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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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Perbandingan Kejadian Agitasi pada Pasien Dewasa Bedah Rawat Jalan yang menjalani Anestesi Umum dengan Menggunakan Desfluran atau Sevofluran Andika C. Putri; A. Muthalib Nawawi; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
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Latar Bekang dan Tujuan: Agitasi pascaanestesi merupakan masalah yang kadang muncul pada pasien yang dilakukan anestesi umum. Masih terdapat kontroversi mengenai keuntungan relatif perioperatif dari penggunaan inhalasi desfluran atau sevofluran sebagai pemeliharaan anestesi pada pasien bedah rawat jalan. Penelitian ini bertujuan untuk mengetahui perbandingan besarnya kejadian agitasi pascaanestesi pada pasien bedah rawat jalan yang dilakukan anestesi umum dengan menggunakan desfluran atau sevofluran.Subjek dan Metode: Penelitian bersifat eksperimental prospektif dengan uji acak terkontrol buta tunggal, dilakukan pada 94 pasien bedah rawat jalan ASA I yang mendapat anestesi umum. Subjek dipilih acak dan dibagi dalam dua kelompok: kelompuk desfluran mendapat anestesi pemeliharaan dengan desfluran dan kelompok sevofluran mendapat sevofluran. Kedua kelompok di induksi dengan propofol 2 mg/kgbb, fentanyl 2µ/kgbb, atrakurium 0,1 mg/kgbb, kemudian dilakukan pemasangan LMA (Laryngeal Mask Airway). Untuk pemeliharaan anestesi, subjek dipilih secara acak mendapatkan desfluran atau sevofluran. Monitoring standar termasuk laju nadi, laju napas, tekanan darah non invasif, saturasi, temperatur, dikur secara kontinyu dengan mesin monitor. Anestetika volatil dihentikan ketika prosedur bedah telah selesai dilakukan. Dilakukan penilaian agitasi pada pasien sejak LMA dilepaskan, penggunaan obat-obat anestesi telah dihentikan, kemudian pada menit ke 5, 10, 15, 20, 25, 30, dst setiap lima menit sampai dengan 120 menit setelahnya dengan menggunakan Riker Agitation-Sedation Scale/Skala Agitasi-Sedasi Riker. Di ruang pemulihan, dilakukan juga pencatatan data hemodinamik, penilaian VAS pada pasien, pemberian analgetik tambahan serta Modified Aldrete Score.Hasil: Dari hasil pengamatan didapatkan 7 pasien mengalami agitasi pascaanestesi dari 47 sampel kelompok desfluran (14,9%), sedangkan hanya 5 pasien yang mengalami agitasi dari 47 sampel kelompok sevofluran (10,6%). Meskipun secara frekuensi kejadian agitasi pascaanestesi pada kelompok desfluran lebih besar dibandingkan dengan kelompok sevofluran, namun perbedaan tersebut tidak bermakna secara statistik. Tidak terdapat perbedaan bermakna dari data hemodinamik kedua kelompok perlakuan selama observasi masa pemulihan anestesi. Terdapat perbedaan yang bermakna secara statistik dalam hal perbandingan lama bangun, kelompok desfluran lebih cepat bangun dibanding dengan kelompok sevofluran. Kelompok desfluran lebih cepat mencapai skor 10 dari modifikasi Aldrete dibvandingkan dengan kelompok sevofluran.Simpulan: Perbandingan besarnya kejadian agitasi pada kelompok yang dilakukan anestesi umum menggunakan desfluran dengan kelompok yang menggunakan sevofluran secara statistik tidak terdapat perbedaan yang bermakna. Prosentase agitasi pada kedua kelompok dapat dikatakan tidak terlalu tinggi jumlahnya, sehingga desfluran maupun sevofluran masih baik digunakan untuk pasien bedah rawat jalanThe Comparative of Agitation Incidency in Adult one day Surgery with General Anesthesia Desflurane or SevofluraneBackground and Objective: Postoperative agitation is a problem that sometimes occurs in patients who underwent general anesthesia. There is still controversy about the relative advantages of the use perioperative desflurane or sevoflurane inhalation as maintenance of anesthesia in ambulatory surgical patients. This study aims to determine the comparative magnitude of the incidence of post-operative agitation with ambulatory sugery performed under general anesthesia using desflurane or sevoflurane.Subjects and Methods: Experimental studies with a prospective single blind randomized controlled trial conducted in 94 surgical patients ASA I outpatient who received general anesthesia. Subjects were randomly selected and divided into two groups: group desflurane received maintenance anesthesia with sevoflurane group received desflurane and sevoflurane. The two groups in induction with propofol 2 mg / kgbb, fentanyl 2µ / kgbb, atrakurium 0.1mg / kgbb, then do the installation of LMA (Laryngeal Mask Airway) was installed. For maintenance of anesthesia, subjects were randomly selected to get desflurane or sevoflurane. Standard monitoring including pulse rate, breathing rate, non-invasive blood pressure, saturation, temperature, measured continuously with engine monitor. Anestetika volatile suspended when the surgical procedure has been completed. An assessment of agitation in patients since the LMA is released, the use of anesthetic drugs have been discontinued, and at minute 5, 10, 15, 20, 25, 30, and so on every five minute to 120 minutes later by using the using the Riker Agitation-Sedation Scale / Riker's Agitation-Sedation Scale. In the recovery room, also performed hemodynamic data recording, the patients VAS assessment, provision of additional analgesic and Modified Aldrete Score.Results: result found 7 patients experienced postoperative agitation desflurane group of 47 samples (14.9%), whereas only 5 patients with agitation of 47 samples sevoflurane group (10.6%). Although the frequency of occurance of postoperative agitation in desflurane group large than the sevoflurane group, but the difference was not statiscally significant. There were no significant differences in hemodynamic data from both treatment groups during the observation period of anethesia recovery. There was no statiscally significant differences in terms of comparison longer wake up, wake up faster desflurane group compared with the sevoflurane group. Desflurane group more quickly achieve a score of 10 from the scoring modification aldrete compared with sevoflurane groupConclusion: The Comparative magnitude of the incidence of agitation in the group that performed under general anesthesia using desflurane with the use of sevoflurane group was statistically no significant difference. The percentage of agitation in two groups can be said is not very high number, so desflurane and sevoflurane are both used for outpatient surgery patients

Tata Kelola Edem Paru Neurogenik Riyadh Firdaus; Syafruddin Gaus; Bambang J. Oetoro; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
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Edem paru neurogenik merupakan salah satu komplikasi pernafasan yang dapat muncul setelah cedera/trauma susunan saraf pusat. Bervariasinya laporan epidemiologi dan patofisiologi edem paru neurogenik dapat menyebabkan misdiagnosis yang dapat memperburuk prognosis pada pasien yang mengalami edem paru neurogenik. Patofisiologi edem paru neurogenik diduga dimulai dari kerusakan pada persarafan autonom pembuluh darah pulmonal dan stimulasi berlebihan dari pusat vasomotor susunan saraf pusat, yang kemudian menyebabkan berbagai perubahan yang terjadi pada pembuluh darah pulmonal hingga disfungsi jantung. Investigasi klinis harus dilakukan hati-hati karena manifestasi klinis yang dapat menyerupai edem paru kardiogenik dan non-kardiogenik lainnya, hasil pemeriksaan yang tidak spesifik, dan tidak adanya kriteria diagnosis. Saat ini belum ada pedoman tata kelola edem paru neurogenik yang dapat diterima secara luas, namun berbagai studi dan literatur menyebutkan tata kelola edem paru neurogenik berupa tata kelola suportif airway, breathing, circulation, di samping tata kelola penyebab cedera/trauma susunan saraf pusat memiliki prognosis yang baik, oleh karena itu identifikasi, investigasi, dan tata kelola edem paru neurogenik harus dilakukan secepatnya. Edem paru neurogenik dapat beresolusi dengan baik dalam 48–72 jam setelah mendapatkan tata kelola yang adekuat.Management of Neurogenic Pulmonary EdemaNeurogenic pulmonary edema is one of respiration complication caused by injury of central nervous system. Due to the vary of neurogenic pulmonary edema epidemiology and pathophysiology leads to misdiagnosed of neurogenic pulmonary edema, which could worsen the clinical condition patients. The pathophysiology of neurogenic pulmonary edema is believed caused by lesion on the autonomic central of vascular pulmonary bed and overactivation of central vasomotor system, which leads to alteration of vascular pulmonary conditions and cardiac dysfunction. Clinical investigation should be done carefully, because the clinical manifestations of neurogenic pulmonary edema mimicking the cardiogenic and non-cardiogenic pulmonary edema, non-spesific diagnostic modalities, and none diagnostic criteria in neurogenic pulmonary edema. Although nowadays none of management guidelines of neurogenic pulmonary edema accepted widely, many study reported the good outcome of supportive management of airway, breathing, and circulation besides the primary management of central nervous system injury. Hence, clinical identifications, investigations, and management of neurogenic pulmonary edema should be done immediately, because of good clinical outcome in 48 – 72 hours with adequate management.

Terapi Hipotermi setelah Cedera Otak Traumatik Dewi Yulianti Bisri; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Mekanisme proteksi otak hipotermi adalah mengurangi kebutuhan metabolik, cerebral metabolic rate for oxygen (CMRO2), eksitotoksisitas, menurunkan pelepasan glutamat, menurunkan pembentukan radikal bebas, mengurangi pembentukan edema, stabilisasi membran, memelihara adenosine triphosphate (ATP), menurunkan influx Ca, dan tekanan intrakranial. Sedangkan komplikasi hipotermi berat adalah pneumonia, sepsis, disritmia jantung, hipotensi, masalah perdarahan dan menggigil. Temperatur ideal untuk hipotermia terapeutik adalah 35 0C. Pertanyaan untuk terapi hipotermik (HT) adalah bagaimana mekanisme terapi hipotermi sebagai protektor otak? Berapa derajat C penurunan suhu tubuhnya? Bagaimana cara melakukan penurunan suhu? Berapa cepat hipotermia harus dicapai? Berapa lama hipotermi dipertahankan? Bagaimana memulihkan ke normotermi (rewarming)? Bagaimana hasilnya? Apakah ada penelitian yang sedang berlangsung? Untuk menggunakan hipotermia sebagai neuroprotektor, diperlukan mencapai keadaan hipotermi secepat mungkin setelah cedera dan pertahankan pada level aman. Metode hipotermi terapeutik adalah pendinginan permukaan tubuh, pendinginan endovaskuler, pendinginan kepala. Selama penghangatan kembali pasien dengan hipertensi intrakranial telah diketahui bisa terjadi peningkatan tekanan intrakranial selama pemanasan yang cepat. Dianjurkan pemanasan lambat lebih dari 12 jam dengan kecepatan 0,1 0C/jam. Sebagai simpulan, hipotermi terapeutik masih kontroversi, tapi dalam situasi klinik pertahankan suhu pasien 35 0C dan harus dihindari temperatur lebih dari 37 0C. Untuk mencapai suhu inti 35 0C dianjurkan digunakan metode pendinginan permukaan tubuh. Hypothermia Therapy after Traumatic Brain InjuryThe mechanism of hypothermia as neuro protector are by reducing metabolic demand of the brain, cerebral metabolic rate of oxygen (CMRO2), excitotoxicity, decrease the glutamate release, reduction of free radical formation, edema formation, membrane stabilization, maintains adenosine triphosphate (ATP), decrease in Ca influx, and intracranial pressure. In the order hand, complication of deep hypothermia are pneumonia, sepsis, cardiac dysrrhythmia, hypotension, bleeding problem and shivering. The ideal temperature for therapeutic hypothermia is 35 0C. Question arised for hypothermic therapy (HT) are what is the therapeutic mechanism of HT as neuroprotective? What is the proper degree for hypothermia? What can we do to induce hypothermia? How soon should we do the HT? How long hypothermia should be maintain? How to restore normothermia (rewarming)? What is the result? Is there any ongoing research?. For the use hypothermia as one of neuroprotective therapy, it is necessary to implement it as soon as possible after the insult and to maintain it at the lowest safe level. Methods of therapeutic hypothermia are surface cooling, endovascular cooling, as well as selective head cooling. During rewarming, patients with intracranial hypertension are known to have reflex that would increase ICP during rapid rewarming. Slow rewarming over a period of 12 hrs at the rate of 0.1 0C/hr is desirable. As conclusion, therapeutic hypothermia still controversial, but in clinical situation keep the patient 35 0C is desirable and temperature more than 37 0C should be avoided. To reach core temperature 35 0C, surface cooling is recommended.

Manajemen N-IOM (Manajemen Neurologi-Intraoperatif) pada Eksisi Tumor Myelum dan Dekompresi Stabilisasi Servikal C2-C6 Rusly, Andri; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Pemantauan neurofisiologis intraoperatif (N-IOM) berkembang menuju standar perawatan untuk meminimalkan risiko cedera jalur saraf selama prosedur bedah saraf. Pentingnya tidak hanya terletak dalam mendiagnosis cedera pada periode perioperatif untuk pasien yang berisiko tinggi serta komplikasi neurologis dari operasi tetapi juga dalam menciptakan kesempatan untuk menyelamatkan jaringan saraf yang berisiko sebelum kerusakan menjadi ireversibel. Operasi pada tulang belakang merupakan salah satu operasi dengan tingkat resiko tinggi untuk mencederai jaringan sehat sekitar, oleh sebab itu teknik anestesi dengan N-IOM akan sangat membantu mengurangi komplikasi durante operasi. Beberapa penelitian sebelumnya meneliti tentang kombinasi yang berbeda dari teknik N-IOM (seperti somatosensory evoked potentials [SEPs], motor evoked potentials [MEPs], direct wave, free- running electromyography). Hasilnya didapatkan bahwa penggunaan N-IOM multimodal untuk operasi tumor sumsum tulang belakang memberikan hasil yang lebih baik daripada penggunaan N-IOM dengan satu teknik. Teknik N-IOM dengan menggunakan sedasi seperti propofol dan dexmedetomidine yang dikombinasikan dengan opioid seperti fentanyl dapat menjaga kedalaman anestesi pasien tanpa mengganggu sinyal N-IOM itu sendiri. Untuk memaksimalkan nilainya, penting tim operasi untuk memiliki pemahaman dasar tentang prinsip-prinsip neuromonitoring dan ahli anestesi untuk memahami bagaimana hal itu dapat dipengaruhi oleh anestesi. Oleh karena itu, diperlukan teknik anestesi yang optimal dimana hemodinamik pasien tetap terjaga selama pembedahan dan monitoring IOM tetap dapat dilakukan.Management N-Iom (Neurology-Intraoperative Management) at Tumor Myelum Exition Decompression and Stabilization Cervical C2-C6AbstractIntraoperative neurophysiological monitoring (IOM) is advancing towards the standard of care for the risk of neural pathway injury during neurosurgical procedures. The importance lies not only in finding a diagnosis in the perioperative period for high-risk patients as well as neurologic complications from surgery but also in creating opportunities to salvage neural tissue before the damage becomes irreversible. Surgery on the spine is one of the operations with a high level of risk for injuring the surrounding health tissue, therefore the anesthetic technique with N-IOM will greatly help reduce complications during surgery. Several previous studies investigated different combinations of N-IOM techniques (such as somatosensory evoked potentials [SEPs], motor evoked potentials [MEPs], direct wave, free-running electromyography). The results showed that the use of multimodal N-IOM for spinal cord tumor surgery gave better results than the use of a single technique N-IOM. N-IOM techniques using sedatives such as Propofol and Dexmedetomidine in combination with Opioids can maintain the depth of anesthesia without interfering with the N-IOM signal itself. To maximize its value, it is important for the operating team to have a basic understanding of the principles of neuromonitoring and the anesthesiologist to understand how it can be affected by anesthesia. Therefore, an optimal anesthetic technique is needed where hemodynamics is maintained during surgery and IOM monitoring can still be performed.

Manajemen Anestesi untuk Evakuasi Hematoma akibat Perdarahan Intraserebral pada Kehamilan 22–24 Minggu: Non Seksio Sesarea Ahmado Oktaria; Dewi Yulianti Bisri
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Sekitar 50% dari semua kematian karena trauma berhubungan dengan cedera kepala. Tinjauan terbaru, angka kematian yang disebabkan trauma pada ibu hamil karena cedera langsung pada kepala sekitar 10%. Pertimbangan anestesi untuk pembedahan selama kehamilan mencakup keselamatan terhadap ibu dan janin. Perubahan anatomi dan fisiologi ibu yang disebabkan kehamilan memiliki dampak klinis dan risiko tinggi bagi ibu dan janin yang menjalani tindakan anestesi. Wanita berusia 22 tahun yang tengah hamil 22 minggu (G1P0A0) tertabrak mobil saat mengendarai sepeda motor tanpa menggunakan helm 4 jam sebelum masuk rumah sakit. Pasien menderita cedera kepala disertai penurunan kesadaran. Dari pemeriksaan fisik didapatkan GCS 9 (E2M5V2), tekanan darah 120/80 mmHg, denyut jantung 92 x/menit, respirasi 22–24 x/menit dan saturasi oksigen 99% dengan sungkup muka non-rebreathing (SMNR) 8 liter per menit. Kraniotomi evakuasi dilakukan dalam anestesi umum, induksi anestesi dengan menggunakan isofluran 2 vol%, lidokain 75 mg, fentanil 100 mcg, propofol 80 mg, vecuronium 5 mg dan O2: udara 50:50. Denyut jantung janin diperiksa setiap jam dengan hasil sekitar 120–130 x/menit. Pada trauma selama kehamilan, janin dapat mengalami cedera langsung atau tidak langsung yang disebabkan karena pengaruh obat-obatan (inotropik, manitol, furosemid), hipotensi, hipoksemia atau tindakan yang dilakukan terhadap ibu (hiperventilasi untuk mengontrol tekanan intrakranial). Seksio sesarea tidak dilakukan kecuali untuk alasan obstetrik. Anesthesia Management for Hematoma Evacuation caused by Intracranial Hemorrhagic on Pregnant Woman with 22–24 Gestational Weeks: Non Cesarean SectionApproximately 50% of all trauma deaths are associated with head injury. In a recent review of pregnant trauma deaths, approximately 10% of maternal trauma deaths were directly due to head injury. Anesthetic considerations for surgery during pregnancy include concern for the safety of both the mother and fetus. Alterations in maternal anatomy and physiology induced by pregnancy have clinical anesthetic implications and present potential hazards for the mother and fetus undergoing anesthesia. A 22 years old female with 22 weeks of gestation (G1P0A0) hit by a car while riding a motorcycle without using helmet 4 hours before admission. She got a traumatic head injury with drecreased level of consciousness. The physical examinations were GCS 9 (E2M5V2), blood pressure 120/80 mmHg, heart rate 92 bpm, respiration rate 22–24 times per minute and SpO2 99% with simple mask non rebreathing 8 liter per minute. Emergency craniotomy surgery was held under general anesthesia by using isoflurane 2 vol%, lidocaine 75 mg, fentanyl 100 mcg, propofol 80 mg, vecuronium 5 mg with O2 : air 50:50. The fetal heart sound was checked every hour which was approximately 120–130 bpm. In trauma during pregnancy, the fetus may have affected by the direct injury itself or affected by any other insult caused by hypotension, hypoxemia or maternal therapeutic drugs or maneuvers (e.g. inotropes, mannitol, furosemide, hyperventilation for control of intracranial pressure). Caesarean delivery is not performed except only for obstetric reasons.

Penggunaan Remifentanil pada Pasien Pediatrik dengan Meningokel yang Dilakukan Tindakan Eksisi Meningokel Sikumbang, Kenanga Marwan; Lahdimawan, Ardik
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Meningokel adalah kondisi kegagalan fusi selubung saraf medulla spinalis yang umum ditemui pada pasien pediatrik. Koreksi meningokel dilakukan dalam posisi prone yang memerlukan tatalaksana anestesi yang hati-hati. Fisiologi neonatus dan infant berbeda dengan orang dewasa, karena fungsi fisiologis system organ masih imatur dan menyebabkan safety margin terbatas, sehingga pilihan obat adalah yang metabolismenya tidak tergantung pada fungsi hati dan ginjal normal. Dalam bidang neuroanestesi pediatrik, penggunaan remifentanil semakin luas, karena onset cepat, efek analgesik poten dan eliminasi cepat. Seorang bayi laki-laki, usia 7 bulan dengan berat badan 7 kg, diagnosis meningokel lumbosacral dilakukan tindakan eksisi meningokel. Pasien diberikan remifentanil 1 mcg/kgbb selama 1 menit dilanjutkan dengan remifentanil kontinyus 0.05-1mcg/kgbb/mnt. Induksi dengan propofol, diberikan atracurium sebelum intubasi. Selama operasi kondisi stabil, tidak terjadi episode bradikardi dan pascaoperasi pasien langsung diekstubasi. Penggunaan remifentanil menjadi pilihan karena onset cepat, efek analgesik poten, eliminasi cepat dan memberikan stabilitas hemodinamik selama operasi. Operasi dengan posisi prone pada pasien pediatrik memerlukan kehati-hatian terutama saat memposisikan pasien, dimana harus yakin pipa ett tidak mengalami dislokasi atau kinking, mencegah efek penekanan pada mata dan pencegahan terjadinya neuropati perioperatif. Pemakaian remifentanil pada kasus ini memberikan stabilitas hemodinamik yang baik dan pulih sadar yang cepat.Using Remifentanyl For Pediatrik Patient With Meningocele Underwent Meningocelectomy Under General AnesthesiaAbstractMeningocele is failure of the neural tube to close during first trimester pregnancy which is the most common conditions in pediatrik patient. Correction is performed under prone position with carefull anesthestic procedure. The physiology of neonates and infants are different from that of adults. Immaturity of their vital organ systems narrows the safety margin of perioperative management including anesthesia. Remifentanil is becoming increasingly popular for this purpose. Remifentanil has favorable characteristics for anesthesia in neonates such as rapid onset, potent analgesic effect, and rapid elimination. A baby boy 7 months old, 7 kg, with meningocele lumbosacral underwent meningocelectomy. The patient was given remifentanil 1 mcg/kgbw/iv in one minute and continuous 0.05-0.1 mcg/kgbw/mnt. Induction with propofol iv, atracurium before intubation. Stability hemodynamic during the operation, no episode of bradycardia and patient extubated early after the operation. Remifentanil is an ultra-short-acting opioid, with rapid onset, produces profound analgesia, rapid offset and good stability of hemodynamic during the operation. The operations are carried out prone, careful positioning is paramount to avoid complications like dislodging or kinking of the endotracheal tube, corneal abrasion or perioperative neuropathy. Using remifentanyl in this case report given good hemodynamic stability dan rapid emergence.

Anestesia untuk Operasi Syringomyelia C2-7 dengan Penyulit Obesitsas Mellitus Tipe II Betty Roosiati; Bambang J. Oetoro
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Syringomyelia refers to the cystic cavitation of the spinal cord. Two main forms of syringomyelia have been described: communicating syringomyelia and non communicating syringomyelia. In communicating syringomyelia, there is primary dilatation of the central canal that is often associated with abnormalities at the foramen magnum such as tonsillar herniation (Chiari malformation) and basal arachnoiditis. In non communicating syringomyelia, a cyst arieses within the cord substance itself and does not communicate with the central canal or subarachnoid space. This patients is clasified as communicating syringomyelia due to Chiari malformation. Obesity and diabetes mellitus type II as comorbid in this case. The surgery was done under general anesthesia, prone position uneventfull.Anethesia for C2-7 Syringomyelia Surgery with Comorbid Obesity and Diabetes Mellitus Type IISyringomyelia adalah kista pada medulla spinalis. Ada dua bentuk utama dari syringomyelia yaitu communicating syringomyelia dan non communicating syringomyelia. Communicating syringomyelia adalah dilatasi primer dari kanalis sentralis dan sering berhubungan dengan abnormalitas pada foramen magnum, misal herniasi tonsillar (Chiari Malformasi) dan arachnoiditis basal. Non communicating syringomyelia, kista berasal dari medulla spinalis dan tidak berhubungan dengan kanalis sentralis atau ruang subarachnoid. Pasien ini termasuk golongan communicating syringomyelia karena adanya Chiari malformasi. Obesitas dan diabetes mellitus tipe II sebagai comorbid. Operasi dilakukan dengan anestesi umum dalam posisi prone.

Anestesi Posisi Prone untuk Pengangkatan Tumor Torakal Posterior Pasien Pediatri dengan Malnutrisi Kronis dan Gangguan Metabolik Kulsum, Kulsum; Rachman, Iwan Abdul; Prihatno, MM. Rudi; Jasa, Zafrullah Kany
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Malnutrisi kronis adalah suatu keadaan dimana tubuh mengalami gangguan dalam penggunaan zat gizi untuk pertumbuhan, perkembangan dan aktivitas. Gangguan metabolik yaitu kondisi adanya kelainan proses metabolisme pada tubuh akibat defisiensi enzim atau hormon. Posisi prone pada neuroanestesi pediatrik tulang belakang dilakukan untuk mencapai tekanan perfusi otak dan tulang belakang yang normal. Tujuan kasus ini membahas pengelolaan neuroanestesi pediatrik pada posisi prone dengan adanya kelainan malnutrisi kronis merupakan hal yang rumit sehingga diperlukan manajemen agar menghasilkan outcome yang baik. Anak laki laki, 8 tahun, 15 kg, 102 cm, benjolan di punggung belakang yang keluar merembes cairan dengan diameter 7 cm sejak lahir, kelemahan anggota gerak, buang air besar dan buang air kecil tertahan. Dilakukan VP-shunt 2 minggu lalu. Premedikasi dengan midazolam dan fentanyl. Induksi menggunakan propofol dan ada penambahan saat laringoskopi dan intubasi. Fasilitas intubasi dengan atracurium. Pemeliharaan anestesi dengan O2 + udara + sevofluran 2% dengan fraksi oksigen 50% + propofol dan rocuronium bolus intravena. Monitoring tanda vital (tekanan darah, denyut jantung, frekuensi nafas, saturasi oksigen, jumlah dan warna urin) serta end tidal CO2. Hasil setelah pengangkatan tumor selama 2 jam hemodinamik relatif stabil, tekanan darah 100120/6080 mmHg. Pasien ditempatkan di Pediatric Intensive Care Unit. Simpulan: diperlukan manajemen neuroanestesi pediatrik untuk menangani kasus malnutrisi kronik dan gangguan metabolik pada pengangkatan tumor torakal posterior agar menghasilkan outcome yang baik.Prone Position Anesthesia for Posterior Thoracal Tumor Removal Pediatric Patient with Chronic Malnutrition and Metabolic DisorderAbstractChronic malnutrition is a condition where the body experiences a disruption in the use of nutrients for growth, development and activity. Metabolic disorders are conditions in which there are abnormal metabolic processes in the body due to enzyme or hormone deficiency. The prone position in pediatric spinal neuroanesthesia is performed to achieve normal cerebral and spinal perfusion pressure. The purpose of this case is to discuss the management of pediatric neuroanesthesia in the complicated prone position in order to produce good outcomes. Boy, 8 years old, 15 kg, 102 cm, a lump in the back that came out seeping fluid with a diameter of 7 cm from birth, weakness in limbs, bowel movements and urinary retention. Performed a VP shunt 2 weeks ago. The premedication method uses midazolam and fentanyl. Induction uses propofol and there are additions during laryngoscopy and intubation. Intubation facilities with atracurium. Maintenance of anesthesia with O2 + air + sevoflurane 2% with 50% oxygen fraction + propofol and intravenous rocuronium bolus. Monitoring vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation, amount and color of urine) and end tidal CO2. Tumor removal results for 2 hours hemodynamically are relatively stable, blood pressure 6080/4050 mmHg. Patients are admit to the Pediatric Intensive Care Unit. Conclusion: pediatric neuroanesthesia management is needed to handle chronic malnutrition and metabolic disorders in the removal of posterior thoracic tumors in order to produce good outcomes.

Fast Track Anesthesia untuk Prosedur Kraniotomi Evakuasi Hematom karena Stroke Hemoragik Bona Akhmad Fithrah; Bambang Suryono; Siti Chasnak Saleh; Himendra Warga Dibrata
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Fast tract anesthesia pertama kali dikenalkan pada periode 1990 dengan maksud untuk untuk mencegah kerusakan multi organ, komplikasi dan berujung pada masa pemulihan yang cepat. Dengan masa pemulihan yang cepat diharapkan akan mengurangi penggunaan ruang rawat intensif dan masa tinggal di rumah sakit yang lebih pendek. Prosedur fast tract bukan sekedar ekstubasi cepat tapi juga bagaimana mengelola pasien secara efektif dan efisien anestesi dalam periode perioperatif. Kondisi preoperatif yang baik. Penggunaan obat obatan kerja pendek-menengah dan prosedur yang singkat sangat menentukan kesuksesan fast track anesthesia. Akan kami laporkan suatu kasus perdarahan intrakranial, laki laki 60 th masuk ke IGD dengan keluhan sakit kepala berat, pasien dengan riwayat hipertensi tidak terkontrol, diabetes mellitus dan stroke non hemoragik sebelumnya tahun 2013. GCS masuk E3M6Vapasia. Tekanan darah 180/110 mmHg saat masuk. Dari CT scan kepala didapatkan perdarahan intracrebri pada lokasi temporoparietal kiri. Dilakukan prosedur evakuasi hematom segera. Gejolak hemodinamik saat laringoskopi direk dicegah dengan menggunakan lidokain intravena. Saat intraoperatif dilakukan teknik balans anestesi antara intravenous anestesi dengan gas anestesi. Analgetik diberikan intermitten dan relaksan diberikan secara kontinyu. MAP dipertahankan sekitar 90-110. Gula darah diperiksa setiap jam dan dipertahankan dengan drip insulin. Hemodinamik intraoperatif relatif stabil. Prosedur evakuasi hematom dilakukan selama tiga jam. Dengan pertimbangan kesadaran preoperatif yang baik, prosedur yang tidak terlalu lama, hemodinamik stabil selama operasi, udem jaringan otak yang minimal tidak ada kerusakan jaringan yang berat maka dilakukan ekstubasi dan pasca operasi pasien dirawat di HCU. Pasien dirawat selama dua hari di HCU dan hari ke delapan pasien sudah keluar dari rumah sakitFast Track Anesthesia untuk Prosedur Kraniotomi Evakuasi Hematom karena Stroke HemoragikFast tract anesthesia first time introduced in early 1990 with aim to prevent multi organ failure, complication and speedy recovery. With a quick recovery will reduce intensive care unit usage and reduce length of stay in the hospital. Fast tract anesthesia not just early extubation but also how to manage with effective and efficient anesthesia during perioperative. Good preoperative condition, using short acting drug and short procedure will determinate the successful of fast tract anesthesia. Here we report an intracerebral hemorrhage with fast tract anesthesia. Men, 60 yo attended to the ER with complaining severe headache. Patient with uncontrolled hypertension, diabettes mellitus and stroke non hemorahic in 2013. GCS when admission E3M6Vaphasia and blood pressure 180/110 mmHg. CT scan said intracerebri hemmorhage at left temporoparietal. Evacuation hematom performed urgently. Hemodinamic unstability during laringoscopy direct prevent with lidocaine intravenous. Anesthesia performed with balamnce anesthesia using intravenous and inhaled anesthesia. Analgetic intermitten, muscle relaxant given continuosly. MAP controlled 90-110. Blood glucose check every one hour and stabilized using insulin. During operation hemodynamic relatively stable. Procedur completed after three hours. Considering preoperatif awareness still good, not too long procedur, hemodynamic stable, and minimal brain edema or other brain tissue damaged patient extubated and transport to High care unit.patient was observed in the HCU for two days and after eight days stayed in the hospital patient can go back home.

Gangguan Koagulasi dan Hubungannya dengan Luaran Pascacedera Otak Traumatik Kenanga Marwan; Nazaruddin Umar; Siti Chasnak Saleh; A Himendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Gangguan koagulasi umum terjadi pada cedera otak traumatik (COT) dan seringkali memperburuk luaran. Gangguan ini diawali dengan lepasnya faktor jaringan dan trombin secara berlebihan pada bagian otak yang rusak, yang selanjutnya mengaktifkan jalur koagulasi. Gangguan koagulasi pada COT bersifat kompleks dan berupa kombinasi koagulopati dan hiperkoagulabilitas. Hiperkoagulabilitas dikaitkan dengan terjadinya disseminated intravascular coagulation (DIC) secara sistemik dan secara lokal dengan terbentuknya mikrotrombi di area penumbra daerah yang mengalami kontusi. Nilai abnormal fungsi koagulasi dapat terjadi karena kerusakan endotel saat cedera langsung dan tidak langsung oleh proses inflamasi, toksin dan iskemia. Koagulopati terjadi akibat turunnya jumlah platelet dan faktor pembekuan akibat kehilangan darah atau karena kosumsi oleh DIC, dan dipercepat dengan dilusi, asidosis dan hipotermi. DIC merupakan prediktor penting luaran COT yang buruk. Coagulation Disorders Post Traumatic Brain Injury Related OutcomeTraumatic disorder of hemocoagulation is common in traumatic brain injury (TBI) and frequently related to poor outcome. It begins with the massive release of thrombin or tissue factor from damage brain cells, following the activation of coagulation pathway. Coagulation disorder in TBI are complex and characterised by combination of coagulopathy and hypercoagulability. A hypercoagulable state may be generalised in the case of disseminated intravascular coagulation (DIC) or local with the development of microthrombi in the penumbra of a contusion. The presence of abnormal coagulation test in traumatic brain injury may be caused by cerebral vascular endothelial damage after direct injury, as well as indirect damage through inflammation, toxins, and ischaemia. Coagulopathy may result from depletion of platelets and clotting factors following blood loss or comsumption due to DIC, and may further be enhanced by dilution, acidosis and hypothermia. DIC is an important predictor of poor outcome in TBI.

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Contact Name Agni Susanti

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

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Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

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+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