pemulangan dari rumah sakit.Simpulan: Faktor koagulasi berkepanjangan pada semua kasus menunjukkan risiko lebih tinggi untuk APCD pada bayi. Penatalaksanaan dini APCD prabedah dan pascabedah memberikan hasil yang baik. Tindakan kraniotomi evakuasi kurang dari 3 hari dari interval onset memberikan hasil yang baik pada skor Children Coma Scale (CCS). Subdural Hematoma in Neonates with Acquired Prothrombine Complex Deficiency (Apcd) Syndrome at Hasan Sadikin Hospital from July 2010 till February 2011 Background and Objective: APCD syndrome is one of the most serious diseases affecting infants. It leads to a high mortality rate and permanent neurological sequelae among the survivors when related with SDH. There are reports about high prevalence of using herb-liquor extracts and diet restriction among mothers of infants with the APCD syndrome. Vitamin K2MK4 levels in breast milk obtained from mothers who had used herb-liquor extracts were lower than vitamin K2MK4 levels in breast milk obtained from mothers who had not used herb-liquor extracts.Subject and Method: Six infant cases which diagnosed with spontaneous SDH due to APCD syndrome, reviewed from July 2010 to February 2011 at Hasan Sadikin Hospital Bandung. Data reviewed include history taking, physical examination, CT-scan results, laboratory results, management and findings during operationResult: All six infants showed evidence of having history, sign and symptoms, and bleeding disorder suggesting SDH due to APCD. Management on all cases above included early CT-scan evaluation, the treatment of APCD and immediate surgical intervention resulted on good outcome on post surgery result and hospital disposalConclusions: Prolonged coagulation factors on all cases suggest higher risk for APCD on the infant. Craniotomy evacuation surgery less than 3 days interval from onset immediately gave better outcome on Children Coma Scale (CSS) score.

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)
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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.

Penatalaksanaan Anestesi dengan TIVA Propofol-Dexmedetomidine-Fentanyl untuk Operasi Meningioma Frontalis Sinistra Rebecca Sidhapramudita Mangastuti; A. Himendra Wargahadibrata; Nazaruddin Umar
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Meningioma merupakan tumor intrakranial jinak yang sering ditemukan. Berasal dari jaringan meningen dan medulla spinalis, tidak tumbuh dari jaringan otak. Pada kasus ini, pasien laki-laki, 46 tahun, 80 kg, datang ke rumah sakit dengan keluhan kejang berulang dan sakit kepala yang hilang timbul sejak 5 bulan yang lalu. Kesadaran composmentis, GCS 15, pupil isokor bilateral 2 mm, hemodinamik stabil, jantung dan paru tidak ada kelainan dan tidak ada kelumpuhan atau kelemahan pada ke empat ekstremitas. Magnetic Resonance Imaging (MRI) brain ditemukan masa hipointens yang melekat dengan meningen di frontal kiri ukuran 52x48x43 mm, kesan convexitas meningioma disertai perifokal edema dengan midline shift ke kanan sekitar 7 mm. Disimpulkan meningioma frontal sinistra dan dianjurkan kraniotomi pengangkatan tumor. Operasi dilakukan dengan anestesi umum. Tehnik anestesi menggunakan Total Intra Venous Anesthesia (TIVA) dengan syringe pump. Operasi berlangsung selama 7 jam dan tumor dapat terangkat semua. Jumlah perdarahan 1000 mL. Pasien mendapat 300 ml Fresh Frozen Plasma (FFP) dan 500 ml Packed Red Cell (PRC) intraoperasi. Untuk mengurangi tekanan intrakranial, diberikan manitol 0,5 gram/kgBB dan drainase cairan serebrospinal 10–20 mL langsung ke ventrikel lateral oleh operator. Pascaoperasi, pasien diekstubasi dan rawat diruang ICU. Dengan data five year survival rate untuk meningioma jinak 70%, meningioma ganas 55%, diharapkan prognosis pasien pascaoperasi adalah dubia ad bonam. Management Anesthesia with TIVA Propofol-Dexmedetomidine-Fentanyl for Meningioma Frontalis Sinistra OperationMeningiomas are the most common benign intracranial tumors. These tumors originate from the meninges and spinal cord, not from the brain tissue. A 46 year old 80 kgs male patient, was admited to the hospital with recurrent seizures and intermittent headaches that occured since five months ago. He was fully alert, GCS 15, both pupils were isokor (2 mm), with stable hemodynamic, no parese in all extremities and normal heart and lung. Magnectic Resonance Imaging (MRI) result showed a 52x48x43 mm mass attached to the meninges at the left frontal with perifocal tumour edema and midline shifted to the right about 7 mm. The patients was diagnosed with the left frontal meningioma and suggested for craniotomy tumour removal. The surgery was performed under general anesthesia using. Total Intra Venous Anesthesia (TIVA) with syringe pump. The 7 hours surgery performed uneventfully with total bleeding of 1000 mL and the patient was received 300 mL Fresh Frozen Plasma (FFP) and 500 ml Packed Red Cell (PRC) intraoperatively. To reduce intracranial pressure, a 0.5gr/kg mannitol was and a 10–20 cc of cerebrospinal liquor drainage through the lateral ventricle was performed by the operator. The patient was extubated after the operation and admitted the ICU for futher management. With the five year survival rate of 70% for benign meningioma and 55% for malignant meningiomas, the prognosis of this patient is dubia ad bonam.

Tatalaksana Vasospasme Serebral Pasca Perdarahan Subarahnoid Widiastuti, Monika; Rahman, Iwan Abdul; Mafiana, Rose -; Jasa, Zafrullah Khany
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Vasospasme cerebral merupakan penyebab morbiditas dan mortalitas utama pada pasien dengan perdarahan subarahonid. Delayed ischemic neurologic deficit yang berhubungan dengan vasospasme serebral menyebabkan kematian pada 50% pasien yang bertahan pada periode awal setelah aneurisma ruptur yang ditangani. Onset vasospasme serebral yang bervariasi, mulai dari 24 jam pasca perdarahan subarahnoid atau subarahcnoid hemorrhage (SAH) sampai dengan 14 hari, patofisiologi vasospasme serebral yang kompleks dan cara diagnosis yang masih kontroversial, turut berkontribusi terhadap morbiditas dan mortalitas yang tinggi pada pasien dengan SAH. Evaluasi ketat selama perawatan di ICU untuk mendeteksi kejadian vasospasme serebral awal sangat penting, setiap gejala neurologis baru yang muncul harus diperiksa dan ditangani secepatnya. Banyak obat-obatan yang diteliti untuk mengatasi vasospasme serebral namun efektifitasnya masih dipertanyakan. Tatalaksana utama yang dulu diketahui adalah dengan melakukan terapi triple H, namun hal ini sudah ditinggalkan. Induced hypertension menjadi satu-satunya bagian dari terapi triple H yang masih digunakan, namun belum banyak dipergunakan secara luas. Oleh karena itu perlu dikaji lebih lanjut bagaimana tatalaksana SAH untuk mencegah luaran yang buruk.Management of Cerebral Vasospasm after Subarachnoid HemorrhageAbstractCerebral vasospasm is the main etiology of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH) patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The variant onset of cerebral vasospasm, start from 24 hours after SAH up to 14 days after, complex pathophysiology, and the diagnosis of vasospasm has still been met with some controversy, contribute to the high morbidity and mortality in these patients. Vigilance evaluation during ICU care to detect cerebral vasospasm as early as posssible is essential, any new onset of neurological symptoms need to be investigated and treated immediately. Many studies reported some agents for the treatment of cerebral vasospasm, however their roles remain uncertain. Triple H therapy was known as a main treatment for vasospasm, however it is no longer applied nowadays. Induced hypertension become the only part of Triple H therapy used yet it is not well recognized. Therefor, there is a need for thorough evaluation regarding treatment of SAH to prevent poor outcomes.

Total Intravenous Anesthesia pada Geriatri dengan Meningioma Parietalis Rebecca Sidhapramudita Mangastuti; Nazaruddin Umar; Marsudi Marsudi
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
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Meningioma merupakan tumor intrakranial jinak yang sering ditemukan. Tumor ini berasal dari jaringan meningen dan medulla spinalis, tidak tumbuh dari jaringan otak. Gejala klinis baru dirasakan saat terjadi penekanan pada otak atau jaringan yang terdesak oleh tumor. Operasi pengangkatan tumor meningioma merupakan tindakan yang dianjurkan. Penatalaksanaan anestesi bertujuan menghindari terjadinya hipertensi intrakranial dan pembengkakan otak (brain bulging). Pada kasus ini, pasien wanita, usia 71 tahun, berat badan 60 kg, datang ke rumah sakit dengan keluhan tangan dan kaki kanan lemah dan tidak dapat berbicara (aphasia) sejak 2 bulan sebelum masuk rumah sakit. Kesadaran somnolen, E3M6V afasia, pupil isokor bilateral 2 mm, hemodinamik stabil, jantung normal, tuberculosis paru sinistra. Fungsi motorik dan sensorik ekstremitas kanan terganggu. MRI 3T dan MRA 3T Head Contrast didapatkan massa tumor kistik ring enhance 5,8 x 4,6 x 5 cm berisi cairan kental.Tampak pula massa tumor padat dan bercak perdarahan didalamnya ukuran 4,3 x 5,1 x 5 cm mencakup lobus parietal kiri dan lobus occipital kiri disertai perifokal edema disekitarnya. Dari hasil yang ada, disimpulkan pasien menderita meningioma parietalis sinistra dan tindakan yang dianjurkan adalah craniotomi pengangkatan tumor. Operasi dilakukan dengan anestesi umum. Operasi berlangsung selama 6,5 jam dan tumor dapat terangkat semua. Jumlah perdarahan 2000 ml. Pasien mendapat 300 ml Fresh Frozen Plasma (FFP) dan 500 ml Packed Red Cell (PRC) intraoperasi. Untuk mengurangi tekanan intrakranial, digunakan total intra venous anesthesia (TIVA) dengan syringe pump dan diberikan manitol 0,5 gram/kgBB. Pascaoperasi, pasien tidak diekstubasi dan rawat diruang ICU. Five year survival rate untuk menigioma jinak 70%, meningioma ganas 55%. Total Intravenous Anesthesia for Elderly with Meningioma Parietalis SinistraIntracranial meningiomas are benign tumors that are often found. These tumors originate from the meninges and spinal cord tissue, brain tissue does not grow out of. Clinical symptoms felt during a new emphasis on the brain or tumor tissue driven by. Surgical removal of the meningiomas tumor is a recommended actions. Management of anesthesia aims to avoid the occurrence of intracranial hyperternsion and brain bulging. In this case, female, 71 years, weight 60 kg, came to the hospital with complaints of arm and right leg is weak and unable to speak (aphasia) since 2 months before admission. Somnolence, E3M6V aphasia, pupil isocor 2 mm, hemodynamic stable, normal heart, the left pulmonary had tuberculosis. Motor function and sensory impaired right limb. MRI 3T and MRA head contrast found cystic tumor mass 5,8 x 4,6 x 5 cm and solid tumor mass measures 4,3 x 5,1 x 5 cm. From the result, it was consluded the patients suffering from the left parietal meningioma and recommended actions are craniotomy removal of the tumor. The operation if perfomed under general anesthesia. The operation lasted for 7 hours and the tumor can be taken out. The amount of bleeding 2000 ml. Patients received 300 ml Fresh Frozen Plasma (FFP) and 500 ml Packed Red Cell (PRC). To reduce intracranial pressure, we used total intra venous anesthesia (TIVA) and given manitol 0,5 gr/kg. Postoperatively, patients had not been extubation and take care in ICU unit. Five year survival rate of 70% for benign meningioma and 55% for malignant meningiomas.

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.

Manajemen Perioperatif Epidural Hemorrhage Akibat Cedera Otak Traumatik I Putu Pramana Suarjaya; A. Himendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Epidural hemorrhage (EDH) adalah perdarahan yang terjadi pada ruang epidural, biasanya terjadi pada fossa kranii media karena adanya laserasi arteri meningea media, walaupun bisa juga terjadi pada fossa anterior ataupun posterior. Bentuknya biasanya lentikuler dan dibatasi oleh garis sutura di mana lapisan perikranial dura melekat ke kranium. Secara klasik, pasien EDH memiliki lucid interval, yakni periode adanya kesadaran yang jernih sebelum terjadinya penurunan kesadaran. Gejala klinis sebagai akibat dari hematoma intrakranial seperti EDH, terutama tergantung pada besarnya volume dan kecepatan hematoma ini terbentuk. Bila hematoma terbentuk dengan cepat, terjadi peningkatan tekanan intrakranial (TIK) yang akan menimbulkan perburukan neurologis sampai dapat mengancam kehidupan. Pengelolaan perioperatif pasien dengan cedera otak traumatik yang mengalami EDH bertujuan mempertahankan perfusi dan oksigenasi otak, mengendalikan TIK serta dekompresi dan evakuasi perdarahan dengan pembedahan pada sebagian kasus. Kami membahas manajemen perioperatif pada 2 orang pasien, seorang anak dan seorang remaja yang mengalami EDH karena cedera otak traumatik yang menjalani kraniotomi emergensi untuk evakuasi perdarahannya. EDH sangat penting untuk cepat didiagnosa, karena bila terdeteksi segera dan dilakukan evakuasi perdarahan, biasanya hasilnya baik dengan mortalitas kurang dari 10%. Evakuasi dan kontrol perdarahan segera sangat penting untuk keselamatan pasien dan menghindari cedera neurologis yang permanen.Perioperative Management of Epidural Hemorrhage Due to Traumatic Brain InjuryEpidural hemorrhages (EDH) are bleeding in epidural space, usually occur in the middle cranial fossa via laceration of the middle meningeal artery, although they can also occur in the anterior and osterior fossae. They are usually lenticular shaped and are bounded by suture lines where the pericranial ayer of dura attaches to the skull. Classically patients suffered from EDH experience a lucid interval which is a period of intact consciousness prior to deterioration.Clinical symptom of intracranial hematoma such as EDH, mainly depend on volume and rate the hematoma formed. If the intracranial hematoma formed rapidly, there will be a sudden rise on ICP which led to neurologic deterioration that could be deleterious. Perioperative management of intracranial hematoma such as EDH is to maintain brain perfusion and oxygenation, control the ICP, and surgical decompression in some cases. We are scussing perioperative management of two cases suffered from EDH due to traumatic brain injury who underwent emergency craniotomy for clott evacuation.These are important injuries to identify;if detected early they are usually associated with good outcome and have a mortality of less than 10%. Early bleeding control and hematoma evacuation are very important to patient safety and avoid any permanent neurologic injury.

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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

Location
,

INDONESIA