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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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Anestesia untuk Kraniotomi Tumor Supratentorial Lalenoh, Diana Christine; Lalenoh, Hermanus; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Tumor supratentorial tersering pada orang dewasa adalah glioma (36%), meningioma (32.1%), dan adenoma pituitary (8.4%). Sekitar separuh dari tumor tersebut adalah ganas. Mayoritas tumor tumor tersebut (80%) adalah supratentorial. Untuk seluruh tumor primer, rata-rata usia terdeteksi adanya tumor otak adalah 57 tahun. Angka pasti insidens metastase tumor otak tidak diketahui namun diperkirakan cukup rendah. Dari sekitar 25% pasien yang meninggal karena kanker, ditemukan adanya metastase dari tumor sistem saraf pusat (SSP) pada otopsi. Ada lima sumber keganasan yang sering metastase ke otak yaitu kanker payudara, kanker kolorektal, kanker paru, dan melanoma. Enam persen dari pasien dengan komplikasi tersebut muncul dalam 1 tahun setelah terdeteksi adanya tumor primer. Lima jenis kanker tersebut yang sering menyebabkan metastase otak pada sekitar 37.000 kasus di Amerika Serikat. Jurnal Neuroanestesia Indonesia 17 Dilaporkan keberhasilan penanganan anestesi pada seorang pasien, wanita 56 tahun, dengan berat badan 65 kg. Pasien tersebut didiagnosis sebagai Space Occupaying Lession (SOL) kanan DD/Meningioma. Pasien dilakukan operasi kraniotomi untuk pengeluaran tumor. Tekanan darah saat masuk kamar operasi 176/100 mmHg, laju nadi 98 kali / menit, laju napas 20 kali / menit, suhu badan 370 C, dan GCS E4V5M6. Pasien diinduksi dengan Fentanyl 100 ?g, Propofol 100 mg, fasilitas intubasi dengan Rocuronium 40 mg, Lidokain 70 mg, dan pemeliharaan dengan Sevofluran dan Oksigen serta Propofol kontinyu, dan penambahan fentanyl dan rokuronium intermiten. Infus terpasang dua jalur. Operasi berlangsung selama tujuh jam dua puluh menit. Dengan terpasang nasal kanul dan oksigen 3 liter/menit, pasien dipindahkan ke ICU. Pasien dirawat selama satu hari di ICU, kemudian dipindahkan ke ruangan. Setelah lima hari pasien dirawat di ruangan kemudian pasien dipulangkan dan rawat jalan dengan dokter bedah saraf. Anestesi untuk tumor supratentorial membutuhkan suatu pengertian mengenai patofisiologi dari penekanan tekanan intrakranial (TIK) lokal maupun secara keseluruhan; pengaturan dan pemeliharaan perfusi intraserebral; bagaimana menghindari akibat pengaruh sekunder dari sistemik terhadap otak. Persiapan perioperatif yang cermat dan terstruktur sangat penting pada penanganan anestesi untuk tumor supratentorial, yang meliputi persiapan pasien preoperasi, persiapan kelengkapan obat, alat, dan monitoring, serta perencanaan pelaksanaan anestesi sampai dengan pananganan pasca operasi.Anesthesia For Craniotomy Supratentorial TumorThe common supratentorial tumors in adults are glioma (36%), meningioma (32.1%), and adenoma pituitary (8.4%). Approximately half of these tumors are malignant. The majority of them ( 80%) are supratentorial. For the entire primary tumor, the average age when a brain tumor was detected is 57 years old. The exact number of metastatic brain tumor incidence is unknown, but it is assumed quite low. The existence of metastatic tumor of the central nervous system (SSP) is found at the autopsy of around 25% of patients who died of cancer. There are five sources of malignancy which often cause metastasis to the brain, namely breast cancer, colorectal cancer, lung cancer, and melanoma. In six percent of patients, these complications appeared within a year after the primary tumor is detected. These five cancers frequently cause the brain metastases in approximately 37.000 cases in the United States. It is reported the successful handling of anesthesia on a woman 56 years old, weighing 65 kg. This patient was diagnosed with Space Occupying Lession (SOL) right DD / Meningioma. Craniotomy surgery was performed for tumor expenditure. At the time she entered the operating room, her blood pressure was 176/100 mmHg, pulse rate beats / minute, respiratory rate 20 times / minute, body temperature of 37o C, and GCS E4V5M6. She was induced with Fentanyl 100 mg, 100 mg Propofol; intubation facilities are Rocuronium 40 mg, Lidocaine 70 mg, maintenance with Inhalan Sevoflurane and Oxygen, along with continuous Propofol, the addition of Fentanyl and intermittent Rocuronium. Infusion was attached in two pathways.The surgery lasted seven hours and twenty minutes. With nasal cannula and oxygen 3 liters / minute attached, the patient was transferred to ICU. She was treated for one day in ICU, before moved into a ward. After stay in the ward for five days, she was discharged and became an outpatient of neurosurgeon. Anesthesia for supratentorial tumor requires an understanding of pathophysiology of intracranial pressure (ICP) suppression locally and entirely; setting up and maintenance of intracerebral perfusion; how to avoid secondary effects of a systemic effect on the brain. Accurate and structured perioperative preparation is critical for handling of anesthesia for supratentorial tumors, which includes the preparation of the patient pre-surgery, completeness preparation of drugs, devices, and monitoring, as well as planning the implementation of the anesthesia until post-surgery tendance.

Perbandingan Mini Mental State Examination (MMSE) dan Clock Drawing Test (CDT) untuk Mendeteksi Disfungsi Kognitif pada Cedera Otak Traumatik Ringan dan Sedang Oktivia, Wenny; Fuadi, Iwan
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Latar Belakang dan Tujuan: Disfungsi kognitif sering terjadi pada pasien cedera otak traumatik (COT). Gangguan neuropsikologik yang disebabkan oleh cedera otak traumatik ringan dan sedang berupa penurunan kecepatan memproses informasi, gangguan perhatian, orientasi, dan fungsi eksekutif. Pemeriksaan disfungsi kognitif yang sering digunakan adalah Mini Mental State Examination (MMSE). Saat ini sedang dicari pemeriksaan lain yang lebih mudah dilakukan dan memiliki sensitifitas dan spesifisitas yang lebih baik, yaitu dengan Clock Drawing Test (CDT). Penelitian ini bertujuan membandingkan MMSE dan CDT dalam mendeteksi disfungsi kognitif pada COT ringan dan sedang. Subjek dan Metode: Penelitian menggunakan observasi analitik cross sectional, dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan Januari hingga April 2018. Pasien dibagi menjadi kelompok COT ringan (n=16) dan sedang (n=16) yang masing-masing dilakukan pemeriksaan MMSE dan CDT. Hasil: Dengan nilai cut-off MMSE 26,5 didapatkan sensitivitas 93,8% dan nilai spesifisitas 81,3%, sedangkan menggunakan nilai cut-off CDT 2,5 didapatkan sensitifitas dan spesifisitas CDT 100%. Simpulan: CDT memiliki sensitivitas dan spesifisitas yang lebih baik untuk mendeteksi disfungsi kognitif pada COT ringan dan sedang.Comparison of Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) on Detecting Cognitive Dysfunction on Mild and Moderate Traumatic Brain InjuryAbstractBackground and Objective: Cognitive dysfunction often found in Traumatic Brain Injury (TBI). TBI can triggers neurophysicological, such as slower information processing, attention deficit, orientation disturbance, and executive function. There are methods to evaluate cognitive dysfunction, but none are showing 100% sensitivity and specificity. The frequently used method is Mini Mental State Examination (MMSE). Currently, other examinations are being sought that are easier to do and have better sensitivity and specificity, namely the Clock Drawing Test (CDT). This study is aimed to compare MMSE and CDT to detect cognitive dysfunction in Mild and Moderate TBI. Subject and Method: This study is using analytical observation and cross-sectional study design, it was held in Hasan Sadikin Hospital Bandung throughout January 2017 to April 2018. Subjects are divided into Mild TBI group (n=16) and Moderate TBI group (n=16), both groups were given MMSE and CDT. Result: Using cut-off point 26,5 for MMSE the sensitivity and specificity are 93.8% and 81.3%, while CDT achieved 100% sensitivity and specificity. Conclusion: CDT has a better sensitivity and specificity on detecting cognitive dysfunction in Mild and Moderate TBI.

Pulih Sadar Pascaanestesi yang Tertunda Permatasari, Endah; Lalenoh, Diana C.; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
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Dengan penggunaan obat-obatan anestesi dengan kerja singkat, umumnya pasien dapat segera dibangunkan pascaoperasi dan pembiusan. Namun dapat terjadi proses pulih sadar yang tertunda karena berbagai penyebab. Proses pulih sadar yang tertunda pascaanestesi masih merupakan suatu masalah bagi ahli bedah dan anestesi. Seharusnya pada akhir operasi dan pembiusan, pasien sudah kembali ke tingkat kesadaran penuh, mampu mempertahankan reflex jalan nafas dengan ventilasi yang adekuat dengan nyeri yang terkendali. Waktu proses pulih sadar pascaanestesi dapat bervariasi dan tergantung dari berbagai faktor risiko terkait kondisi pasien prapembedahan, jenis anestesi yang diberikan dan lama operasi. Pulih sadar pascaanestesi yang tertunda terutama disebabkan oleh medikasi dan obat-obatan anestesi pada waktu perioperatif. Penyebabnya multifaktor dan obat-obatan anestesi tidak selalu menjadi penyebab. Apabila faktor penyebab lain telah dapat disingkirkan maka wajib dipertimbangkan yang menjadi penyebab adalah kelaian intrakranial akut. Sembari mencari penyebab, tatalaksana awalnya adalah mempertahankan jalan nafas, pernafasan dan sirkulasi. Walaupun proses pulih sadar yang tertunda pascaanestesi jarang ditemukan, mengenali gejala dan penyebab menjadi wajib untuk dapat dilakukan tatalaksana proses pulih sadar yang tertunda pascaanestesi sehingga dapat mengurangi morbiditas dan mortalitasnya. Diagnosis yang akurat adalah kunci tatalaksana dan ahli anestesi memegang peran penting dalam mencegah terjadinya komplikasi anestesi ini.Delayed Emergence from AnaesthesiaThe use of fast acting general anaesthetic agents leads to patients awaken quickly in the post operative period. However sometimes recovery is protracted and the list of possible causes in long. Delayed emergence from anaesthesia remains a major cause of concern both for anaesthesiologist and surgeon. Ideally, on completion of surgery and anaesthesia, the patient should be awake or easily arousable, protecting the airay, maintaining adequate ventilation and with their pain under control. The time taken to emerge to fully consciousness is affected by patient factors, anaesthetic factors, duration of surgery and painfull stimulation. The principal factor for delayed awakening from anaesthesia assumed to be the medications and anaesthestic agents used in the perioperatif period. Delayed emergene from anaesthesia is often multifactorial and anaesthetic agent may not always be the culprit. When other causes are excluded, the possibility acute intracranial event should be considered. While the specific cause is being sought , primary management is always support of airway, breathing and circulation. Although delayed emergence from general anesthesia is not uncommon, recognizing the cause and instituting timely treatment is imperative in condition where delayed therapy can increase morbidity and mortality. Accurate diagnosis is the key of management and anesthesiologist play a key role in the prevention of this anesthetic complication.

Penatalaksanaan Anestesi pada Pasien dengan Tumor Supratentorial Berukuran Besar Suspek Konveksitas Meningioma Wullur, Caroline; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Penatalaksanaan anestesi untuk kasus meningioma memiliki beberapa hal khusus yang penting untuk dilaksanakan. Jaringan otak tertutup oleh tulang kranium. Karena hubungan kontinu dari aliran darah dan volume jaringan otak, maka resiko perdarahan dan edema sangat tinggi. Tanpa pendekatan anestesi yang tepat, maka dapat meningkatkan resiko edema dan perdarahan otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien berusia 35 tahun dengan keluhan nyeri kepala di daerah frontal disertai dengan penurunan penglihatan sejak 1 tahun sebelum masuk rumah sakit. Pasien tidak pernah mengalami kejang ataupun penurunan kesadaran. Pasien didiagnosa dengan tumor supratentorial ec suspek conveksitas meningioma yang direncanakan dilakukan pembedahan kraniotomi untuk pengangkatan tumor. Status fisik ASA 2 dengan defisit neurologis. Pasien dilakukan dengan anestesi umum dengan intubasi. Induksi dengan fentanil, propofol dan vecuronium. Operasi berlangsung selama 7,5 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif selama 2 hari sebelum pindah ke ruangan. Perlakuan anestesi dan pengaturan faktor fisiologi mempunyai dampak yang besar terhadap jaringan otak. Dokter anestesi harus mempunyai pengetahuan mengenai efek obat dan manipulasi lainnya untuk mencapai hasil operasi yang baik.Anaesthetic Management of a Patient with Large Supratentorial Brain Tumor Suspected Convexity MeningiomaAnesthesia for meningioma cases has several specific important considerations. The brain is enclosed in a rigid skull. Brain tissue is highly vascularized therefore the risk of bleeding and edema are very high. Without the correct anaesthetic approach, the risk of bleeding and edema due to surgical manipulation may be increased. This phenomenon may have negative impact since the visual of surgical field will be limited. In this case, we reported a 35-year old female patient with severe headache at the frontal region accompanied with visual impairment since 1 year prior to hospital admittance. This patient was never experienced any seizures or inconsiousness. Patient was diagnosed with supratentorial tumor caused by suspect of convexity meningioma and was planned tumor removal craniotomy. ASA II physical status with neurological deficit. The patient was on general anaesthesia with intubation. Induction was performed using fentanyl, propofol and vecuronium while continuous propofol and vecuronium were used for maintenance. The surgery lasted for 7.5 hours. After surgery, the patient was treated in the Intensive Care Unit for 2 days prior to inpatient ward transfer. Anaesthetic management and physiological factors control have a positive impact on the brain tissue. Anaesthesiologist must have the comprehensive knowledge on drug effects and other manipulations to achieve positive result of a surgery.

Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung Muhafidzah, Novi Fatni; Mansur, Sobaryati; Pranggono, Emmy Hermiyanti; Wibisono, Yusuf; Juli, Cep; Gamayani, Uni; Gunadharma, Suryani; Cahyani, Aih
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Latar Belakang dan Tujuan: Pneumonia adalah komplikasi non neurologis paling sering pada stroke akut (22%) yang meningkatkan angka kematian, lama rawat inap dan biaya perawatan. Perlu dilakukan identifikasi faktor-faktor risiko terjadinya pneumonia salah satunya neurogenic pulmonary edema (NPE) agar dapat dilakukan pencegahan dan intervensi dini. Tujuan penelitian ini untuk mengetahui gambaran faktor-faktor risiko terjadinya pneumonia (termasuk NPE) pada pasien stroke akut di RSUP Dr Hasan Sadikin Bandung.Subjek dan Metode: Deskriptif observasional prospektif, metode consecutive sampling, periode September - Oktober 2019, mengumpulkan data primer pasien stroke akut yaitu derajat keparahan stroke, tipe, lokasi dan ukuran lesi stroke, terapi dan tindakan selama perawatan, komorbiditas (termasuk NPE). Pneumonia ditegakkan berdasarkan kriteria Centers for Disease Control and Prevention (CDC), NPE berdasarkan kriteria Davison.Hasil: 30 orang mengalami pneumonia pada pasien stroke akut (28,30%). Kejadian pneumonia, lebih sering ditemukan pada pemakaian Nasogastric Tube (NGT) (90%), disfagia (64,71%), lokasi infark Sirkulasi Anterior Total (SAT) (61,54%), ukuran infark besar (61,54%), GCS 9-12 (50%) dan NIHSS 16-20 (50%). NPE didapatkan pada 6,60% pasien stroke akut, 54,17% diantaranya menjadi pneumonia.Simpulan: Kejadian pneumonia pada pasien stroke akut lebih banyak ditemukan pada pemakaian NGT, disfagia, stroke infark lokasi SAT, ukuran infark besar, GCS lebih rendah dan derajat keparahan stroke lebih berat.Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital BandungAbstractBackground and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung.Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria.Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia.Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

Kerusakan Barier Pertahanan Alamiah: Sawar Darah Otak Arianto, Ardana Tri; Sudjito, M. H
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Sawar Darah Otak (SDO) adalah struktur membran yang secara primer memisahkan serta memfiltrasi darah ataupun zat dari sirkulasi sistemik yang masuk ke dalam sirkulasi otak. Sawar Darah Otak merupakan penghalang fisik antara pembuluh darah lokal dan sebagian besar dari sistem saraf pusat itu sendiri, dan tempat berhentinya zat makromolekul. Konsep Sawar Darah Otak pertama kali diperkenalkan oleh Paul Ehrlich. Paul Ehrlich menemukan bahwa injeksi intravena perwarna ke dalam aliran darah meninggalkan noda pada seluruh jaringan di sebagian besar organ kecuali otak. Pada trauma kerusakan sawar darah otak banyak diakibatkan oleh rusaknya integritas membrane sawar darah otak dan pada tumor disebabkan oleh peningkatan permeabilitas sawar darah otak akibat invasi sel tumor. Pada keadaan trauma, disfungsi sawar darah otak dapat terjadi secara cepat ataupun lambat, gangguan dari kompleks tight junction dan integritas membran menghasilkan peningkatan permeabilitas seluler. Sedangkan tumor otak dapat menyebabkan peningkatan permeabilitas sawar darah otak, pembengkakan jaringan sekitar tumor, dan terjadi absorpsi serta pengeluaran cairan dan protein dengan cairan serebrospinal di ventrikel. Terapi kortikosteroid menurunkan ekspresi dari vascular endothelial growth factor (VEGF) yang diproduksi edema yang terikat dengan sel endotel. Pengelolaan perioperatif penting untuk mengetahui hal-hal yang berkaitan tentang sawar darah otak dikarenakan kompleksitas dari anatomi, fisiologi, fungsi transpor sampai hubungan antara sawar darah otak dengan gangguan neurologis seperti yang terdapat pada kasus cedera otak traumatik dan tumor otak.Disruption of Natural Defense Barrier: Blood-Brain BarriereThe blood brain Barrier (BBB) is a structural membrane that separates and filters blood and subtances that enters the cntral nervous system from systemic circulation. It is a physical barrier between the local blood vessels and most parts of the central nervous system itself, and the flow of macro substances. The concept of the blood brain barrier was first introduced by Paul Ehrlich. He found that intravenous injection of dyes into the bloodstream stained all the tissues in most organs except the brain. In traumatic brain injury, vascular disruption causes damage to integrity of the membrane BBB while in case of tumor, there's an increase of permeability due to tumor cell invasion. In traumatic brain injury , the onset of BBB dysfunction can be immediate or delayed, increased cellular permeability is the result of thr damage of the tight junction complex and membrane integrity. Brain tumor can increase the permeability of BBB edema in the surrounding area, and cause absorption and excretion of cerebrospinal fluid and protein in to the ventricel. Corticosteroid therapy can reduce the expression of vascular endothelial growth factor (VEGF) in the edematous endothelial cells. Perioperative mamagemrnt requires comprehensive knowledge of the complexity of blood brain barrier's anatomy, physiology, transport function, and the relation between BBB with neurologic dysfunctions which are commonly seen in traumatic brain injury and tumor.

Tatalaksana Pasien Post Ventriculo Peritoneal (VP) Shunt et causa Meningitis disertai Aspirasi Pneumonia dan Gagal Napas di Ruang Rawat Intensif Kurniawan, Arief; Zulfariansyah, Ardi
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
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Ventriculo Peritoneal (VP) Shunt adalah tindakan operasi pemasangan kateter yang menghubungkan ventrikel otak dan rongga peritoneum. Tindakan VP Shunt bertujuan menurunkan tekanan intrakranial yang tinggi pada hidrosefalus. Pasien hidrosefalus akibat meningitis sering mengalami gagal napas akibat gangguan otak atau aspirasi pneumonia. Terapi ventilasi mekanik diperlukan sebelum, selama dan setelah operasi VP Shunt. Laporan kasus laki-laki 21 tahun datang ke rumah sakit karena gangguan kesadaran dan didiagnosis dengan meningitis. Pasien mengalami gagal napas akibat aspirasi pneumonia dan mendapat terapi ventilasi mekanik, kemudian menjalani operasi VP Shunt atas indikasi hidrosefalus komunikan. Induksi anestesi menggunakan fentanil dan propofol, pemeliharaan anestesi menggunakan sevofluran dan analgesi pascabedah menggunakan fentanil kontinyu. Berdasarkan pemeriksaan cairan serebrospinal pasien didiagnosis meningitis serosa akibat Tuberkulosis. Pasien mendapat terapi antibiotik empirik untuk aspirasi pneumonia dan antituberkulosis. Setelah kesadaran membaik dan weaning ventilator pasien dipindahkan dari ruang perawatan intensif.Management Patient Post Ventriculo Peritoneal (VP) shunt et causa Meningitis with Pneumonia Aspiration and Respiratory Failure in ICUAbstractVentriculo Peritoneal (VP) Shunt is a surgery that connects the brain ventricles and the peritoneal cavity with a catheter. VP Shunt aims to reduce high intracranial pressure in hydrocephalus. Hydrocephalus patients due to meningitis often experience respiratory failure from brain disorder or pneumonia aspiration. Mechanical ventilation therapy is needed before, during and after VP Shunt surgery. Case report of 21-year-old came to the hospital with decreased of conciousness and diagnosed with meningitis. The patient experienced respiratory failure and received mechanical ventilation therapy in the intensive care unit. The patient underwent VP Shunt surgery for indications of communicant hydrocephalus. Induction of anesthesia used fentanyl and propofol, maintenance of anesthesia used sevoflurane and postoperative analgesia used continuous fentanyl. Based on the results of the examination of cerebrospinal fluid, the diagnosis leads to serous meningitis due to Tuberculosis bacteria. Empiric antibiotics therapy for aspiration pneumonia and antituberculosis were given even if no bacteria was found in the blood or cerebrospinal fluid. After improvement in clinical condition and weaning from mechanical ventilator, the patient discharge from the ICU and sent to the ward.

Perbandingan antara Sevofluran dan Isofluran terhadap Gangguan Fungsi Kognitif Pascabedah Tumor Otak menggunakan Mini Mental State Examination (MMSE Wullur, Caroline; Redjeki, Ike Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
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Latar Belakang dan Tujuan: Pasien dengan tumor otak sering mengalami gangguan fungsi kognitif yang berdampak terhadap fungsi fisik, psikologis, sosial, dan vokasional. Post operative cognitive dysfunction (POCD) adalah ganggguan kognitif pascabedah yang paling sering terjadi. Anestesi umum yang digunakan dapat berpengaruh terhadap gangguan fungsi kognitif. Anestetika inhalasi sevofluran dan isofluran merupakan anestetika inhalasi yang paling sering digunakan untuk prosedur kraniotomi tumor otak. Tujuan penelitian adalah untuk mengetahui perbandingan efek antara sevofluran dan isofluran terhadap fungsi kognitif pascabedah tumor otak.Subjek dan Metode: eksperimental acak terkontrol buta tunggal melibatkan 44 pasien dengan tumor otak yang menjalani kraniotomi tumor otak pada bulan April?Oktober 2015. Data dianalisis dengan uji-t tidak berpasangan, Chi kuadrat, Mann Whitney dan Komolgorov Smirnov, nilai p0,05 dianggap bermakna. Fungsi kognitif diukur menggunakan uji mini mental state examination (MMSE) yang dinilai saat pre-operatif dan pascabedah pada jam ke 6, 12, 18, 24, 48, 72, 96, dan 120. Hasil penelitian menunjukkan MMSE pascabedah pada kelompok anestetika inhalasi sevofluran lebih tinggi dibanding dengan isofluran pada 6, 12, 18, 18, 24, 48 dan 72 jam pascabedah dengan perbedaan bermakna (p0,05).Simpulan: Anestetik inhalasi sevofluran menimbulkan gangguan fungsi kognitif pascabedah yang lebih ringan dibanding dengan isofluran pada pasien yang menjalani kraniotomi tumor otak.Comparison between Sevoflurane and Isoflurane on Cognitive Dysfunction Post Craniotomy Tumor Removal assessed using Mini Mental State Examination (MMSE)Background and Objective: Patients with brain tumor often experience cognitive dysfunction that may have an impact on physical functioning, psychology, social and vocacional functioning. Post operative cognitive dysfunction (POCD) is the most common post surgical cognitive dysfunction. General anaesthesia may have an impact on POCD. Sevofluran and isoflurane are the two most commonly used inhaled anaesthetic agents for craniotomy tumor removal. The aim of this study is to compare the effects between sevoflurane and isoflurane on cognitive functions after brain tumor surgery.Subject and Method: This is a randomized controlled trial involving 44 ASA II patients who underwent craniotomy tumor removal under general anaesthesia between period of April?October 2015. Statistical analysis using unpaired t-test, Chi Square, Mann Whitney and Komolgorov Smirnov test with p0,05 as statistically significant. Cognitive function was assessed using mini mental state examination (MMSE) preoperatively and postoperatively at 6, 12, 18, 24, 48, 72, 96 and 120 hour postoperative. Result: shows that postoperative MMSE was higher in sevoflurane group compared to isoflurane on 6, 12, 18, 24, 48, 72 hours postoperatively with statistical significance (p0,05). Conclusion: Inhaled anaesthetic agent sevoflurane causes less postoperative cognitive disturbance compared to isoflurane on patients undergoing craniotomy tumor removal.

Komplikasi Mual Muntah Pascaoperasi Bedah Saraf Rahmatisa, Dimas; Rasman, Marsudi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Mual, dan muntah adalah termasuk diantara keluhan-keluhan paling sering terjadi, dan dapat timbul pada kasus anestesia umum, regional, atau lokal. Insiden muntah sekitar 30%, kejadian mual adalah sekitar 50%, dan sebagian dari pasien berisiko tinggi, angka postoperative nausea and vomitting (PONV) bisa mencapai 80%. Faktor risiko PONV paling besar adalah jenis kelamin wanita, diikuti oleh riwayat motion sickness dan usia, lalu penggunaan anestesia inhalasi, durasi anestesia, penggunaan opioid pasca operasi dan terakhir penggunaan N2O. Pada kasus operasi bedah saraf, khusunya pada pengangkatan tumor, terdapat beberapa bahaya yang dapat terjadi bila PONV ini tidak ditangani dengan baik. Pada pasien bedah saraf, secara umum, kita harus menjaga agar tekanan intra kranial tetap dalam batas normal, sehingga aliran darah otak, dan tekanan perfusi otak dapat terjaga dengan baik. Jika terjadi PONV, maka tekanan intraabdomen akan meningkat, dan tentunya akan juga berpengaruh kepada kenaikan tekanan intrakranial. Disamping itu, pasien pasca pengangkatan tumor, akan rentan terhadap terjadinya perdarahan ulang yang tadinya sudah berhenti saat selesai operasi. Perdarahan dapat terjadi pada tumor bed dan dapat menyebabkan komplikasi yang fatal. Dari berbagai penelitian mengenai PONV pada operasi bedah saraf, faktor lokasi operasi tidak terlalu banyak berpengaruh. Operasi infratentorial memiliki angka PONV yang lebih tinggi, dihubungkan dengan lebih lamanya durasi operasi.Postoperative Nausea and Vomiting (PONV) Complication after NeurosurgeryNausea, and vomiting are among the most common complaints, and may occur in the case of general, regional, or local anesthesia. The incidence of vomiting is about 30%, the incidence of nausea is about 50%, and some of the patients are at high risk, Postoperative nausea and vomitting (PONV) rate can reach 80%. The strongest predictor of PONV is female gender, followed by history of motion sickness, age, inhalation anesthetic drugs, postoperative opioid, and using of nitrous oxide. In neurosurgery patients, in general, we must keep the intra-cranial pressure within normal limits, so that the cerebral blood flow, and the cereberal perfussion pressure can be well preserved. If there is PONV, the intraabdominal pressure will increase, and will certainly also affect the intracranial pressure. In addition, patients post-tumor removal, will be vulnerable to the occurrence of re-bleeding that had been stopped when completed surgery. Bleeding can occur in tumor beds and can cause fatal complications. According to various studies on PONV in neurosurgical surgery, the location factor of the surgery did not have much effect. Infratentorial surgery has a higher PONV number, associated with longer duration of operation.

Penggunaan Dexmedetomidin untuk Operasi Meningioma Petroclival dengan Intraoperatif Neurophysiological Monitoring Permatasari, Endah; Suarjaya, I Putu Pramana; Saleh, Siti Chasnak; Wargahadibrata, A Himendra
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Dexmedetomidin merupakan obat baru yang popular dalam neuroanesthesia dan neurocritical care. Tumor supratentorial yang tersering ditemui pada orang dewasa adalah glioma, meningioma dan adenoma hipofisis. Penggunaan intraoperative neurophysiological monitoring (IOM) dapat mengurangi risiko defisit neurologis pascaoperasi. Penggunaan IOM memiliki kelebihan karena dapat mendeteksi lebih dini kelainan saraf yang mungkin akan terjadi. Seorang pasien, wanita 45 tahun dengan berat badan 60 kg dengan diagnosis meningioma petroclival kiri. Pasien dilakukan operasi kraniotomi pengeluaran tumor. Selama operasi digunakan pemeliharaan obat dexmedetomidin dan propofol.Dilakukan pemantauan menggunakan IOM. Pembiusan dan operasi berlangsung selama 5 jam. Pasien langsung dibangunkan pascaoperasi dan dirawat di ICU. Anestesi untuk operasi tumor meningioma petroclival dengan pemantauan IOM membutuhkan suatu pemahaman mengenai patofisologi otak, pengaturan dan pemeliharaan perfusi otak serta menghindari komplikasi sistemik akibat cedera otak yang terjadi. Penggunaan IOM memperbaiki luaran pasien karena dapat mendeteksi lebih dini defisit neurologis sehingga intervensi dapat dilakukan lebih awal. Pemilihan obat-obat anestesi yang tepat menjadi kunci manajemen anestesi pelaksanaan kasus ini.Dibutuhkan komunikasi yang erat antara neurofisiologist, dokter anestesi dan ahli bedah untuk interpretasi IOM.The use of Dexmedetomidine for Craniotomy Meningioma Petroclival Tumor Removal with Intraoperative Neurophysiological MonitoringDexmedetomidine is a new drug gaining popularity in neuroanestesthesia and neurocritical care practice. The most common supratentorial tumor found in adults are gliomas, meningiomas and pituitary adenomas. The use of intraoperative neurophysiological monitoring (IOM) can reduce the risk of postoperative neurological deficits. Use of IOM has the advantage of early detection of neurological disorders that might happen. A patient, a 45-year-old woman with a body weight of 60 kgs and diagnosed with left meningioma petroclival. Patient is carried out a surgery craniotomy for tumor removal. During the procedure dexmedetomidine and propofol are used. The procedure lasts for 5 hours. Patient was awakened immediately postoperatively for further monitoring in the ICU. The use of IOM in craniotomy petroclival meningiomatumor removal requires an understanding of the brain patophysiology, maintenance of cerebral perfusion pressure and avoiding systemic complications of brain injury that might occur. Use of IOM may improve patient outcomes as it can detect neurological deficits more quickly so that intervention can occur earlier. Selection of the appropriate anesthetic drugs is the key implementation anesthetic management of this case. A close working working relationship of the monitoring team, the anesthesiologist, and the surgeon is the key to the successful conduct and interpretation of IOM.

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Agni Susanti

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jurnalneuroanestesi@gmail.com

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

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