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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 354 Documents

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Patofisiologi Kejang dan Perubahan Susunan Saraf Pusat pada Eklampsia Emilzon Taslim
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
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Eklampsia merupakan komplikasi serius kehamilan yang menimbulkan berbagai komplikasi neurologis seperti nyeri kepala, gangguan penglihatan, mual, muntah, koma, dan kejang. Patofisiologi/ Patogenesis kejang serta perubahan sitim saraf pusat eclampsia belum diketahui secara pasti dan merupakan pokok bahasan yang terus diteliti secara ekstensif. Beberapa mekanisme etiologi yang berimplikasi terhadap patofisiologi /pathogenesis kejangeklampsiadan berbagai perubahan sistem saraf pusat meliputi vasospasme hipertensis ensefalopati, edema serebral (terutama edema vasogenik), iskemia uteroplasental, dan kerusakan/ disfungsi endotel. Komplikasi neurologic eklampsia mirip dengan hipertensi ensefalopati yang ditandai dengan peningkatan tekanan darah secara akut dan ekstrim sehingga menyebakan kerusakan sawar darah otak, berkuranganya aliran darah ke otak, gangguan autoregulasi, hiperperfusi, dan edema. Edema otak pada pasien peeklampsia-eklampsia juga berhubungan dengan abnormalitas penanda kerusakan endotel. Pathophysiology of Convulsion and Central Nervous System Changes in EclampsiaEclampsia is a serious complication of pregnancy due to some neurologic complications, including convulsion and central nervous system changes in eclampsia remains unknown and contionues to be the subject of extensive investigation. Some of etiologic mechanisms that are implicated in the pathophysiology/pathogenesis of eclamptic convulsion and other central nervous system change have included vasopasm hypertensive, encephalopathy, cerebral edema (mostly vaspgenic edema), the uteroplacental ischemia, and endothelial damage/endothel dysfunction. Neurologic complication of eclampsia are thought to be similar to hypertensive encephalopathy in which an acute, excessive elevation in blood pressure causes blood-brain barrier disruption, lossof cerebral blood flow autoregulation, hyperperfusion, and edema formation, Brain edema in patients with preeclampsia-eclampsia also was associated with abnormalities in endhotelial damage markers.

Pengelolaan Anestesi untuk Eksisi Tumor Intradura Intramedula (IDIM) Setinggi Vertebra Cervical 5-6 dengan Panduan Intraoperative Neurophysiological Monitoring Santosa, Dhania Anindita; Harijono, Bambang; Hamzah, Hamzah; Jasa, Zafrullah Kany; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Eksisi tumor intradura intramedula (IDIM) dengan bantuan intraoperative neurophysiological monitoring (IOM) merupakan suatu teknik pembedahan yang bertujuan agar eksisi tumor dilakukan semaksimal mungkin, dengan meminimalkan defisit neurologis akibat pembedahan. Penanganan anestesi pada eksisi tumor IDIM dengan bantuan IOM ini, seorang ahli anestesi perlu menguasai ilmu dan keterampilan neuroanestesi untuk pembedahan tulang belakang, selain itu juga pemilihan teknik, jenis dan dosis obat yang mendukung pelaksanaan pembedahan dengan IOM ini. Seorang laki-laki usia 52 tahun dengan tumor IDIM setinggi vertebra cervical 56 menjalani pembedahan eksisi tumor dengan bantuan IOM. Pembedahan dilakukan di bawah pengaruh anestesi umum dengan induksi intravena. Laringoskopi dilakukan dengan video laryngoscope. Pembedahan dilakukan dengan panduan IOM, selama anestesi diberikan total intravenous anesthesia tanpa pemberian pelumpuh otot tambahan setelah intubasi. Pembedahan berlangsung selama enam jam dan tumor dapat terangkat seluruhnya. Tantangan selama periode perioperatif adalah penilaian dan persiapan prabedah yang teliti, posisi pasien dan pemilihan teknik anestesi yang tepat.Anesthesia Management for Cervical 5-6 Intradural Intramedullary (IDIM) Tumor under Intraoperative Neurophysiological Monitoring GuidanceExcision of intradural intramedullary (IDIM) tumor using intraoperative neurophysiological monitoring (IOM) is one surgical technique aiming to excise tumor as maximum as possible, with minimum neurological deficit. In anesthesia management for IDIM tumor excision under IOM guidance, an anesthesiologist is required to master neuroanesthesia knowledge and skill, especially for spine surgery. Moreover, understanding the art of anesthesia technique, drug and dose supporting surgery with IOM. A male patient, 52 years old, with IDIM tumor at the level of cervical 5-6th underwent surgery for tumor excision using IOM. Surgery was done under general anesthesia, started with intravenous induction, and intubation was done using video laryngoscope. Surgery was done under IOM guidance, total intravenous anesthesia was implemented and no additional muscle relaxant was given after intubation. Surgery lasted for six hours and tumor was resected completely. Challenges during perioperative period are meticulous preoperative assessment and preparation, patient positioning and appropriate anesthesia technique.

Mannitol untuk Hipertensi Intrakranial pada Cedera Otak Traumatik: apakah masih diperlukan? Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
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Angka kejadian cedera otak traumatika (COT) masih cukup tinggi berkisar 1,4 juta pertahun dengan angka kematian 1520%. Peningkatan tekanan intrakranial (TIK) sangat sering terjadi setelah COT yang dihubungkan dengan angka mortalitas dan morbiditas. Terapi hipertensi intrakranial harus dimulai bila tekanan intrakranial 20 mmHg atau lebih, karena makin tinggi kenaikan tekanan intrakranial makin tinggi mortalitas. Komplikasi peningkatan TIK adalah terjadinya iskemia dan herniasi otak. Pada guideline terapi hipertensi intrakranial dikenal first-tier therapy dan second-tier therapy. First-tier therapy adalah drenase cairan serebrospinalis, hiperventilasi sedang mencapai PaCO2 3035 mmHg, dan pemberian osmotik diuretik mannitol. Mannitol mampu menurunkan volume otak dan TIK, mengurangi viskositas darah, meningkatkan aliran darah otak, sehingga akan memperbaiki pasokan oksigen. Peningkatan deformabilitas eritrosit akan membantu menurunkan TIK. Akan tetapi, Cochrane systematic review menemukan tidak cukup data untuk membuat rekomendasi penggunaan mannitol untuk pengelolaan pasien cedera otak traumatik.Terapi diuretik dengan mannitol 0,251 g/kg diinfuskan dalam waktu lebih dari 10 menit sampai 20 menit dan diulang setiap 36 jam. Osmolaritas plasma harus dipantau dan tidak boleh lebih dari 320 mOsm/L. Efek akan dimulai pada menit ke 1530 setelah pemberian dan menetap 90 menit sampai 6 jam. Simpulannya adalah karena dari guideline Brain Trauma Foundation yang menyebutkan bahwa mannitol digunakan untuk first-tier therapy, maka pada pekerjaan sehari-hari dalam mengelola pasien cedera kepala berat dengan hipertensi intrakranial kita tetap memberikan terapi mannitol. Mannitol for Intracranial Hypertension in Traumatic Brain Injury: is it still needed? The incidence of traumatic brain injury (TBI) remains high, about 1.4 million per year with a mortality rate of 1520%. Increased intracranial pressure (ICP) is very common after TBI. Increased ICP is associated with incidence of mortality and morbidity. Intracranial hypertension therapy should be initiated when the ICP is 20 mmHg or more, as higher increase in ICP will increase mortality. Complications of elevated ICP include brain ischemia and brain herniation. Intracranial hypertension treatment guidelines include first-tier and second-tier therapy. First-tier therapy is cerebrospinal fluid drainage, hyperventilation, achieving PaCO2 3035 mmHg, and osmotic diuretic: mannitol administration. Mannitol can reduce brain volume and ICP, reduce blood viscosity, improve cerebral blood flow, therefore improving the supply of oxygen. Increased erythrocyte deformability will help to reduce ICP. However, the Cochrane systematic review found insufficient data to make recommendations on the use of mannitol for the management of TBI patients. Diuretic therapy with mannitol 0.25 to 1g/kg infused in just over 10 minutes to 20 minutes and repeated every 36 hours. Plasma osmolarity should be monitored and should not be more than 320 mOsm/L. Effect will begin 1530 minutes after administration and settled 90 minutes to 6 hours. Brain Trauma Foundation guidelines states that mannitol is used as first-tier therapy, therefore we administer manitol as part of management of patients with severe head injury with intracranial hypertension.

Konsep GHOST- CAP untuk Proteksi Otak Perioperatif pada Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
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Kerusakan otak adalah cedera yang menyebabkan rusak atau memburuknya sel otak yang disebabkan oleh berbagai kondisi seperti trauma kepala, pasokan oksigen yang tidak memadai, infeksi atau perdarahan intrakranial. Proteksi otak adalah intervensi terapeutik preemptif untuk memperbaiki outcome neurologik pada pasien yang berisiko terjadinya iskemi serebral, sedangkan resusitasi otak merujuk ke intervensi terapeutik yang dimulai setelah terjadinya iskemi. Targetnya adalah terapi iskemi dan mengurangi cedera neuron. Kerusakan otak perioperatif adalah salah satu komplikasi merugikan yang paling serius dari operasi dan anestesi, mengakibatkan defisit neurologis baru pasca operasi. Konsep GHOST-CAP, yang merupakan akronim dari Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure dan PaCO2, digunakan pada periode pascaoperatif. G: target level glukosa antara 80 dan 180?mg/dL. H: hemoglobin, ambang batas 79g/dL. O: oksigen, targetkan SpO2 antara 94 dan 97%. S: konsentrasi sodium mempengaruhi volume otak, kadar sodium hingga 155?mEq/L dapat ditoleransi. T: temperatur diatur untuk mengoptimalkan fungsi seluler, tetapi suhu inti ?38,0C harus dihindari. C: kenyamanan pasien (comfort), termasuk kontrol nyeri, agitasi, kecemasan, dan menggigil. A: tekanan darah arteri adalah penentu utama aliran darah otak (CBF), pertahankan tekanan arteri rata-rata (MAP) 80?mmHg dan tekanan perfusi otak (CPP) 60?mmHg. P: perubahan akut PaCO2 menyebabkan perubahan CBF, maka PaCO2 tidak boleh kurang dari 35 mmHg. Tulisan ini mengkaji konsep GHOST-CAP untuk proteksi otak perioperatif, apakah cukup memadai atau harus ditambah.GHOST-CAP Concept for Perioperative Brain Protection in Traumatic Brain InjuryAbstractBrain damage is an injury that causes damage or worsening of brain cells caused by various conditions such as head trauma, inadequate oxygen supply, infection or intracranial hemorrhage. Brain protection is a preemptive measure of therapeutic interventions to improve neurological outcomes in patients at risk of cerebral ischemic, while brain resuscitation refers to therapeutic interventions that begin after the occurrence of ischemic. The target is ischemic therapy and reducing neuronal injury. Perioperative brain damage is one of the most serious adverse complications of surgery and anesthesia, resulting in new postoperative neurological deficits. The concept of GHOST-CAP, an acronym for Glycemia, Hemoglobin, Oxygen, Sodium, Temperature, Comfort, Arterial Pressure and PaCO2, can be used in the postoperative period. G: The target level of glucose is between 80 and 180 mg/dL. H: hemoglobin threshold is 7-9 g/dL. O: oxygen, target SpO2 between 94 and 97%. S: Sodium concentration affects brain volume, sodium levels up to 155 mEq/L are tolerable. T: temperatures regulated to optimize cellular function, but core temperatures 38.0C should be avoided. C: patient comfort, including pain control, agitation, anxiety, and chills. A: Arterial blood pressure is the main determinant of cerebral blood flow (CBF), maintaining an mean arterial pressure (MAP) of 80 mmHg and cerebral perfusion pressure (CPP) of 60 mmHg. P: Acute changes in PaCO2 cause CBF changes, PaCO2 not to be less than 35 mmHg. This paper examines the GHOST-CAP concept for perioperative brain protection, whether adequate or should be supplemented

Prediktor Outcome pada Cedera Kepala Traumatik (Glukosa, Laktat, SID, MDA, Cerebral Extraction Ratio for Oxygen/CERO2 ) Suyasa, Agus Baratha; Sudadi, Sudadi; Rahardjo, Sri; Suryono, Bambang
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Latar Belakang: Jaringan tubuh memiliki kebutuhan yang berbeda terhadap glukosa. Otak memiliki kebutuhan yang paling besar terhadap glukosa. Otak sangat rentan terhadap iskemia yang menunjukkan bahwa otak memiliki laju metabolik yang tinggi. Mekanisme injury iskemia adalah perubahan biokimia dan perubahan fisiologis yang terjadi karena ganguan sirkulasi. Perubahan-perubahan tersebut seperti: (1) Hilangnya phospat energi tinggi, (2) Asidosis karena proses anaerob yang menghasilkan laktat dan (3) No Reflow karena oedem otak. Penggunaan kadar laktat sebagai indikator iskemia jaringan, telah banyak dilakukan dalam berbagai penelitian. Hasil-hasil penelitian tersebut menunjukkan bahwa kadar laktat dapat digunakan sebagai penanda awal untuk memprediksi resiko komplikasi, mortalitas post operatif dan kejadian MOF (Multiple Organ Failure). Belakangan banyak dibicarakan mengenai hubungan perubahan SID dengan outcome klinis yang buruk. Mereka menemukan bahwa SID/SIG merupakan prediktor kuat terhadap outcome pasien. Stres oksidatif merupakan salah satu mekanisme yang terlibat dalam kerusakan saraf akibat iskemia dan reperfusi, diperkirakan karena terbentuknya lipid peroksidase. MDA digunakan sebagai penanda dari peroksidasi lipid, terutama untuk proses-proses yang berhubungan dengan stress oksidatif. Rasio ekstraksi oksigen serebral (CERO2) dapat dipergunakan sebagai indikator adanya iskemia otak. Subyek dan Metode: Sebelas pasien cedera kepala traumatik dengan GCS awal 5-12 yang menjalani operasi kraniotomi evakuasi, dilakukan pengamatan terhadap kadar glukosa, laktat, SID, MDA, nilai CERO2 serta outcome (nilai APS Score) dari pre operasi sampai 3 hari pasca operasi di ICU. Sample darah diambil dari vena jugularis interna dan arteri radialis. Hasil pengamatan dianalisa untuk melihat hubungan antara variabel pengamatan dengan outcome. Hasil: Ditemukan hubungan yang kuat antara variable kadar laktat, MDA, CERO2 terhadap outcome pasien secara umum. Namun terdapat variasi jika analisa dilakukan menurut kondisi waktu pengamatan. Hari ke-2 adalah waktu yang paling ideal untuk melihat pengaruh kadar laktat terhadap outcome sedangkan untuk melihat hubungan MDA dan CERO2 terhadap outcome, waktu pengamatan paling ideal hari ke-3. Simpulan: Variabel kadar laktat, MDA dan OER menunjukkan hasil yang menjanjikan sebagai prediktor outcome pada pasien dengan cedera kepala traumatik pasca kraniotomi walaupun belum dapat di simpulkan dan dijadikan acuan secara luas. Perlu suatu penelitian multicentre dengan jumlah sample yang lebih banyak serta desain penelitian yang baik untuk mendapatkan hasil yang benar-benar dapat di jadikan acuan secara luas mengenai variabel prediktor serta waktu pengamatan sehingga dapat memberikan informasi yang baik tentang prognosis outcome pasien cedera kepala traumatik, yang tetap berdasar pada patofisiologi cedera kepala serta kaskade kematian sel karena cedera otak sekunder.Predictor of Outcome in Traumatic Brain Injury (Glucosa, Lactate, SID, MDA, Cerebral Extraction Ratio for Oxygen/CERO2) Background: The tissue has a different requirement for glucose. The brain has the greatest need for glucose. The brain is very susceptible to ischemia suggests that the brain has a high metabolic rate. Mechanism of ischemic injury is the biochemical changes and physiological changes that occur due to circulatory disturbances. Such changes as: (1) The loss of high energy phosphate, (2) acidosis due to anaerobic process that produces lactic and (3) No Reflow because of brain edema. The use of lactate levels as an indicator of tissue ischemia, has been widely applied in various studies. The results of these studies indicate that the levels of lactate can be used as an early marker for predicting the risk of complications, postoperative mortality and the incidence of MOF (Multiple Organ Failure). Lately a lot of talk about the relationship SID changes with poor clinical outcome. They found that the SID / SIG is a strong predictor of patient outcome. Oxidative stress is one of the mechanisms involved in neuronal damage due to ischemia and reperfusion, presumably due to the formation of lipid peroxidation. MDA is used as a marker of lipid peroxidation, especially for processes associated with oxidative stress. CERO2 can be used as an indicator of cerebral ischemia.Subjects and Method: Eleven patients with a traumatic head injury initial GCS 5-12 who underwent craniotomy with evacuation operations, was observed on levels of glucose, lactate, SID, MDA, the CERO2 and the outcome (the APS Score) from pre surgery to 3 days after surgery in the ICU. Blood samples taken from the jugular internal vein and radial artery. Observations were analyzed to see the relationship between the variables with the outcome observations.Results: Found a strong relationship between the variable: levels of lactate, MDA and CERO2 on patient outcomes in general. But there are variations between them according to the conditions when the analysis carried out observations. Day 2 is the most ideal time to see the effect on outcome of lactate levels whereas to see the relationship between the MDA and CERO2 to outcome, the observation idealy taken on day 3.Conclusion: The variables, levels of lactate, MDA and CERO2 showed promising results as a predictor of outcome in patients with traumatic brain injury after craniotomy, although not yet to be concluded and is widely used as a reference. Need a multicentre study with more number of samples and good research design to get the results that can really make a reference in a broad range of predictor variables and the observations so as to provide good information about the prognosis of outcome of patients with traumatic brain injury, who remain based on the pathophysiology of brain injury and cell death cascade of secondary brain injury.

Manajemen Anestesia pada Evakuasi Epidural Haemorrhage (EDH) dengan Pendarahan Masif Huda, Nurul; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Cedera otak traumatik menjadi penyebab dari mortalitas dan morbiditas di seluruh dunia. Epidural Haemorrhage (EDH) merupakan salah satu bentuk cedera otak traumatik dimana waktu adalah indikator yang harus diperhatikan dalam tatalaksananya. Fokus utama selama penatalaksanaan kasus cedera otak traumatik adalah stabilisasi pasien dan mengendalikan tekanan intrakranial, serta mempertahankan oksigenasi dan perfusi otak. Selanjutnya dilakukan dekompresi dengan pembedahan. Evakuasi dan kontrol perdarahan harus dikerjakan dalam waktu singkat untuk menghindari cedera lebih lanjut. Praktik neuroanastesi, sebagai penunjang dalam tatalaksana cedera otak traumatik, sering diasosiasikan dengan kejadian kehilangan darah yang mengakibatkan kondisi anemia selama periode intra operatif dan pasca operatif. Meskipun anemia berkorelasi dengan hasil akhir yang buruk pada pasien cedera otak, transfusi sel darah merah untuk mengoreksi kondisi anemia juga berkorelasi dengan hasil akhir yang buruk pada pasien. Masih belum ada rekomendasi yang jelas mengenai pemberian transfusi, apakah restriksi atau masif, terkait dengan manfaat yang diberikan. Pasien laki-laki, usia 51 tahun dengan keluhan penurunan kesadaran dan muntah-muntah, rujukan dari rumah sakit sebelumnya dengan diagnosis cedera kepala sedang 225 dengan EDH temporoparietal 96cc, midline shift 11mm ke kanan, edema serebri. Selama durante operasi terjadi perdarahan masif yang mengganggu status hemodinamik sehingga diberikan transfusi komponen darah sampai didapatkan status hemodinamik yang stabil. Pada perawatan pasca operasi di ICU, kondisi pasien relatif baik.Blood Transfusion Management for Epidural Haemorrhage (EDH) Evacuation with Massive BleedingAbstractTraumatic brain injury causes mortality and morbidity worldwide. Epidural Haemorrhage (EDH) is a form of head injury where time is an indicator that must be considered in its management. The main focus during traumatic brain injury management is patient stabilization and control of intracranial pressure, as well as maintaining brain oxygenation and perfusion. Subsequently, surgical decompression was performed. Evacuation and bleeding control should be done in a short time to avoid further injury. The practice of neuroanesthesia, as a support in the management of traumatic brain injuries, is often associated with blood loss that results in anemia during the intraoperative and postoperative periods. Although anemia correlates with poor outcome in brain-injured patients, red blood cell transfusion to correct anemia also correlates with poor outcome in patients. There are still no clear recommendations regarding the administration of transfusions, whether restrictive or massive, regarding the benefits provided. Male patient, age 51 years with complaints of decreased consciousness and vomiting, referred from the previous hospital with a diagnosis of moderate head injury 225 with 96cc temporoparietal EDH, 11mm midline shift to the right, and cerebral edema. During the operation period, there was massive bleeding that interfered with the hemodynamic status so that blood components were transfused until a stable hemodynamic status was obtained. In postoperative care in the ICU, the patient is relatively in good condition.

Tatalaksana Anestesi Pada Posisi Telungkup untuk Laminektomi Pengangkatan Tumor Satriyanto, M. Dwi; Harahap, M. Sofyan; Oetoro, Bambang J.; Wargahadibrata, A. Hmendra; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Tindakan anestesi dengan posisi telungkup sering diperlukan guna memfasilitasi akses operasi pada berbagai tindakan bedah termasuk bedah saraf, antara lain pada tindakan pembedahan tulang belakang. Selain perubahan fisiologis, dapat juga terjadi beberapa komplikasi pada posisi telungkup yang harus mendapat perhatian khusus, sehingga diperlukan pemahaman yang baik akan masalah ini. Kasus: Telah dilakukan laminektomi guna pengangkatan tumor intra-ekstradura setinggi vertebra lumbal 4 sampai sakrum 2 dalam posisi telungkup pada seorang pasien laki-laki berusia 18 tahun. Pengaturan posisi dari telentang ke telungkup prabedah maupun pengembalian posisi dari telungkup ke telentang pascabedah, mendapat perhatian khusus. Status hemodinamik selama tindakan anestesi berlangsung dengan baik. Pascabedah, pasien di observasi di ruang pulih selama beberapa jam, kemudian dipindahkan ke ruang rawat setelah skor modifikasi dari Aldrete mencapai 10.Anesthesia Management In Prone Position For Laminectomy Tumor RemovalAnesthesia procedure in the prone position was often necessary in order to facilitate access to a variety of surgical operations, including neurosurgery among others, the spine surgery. In addition to physiological changes, some complications can also occur in the prone position that should receive special attention, so it requires a good understanding of this issue. Case: Laminectomy was being done for removal of the tumor intra-ekstradura at 4th lumbar vertebra to 2nd sacrum vertebra in the prone position in a male patient aged 18 years. Arrangement of the supine position to prone position preoperative and return to the supine position of the postoperative, gets special attention. emodynamic status during anesthesia procedure was progressing well. Postoperative, patients in the observation in the recovery room for several hours, then transferred to the ward after modified Aldrete score reached 10.

Pengelolaan Anestesi pada Perdarahan Intrakranial Akibat Stroke Hemoragik Lalenoh, Diana Christine; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Perdarahan Intraserebral /Intra cerebral haemorrhage (ICH) terjadi pada sekitar 20 orang dalam 100.000 populasi per tahunnya. Tipikal pasien stroke hemoragik adalah sepuluh tahun lebih muda dari pasien stroke iskemik. Mayoritas lokasi perdarahan ICH adalah subkortikal dan lebih 50% dari perdarahan intraserebral spontan terjadi dalam ganglia basalis. Populasi yang beresiko tinggi adalah pria, usia lanjut, serta ras Afrika, Amerika, dan Asia. Stroke merupakan satu diantara sekian banyak situasi klinik yang memerlukan proteksi sistem saraf optimal. Obat-obatan seperti Barbiturat, Etomidat, Propofol, Isofluran, Metilprednisolon, Tirilazad mesylat, Nimodipin, Nikardipin, dan Mannitol sering digunakan untuk proteksi jaringan saraf. Pada laporan kasus ini dilaporkan keberhasilan penanganan anestesi pada penderita pria, 41 tahun, berat badan 60 kg, dengan diagnosis Perdarahan Intrakranial/ICH parietal kiri dengan edema ec stroke hemoragik. Pasien menjalani tindakan kraniotomi untuk evakuasi bekuan darah yang durante operasi ditemukan pada percabangan arteri serebri media kiri (arteri Talamostriata). Tekanan darah awal saat masuk kamar operasi adalah 214/142 mmHg, laju nadi 92 kali/menit, laju napas 28 kali/menit, suhu 360C. Glasgow Coma Scale / GCS E1 V1 M4. Sesudah tiga setengah jam operasi selesai dan pasien ditransfer ke Intensive Care Unit / ICU. Sesudah enam hari pasien dipindahkan ke ruangan. Penanganan anestesi untuk perdarahan intrakranial karena stroke hemoragik adalah sangat penting untuk menerapkan prinsip dasar neuroproteksi baik secara farmakologik maupun non farmakologik, di samping penanganan untuk hipertensi emergensi.Anesthesia Management in Intracranial Haemorrhagic Because of Haemorrhagic Stroke Intra cerebral haemorrhage (ICH) burdens approximately 20 in 100,000 people every year. The typical hemorrhagic stroke patient is ten years younger than the ischemic stroke patient. Most ICH bleeds are subcortical and over 50% of spontaneous intracerebral hemorrhages occur in the basal ganglia. Populations at greatest risk include men, the elderly and African American, and Asian. Stroke is one of among clinical situations where protecting the central nervous system is a priority. Drugs such as barbiturates, etomidate, propofol, isoflurane, methylprednisolone, tirilazad mesylate, nimodipine, nicardipine, and mannitol are used for protecting the nervous tissue. Here we report successful anesthetic management in male, 41 yrs old, 60 kgs body weight, diagnose was left parietal Intra Cranial Haemorrhage (ICH) with oedema ec Haemorrhage stroke. Undergoing Craniotomy procedure to evacuate blood clot in left median cerebral artery (Thalamo Striata artery). Blood pressure was 214 / 142 mmHg, HR 92 x / m, RR 28 x /m ,core temperature 360 C. GCS E1 V1 M4. After undergoing 3 hours and 30 minutes anesthesia for craniotomy was ended, patient transfer to ICU. After 6 days patient was transfer to ward. Anesthesia managementi in Intracranial Bleeding ec Haemorrhagic Stroke is very important for basic brain rescucitation perioperatively with pharmacological and non pharmacological strategies, besides principle management of hypertensive emergencies.

Pengelolaan Perioperatif Cedera Medula Spinalis Servikal karena Trauma dengan Tetraparesis Frankle C Asia Basuki, Wahyu Sunaryo; Bisri, Dewi Yulianti; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
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Cedera medula spinalis akut relatif jarang namun menjadi salah satu kejadian trauma yang berakibat fatal. Kejadian ini sering terjadi pada laki-laki dewasa muda. Kecelakaan lalu lintas merupakan penyebab utama dari kejadian ini, disusul oleh kejadian trauma di rumah, industri dan olahraga. Tujuan utama dari pengelolaan cedera medula spinalis akut adalah mencegah medula spinalis dari cedera sekunder dan memperbaiki fungsi neurologis, mencegah perubahan alignment dan menjaga stabilitas columna vertebralis untuk mendapatkan hasil pemulihan neurologis dan rehabilitasi yang maksimal. Ahli anestesi berperan besar mulai awal pengelolaan secara optimal cedera medula spinalis akut ini. Seorang laki-laki, 57 tahun, dibawa kerumah sakit karena kecelakaan sepeda motor. Pada pemeriksaan fisis, didapatkan laju nafas 24x/menit, nadi 70x/menit, tekanan darah 110/61 mmHg, perfusi baik, GCS 15, dan tetraparesis. Dalam perawatan selanjutnya, terjadi bradikardia (nadi 50-61 x/menit) dan hipotensi (tekanan darah 80-90/40-60 mmHg). Dilakukan laminoplasti dekompresi stabilisasi segera.Perioperative Management Traumatic Cervical Spinal Cord Injury with Tetraparesis Frankle C AsiaAcute spinalis cord injury (SCI) is relatively rare but can be a fatal trauma event. Young adult men are most commonly affected. Traffic accident is a frequent cause, followed by accidents at homes, industries, and in sports. The primary goals of the management of acute SCI are to prevent secondary injury of the spinal cord, improve neurological functions, prevent disruption in alignment, and maintain the stability of the vertebral columns. These serve to achieve neurological recovery and maximal rehabilitation. Anesthesiologists play an important role in the optimal management of acute SCI. A 57-year-old man was brought to the hospital due to a motorcycle accident. Physical examination revealed respiratory rate 24 x/minutes, heart rate 70 x/minutes, blood pressure 110/61 mmHg, good perfusion, GCS 15, and tetraparesis. During hospitalization, the patient developed bradycardia (heart rate 50-61 x/minutes) and hypotension (blood pressure 80-90/40-60 mmHg). Immediate decompressive laminoplasty stabilisation was performed.

Awake Craniotomy pada Biopsi Steriotaktik Tumor Supratentorial di daerah Thalamus Dextra et causa Suspect Thalamic Glioma Satriyanto, M. Dwi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Awake craniotomy merupakan suatu prosedur yang banyak digunakan pada kasus-kasus intrakranial dengan berbagai tujuan, yang memungkinkan dapat menentukan lokasi kelainan di otak yang akurat dan meminimalkan risiko cedera neurologis selama tindakan. Peran anaesthesiologist adalah untuk memberikan analgesia dan sedasi yang memadai sambil mempertahankan ventilasi dan stabilitas hemodinamik pada pasien yang sadar dan harus kooperatif selama tindakan berlangsung. Seorang wanita berusia 32 tahun dengan tumor supratentorial at region thalamus dextra et causa suspek thalamic glioma untuk dilakukan tindakan steriotaktik biopsi dengan Awake craniotomy. Pada pemeriksaan ditemukan keluhan sulit berjalan sejak 4 tahun karena sisi tubuh bagian kiri lemah, bicara cedal, mulut mencong ke kanan, kejang pada kepala dan mata sebelah kiri. Pasien dirujuk karena muntah hebat dan sakit kepala hebat 1 minggu terakhir, kesadaran komposmentis, GCS E4M6V5. Paresenerves VI kanan-kiri, parese nerves VII sinistra sentral. Pemeriksaan laboratorium, ECG dan foto thorak tidak didapatkan kelainan, sedangkan pada MSCT kepala didapat kan adanya massa berbatas tidak tegas, dinding tidak teratur dengan kalsifikasi minimal di thalamus kanan disertai edema perifokal kemungkinan suatu low grade astrocytoma dan hydrocephalus obstruksi. Tindakan biopsi steriotaktik terhadap tumor supratentorial ini dilakukan dengan tehnik anestesi awake craniotomy dengan obat dexmedetomidin, propofol dan fentanyl. Pengawasan pasien di ruang pemulihan selama 4 jam.Setelah Modified Aldrete score 910, pasien dipindahkan ke ruangan.Awake Craniotomy in Stereotactic Biopsy for Supratentorial Tumorsat Thalamus Dextra Region et causa Suspect Thalamic GliomaAwake craniotomy is a procedure that is widely used in intracranial procedures with a variety purposes, which also allows an accurate localization of abnormalities in the brain, and to minimize the risk of neurological injury. Anaesthesiologist role is to provide adequateanalgesia and sedation while maintaining ventilation and hemodynamic stability in patients that still conscious and cooperative during the surgery. A 32years old woman with supratentorial tumor at theright thalamus with suspected thalamic glioma. Stereotactic biopsy was performed under awake craniotomy.She was sufferedwith difficulty in walking for 4 years due to weakness of the left side of the body,slurred talking, and lopsided mouth to the right, withspastic on the head and left eye. She was referred because of severe vomiting and headaches since 1 week, but still fully alert withGCS E4M6V5. She had bilateral nerve VI and central of left nerve VIIpareses. Her laboratory examinations, ECG and thoracic images were normal, whereas MSCT showeda mass with not firm verge, irregular wall with minimal calcification in the right thalamus and perifocaledema, suggested as a low grade astrocytoma and hydrocephalus obstruction. Stereotactic biopsy of supratentorial tumors was performed under awake craniotomy with dexmedetomidine, propofol and fentanyl. The patient was observed at the PACU for 4 hours, and after Modified Aldrete score reached 910, the patient was transferred to the ward.

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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