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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 Anestesi pada Pasien dengan Tumor Regio Pineal yang Menjalani Kraniotomi Pengangkatan Tumor dengan Posisi Duduk Widiastuti, Monika; Bisri, Dewi Yulianti; Harahap, M Sofyan; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Tumor regio pineal memiliki insiden 0.4-1% dari tumor intracranial. Lokasinya yang dalam, di antara kedua hemisfer otak, berdekatan dengan batang otak dan hipotalamus menjadi tantangan bagi bedah saraf. Operasi dengan supracerebellar approach dalam posisi duduk adalah pilihan terbaik untuk mencapai lokasi. Posisi duduk juga memfasilitasi lapang operasi yang optimal dengan retraksi cerebellum minimal. Posisi duduk membawa tantangan tersendiri untuk dokter anestesi, dengan segala kompleksitas saat memposisikan pasien dan risiko komplikasinya. Venous air embolism adalah pertimbangan utama yang jika tidak terdeteksi dan ditangani dapat menyebabkan kolaps kardiovaskular dalam waktu singkat. Pasien laki-laki berusia 38 tahun datang dengan keluhan nyeri kepala berat dan penglihatan kabur sejak 4 bulan sebelum masuk rumah sakit. Hasil Magnetic Resonance Imaging menunjukkan adanya massa di regio pineal dengan edema perifokal, tanpa deviasi struktur midline. Pasien dilakukan kraniotomi pengangkatan tumor dalam posisi duduk. Operasi berjalan selama 10 jam dengan hemodinamika stabil dan tidak terjadi komplikasi, dalam anestesi umum dengan kombinasi intravena dan inhalasi. Prinsip ABCDE neuroanestesi, posisi duduk dan implikasinya, dan lokasi operasi yang sulit adalah pertimbangan-pertimbangan anestesi yang harus diperhatikan pada pasien ini. Evaluasi preoperasi yang baik, komunikasi dan koordinasi yang baik antara tim bedah dan anestesi sangat diperlukan untuk kelancaran dalam kraniotomi dalam posisi duduk.Anesthetic Management of Patient with Pineal Region Tumor Underwent Craniotomy Tumor Removal in Sitting PositionAbstractIncidence of pineal regio tumor is 0.4-1% of intracranial tumors. Its location which is buried between two cerebral hemispheres, close to brainstem and hypothalamus become a difficult challenge for the neurosurgeon. Surgery with supracerebellar approach in sitting position is the best method to access the lesion. Sitting position also facilitates the optimal visual field with minimal retractions. However, for anesthesiologist, sitting position is challenging since it has its own complexities during positioning the patient and the risk of complications. Venous air embolism is one of the main concern and if not detected early and treated appropriately would leads to cardiovascular collapse instantly. This is a case of a 38-year-old male with chief complaint of severe headache and blurred vision started 4 months before admission. The Magnetic Resonance Imaging showed a pineal region tumor with perifocal edema, without midline deviation. The patient underwent craniotomy tumor removal with sitting position. The procedure lasted for 10 hours and uneventful. The principle of ABCDE neuroanesthesia, sitting position and its implications, and difficult tumor location are some anesthesia considerations for this patient. A thorough preoperative evaluation, good communication and coordination between surgery and anesthesia team are needed for a smooth uneventful procedure performed in sitting position.

Manajemen Anestesia pada Carotid Endarterectomy: Pasien dengan Kinking Arteri Karotis Interna Riyadh Firdaus; Iwan Fuadi; Sri Rahardjo; A Himendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
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Prosedur Carotid Endarterectomy (CEA) adalah prosedur penting untuk pencegahan stroke karena sumbatan arteri karotis. Seorang laki-laki 71 tahun akan dilakukan operasi CEA. Pasien mengeluh pusing berputar, riwayat hipertensi diakui sejak 10 tahun dengan tekanan darah tertinggi 170/100 mmHg, riwayat stroke diakui 1 tahun yang lalu dan 1,5 bulan lalu. Gejala sisa stroke saat ini kelemahan extremitas sebelah kiri. Pasien terdapat riwayat sakit jantung, irama tidak teratur, tidak disertai sesak nafas 1 tahun yang lalu dan saat itu diberikan amiodaron tablet. Operasi dilakukan dengan anestesi umum, menggunakan pipa endotrakeal no.8.0, ventilasi kendali. Obat yang dipergunakan adalah midazolam 1 mg iv, fentanyl 150 mcg iv, propofol 70 mg iv, rocuronium 40 mg iv. Rumatan dilanjutkan dengan sevofluran, fraksi oksigen 45% dan propofol bolus jika diperlukan. Monitoring tanda vital (tekanan darah, nadi, SaO2, elektrokardiografi) dan artery line. CEA dilakukan selama 3,5 jam, tidak ditemukan stenosis tetapi terdapat kinking. Selama operasi hemodinamik relatif stabil. Pascaoperasi pasien di rawat di ruang perawatan intensif. Berbagai pendekatan bedah telah dikemukakan untuk kinking arteri karotis interna. Pilihan pendekatan dipengaruhi oleh pemilihan pasien, penilaian praoperasi optimasi, dan manajemen perioperatif perawatan untuk pasien yang akan menjalani CEA. Anesthetic Management for Carotid Endarterectomy:Patient with Internal Carotid Artery KinkingCarotid endarterectomy (CEA) is an important procedure for stroke prevention due to obstruction of carotid artery. A 71 years old male was scheduled for CEA surgery. The patient complained of spinning headache. He had been suffered from hypertension since 10 years ago with highest blood pressure of 170/100 mmHg, and had a two times stroke 1 year and 1.5 months ago. Sequelae symptom of stroke is weakness on the left extremity. Patient also had a history of heart disease, irregular rhythm, without shortness of breath approximatelly1year ago, treated with amiodarone tablets. The CEA operation was performed under general anesthesia using endotrachenal tube 8.0, controlled ventilation, 1 mg midazolam, 150 mcg fentanyl, 70 mg propofol and 40 mg rocuronium, given intravenously. Maintenance of anesthesia was done using sevoflurane, oxygen fraction of 45% and propofol 10 mg given intermittently as needed. Noninvasive vital signs monitoring and invasive arterial blood pressure were recorded. Hemodynamics were stable during the 3.5 hours operation. We found no plaque but a kinking on the carotid artery. Postoperatively, patients was admitted to the intensive care unit. Various surgical approaches have been done and developed to manage the internal carotid artery kinking. Options approach is influenced by patient selection, preoperative assessment and optimization, and perioperative management and care for patients undergoing CEA

Karakteristik Klinis Pasien Trombosis Sinus Venosus Serebral (TSVS) di Ruang Rawat Inap Neurologi Rumah Sakit Hasan Sadikin Bandung Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
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Latar Belakang dan Tujuan: Trombosis sinus venosus serebral (TSVS) merupakan penyakit akibat oklusi struktur vena intrakranial, termasuk sinus serebral, vena korteks, dan bagian proksimal vena jugularis. Keterlambatan diagnosis dan terapi dapat mengakibatkan terjadinya komplikasi seperti infark berdarah bahkan kematian.Tujuan penelitian ini adalah untuk mengetahui karakteristik klinis pasien TSVS yang diagnosisnya telah dikonfirmasi melalui pemeriksaan DSA. Metode: Penelitian ini bersifat deskriptif observasional retrospektif. Pada pasien yang telah didiagnosis TSVS di Bagian Neurologi Rumah Sakit Hasan Sadikin Bandung periode Juni 2015 sampai November 2017.Hasil: Terdapat 33 subjek dengan rentang usia 40-49 tahun (24,2%) dan mayoritas adalah perempuan sebanyak 22 orang (66,7%). Faktor resiko terbanyak adalah infeksi 8 orang (24,2%), dan kondisi protrombotik sebanyak 6 orang (18,2%). Gejala klinis terbanyak adalah nyeri kepala yaitu 27 orang (81,8%). Lokasi sinus yang tersering mengalami trombosis adalah sinus transversus pada 28 orang dengan gejala mayoritas nyeri kepala. Kadar D-Dimer ditemukan meningkat dengan rata-rata 1,21 mg/L.Simpulan: Pasien TSVS terjadi pada perempuan dengan rentang usia dekade pertengahan dan faktor resiko terbanyak adalah infeksi. Nyeri kepala merupakan gejala paling sering. Lokasi trombosis mayoritas terjadi pada sinus transversus dan ditemukan peningkatan D-Dimer.Clinical Characteristics of Cerebral Venous Sinus Thrombosis (CVST) Patients in Neurology Ward Hasan Sadikin General Hospital BandungAbstractBackground and Objective: CVST is an entity caused by intracranial vein, including cerebral sinuses, cortical vein and proximal part of the jugular vein. A delay in diagnosing and treating can result in brain infarct with hemorrhagic transformation, even death. The goal of this study is to learn the clinical characteristics of patients with CVST that had been confirmed by DSA.Method: This was a retrospective observational descriptive study and subjects were hospitalized patients which had been diagnosed CVST in Neurology ward Hasan Sadikin General Hospital from June 2015 to November 2017.Results: there was 33 subjects with most (22 patient/66.7%) being women between 40-49 years old. In this study the most frequently found risk factor was infection in 8 subjects (24.2%), prothrombotic conditions in 6 subjects (18.2%). The clinical manifestations were mainly headache in 27 subjects (81,8%). The sinus most often involved was the transverse sinus (28 subjects) with the clinical manifestation being headache. D-dimer levels were also increased with mean 1.21 mg/dl.Conclusion: CVST patients are mostly in women at the midle age of decade, with infection being the most frequent risk. Headache was the most frequent clinical manifestation. Location of thrombosis were more often found on the transverse sinus and D-Dimer level was increased.

Krisis Tiroid Pascakraniotomi Mikro pada Makroadenoma Hipofise disertai Akromegali Yasmine Kartika Putri; M. Sofyan Harahap
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
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Tumor Hipofise sering terjadi pada dewasa dan mewakili 10% tumor intrakranial. Akromegali adalah sindrom klinik yang disebabkan oleh produksi hormon pertumbuhan yang berlebihan dan diketahui sebagai penyakit yang jarang, yang ditandai oleh sekresi yang berlebihan hormon pertumbuhan (GH, growth hormone) dan faktor pertumbuhan seperti insulin (IGF-1/Insulin Growth Factor-1). Insiden keseluruhan akromegali diperkirakan mencapai 3 sampai 5 kasus baru per juta populasi. Akromegali dapat muncul bersamaan dengan gangguan tiroid. Lini pertama pengobatan untuk akromegali adalah operasi transsphenoidal. Manajemen perioperatif operasi hipofise membutuhkan penanganan oleh tim bedah saraf, neuroanaesthesiologists dan ahli endokrin. Semua pasien dengan adenoma hipofise memerlukan evaluasi endokrin menyeluruh pada periode pre-operatif dan di follow-up saat periode post-operatif. Seorang wanita 50 tahun masuk Rumah Sakit dengan keluhan kedua tangan dan kaki membesar, telapak kaki menebal dan bengkok, rahang dan hidung membesar. Riwayat pengobatan hipertiroid ± 3 tahun. Dari pemeriksaan magnetic resonance imaging (MRI) kepala dengan kontras didapatkan makroadenoma hipofise. Pasien menjalani prosedur operasi craniotomi mikro transsphenoidal. Pasca operasi pasien dirawat di ICU dan mengalami perburukan dan pada akhirnya meninggal di hari kedua perawatan ICU oleh karena krisis tiroid.Thyroid Crisis Post Microcraniotomy of Macroadenoma Pituitary Accompanied AcromegalyPituitary tumors are common in adults and represents 10% of intracranial tumors. Acromegaly is a clinical syndrome caused by the production of excess growth hormone and it is known as a rare disease, which is characterized by excessive secretion of growth hormone (GH) and growth factors such as insulin (IGF-1, Insulin Growth Factor-1). The overall incidence of acromegaly is estimated at 3 to 5 new cases per million population. Acromegaly can coexist with thyroid disorders. First-line treatment for acromegaly is transsphenoidal surgery. Perioperative management of pituitary surgery requires treatment by a team of neurosurgeons, neuroanaesthesiologists and endocrinologists. All patients with pituitary adenoma requires a thorough pre -operative endocrine evaluation and a follow- up in post- operative period. A 50 years old woman entered a hospital with complaints of swollen both hands and feet, thicken and crooked foot, enlarging of jaw and nose. She had a history of ± 3 years hyperthyroid treatment. Magnetic resonance imaging (MRI) examination of the head with the contrast obtained macroadenoma pituitary. Patiens underwent micro- surgery procedures of craniotomi transsphenoidal. Post-surgery, Patient being observed in the ICU and her condition was deteriorated and she eventually died on the second day due to thyroid crisis.

L-Arginine, Suatu Peluang Neuroproteksi terhadap Pasien Preeklampsia yang mendapat Problem Neurologis Utami, Niken Asri; Jasa, Zafrullah Kany
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Preeklampsia mengakibatkan komplikasi pada 35% dari seluruh kehamilan. Dihubungkan dengan persalinan prematur, solusio plasenta dan lahir mati serta komplikasi stroke iskemik, stroke perdarahan, edema serebri serta kejang. Pasien dengan preeklampsia menunjukkan peningkatan tekanan perfusi otak pada arteri serebri media, anterior dan posterior, disertai perubahan indeks resistensi arteri serebri. Insiden komplikasi serebrovaskuler menyumbangkan 40% kematian maternal. Terjadi gangguan autoregulasi dan pembentukan edema. Gangguan autoregulasi dihubungkan dengan penurunan resistensi serebrovaskuler, hipoperfusi otak, disrupsi sawar darah otak serta edema vasogenik. Terjadi peningkatan sitokin pro inflamasi dan aktivasi sel-sel glia otak. L-Arginine adalah kompleks asam amino yang memiliki bentuk aktif dalam bentuk L-Arginine (2 amino 5 guanidino pentanoic acid). Substrat L-Arginine untuk membentuk nitric oxide (NO) memiliki peran penting pada pembuluh darah. Pemberian L-Arginine secara intravena 5 menit setelah terjadinya cedera mengembalikan nilai aliran darah otak, memperbaiki sirkulasi serebral serta secara signifikan mereduksi volume otak yang memar. Efek neuroprotektif yang sama telah diamati terjadi pada percobaan lain model cedera otak traumatik dan pada beberapa model iskemia serebri dengan pemberian dini L-Arginine. L-Arginine dapat menjadi agen neuroproteksi potensial yang sangat menarik untuk memperbaiki serebral setelah cedera otak.L-Arginine, a Neuroprotection Chance for Preeclampsia Patients with Neurological ProblemAbstractPreeclampsia complicates 3 5% of all pregnancies. Preeclampsia is associated with premature delivery, placental abruption and stillbirth and can lead to complications, such as ischemic stroke, hemorrhagic stroke, cerebral edema and seizures. Patients with preeclampsia shows an increase in cerebral perfussion pressure (CPP) in anterior, middle and posterior cerebral arteries, with accompanying changes in cerebral artery resistance indices. The incident of cerebrovascular complications contributes to 40% of maternal death. Disturbance in autoregulation and subsequent edema formation. Disturbance in CBF autoregulation also associated with decrease in cerebrovascular resistance, brain hypoperfusion, blood brain barrier (BBB) disruption and vasogenic edema. There is also an increase in release of pro inflammatory cytokines and glial cells activation. L- Arginine is an amino acid complex, with active form in L-Arginine (2 amino 5 guanidino pentanoic acid) found in vegetable and animal origin proteins, such as dairy, meat and most of all in fish and nuts. L-Arginine substrate creating Nitric Oxide (NO) plays important role in vascular. Intravenous administration of L-Arginine 5 minutes after brain injury restores cerebral blood flow (CBF) level, improves cerebral circulation and significantly reduces the contused brain volume. The same neuroprotective effect on another traumatic brain injury (TBI) model was observed and also found in cerebral ischaemia model with early administration of L-Arginine. L-Arginine can be a potential neuroprotective agent to improve of cerebral circulation after brain injury

Efek Proteksi Otak Metamizol Intravena Sebagai Farmakologik Hipotermi Terhadap Suhu Inti Dan Kadar Interleukin-6 Pada Pasien Cedera Kepala Berat Muhammad Erias; Ruli Herman Sitanggang; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
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Latar Belakang dan Tujuan: Cedera kepala berat merupakan salah satu penyebab mortalitas dan morbiditas bagi pasien pasca trauma. Sirkulasi sitokin interleukin-6 (IL-6) pada cedera kepala berat dan proteksi otak dalam pengaturan suhu berhubungan dengan hasil luaran berupa morbiditas dan mortalitas. Tujuan dari penelitian ini mengkaji efek proteksi otak metamizol intravena sebagai farmakologik hipotermi terhadap suhu inti dan kadar interleukin pada cedera otak traumatik. Subjek dan Metode: Penelitian merupakan penelitian tersamar acak ganda yang dilakukan pada 30 pasien dewasa dengan cedera kepala berat yang dikelompokkan menjadi dua kelompok yaitu kelompok kontrol dan kelompok metamizol (M). Kelompok M diberikan metamizol intravena 15 mg/kgbb setiap 8 jam selama 72 jam. Data yang dicatat adalah suhu membran timpani setiap 8 jam dan kadar IL-6 setiap 24 jam selama 72 jam. Penelitian dilakukan selama bulan Juli sampai Agustus 2016 dan hasil penelitian diuji statistik menggunakan uji t berpasangan, uji Mann-Whitney, Uji Chi-square dan uji Fisher's Exact. Hasil: Penelitian menunjukkan bahwa nilai IL-6 pada kelompok M 244,20±93,07, lebih rendah dari kelompok K 375,20±152,62 dengan nilai p=0,006 pada jam ke-48 dan pada jam ke-72 dengan kadar IL-6 197,20±76,03 dan nilai p=0,008 sehingga bermakna secara statistik (p0,05). Subjek pada kelompok M juga menunjukkan suhu tubuh yang lebih rendah secara keseluruhan dan bermakna secara statistik (p0,01). Simpulan: Metamizole mempunyai efek proteksi otak dan mempunyai kegunaan sebagai farmakologik hipotermi pada cedera kepala traumatik.Effect Brain Protection Metamizol Intravenous as Pharmacalogic Hypothermia to Core Temperature and Interleukin-6 Level in Severe Traumatic Brain InjuryBackground and Objective: Severe traumatic brain injury (TBI) is one of the major cause of morbidity and mortality in trauma. Circulating interleukin-6 (IL-6) and neuroprotection from temperature has a strong relation with improve outcome. The aim of this study is to evaluate the brain protection properties of intravenous metamizole as a hypothermic pharmacologic in reducting IL-6 and core temperature regulation on severe TBI. Subject and Method: This is a randomized controlled trial to 30 adult pasien with severe TBI which was distributed into two groups which was control group (K) and metamizole group(M). The M grup was given 15 mg/kgbw of intravenous metamizole every 8 hours for 72 hours. Core temperature from the tympnic membrane every 8 hours and IL-6 every 24 hours was noted for 72 hours. This studi was conducted from July to August 2016 and the data was then analyzed statistically using the paire t test, Mann-Whitney test, Chi-Square test and Fishers’s Exact test. Result: Shows that IL-6 on the M group was 244.20±93.07 which was lower than the K group at 375.20±152.62 with p=0.006 on the 48th hour and on the 72nd hour with IL-6 at 197.20±76.03 with p=0.008 which is statistically significant (p0.005) and also shows lower temperature at every recording with p0.01. Conclusion: Metamizole has brain protecting properties in reducing circulating IL-6 and has uses as a hypothermic agent in severe TBI.

Penatalaksanaan Anestesi untuk Tumor Neuroendokrin Syafruddin Gaus; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Tumor neuroendokrin sering ditemukan pada orang dewasa dengan angka kejadian 10%-15% dari seluruh neoplasma intrakranial dan tertinggi pada dekade ke 4 sampai ke 6 kehidupan. Penderita dengan tumor neuroendokrin mempunyai tantangan yang unik untuk dokter ahli anestesi karena peranan yang penting kelenjar hipofise pada sistem endokrin.Tantangan ini mulai saat pemeriksaan prabedah dan berlanjut selama operasi serta periode pascabedah. Banyak teknik anestesi dan obat anestesi yang dapat diberikan pada pembedahan tumor neuroendokrin. Pemilihan obat anestesi tergantung pada penyakit komorbititas penderita dan riwayat anestesi sebelumnya. Apabila diinginkan penderita cepat sadar untuk segera dilakukan pemeriksaan neurologik maka dapat digunakan obat-obat yang cepat dieliminasi (misalnya propofol dan remifentanil) atau anestetika inhalasi dengan kelarutan dalam darah yang rendah (misalnya sevofluran) merupakan pilihan yang rasional. Keberhasilan pembedahan dan penatalaksaan anestesi pada penderita tumor neuroendokrin memerlukan pendekatan multidisiplin dan sangat tergantung pada kualitas perawatan perioperatif. Anesthesia Management for Neuroendocrine TumorNeuroendocrine tumor is commonly in adult patient with incidence 10-15% in all of intracranial neoplasm and highest at 4th-6th of life decade. Patients with neuroendocrine tumor have an unique challange for anesthesiologist because the important role of pituitary gland in endocrine system. The challange came during preoperative, intraoperative and postoperative periode. Many of anesthesia technique and anesthetics can use for neuroendocrine tumors surgery. The choice of anesthetics depend on comorbid diseases and history of anesthesia previously. If needed fast emergens for neurological evaluation, it can be use drug with fast elimination (ex propofol and remifentanil) or inhalation anesthetic with low coefficient partition (ex sevoflurane) is rational choice. The successful surgery and anesthesia management for neuroendocrine patient need multidisipline approach and depend on the quality of postoperative care.

Pengelolaan Anestesi pada Pasien yang dilakukan Eksisi Tumor Medula Spinalis Servikal 2-3 dengan Ventrikel Ekstra Sistole Maharani, Nurmala Dewi; Rachman, Iwan Abdul; Bisri, Dewi Yulianti; Sudadi, Sudadi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
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Penyakit yang mengakibatkan kompresi medulla spinalis dapat mengakibatkan iritasi pada sistem saraf otonom. Hiperinervasi saraf simpatis berisiko tinggi pada aritmia ditandai adanya perubahan pada elektrokardiografi, yakni perubahan durasi gelombang P, durasi QRS, depresi segmen ST, interval puncak gelombang T dan ventrikel ekstrasistol. Laki- laki 52 tahun dengan tumor intra-ektramedullar pada area cervikalis 2-3 dengan tetraparesis dan ventrikel ektrasistol dilakukan wide eksisi tumor dan stabilisasi posterior. Pemeriksaan fisik nadi 90 x/menit teraba tidak teratur. Elektrokardiogarfi (EKG) didapatkan hasil irama irreguler 82 x/menit, ventrikel ektrasistol 10 x/menit. Echocardiography menunjukkan disfungsi diastolik grade 3 preserved LV function. Sebelum operasi pasien diberikan terapi ventrikel ektrasistol dengan menggunakan analgetik dan amiodaron 150 mg (10 mL) pada 10 menit pertama, dilanjutkan dengan 360 mg (200 mg) untuk 6 jam selanjutnya, 540 mg untuk 18 jam berikutnya dan analgetik. Induksi anestesi dilakukan dengan midazolam 3 mg, fentanyl 200 mcg, lidokain 60 mg, propofol 100 mg, dan atricurium 30 mg serta intubasi manual in-line. Dilakukan pemasangan arteri line dan kateter vena sentral setelahnya pasien diposisikan prone. Pembedahan berlangsung 6 jam. Pasien dirawat di ICU 2 hari sebelum pindah ruang rawat biasa. Pemberian amiodarone sendiri dapat dipertimbangkan pada ventrikel ekstrasistol maligna yang memerlukan tatalaksana segera dengan pertimbangan hemodinamik pasien dalam keadaan stabil.Anesthesia Management for Cervical 2-3 Spinal Cord Tumor with Ventricles ExtrasystoleAbstractCompression of the spinal cord can cause irritation to the autonomic nervous system. Hyperinervation of sympathetic nerves at high risk for arrhythmias characterized by electrocardiographic results in changes in P-wave duration, QRS duration, ST-segment depression, T-wave peak interval, and ventricular extrasystole. A 52-year-old male with an intra-extramedullar tumor in cervical 2-3, tetraparesis, dysrhythmias, and ventricular extrasystole bigemini. Wide excision of tumor and posterior stabilization would be performed. The pulse was 90x/minute palpable irregularly. Electrocardiography examination revealed irregular rhythm 82 x/minute and ventricular extrasystole 10 x/minute. Echocardiography showed grade 3 diastolic dysfunction with preserved LV function. Before the procedure, the patient was given management for the dysrhythmia and ventricular extrasystole with analgetics and amiodaron 150mg (10ml) in the first 10 minutes followed by 360mg (200mg) for the next 6 hours, 540mg for the next 18 hours and analgetics. General anesthesia carried out with midazolam 3mg, fentanyl 200mcg, lidocaine 60mg, propofol 100mg, and atricurium 30mg, with manual intubation in-line. After arterial line and central venous catheter insertion, the patient was placed in the prone position. Surgery lasted for approximately 6 hours. The patient was treated in the ICU for 2 days before moving to the usual ward. Amiodarone can be considered in ventricular extrasystole requiring immediate treatment with stable hemodynamic.

Tatalaksana Anestesi pada Pendarahan Intraserebral Spontan Non Trauma M. Dwi Satriyanto; Siti Chasnak Saleh
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Pendarahan Intraserebral (PIS) adalah ekstravasasi darah yang masuk kedalam parenkim otak, yang dapat berkembang ke ruang ventrikel dan subarahnoid, yang terjadi secara spontan dan bukan disebabkan oleh trauma (non traumatis) dan salah satu penyebab tersering pada pasien yang dirawat di unit perawatan kritis saraf. Kejadian PIS berkisar 10–15% dari semua stroke dengan angka kematian tertinggi tingkat dari subtipe stroke dan diperkirakan 60% tidak bertahan lebih dari satu tahun. Laki-laki 18 tahun, datang dengan keluhan penurunan kesadaran setelah sebelumnya merasakan lemas pada anggota gerak kanan yang terjadi tiba-tiba saat mengendarai kendaraan. Pada pemeriksaan didapatkan kesadaran GCS E3M5V2 dengan hemodinamik cukup stabil, dan terdapat hemiplegi dextra. Pasien dirawat di perawatan intensif selama 4 hari, karena kesadaran menurun menjadi E2M4V2 maka dilakukan MSCT ulangan, dan ditemukan PIS bertambah (kurang lebih 30cc) dibandingkan dengan MSCT sebelumnya dengan midline shift lebih dari 5mm. Diputuskan untuk dilakukan tindakan kraniotomi evakuasi segera dengan pemeriksaan penunjang yang cukup. Tindakan kraniotomi evakuasi pada pasien PIS menjadi tantangan bagi seorang spesialis anestesiologi, sehingga diperlukan pengetahuan akan patofisiologi, mortalitas PIS dan tindakan anestesi yang harus dipersiapkan dan dikerjakan dengan tepat. Anesthesia Management in Spontaneous-Non Traumatic Intracerebral HemorrhageIntracerebral hemorrhage (ICH) is the extravasations of blood into the brain parenchyma, which may develop into ventricular and subarachnoid space, that occurs spontaneously and not caused by trauma (non-traumatic), and one of the most common causes in patients treated in the neurological critical care unit. ICH represents approximately 10–15% of all strokes with the highest mortality rates of all stroke subtypes and about 60% of patients with ICH may not survive within the first year. A 18 years old male with loss of consciousness after suffering from sudden right limb weakness while driving a vehicle. On examination, the level of consciousness (GCS) was E3M5V2 with stable hemodynamic and right hemiplegia. Patients was managed in intensive care unit (ICU) for 4 (four) days, and because of the decreasing level of consciousness to E2M4V2, the MSCt test was performed and the result revealed an ICH (approximately 30cc) compared to the previous MSCt with more than 5mm midline shift. Immediate craniotomy evacuation was then performed. Craniotomy evacuation in ICH patients is challenging for an anesthesiologist.Therefor, require a thorough understanding of the pathophysiology as well as mortality of ICH and anesthetic management should be prepared and done properly.

Durasi Operasi yang Memanjang pada Pasien dengan Tumor Cerebellopontine Angle (CPA) Harrison, Harrison; Sikumbang, Kenanga M.; Hardian, Rapto
Jurnal Neuroanestesi Indonesia Vol 9, No 1 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tumor Cerebellopontine angle (CPA) merupakan tumor fossa posterior terbanyak dan merupakan 5-10% dari tumor intrakranial. Penatalaksanaan anestesi pada kasus tumor CPA sangat menantang, dan memerlukan perhatian khusus terhadap disfungsi batang otak, posisi pasien, pemantauan neurofisiologi intraoperatif, dan adanya risiko venous air embolism (VAE). Pasien wanita, 16 tahun, 45 kg, suspek CPA tipe schwannoma akustik dengan keluhan sakit kepala selama 2 bulan. Tidak ada riwayat tinitus dan gangguan keseimbangan. CT-scan kepala memperlihatkan massa padat dengan bagian kistik di cerebellopontine angle kanan. Prosedur pembedahan dilakukan dalam posisi prone dan memanjang hingga 13 jam. Rumatan anestesi ditujukan untuk stabilisasi hemodinamik dan pencegahan hipotermia dengan penghangat blower dan infus hangat. Perdarahan selama pembedahan sekitar 1800 ml. Pasien diekstubasi setelah 3 hari di ICU. Prosedur bedah untuk tumor CPA memiliki risiko tinggi dan membutuhkan waktu lama, sehingga meningkatkan mortalitas dan morbiditas akibat risiko hipotermia dan ketidakstabilan hemodinamik yang lebih tinggi. Pada kasus ini dengan keterbatasan alat monitoring, dilakukan observasi ketat untuk kejadian VAE dan pencegahan komplikasi pascabedah dengan menjaga hemodinamik tetap stabil dengan pemberian cairan adekuat dan pencegahan hipotermia dengan penggunaan blower warmer dan infus hangat. Pada kasus ini, lama pembedahan selama 13 jam diantisipasi dengan monitoring yang ketat, pemberian volume adekuat dan pencegahan hipotermi.Prolonged Operation in Patient with Cerebellopontine Angle (CPA) TumorAbstractCerebellopontine angle (CPA) tumor is the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Anesthetic management is very challenging and needs special attention due to brain dysfunction, patient position, neurophysiological monitoring intraoperative, and the risk of venous air embolism (VAE). Female patient, 16 years old, 45 kg, with a suspected CPA acoustic schwannoma presented headache for 2 months. No history of tinnitus and balance disorders. Head CT-scan showed solid mass with cystic sections at right cerebellopontine angle. During procedure patient was in prone position and the operation took 13 hours long. Maintenance anesthesia aims to stabilize hemodynamic with adequate fluid replacement and prevention hypothermia with blower warmer and fluid warmer. Blood loss during the operation about 1800 ml. The patient was extubated after 3 days in the ICU. Surgical procedure in cerebellopontine angle surgery has a high risk and requires a long time. Prolonged duration of surgery will increases mortality and morbidity, because of the higher risk of hypothermia and hemodynamic instability. With limited monitoring equipment, we stabilize hemodynamic and to prevent the risk of VAE by adequate volume replacement. Hypothermia prevention by blower and fluid warmer. In this case, 13 hours long the operation makes us should maintenance hemodynamic by given adequate volume replacement and prevention of hypothermia.

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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

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

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INDONESIA