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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 Pemberian Dexmedetomidine dengan Fentanyl Intraoperatif terhadap Kedalaman Anestesia dan Kecepatan Pemulihan pada Operasi Bedah Saraf Jasa, Zafrullah Kany; Heriansyah, Teuku; Muttaqin, Muttaqin
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
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Latar Belakang dan Tujuan: Anestesi bebas opioid merupakan diskusi baru dalam dunia anestesi. Bukti menunjukkan bahwa opioid memiliki efek samping yang tidak diinginkan. Dexmedetomidine merupakan suatu reseptor agonis a2-adrenergik selektif yang memiliki efek sparing opioid serta kecepatan pulih sadar anestesi yang lebih baik. Penelitian ini bertujuan membandingkan efektifitas dexmedetomidine dan fentanyl terhadap kedalaman anestesi dan pemulihan pasca anestesi pada operasi bedah saraf supratentorialSubjek dan Metode: Total 40 sampel penelitian dibagi menjadi 2 grup: A (Dexmedetomidine) dan B (Fentanyl) dengan total sampel 20 pada tiap grup. Kedua grup dilakukan pemasangan alat bispectral index (BIS) selama pembedahan. Kedua grup akan dinilai kecepatan pemulihan pasca anestesi sejak obat anestesi dihentikan.Hasil: Berdasarkan uji statistik didapatkan hasil bahwa penggunaan dexmedetomidine dan fentanyl memiliki efek anestesi optimal, dimana tidak terdapat perbedaan signifikan di antara keduanya dalam hal mencapai level anestesi optimal berdasar indeks BIS. Didapatkan pula hasil waktu pulih pasca anestesi dexmedetomidine lebih cepat dibandingkan pemberian fentanyl, dengan perbedaan waktu 5,10 menit (p0,05), dengan terdapat perbedaan signifikan kecepatan pulih pasca anestesi antara penggunaan dexmedetomidine dan fentanyl.Simpulan: Penggunaan dexmedetomidine pada operasi bedah saraf supratentorial memiliki kecepatan waktu pulih pasca anestesi yang lebih baik dibandingkan fentanylComparison of Dexmedetomidine Administration with Intraoperative Fentanyl to The Depth of Anesthesia and Recovery Speed in NeurosurgeryAbstractBackground and Objective: Opioid free anesthesia is a new discussion in the world of anesthesia. The available evidence suggests that opioids also have unintended effects. Dexmedetomidine is a selective 2-adrenergic receptor (?2-AR) agonist drug, that this drug has an opioid-sparing effect, and a faster recovery rate after anesthesia. To compare the effectiveness of dexmedetomidine and fentanyl on the depth of anesthesia and post-anesthesia recovery in supratentorial neurosurgery operations.Subject and Methods: A total of 40 research samples was divided into 2 groups, namely group A (Dexmedetomidine) and group B (Fentanyl). The number of research samples in each group was 20 people. Both groups of patients will be fitted with a bispectral index (BIS) during surgery. Both groups will measure the post-anesthesia recovery time since the anesthetic drug was discontinuedResults: Based on statistical tests, it was found that the use of dexmedetomidine and fentanyl had an optimal anesthetic effect, where there was no significant difference between these two anesthetic agents in achieving optimal anesthetic levels based on the BIS Index. From statistical analysis was found that post-anesthesia recovery time on dexmedetomidine was faster than the administration of fentanyl, with a difference of 5.10 minutes (p0.05) with statistically significant difference in the speed of post-anesthesia recovery between the use of dexmedetomidine and fentanyl.Conclusion: The use of dexmedetomidine in supratentorial neurosurgical surgery anesthesia has a faster post- anesthesia recovery time than the use of fentanyl.

Penatalaksanaan Anestesi untuk Operasi Tumor Fossa Posterior disertai Hidrosefalus Aulyan Syah, Bau Indah; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Operasi tumor fossa posterior mempunyai permasalahan spesifik antara lain penekanan jalur aliran cairan serebrospinal sehingga terjadi hidrosefalus yang akan meningkatkan tekanan intrakranial. Seorang wanita 25 tahun, berat badan 52 kg masuk ke rumah sakit dengan keluhan utama kepala pusing yang dialami sejak 5 jam sebelum masuk rumah sakit disertai mual, muntah, telinga rasa berdengung, dan nyeri ulu hati. Hasil pemeriksaan MSCT kepala axial tanpa kontras ditemukan hidrosefalus non-communicating, tumor serebellum hemisfer kanan, curiga astrositoma, diagnosis banding medulloblastoma. Pada pemeriksaan MSCT kepala potongan aksial, coronal dan sagittal dengan kontras ditemukan massa tumor daerah fossa posterior, sangat mungkin suatu pilokistik serebelar astrositoma disertai hidrosefalus ringan, didiagnosis hidrosefalus tipe obstruksi dan tumor serebellum serta ditemukan tanda-tanda peningkatan tekanan intrakranial dengan hidrosefalus, sehingga dilakukan pemasangan VP-shunt sebelum eksisi tumor. Teknik anestesi dilakukan dengan metode untuk mempertahankan perfusi otak sambil memelihara otak tetap rileks demi memfasilitasi pembedahan seperti hiperventilasi, pemberian mannitol 20% dan mempertahankan MAP yang adekuat. Operasi VP-shunt dalam posisi supine dan operasi fossa posterior dalam posisi prone berlangsung selama 4,5 jam. Dilakukan penundaan ekstubasi postoperatif. Ekstubasi dilakukan keesokan harinya di unit perawatan intensif. Pasien tersedasi dan terventilasi selama 14 jam. Tidak ditemukan adanya emboli udara vena. Pasca ekstubasi, pernapasan adekuat, hemodinamik stabil, dan tidak ada gangguan neurologis yang signifikan.Management of Anesthesia for Fossa Posterior Tumor with Hydrocephalus Surgery Fossa posterior tumor removal procedure may have spesific problem including obstruction of cerebral spinal fluid pathway, development of hydrocephalus and an increased intracranial pressure. A 25 year old woman, 52 kgs, admitted to the hospital with major complaint of dizziness occurred approximatelly 5 hours prior to hospital admission. The patient also suffered from nausea, vomiting, buzzing hearings, and heartburn sensation. The non-contrast MSCT revealed a non-communicating hydrocephalus, tumor of the right cerebellar hemisphere, suspected as astrocytoma with differential diagnosis of medullablastoma. From axial, coronal and sagittal view of MSCT with contrast, a tumor mass was found in the posterior fossa, and most likely to be considered as a polycystic cerebellar astrocytoma with mild hydrocephalus. She was diagnosed with obstructive type of hydrocephalus and cerebellar tumor with increased intracranial pressure signs due to hydrocephalus, and planned for VP shunt prior to the tumor removal. To maintain brain perfusion as well as to ensure brain relaxation, anesthesia management was done with several methods such as hyperventilation, administration of mannitol 20%, while maintaining adequacy of MAP. The VP shunting was conducted in supine position, whilst the posterior fossa excision in conducted in prone position. Both procedures were done in 4.5 hours. Postoperative extubation was postponed until the following day at the intensive care unit. The patient was sedated and ventilated for 14 hours. No sign of venous air embolisms. Post extubation on the next day, the patients breathing and hemodynamic statuses were both stabile and adequate, with no significant neurological defect.

Hubungan Jumlah Leukosit dan C-Reactive Protein (CRP) dengan Luaran Pasien Cedera Otak Traumatik (COT) berdasarkan Skor Glasgow Coma Scale (GCS) di RSUD Ulin Banjarmasin Maulana, Irvan; Sikumbang, Kenanga M.; Asnawati, Asnawati
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Latar Belakang dan Tujuan: Tingkat keparahan dari cedera otak traumatik (COT) dapat dinilai menggunakan Glasgow Coma Scale (GCS). Saat terjadi cedera kepala, tubuh akan melepaskan berbagai mediator inflamasi, leukosit dan penanda radang yaitu C-Reactive Protein (CRP). Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara jumlah leukosit dan CRP dengan luaran pasien COT berdasarkan skor GCS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian menggunakan studi desain observasional analitik dengan rancangan potong lintang. Data diambil secara consecutive sampling. Hasil: Didapatkan 45 subjek dengan hasil rerata jumlah leukosit dan kadar CRP tertinggi ada pada pasien COT berat diikuti dengan COT sedang dan COT ringan. Pada hari ke-7, didapatkan 41 pasien dengan luaran yang baik dan 4 pasien dengan luaran yang buruk. Analisis menggunakan uji korelasi Spearman menunjukan terdapat hubungan antara jumlah leukosit (p=0,004; r=0,424) dan CRP dengan luaran pasien COT (p=0,043; r=0,361). Simpulan: Terdapat hubungan antara jumlah leukosit dan kadar CRP dengan luaran pasien COT berdasarkan skor GCSAssociation of Leukocyte Count and C-Reactive Protein (CRP) Levels with Traumatic Brain Injury (TBI) Patient Outcome based on Glasgow Coma Scale (GCS) Score in Ulin General Hospital BanjarmasinAbstractBackground and Objective: The severity of traumatic brain injury (TBI) can be assessed using the Glasgow Coma Scale (GCS). When head injury occurs, the body releases various inflammatory mediators, leukocytes and inflammatory markers, namely c-reactive protein (CRP). The purpose of this study was to determine whether there is a correlation between the leukocyte count and CRP levels with the outcome of TBI patients based on GCS scores in Ulin Hospital Banjarmasin. Subject and Method: This research is an analytic observational with cross-sectional approach. Data acquired with consecutive sampling method. Result: We Obtained 45 subjects with the highest mean of leukocytes count and the highest CRP levels in patients with severe TBI followed by moderate TBI and mild TBI. On the 7th day, 41 patients had good outcome and 4 patients had bad outcome. Analysis using the Spearman correlation test showed that there was a relationship between the leukocyte count (p = 0.004; r = 0.424) and CRP levels with the outcome of TBI patients (p = 0.043; r = 0.361).Conclusion: It was concluded that there is a correlation between leukocyte count and CRP levels with the outcome of TBI patients based on GCS scores

Penatalaksanaan Anestesi Untuk Kliping Ruptur Aneurisma Serebral Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Aneurisma cerebral merupakan suatu kelainan vaskuler intraserebral, dengan angka kejadian sekitar 5% dari jumlah populasi pada usia 45-60 tahun. Perdarahan subarachnoid (Subarachnoid Hemorrhage /SAH) merupakan gejala serius dari aneurisma yang ruptur dengan angka kejadian berkisar antara 10-15 kasus per 100.000 populasi. Aneurisma yang pecah ulang atau iskemia merupakan masalah utama pada pengelolaan perioperatif pasien dengan aneurisma serebral. Seorang wanita berusia 73 tahun, berat badan 80 kg dengan aneurisma sakuler dari arteri vertebralis kanan bagian proksimal dari arteri sereberal posterior inferior (Posterior Inferior Cereberal Artery /PICA) dengan gambaran SAH, GCS 7, tekanan darah 200/160 mmHg, nadi 100 x/ menit, respirasi 18 x/permenit dengan Kriteria Hunt and Hess III-IV. Dilakukan intubasi dan penanganan tekanan darah di Unit Gawat Darurat dan pasien dirawat di ICU. Di ICU pasien diventilasi, dengan sedasi propofol 1 mg/kgBB/jam, diberikan perdipine 0,5 mg/kg BB/menit, dan pasien dapat diekstubasi hari ke-10 setelah perawatan di ICU. Operasi dilakukan pada perawatan hari ke 17, dengan keadaan prabedah GCS 13, tekanan darah 160/80 mmHg, nadi 90 x/menit, respirasi 14 x/menit SpO2 100% dengan binasal canul, dan direncanakan dilakukan kliping aneurisma. Dipasang alat pantau tekanan darah non-invasif, EKG, SpO2, dan urine kateter. Pasien tanpa premedikasi, induksi dengan propofol, fentanyl, lidokain, dan fasilitas intubasi dengan rocuronium 0,9 mg/kg BB. Rumatan anestesi dengan Sevofluran - Oksigen 40% - propofol kontinyu 1-3 mg/kg/jam - vecuronium 0,1 mg/kgBB/jam. Pemasangan arteri line setelah induksi anestesi. Untuk pengaturan tekanan darah sebelum dan saat kliping temporari dan permanen dengan nitrogliserin titrasi. Pascabedah pasien dipindahkan ke ICU, tidak diekstubasi, dan dilakukan ventilasi mekanis selama 24 jam, dan dirawat selama 12 hari, dengan mendapatkan terapi hipertensi dengan menaikkan tekanan darah maksimal 20% dari nilai dasar. Pasien di pindahkan ke ruangan GCS 15, Tekanan darah 140/90 mmHg, Nadi 80x/menit, respirasi 12x/menit SpO2 100%. Komplikasi pada post operasi aneurisma adalah hidrocephalus, rebleeding, kejang dan vasospasme. Adanya penurunan kesadaran pascabedah terutama disebabkan karena menurunnya aliran darah otak akibat vasospasme. Pencegahan dan penanganan kemungkinan terjadinya komplikasi ini dapat memperbaiki luaran pasien. Penatalaksaanaan preoperasi, intraoperatif dan postoperatif yang benar dapat memperbaiki luaran pasien.Anesthesia Management For Clipping Cerebral Aneurysm RuptureCerebralaneurysm is considered an intra cerebrovascular structural dysfunction, with the incidence rate around 5% of total 45-60 years of age population. Subarachnoid Hemorrhage (SAH) is considered a serious symptom of ruptured aneurysm and the incidence rate is around 10-15 cases per 100.000 human population. Re-ruptured or ischemia are the main problems in perioperative management of patient with cerebral aneurysm. A 73-year-80 kg BW female with saculler aneurysm on the right vertebral artery proximal to Posterior Inferior Cereberal Artery (PICA) and the appearance of subarachnoid haemorrhage (SAH), GCS 7, blood pressure 200/160 mmHg, heart rate 100 beats/minute, respiration rate 18 beats/minute with the Hunt and Hess Criteria III-IV was admitted to the hospital. Performed intubation and hypertension management at the emergency ward and the patient was treated at the ICU. At the ICU, the patient was on ventilator, sedated using propofol 1 mg/kgBW/hr, perdipine 0,5 mg/kgBW/minute, and the patient was extubated on the day-10 after ICU treatment. The surgery was performed on the day-17, and the presurgery descriptions were GCS 13, blood pressure 160/80 mmHg, heart rate 90 beats/minute, respiration rate 14 beats/minute, SpO2 100% with oxygenation using binasal canule, and the patient was scheduled for aneurysm clipping. A non-invasive monitor was installed for blood pressure, ECG, SpO2 and urine foley catheter was also installed. The patient was without premedication, inducted using propofol, fentanyl, lidocain, and facilitate intubation with rocuronium 0,9 mg/kgBW. Anesthetic maintenance using Sevoflurane - oxygen 40% - propofol continuously 1-3 mg/kgBW/hr - vecuronium 0,1 mg/kgBW/hr. Installation of arterial line was performed right after anesthetic induction. Nitrogliserin titration was used to manage blood pressure before and during temporary and permanent clipping. After surgery, the patient was transferred to ICU, unextubated, and was on mechanical ventilator for 24 hr, being treated for 12 days, and received hypertension therapy by increasing the blood pressure 20% maximum from the baseline. The patient was then transferred to the inpatient ward at GCS 15, blood pressure 140/90 mmHg, heart rate 80 beats/minute, respiration rate 12 beats/minute, and SpO2 100%. Complications that may occur at the post aneurysm surgery were hidrocephalus, re-bleeding, seizure and vasospasm. The awareness decline post surgery may due to the decreasing of intra cerebral blood circulation due to vasospasm. Anticipation and management the possibility of those complications may determine the patients outcome. The correct management of pre-surgery, intrasurgery and post surgery will improve the patient outcome as well.

Tata Kelola Anestesi pada Bedah Fossa Posterior Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Fossa posterior merupakan daerah yang cukup sempit, dimana didalamnya terdapat otak kecil, batang otak serta saraf kranial. Kelainan-kelainan yang dapat terjadi pada cerebellum adalah tumor, perdarahan maupun iskemia. Penatalaksanaan anestesi pada fossa posterior harus sangat hati-hati dan teliti, baik pada periode prabedah, bedah maupun pascabedah. Selain itu juga diperhatikan terkait masalah posisi pasien yang sangat spesifik. Pada periode pascabedah harus hati-hati untuk menentukan apakah dilakukan ekstubasi atau tetap dalam kondisi terintubasi. Monitoring terhadap jalannya anestesi serta kemungkinan terjadinya komplikasi adalah hal yang sangat penting. Pencegahan terhadap kemungkinan terjadinya komplikasi harus dilakukan. Setelah operasi selesai, diharapkan pasien dapat segera sadar untuk dilakukan penilaian neurologis. Apabila akan diekstubasi, harus dilakukan dengan hati-hati untuk menghindari kenaikan TIK akibat batuk dan bucking.Anesthetic Management in Posterior Fossa Surgery Posterior fossa is a narrow space, which is occupying by cerebellum, brain stem and cranial nerves. The abnormalities that can be happen in cerebellum including neoplasm, hemorrhage or ischemia. Anesthesia management in posterior fossa surgery must be done with caution and thorough, in preoperative, intraoperative and postoperative period. In addition, the patient position is must be cleared and specified before. In the postoperative period, the physician must be carefull in determine, which is extubated or keep in intubation conditions. Monitoring on the anesthetic and the possibility to a complication is a very important condition too. Prevention on the possibility for any complication must be taken. In postoperative period, hopefully the patient can awake as soon as possible, so the neurological examination can be done. If the patient will extubated, this procedures have to very smooth and no coughing and bucking for prevent the elevated ICP.

Penanganan Cedera Kepala Berat disertai Intoksikasi Alkohol Akut dengan Panduan Transcranial Doppler Paskaoperasi Krisna J. Sutawan, Ida Bagus; Gaus, Syafruddin; Oetoro, Bambang J.
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
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Cedera kepala yang disertai dengan intoksikasi alkohol akut memerlukan suatu perhatian khusus selain karena nilai GCS yang digunakan untuk menggolongkan derajat beratny cedera kepala penilaiannya dipengaruhi oleh intoksikasi alkohol, juga karena pengaruh alkohol pada susunan saraf pusat. Transcranial doppler (TCD) dapat digunakan secara noninvasif untuk mengevaluasi aliran darah ke otak, tekanan intrakranial dan tekanan perfusi serebri. Panduan TCD membantu dalam pengambilan keputusan pada perawatan pascaoperasi. Seorang laki-laki 23 tahun dengan GCS E1V2M4, dari foto CT-scan didapatkan subdural hematoma lobustemporoparietal kanan yang menyempitkan sisterna ventrikel lateralis kanan dan deviasi midline sejauh 0,54 cm ke kiri. Pasien ditangani sesuai dengan standar prosedure operasional cedera kepala berat, operasi evakuasi hematoma dan kranietomi berjalan dengan lancar. Dua belas jam pascaoperasi pada pemeriksaan TCD didapatkan aliran darah dan tekanan intrakranial normal, sehingga pasien diextubasi dengan GCS 15 hanya dalam waktu 18 jam pascaoperasi.Management of Severe Head Injuri with Alcohol Intoxication guided by Pascaoperatif Transcranial DopplerHead injury associated with alcholol intoxication needs special concideration, not only because GCS which is used to classifying the severity of head injury is affected by alcohol intoxication, but also because of the effect of alcohol to the central nervous system. Transcranial doppler (TCD) can be used noninvasifly to evaluate cerebral blood flow, intracranial pressure and cerebral perfusion pressure. TCD guidance helps in decision making on postoperative management. Twenty three years old male, GCS E1V2M4 , on a CT-scan image there is a subdural right lobustemporoparietal hematoma constricting the right ventricular lateral system and a midline deviation of 0.54 cm to the left. Patient was managed according to standart operational procedure for severe head injury, hematoma evacuation and craniectomy procedures went smoothly. Twelve hours postoperative, from TCD examination obtained normal blood flow and intracranial pressure, so patients were extubated with GCS 15 in just 18 hours postoperatively.

Tehnik Proteksi Otak pada Pembedahan Non Neurosurgery (Radical Neck Dissection) dengan Premorbid Space Occupying Lesion (SOL) dan Infark Serebri Laksono, Buyung Hartiyo; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Insidensi kasus tumor dengan metastase otak berkisar antara 100.000 sampai 170.000 pertahun. Metastase otak bersifat multiple dengan 80% terletak pada hemis ferserebri. Pendesakan akibat lesi tersebut mengakibatkan gangguan neurologis dan peningkatan tekanan intrakranial (TIK). Seorang laki-laki, 62 tahun dengan tumor sub mandibula direncanakan radical neck dissection. Pada pasien didapatkan proses metastase pada serebri dan cerebropontine angle disertai infark serebri daerah pons dan otak tengah. Defisit neurologis berupa kelemahan ekstremitas kanan dan disartria. Preoperatif diberikan kortikosteroid untuk menurunkan edema perifokal. Tatalaksana anestesi dengan prinsip tehnik proteksi otak, dilakukan induksi kombinasi dengan midazolam, fentanyl, lidokain, propofol dan rocuronium. Kontrol ventilasi target paCO2 3035 mmHg. Pemeliharaan anestesi dengan kombinasi sevofluran dan propofol. Pembedahan berjalan 7 jam, temperature selama pembedahan 3536 C dan MAP dijaga 70 mmHg. Dilakukan ekstubasi, setelah menilai status neurologis dan hemodinamik, difasilitasi dengan lidokain. Pascabedah tidak didapatkan perburukan defisit neurologis. Pasien dirawat di ICU selama 2 hari kemudian ke ruangan dengan perbaikan status neurologis. Tehnik proteksi otak bertujuan mencegah cedera sekunder dari SOL dan iskemia. Tindakan anestesi dan pembedahan dapat menambah perburukan cedera sekunder. Penatalaksanaan anestesi yang baik dengan prinsip proteksi otak akan menghasilkan outcome pembedahan sesuai yang diharapkan. Brain Protection Technique in Non Neurosurgical Procedure (Radical Neck Dissection) on a Patient with Space Occupying Lession (SOL) and Cerebral InfarctionThe incidence of tumors with brain metastases ranged from 100,000 to 170,000 per year. Brain metastases are multiple with 80% of lesion located on the cerebral hemispheres. These lesions could cause neurological disorders and increase intracranial pressure (ICP). A 62 years old male, diagnosed with sub mandibular tumour was scheduled for radical neck dissection. From preoperative evaluation he hadcerebral metastasis at the cerebrum and cerebro-pontine angle with cerebral infarction at pons and middle brain regions. Neurological deficits were weakness of the right limband dysarthria. The patient received corticosteroids pre-operatively to reduce perifocal edema. Anesthesia management was given using brain protection principles. Induction was done by using midazolam, fentanyl, lidocaine, propofol and rocuronium. Ventilation was controlled with a target PaCO2 of 3035 mmHg. Sevoflurane and propofol was given as anesthesia maintenance. Surgery was done for 7 hrs, temperature was 3536 C during surgery and MAP was maintained 70 mmHg. Extubation was done after assessing the neurologic and hemodynamic status,facilitated with lidocaine. There was no worsening of neurologic deficits post surgery. Patients was managed in the ICU for 2 days and transferred to ward with increased neurological state. The technique of brain protection aims to prevent further process of secondary injury from SOL and ischemia. Anesthesia and surgery itself could increase the progression of secondary injury. Anesthesia management usingbrain protection principles will provide better outcomes as expected.

Diagnosis dan Manajemen Anestesi pada Pituitary Apopleksia Tidak Fatal dengan Manifestasi Schizofrenia Cahyadi, Arief; Rachman, Iwan Abdul; Jasa, zafrullah Khany; Mafiana, Rose
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Tumor hipofisis dapat disertai gejala neuropsikiatri. Apopleksia pituitari (AP) merupakan kejadian jarang akibat infark dan perdarahan tumor hipofisis. Pemulihan total masih mungkin terjadi walaupun pada kasus berat dengan terapi pembedahan maupun konservatif. Terapi pembedahan dipilih bila adanya tanda peningkatan intrakranial dengan kondisi klinis dan neurologis yang tidak stabil. Seorang laki laki, umur 36 tahun dengan keluhan gangguan bicara mendadak sehari sebelum masuk RS, dengan riwayat terapi skizofrenia selama 8 bulan. Pasien mengalami penurunan kesadaran dalam perawatan dan didiagnosis tumor hipofisis anterior dengan komponen apopleksia dari CT-scan kepala. Pasca operasi transphenoid urgensi diterapi vasopresin intramuskular akibat poliuria. Penatalaksanaan anestesi pada pembedahan AP tidak berbeda dengan tumor hipofisis lainnya, hanya saja kondisi AP dapat bersifat urgensi. Satu bulan pasca pembedahan, pasien sudah lebih mudah berbicara, mulai beraktifitas fisik, dan halusinasi suara sudah tidak ada. Tatalaksana AP memberikan tantangan dalam manajemennya. Keluhan yang ditemukan dapat berupa halusinasi. Hingga kasus ini dilaporkan, ada satu publikasi kasus AP dengan psikosis akut dan keterlambatan diagnosis masih mungkin terjadi. Kecurigaan gangguan organik tetap perlu dipikirkan pada gangguan neuropsikiatri. Gangguan produksi urin bisa terjadi pasca operasi yang disebabkan beberapa hal sehingga memerlukan pemantauan ketat status hidrasi untuk menghindari morbiditas dan mortalitas yang mungkin terjadi.Anesthesia Management in Urgency Transsphenoidal Tumor Resection with Pituitary Apoplexy Presenting and SchizophreniaAbstractPituitary tumors may be accompanied by neuropsychiatric symptoms. Pituitary Apoplexy (PA) is a rare condition due to infarct or bleeding in pituitary tumors. Complete recovery is still possible even in severe cases with either surgical or conservative therapy. Surgery is a choice if there is evidence of increased intracranial pressure with unstable clinical and neurological conditions. Adult man, 36 yo, with sudden difficulty to speak a day before, with history of schizophrenia since 8 months ago. The patient suffered a decrease in consciousness in hospitalization and was diagnosed with anterior hypophysis tumor with apoplexy by CT-scan results. Post transsphenoidal urgency surgery, the patient was treated with vasopressin IM due to polyuria. Anesthesia management in PA surgery is the same as other pituitary tumor surgery, however, PA can be urgent. One month after surgery, the patient is more easier to talk, start physical activities, and auditory hallucination is not heard again. Management PA had its own challenge. Symptoms can be hallucinations. Until this case was reported, there was one published case of AP with acute psychosis and delay in diagnosis is still possible. Suspicion of organic disorders still needs to be considered in neuropsychiatric disorders. Impaired urine production might occur postoperatively due to several reasons so it requires close monitoring of hydration status to prevent possible morbidity and mortality.

Terapi Hiperosmolar pada Cedera Otak Traumatika Rachman, Iwan Abdul; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatika merupakan kasus yang sering ditemukan yang berhubungan dengan morbiditas dan mortalitas yang tinggi. Hipertensi intrakranial dan edema serebral adalah manifestasi utama dari cedera otak berat, keduanya dikenal sebagai kontributor utama pada cedera otak sekunder dan memiliki luaran neurologis yang buruk. Tatalaksana pasien dengan peningkatan tekanan intrakranial dan edema serebral akibat cedera otak traumatika yaitu mengontrol ventilasi, mempertahankan homeostasis otak dan fungsi tubuh, pemberian sedasi, serta terapi hiperosmolar. Manitol dikenal secara luas sebagai terapi utama pada terapi hipertensi intrakranial, namun larutan salin hipertonik dan natrium laktat hipertonik juga merupakan terapi alternatif yang potensial untuk terapi hipertensi intrakranial. Pemberian obat hiperosmolar pada pasien cedera kepala berat bertujuan untuk menurunkan kadar air dalam daerah interstisial otak akibat efek hiperosmolarnya sehingga terjadi penurunan tekanan intrakranial meskipun terdapat beberapa mekanisme lain yang kemungkinan juga terlibat dalam terjadinya penurunan tekanan intrakranial. Sekarang ini efektivitas cairan hiperosmotik dalam mengurangi edema pada jaringan yang pembuluh darahnya mengalami kerusakan masih dipertanyakan. Bahkan penggunaan obat-obatan tersebut sebagai terapi hiperosmolar diduga malah meningkatkan angka kematian karena dapat memperluas edema sehingga semakin memperburuk peningkatan tekanan intrakranial.Hyperosmolar Therapy in Traumatic Brain InjuryTraumatic brain injury is a common case and related with high morbidity and mortality. Intracranial hypertension and cerebral edema are the main manifestation from severe brain injury and known as main contributor for secondary brain injury, with detrimental neurological outcome. Management of elevated intracranial pressure and cerebral edema are controlling ventilation, maintaining brain homeostasis as well as body function, sedation, and hyperosmolar fluid therapy. Mannitol has been widely known as the main therapy for intracranial hypertension, showever, hypertonic saline and hypertonic sodium lactate are considered as potential alternative therapy for intracranial hypertension. The provision of hyperosmolar theraphy for severe head injury patients aims to reduce water content in the interstitial of the brain for its hyperosmolar effect that would decrease intracranial pressure, even though there probably other mechanism which involve for the decrease of intracranial pressure. In present day, the effectiveness of hyperosmolar fluid in reducing edema in the damaged tissue with impared blood vessel remains questionable. Moreover, the usage of those medication as hyperosmolar therapy allegedly increases mortality because it could adjuct the edema which would exacerbate extension of edema which exacerbate the increase of intracranial pressure.

Pengelolaan Neuroanestesi pada Pasien dengan Pentalogy of Fallot Putra, Eka Satrio; Suryandari, Retno; Purwoko, Purwoko; Arianto, Ardana Tri
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Pentalogy of Fallot (POF) salah satu jenis cacat jantung bawaan sianotik langka yang berpotensi tinggi komplikasi abses cerebri. Abses cerebri sering dijumpai pada kelainan jantung sianotik karena terjadinya hipoksia kronis dan yang kedua adalah hiperviskositas karena berkurangnya aliran mikrosirkulasi ke otak. Kami melaporkan seorang anak laki-laki berusia 6 tahun, berat badan 14 kg dengan abses otak multiple yang disertai dengan Pentalogy of Fallot (POF) yang akan dilakukan kraniotomi evakuasi abses. Pemeriksaan fisik preoperatif didapatkan GCS E4V5M6, SpO2 preductal 88%, post ductal 84 % dalam posisi supine. Pada sistem kardiovaskular didapatkan bunyi jantung I-II regular, bising sistolik terkuat di parasternal kiri ICS 3 grade 3, clubbing finger. Nilai hemoglobin 14,4gr%, hematokrit 43%, leukositosis 13,200/mm Tujuan anestesi pada penyakit jantung sianotik POF adalah menjaga curah jantung dengan mempertahankan denyut jantung, kontraktilitas juga preload, mencegah peningkatan rasio PVR:SVR serta menghindari hipersianosis akibat peningkatan mendadak kebutuhan oksigen sistemik. Pilihan agen anestesi harus didasarkan pada fisiologi pasien dan tujuan menyeimbangkan aliran darah paru dan sistemik. Rehidrasi yang adekuat sebelum induksi dan penggunaan diuretik manitol dapat dipertimbangkan mengingat hiperviskositas menurunkan pengiriman oksigen ke otak. Peningkatan TIK dari ketamine dapat dikurangi dengan hiperventilasi, kombinasi dengan benzodiazepin dan dengan pencegahan hipercapnia. Maka dari itu monitoring end tidal CO2 (ETCO2) perlu diperhatikan. Pengelolaan perioperatif pasien POF pada kasus evakuasi abses cerebri pada anak laki- laki usia 6 tahun pada laporan berikut ini menuliskan pentingnya pemahaman akan patofisiologi POF dan teknik neuroanestesi untuk mendapatkan luaran yang baik.Neuroanesthesia on Patient with Pentalogy of FallotAbstractPentalogy of Fallot (POF) is a rare type of cyanotic congenital heart defect with high risk of having cerebral abscesses as one of its complications. Cerebral abscesses are often found in cyanotic heart disease due to chronic hypoxia and hyperviscosity reduced microcirculatory flow to the brain. We report a 6-year-old boy, 14 kg body weight with multiple brain abscesses accompanied by Pentalogy of Fallot (POF) who undergone a craniotomy to evacuate the abscess. Preoperative physical examination found GCS E4V5M6, other vital signs within normal limits, preductal oxygen saturation 88%, post ductal oxygen saturation in supine position 84%. The I-II heart sounds are regular with grade 3 systolic murmur in the left parasternal third intercostal space and clubbing finger was found. The laboratory shows a hemoglobin value of 14.4gr%, hematocrit of 43%, leukocytosis 13,200/mm. The goal of anesthesia in cyanotic heart disease is to maintain cardiac output by stabilize heart rate, contractility as well as preload, prevent the increase of PVR:SVR ratio and avoid hypercyanotic due to sudden increase in systemic oxygen demand. The choice of anesthetic agent must be based on the patient's physiology. Adequate rehydration before induction and use of mannitol diuretics can be considered to reduce hyperviscosity that decrease oxygen delivery to the brain. Increased intracranial pressure from ketamine can be reduced by hyperventilation, in conjunction to benzodiazepines and prevention of hypercapnia. Therefore, monitoring end tidal CO2 (ETCO2) needs to be done. This case report delineating the perioperative management of a 6 years old boy with POF underwent evacuation of cerebral abscesses, will highlight the importance of understanding the pathophysiology of POF and neuroanesthesia techniques in order to receive a good outcome.

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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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Abstract

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Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

Phone
+6287722631615

Journal Mail Official
jni@inasnacc.org

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

Location
,

INDONESIA