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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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Manajemen Neuroanestesi pada Sindrom Dandy Walker dengan Hiperkalemia Kulsum, Kulsum; Mafiana, Rose; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Sindrom Dandy Walker termasuk hidrosefalus yang sangat jarang terjadi dengan insiden 1 kasus dari 65 kasus hidrosefalus berdasarkan penelitian profil hidrosefalus di RSUDZA Banda Aceh. Insiden di Indonesia sebanyak 5060% kasus dari operasi bedah saraf. Kasus berikut seorang bayi laki-laki lahir prematur, umur 1 bulan, berat badan 3,5 kg, ukuran lingkar kepala 45 cm, muntah dan kejang. CT-Scan terdapat kista, kalium 7 mmol/l ditegakkan diagnosa sindrom Dandy Walker dengan hiperkalemia. Manajemen neuroanestesi dengan cara premedikasi dan pemasangan kateter intravena 24G dengan sevofluran via masker O2 100% setelah jalur vena terpasang, diberikan fentanil 10 mcg sebagai analgetik dan induksi propofol 10 mg. Rocuronium 3,5 mg sebagai fasilitas intubasi. Pemeliharaan anestesi dengan sevofluran dan oksigen. Ventilasi frekuensi nafas 30 x/menit dilakukan manual dan kemudian dengan ventilator TV 30 ml, I:E = 1:1,5, RR 30 kali per menit, FiO2 100%. Monitoring hasil frekuensi nadi 100 130 kali per menit, SpO2 100%, suhu afebris, CO2 30 mmHg. Simpulan: sindrom Dandy Walker kasus yang sangat jarang terjadi dan hidrosefalus sering bersamaan dengan hiperkalemia terjadi pada bayi prematur karena gangguan reaborbsi kalium dan terjadi perpindahan kompartemen dari intraseluler ke ekstraseluler sehingga kalium banyak di ekstraseluler, maka diperlukan manajemen neuroanestesi pediatrik yang adekuat.Neuroanesthesia Management in Dandy Walker Syndrome with HyperkalemiaAbstractDandy Walker syndrome including hydrocephalus which is a very rare case with the incidence of 1 case out of 65 cases of hydrocephalus based on a study of hydrocephalus profile at Zainal Abidin Hospital, Banda Aceh. The incidence of Dandy-Walker syndrome in Indonesia are about 50 - 60% cases from all of neurosurgical cases. The following case was a premature baby, 1 month old, weight 3.5 kg, head cicumference 45 cm, vomit and seizure. Cyst was found in the head CT scan and the potassium level of 7 mmol/l. The patient was diagnosed with Dandy-Walker Syndrome with hyperkalemia. Neuroanesthesia management by premedication and infusion using intravenous cathether 24G with sevoflurane and 100% O2 mask After succesful intravenous cathether, given fentanyl 10 mcg as analgesic and propofol 10 mg as induction. Rocuronium 3.5 mg as a facility for intubation. Maintenance of anesthesia with sevoflurane and oxygen. Respiratory rate 30 breaths per minute with ventilation that was done manually and then with TV on ventilator 30 ml, I: E = 1: 1.5, RR 30x/min, FiO2 100%. Monitoring pulse frequency results of 100130 beats per minute, 100% SpO2, temperature afebrile, CO2 30 mmHg. Conclusions: Dandy-Walker Syndrome was a very rare case and hydrocephalus was often followed with hyperkalemia that occur in premature infants due to potassium reaboration disorder and the displacement of compartment from intracellular to extracellular so that potassium was abundant at extracellular, hence adequate pediatric neuroanesthesia management was needed.

Tight Brain pada Anestesi Awake Craniotomy dengan Dexmedetomidine Riyadh Firdaus; Dewi Yulianti Bisri; Siti Chasnak Saleh; A. Hmendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
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Anestesi pada awake craniotomy dilakukan dengan menggunakan salah satu atau kombinasi dari teknik scalp block, sedasi dengan propofol dan dexmedetomidine. Teknik ini memfasilitasi awake craniotomy sehingga pemetaan intraoperatif fungsi korteks elokuen yang memfasilitasi reseksi tumor secara radikal. Kebutuhan pemetaan korteks adalah untuk menggambarkan fungsi otak antara lain bicara, sensorik dan motorik dengan tujuan mempertahankan selama dilakukan reseksi. Obat yang diberikan harus dapat memberikan level sedasi dan analgesia yang adekuat untuk mengangkat tulang tetapi tidak mempengaruhi tes fungsional dan elektrokortikografi. Prosedur ini sama dengan kraniotomi standar dengan perbedaan pasien sadar penuh selama pemetaan korteks dan reseksi tumor. Dexmedetomidine adalah suatu agonis adrenoreseptor α-2 spesifik dengan efek sedatif, analgetik, anesthetic sparing effect, efek proteksi otak, tidak adiksi, tidak menekan respirasi dan pasien mudah dibangunkan. Wanita, 54 tahun dengan keluhan utama kejang berulang sejak 3 hari yang lalu. Berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang pasien didiagnosis tumor lobus frontal kanan. Pasien dilakukan pengangkatan tumor dengan teknik awake craniotomy. Pasien dilakukan scalp block, sedasi dengan propofol dan dexmedetomidine. Saat operasi berlangsung didapatkan kondisi tight brain. Dexmedetomidine dipertimbangkan sebagai salah satu faktor yang mempengaruhi relaksasi otak selama operasi. Lama operasi kurang lebih 5 jam. Pascaoperasi pasien dirawat di HCU.Tight Brain on Awake Craniotomy Anesthesia with DexmedetomidineAnesthesia in awake craniotomy is done using scalp block, propofol sedation, dexmedetomidine sedation or a combination of the three. This technique facilitate awake craniotomy such that intraoperative mapping of eloquent cortical function can be done in radical tumor resection. The need for cortical mapping is to describe and maintain brain function such as speaking, sensoric and motoric function throughout the resection process. The drug given must be able to provide adequate sedation and analgesia for bone removal but do not interfere with the result of function test and electrocorticography. This procedure is similar to other craniotomy, however the patient is alert during cortical mapping and tumor resection and is able to speak after tumor is resected. Dexmedetomidine is an alpha 2 adrenoreceptor agonist with specific effects such as sedation, analgesia, anesthetic sparing, cerebral protection, non addictive, does not suppress respiration, comfortable and easy to recover from. A case of 54 years old female with chief complaint of recurrent seizure in the last 3 days prior to admission is described. Based on history and examination, patient is diagnosed with right frontal lobe tumor. Patient underwent tumor resection using awake craniotomy technique. Scalp block combined with propofol and dexmedetomidine sedation was done. During the surgery, tight brain was encountered. Dexmedetomidine was evaluated as one of the factors that influence the brain relaxation throughout surgery. The Surgery took 5 hours, post surgery patient is observed in HCU.

Penatalaksanaan Anestesi pada Pasien Stroke Hemoragik Rebecca Sidhapramudita Mangastuti; Bambang J. Oetoro; Sudadi Sudadi
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Stroke terjadi akibat terganggunya aliran darah ke otak secara tiba-tiba. Penyebab terbanyak stroke adalah berkurangnya pasokan darah ke otak (stroke iskemik). Penyebab stroke lainnya adalah perdarahan (stroke hemoragik). Perdarahan intraserebral (ICH) terjadi akibatnya pecahnya pembuluh darah otak. Lokasi terjadinya stroke dapat di basal ganglia, cerebelum, batang otak atau kortek serebri. Penyebab perdarahan intraserebral adalah hipertensi, trauma, infeksi, tumor, defisiensi faktor pembekuan darah, terapi antikoagulan, malformasi arterivena (AVM). Laki-laki, 67 tahun dengan GCS 5 (E1M3V1) dengan terapi rutin antikoagulan menderita serangan stroke hemoragik. CT scan memperlihatkan adanya perdarahan intraparenkim lobus parieto-temporo-oksipital kanan 53,3 ml, perifokal edema, herniasi subflacin kiri 13,9 mm dan herniasi central downward. Pasien dilakukan kraniotomi evakuasi hematom dan dekompresi dengan anestesi umum. Pasien dalam kondisi umum stabil saat operasi berlangsung. Postoperasi, pasien dirawat di Intensive Care Unit. Pasien dinyatakan mati batang otak pada hari kedua pasca operasi dan meninggal pada hari keempat. Anesthetic Management in Patients with Hemorrhagic StrokeStroke is triggered by a sudden interruption of blood supply to the brain. The most frequent etiology of stroke is decrease blood supply to the brain (ischemic stroke). Another stroke is caused by rupture of blood brain vessel (hemorrhagic stroke). Intracerebral hemorrhage (ICH) occurs when a blood vessel within the brain bursts. Stroke locates mainly in basal ganglia, cerebellum, brain stem or cerebral cortex. The common cause of intracerebral hemorrhage are hypertension, trauma, infection, tumors, blood coagulation factor deficiencies, anticoagulant therapy, or arteriovenous malformations. We reported a 67-years old, man with, GCS 5 (E1M3V1) on routine anticoagulant therapy who experienced hemorrhagic stroke. Brain CT-scan examination showed bleeding in intra parenchimal right parieto-temporo-occipital lobe about 53,3 mL, perifokal edema, subflacin sinistra 13,9 mm and central downward herniation. Patient was performed craniotomy to evacuate the hematome and decompresion with general anesthesia. During surgery patient had a relatively stable condition. After surgery, the patient was treated in intensive care unit but declared brain stem dead on day-2 post surgery an died day-4.

Disfungsi Kognitif Post Operatif pada Geriatri Maharani, Nurmala Dewi; Halimi, Radian A; Mafiana, Rose; Gaus, Syaruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Postoperative Cognitive Dysfunction (POCD) adalah gangguan neurokognitif yang ditandai dengan penurunan kinerja kognitif setelah operasi dan anestesi. POCD ditandai dengan gangguan memori, penurunan proses informasi, berkurangnya perhatian, serta perubahan suasana hati dan kepribadian. Insidensi POCD pada pasien lanjut usia ( 60 tahun) sekitar 25,8% dalam tujuh hari setelah operasi dan 10% dalam tiga bulan setelah operasi. Faktor risiko dan etiologi yang menyebabkan POCD dapat dikurangi dengan edukasi pasien yang baik, perawatan pasien, dan sanitasi yang tepat sehingga dapat mencegah kecenderungan gejala POCD pada pasien tersebut. Pemeriksaan dapat dilakukan dengan tes pembelajaran kata, tes pembuatan Jejak, tes ketangkasan manual, dan tes kemampuan untuk mengingat urutan angka. Mini Mental State Examination (MMSE) sebagai tes untuk melakukan skrining demensia. MMSE terkadang digunakan untuk mengukur POCD. MMSE dapat digunakan dalam praktik klinis rutin untuk mengidentifikasi demensia subklinis pra operasi yang akan menempatkan pasien pada risiko yang lebih tinggi untuk berkembang menjadi POCD. Penatalaksanaan pada POCD meliputi dua pendekatan yaitu penegakkan diagnosis secara cepat dan pencegahan gejala POCD. Pencegahan dapat dilakukan dengan mengetahui faktor risiko preoperatif, intraoperatif, dan postoperatif. Pasien dengan POCD persisten mengalami dampak negatif pada kualitas hidup, kinerja memori subjektif, emosional, dan mungkin didapatkan konsekuensi kesehatan seperti demensia dan kematian dini.Post Operative Cognitive Dysfunction among Elderly PatientsAbstractPostoperative Cognitive Dysfunction (POCD) is a neurocognitive disorder characterized by decreased cognitive performance after surgery and anesthesia. POCD is a complication characterized by memory impairment, decreased information processing and reduced attention, accompanied by changes in mood and personality. The incidence of POCD in elderly patients ( 60 years) was approximately 25.8% within seven days after surgery and 10% within three months after surgery. The risk factors and etiology that lead to POCD can be reduced by good patient education, patient care and proper sanitation can prevent the tendency of POCD symptoms in these patients. Examination can be done with the learning test, the word learning test, the tracing test, the manual dexterity test, the ability test to remember a sequence of numbers. Mini Mental Status Examination (MMSE) as a screening test for dementia. MMSE is sometimes used to measure POCD. MMSE can be used in routine clinical practice to identify preoperative subclinical dementia that would put patients at a higher risk of developing POCD. Management in POCD includes two approaches, namely rapid diagnosis and prevention of POCD symptoms. Prevention by knowing the risk factors preoperative, intraoperative and postoperative. In patients with persistent POCD, it has a negative impact on quality of life, subjective memory performance, emotional symptoms, and possible health consequences such as dementia and premature death.

Tatalaksana Anestesi pada Microvascular Decompression (MVD) Bau Indah Aulyan Syah; Siti Chasnak Saleh; Sri Rahardjo
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Microvascular decompression (MVD) nervus kranialis merupakan salah satu terapi untuk trigeminal neuralgia, spasme hemifacialis, dan neuralgia glosspharyngeal. Seorang wanita 52 tahun masuk ke rumah sakit dengan keluhan utama kedutan pada wajah sebelah kiri selama 17 tahun dan telah berobat ke beberapa dokter, termasuk suntikan botoks, namun hasilnya tidak memuaskan. Pemeriksaan MRI otak menunjukkan persilangan arteri cerebellaris anterior inferior (AICA) kiri dengan N. VII di daerah entry zone. Hal ini dapat menyebabkan TIC fasialis kiri. Pasien ini didiagnosis dengan spasme hemifasialis sinistra dan akan menjalani prosedur MVD. Pasien dianestesi dengan teknik anestesi umum intubasi endotrakea dengan menerapkan prinsip-prinsip neuroanestesia. Pada pasien ini tidak ditemukan tanda-tanda peningkatan tekanan intrakranial, namun dalam memfasilitasi pembedahan untuk dekompressi saraf yang tertekan, sangat penting untuk menurunkan volume otak. Karena itu, diterapkan beberapa metode, seperti hiperventilasi volunter, pemberian mannitol 20% 150mL dengan mempertahankan batas autoregulasi. Kombinasi anestesi inhalasi (sevofluran 0,6-1,5%) dan intravena (propofol kontinyu 60–100mg/jam), relaksasi dengan vecuronium kontinyu 2,5–4,5mg/jam. Cairan rumatan dipilih ringer fundin 400ml dan NaCl 0,9% 500ml melalui 2 jalur intravena. Operasi berjalan selama 2 jam, pendarahan sebanyak 150mL, urin 1000mL dilakukan ekstubasi segera setelah operasi selesai. Pasca anestesi, pernapasan dan hemodinamik stabil dan adekuat. Pemeriksaan neurologis di ruang pemulihan didapatkan kedutan menghilang Anesthesia Management for Microvascular Decompression (MVD)Microvascular decompression (MVD) cranial nerves as a therapy for trigeminal neuralgia, hemifacial spasm, and glosso pharyngeal neuralgia. A 52 years old female, came to the hospital due to the twitching on the left side of her face. She had been experiencing the twitching for over 17 years, had been treated by several doctors, including Botox injection, but with no satisfying outcome. MRI examination showed intercrossing of the left anterior inferior cerebellar artery (AICA) with the seventh cranial nerve in the area of entry zone. The condition caused the left facial TIC. She was diagnosed with left hemifacial spasm and planned for a MVD procedure. The patient was anesthetized with endotracheal intubation under general anesthesia using neuroanesthesia principles. There was no sign of increased intracranial pressure. Nevertheless, it is importance to facilitate the nerve decompression procedure by reducing the brain volume that can be perform with several methods, such as voluntary hyperventilation, administering mannitol 20% 150 mL while maintaining the autoregulation level. Combination of inhalation (sevofluran 0,6-1,5%) and intravenous anesthesia (propofol continuously 60–100mg/hour) was chosen, relaxation was obtained with continuous vecuronium 2,5-4,5mg/hr. Maintenance of intravenous fluids were Ringer fundin 400ml and NaCl 0,9% 500ml delivered via two intravenous routes. The operation was last for 2 hours, the amount of bleeding was 150 mL, and the urine was 1000 mL. The patient was extubated immediately after the operation. Breathing and hemodynamic post anesthesia were both stable and adequate. Neurological examination in the recovery room revealed no more twitching observed.

Ventilasi Mekanik yang Memanjang pada Pasien Cedera Otak Traumatik Berat dengan Subdural Hematoma Putri, Dini Handayani; Rachman, Iwan Abdul; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
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Cedera otak traumatik (COT) adalah suatu proses patologis pada otak yang berasal dari luar tubuh, yang dapat menyebabkan kerusakan permanen atau sementara dari fungsi otak. Salah satu perdarahan otak yang sering menyertai terjadinya COT berat adalah subdural hematoma (SDH). Pasien laki-laki 41 tahun, datang ke rumah sakit dengan penurunan kesadaran GCS E2M2V2 akibat kecelakaan. Pasien dilakukan tatalaksana dan diintubasi di IGD, hasil CT-Scan memperlihatkan SDH, dan edema serebri. Pasien dilakukan evakuasi hematom dengan anestesi umum, diinduksi dengan fentanil 100 ?gr, propofol 20 mg dan atracurium 20 mg intravena. Pemeliharaan dengan sevofluran, propofol kontinyu, fentanil dan atracurium intermiten. Pascaoperasi pasien mengalami ventilator associated pneumonia (VAP), diberikan antibiotik sprektum luas untuk pemulihan paru, pada hari ke 10 pasien dilakukan trakeostomi. Pasien dapat disapih dari ventilator hari ke 21 dengan GCS E4M4Vtrach tanpa kontak, dengan skor GOS (Glasgow Outcome Scale) 3, direncanakan untuk homecare. COT berat membutuhkan tatalaksana pascaoperasi yang lebih kompleks, antisipasi penggunaan ventilasi mekanik yang memanjang, risiko VAP serta pertimbangan pemasangan trakeostomi secara cepat hingga pemberian antibiotik yang adekuat untuk mendapatkan hasil luaran terbaik.Prolonged Mechanical Ventilation in Severe Traumatic Brain Injury Patients with Subdural HematomasAbstractTraumatic brain injury (TBI) is a pathological process in the brain that originates from outside the body, which can lead to permanent or temporary damage to brain function. One of the brain hemorrhages that often accompanies severe TBI is subdural hematoma (SDH). Male patient 41 years old, was admitted to our hospital with decreased of consciusness with GCS E2M2V2 due to a motorcycle accident. The patient was intubated in the emergency room and then performed head CT scan examination which showed SDH and cerebral edema as the result. Patients then underwent hematoma evacuation under general anesthesia, induced with fentanyl 100 g, propofol 20 mg and atracurium 20 mg intravenously. Maintenance of anesthesia with sevoflurane, continuous propofol, fentanyl and intermittent atracurium. Postoperatively the patient experienced ventilator associated pneumonia (VAP) and given broad-spectrum antibiotics for lung recovery, then on the 10th day tracheostomy was performed. Patients can be weaned from the ventilator on day 21st with GCS E4M4Vtrach without contact, with a GOS (Glasgow Outcome Scale) score of 3, and was planned for homecare. Severe TBI requires more complex postoperative management, anticipation of prolonged use of mechanical ventilation, risk of VAP and consideration of rapid tracheostomy installation to adequate antibiotic administration to obtain the best outcome.

Prosedur Operasi Kombinasi Frontolateral dan Pterional pada Kraniofaringioma di Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh Imam Hidayat; Rahadian Indarto Susilo; Zafrullah Kany Jasa
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
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Kraniofaringioma merupakan tumor intrakranial yang terdapat pada fosa hipofisis dan sepanjang sisterna suprasellar hingga hipotalamus. Defenisi kraniofaringioma menurut WHO adalah tumor jinak pada daerah sella yang berasal dari kantong ratkhe epithelial yang mana insidensinya 1,34 pasien per 1 juta penduduk. Usia rata-rata pasien adalah 0 – 14 tahun dimana usia puncak terjadinya tumor ini berada diantara 5 hingga 14 tahun. Dilaporkan seorang laki-laki 22 tahun datang ke Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh dengan keluhan nyeri kepala, mual, muntah, penurunan tajam penglihatan dan jika berjalan sering menabrak. Pada pemeriksaan fisik didapatkan penurunan tajam penglihatan dan defek lapangan pandang lateral serta ditemukan pupil anisokor 4 cm/ 2 cm. Pada pemeriksaan darah rutin ditemukan nilai yang normal, thyroid stimulating hormon (TSH) normal, dan prolaktin serum normal. Pada pemeriksaan MRI kepala dengan kontras ditemukan massa berukuran 5,12cm x 2,63 cm menonjol dari sella tursika berbatas tegas dan terisi kontras. Terhadap pasien dilakukan prosedur operasi kombinasi frontolateral dan pterional serta dilakukan total removal tumor. Hasil histopatologi pascaoperasi menunjukkan suatu adamantinomatous kraniofaringioma. Komplikasi yang muncul pasca pembedahan pada pasien ini adalah terjadinya diabetes insipidus.Combination Frontotemporal and Pterional Operative Approach in Craniopharyngioma in dr. Zainoel Abidin General Hospital Banda AcehCraniopharyngioma is an intracranial tumor that occurs in the region of the pituitary fossa and suprasellar cisterns along to the hypothalamus. Craniopharyngioma is brain tumor which is defined by WHO as a benign tumor in the sella region derived from Ratkhe pouch epithelium in which the incidence is 1.34 patients per 1 million population. The average age of patients was 0-14 years of age peaks where the tumor is located between 5 and 14 years. Reported a man 22 years old came to the General Hospital dr. Zainoel Abidin Banda Aceh with symptoms of headache, nausea, vomiting, decreased vision acuity. On physical examination found a decrease in visual acuity, lateral visual field defects, and found the anisokor pupil 4 cm / 2 cm. In routine blood tests found normal value, normal Thyroid Stimulating Hormon (TSH) and normal serum prolactin. MRI head with contrast was found mass measuring 5,12cm x 2.63 cm protruding from the sella tursika demarcated and filled with contrasts. Currently treated by surgical total removal tumor with combination of frontolateral and pterional surgery approach. Postoperative histopathologic results showed a adamantinomatous craniopharyngioma. In this case, complication that occur after surgery procedure is diabetes insipidus.

Pertimbangan Anestesia untuk Pasien dengan Deep Brain Stimulator Tertanam yang Menjalani Prosedur Diagnostik dan Pembedahan Santosa, Dhania A; Rasman, Marsudi; Hamzah, Hamzah; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
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Deep brain stimulation (DBS) akhir-akhir ini sering digunakan untuk penyakit Parkinson dan kelainan pergerakan lainnya. DBS sendiri merupakan suatu stimulator yang ditanam pada nukleus dalam di otak dan disambungkan dengan pembangkit pulsasi yang ditanam di bawah klavikula. Sebagai konsekuensinya, ahli anestesiologi akan lebih sering menghadapi pasien dengan sistem DBS tertanam dalam tubuh mereka untuk menjalani prosedur diagnostik dan pembedahan. Anestesia pada pasien-pasien ini memerlukan perhatian khusus karena adanya potensi interferensi antara neurostimulator dan alat-alat lainnya yang dapat menbahayakan pasien. Oleh karenanya penting bagi ahli anestesi untuk memahami hal-hal khusus pada pasien dengan deep brain stimulator tertanam yang menjalani tindakan diagnostic maupun pembedahan. Panduan mengenai hal-hal yang perlu diperhatikan oleh ahli anestesi pada pasien seperti ini masih sangat kurang dan masih sangat bergantung pada laporan kasus atau panduan yang berasal dari pabrik pembuatnya. Tujuan penulisan artikel ini adalah untuk memberikan gambaran singkat mengenai sistem DBS dan penanganan anestesi pada pasien dengan alat DBS tertanam.Anesthesia Considerations in Patients with Implanted Deep Brain Stimulator undergoing Diagnostic and Surgery ProceduresDeep brain stimulation (DBS) has become an increasingly common treatment for Parkinsons disease and other movement disorders. DBS consist of implanted stimulator at deep nuclei of the brain and, connected to a pulse generated which is implanted under clavicle. Consequently, anesthesiologists will increasingly encounter patients with implanted DBS system facing diagnostic and surgery procedures. Anesthesia management in such patients requires specific considerations due to the possible interference between neurostimulator and other devices which are potentially harmful to the patient. Therefore, it is important for anesthesiologists to understand specific issues in patients with implanted deep brain stimulator undergoing surgery and other diagnostic procedures. Guideline on these specific issues is very limited and highly relies on case report and manufacturers manual. The purpose of this review is to provide brief overview on DBS system and anesthesia considerations in patients with implanted DBS

Statin sebagai Protektor Otak pada Cedera Otak Traumatik Kenanga Marwan; Cindy Elfira Boom; Rovina Ruslami
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
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Cedera otak traumatik (COT) masih menjadi masalah morbiditas dan mortalitas utama di dunia. Cedera otak traumatik dengan cepat mencetuskan cedera sekunder yang yang dapat memperburuk outcome. Proteksi otak bertujuan untuk mencegah cedera otak sekunder dengan cara melakukan metode dasar, hipotermi, neurofarmakologi dan kombinasi hipotermi dan farmakologik. Metode dasar pada proteksi otak adalah dengan cara menjaga jalan napas bebas sepanjang waktu, oksigenasi yang adekuat, mencegah hipokarbia, pengendalian tekanan darah, pengendalian tekanan intrakranial, pengendalian tekanan perfusi otak, dan pengendalian kejang. Neurofarmakologi pada proteksi otak yaitu dengan menggunakan obat yang memiliki efek proteksi otak. Statin, suatu inhibitor 3-hydroxy-3-methyglutaryl coenzym-A (HMG CoA) reduktase telah dikenal sebagai obat penurun lemak darah. Statin memiliki efek pleiotropik yang bersifat kolesterol-independen dengan efek yang potensial dalam tatalaksana gangguan neurologis. Efek ini berupa kemampuan menurunkan hemostasis dengan cara mengurangi efek trombosis dan kaskade koagulasi, meningkatkan fibrinolisis dan kaskade antikoagulasi, memperbaiki fungsi endotel, mempercepat bioaviabiltas nitrat oksida, antioksidan, aktifitas imunomodulasi dan antiinflamasi, serta menstabilkan plak aterosklerosis. Pada kasus COT, statin menurunkan trombosis intravaskuler dan menurunkan mediator inflamasi seperti TNFα, IL-6 dan IL-1β. Hal ini membuat statin menjadi kandidat yang ideal untuk penanganan cedera otak akut.Statin As Brain Protector In Traumatic Brain InjuryTraumatic brain injury (TBI) still represents the leading cause of morbidity and mortality in the world. Traumatic brain injury could rapidly develop secondary brain injury after trauma that can make worst the outcome. Brain protection procedures to prevent secondary brain injury are basic method, hypothermia, neuropharmacology, and combination of both hypothermia and neuropharmacology. Basic method such as patency airway, adequate oxygenation, blood pressure control, intracranial pressure monitoring, maintain cerebral perfusion pressure and prevent of seizure. Neuropharmacology is one technique to do brain protection by using drugs with neuro-protection effect. Statin, 3-hydroxy-3-methyglutaryl coenzym-A (HMG CoA) reductase inhibitor is hypolipidemik drug which has pleiotropic effect in cholesterol-independen manner and suggest potential effect in neurologic disorder such as decreased hemostatic and decreased thrombotic effect and cascade coagulation, increased fibrinolytic and anticoagulation cascade, improve endothelial function, increase nitric oxide bioaviability, antioxidan, immunomodulation and anti-inflammatory activity and stabilize plaque atheroslerotic. In TBI, statin reduce intravascular thrombocytosis and decreased inflammatory mediator like TNF α, IL-6 dan IL-1β. These makes statin becomes ideal candidate for management acute brain injury.

Cedera Kepala Berat Pada Pasien Hamil M. Zafrullah Arifin; Subrady Leo SS; Firman Priguna T
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Cedera kepala pada wanita dengan kehamilan dapat meningkatkan resiko morbiditas dan mortalitas bagi ibu dan janinnya. Komplikasi yang dapat terjadi antara lain kematian ibu, syok, perdarahan intrauterin, kematian janin intrauterin, trauma janin, abruptio placenta, ruptur uterin. Penyebab tersering dari trauma tersebut antara lain kecelakaan lalulintas, terjatuh dari ketinggian, kekerasan dalam rumah tangga, dan luka tembak. Banyak penilaian dan penanganan yang unik untuk kasus ini, meskipun evaluasi awal dan resusitasi sasaran utama untuk menyelamatkan ibu. Setelah keadaan ibu stabil baru dilakukan evaluasi dan penilaian dari janin. Monitoring tokokardiografi, pemeriksaan ultrasound, CT-Scan kepala dapat dilakukan disertai dengan tindakan kraniotomi dan atau seksio sesarea. Subjek dan Metode: Penelitian observasional dari tahun 2008-2012, serial kasus, pada wanita hamil yang mengalami cedera kepala berat dan dilakukan operasi untuk evakuasi hematoma. Hasil: Selama 3 tahun terakhir telah dilakukan tindakan pembedahan untuk penderita cedera kepala dengan kehamilan sebanyak 3 kasus, dua diantaranya disertai dengan seksio sesarea. Simpulan: Kasus cedera kepala pada wanita dengan kehamilan tergolong jarang dan penanganan dini multidisiplin pada cedera kepala berat pada kehamilan dapat menurunkan risiko morbiditas dan mortalitas untuk ibu dan janin Severe Head Injury in Pregnant Patients Background and Objective: Head injury in pregnancy can increase the risks of mortality and morbidity, both for the mother and fetus. Common complications are including death, shock, intrauterine bleeding, intrauterine fetal death, fetal trauma, placental abruptio and, uterine rupture. Motor vehicle accident, falls, assault and gun shot wound are the primary cause of injury. Treatment and recognition of this cases are unique, even though the main target are early evaluation and resuscitation of the mother and afterward, the fetus. Tococardiography monitoring, ultrasound, and head CT Scan can be perform with or without craniotomy and caesarean section.Subject and Method: An observasional study taken from the year of 2008-2012, a serial case report in pregnant women with severe head injury undergoing operation for evacuation of hematoma.Result: During the last 3 years, three patients had underwent surgery for head injury with two of them underwent a sectio caesarean procedure.Conclusion: The incidence of head injury in pregnant women is considered very rare and an early multidiciplinary management for head injury in pregnancy can decrease the risk of morbidity and mortality for both the mother and the fetus.

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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

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

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INDONESIA